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Once You Get Sick, Are You the Same Person?

Personal Perspective: Should you invest in someone who has a chronic illness?

Key points

  • In spite of what we think, chronic illness does not leave us the same person as before.
  • Part of living with illness is seeing what has changed and what is still "you."
  • An essential part of this process is appreciating what is of value in people, ourselves and others.
  • What sick people need is for you to still have an interest in being close to them; this may not be easy without understanding value.
 Artem; Minsk, Belarus/Pexels
Source: Artem; Minsk, Belarus/Pexels

It has become commonplace for sufferers of disabling conditions to plant a flag of identity, boldly declaring that despite the changes that have befallen them, they remain the same person. Although I sympathize with and even admire this, as a former practicing psychiatrist who is very diminished due to multiple medical problems, I plant no such flag.

To jump to the conclusion: In brief, I am not still me. After many years of practice, I can tell you with certainty that many of my former patients feel the same way. Trusting that we understand each person has their own story to tell, I’ll share the story of being chronically ill that seems common to us all.

First, the direct evidence that I am not still me: I cannot do a fraction of what I used to. I am no longer in the fast lane. I am not as sharp and tend to focus on my health problems. Physically, I look very different, and I feel different.

As for the circumstantial evidence, I will merely state that if a person were still the same, then others would treat him the same way as always. They do not.

This latter point can easily become a source of bitterness. But I have learned that while illness is the subject of my life, it cannot be the subject of my relationships.

We could debate a core identity, an essence, and indeed I sense something like that deep within myself. Many important things about me have not changed. So, the picture is by no means bleak, and I am far from unrecognizable.

Becoming either severely or chronically ill begins like other tragedies. People come by with consolations and lasagna. This may stretch out for a few weeks, and then it quickly thins out to a few stragglers. Some are friends you didn’t know you had. But people are busy and have lives. Life is about life. Illness is about illness. They are not the same. Having a mental disorder does not even merit lasagna. You stay home while coworkers whisper about a “breakdown.”

Life goes on with the body or mind as a vessel with which you sail through your day, getting done what needs doing. The demands of a healthy body and mind are rolled into daily rituals. Go to work, come home to a good meal, do some reading, watch TV, and get a good night’s sleep. Illness, on the other hand, is a creaky, whining, painful companion demanding attention before you can even make your oatmeal. It is like putting up with a surly child that only a parent could love.

People tend to crave likeness. Soccer fans usually like soccer fans. Democrats, Democrats. But sick people don’t crave sick people. They crave jumping back into life. But barring that, they crave interest. (I am using the word “interest” instead of “caring,” “understanding,” and that sort of thing because the need is not only about concern.)

Interest is about more than mere attitude. It is about investment. I think this may be why Freud’s first English language translator made the unusual decision to take Freud’s use of the common German word for “interest” and translate it into the Greek, cathexis. Cathexis carries the sense of transferring part of yourself, some energy, perhaps, into another, as you would money into a bank account. In the case of what sick people crave, interest is more than sheer energy. It is an investment in time, openness to others’ experiences, and involvement.

When on the receiving end, you know interest when you get it. You can feel the gift of time, curiosity, and the wish to be part of your life. We all know it. It is not the hand on the doorknob while asking, “Do you have any other questions?” It is sitting comfortably with you, in no rush for anything.

Any discussion of interest and investment raises the issue of worth. Simply put, if I’d like you to invest interest in me, is it because I am worth it? More broadly, what makes people like me worth investing in?

Do I need to produce more than I cost (in which case, I have a big problem)? Or perhaps plain old human dignity generates enough worth on its own.

The harder question may be the negative version. Namely, if people are not interested in the chronically and untreatably ill, what does that tell us about our worth?

People assess their own worth differently. It’s a very personal and potentially troubled calculus. For the sick themselves, illness is usually perceived as a demotion, a particularly self-centered one. Your world is small and mostly about your needs. You count your pills, go to appointments, and rest because you must. Sickness can be a selfish shadow.

I am not convinced that because I did worthwhile things in the past that my identity and value are stamped in stone. Again, I don’t feel like I used to, nor do people treat me that way. We are who we are now, shaped by the past and pulled towards the future. I am all of that, sharpened to a point by what matters to me today, what happens to me, and the paths I choose to take.

The challenge to my friends and colleagues, as well as myself, is what merits interest in this new me? If I do not see others placing value on who I am now, can I begin to do it myself?

I can, and I must.

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