MIND AND ARTHRITIS
DR VAIJAYANTI LAGU JOSHI (Consultant Rheumatologist, Deenanath Mangeshkar Hospital)
Health is defined as not just absence of disease but a physical, mental and social well being of an individual. Arthritis is a disease that affects both the physical (e.g. walking, standing, activities of daily living) and psychological (i.e. well-being, self-image and productivity) abilities of people in all walks of life.
Rheumatological disorders, different types of arthritis are chronic, painful, multifactorial (no single cause), controllable to some extent but non-curable. Patients suffering from arthritis experience symptoms ranging from mild inconvenience and discomfort to complete debilitation due to joint inflammation, cartilage destruction and irreversible deformities.
Joint pain and swelling, reduced mobility and physical weakness, general tiredness, trouble sleeping and exhaustion are other common symptoms. All of these symptoms can greatly affect patient’s everyday life and overall well-being. Rheumatoid arthritis is relatively common in young women. The limitations it can cause come right at a time when most of their peers are in good health, and that can be hard to deal with. The disease may have an impact on many different parts of a relationship, such as the roles you have, the division of chores in the household, mutual plans and what you can do together in your spare time. Physical pain, disability, deformities, dependence, helplessness lead to frustration, grief, depression and negativity. Arthritis is not just an individual problem but becomes a family and later a social problem with lot of economic and mental burden. We as physicians are trained to look at physical condition , disease parameters, laboratory investigations , drug’s efficacy and side effects , complications of disease to a great extent however….. we are not just dealing with human bodies but human minds also.
What is mind? This question has perplexed philosophers, scientists, historians and ordinary people across time and cultures –Mind is the part or faculty of a person by which one feels, perceives, thinks, remembers, desires, and imagines. Mind affects body and body affects mind. Mind is the most important part of our body and personality.
We often don’t realize that our minds are constantly chattering, which can be stressful. Stress intensifies pain. Few conditions like fibromyalgia are found to be psychosomatic where there is lot of mental stress leading to widespread diffuse ongoing pains. There is no classical PILL / MEDICINE which can be offered to those patients. Lot of counseling, lifestyle changes, relaxation techniques do help those patients. They do need something more than medications. We as treating doctors have experienced it so many times that effects of drugs / medications for similar disease in different patients for the same condition are different. Patients who are positive, motivated, supported well by their family members do really well as compared to others. Those observations are being evaluated scientifically. There are a number of different psychological and psychotherapeutic approaches designed to help people with chronic illnesses like rheumatoid arthritis to deal with pain and other symptoms. The main approaches include the following:
• Relaxation techniques like meditation , progressive muscle relaxation , yoga / tai-chi techniques
• Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) helps people to recognize patterns of thought and behavior that can make it more difficult for them to deal with their condition, and then to change them. CBT is also about offering practical support: For example, someone may practice saving up their energy and setting goals that they are able to reach despite having rheumatoid arthritis. Behavioral therapy treatments are often combined with other approaches, such as relaxation techniques. Researchers found that meditation (i.e. altering one's level of consciousness to achieve a specific benefit, such as pain reduction or psychological well-being) produced positive effects in the body's immune functions. The effects of mindfulness (a western, non-sectarian, research-based form of meditation, as a means of increasing awareness of both the sick toward or the healthy to maintain optimal health and well-being) have been shown to mitigate the pain and barriers to psychological well-being for persons, who suffer from various rheumatic conditions.
Medicine is not just the science but an art to deal with living beings. Mindfulness is “Paying attention, on purpose, in the present moment, without judgment, as if your life depends on it. While the mechanisms of mind-body practice to improve rheumatic disease are not fully understood, these practices have been found to improve balance and movement, relieve pain, lower blood pressure and reduce falls in patients with various rheumatic conditions. Practices such as tai chi, qi gong, Feldenkrais, yoga and meditation may also provide ancillary benefits to these patients, such as increased mindfulness, relaxation and an improved sense of well-being.
We learn about all the events in our world, we feel all the emotions, we make choices and control all the actions that we do. Whether we enjoy or become upset, it all happens in our mind. Thus, mental health is nothing but feeling capable and competent, being able to handle normal levels of stress, maintaining satisfying relationships, and leading independent life and being able to bounce back or recover from difficult situations. So let’s have a healthy mind to overcome all the challenges posed by arthritis in life.