Rheumatoid arthritis is a maddening disease.
Despite all of the exciting breakthroughs in the field of immunology, the cause and cure of RA remains elusive. And then there’s the temperamental nature of RA—waxing and waning, virtually impossible to predict. It is understandable how many people—including some respected researchers—believe that a person’s personality determines who contracts RA and who doesn’t…that there is an actual “arthritis personality”.
Personality=Arthritis

The Mind/Body Connection

The idea that the mind influences one health is not a new concept. Hippocrates, the father of modern medicine said:

“The patient was the real thing, the disease not an entity but a fluctuating condition of the patient’s body, a battle between the substance of disease and the natural self-healing tendency of the body.”

And there is some rationale for the link between personality and illness. Nowadays, even the most conservative doctors will admit that an aggressive, “Type A” personality can lead to hypertension, heart attacks or strokes. There is rising credence to the idea of a “Cancer Personality” (e.g. repressed anger, excessive need for approval) although it should be emphasized this has not been clinically proven. And then there is rheumatoid arthritis—capricious and temperamental, illogical and cruel—a sort of Freudian symbol for women…and, of course, women are usually its’ victim.

In fact, in some of the early research on arthritis and personality, you can find Freud’s indelible mark. Only women were tested, the arthritic personality said to be:

* self-conscious
* rigid
* inhibited
* shy
* conforming
* frigid

Later researchers concluded that the study was flawed by faulty research methods in that there was an inadequate definition of arthritis and that the personality information gathered during the interviews were inconsistent. Still, the idea of an “arthritis personality” was established.

The Birth of Psychoneuroimmunology

In 1964, psychiatrist George Solomon started the field of “psychoneuroimmunology”—the science that explores connections between personality and the immune system. He and Rudolf Moos of Stanford University conducted a study on women with RA and their non-arthritic sisters. He found that certain personality traits of the arthritic women were not found in the non-arthritic sisters. This time, the arthritic personality was said to be:

* passive
* self-sacrificing
* overly sensitive to the anger of others
* compliant
* anxious
* depressed
* unable to express anger

Solomon and Moos then concluded that people who are genetically predisposed to RA but are emotionally healthy could actually prevent the disease.

It must be kept in mind that these women were tested after contracting RA; it did not seem to occur to Solomon and Moos that their personalities could have changed in response to the disease. It is also interesting that—again—only women were tested. As a psychiatrist, it is possible that Dr. Solomon could have given credence to the Freudian idea of the “hysterical woman”, i.e. women being so swayed by their emotions that they could actually cause themselves to become ill and disabled.

This tendency for doctors to disregard women’s complaints as “being in their head” still occurs today. In a recent study, women were found to be twice as likely to die from a heart attack than men. Apparently, when men complain of chest pain, they are immediately hooked up to an ECG but when women complain of chest pain, doctors tend to attribute it to stress. Many women leave their doctors with a prescription for antidepressants—if anything at all

The Granola Effect

Psychiatrists aren’t the only people who blame RA on personality. Naturopaths, homeopaths, holistic “healers” and the like, also believe that a person’s personality can result in chronic disease, including RA. According to naturopath David Hoffman, the arthritic personality consists of:

* static anxiety
* rationalization
* dependency
* reduced ability to express emotions openly
* infantile aggression

Hoffman also believes that “friction in the joints” is directly attributable to the patient’s “friction with other people”. Since there has not been a single replicated study in which holistic medicine produced a measurable effect on RA, one is tempted to believe that the reason naturopaths blame the patient’s personality is to provide a ready-made excuse when their treatments fail (i.e. the patient doesn’t improve because she refuses to “change her personality”).

Arthritis=Personality

“Learned Helplessness”

The chronic pain, stiffness and malaise of RA can produce incredible stress. In a now infamous study, dogs were placed in cages with electrified bottoms. Intermittently, the researchers would shock the dogs. At first, the dogs would struggle and try to escape. After realizing that there was no escape, however, the dogs stopped struggling, and simply huddled on the floor…even when there was a means of escape. This rather cruel experiment lead to the theory of “learned helplessness”.

Other studies have confirmed that if there is a repeated inability to do something about stress, a pattern of behavior develops that is characterized by “giving up”. Eventually, the victim is unable to clearly assess the causes of stress or to formulate solutions for dealing with them. The relentless, seemingly inescapable pain of RA is a perfect example of a persistent stressor; its victims can easily conclude that any action on their part is futile.

While “learned helplessness” may be too generalized a term, depression is a common problem with RA patients; it has been estimated that at least 40% will experience a period of severe depression. Many of the personality traits espoused by Solomon and others: difficulty in expressing emotion, overly sensitive, inhibition—even “infantile aggression”—are likely the effects of depression.

Self-Conception and RA

If these traits are the result of arthritis-induced depression, can one’s personality be altered for a healthier outcome? Probably not. In a recent study in Sweden, researchers tested two groups. The first group had what was considered a “positive” personality, showing traits such as a “fighting spirit”, acceptance (as opposed to giving in), and revaluation. The second group demonstrated “negative” personality traits: they were reserved, tended to “protest” their fate and felt there was a significant deprivation of life. It was believed that there would be a correlation between the “positive” thinkers and lesser symptoms. However, disease indicators correlated only weakly with self-conceptions; there was little if any difference in the severity of the “positive” thinkers and the “negative” thinkers.

The Efficacy of Coping

In the same study, however, researchers noted that while personality had little to do with severity, it could make a significant difference in coping. The attitudes demonstrated by the “positive” thinkers helped them to deal with RA in a way that allowed them to function as normally as possible. In yet another study on personality traits, it was found that certain traits helped patients cope with RA more effectively than others. The traits—both “positive” and “negative” are:

* Neuroticism
Anxious, self-pitying, tense, touchy, unstable, worrying

* Extraversion
Active, assertive, energetic, enthusiastic, outgoing, talkative.

* Openness to Experience
Curious, imaginative, insightful, having wide interests.

* Agreeableness
Appreciative, forgiving, generous, kind, sympathetic, trusting.

* Conscientiousness
Efficient, organized, reliable, responsible.

It was found that the subjects who exhibited “positive” traits—extraversion, openness to experience, agreeableness and conscientiousness—managed their RA much better than those who exhibited neuroticism; that, while there was no difference in the severity of their symptoms, they were able to live their lives more freely. It also found that the more perceived control the subject had over RA, the more effectively he or she coped with pain.

Should we then conclude that there is no such thing as an “arthritis personality”? Yes and no. As of yet, there is no replicated clinical evidence that personality traits can trigger RA. However, many people with RA report that a major stressor (death in the family, divorce etc ) in their lives occurred just before onset of the disease. Even though there is no convincing evidence of a link between stress and severity of symptoms, it is known that stress can alter the immune system. Also, a link has been found between RA patients who have a history of depression or anxiety disorders and increased fatigue.

So far, psychoneuroimmunology and the treatment of RA has a fairly dismal record. The concept of an “arthritis personality” is not a harmless one, either. Many people with RA are beset with guilt—they do not need the added stress of believing that they “caused” their arthritis—nor do they need their families, friends and coworkers believing that RA is simply neurotic behavior, that, if they would just “think positive”, they would be cured. As far as studying the links between personality and RA, most patients with RA would probably prefer already-scarce funding to go towards finding a genuine cure.

Generally speaking, we Americans are viewed as being fairly happy-go-lucky people (we are also viewed as being fat, vulgar, arrogant and violent…but then, that’s another article). Even Henry Miller—and I don’t think anyone ever accused him of being a Pollyanna—confessed that he sometimes irritated his French companions with his chronic cheerfulness, admitting, “I’m just as retarded as any American.”

With the skyrocketing popularity of Prozac, however, I believe we are showing some cracks in our rugged individualism. True, we don’t make depression a national pastime as they do in Sweden, but in America, I believe that depression is finally coming out of the closet.

So if the average American can confess to being depressed, then we in the arthritic community might as well admit it: depression and rheumatoid arthritis go hand-in-hand. Why? Because we have been slapped down by a disease that robs us of our mobility, our independence, our jobs, our social lives and—to a lesser or greater extent—our dignity. We are financially devastated, frightened about the future, lonely, angry and defenseless against the ultimate betrayal: being attacked by our own bodies.

Most of us could adapt to even these changes within time, though. We can survive death and divorce, eventually. So why is it that 90% of people with RA will experience occasional depression and 40% will be treated for severe depression? The number one reason for depression—and as my father-in-law says, this ain’t rocket science, folks—is pain. Pain—that great malefic god—is constant, relentless, capricious and, worst of all, greedy. Pain doesn’t want to share you with anybody; he wants you all to himself.

And only those in pain understand the loneliness that comes with pain.

Okay, now that we’re being honest, I’ll even be more frank: recently, I asked my doctor for antidepressants. Yes, me: the Joan of Arc of arthritis, smile warrior, exercise ninny and happy Heidi. I had a rough summer, arthritis-wise, one of the worst I’ve had. That, combined with some family/financial issues, sank me into deep dark hole. I guess you could say that I lost some of my infamous “adaptive techniques”.

So am I suggesting that we all go on antidepressants? No, of course not. I’m just giving an example how even the most positive of us can get worn down occasionally. And, while there is no evidence that depression exacerbates pain, it does diminish your coping skills which can lead to increased severity of symptoms. It can be argued that in some cases, depression can be more debilitating that arthritis itself…and arthritis and depression can be indescribably miserable.

So what do we do about it?

Well, first of all, roll out of bed, rub the cobwebs out of those unblinking eyes and take a test from the folks at the National Institute for Mental Health. This will help determine whether you are just in an inflammation funk or if you are clinically depressed. If you are experiencing four or more of the following symptoms for more than two weeks, you should seek help immediately.

* Persistent sad, anxious or “empty” feeling
* Feelings of hopelessness and/or pessimism
* Feelings of guilt, worthlessness and/or helplessness
* Loss of interest or pleasure in ordinary activities, including sex
* Sleep disturbances (including insomnia, early-morning waking and/or oversleeping)
* Eating disturbances (changes in appetite and/or weight loss or gain)
* Decreased energy, fatigue and/or a feeling of being “slowed down”
* Thoughts of death or suicide, or suicide attempts
* Restlessness and/or irritability
* Difficulty in concentrating, remembering and/or making decisions

If, however, you are not experiencing four or more of these symptoms, or if you believe that this is a temporary case of the arthritis blues, read on for tips to feel better.
Depression Busters
Will any of these tips “cure” your depression? Probably not. But as easy as it is to get mired in depression, distraction can sometimes be surprisingly effective. Try any or all of these ideas…most of them are free.

Give in to it
You heard me. Sometimes the best thing to do is just…go with it. Allow yourself 24 hours of self-pity. Stay on the couch. Eat ice cream. Watch Gilligan’s Island and the Late, Late, Late show. Cry. After wallowing for a day or two, you just might be ready to take a shower and rejoin life.

Get Outside
Get out of the house. It doesn’t matter where you go or what you do…just get out and stop staring at those same four walls. Who knows? Even the fresh air could revive you.

Exercise
(I can actually hear all those eyeballs rolling in their sockets). I know, I know…exercising is the last thing you want to do. But endorphins and adrenaline are powerful drugs…some studies suggest that vigorous exercise is as effective as Prozac. In any case—provided the exercise is arthritis-friendly—it can’t hurt.

Keep a Journal
There’s something about writing that stops all those dark thoughts from circling in your head.

Listen to Music
Choose songs that have strong, positive meaning for you. And who doesn’t feel better after a rousing chorus of R-E-S-P-E-C-T?

Go for a Long Walk
True, I could have put this under either “Get out of the House” or “Exercise”, but I think that long, meandering walks have a way of “wearing out” bad feelings.

Sing
It doesn’t matter if you’re Beverly Sills or if you torture dogs…throw your head back and sing. I don’t know why this works, but try it: I guarantee that you’ll feel a little better.

Seek Out Other People
This one is tricky. Being depressed causes you to withdraw but the more you withdraw, the more depressed you’re likely to become. Call one of your friends…especially if they’re troubled too. It might sound a little sadistic, but sometimes listening to other people’s problems helps you keep your own in perspective. As a corollary:

Participate
In your own small way, rejoin the human race. Drag yourself to your support group, book club, coffee circle…whatever you usually do, keep doing. Sometimes if you pretend that you feel alright, you start feeling alright.

Check your Medication
We all have our own unique chemistry; some of us react more strongly to certain drugs. Corticosteroids (Prednisone and the like), in particular, are notorious for causing depression and anxiety.

Distract Yourself with Something Boring
Clean out one drawer. Pay your bills. Organize anything. Not only will it distract you from your problems, it will give a (small) sense of accomplishment, which always makes you feel better. When you’re through being practical:

Do Something Frivolous
Buy flowers. Read a comic book. Eat a banana split. Challenge your kids to a bubble-blowing contest. Buy something useless. Pour an entire bottle of Mr. Bubble into your bath. Remember what it is like to have fun.

Invest in Comedy
Read A Confederacy of Dunces. Or, if you don’t have the energy to read, rent five comedies from the video store. My pick for impossible-not-to-laugh videos? Raising Arizona, Funnybones, After Hours (the one by Martin Scorcese), Being John Malkovich and anything by Monty Python.

Do Unto Others
It’s corny, but true…doing something nice for someone else just makes us feel all warm and fuzzy inside. Volunteer—community agencies are always short of volunteers and are not picky about abilities. Or buy something for a friend for no reason. Cook a fancy dinner and take it over to an elderly person. It doesn’t matter what you do, as long as you are doing for someone else…which takes the focus off of yourself.

Try to put Things into Perspective
Chronic pain is so overwhelming that it can take over our thoughts. Sometimes we need to take a step back and truly examine our lives. Take an inventory of what is good, helpful or positive in yourself and in the people around you. You might discover happiness that you hadn’t recognized before.

Now, Here’s a few “Don’ts”…
Do Not Make any Major Life Decisions
You are literally not in your right mind. Don’t sign any papers, pack any bags or kick anyone or anything out of your house just yet…wait until you are feeling better.

Don’t Lash Out
Depression often leads to irritability. Lashing out at others—and receiving a tongue-lashing in kind—will only make you feel worse, and could damage important relationships.

Leave Your Credit Card at Home
There’s nothing wrong with buying yourself a small gift, if it makes you feel better…but save the sprees for after you win the lottery. There’s nothing like an unpaid stack of bills to send you spiraling back into depression.

Padlock the Refrigerator
Go ahead and have that indulgent treat…and then give your waistline a break. Obesity, like bankruptcy, will not help your condition.

Now it’s your Turn
Talk to me…what causes you to become depressed and what do you do about it? Tell me about it in Feedback. This is your time to vent, rage, cry or offer hope…and you may remain anonymous. Depression is something that we all experience from time to time…let’s share our experiences—not only to help each other, but to remove the stigma that keeps some of us from getting help when we need it.