A old book for getting well but looks like good book

[Guest guest]

My girlfriend sent me the link to this book loks like a good one to

get. enjoy

Heidi

Chapter 1:

Studies show life is hard.

" One thing I learned early. Being a victim just doesn't work. "

- AIDS survivor Bob Lawrence

This book is about getting well, when life seems weighted against the

possibility of our doing so. It explains how we can recover our

health and improve our lives, despite " chronic " problems for which

medicine has no cure. In these pages, you will find all the ideas and

inspiration you need for successful self-care, ways to get better

even in difficult circumstances.

Here's an example of what we're up against, and how self-care helps.

When Wong was 45, she already had hypertension, thyroid

disease, and clinical depression. " I wasn't taking care of myself, "

she remembers, which is understandable, since her husband had left

her, with a rebellious daughter, aging parents, and a stressful

job. " I didn't complain, " she says. " In our culture, you're not

supposed to. "

Then she found herself in the Emergency Room, bleeding heavily from

what turned out to be uterine cancer. Facing yet another illness,

got fed up:

" Lying there, waiting for surgery, I promised 'If I make it through

this, I am going to start doing something for myself.' I couldn't

have told you what, but I'd been taking care of everyone but me, and

it had to change. Afterward, I went to the Health Education office

[of her hospital] to see what they had. I signed up for stress

reduction programs and stretching classes. Later, I started

exercising and meditating. "

" It took me years to realize I had to put myself first. I cut back

work to four days a week. I still take care of my parents; I'm still

there for my daughter, but I make sure I get to my programs and do my

meditation every day. My self-esteem is higher, because I'm taking

time out for myself. My family relationships are actually better than

ever; I have more energy, and my health has been improving. "

isn't out of the woods yet, and she will probably never be able

to throw away her medicines or party like a teenager. But she has

taken control of her life, stabilized her condition, improved her

general health, and become a positive, lively person, a joy to be

around; no small accomplishment for a woman in her situation.

Getting well, or overcoming illness, doesn't necessarily mean cure;

it doesn't mean living forever. It doesn't mean a list of dos and

don'ts, pills to take and foods to avoid. It means improving our

condition and gradually making our lives happier, healthier, more

fulfilling. How much our health improves depends on the severity of

our illness, the conditions of our lives, and the internal and

external resources we can bring to bear. How much better we feel,

depends mostly on us.

What's in it for me?

Unlike some other self-care books, this one doesn't say we make

ourselves sick or think ourselves well. It doesn't say, " take control

of your life, " while glossing over the difficulties involved. It

doesn't even say, " Follow your doctor's orders. " Instead, it gives a

practical, five step program for recovery:

Slow down. Save some energy for our bodies and lives, instead of

giving every last ounce to work, worry, other demands, or

entertainment.

Make a change. Change something in our lives that damages us. No

matter how small, any successful change builds our self-confidence

and makes the next change easier.

Get help. We can't do it alone; life is a cooperative effort. Learn

to find and ask for help.

Value our bodies and our lives. Listen to our bodies and treat them

with respect. Fill our lives with more pleasure, love, and reasons to

live.

Grow up. Educate ourselves, take responsibility, be assertive. Accept

ourselves the way we are, but don't give up on getting better.

These steps would sound intimidating, even to me, except for three

things. First, we rarely need the whole program. Anything we do for

ourselves is likely to pay dividends. Second, every single step

should feel good; the whole idea, supported by scientific studies, is

that improving quality of life will improve our health. Third, you're

probably doing many things right already.

So it's not as hard as it sounds. In these pages, we will meet people

who have carried this program out, over years, one step at a time.

They have overcome AIDS, heart disease, arthritis, chronic fatigue,

lupus, fibromyalgia, asthma, cancer, and other conditions, including,

in my case, multiple sclerosis. These are people I have nursed,

interviewed or coached, not an elite group, but people with problems

like those we all have. If they can do it, you can, too.

I am not promising any picnic or any miracles, though picnics are

good for you, and miracles happen all the time. Overcoming chronic

conditions is a challenge; it calls for all our intelligence,

courage, and creativity, and all the help we can get. Barriers will

block our way, and sometimes we won't even know they're there, just

that we're stuck. This book will help identify and overcome them.

With effort, time, and a few breaks, we may find the journey of

recovery leading us to better lives, and better health than we had

ever thought possible.

Not our fault

Before planning how to get well, it may help to consider the various

reasons we get sick, only a few of which are under our control.

Sometimes our genes are programmed for susceptibility to one or

another awful disease. Some environments subject us to toxic

chemicals, natural or man-made, while others are full of hostile

organisms. Some of us live amid violence, without ever knowing

physical safety, or in crazy families who deprive us of emotional

security and self-respect. We may lack sufficiently healthy food or

water. We may grow up without opportunities for exercise, fresh air,

education, relaxation, or love.

Studies of stressful life events - job loss, divorce, relocation,

death of a family member etc. - consistently show higher rates of all

types of disease following such stressors. To these, we add all our

maladaptive responses to life's insults: bad posture, attitudes, or

diets, unacknowledged emotions, lack of exercise, overwork, hurry,

various forms of self-abuse and addiction. All of these injurious

behaviors were learned somewhere or adopted before we knew better,

for reasons that were necessary, or at least seemed like good ideas

at the time.

Most diseases, then, except for overwhelming infections or pure

genetic defects, arise from numbers of factors stretching back

through our lives and heredity, and outward through all our social

and environmental influences, a web of causation that we can never

completely sort out. For various reasons, our bodies (and minds) do

not get their needs met, and they react by getting sick. Our bodies

weren't made to last forever, and years of wear and tear eventually

cause breakdowns.

Therefore, it makes no sense to blame ourselves for illness, to feel

guilty about things we could not control. Guilt doesn't do anyone any

good. Far worse than guilt, though, is helplessness, the feeling that

turns us into victims without hope of salvation. Research shows that

people with high " self-efficacy " (belief we can do the things we set

out to do) and " internal locus of control " (believing we control much

of what happens to us,) have fewer complications, less distress, and

slower progression of illness than those who feel less powerful.

Although we often don't know how much, if any, influence we actually

have, we're better off acting as though we do. As we'll see in

Chapter 6, we often have more control than we realize.

Fight back with self-care

Though it's not a universal reaction, we have a right to grieve, a

right to be angry, and often a little scared, about health problems.

The question is: what do we do with those feelings? This book says

when life makes us sick; we can fight back with self-care. Use anger

as motivation to change harmful life situations (like a stressful job

or a family that smokes despite our lung disease.) Employ fear of

future complications as a reason to change unhealthy behaviors and

attitudes. Allow sadness to extend into feelings of compassion, and

even love, for our bodies and our whole selves, who struggle with so

much difficulty.

Chronic conditions are not our fault, but no one else will fix them

for us, nor can they. Only we can take care of ourselves. We can't

change our genes or our age, but everything else is up for grabs. We

can even delay or modify the expression of our bad genes in many

cases.

The same dynamic applies, whether we have arthritis, herpes,

hepatitis, depression, or any other health problem. The disease is

there; it has genetic, historical, or environmental causes. Our

response to it, though, makes a huge difference in how much we suffer

and how likely we are to get well. Even in conditions

labeled " chronic, " or " progressive, " we can often slow, stop, or

reverse the rate of progression or recurrence, and the severity of

symptoms, by measures such as the ones described in this book.

Health reflects life

Annoying fact: the better our lives, the better our health is likely

to be. Studies show life is unfair in this way. Among these findings:

low job satisfaction is the number one predictor for future heart

attacks. Socioeconomic standing - income, educational level, power -

predicts general health better than any other single factor, except

age.

It gets worse. College students who remembered loving relationships

with their parents have been found, 30 years later, to have far less

illness than those whose parental relationships were more strained.

Those who believe their spouses love them, live longer. People with

more friends are healthier. Laughter and happiness make the immune

system work better. Sex is good for you; fun is good for you. People

who report lower stress levels have lower blood pressures and

stronger hearts.

It is almost as if our bodies know how we feel about our lives, as if

our immune systems and all our other miraculous self-healing

mechanisms get discouraged when we do, feel hopelessness, grief and

stress when we do. It's not just that happy people exercise more or

eat better - though they tend to. " Mind/body " research demonstrates

that our bodies, especially our unconscious self-care systems (such

as the immune system,) react to our life situations as strongly as do

our conscious selves.

The immune system's sensitivity to life conditions has been proven

beyond reasonable doubt. A 1977 Australian study, often replicated,

found that T-lymphocytes (a type of white blood cell) were less

active in people whose spouses had recently died. When they took

those lymphocytes and put them in a test tube with a protein they

would normally attack, the bereaved cells made only a halfhearted

attempt to fight. It was like those cells were saying, " What's the

use? Without [the deceased spouse,] it's just not worth it. " Of

course, blood cells do not " think " in this sense, but the result is

the same. The wounds of recently bereaved people also heal more

slowly than those of others. In a number of studies, students with

fewer friends, or more stress, have shown decreased immune responses.

Studies of heart patients have found severity of blocked arteries and

frequency of heart attacks varies greatly with a number of life

situations, including quality of marriage, satisfaction at work,

number of friends, even owning a good dog. I am certain that other

body systems will be found responsive to life conditions, as soon as

someone looks. If nothing else, every organ from the skin to the

bowels reacts negatively to too much stress.

Science is telling us that we cannot separate our health from our

lives. Stress, loss, isolation, economic insecurity, and other

hardships tend to make us sick. Self-confidence, love, happiness, and

relaxation are examples of conditions that help us heal. Therefore,

getting well is largely a question of improving our quality of life.

My ticket out of here

Sometimes sickness is a logical answer to life's pressures, a

syndrome I call, " Illness is my one and only ticket out of here. "

When demands become overwhelming, when our lives become too tense,

too stressful, too painful or crazy, and when we lack the ability or

willingness to change them, our bodies may escape by getting sick, or

even dying.

We can see this in some children diagnosed as " failure to thrive. "

Kids who are neglected or abused sometimes stop growing. Their glands

simply stop producing growth hormones. Often, when these children go

to hospitals or foster homes, the hormones kick in, and they start

growing again. But when they are sent back to the place where they've

been neglected, even if they get adequate food and shelter, they may

once again shut down their growth process. Obviously, this is not

done consciously; it is the body's response to intolerable

conditions.

Similar things happen to adults. My former nurse manager, Margaret

Washington, had terrible high blood pressure, what doctors

call " malignant hypertension. " She took three medicines, and still

frequently ran numbers like 230/120, which would justify an emergency

room visit for you or me. At 55 years old, she was somewhat

overweight and underexercised, but not nearly enough to account for

her life-threatening pressure readings.

Margaret had worked her way up from the bottom, all the way from a

nurses' aide to a manager with a Master's degree, while raising

children and later, grandchildren. In spite of her accomplishments,

she never felt respected or safe among our administration. As

virtually the only African-American in nursing leadership, she felt

scrutinized and judged. Whether or not this feeling was accurate, it

left her constantly anxious. She tried to work harder than everyone

else, worried all the time, and took great pains not to offend or

upset anyone in management. Because of her family's financial needs,

she was not willing to resign. She was on her way to a stroke, heart

attack, or kidney failure, and it looked like a short trip.

What saved Margaret was a twisted blessing. To cut expenses, the

company laid her off with a decent retirement package. Within four

days, her pressure was on its way down. It continued dropping for the

next three months, and currently she is on only one medication, and

has a normal blood pressure. She took a part time job, teaching

parenting skills to young single mothers, which she had long wanted

to do.

Was the job making Margaret sick, was it her genes, or was she making

herself sick? I would call it a combination, but one thing is clear:

if she hadn't gotten out of there in one piece, she would have gotten

out crippled, or in a coffin.

The Activity/Pain Cycle

Margaret was living the fatal version of what chronic pain

specialists call the activity/pain cycle. People with chronic pain

often work and push themselves until pain makes them stop. Then

they'll rest for the minimum possible time, and try to resume

working, until pain stops them again. Chronic pain is so exhausting

that, by then, they're usually through for the day.

When I heard about the activity/pain cycle, I thought, " This isn't

just pain; it applies to every symptom and illness in life. " Illness

protects us by allowing us to stop beating our head against the wall,

to take a break from endless demands and stress. Since our bodies

desperately need us to stop, we aren't likely to get well, unless we

find some other way to protect ourselves. Illness can often be seen,

then, as the body screaming for help.

One treatment goal in chronic pain is to move people to an

activity/rest cycle, where we follow our bodies' rhythms and stop

before pain builds up. On the activity/rest cycle, people wind up

doing more and suffering less. Most find it very hard to make this

particular change, though. Our society essentially lives a mass

version of the activity/pain cycle, where it's not okay to stop until

we break down. It's not okay to ask for help until we are disabled,

and not okay to take a day off without a doctor's certificate.

Doctors call taking advantage of illness to get some relief from the

struggles of life, " secondary gains. " These gains can include more

rest, attention from family and health care providers, sympathy,

escape from intolerable stresses, and medications that numb physical

and psychic pain. Going for these " gains " doesn't make us lazy or

crazy. It doesn't mean we're making ourselves sick - life takes care

of that - but it may explain why we find it hard to get well. On the

activity/pain cycle, illness can be " healthier, " in many ways, than

health.

There is a better way, though. We can change the aspects of life that

damage us and adapt to, or escape the things we cannot change. When

we are being abused at work, home or in between, or when we abuse

ourselves, our bodies tend to get sick. When we change those

situations, attitudes or behaviors, we'll feel better, our immune and

self-repair systems will work better, and usually, our health will

get better, although how much better varies widely. It won't happen

all at once, but we can get out of the activity/sickness horror show.

My Starting Point

This book is full of great stories meant to inspire or instruct in

some way. They can wait, though. It starts with my own, not very

inspirational experience, because that is the source of the book.

Twelve years ago, I was diagnosed with multiple sclerosis (MS), after

ten years of unexplained symptoms. Before my diagnosis, I ran around

like a headless chicken, and not just any chicken. I was Super

Headless Chicken, committed to raising two children, splitting

housework with my wife, Aisha, working as a nurse, improving my

neighborhood, saving the environment, developing a songwriting

career, and some more goals I can't remember now. With such divided

loyalties, I naturally did a rather poor job at all of them.

In 1989, I developed extreme weakness in my right leg, then loss of

vision in both eyes. At first, I tried to tough it out, because I

didn't want to change. It took me five years, and two more MS attacks

to accept my new reality and start paying attention to my body, but

finally, I got with the self-care program. First, I rested; I

listened to relaxation and guided imagery tapes that helped me hear

what my body needed. Its message was pretty simple: Do one thing at a

time. Get help. Breathe. You can go a long way with those three

instructions, and gradually I learned to get moving again, according

to my body's rhythms.

I made changes, starting with exercise, a gentle form of yoga, which

I now do twice a day, and gradually adding swimming and

weightlifting. I cut back to part-time work and started meditating

daily. (Fortunately, my family supported me through these changes.)

I got help from doctors. I never used the high-tech injectables that

slow the progression in some cases of MS. They weren't approved for

my type of MS, and I felt the costs, side effects and hassle

outweighed the modest benefits claimed by manufacturers. My

neurologist has supported these decisions, even while prescribing

those meds for other patients who wanted them. I take one medication

to control symptoms, along with supplements and an over the counter

medicine (aspirin) that makes sense to me. At various times, I have

pursued alternative treatments and used other self-care techniques,

as I'll describe later.

As the years pass, so far, my MS has progressed but slowly, perhaps

because my life is getting better. I have new symptoms, but also new

abilities and strengths. I am probably in my best shape ever -

admittedly, that isn't saying much - and my days are so full of love

and happiness, it's disgusting (at least, most days.) I have learned

to forgive others and myself, to accept what life gives, to be more

open with people but stand up for myself, even if I sometimes have to

do it sitting down. I sincerely believe that my self-care program has

contributed to the relative stability of my MS, and that my response

to MS has improved the quality of my life. I know how lucky I am to

be able to say that.

A nursing perspective

My 25 years as a nurse helped me make sense of my situation and find

ways forward. In nursing, we're grounded in the scientific approach

of medicine, but trained to see that people's health cannot be

separated from the entirety of their lives. This book largely

reflects a nursing view, one that gives full importance to genetics

and biochemistry, but also to the practical, emotional and spiritual

dimensions of individual lives, and the interactions between all of

these factors.

In my work as a nurse and health coach, I spend time with hundreds of

people with a variety of health conditions. I got the idea for the

book when I realized that most of them, at all levels of health,

weren't doing nearly as well as they could. Not only my patients, but

my coworkers were living with pain and unhappiness, and often seemed

too worn down, angry, careless, or hopeless to take care of

themselves.

I wondered how I had come to be one of the most productive and

positive people on the job, because I had distinct memories of being

miserable much of my adult life. What had changed? Was I doing

something right, or was I just lucky? What factors kept my associates

and patients from taking better care of themselves? Searching for

answers led me to the interviews, studies and stories that make up

the body of this book.

Cost/benefit analysis

My research and experience with self-care often came back to issues

of motivation. While the medical profession attributes unhealthy

behavior to our not knowing what's good for us, ignorance is only a

small part of the problem. The behaviors of the most knowledgeable

groups, doctors and nurses, are no better than those of others with

comparable incomes. In reality, the decision to engage, or not to

engage, in self-care usually results from a rational, though

subconscious, cost/benefit analysis. Like any change, getting well

involves time, effort, and courage; we won't attempt it if the

benefits are too meager or the costs too high.

Wouldn't relief of pain, avoidance of complications, better function,

and longer life be sufficient motivation? It's not that simple. Our

lives, and our roles in them, have their pluses and minuses, pleasure

and suffering, joys and grief. Too little of the good things and too

much of the bad can sharply lower our estimate of the value of

wellness.

Pain also has its hidden upside. Many of us may believe we somehow

deserve our pain, may let physical pain distract us from emotional

pain, or may find in pain (or fatigue) our only way to take a break

from constant work, or to accept help. Even " feeling better " brings

conflict if part of us believes we deserve to suffer, if feeling bad

gets us positive attention, or if the effort involved in feeling

better seems too frightening.

The things that raise the costs and lower the perceived benefits of

getting well are barriers to self-care. They are often the same

aspects of life that contributed to our illness in the first place.

We didn't cause them, usually, but with a little help, we can solve

these problems and start getting better.

Barriers to self-care

First, we need reasons to live and work at getting well. Some of us

live in circumstances that make life difficult, and positive

experiences hard to come by. If I dread getting up and going to work,

and dread coming home to an angry household, why should I care about

getting well? If I am lonely, tense, in pain, with little pleasure,

purpose or security, or under constant stress, why should I exercise,

stop smoking, or stop taking heroin, for that matter? So I can live a

few years longer? Why would I want to?

Reasons to live are plentiful, however, and most of them are cheap.

People keep going for an incredible variety of motives, some of them

fascinating, mostly covered in Chapter 5.

Some believe life may be worth living, but they, themselves, are not.

Low self-esteem, not valuing ourselves, inhibits self-care. Many of

us don't believe we can give ourselves the time and energy required

to maintain our health. Everyone else's needs are more important than

ours, and we don't feel we have permission to be well. We deal with

getting such permission in Chapter 6.

Loss of Hope

Another de-motivator is absence of hope. Why try to get well if it

won't do any good? (As in, " You have less than a year to

live, " " You'll never walk/run/play the xylophone again, " or, " Your

condition is chronic and progressive. You can't get better. " )

Hopelessness also comes from miserable social or economic

situations: " I'll never find someone to love/a place to live/a good

job. " It's a killer, leading to complications, suffering, and earlier

death. Professionals who take away clients' sense of hope are guilty

of malpractice.

Lack of self-confidence also deprives us of hope. We may not believe

in our ability to do what we set out to do ( " low self-efficacy. " ) Or

we may not believe that self-care will do any good. This book gives

exercises for building self-efficacy, information supporting our

power to help ourselves, and inspiring stories of people who have

succeeded.

Resistance to Change

Fear of change raises the perceived costs of self-care. The one

absolute requirement for overcoming illness is a willingness to

change - if you're sick, being well is a change - but change is scary

and difficult for many of us. In addition to the discomfort of

changing behavior, attitude, or life situations, we may fear giving

up secondary gains, or fear the conflict change can bring. We may

have good reasons for cherishing self-damaging habits and not want to

let them go. Building our capacity for change is covered in Chapter 3.

Unloving our bodies

Our attitude towards our bodies affects how we see the costs and

benefits of getting well. Do we enjoy and appreciate our bodies?

Listen to them? Love them? If we do, we'll be much more likely to put

some effort into them. If we, like most of society, regard them as

machines or beasts of burden, as ugly or deficient in some way, we'll

probably let them fall apart. Learning to love our bodies is taught

in Chapter 7.

Lack of support

Even when our motivation for wellness is high, there are a host of

potential barriers. Sometimes our disease moves too fast; we can

barely keep from sinking in a tide of painful change, much less think

about getting well. Fortunately, such virulent conditions are rare,

but if you have one, this book may not be right for you. A more

common barrier is lack of support: too many demands and not enough

help. Ways of slowing down and easing demands are given in Chapter 2.

Too many of us are isolated, left stranded in our highly mobile

society, with few friends, strangers to our neighbors. Some are

emotionally and physically distant from our families; some, many

foster children, for example, never had a chance to connect with

them. Others don't know how to ask for available help, or are afraid

to ask. Chapter 4 covers finding, requesting, and accepting support.

Looking up at the white coats

Getting well, like dealing with other life problems, is extremely

hard for people with little education, especially for those on

society's bottom rungs. Recovery requires taking some control of our

lives and our care. That's a tough assignment when you have never had

power over much of anything. We may have to speak up to doctors and

other professionals, and demand respect where little is sometimes

given. This situation can be stressful enough to keep some of us from

seeking help at all. Self-care requires informing ourselves, a

difficult task for poor readers, and for those who have been raised

not to ask questions. Help in dealing with such situations is given

in Chapter 6.

Socioeconomic factors, for many of us, cause more difficulty than the

disease symptoms themselves. We have to find ways to pay for

treatment, keep a roof over our heads, care for our families if we

have them. We may have to weigh time and money spent in self-care

against other crucial needs, or simply lack convenient access to

resources that could help us. We may not find care providers familiar

with our culture or language.

Some of us grew up with abusive or dysfunctional parents or

caregivers who left us unloved and fearful. Others suffer from

psychological problems - depression, anxiety, or worse - which make

getting well appear a decidedly mixed blessing. Some of us have no

role models; we've never known people who take care of themselves, so

we never learned how. Such socioeconomic and psychological factors

may limit, though not eliminate, self-care options.

So I don't want to hear about any of you criticizing a person with

illness for not being more positive. Asking, " why haven't you gone

back to school? " or " why are you still depressed? " If I hear of any

of you doing that, I'll come over and go upside your head with my

cane. Those of us who start from harder places may have less

ambitious criteria for success. Even so, such barriers can be

overcome! Given support, hope, reasons to live and a willingness to

change, there are ways forward for almost everyone.

The riddle of compliance

Hardly anyone decides consciously to stay sick, to keep suffering.

We " forget " to take our medicines. We are " too tired, " to exercise

or " too busy " to relax. We " don't get around " to writing in a journal

or having that heart-to-heart discussion with our spouse about our

needs. We suddenly find ourselves " craving " some food or activity we

know is bad for us. We " just don't feel like " taking our blood

pressure or doing our stretches today.

These acts of apparent self-sabotage tell us we've come up against a

barrier to self-care. We may be thinking self-blocking thoughts (such

as " People won't like me if I take time for myself. " ) We may have

practical difficulties: the roof may be leaking, the car in the shop,

our mean-tempered aunt moving in with us. We may be lonely, stressed,

even overwhelmed. The shame placed on people in these conflicted

situations is unwarranted; they are part of the life difficulties

that contribute to most cases of chronic illness.

We may have other perfectly valid reasons for " noncompliance " , as

doctors call it when we don't follow their orders. Therapy may be too

expensive, have bad side effects, be ineffective or dangerous, be too

disruptive of our lives, or conflict with our values. We may also

have negative reasons: rebellion against authority or unwillingness

to accept that we have a problem. When faced with noncompliant

patients, care providers should explore these possibilities. This

book explores solutions to them.

Health care workers who try to force healthy behavior on us out of

fear often do more harm than good. Feste, author of The

Physician Within, developed diabetes forty years ago, at age 10, when

that diagnosis usually meant a short and miserable life. She says, " I

can't imagine taking the prevention approach. I can't see myself

getting out of bed in the morning, stretching, and saying, " Well,

another day to prevent blindness and kidney failure! As if that were

a reason to live! " Feste has thrived with her diabetes, she believes,

because she has found meaningful and enjoyable things to do with her

life, not because of fear of the consequences of failure. Each of us

has the ability to follow her inspiring model. We just need to learn

ways over the barriers.

Why we need doctors

Self-care doesn't mean rejecting medicine. Working effectively with

health professionals (Chapters 4, 6 and 10) can make all the

difference in getting well. This book is no substitute for medical

care, or for educating ourselves about our particular condition. I'm

not saying this to avoid getting sued; medical treatment helps in

most conditions, and it's getting more helpful all the time. Good

doctors or nurses will share with us what they know. Medical tests

can help us understand what is happening and monitor our progress. We

nearly always need doctors, and often one or several other healers,

on our health care team.

However, I know of no chronic condition where medical care can effect

a cure all by itself, or where the doctor's contribution is more

important than the patient's. Too often, expensive and invasive

treatments of dubious value distract us from self-care measures that

could be much more helpful. Coronary artery bypass surgery frequently

falls into this category, if it takes the place of relaxation,

exercise, healthy eating and social support (the program developed by

Dean Ornish.) So does indiscriminate use of antidepressants, if they

take the place of exercise, positive self-talk and counseling. In

some conditions like fibromyalgia, irritable bowel syndrome, chronic

fatigue, and some autoimmune conditions, where causes and treatment

are poorly understood, the search for currently nonexistent medical

answers can delay self-care measures more likely to improve our

situation.

Overcoming illness means cooperation with doctors, not attacking

them. Most are overworked and underappreciated, and will welcome

sharing responsibility with their patients. (If they don't, we can

find others.) " Self-management " programs have been shown to reduce

doctor visits, hospitalizations and medication use, saving resources

better used elsewhere. We don't do our doctors any favors by giving

them too much power. They cannot heal us without our participation.

Self-care is a winning proposition for everyone involved.

Recovery, yes. Cure, maybe.

This book applies a recovery model to getting well. Like a 12-step

program, it promises a lifelong strategy for living well, not a cure.

I still have MS; Wong still has hypertension and thyroid

problems, Bob Lawrence, quoted at the top, still has AIDS. I can

guarantee that if you follow all the advice this book gives, and your

doctor gives, and read 20 self-help books, you will still die,

eventually.

What counts, though, is what we do with the time we have, and the

knowledge in this book can empower anyone to live a richer, healthier

life, to take better care of themselves and work better with others.

These skills sometimes lead to cure, more often not, but whatever our

condition, we can always feel better, more well, more fully alive. We

may also wind up as more fulfilled people who tend to bring happiness

and inspiration to those we meet, or at least to annoy them by being

so cheerful.

Doctors have long known that an arthritic person's level of pain and

disability has almost no correlation with the amount of joint damage

visible on X-ray. Neurologists have found that MS patients' symptoms

bear little relation to the scars seen in their brains on an MRI. The

whole person is much more than the disease.

Doctors and educators at Stanford developed a program, the " Chronic

Disease Self-Management Program, " which Kaiser Permanente now

presents as " Healthier Living " (HL.) This program, which I sometimes

facilitate, aims to help people manage their own conditions and

lives. The results, proven repeatedly, include higher self-rated

health, less disability, less limitation on social and role

activities, increased energy, fewer doctor visits and

hospitalizations, and less distress. Yet, participants' conditions

have usually not changed much clinically.

How to use this book

Each chapter of this book presents knowledge to help with specific

areas of self-care. No one needs all of it, so feel free to jump

around to what seems most relevant to you. You may even want to go

straight to Chapter 9, and work on a personal self-care plan.

Self-help exercises and resources for material covered in each

chapter have been placed in their own sections at the back. You may

want to read the book through once - it goes pretty fast - then go

back to the parts that seem right for you, and try the related

exercises.

" The Art of Getting Well, " reflects the work and lives of hundreds of

people who try to live fully and make this world a better place. I

hope you find within these pages the help, information, inspiration,

or at least the entertainment value you are looking for.

The Art of Getting Well: A Five-Step Plan for Maximizing Health When

You Have a Chronic Illness

by Spero R.N.

Paperback $ 15.95 ISBN 0-89793-356-7

Hard Cover $ 25.95 ISBN 0-89793-357-5

256 pp 7-1/4 x 9-1/4

February 2002

Order now from: Amazon.com or Hunter House