Health

Hiding the Pain - 8 Reasons Why

May 6-12 2019 is International Mental Health Week - 

Why do people wrestling with a serious mental or physical illness often hide it from friends and family, isolating themselves in the process?

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We all know of someone - a celebrity, a friend, a  co-worker, family member - who has grappled with a severe illness that attacks their body or mind. Sometimes their war is lost without us even having been aware of the battle going on.

Hiding Their Pain

Gradual withdrawal from friends and family - regardless of the cause - is not easy to pick up on, even when you live with someone. It's even harder when you only see the person occasionally. It's easy to avoid contact by phone or email - or to deflect questions or give the answers you think people want to hear, when you have time to think about it before responding.

Mental Illness

In the space of one week, fashion designer/ retailer Kate Spade and TV food journalist Anthony Bourdain, each took their own lives. Friends, family, and fans were surprised and devastated by their suicides. These highly successful people were also successful at hiding their inner struggles.

Mental illnesses such as bipolar disease, schizophrenia, severe anxiety, depression, etc. are often debilitating disorders. Combine this with high intelligence and personal expectations - and you have a breeding ground for emotional pain with the added capacity to cover it up.

Physical Illness

Three friends and entrepreneurs that I have known for many years became ill in the last 3 years. In each case, they were highly motivated, self-reliant people that epitomized the "can do" positive attitude needed to overcome obstacles and be successful in running a business. Whether because they were in denial about it themselves, or for other reasons, they chose not to share the extent and severity of their illness with me (and others) in the many months leading up to their death from terminal illnesses. In one case it was a complete surprise to me that they were sick at all. 

Daniel Thomas, a 32-year-old cancer patient from England, shared his personal insights and experiences on his website PeeWeeToms.com and YouTube channel. These excerpts from his Cancer is a Lonely Place post poignantly express his hidden pain:

"Pretending to be ok is the hardest part not to upset people, and the constant you can do this, the constant chatter of people behind my back, the lies that are told, the rumours, the you’ll be fine’s. I may be fine, but ill be disabled, I may be fine but I will have nothing of my old life left!"

"Cancer is a lonely place, it’s a feeling that seems to rip you apart, tears you limb from limb, it’s like a constant annoyance cropping up in every thought, every moment. It’s consuming..."

"That brave face that hides the pain, that hides the reality of it all, that same brave face that doesn’t know whether to run, hide or just disappear."

Sadly, Daniel passed away in September 2018, 9 months after starting a video blog to chronicle his cancer journey, and addresses the lack of emotional and mental support services for cancer patients in this post below.

So I asked myself, and psychologist Lesley Hannell, this question:

WHY Do People Hide Pain and Illness?

Background

Psychiatrists and psychologists would agree that a person's personality is formed at an early age.

Decisions or events in childhood - and the resulting outcomes - influence a person's perception of themselves and their way of dealing with events or making decisions in the future. Often the perceptions they've formed about themselves and their world view are so strong, that to challenge this thinking could cause their house of cards to collapse. Shifting their perception is painful and scary...and therefore something that many people avoid.

Swiss psychiatrist and psychoanalyst Carl Jung posited that everyone has a "shadow self". The shadow self is the repressed and unknown aspects of our personality hidden from ourselves, including traits often considered to be negative. Many of the reasons for hiding mental mental pain or physical illness may apply to most people, but perhaps are even more applicable, or exponentially more likely to apply, for someone who ticks one or all three of these boxes:

  • high achiever
  • very intelligent
  • high expectations of themselves 

Glennon Doyle Melton shares her individual story below - the emotional and mental pain she experienced, how and why she tried to cover it up for many years.

8 Reasons Why People Hide Their Pain

People struggling with a serious mental or physical illness experience emotional turmoil along with their other symptoms. We can only guess at what may be multiple factors contributing to someone choosing to withdraw and keep the extent of their illness a secret, but here are some more of the common reasons:

    1. They are in denial - "I'm ok...it's not a big deal". They don't think they have a problem, or that it's not serious - or they simply don't want to be sick. "I don't do cancer".
    2. Their personality /self-perception is that of a strong person, who doesn't need help. As a result, they may also believe or feel that:
      1. Mental or physical pain is a weakness.
      2. Others will perceive them as weak or needing help.
    3. They want to spare other people from worrying about them.
    4. They have to feel safe in the world. Admitting to yourself that you have a serious illness can shake your world/life view, which opens the door to the next reason, fear. 
    5. They are scared of the illness and the potential outcomes of the illness. Confronting your own fear is scary, let alone exposing it to others. 
    6. *Their mental illness is such that they don't have a full awareness of it (anosognosia), and/or the ability to deal with the resulting emotional pain  - or ask for help with it.
    7. Stigma around a serious physical or mental illness, and a conscious awareness of the potential (negative) consequences of revealing details of that illness. 
    8. A purely instinctive, subconscious need to protect themselves. In the animal world, if a creature is injured they will avoid contact or hide themselves so that they can't be attacked when they're at their most vulnerable. 

*Clinical psychologist and Columbia University forensic psychologist Dr. Xavier Amador - who had a schizophrenic brother - explains the impacts of anosognosia and how to have different conversations that can open the lines of communication and re-establish relationships. 

What Can You Do About It?

Recognizing that there could be a problem is the first step. 

Deterioration of previously open communications, withdrawing or distancing themselves from friends and family (avoiding family gatherings, being in the same room for an extended time with another person, etc), and retreating from social media, are some external indicators of an internal struggle. Verbal, physical and facial cues may be subtle and hard to be pick up on in person. 

If our first question as friends, family or colleagues of an ill person is WHY hide the pain, our second and more important question is, what can WE do about it? How can we help them?

In some instances, friends and family may know (or become aware) that someone has a mental illness, and realize they need access to mental health services. Getting them those services may be the easiest part of what is usually a lifelong wellness journey. 

In the case of a severe physical illness, it may not be as well recognized by friends, family, or even medical professionals, that their mental health is in jeopardy as well. Cancer support groups and individual counselling for cancer patients may be important but overlooked avenues of support.

Below, this cancer counsellor explains the benefits of counselling support services.

Starting the Conversation

Having a conversation about a serious illness such as cancer or schizophrenia is difficult at the best of times, with someone who is aware of and open about their situation. If the person is unaware of or hiding the extent of their illness, talking to them can be like trying to walk across a field of communication landmines. 

Psychologist Lesley Hannell suggests some conversation starters or tactics could include phrases that shift their internal focus:

  • "I" Statements/ Questions: "I'm starting to notice..."  "This is hurting me..."
  • Imagine external reactions and outcomes: "What would happen if you.tell people you're ill?"   "What's the mostly likely scenario?"
  • Reversing the situation: "How would you react if someone told you they were sick?"
  • Support messages: "You're not alone in this." "I love you." "I'm not going to leave you."

Use of reflective, respectful, and empathetic listening is the foundation of the LEAP approach, to keep the conversation and relationship going. (See above for Dr. Xavier Amador's explanation and examples of LEAP specific to mental illness with delusions and anosognosia)

  • Listen (reflectively with respect and without judgment)
  • Empathize (strategically with emotions stemming from delusions)
  • Agree (find areas of agreement - abandon your goal of agreeing the person is sick)
  • Partner (on things you can agree on)

If they're not ready to talk or don't want help from support services, all you can do is wait in love and hope for a shift, respecting their decision and timeline for when that might occur. 

In the meantime - take care of yourself and get the education, help and support YOU need in order to stay mentally and physically healthy. You can't help someone else put their oxygen mask on if you can't breathe yourself. 

Support Resources:

Canadian Mental Health Association

MentalHealth.Gov

Canadian Cancer Society

American Cancer Society

**This article is for general informational purposes only. Obtain expert advice from a qualified practitioner about your unique situation.**

Anita Hamilton

50+ World editor & baby boomer writer Anita Hamilton has always been interested in the "real people" stories behind the characters that create and inhabit the world of music, books, movies, television shows, current events, history, etc. A lifelong love of research (ok, nosiness) and writing, combined with a loving and supportive family complete with 3 mini-dachshund minions, keeps her busy.

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