The illness experience

To understand the potential benefits of mindfulness in physical medical conditions it may be helpful to think about the illness experience itself. Take the case of cancer, which for almost everyone challenges their world view and self concept, often requiring debilitating and sometimes mutilating treatments, with an uncertain future. On an existential level people are forced to confront their own mortality in a real way, often for the first time. The possibility of one’s death becomes real and potentially imminent, and substantial and perhaps permanent changes in functional abilities, appearance, and lifestyle may follow, as well as having to face the possibility of ongoing pain and dysfunction. Life plans are necessarily altered, and the future is premised on whether or not the illness comes back or gets worse. On a psychological level, illness and treatment often produce a sense of unpredictability, loss of control, and feelings of anxiety and fear. After treatment, no matter how successful, for most people there is a lingering fear of recurrence or progression, which turns every ache and pain into a potential life threat. Escalating anxiety can then set up a negative spiral, which results in worsening of the suspicious symptoms due to muscle tension and hypervigilance, followed by greater fear and certainty of recurrence. Mindfulness practices allow a short-circuiting of this process to prevent such escalation.

In general, most people function well because they assume more control over the course of their lives than they really have; diagnosis with a chronic or life-threatening illness throws this inaccurate conception into sharp relief. In response, many people try harder to control some aspects of their lives, but within the framework of diagnosis, treatment, and an uncertain future, this is often a losing battle. The best response is actually to embrace uncertainty, but for many people this is a tall order.

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