After reading Sam Horn's wonderful post, Are You an Introvert, Extrovert or Ambivert?, I wondered whether I was truly introverted or, perhaps more aptly, RA-converted.
I think it's a bit of a chicken-egg scenario. Has rheumatoid arthritis forced me out of the ambiverted/extroverted (?) lane and into the introverted one?
When I look back at my elementary school report cards, it wasn't uncommon to read, "Marianna would do much better if she didn't talk so much in class." Does that sound like an introvert to you? What happened? Most likely it was stress and then stress and RA that manipulated me into seeking silence and solace from the high speed and high energy lane of life.
But not each and every time. Then, as now, it depends how I'm "wrestling" with RA. Where I am. Who I spend time with. How much sleep I have. What I eat. Even the weather. The point I'm making is that life is not static. So many variables exist; some are controllable, others are not. Things change and it is in our best interests to learn strategies to help us be flexible as we encounter roadblocks and potholes.
Retreat to Restore
When the tank is empty, often the only recourse is to put on your turn signal and exit. Talk to anyone with RA, or read one of the many blogs or social media posts, and you'll see that fatigue is a very common side-effect. At times, "fatigue" doesn't even begin to cover how you feel when RA has its way. During those times, I often use the French word épuisé to describe how I feel. It means "exhausted," but like many foreign words, its use connotes a deeper essence of exhaustion.
When I was teaching full-time, I often stayed in my classroom during recess and lunchtime. I turned off most of the lights and enjoyed the quiet. This was my attempt at recalibration. A way to refuel so I could get through my afternoon classes. I had not yet become Auntie Stress, so I didn't know what I now do about stress and how it further impacts one's equilibrium. More importantly, what to do about it.
The need for downtime didn't stop with work. Much like Sam described in her article, attendance at a conference or a meeting might necessitate a retreat. I may even need alone time during or after social outings. Usually a few hours of engagement is plenty. Then I've had enough. Fortunately, most of my friends and family understand that my rules of engagement come with limits. (Thank you for that!)
Hearing loss adds another layer of exhaustion
Hearing loss increases the diameter of the energy drain. A lot of brain power is used to decode and make sense of speech. I find that all my senses are heightened in order to engage in meaningful conversation. That's an additional toll on a body that is already burning through the fuel. If there's background noise, it becomes even more difficult.
See my article on HealthCentral.com: Hearing Loss with Rheumatoid Arthritis.
Sometimes it's hard to be around the non-stop talkers; the monopoly on conversation doesn't allow for the conversational ping-pong-game or give and take that provides a break in intense listening. The machine gun fire of words assaults the brain; it has to work hard to decipher what is being said. RA already drains the fuel tank. With the addition of hearing loss, sometimes it's like someone has attached a vacuum cleaner to me and sucked out whatever energy I have left.
Suffering can occur when there is a disconnect; a mismatch between your "operating style" and how your disease makes you feel and do. While the spirit may be willing, the body may not be. The desire to socialize climbs into the backseat and the need to regroup drives you to the peace and quiet of home.
Be careful. Once there you may begin to stew with a slew of negative thoughts and feelings, including FOMO (fear of missing out). This is stress-producing and inflammation-inducing. The more you loop those negative thoughts and feelings, the more you could suffer.
Be Aware of Tachykinin (TK)
It's a fun word to say, but not so fun when it floods your brain. In a lab at Caltech, David Anderson discovered that Tachykinin, a neuropeptide, is released when the mice and fruit flies he was studying didn't get enough social or physical contact. Fear increased, as did aggression.
I couldn't find any evidence pointing to human studies, but the assumption is that Tachykinin is also released in humans who experience the same conditions.
"These studies provide just a glimpse of the ways in which studies of aggression in the vinegar fly can help us to understand aggression in mammals, including humans. First, the identification of cells that control aggression in the fly brain reveals general principles about how aggressive behavior is encoded in the brain, even if the anatomical details of the fly brain and mammalian brain are different. Second, the identification of genes that control aggression in the fly can prompt us to ask whether similar genes may also control aggression in mammals, including humans. In the case of the TK gene, that turned out, surprisingly, to be true. While it may not be the case that every gene that controls aggression in flies has a counterpart that controls fighting in mammals, it is usually the case that where there is smoke, there is fire. And that encourages us to continue our own fight to get to the bottom of the biological mechanisms that control this fundamental and fascinating, but also fearsome, behavior."
I first learned about TK from the enlightening Huberman Lab podcast. Andrew Huberman, who speaks eloquently on a wide range of topics, postulated the theory that perhaps all the instability that we see, particularly during this pandemic, is partially related to too much TK. Fear of the unknown, fear of threat and fear of insufficiency may lead to more unrest and aggression.
It makes sense; the chemicals in our body do influence how we feel. To avoid being completely tossed about like tumbleweed in the storm of our thoughts, feelings and emotions, onboard tools, techniques and strategies. We need a Star Trek tricorder to readily test our physiological state. In lieu of a tricorder, I use another type of technology that allows me to turn to my heart.
How do you reconcile the need for alone/restorative time and the importance of contact, especially in light of the Tachykinin molecule?
Customize a Strategy
It's important to come to terms with what your emotional, mental, physical and spiritual needs are and how best to align them with the bossy nature of RA.
Humans need social contact. How much contact and at what cost? That differs for people, think introvert, ambivert or extrovert. (Or RA-convert?) If you're feeling well, I suspect it will also differ. If you're chained to a debilitating and painful chronic illness, it may be difficult to socialize, even if you crave it. Some people in your circle can sap your energy very quickly. Others can fly into your life to provide you with a mid-air refueling. Suddenly, your energy surges, as does your sense of connection.
How to be OK
Please don't discount the importance of pets in your life. They provide an important form of connection; the corollary to this is if the worry about their health and care overarches the love and joy you feel when you have them in your life. Remember that when you practice stress techniques, you have the potential to sync your heart beat with your fur baby.
Texting, phone and other digital services can help to bridge the gap, although generally, I find in-person contact much more satisfying, unless an energy vampire swoops in, of course. That's when it's important to be honest with yourself and others.
Find ways to calmly express your needs in a matter-of-fact way that honours your abilities. For example, I let people know that when we're in the car together, conversation is too difficult. The car and road noises, plus the nature of the seating is not a conducive hearing environment.
Perhaps you may wish to take a page out of Lene Andersen's book and implement a Mandatory Rest Period. Check out Lene's interview on RheumaBlog. Experiment, adjust, adapt until you find what works best for you.
Having said all this, there are many times when we cannot customize our environment to suit our needs. That's when flexibility, preparation and understanding can help.
I've found that a regular stress practice helps me to accept my reality. Letting go of the expectations that I and others place on me can take the sting out of the way I wish things were and the way they actually are.
As Sam so eloquently states:
"It's not indulgent to go off by yourself when you crave space, it's an investment in being your best self and doing your best work."
When you live with RA, craving and then allowing yourself to take that alone time may be an important part of your self-care practice. Do it for the health of it. When you feel better, you do better. We all benefit when that happens.