Flare-Ups - Pacific Standard

Flare-Ups

Are my emotions making me ill?
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(Photo: Sherry Yates Young/Shutterstock)

(Photo: Sherry Yates Young/Shutterstock)

When he died, I got sick. He was family—if not by blood then by love. A friend’s father. For all but the first few years of my life he had cared for me when others had faltered. He sheltered and fed me, taught me to question and listen and believe, in equal doses. And then when I was 30 years old, he was gone.

My grief felt like the final moment of falling down, when you hit the ground and rise up too quickly, your body in shock. Only my grief felt like this over and over again. I felt a constant pressure in my chest, which I tried to ignore: I was single. I lived alone. I was working as a freelance editor and was finishing my college degree on the side. I had to perform the necessary tasks of keeping myself in one piece. But there were times when I would go blank, dark holes of mental space in which I would get lost. My body became staggeringly unreliable, and even breathing required effort. I cried a lot, ugly deep sobs that left me red-faced and faint, gasping to get enough oxygen.

Two weeks before his death, I had also quit smoking, after a 10-year, pack-a-day habit. Cold turkey. At first, I thought the cough I developed felt almost good, a clearing-out of the terrible feelings inside me. When I’d awake at 4 a.m. hacking up smoker’s phlegm so hard I tasted hints of vomit, I told myself: This is good. You’re getting it out of your system. The toxins, the grief.

That was eight years ago. The coughing hasn’t stopped.

ABOUT A YEAR AFTER my asthma began, I saw a doctor, who gave me an inhaler and told me I might have allergies. I also saw an acupuncturist. She felt the pulses in my wrists for a long time. She looked at my tongue. She asked me about my diet and my bowel movements, my symptoms, and my body’s particular quirks or pains.

I’m not misfiling religion in the science drawer; I know illness is not an emotion. And yet I also know that my grief, like my asthma, is always present. I know that I am deeply sad and I cannot breathe.

Then she said, “It’s your lungs. Grief. Unresolved grief. Especially related to fathers.”

I laughed a little bit in disbelief—she didn’t know a father figure of mine had recently died, although she did know I was depressed. I burst into tears. And I felt relieved.

In addition to using the inhalers my medical doctor gave me, there are a thousand things I am supposed to do to try and manage my asthma. Get allergy tests. Buy fancy vacuums and dust-mite covers for every fabric surface in my home. Give up my shelves of old books and vinyl records. Remember my inhaler every time I go on a hike or to a hilly neighborhood. Performing these acts of self-care is exhausting, expensive, and often difficult to measure in terms of results. The day of that acupuncture appointment, sitting in a windowless room in an office deep in the fog of San Francisco’s Richmond district, I was delivered a relatively easy diagnosis, a narrative that I could seize on to explain my ongoing illness to myself: I got sick because he died and I never recovered.

IN DIAGNOSTIC TERMS, "ASTHMA" is a word used to describe a specific set of symptoms. When a person has asthma, their bronchial tubes are inflamed. As result, they have trouble breathing. An asthmatic person might experience a range of symptoms, most notably coughing, wheezing, and tightness of the chest. Asthma can be triggered by any number of external factors, including allergies, air pollution, strong odors, or cold air. The condition can be steady or random, mild, or extreme or both in turn. Nearly 25 million Americans currently have asthma. There is no cure.

Most days, my asthma presents as a nagging cough similar to the kind you might get while recovering from a cold. At night, though sometimes all day (and always when lying down), I wheeze with every breath, in and out. I cannot run for more than five minutes without stopping. Most nights, I wake myself up with the sound of my own labored breathing. I suffer from fatigue so powerful it borders on clinical.

Sometimes, my bronchial tubes become so inflamed they can barely function, and I am blindsided with a bout of wheezing so bad it turns to panicked gasping. Panic turns back to wheezing, and that’s what they call an asthma “attack,” or a flare-up. Flare-ups can last for minutes or hours. When I have a bad flare-up, I feel as though I have been buried alive inside a particularly thick clay soil, one that is porous enough to keep me conscious but dark enough to let you know you’re never digging out; I can feel—physically, viscerally—my lungs beneath my ribs, and how quickly and how desperately they are not working. The experience is terrifying.

About once a year, my asthma will combine with an infection and evolve into pneumonia. Asthma exacerbates pneumonia, pneumonia exaggerates asthma, and the cycle of illness and of inflammation and panic continue.

I have otherwise spent my life as a healthy person. When I talk about my asthma, I often belittle it by adding, “But it’s not that bad,” or “Other people have worse stuff going on.” Recently I decided to stop. The reality is that I have a chronic illness, one that seriously affects my quality of life. Nobody really knows why. Even though I am a former smoker, my doctors say there is no way to know whether the asthma is a direct result. I have no symptoms of other lung diseases. As a person prone to allergies, it’s possible I would have developed asthma even if I had not smoked.

Because we cannot prevent it, asthmatics treat the symptoms. I take two different inhalers daily and steroids on occasion. I stay away from dust. I avoid cold winds and smoky rooms. I swallow capsules of turmeric, which my doctor told me fights inflammation. I practice yoga and breathe deeply. I sit in steam rooms and saunas. I avoid excessively damp or dry environments. I cut gluten, dairy, and sugar from my diet, and slowly add them back in to determine whether I’m allergic. I purchase air purifiers, humidifiers, and de-humidifiers. I purchase a tattoo that spreads across my back over the area above my lungs, letting the needle’s vibrations massage my insides. And I get acupuncture.

TRADITIONAL CHINESE MEDICINE HAS been practiced in China for thousands of years, and in the United States widely since the late 20th century. The term “traditional Chinese medicine” is broadly used to describe both a system and philosophy of medicine, and the treatments used within that system. The treatments include acupuncture, herbal and dietary therapies, and massage.

In the West, acupuncture has been studied for scientific efficacy over and over again, with mixed but generally positive results. Some people swear by Chinese medicine, some swear it off as pseudo-science, and many American health care providers now recognize it as a complementary treatment to Western medicine.

Traditional Chinese medicine works on the principal that our bodies are regulated by meridians—channels through which energy and fluids flow. (Acupuncture points lie at specific places along those meridians.) The meridian networks are incredibly complex, but essentially, each primary meridian is attached to—influenced by and affecting—certain organs. Each organ is associated with certain emotions, both positive and negative. The positive emotion associated with the lungs is joy. The negative one is grief.

The connection between asthma and emotions is equally interesting to Western researchers. Increasingly, researchers are studying potential links between psychosocial stress and asthma, particularly in young people. Studies from Harvard Medical School, Brigham and Women’s Hospital, and the University of Pittsburgh suggest that stress influences asthma. Some minority and socioeconomic groups that experience very high levels of individual, family-related, and community-related stress also have higher rates of asthma than the general population. In addition, stress affects asthma itself, in terms of how the body will behave when asthma is present as well as in how the condition will progress. In medicine and in the popular imagination, we are beginning to accept that the emotions and experiences we lump together as “stress” can make us very sick, and can even be a cause of illness, not just something that exacerbates it. But we’re not very good at treating stress.

A practitioner of Chinese medicine approaches the body as a holistic system, emotions and all, and works to restore balance in the system. In traditional Chinese medicine, specific terms like “heat,” “wind,” or “damp” are used to describe the specific states of the organs and the meridians. According to my current acupuncturist, I have an excess of heat in my lungs, but it is a mix of dry and damp heat, which makes it particularly difficult to treat.

When I asked about the relationship between grief and my asthma, my acupuncturist put it like this: ”Chinese medicine recognizes that when the organs are working properly”—here she made a circular motion with her hands over her abdomen and patted her head with her other hand—“then the head and emotions are healthy.”

“But shouldn’t it be the other way around,” I asked. “Didn’t my emotions cause my illness?”

“Well, it works both ways,” she said. “Everything does.”

That grief can be if not a cause then a source of my asthma is something solid I can hold on to, much more so than doctors’ mantras of “We don’t know, there is no cure.” I’m not sure how medically sound the diagnosis is, either in Chinese or Western medicinal terms. But I don’t care. I believe grief is why my lungs don’t work.

I’m not misfiling religion in the science drawer; I know illness is not an emotion. And yet I also know that my grief, like my asthma, is always present. I know that I am deeply sad and I cannot breathe.

IN ILLNESS AS METAPHORher landmark critical dissection of cultural attitudes around sickness, Susan Sontag dismantled our tendency to view illness as anything other than the illness itself.

In addition to using the inhalers my medical doctor gave me, there are a thousand things I am supposed to do to try and manage my asthma. Get allergy tests. Buy fancy vacuums and dust-mite covers for every fabric surface in my home. Give up my shelves of old books and vinyl records.

She argues that when we imbue an illness with a narrative, imagery, personality—metaphor—we “put the onus of the disease on the patient. ... Cure is thought to depend principally on the patient’s already sorely tested or enfeebled capacity for self-love.”

There is no proven treatment for grief, and each person—each culture—grieves differently. We can stave off and mitigate its effects. We can find ways to more steadily keep the violent oscillations at bay. I am attracted to the diagnosis of grief in part because it simultaneously gives me responsibility and absolves me of responsibility. If grief is what made me sick, then I could conceivably heal.

According to Sontag, the ultimate purpose of invoking metaphor to explain illness is the human urge to avoid death—“the obscene mystery, the ultimate affront.” Where do I stand in relation to the truth if my sickness is a reaction to death itself? Why would my emotional state not affect my body? Even steely eyed Sontag had to admit that emotions can have a medical, non-metaphorical effect on a person’s immune system. But grief isn’t a metaphor.

AMONG WESTERN MEDICAL PRACTITIONERS, grief is understood to be a psychological state. But practitioners disagree on how to treat it. In 2013, the release of the DSM-V included a change in the diagnostic criteria for grief-related depression, setting off a debate within the psychiatric community about whether medicalizing grief is the best way to encourage better treatment of it. As Americans, we have few cultural resources in place that ameliorate or even allow space for the process of death and grieving. If we declared grief an official illness, would we then also expect common standards for recovery?

Grief has no timeline. It does not improve steadily. The progress of grief doesn’t look like a chart on a clipboard, abating in a straight line as the healing process does its thing. Neither does the march of asthma. To have a chronic illness is to live in a state of non-progress: you have “good days” or “bad days,” states of remission or “flare-up.” My asthma is not treated, it is “managed.” And like grief, it attacks without strategy or logic. But grief is neither disease nor metaphor. It is one of the pre-existing circumstances, the calculated risks, of being human. It is a symptom of our condition, it is real, and it is incurable.

The Weekend Essay is a Saturday series edited by Leah Reich.

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