Have you created a 40 item treatment plan in your bullet journal? Do you judge yourself daily for not meditating, taking all your supplements, doing your strengthening exercises, pacing, or other lifestyle treatment strategies? You’re probably applying perfectionism towards your pain self-management treatment plan. Of course, you probably know that all the guilt and self-blame isn’t helpful, but it’s hard to stop the judgemental voice in your head that says “What’s wrong with you? You couldn’t even find 10 minutes in your entire day to meditate?”
According to science, there are three types of perfectionism: self-oriented, socially prescribed, and other-oriented (Willard, 2019). Let’s take a look at what each of these mean in turn and how they can impact life with chronic illness.
Self-oriented perfectionism means that you set unachievable standards for yourself, and then berate yourself for failing to live up to them. For individuals with chronic illness, this can play out in two different ways. In life before illness, you had ambitions to be great at whatever it is you loved doing. You drove yourself hard in pursuit of those goals. And then along the way, you got sick. Now, you may blame yourself for becoming ill, seeing it as a failure, and judging yourself harshly for not succeeding at living up to your pre-illness potential. In comparison to your pre-illness abilities, you may now criticize yourself for struggling to do basic things like do the laundry, make the bed, write a blog article, cook dinner, meet a friend for coffee.
The faulty premise behind this thinking is that we have complete control over our symptoms, and it’s just a matter of finding the right combination of treatments, when in reality most of the strategies mitigate illness symptoms, but don’t cure them. Fear of losing control, and the difficult emotions of disappointment, frustration, shame, and guilt, drives us to try harder to get it right. But sometimes what we really need to do is give ourselves a break, and acknowledge the flux of illness symptoms is beyond our control, and that it’s better to go with the flow of our illness than steer a course upstream.
Socially prescribed perfectionism means that important people in our lives, or society at large, are holding us to unrealistic standards. The pressure to put on a mask and pretend that everything is fine is overwhelming. It can be an important strategy to avoid the pain of being disbelieved or having intrusive questions asked. There is a huge amount of social pressure to end conversations on a positive note, like saying “But I have a new referral to another specialist that I’m really hopeful about.” People with chronic illness are all too familiar with the toxic positivity evangelists who healthsplain that all you need is the right attitude and you will be cured. I had a doctor who blamed the failure of a treatment (a nerve block) on the fact that I became emotional during the procedure (having four-inch needles poked into your nerves while being ignored by a team of doctors can do that!). God forbid you express frustration or sadness during an appointment as you discuss your life-changing illness! If I had kept my positivity mask on, then I wouldn’t have been blamed for the failed treatment. Socially prescribed perfectionism is the mask you feel you have to wear outside of your inner circle. But sometimes, we impose this mask onto ourselves, when we could admit we’re not ok, and ask for help. In these situations, socially prescribed perfectionism gets in the way, because we want to been seen by ourselves, and others, as holding it perfectly together.
Other-oriented perfectionism is less relevant to individuals with chronic illness as it involves holding other people to our high standards. However there can be a disappointing reaction among some people in the chronic illness community to an individual expressing their no-end-in-sight distress. The “but have you tried…” response piles judgement on someone who is suffering. Even worse is the “but I cured myself doing…” Expressing sympathy means acknowledging each person’s situation is unique, and accepting others where they are at, instead of lecturing them on not trying hard enough.
Proponents of mindfulness (*raises hand*) and cognitive behavioural therapy (CBT) need to be aware that communicating the message to others that their illness occurs because they are “thinking wrong” is damaging and harmful. It simply reinforces toxic perfectionism by blaming the individual, and inviting the individual to self-blame, by suggesting that thinking patterns can cause or cure illness. Instead, we should explain the difference between the physical pain of illness and the mental/emotional suffering caused by illness. Strategies like CBT or mindfulness can reduce the suffering of illness, and sometimes alleviate the physical discomfort of the illness. But not practicing CBT or mindfulness strategies does not cause illness, nor does practising CBT/mindfulness cure illness.
So how can you break free of toxic perfectionism? Befriend yourself. Treat yourself with the understanding and kindness of a good friend. “What would a best friend say?” is something you can ask yourself when you’re feeling anxious, guilty, critical, frustrated, or ashamed. Or to flip the question, “What would I say to a friend or family member if they were in my situation?”
“You’re only human,” “we all make mistakes,” “this isn’t your fault,” “you can always begin again tomorrow,” “maybe this is just beyond your control right now,” “what is something nice you can do for yourself right now?”are all things you can get used to saying to yourself. There are self-compassion meditations (loving-kindness meditations) that you can do to practice reacting with compassion instead of judgement. In these practicrs you repeat silently to yourself wishes, or blessings, for your own well-being: “May I be safe, May I be peaceful, May I embody self-kindness, May I live fully” are the ones that resonate with me. Here are some further resources:
Tara Brach, Radical Acceptance: Embracing your life with the heart of the Buddha
Kristin Neff, Self-Compassion: The proven power of being kind yourself Christopher Germer, The Mindful to Self-Compassion
Willard, K. (2019, June 17). Perfectionism and Chronic Illness. Psychology Today. Retrieved from: https://www.psychologytoday.com/ca/blog/chronically-me/201906/perfectionism-and-chronic-illness
Flett, G.L, Baricza, C., Gupta, A., Hewitt, P.L., & Endler, N.S. (2011). Perfectionism, psychosocial impact and coping with irritable bowel disease: A study of patients with Crohn’s disease and ulcerative colitis. Journal of Health Psychology, 16(4), 561-71.
Linnett, R. J., & Kibowski, F. (2018, June 22). A closer look at multidimensional perfectionism and multidimensional self-compassion. https://doi.org/10.31234/osf.io/bcu37
Molnar, D.S., Sirois, F.M., & Methot-Jones, T. (2016). Trying to be perfect in an imperfect world: Examining the role of perfectionism in the context of chronic illness. In F.M. Sirois & D.S. Molnar (Eds.), Perfectionism, Health, and Well-Being, pp. 69-99. Switzerland: Springer International Publishing.