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Posted by: Malaika | 2011/09/15

Psychological/psychosocial effect of chronic disease

Hi doc. I apologise for the length but it is a life-affecting story.

I am turning 38 and have been suffering from a disease since age 10. Now, nearly 28 yrs later, I feel I am finally coming apart at the seams. I feel I cannot wake up another day to swallow yet more pills and check how much worse I am. I have reached some sort of breaking point and I no longer know how to cope.

I suffer from severe and unrelenting acne. A couple of ppl will stop reading at this point and wonder with irritation why I would write about such a trivial thing. To ppl like me, it is not trivial. I have been on some form of medication or other, for close to 28 years. Every day, I have taken something internally or applied something topically.

I’ ve used Roaccutane, the ‘ acne cure’ , seven times. To the point of it causing severe bone weakening, where I would walk with difficulty for the first few hours of the day. I’ ve been on every anti-acne oral contraceptive there is, every antibiotic there is. I’ ve made money doing extra work to save up for cosmetic procedures - which failed. I’ ve beaten the pharmacy aisles looking for any new product, anything new. I''ve gone to faraway pharmacies in case they have something my usual ones do not.

On the social side, I’ ve avoided being in family photos, not gone to the shops during the day, not accepted invitations to meet with old friends, who would be shocked to see I still have horrible acne 20 yrs after they last saw me. I’ ve met nice guys in the evening, under my trademark thick make up and hat (I have a collection of over 50 hats and caps) and have given them my number... then the next day not answered their calls because too often they want to meet for lunch. And I cannot do daytime meets because even thick make up cannot hide the bumps, scars and pits.

I’ ve gone to interviews and been unable to look the interviewer in the eye. In the past 9 years I have had four periods of unemployment, which I will put down to terrible self-confidence on the job and at interviews. Where I have landed jobs, I’ ve refused to make friends with other colleagues, in order to avoid them staring at my pitted skin. In meetings I never talk, as ppl always look at the speaker. At every job I’ ve had, I’ ve been the only one with severe acne. I am usually the only one with bad skin at all. Acne worse than teen acne, is just not something you see in the corporate environment.

Right now I am taking seven medications, five of which are prescription pills (two kill ‘ p-acnes’  skin bacteria, two are powerful anti-testosterone drugs, and one addresses abnormal keratinisation.) The other two medications are for topical use. Of the total 7, only one is new to me. I have gone to over 30 doctors and dermatologists in my life and their recommendations, understandably, are all very similar. Hence I’ ve also seen herbalists, naturopaths, dieticians etc. To no avail. I‘ ve been to labs to have my bloods and hormones tested, had allergy tests, I’ ve been under laser lights and I’ ve had chemical peels. And I’ ve also had periods of doing nothing. Sometimes, feeling drugged and toxic, I stop all meds and creams. A while will pass, then the state of disease gains momentum and the acne suddenly worsens, spreading even to my neck and chest/back and I am forced to go back to intense drug treatment.

As I near my 28th year of acne, I just feel a sort of inner collapse. I went to the pharmacy last week to get yet another prescription from yet another dermatologist for yet another drug I''ve taken before. As I stood there waiting for the pharmacist to ring things up, I suddenly started sobbing. She was very taken aback and I just told her I cannot cope any more. She was very sympathetic and told me she knew someone excellent with skin, someone who would surely help me. I expectantly asked his name...and it is someone I have seen before.

Other ppl have various diseases they live with since childhood. I have extremely severe acne. It has affected everything about me. It has maimed my life the way it has maimed my skin - my life has the same pockmarks my skin does.

I cannot cope anymore and need to know who to speak to. I cannot cope with a life of chronic disease anymore.

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Our expert says:
Expert ImageCyberShrink

Most chronic diseases or disorders can cause continuing problems within one's psyche. Acne is a minor nuisance to a fortunate many people, and can be a really severe and horrible afliction to some. A good dermatologist should be able to help ; "cosmetic procedures" are useless unless needed to tidy up after the acne has been vanquished. And Roaccutane, though apparently useful in many people can also cause very severe depression, which in turn can make the skin condition more resistant to treatment, so seeing a shrink to check for depression and to treat it if necessary, could be a good idea.
Its not only an issue of helping you to cope with the burden of this illnes ( and that's an excellent reason in itself ) but that doing so might help gain more useful traction with some of the more specific treatments.
Malaika raises several really important points. Society's shallow concentration on totally superficial prettyness is highly unfair to the majority of us who are not pretty ( though the marketers of worthless but expensive cosmetics encourage most to believe they can become pretty with enouh gunk applied to their face. And we don't sufficiently recognize the more enduring and trustworthy beauty of personality which does not match facial prettiness.

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Our users say:
Posted by: cybershrink | 2011/09/17

Most chronic diseases or disorders can cause continuing problems within one's psyche. Acne is a minor nuisance to a fortunate many people, and can be a really severe and horrible afliction to some. A good dermatologist should be able to help ; "cosmetic procedures" are useless unless needed to tidy up after the acne has been vanquished. And Roaccutane, though apparently useful in many people can also cause very severe depression, which in turn can make the skin condition more resistant to treatment, so seeing a shrink to check for depression and to treat it if necessary, could be a good idea.
Its not only an issue of helping you to cope with the burden of this illnes ( and that's an excellent reason in itself ) but that doing so might help gain more useful traction with some of the more specific treatments.
Malaika raises several really important points. Society's shallow concentration on totally superficial prettyness is highly unfair to the majority of us who are not pretty ( though the marketers of worthless but expensive cosmetics encourage most to believe they can become pretty with enouh gunk applied to their face. And we don't sufficiently recognize the more enduring and trustworthy beauty of personality which does not match facial prettiness.

Reply to cybershrink
Posted by: Malaika | 2011/09/16

Hi Just Asking yes it is a disease. Disease is medically defined as

" any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs, and whose etiology, pathology, and prognosis may be known or unknown." 

I so hope CS can help me too. I just want to know where one goes for support or what one does to cope with being in an everyday state of disease. Alcoholics have AA - alcoholism is a disease. There are support functions for ppl with psoriasis, lupus, breast cancer, stuttering, autism, depression, you name it.

A person with a face disfigured from lifelong acne has no support system but themselves. As I said above, it has disfigured my personality too because all I want to do is stay away from ppl. It''s not worth the stares and whispers, I am yet to get over the horrific childhood taunts, I don''t need ''subtle'' adult ones as well. It amazes me that even tho adults are supposed to have more tact, it still happens that I walk into some place and will hear someone quietly say ''Man, what sh*t skin she''s got.''

People, I have realised, are naturally cruel, not naturally kind. I just stay at home if I''m not at work. It''s simply not worth the emotional pain of facing the world as an un-beautiful person.

Reply to Malaika
Posted by: Just Asking | 2011/09/15

Dear Cyber Shrink is acne a disease?
What is the definition of disease?

Malika l wish you well, hope CS can help.

Reply to Just Asking

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