Would you agree that acceptance leads to being able to achieve more?

Would you agree with the following idea?

If you can reach a state of acceptance of your illness and the limitations, then you can better work within those limitations and achieve more than before because you're now able to set realistic goals, instead of setting goals that don't respect the reality of having a limiting chronic illness.

It sounds sensible doesn't it? Maybe not right for everyone and every situation but still sensible.

But there is a problem: it makes an assumption of how your mind works and proposes a specific causal relationship between acceptance and ability to do and achieve more.

In this idea, the mind is a force that makes positive change happen.

There are alternative explanations for an apparent relationship between acceptance of one's illness and a subsequent ability to do more. Maybe a person becomes more accepting because the situation they're in or the illness, have become less severe and therefore easier to accept. This improvement might also allow them to achieve more and better work around the limitations they still have. In this alternative interpretation, the conscious mind is just a commentator with little real influence. Maybe they're becoming interested in attempting to do more and solve their problems because they actually have some capacity to do that now, whereas before they did not.

And I think that this alternative explanation seems more correct. If the first was more correct, all these think-yourself-better approaches would consistently achieve great results.

These narratives of the mind making positive change happen seem to be everywhere in healthcare, with little or no evidence that they're actually correct, and at least so it seems, underwhelming results. The habit of creating explanations for why things happens, with little thought, is a bad one.

 

I agree with your feelings about "thinking happy thoughts" is supposed to be such a great cure-all ... without reliable proof. Likewise about creating explanations without proof, which some people then hold onto fanatically.

For ME, I feel that my 'think myself better' function is broken. How am I supposed to 'push through this' when my 'push through this' function isn't working? The people who are pushing this technique for chronically ill people obviously never suffered that sort of illness.

 

I would agree with this part

but this part depends on the level that the individual is affected by their illness.

It might be the case that working with your limitations allows you to achieve more, but it also could be that it allows you to achieve the same amount as before, but achieve it sustainably. And a third option is that accepting your limitation might actually lead to doing less, in order for it to be sustainable.

So, it depends.

 

I think if you can accept your illness and it's limitations, it can put you in a better place mentally, but I don't know that you will necessarily be able to achieve more. That would all depend on how severe your illness is.

 

Its funny i saw the title thread question slightly differently.
So

Yes

But only because when i accepted that i was ill and swallowed the bitter pill of reality instead of trying to force my body into a different one, i stopped doing things that, as a person with ME are counter productive.
So for a long time i thought that if i believed & behaved as i wanted reality to be - so if i behaved a s a well person - it would somehow magically create the reality as i wanted it to be. I was in denial about being 'really' ill for a long time.

What i found was that when i finally accepted the new reality of being a chronically sick/disabled person, of having ME and that what i'd lost actually might be gone forever & i grieved. Hard.

After that i started to behave in ways that helped myself more. So forexample i started 'properly' pacing, saying no to less important things so i could do what was important, instead of trying to do it all and then being too ill to do what was important. Which meant less time in PEM & less energy spent maintaining the 'denial' - which i've found takes a lot more energy to keep the metaphorical cupboard door shut, holding off the tsunami of grief, took a lot of energy, when i let it hit me, came to acceptance and then had a lot more mental/emotional energy to do other things.

So yes acceptance helped me 'achieve more'. But only if by 'acheive more' we mean get more done than when you havent accepted you cant do everything you want/need to & are therefore expending energy in counter productive ways.

So i can achieve a lot more overall in a day, if i break it all up with frequent rests - whetherit feels like i need one at that moment or not. Than i could if pretended to myself i wasnt ill & started doing all the day's planned tasks in one go, leading to me collapsing sooner & then being able to do nothing else for the rest of the day and probably ruining the next day too.

So really its the opposite to the 'positive thoughts = feel better' stuff. I have found unequivocally, that accepting reality- no matter how dark, allows me to deal with said reality in a way that maximises good results.

sorry that was rambly not at my best

 

True. Because how can we hope to adapt better to a difficult situation without seeing the reality as it is? One cannot adapt to a chimera, even if you pursue it and desire it with all your might. Sooner or later, the test of reality will strike (and we know it so well with ME).

For my part, I would say that acceptance has led me to live better with ME, not necessarily to do more. Like all of you, I adapted by finding ways, developing strategies respecting my energy capacities of the moment, which allowed me to continue to meet certain basic needs of daily life. My acceptance process allows me to live better with daily imperfection (ex. what I would have liked to do but cannot do), stop wasting energy revolting against my limits and the fact that PEM will end up coming anyway, despite all my precautions. Realizing that I still experience small pleasures in doing things that I love, in continuing to be in contact with the few significant and loved people around me.

I call it adaptation, nothing more.

 

Very well said @Lilas & if i may say very eloquent, i dont know why you believe your English isnt good! Its excellent if you ask me

 

I think the term is used lots in the emotional sense or to bring in some 'mind' aspect.

But it also is just what pacing actually is. Just like someone joining a running group accepting that trying to sprint the whole way around 400m ends in them crawling the last 1-200m and they get a better time if they change strategy. It doesn't have to involve acceptance any greater than most normal people end up knowing their own body and working with it.

Which is what people - whether they thought they didn't have CFS because the description didn't fit and no investigations were done, or whether they did - ending up doing for years. When events and other people allowed them ie their life wasn't dominated by other things. Call it 'being honest with yourself' or pragmatic, even when the idea of illness or what it is was taken out of the equation specifically. It also stops you ending up collapsed somewhere because you learned your lesson not to push boundaries expecting a different result.

And yes to being more tenacious and clever in working out how to make things easier. Just naturally cutting out wastage better and better. And you do learn to make the most of every ounce of energy if you get to a stage where you have a reliable sense of what that is and are allowed to. Efficiency is v high in people with ME surely (I'm imagining the advice I've given to friends with kids and 'too much on' you can immediately trot off, get deliveries, organise x like this and so on).

We now know that it is (probably? almost certainly? - it's strange we don't know that one either, but it would take a heck of a methodology there) what is needed long term to progress your health out of relapse (though no guarantee).

The emotional/mind addition of 'acceptance' might help some to visualise that differently as a tool to achieve the same end, or some other benefit in a different way. But as far as its implication in recovery - well that is hard to separate from the bit we know does do the improvement part given not fighting your body would be implicit within that. Some people have functional coping strategies in life, others emotional anyway (address the problem vs destress first) and I guess being 'blocked' from what you need might be more of an issue - but in recovery vs other impacts and harder to cope with there are all sorts of complexities to that conundrum surely?

Nope in fact I think they've got it back to front (and trying to be lazy and just use the grief blueprint so they can repurpose old material). I think that as you naturally get into the swing of how your new body works and making the best of it - if the BPS don't stop that from being allowed - then your ability to like and appreciate yourself and recognise achievements and potential comes from that.

You can't cart-before-horse telling someone to accept it before they've been able to work out their baseline - whichever way they do it (which might include fun or important things you won't compromise but do rest before and after for and so on). It comes naturally as a result of the pacing and physical stuff and getting the control that comes with some sense of knowing what will cause what so at least having more choice over what you do (e.g. by clearing diary of other things).

Otherwise it would be like any other disability, talking someone through accepting having to use a wheelchair and theorising some generic how that needs to feel as a process before giving them the damn thing and letting them get good at it and what it allows them to do, work out how they tackle the tricky obstacles with it (non-ramp areas, which stations have lifts).

Oooh this is a good question!

 

Too right. Contradiction in terms that someone would professionally talk about goals and acceptance whilst claiming to know about ME.

Tenacious as you can be, anything needs to be incremental - and goals need to be what you want/need not 'achieve' in some pat on the head get a medal sense.

Looking back and admiring how bloomin good you are or what you've done despite is one thing - goals in the sense of planning (thinking you'll 'step up' somehow), from someone else just smacks a bit of ME-ableism (why is it and when did it happen that people like physios starting incorporating CBT anyway?).

Managing to reduce the strain - now that is real goals, like how can I make as good a dinner but with way less effort, managing to make a week where you only have 3 good hours as enjoyable as it can be given other 'must-dos' you have (noting nothing is 'enjoyable' when you are stranded above baseline, to norms I ask them to imagine being stranded at Alton Towers when they have flu and someone saying it'll cheer them up). That is real skill - they should be learning from us.

 

In a sense accepting my limitations and learning to pace properly has led to me achieving more overall. Or maybe it would be more accurate to say it has allowed me to not achieve less than the little I'm capable of (I'm using 'achieve' in the sense of just being active doing whatever, I'm not talking about achieving specific goals). This doesn't involve the mind in the positive thinking way, instead the mechanism is as simple as spending much less time in PEM. Before accepting the hard truth of my limitations I'd bloody-mindedly do that extra 10 minutes of activity to finish a task - and then spend the next week unable to maintain my usual low baseline activity level. A very small amount of extra activity leads to a very large reduction in subsequent activity. A matter of arithmetic.

The following is a simplistic example but it illustrates the point. If sustainable activity level is 60min spread out over the day, and if 10min extra causes subsequent activity to to reduce to 1/3 because of PEM, then:

day 1: 60+10=70min

days 2-7: PEM so only 20min/day, so 6 x 20min = 120min

total for week: 70+120=190min​

Compare to week without PEM:

days 1-7: 60min/day = 420min total for week​

Additionally, acceptance probably saves a bit of emotional energy. No fighting and raging against the disease which means you're more likely to spend what little energy you have on more enjoyable and fruitful activities. That may feel as though you're doing more because you're getting more out of it.

And less PEM means lower overall symptom load which I'd take as a win even without the added bonus of getting more activity in.

Of course the above example won't apply to everyone. If your circumstances are such that you can't pace yourself out of continuous PEM it's unlikely to work, unfortunately, no matter how much you do or don't accept your situation.

 

Should I stop trying to get help for invisible problems? Should I accept that people in the NHS will always be rude to me? That I will get eyes rolled at me? That doctors will sit in surgeries doing an imitation of a brick wall while I try and say something that will get through their armour, and will prove they are listening?

This idea of "acceptance" of an illness that will never get better just seems to me to be a way of saying "I'm accepting that I'm just waiting to die".

 

hmm good point. The acceptance issue seems to be more of an issue for those without ME, who should be accepting. I worry that 'acceptance courses' are all about accepting that - which would be nice and convenient for those who in my mind are behaving unacceptably, and most of us strike a balance already of picking battles whilst not damaging ourselves by letting everyone do what they want to us.

From what I've seen of those (non-ME) who've been on CBT courses, and drop in the 'what I've learned' so you know it is from there it is used as a vehicle to tell people the issue is with them and they should just accept earning less money or that they 'aren't up to stressful jobs' (whatever job isn't). Which isn't the right message in the way it seems to be done, for people who've often ended up where they have due to being treated badly, not because the job should have been an issue.

I get a chilling feeling of them being a 'calm the people' edge to them - all very well for people who are overdoing it and stuck in a mindset (of unreasonable ambition), but it seems to go further than this and tells them what the problem is (and it's that) rather than having different variations where they think 'no, you were badly treated but you were very good at what you did and we should be focusing on what you need to heal from that and not it let it drag you down'.

I don't think this is real psychology in this sense, and when one-way and already-decided in what the outcome should be for people it just feels like brainwashing (can't think of a less dramatic word that would still be accurate). There is accepting limitations (energy), and not getting dragged down by bigotry, bad treatment in the past, 'unfairness of life' and then there is running a course telling people to accept bigotry, bad treatment and unfairness and 'maybe it's you and you are best just reducing your expectations from life'. It worries me there is an inadvertent foray into the latter. Which when there is disability involved (which could and should be adjusted for - not assumed 'you shouldn't be ambitious) in particular makes me pretty queasy (that those around them are being taught).

For context: I have a personal story of a colleague at work (same level but they were a manager, they did not realise I had an illness that equated to a disability as I outputted more than them) saying "we need more of people like x (who is in a wheelchair and v good at job and she didn't realise side-moved to a bigger company to be able to have upward options) who are really good at what they do and will want to stay in the role for years - unlike these young grads". I talked to x later, and confirmed said assumption must have been made only on the basis they were in a wheelchair - so mustn't be ambitious even though more than capable of stepping up. And as we all know lower-paid jobs don't equate to 'less stress' necessarily, and certainly rarely less exertion. It's a bit implicit know your place and learn to be happy with it.

 

I think I have more mental energy left when I am in a place of acceptance as opposed to the times when I am angry or in denial about it all. This tends to cycle and get triggered accordingly.

It's funny how sometimes we are encouraged to accept in order to be able eventually to do more yet also can be told to deny the severity and impact of our symptoms

 

I see acceptance and commitment therapy as a political tool to deny the patient any help via medicine or other social accommodations .after all it is not the medical profession who has to endure endless symptoms and the suffering they bring .

 

[ EDIT: I wrote my comment thinking this thread was about acceptance as a general idea. I didn't realize the context was Acceptance and Commitment Therapy (ACT), something I had never heard of. Sorry for any confusion! ]

Another good thing about acceptance is it might lead to the use of mobility aids or other tools. (Side note: Is a chair in the shower a mobility aid? Or does that term just cover canes/crutches/wheelchairs/etc?) Anyway, resisting the use of these aids/tools often happens when someone does not want to accept their limitations.

If you think of achievement in a broad sense - reducing or avoiding symptoms, reducing the risk of falls/fainting, and so on - then acceptance which leads to use of these tools can lead to more achievement. It depends a lot on the patient/situation, of course.

For example, for a long time I could rarely go to the store due to my orthostatic intolerance. I couldn't stand in line. There were many times when I abandoned a shopping basked or cart because I suddenly got too sick to stand (dropping blood pressure, pre-syncope symptoms). I had to go to back to my car, recline the seat, and rest.

But then I got a portable folding cane/seat. After that I could pick up something at the store as long as it was a good day and the line was short (5+ minutes). I would call that achieving more.

 

I make a difference between acceptance and resignation, and also between acceptance in the personal sphere, i.e. accepting I'm ill and have to adapt to my limitations (which I do, most of the time), and accepting of - or resigning oneself to - the widespread idiocy and unfairness in the wider world (which I don't).

The two are linked of course. Accepting that I have to live within my personal ME-imposed limitations means I have to choose my battles against unfairness in the wider world more carefully than a healthy person would.

Acceptance of ME, to me, has two main dimensions. One, it's about acknowledging that right now I'm ill and the best I can do, right now, is to live within the limits ME imposes on me and yes, that sucks but the alternative - a continuous downhill slide of PEM - sucks even more. Two, acceptance also means acknowledging uncertainty. Things could stay like they are, they could get worse, they could get better. That's where I think acceptance differs from resignation. Resignation is more of a passive thing, closer to giving up. Whereas acceptance has more room for action, within one's personal limits, to try and nudge the odds towards a better future.

I admit I don't know if the distinction between resignation and acceptance still makes sense for the extremely severely affected. And I think everybody, healthy or ill, has to resign themselves to things they can't do anything about. A matter of choosing which strategy to apply to what problem and individual answers will vary.

 

Acceptance and commitment is another BPS tactic to save the insurance companies and health care system funders money from costly testing and treatments.

It has creeped into long-covid treatments as well, telling patients that in order to recover, the patients must take an active role and put effort in getting better, which means CBT and GET. And if you do not get better, guess what... it's the patient's fault for not trying hard enough. And that means purchasing costly brain retraining treatments by the way.

 

The very notion of acceptance is an ambiguous concept here. In simpler terms, its waffle.

I agree with most of the comments on this thread. If I were up to reading in detail right now I might agree with nearly all.

It is helpful to accept your situation, but that means accepting your limitations. It does not mean ignoring your limitations. Finding ways to adapt or work around limitations is what we already do. Learning to accept trying to pace can be very hard when societal life demands are pressing on you.

Except at first when patients are still learning, its not patients who need to accept disability. Its society, including government agencies and corporations. So would all government employees, insurance and health employees, employers and boards of directors, and the whole medical establishment, be prepared to undergo acceptance training? Under what circumstances? I think it more likely to see marshmallow rain out of a bright yellow sky.