To live our best with Migraine, we need sources of inspiration. I found one such inspiration in The Four Agreements, by Don Miguel Ruiz. Embracing these agreements can help us cope with the emotional fallout of living with an unpredictable disease without a cure. They can also help us develop resistance to the damage of stigma.
In this book, Ruiz shares his wisdom for living a satisfying life in the form of four agreements. His premise is that we all make agreements with ourselves, our loved ones, and our higher power that determine how we will behave and respond to life events. He proposes these four agreements.
- Be impeccable with your word.
- Don’t take anything personally.
- Don’t make assumptions.
- Always do your best.
Application to Migraine
In this four-part series, we’ll be exploring practical ways to implement each of these agreements to improve our Migraine coping abilities. First, we explored ways to speak impeccably about Migraine. In this edition, we’ll examine ways to insulate ourselves from potentially hurtful situations common to the Migraine experience.
Ruiz explains it like this:
“Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering.”
At first glance, this explanation may seem harsh. After all, it really does hurt when someone accuses us of exaggerating symptoms for attention. Who among us doesn’t feel discouraged when a doctor says, “There’s nothing more I can do for you?”
The important thing to remember about this agreement is that mastering it is a PROCESS.
Think of this as a long series of vaccines that gradually protect us from the emotional damage of stigma. We don’t develop this immunity overnight. It’s a mental skill that we ease into, one baby step at at time.
For better or worse, living with Migraine gives us plenty of opportunities to practice this difficult-to-master skill. Whether it’s the misguided opinion of that annoying co-worker or the disappointing results of the latest clinical trial, it’s possible to learn how to take it all in without letting it damage us. The more often we practice, the more resistant we become to the negative emotional effects of both bad news and stigma.
Following this agreement doesn’t mean we don’t have emotional responses to negative messages about Migraine. Of course we will! When we practice this agreement, we slowly change our responses to those messages and to our emotions. It also doesn’t mean we give up or don’t fight stigma. Over time, we can become resilient enough that bad news and stigma no longer prevent us from responding proactively.
We don’t let bad news or stigma win.
These comments are difficult to not take personally. After all, they are directed at us. No one learns to not take anything personally by instinct. It takes practice.
“There’s nothing else to try.”
- When we hear these words from our doctors, naturally, we may feel like failures. It’s important to remember that the doctor’s statement reflects his or her reality, not ours. It rarely says anything about our efforts to manage Migraine. More often, it is a reflection of the doctor’s knowledge about treating Migraine.
- When we realize this, we can acknowledge that solutions to our health problems are beyond the knowledge and skill of this doctor. It’s then easier to reject this statement and find a new doctor with different knowledge and skills.
“That medicine is horrible!”
- In the process of choosing treatment, we may ask other patients to share their experiences. Because everyone responds differently to a given treatment, someone inevitably shares their personal horror story. Those negative stories tend to attract other negative responses.
- Before long, all we read are terrifying reasons to avoid the very treatment our doctor has recommended. We may even consider not filling that prescription.
- The truth is that almost any treatment can be successful or cause unbearable side effects.
- Those who share their experiences are not predicting our failure, but simply sharing from their own knowledge. Even if we’re told by another patient to avoid a given treatment, that’s not necessarily the best advice for our medical situation.
Disappointing or controversial study results
- Sometimes the results of a trial are not what we’d like to hear. Our instinct is to automatically reject the conclusion. Sometimes, the results really are inaccurate. That’s just part of the scientific process.
- Over time, ideas are tested and retested. The ones with merit will consistently produce similar results. The more evidence to support an idea, the more likely it is that the idea is true.
- The challenge for us is learning to accept the results, even if we don’t like the outcome or it doesn’t apply to us. After all, there are always exceptions to every rule. Just because it’s true for most people doesn’t mean it’s true for us.
Accusations that we’re faking or exaggerating symptoms
- These statements are some of the most hurtful because they attack our integrity.
- Most of us are skilled at disguising the severity of our symptoms. It’s a survival skill we’ve acquired. Because we’re so good at “faking healthy,” some people will have difficulty believing us.
- Outward expressions of suffering make people uncomfortable. The natural human instinct generally takes two approaches: 1) try to eliminate the source of suffering, or 2) if that is not possible, we reject the suffering as genuine. After all, that much pain must surely have a cause that can be eliminated!
- The truth is more complicated than human instinct will accept. We must all be trained to recognize that not all pain can be relieved. Not everyone is willing or able to learn this truth.
- When someone accuses us of faking our symptoms, it’s helpful to recognize that they are likely expressing their own discomfort with suffering. Their reaction doesn’t define our experience. It defines theirs.
Unsolicited, uninformed advice or opinions
- These unhelpful suggestions are often based on the desire to eliminate our pain. The person offering such advice usually cares about us and wants to help. They may lack a good understanding of Migraine, but their intentions are good.Other times, these comments are used to judge us unfairly.
- “If you would just ______, your Migraines would go away,” is harder to accept gracefully because it’s wrapped in harsh judgement of our treatment choices. Naturally, we become defensive.
- In choosing how to respond, it can be helpful to recognize that these statements are also a reflection of the human instinct to reject what we can’t fix. The person offering such judgement is communicating their discomfort with our suffering. They may really be saying, “I’m uncomfortable with your suffering and want it to stop,” but few people will actually express this truth. It’s much easier to scapegoat the object of our discomfort than to own it.
Stories of quick fixes or miracle cures
- We’ve all heard a story or two about someone’s sister’s best friend’s boss’ second-cousin who was “cured” of Migraine with a simple fix. Once again, these stories are fueled by the natural competing impulses to either help or distance ourselves from suffering. The story isn’t really about us. Nevertheless, hearing such easy fixes can trigger feelings of inadequacy, as if we were somehow failing.
Being treated like a drug-seeker at the ER
- This one gets to all of us. We’re often reluctant to seek help at the ER in the first place. When the pain gets bad enough that we finally give in, we’re just looking for a little relief. In some cases, we’ve already tried many of the common ER treatments at home. To be offered the same options that have already failed is frustrating. The last thing we need is to be treated like a drug addict looking for a fix.
- This one isn’t about us. It’s about the frustration of health care providers who encounter people who really do abuse emergency rooms. It’s also about hospital policies that limit treatment options for Migraine. That doesn’t mean we have tolerate abusive behavior by medical staff during one of our most vulnerable moments.
- Because we’re in pain, we may be irritable and impatient. It can help if someone comes with us to communicate our needs in a calm, rational manner. It may also help if we bring a list of all our medications and a letter from our headache specialist describing the preferred treatment. The emergency room staff isn’t required to follow those instructions, but they just might.
A parting thought
Just because we recognize that the message isn’t about us, doesn’t automatically change the way we feel. Not taking messages personally isn’t about denying our feelings. It’s about learning to recognize the possible source of the message. When we can do that, we have more options in the way we respond.
The next time we hear a hurtful message about Migraine, we can try something like this:
“When you say things like that, I feel [insert your emotion] and I wonder if you really believe I am sick [or trying my best to feel better, or whatever you’re thinking]. Is that what you mean?”
The response will tell us a lot about that person. We can then choose an appropriate reaction and discover that it’s often not about us at all.
- Ruiz M, Mills J. (2008). The Four Agreements. Thorndike, ME.: Center Point Publications.
© Copyright 2018 Tammy Rome. All rights reserved.
Medical Review by: David Watson, MD