Chronic illness and the holidays: fielding the inevitable questions.

Below is an article I recently wrote for the CCFA e-newsletter. I’m reposting it here—perhaps it can be of help to you. It is written specifically for people with IBD (inflammatory bowel disease) but the boundary-setting technique can be easily adapted for other illnesses.

At the holiday party Aunt Rose asks you in her best “poor dear” voice, “And how are you?” The tone is meant to sound sympathetic and confidential, but the question is audible to everyone in the room. You feel like a loser.

Cousin Betty is serving the salad. “Oh, dear. Is this something you can eat? What about the nuts? You can’t eat nuts, right?” she says. Ears perk up around the table, as you and your bowel become the table centerpiece.

As you explain to the other guests that you have a condition that prevents you from eating nuts (or whatever it is you can’t eat), the diners want to know more. “What is your condition? What is ulcerative colitis? What is Crohn’s disease?” they ask. At times a guest will persist, despite having been told that it’s your intestine that’s the problem. “What exactly are your symptoms? “ he asks, oblivious to his intrusive question.

What is a person with IBD to do? How do you respond?

Many people don’t want to be put on the spot like this, and when they are, they don’t want to be rude. If you feel this way, deciding how to respond can be a stressful balancing act. It helps to plan ahead!

What is the one question you fear you will be asked? Write it down. How will you respond? How much do you want others to know?

In any situation where other people are involved, an important psychological concept to be aware of is “boundaries.” You define your psychological boundary by deciding what information is within your purview and what is not available to others. For example, someone asks you how you are doing. It’s a simple question, yet how you choose to respond can feel overwhelmingly complicated. Perhaps you are feeling well, or perhaps you have been miserable and in pain. You need to think ahead. Do you want that person to know how you really are? How much do you want them to know? Do you think that person needs to know?

Determining and setting your boundaries—the line between your rightful psychological space and others—is a wonderful way to preempt the stress of the holidays. You can relax, knowing that you have done your homework and are prepared to meet the challenges you will face. You can even have fun with it!

To start, determine what you want. What is your boundary? Write it down.

Examples of boundaries:

• “My health will not be a topic of conversation at this gathering.”
• “I will share information only with certain friends.”
• “I will not allow anyone to put food on my plate and push me into eating something I don’t want to eat.”

You can expect that others will attempt to cross your boundary at any gathering. This is normal and natural. You need to position the boundary for them—they don’t know what or where it is! To help the process, it is important to be prepared with appropriate answers and tactics that are kind yet effective.

Let’s say you’d rather your health not be the centerpiece of conversation. Here are some possible actions you can take:

• Speak ahead of time with your closest relatives and friends, and let them know what you want. You could say something like “I know the topic of my health will come up. I don’t want this to be a focus. Please help me divert the conversation to something else. Can you do this with me?”
• Prepare vague answers that will leave the questioner feeling appreciated, then divert. For example: “How are you, really?” an acquaintance asks. “Oh, I’m better. [vague answer] Thanks for asking. [appreciation] Let’s talk about it later, OK? Not here. How are you?” [diversion]

Let’s say Uncle Ted says, “So, tell me about your health. Are you still having that trouble with, uh, what’s it called?”

What is your boundary with Uncle Ted? Know this ahead of time. Below are some possible boundary decisions with suggested responses for each:

• A. You want him to know all about it. Tell him.
• B. You want him to know, but the time and place doesn’t feel comfortable. “I really want you to know. Let’s talk about it later, though, OK?”
• C. You know he doesn’t really care, and it’s none of his business. “Oh, it’s got a long name, but things are under control. [vague answer] (Consider sending him a little wink.) Thanks. [appreciation] What’s up with you, Uncle Ted? How’s your business doing? Are you going on vacation soon? Do you still have that great car?” [diversion]

Again, this useful method consists of using vague answers, briefly expressing appreciation, then diverting the conversation with questions of your own. With a bit of practice, you’ll find that you are in control. You can even approach the exercise of setting your boundaries as a bit of a game, and have fun playing it!

Back at the dinner table, Cousin Betty is still worrying about the nuts in the salad. You might want to give her a big smile and say, “Please don’t worry about a thing. I’ll take exactly what I need. It’s all good!”

Happy holidays!

Abby Caplin, MD practices Mind-Body Medicine and Counseling in San Francisco, and is a member of CCFA’s Northern California Chapter’s Community Medical Advisory Committee (CMAC). She specializes in working with people with life- challenging illnesses, such as Crohn’s disease and ulcerative colitis, to lead empowered lives that promote healing.