Massage Therapy Journal Summer 2025

20 • Massage Therapy Journal

with just about any tissue or organ in the body potentially being affected. 7 The common nature of these conditions leads to a sense of normalization that is unhelpful. We all likely know at least one person with rheumatoid arthritis, lupus, psoriatic arthritis, Crohn’s disease, type 1 diabetes or multiple sclerosis. Unless we know this person well, however, we likely almost always see them “at their best,” when they feel well enough to be out in the world interacting. That doesn’t give us a very real view into what it’s like to live with these conditions. Mental health challenges are common among people who live with autoimmune diseases. A 2013 study in Denmark 8 found that participants (who all had autoimmune conditions) were 45% more likely to develop anxiety or depression, and the Cleveland Clinic reports that as many as 50% of people with MS have clinical depression. 9 People living with type 1 diabetes often develop cognitive deficits across their lifespan that affect attention, information processing speed and executive functions, as well as depression, anxiety and decreased quality of life. 10 In their 2018 paper, “Depressive Syndromes in Autoimmune Disorders of the Nervous System,” Drs. Liu and Tang discuss “pleasure loss” and “sleep disturbance” as common aspects of depressive presentation in people with autoimmune conditions. 11 Living with or caring for someone who lives with an autoimmune condition means your life is significantly disrupted. There is worry and fear about changes in disease progression or severity, flare-ups, as well as endless and sometimes seemingly pointless medical appointments. Many people feel stigmatized and isolated by their illness, and many of these conditions come with chemical and hormonal changes

that can be unpredictable and hard to manage. Changing health status and changing energy levels can lead to one’s life feeling smaller. Many autoimmune conditions are also considered “invisible,” which presents the unique challenge of feeling like a person is constantly working to “prove” how sick they are or how badly they feel. The icing on this difficult cake is that the medications that treat these conditions can even cause depression, anxiety, loss of after appetite, and other exhausting and deeply disheartening side effects. 12 We mentioned earlier that pain isn’t all there is to consider, but we can’t ignore it either. People who live with persistent pain of the kind that can be common in autoimmune conditions are four times more likely than those without pain to suffer from depression or anxiety, and more than twice as likely to have difficulty working. 13 Despite the significant body of knowledge and growing awareness about the impact of autoimmune diseases on mental health, most traditional treatment regimens do not prioritize mental health interventions. When a client is living in a world like the one described above, therapeutic alliance can be an essential piece of what we offer. It’s our job as massage therapy practitioners to understand what these symptoms really mean to the people who live with them. We have to imagine and wonder and even ask about our clients’ experiences so we can address their needs more skillfully. We can demonstrate that we truly see our client by listening fully and believing what they tell us. We can normalize and acknowledge their grief at feeling unwell, at losing autonomy, at simply having to think and work harder to live a so-called “normal” life. As practitioners, we can read books written by people who live with these conditions. We can watch documentaries and read articles and papers. We can learn about the diseases and how they impact the people who live with them so we can bring pleasure and connection and compassion through the incredible gifts of relaxation and nervous system co-regulation. 14

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