Episode 13: When I Choose to Overdo It: Autonomy, Chronic Illness, and the Right to Decide

In Episode 13, Kari explores a deeply familiar tension for people living with chronic illness: being told “don’t overdo it.” While often well-intentioned, Kari explains how this phrase can feel controlling, dismissive, and painful, especially for people who already live with constant limitation and loss.

This episode is not about ignoring consequences or denying the reality of chronic illness. Instead, Kari centers choice and autonomy, emphasizing that chronically ill adults still have the right to decide how they use their bodies, even when those choices come with a cost. She challenges the idea that risk assessment belongs only to healthcare providers or loved ones, pointing out that everyone, ill or not, makes daily decisions that balance effort, desire, and consequence.

Kari distinguishes between denial and intentional choice. Denial looks like ignoring limits and warning signs; intentional choice means understanding the risks, planning for them, and deciding that an experience, connection, or moment of normalcy is worth the recovery that may follow. She shares personal examples, painting a room, tending a garden, attending events, that highlight how quality of life can sometimes matter more than symptom minimization.

The episode also explores the emotional layers beneath choosing to “overdo it”: anger at the unfairness of illness, grief for lost capacity, and even moments of rebellion as a way of reclaiming humanity. Kari normalizes these feelings while encouraging safe, thoughtful decision-making rather than high-risk behavior.

Practical strategies are woven throughout, including planning rest before and after activities, adjusting hydration or medication when appropriate, modifying events, accepting help without shame, and avoiding stacking multiple high-cost activities. Kari also offers scripts for responding to people who repeatedly warn or monitor, helping listeners protect their autonomy without escalating conflict.

The episode closes with reassurance and permission: wanting a full life does not make someone reckless. Choosing joy is not denial; it’s human. Sometimes rest is the right choice. Sometimes the moment is. Both are allowed.

Transcript

0:01

Welcome to both sides of the couch. I'm Carrie, a therapist who also happens to be a human navigating chronic illness, which means I see life from both sides. This is where I share honest stories, lessons, and little reminders that you don't have to have it all figured out to keep showing up. Let's get into today's episode. Welcome to episode 13 when I choose to overdo it, autonomy, chronic illness, and the right to decide. Every chronically ill person knows the phrase and probably hates it. Don't overdo it. It often lands as controlling or dismissive even when well intentioned. But the truth is people with chronic illness already live with constant limitation, and we don't want to be reminded of it by everyone around us. This episode is about choice, not ignoring the consequences. The warnings hit so hard, and sometimes the warnings come from within, but most times they're coming from well-intentioned, loved ones. Support systems, even our therapist and physicians. But being warned kind of feels like being reminded of all the loss that you're already suffering. What looks like overdoing it for you is something benign and simple for the person giving you the warning. Others focusing on your limits before you do can be really hard the exhaustion of having your body monitored by those around you, knowing you're always being watched or people are looking for signs to tell you when they think you've done too much. Sometimes the phrase be careful, can really feel like it's saying Stay small. And that doesn't feel good. Autonomy matters. Even with chronic illness, all adults get to decide how they use their bodies and the limits that they set. Risk assessments aren't unique to chronically ill or disabled people. Everybody does it right, like even a normal body non ill person assess the risk of. Any physical activity or long day ahead of them, chronic illness doesn't erase our agency. We should be able to assess that risk the way that anybody else would with what works best for us balancing our wants and the consequences we might face. I think choosing to participate in life with your eyes open is still choosing. And what I mean by that is I know what could potentially happen if my body reaches its limit or how I might quote, pay for this later. My eyes are open. I'm aware of those things possibly happening, but I may still choose to participate in something with the knowledge that may happen. We don't wanna miss out on special events. Or sometimes we just really wanna do something. I remember a couple that I was seeing and the chronically ill client was like, sometimes I just wanna weed the garden bed like a normal person, and you not allowing me to do that because of the consequences I'll face later takes away. Such a simple given right, that everybody else has. Even if it's something that doesn't even seem that exciting, right? Like nobody wants to weed the garden bed for fun, but you wanna be able to do things that everybody else can do, and you don't wanna have to wait to ask somebody to help you with something every single time it needs done. So having consequences doesn't mean I lose the right to decide. As long as I'm aware of that, I think it's okay. There's a difference between. Being in denial of what these consequences are and intentional choice of, I know that this may happen, but the benefits still outweigh these risks for me, and I'm gonna go ahead and do it. So denial would be pretending there won't be consequences, like not even thinking about your body and its limitations and what may happen if you overdo it. Pushing without planning, like not preparing yourself.'cause I'm able to push myself when I'm not feeling well. If I have my accommodations right, like if I make sure that I'm properly hydrated and I'm taking rest, and like if it's really hot outside, making sure I have something to cool me down, whether it's a cooling towel or a fan or something like that, I can still plan for it and reduce my risks. I could still deal that, but if I'm not planning. At all, and I'm still pushing. That could lead more towards denial and ignoring the warning signs. When I get a high heart rate alert on my watch and it's like your heart rate's really high and you've been standing doing nothing for a long period of time, if I ignore that, that could possibly lead to passing out for me. Intentional choice is when you know the cost. Okay, I'm probably gonna feel pretty exhausted after this if I attend this event, but I really want to it would be worth it for me to have a very low energy day in order to participate in this thing, deciding it's worth it. going back to weeding the garden bed, I really wanna get these weeds out of the way because the weather's about to be bad and I know my partner doesn't have time to do it. So I think I can manage it this time because of the consequences that would happen if I didn't do it myself and planning for the fallout. Okay, so if I do this, this is what's gonna happen. How can I make sure I manage that? I'm gonna make sure that I don't have a big day tomorrow, that I don't have to wake up early. That, work's not gonna be a super stressful day. There's lots of ways you can plan for that. Even that same day or like within the event, I might, we'd have the garden bed and then suddenly I'm at my breaking point and can't do anymore, and I'll have to make sure that I can get myself back inside. In a resting position safely. So thinking ahead for those type of things and then allowing yourself joy anyway, even though it might feel really awful while you're doing it, or later on that day or the next day or several next days. Still finding a way to enjoy that and participate in it because why else would we be doing it? We're doing it.'cause some part of us wants to and get something out of it. I think missing out hurts more than being in a flare. Sometimes chronic illness already shrinks your life so much like things you used to love and be able to do, get taken away from you. I know I mentioned in a previous episode I'm not able to do the long strenuous hikes like I used to be able to do. So my life has kind of shrunken I missed out on doing something that maybe would be pushing my capabilities that might feel much worse during that time period where I'm thinking about missing out on this and wishing that I was able to do it than it would be to do it and just have the flare for the next day later. I think missing meaningful events compounds the grief that chronically ill people experience. You weren't able to be a bridesmaid in your very close friend's wedding because you couldn't stand there long enough for the ceremony or for pictures, or it was too hot where the location was gonna be. I think that would make somebody feel so much worse than. Maybe needing to have a chair during the ceremony or needing to let the bride know you can only do 10 minutes of pictures, it would be worse to not do it at all grief wise than to do it and feel yucky afterwards. Sometimes the memory you get from the experience or the connection with other people. Or just the experience itself is worth the recovery period. I can think of a lot of things I've done to overdo it, recent examples would be getting a room painted so I could move, permanent furniture into the room, having it done before I was ready to move that furniture and painting doesn't sound like. It would be super strenuous for some people, but for me, standing kneeling, the up and down the reaching tends to be really triggering for certain symptoms that I have, and then it makes it harder to plan for resting because I'm a messy pair. I'm covered in paint. I don't wanna sit on anything that I don't want paint on. So it just limits my abilities to take rest. But I really wanted to get this painting done. I wanted the room to look finished. I was on a timeline where if I didn't do it this weekend, it was gonna be a long time before I'd be able to finish it. So it was worth it to me, even though the next couple days were a little tough on my body. I also think there's lots to think about when we look at quality of life versus. Symptom minimization, like, sure, I wanna minimize my symptoms, but I don't wanna lose my quality of life in doing that. I think a lot of people who need a mobility aid to function don't have zero choice in needing that mobility aid a lot of people who can walk use wheelchairs, and you get a choice, right? Like you use the wheelchair or you walk, maybe there's consequences, like you get weak or you get a pain and flare or you pass out. But someone who is paralyzed doesn't have a, they have to use a wheelchair. That's the kind of difference I'm talking about, if the person who struggles with chronic pain when standing too long uses the wheelchair, they get a better quality of life. Maybe they're able to go shopping with friends if they use a wheelchair or they're able to go to a theme park if they use a wheelchair or they're able to go on a vacation if they use a wheelchair. And those things are kind of out of reach if they're not using the mobility device. So quality of life, that's what we're leaning towards. There's also always the emotional layer about all of this. I think anger as a response to hearing, don't overdo it. Anger as a response to the unfairness of your situation. Anger at people not recognizing how difficult things are for you. Grief, I've said that before, but like your grieving changes in life that you did not get a choice in. You're grieving the body. You used to have, you know, maybe you didn't get to choose your body, but you do get to choose how to live in it. Sometimes a little bit of rebellion. I don't wanna be chronically ill today, so I'm gonna push my body past its limits. So for a moment I can pretend I'm not. It's a little bit like reclaiming my humanity, not necessarily being careless.'cause I'm not in complete denial. I just wanna have a few moments where I don't have to think about this. And it's okay to feel these feelings. Letting yourself feel angry without acting destructively can be really helpful. So don't avoid the feelings when they come up. Let them happen. I also want to emphasize that I, for myself and for others, want people to choose to overdo it in a safe way. I want to be responsible, right? And I wanna keep this grounded. Don't go rock climbing. If you know your body can't do it because you could die. Don't go swimming if you know your body can't do it because you could drown, right? We don't want to overdo things that are causing extreme risk to us. And I think most chronically ill people are pretty good about assessing that risk. You know, is this gonna make me more tired? Flare up my symptoms or increase my pain for a little bit. And is that something I can manage? Probably most of the time the answer's gonna be yes because all of those things can happen from doing absolutely nothing at all. Some chronic illnesses don't have a trigger for the symptoms. Your body just has the symptoms no matter what you do. Overdoing it might make it worse, but it isn't necessarily gonna prevent that from happening. Just some gentle thoughts and reminders on choosing to overdo it safely. Plan rest before and after. I think we always plan the after, but the before gets missed Sometimes, like I might've had a busy day the day before. I'm planning to do something and I wake up already fatigued. That's gonna give me less flexibility when I'm choosing to overdo it. Making sure that I have a rest day beforehand, or even like a very quiet morning before I do an activity later in the day can be helpful. And then of course, always after.'cause that's usually where we see the most consequences is directly after or the next day after letting your body rest and all that pain and symptoms kinda let itself set in for the following day. I think some people have the ability also to adjust their meds and that could make things a little bit safer. Some people can increase their meds or take an extra dose than they would need on a normal day to help them push through. And I think you can also adjust your hydration and food if applicable for your chronic illness. I know for me that's. A pretty big adjustment that I make all the time. Like I have my baseline hydration goals, and then when things are more strenuous, that can sometimes double or triple. So messing around with that can make things less symptomatic for me. I also think you can modify the event. Is there a way that you can come a little later, leave a little early, or modify the expectations in some way? Let's use an example of going to a concert. If the concert has an opener that you're not as interested in seeing, coming after that opener's performance is done. So you don't have to sit through that and kind of struggle your symptoms. And then, leaving a little early, you could still hear the last song, but you're exiting a little earlier before the big rush of people come. With a wedding example I think modifying expectations is huge. For one of the chronic illnesses I deal with a lot of people talk about the fact that we can't stand still for very long, when they get invited to be part of a bridal party. That's always like a anxiety driven moment of is it okay for me to ask this person whose wedding it is? If I can have a chair or sit down if needed, or there can be modifications for me to join in on this celebration. I don't want to take away from their day, but I need some modifications. There's no harm in asking. If it's a problem for them, they'll let you know, and then you can figure it out from there. Another good tip is accepting help without shame. Accepting help and asking for help. If there's something somebody can do to make it a little easier for you, then you absolutely should do that, especially if it's a person that really wants to help you. So if we're weeding the garden beds. Maybe you have a hard time getting down on your knees and that's needed in order to weed this garden bed. Perhaps your partner could help you physically get down to that position or get some sort of cushion or chair set up for you so it can make it easier for you. I think you can also plan. Ahead of time with your friends or whoever's gonna be at this event and say, Hey, if I need you to step in and do A, B, and C, can you do that for me? So they know the expectation ahead of time with my painting example. I actually let my partner do the second coat because I just couldn't do it. They had more free time, so I was like, Hey, I really wanna finish this, but I don't think my body's gonna let me. Are you able to do the second coat? I can still point out things where I left off and washed the paint brushes when we're done. My partner was happy to help me and it saved me from having more consequences. Than I already had. One last tip would be don't stack multiple high cost activities. Let's be realistic. Maybe we can do one thing. But if you're gonna do three in a row, that's probably not gonna happen without severe consequences. So we'll take vacation as an example. If you're going on a cruise or skiing and there's excursions and activities involved, you are probably not gonna be able to do everything everyone else is doing every single day. I think theme parks is a big one that I hear people talk about. Maybe you go the first day and the second day you stay back in the hotel room and have a rest day, and you join your companions for dinner that day instead of everything else. Figuring out a way that you can still participate without. Totally wearing yourself out and causing some sort of medical emergency. So how can we respond to other people who like to tell us, don't overdo it. It's said with love. I know it is. I'm sure I've said this to other people before too. I definitely have some version of this that I say to clients when they're planning their week and they're like, I'm gonna do this and that, and I'm like that sounds great, but maybe think about how you're gonna balance rest in there too. So things that you can say though when somebody is making the comment and it's causing those emotional reactions for you. Thank you. I understand the risks and I've decided this was worth it. Short and sweet. I think that gets your point across. I'll manage the consequences if I happen to overdo it. I'm allowed to choose even if it costs me later. This is my choice. And then release the need to convince others that you're capable of doing this. Don't let it get into a back and forth. Just cut it off with one or two statements and move forward. Maybe sometimes you need to reevaluate this. I think there's a difference when don't overdo it as a pattern versus a one off. Maybe we don't say anything to someone when they say it one time, but if it's something, I find this most frequently happens with my partner and other chronically ill people with their partners since they're often a caretaker for us. They're the ones giving us this caution most frequently. And sometimes it isn't a selfish way of, they're saying, oh, don't overdo it.'cause then I'm gonna have to help you or I'm gonna have to take over these responsibilities because you can't. If it's a pattern, maybe there's a need to have a separate conversation and talk about it. Or if there's an upcoming event say. Hey, let's take turns sharing how this makes us feel so we can see how this affects both of us. Share your right to choose and manage the consequences, and explain how you're gonna do that. And then you can also listen to them talk about how it affects them and why that cautions being thrown out to you. I think it's also good check in with yourself and not necessarily others. Fear. So that don't overdo it, I think can make you second guess yourself sometimes. So don't feed into that too much. Trust your gut, you know your body best more than anyone else. Self-compassion when the cost was higher than expected. Sometimes we by history have a good idea of how something's gonna affect us, but sometimes we get it wrong maybe something major happens or it puts us out for way longer than we expected. And that's not your fault. That's not denial. That's not poor planning. That's a body that's unpredictable and there's probably nothing you could have done to forecast that. So be gentle with yourself if that happens. And there's no moral failure in recalibrating in the moment after the event, whatever you need. So in closing, here are my reminders. You're not reckless for wanting a full life. Choosing joy isn't denial. It's humanity, and we deserve that. Chronic illness takes enough from us already ready, and you get to decide how much you give back. Sometimes I choose to rest sometimes. I choose the moment and both are allowed. What is something you would choose again, even knowing the cost? Thanks for listening. Thanks for joining me on both sides of the couch. If something you heard today resonated, share this episode with someone who might need it. And if you'd like to support the show or find more of my work, check the links in the show notes. Until next time, take care of yourself on both sides of the couch.