Can Reconsidering Our Relationship to Time Help Keep Us Present?

“I circled 30 minutes … but it feels more like five hours getting ready for work Monday to Friday and only 15 minutes in a hot bath on weekends,” my patient relayed to me.

Greg (name changed, obviously) is an ambitious young professional who has axial spondyloarthritis. He’s also a really funny guy with a knack for saying things that are philosophically deep in a very comedic way. Here, he told me something that made me rethink much of what we do as rheumatologists. When is a minute actually an hour? And when does a month pass faster than a day? Let’s rheuminate.

Chronos vs. Kairos

For the next week after Greg’s appointment, I couldn’t help but think about the various ways we experience time. Greg’s statement reminded me of something I heard a long time ago in college, on a day that seemed like yesterday. My history professor was discussing the fact that the ancient Greeks had two words for time: chronos and kairos. Chronos is a quantitative sense of time set in units, and kairos is a qualitative sense of time passing. For Greg, 30 minutes is akin to chronos, while the feeling of 15 to 300 minutes passing is more line with kairos.

This all sounds archaic and abstract, but hear me out: This distinction between chronos and kairos is at the heart of rheumatology. Morning stiffness is a great example of this. Greg is not unique in having difficulty articulating a particular duration of morning stiffness. The subjective feeling of stiffness can change the very essence of time—getting out of bed can be an instant, or the anxiety and fear of moving around with a painful, stiff back may dilate that moment into hours.

Worse yet, the sensation of pain changes the way we view the world. Pain has a remarkable capacity to extend the passage of time. When viewing the role of pain as a nerve signal to identify a source of harm, we understand that pain, indeed, would heighten the senses to the passage of time. Rheumatic conditions are often painful, and it is important to acknowledge that, when disease and pain are uncontrolled, time seems to pass slower than we want it to.

Another element is at play in rheumatic conditions. Sympathetic outflow is often increased in patients with rheumatic conditions, even independent of pain. Ensuring that we make time for fight-or-flight responses makes complete sense in the evolutionary context. But when it comes to autoimmune disease, this survival reflex—and its effects on the sense of time passing—seems downright counterintuitive.