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Admitting that we don't feel well takes a great deal of courage. We live in a society that prizes beauty, strength, and productivity, and there is a great deal of shame and self-blame that comes with not living up to that ideal. More often than not, when someone asks us how we are, we're likely to say "just fine" and change the subject.

Our discomfort is compounded when our symptoms are largely invisible. When Jeri, herself chronically ill, is not feeling well, she often gets the rash on her face that is characteristic of lupus. "I get nice rosy cheeks and I do look better," Jeri says. "I tell people I feel awful, and they say, 'You look wonderful.'"

Looking good and feeling bad creates a number of dilemmas for those of us with chronic, invisible illnesses. How much and to whom do we tell that we are sick? What do we say when someone asks us how we are, or tells us how great we look?

At one point in my journey of chronic illness, I would likely have said there was a one-size-fits-all answer to these questions, and it would have been to tell everyone you know everything you know, and make sure they understand it. But whether it's a growing sense of maturity about my illness or a decreasing lack of energy, or some fateful convergence of the two, I no longer feel compelled to explain myself to people I meet on the street. When we accept the fact that we're sick, it's less important that everyone else does, too.

Certainly, those relationships that are most important to us require special care and attention, and in my April column, I'll share some tips for improving communication and strengthening our ties to spouses, parents, children, and best friends. In the balance of this column, I'll share my current thinking about how much, or how little, to reveal in the checkout line at the grocery store, during coffee hour at church, or around the water cooler at the office.

To Tell or Not to Tell

With people we have known for a long time, it can be hard to hide a change in our health or unnecessary to do so. But with newer friends or passing acquaintances, we sometimes struggle with the question of when to say we have a chronic illness and how much detail to reveal. On the one hand, we may feel that if we withhold information, we won't be able to develop a deeper relationship. But on the other hand, we have very little way of knowing how someone will respond to the reality that we're sick.

Each time I told someone I was writing a book about chronic illness and they wanted to know why I was interested in the topic, I held my breath. When I admit that I have health problems, I feel as if I am walking out on a limb that might break without warning. I've been pleasantly surprised to discover that by acknowledging my own limitations, I've opened the door for others to share their health problems, or those of their relatives or friends. You'd be amazed at how many of us are dealing, rather successfully, with ongoing health problems!

In general, however, I think how much we reveal depends on the nature of the relationship; my best friend knows the intimate details of my health problems, but casual acquaintances may only know that I rarely make evening commitments. When I tell business associates that I have chronic health problems, I do so in the broadest of terms, and I try to sound as healthy as I can when I say it! While we might feel that the more sick we seem, the more sympathy and respect we'll command, I think it really works the other way around. I've never had a client question me when I state simply, and without further explanation, that I choose to limit long-distance travel because of health problems. Yet I know instinctively that they don't want to hear about my aches and pains.

Energy and Face-Saving Tips

I hope that some of the following specific tips, garnered both from my own experience and from what others tell me, will help you through some of the awkward situations we all encounter.

Most of us have developed a standard answer to the question, "How are you?"; and I don't think we're being dishonest to use it in social situations. My response, "Hanging in there," some days translates to "by the skin of my teeth," but it works on good days, as well. When someone tells you that you look great, even though you feel awful, a simple and heartfelt "thank you" is always an appropriate response. After all, looking good while feeling bad takes talent!

When someone says that it's hard to believe you're sick, you might acknowledge that even you struggle with the disparity between how you feel and how you look. Try saying something like, "Yes, it's even hard for me to understand how I can feel so bad when I look so well." This disarms your critics and creates common ground.

If you are no longer working because of health problems, and someone asks you what you do, try borrowing a page from Mirielle, who has fibromyalgia. "As little as I can," is her cheery response. Above all, save the limited energy you have to help those who are most important to you understand how you feel. When people tell Angela, who has multiple sclerosis, that she sleeps too much, her reaction depends on the source. To those friends she thinks will understand, she explains why she takes a nap everyday. "For the most part," Angela says, "I just laugh it off and say that some of us are lazier than others."

Susan Milstrey Wells is author of "A Delicate Balance: Living Successfully with Chronic Illness."