According to the U.S. National Institute of Mental Health, “Scientists don’t yet know how depression and chronic pain are linked, but the illnesses are known to occur together.”
Hmmm. Let me propose a connection.
The link between chronic pain and depression is not some mysterious “co-morbid” condition: many of us folks with chronic pain, despite the positive front we often sport, are pretty sad about the stuff we can’t do anymore, pretty sad about cancelling some major life plans, and pretty sad because ongoing pain, physiologically, makes sadness. Perpetual sadness? I think they call that depression.
Over the course of my two and a half years with chronic pain, I have come across the same very sound advice from a variety of trusted sources that suggest I avoid living in the past in order to manage the pain better without the accompanying emotional fallout, and they’re right. Those moments where I can shut out dreams of the effervescent past and resist lamenting a future without daily music, high energy, and red wine are certainly better than the alternative. To this end, regular meditation and visualization have been key in living in a present and imagining a future I feel really good about.
But even with these strategies, and even though loss gets easier with time, there are just going to be those moments where you feel well enough to sing, so you do, and you’re so overwhelmed with how much you miss the sound of your own singing voice (narcissist) that you have to weep/sing for a bit for fear you’ll never get to use that singing voice on a daily basis ever again… fun, sexy time, no? Oh, and you’re also dealing with intense pain or pain management every. day.
Before having chronic pain, I don’t think I could have possibly understood how pain and depression are not just distant cousins, but twins — both evil — that never go anywhere without each other. I would have rationalized it: the pain is just pain, the mind can overcome. It’s all about attitude, right?
Um… Nope. Because I work harder on my attitude now than ever before in my whole little life and I’m struggling with depression for the first time. I have to rest, meditate, and do yoga like a pro, because if my tired, angry, or irritable barometer goes above a certain level the forecast is calling for pain. Perhaps this is the specific cause & effect that still perplexes scientists, but it’s real for many of us.
But please, do not be tempted to call out,
“See? You admitted it: You bring on the pain yourself with your poor emotional state!”
I’m no scientist, but I gather that not matter how rational, serene, equanimous, or laid back, most humans are susceptible a variety of emotions now and then. What also seems about right to me is that not all humans have chronic pain. Thus, I deduce that having feelings such as anxiety, anger, irritation, tiredness are not the primary underlying cause of chronic pain in the first place, nor do they cause “attacks” or “flare ups”. They have the capacity to exacerbate the pain, you bet, but unfortunately, these feelings are still routine parts of being a human, and thus difficult to avoid, especially while you have to adopt a new lifestyle, micro-manage your energy, and try to deal calmly with a massive ongoing transition period.
I think I can relate to Barbara Ehrenreich in Smile Or Die: How Positive Thinking Fooled America And The World when she responds to people’s insistence that her illness is a “gift”:
Breast Cancer, I can now report, did not make me prettier or stronger, more feminine or spiritual. What it gave me, if you want to call this a “gift”, was a very personal, agonising encounter with an ideological force in American culture that I had not been aware of before – one that encourages us to deny reality, submit cheerfully to misfortune and blame only ourselves for our fate.”
Putting on a happy front is not always healing, and having a wide range of emotions is a natural part of life. So please, let’s not ever blame pain solely on attitude or “stress.” While people with chronic pain might be grateful for their pasts and excited about new future plans, we are often still grieving lost abilities while wrangling with ongoing, disabling, depressing pain, and that’s just hard.
For the people who don’t get it:
To doctors who recognized that chronic pain and depression must be treated together: thank you for doing your homework. Thank you to the spoonie community that tells it like it is, and to the vast majority of people in my life who listen to me and tell me how strong I am. I am a lucky woman (maybe minus the whole chronic pain thing though).