Thursday, February 28, 2013

Bringing the Spirit to Its Knees: chronic pain and depression

Self-Portrait with TENS Machine, taken about two and a half years ago

This may come as a surprise to you if you only know me through my blog, but I am not known for my optimism or sunny disposition. My friends know me as an eternal pessimist and I’ve been described as “prickly” more than once. 

This blog is, in fact,  my very conscious effort to learn how to focus not on that which causes me pain – my back injury, oil pipelines, poor grammar, peplums – but on that which makes it easier to bear that pain.

But let’s face it, chronic pain is not conducive to joyful days and high spirits. I don’t know a single person who has suffered from serious chronic pain for more than a few years who has not ended up on an anti-depressant. 

I thought about all this a lot when I got together with my old friend, James, the other day.

James is the chappie on the right. There's no way this car belonged to any of us. We were all dirt poor.
This is how I remember James: spry, playful, and, as you can see in these old photos, very able-bodied. I looked up to him, thinking him so far past me in coolness that I shouldn’t even try. His fashion taste leaned toward that fag macho look so popular in the early 90s: short- shorts, ripped jeans, combat boots, mac jackets (already a long-time Canadian staple). He had a row of many earrings running all the way up one year. He was flirtatious and hip and, in my eyes anyway, upbeat.
James tells me that he made this shirt himself. How many of you remember 501 button-fly jeans, with the fly ripped off? That was the height of cool.

Though we’d been in touch on Facebook for a few years, I had not actually seen James for about 20 years. I knew he, like me, was now disabled and that he, like me, was struggling to deal with all the lifestyle changes, and changes to the body and its abilities that come with sudden disability. I knew that he, like me, struggled with depression.

James thinks all these clothes were thrift but he's not sure. I forgot to ask about the cane.

This is James now. His sense of style remains not dissimilar to that which he favoured in his youth. He’s still a macho looking fag (though not to be confused with the 1970s, Village People version thereof), still in boots and cool glasses, manly denim and slightly bohemian ear piercings. He’s toned it down, as one does as one ages (well as many of us do anyway), but he’s clearly still the same James.

James looks good. He also looks sad. No, he looks depressed. He is depressed.

Who the hell wouldn’t be? I know the feeling. I really really know the feeling. 

When people tell me that I should just “think positive” and not be so negative about my pain, I want to kick them in the teeth and then tell them, “Why aren’t you thinking positively about your pain?” It’s an absurd and extremely insensitive thing to suggest. Mind cannot triumph over matter. It just can’t. Indeed, sometimes matter brings the mind and spirit to their metaphorical knees.

Ring on left: from Barefoot Contessa. Coral and gold ring: a gift from Beau.
As brain science and more holistic approaches to medicine gain more currency, the links between depression and chronic pain are becoming apparent. Pain causes depression. This link requires no intelligence whatsoever. The causal link in the other direction is a harder one. I consider myself a fairly intelligent woman and quick to learn new concepts, but the science of depression prolonging pain is very difficult for me to understand.

What I can say is that it seems that pain and depression seem to form a vicious, mutually parasitic relationship with each other. Each feeds, and feeds from, the other. Pain causes depression, and depression seems to prolong chronic pain. They become so intertwined, they seem inextricable in the heart and mind of the sufferer.

(Noting that anxiety is considered a manifestation of depression, it is worth adding that there is also a strong correlation between PTSD – a severe anxiety disorder -- and prolongation of chronic pain as well as a propensity toward clinical depression.)

I don’t know how chronic pain could not cause depression. It’s a pretty simple equation. If you doubt this, think of how you’ve felt emotionally at, say, day three of a bad flu. Were you at your emotional best? No. Now imagine feeling that way for years. I think you get it.

But once the depression kicks in, it actually makes it harder for the pain to leave the body. I don’t understand the science of this, no matter how many scholarly essays I read on the topic, but I do know it’s true.

So what does one do about this? The sense of helplessness is… well, depressing. Rather than accept that there is a level of helplessness in combating this pain/depression link, I sometimes try to tell myself to “snap out of it and just get better.” 

It doesn’t work that way. I don’t have that kind of power. I go to therapy. I take my medications. I do my physiotherapy. I practice various techniques to sooth and calm myself in my pain. I wear pretty things and write about their joys, trying hard to “focus on the positive.”

But I’m still in pain and I end up blaming myself. Self-blame itself is, in fact, a common symptom of depression. Self-blame only increases the depression, which increases the pain, which increases the depression… You see? It’s a merry-go-round that is distinctly unfun.

Cane: Life; Bracelets: thrift; I got the gold one for $4 from a guy selling used stuff on a blanket on the street. He didn't know it, but it's gold-fill, signed, from the 50s, and worth well over $100, if not more.
The mistake one must not make in seeing the link between depression and chronic pain is assuming that the science on the topic is telling us that pain is “all in our head.” It’s not. If you doubt me, take a look at my C.T. scan. The injury is real and the healing is slow. Therefore, so too is the recovery from depression. The term "vicious cycle" was pretty much invented for this sort of thing.

This past week, I suffered what my physiotherapist calls “a little setback” and I call “oh, my f*cking God, I’m horribly crippled again!” I was back on the cane for a while and in a lot more pain than I’ve been in for years.

I was not happy about it, don’t get me wrong, but it did help me to remember how far I’ve come. Normally, I’m not on my cane anymore and I’m not in the amount of pain I was in years ago. I’m also a lot happier. My depression comes and goes now; its vice-grip has let up. Funny that: I’m less depressed when I’m in less pain. Am I therefore in still less pain because I’m less depressed? So they say.
So, no matter my guilt, no matter my own self-admonitions, no matter my sense of helplessness, I guess I actually am doing something right. 

But don’t let anyone tell you it’s easy.
This graffiti really spoke to both James and me. I think we both wish we felt "feral and free" and we both feel very far from it.

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