The 3rd February 2022 is Time To Talk Day, raising awareness about mental health & opening up opportunities for talking about it. Mental health and chronic physical health conditions are intimately intertwined. There are various potential mental health issues that can be involved, like depression, anxiety, eating disorders, addiction, OCD, personality disorder, and so on. This article will look predominantly at depression, a darker, stigmatised side of chronic illness that doesn’t get enough attention.
Chronic Illness & Depression
Chronic illness, pain or other disability can lead to mental health issues developing, or they can worsen preexisting mental health problems. Any chronic condition can be a catalyst for creating or worsening the likes of anxiety and depression.
There’s a myriad of factors and triggers that can contribute to negative effects on mental health. For instance, the relentless nature of chronic pain, the stress and frustration of fighting for your health, regret at the life lost to illness, guilt for being sick, grief for the loss of relationships and employment, disturbed sleep, physiological changes and imbalances, loneliness, and so on. It all adds up.
Let’s take a little look at just 8 contributory trigger points.
♥ ♥ ♥
1. Exhaustion Of Fighting For Your Health
Those with chronic illness often find themselves in an ongoing fight for their health with medical professionals. They may not be believed or taken seriously. They may be fobbed off for months or even years, watching as their health declines. They may struggle to get the diagnostics or treatments they need. They may have to continually challenge incorrect diagnoses or inaccuracies reporting in their medical records.
A person who has been let down may try to fight the injustices in healthcare, like with campaigning for change, complaining to medical practices and oversight bodies, or starting legal action.
Chronic illness patients may have to fight for years just to be heard and taken seriously with their own health concerns, let alone the difficult the struggle they face if they want to fight for positive change and justice in the healthcare system.
Then there’s the matter of seeing different doctors and specialists for appointments. You have have to start all over again recounting your experience and symptoms. You take a gamble each time with not knowing what this new person will be like. You hope for someone that’s open-minded, efficient, knowledgeable and compassionate. Far too often what patients come up against are closed-mindedness, ignorance and rigid adherence to textbook teachings.
It is utterly exhausting, infuriating and disheartening. Your health is worth fighting for, but sometimes we need to take a break so we can repair the wounds just enough to allow us to get back up and continue the fight.
2. Agitation From Relentless Chronic Pain & Illness
Symptoms of different illnesses and disabilities are potentially endless and limitless, from cognitive impairment and dizziness, to rashes, bowel problems and fatigue. Whatever you deal with, the experience can be incredibly disruptive to your life. Symptoms can be immensely annoying and heartbreaking at the same time. If you don’t have a diagnosis and cause, it’s frustrating to not know where to go next. If you lack tools to manage it and have to face the reality of no cure, it can be devastating.
If you live with chronic pain, you’ll likely know just how aggravating it can be. Pain may wane or be continual, and it can present at varying levels. Whatever your experience of it is, the very nature of chronic pain is disheartening because there’s no expiration date for it. As opposed to the acute pain of cutting your finger, you know that chronic pain is intense and never-ending. You can’t catch a break or look forward to the time when it’s no longer there, unless you’re fortunate in having a type of pain or form of treatment that somehow enables that to happen. For many, chronic pain can only be managed on a day to day basis for the foreseeable future.
It’s perhaps unsurprising to learn that research indicates those living with chronic pain are 4x more likely to experience anxiety and depression than those without pain.
I live with debilitating chronic pain primarily from nerve damage, plus pain from the likes of chronic migraines, widespread inflammation and fibromyalgia. It’s relentless and all-consuming, and it drives me mad. It can leave you agitated, easily annoyed, irritable, angry, and frustrated.
It can burn like a furious fire that makes you want to rage at the world. And it can wear you down, making you want to crawl away and hide from the world.
3. A Lonely Experience
Living with a chronic condition changes the landscape of your life. The “new normal” you find yourself in can feel much smaller and less colourful, especially as illness can cost people so much. A person might lose their friends, family, social life, work, hobbies, romantic relationships, and just about everything else.
You might not be able to do the things you used to, or at least not in the same way. You may end up missing out, and it’s reinforced by seeing what others are doing. We’re bombarded with it online, on social media, in conversation, in advertisements. If your condition started partway through your life, you start thinking about what your old life used to be like. What the future you’d always wanted should have looked like.
The unwritten rules and timelines of society can make any of us feel like we’re behind in life. The things we feel we “should” do or achieve at certain points as we age. Things like having a stable job, career plan, good income, social life, admirable hobbies, fitness goals, marriage, to own a house, have a child, save for retirement. Chronic illness can switch the tracks we’re travelling on, taking us in a different direction or slowing us down. We don’t feel that direction is “good enough” because it’s not the expectation, it’s not mainstream or it doesn’t look like the lives others around you are living.
So what if you’re not able to work and have a high-powered career? So what if you’re not in a relationship when you’re 30? So what if you’re still living with your parents at 40? So what if you’re staying home to watch films rather than sweating it out at the gym or going wine tasting?
It doesn’t and shouldn’t matter what your life looks like or what your accomplishments may or may not be. But it feels like it does, and it’s painful to feel like we’re behind. It’s rubbed in like salt into a wound when we’re asked questions about what we’re doing at the moment; we want to say we have a great career and a life crammed full of exciting things, when in reality we may spend our days in bed unable to function, let alone to work or run a 5k.
4. Disbelief Of An Invisible Illness
What’s a sick person supposed to look like? Most of the time, they’ll look perfectly “fine” and “normal”. The problem is that anyone on the outside can’t see what they’re going through; they have no idea how poorly that person feels or how much physical pain they’re in. Many health conditions are instances of an invisible illness or hidden disability because they’re often not immediately obvious to the eye. A person may sometimes use mobility aids or they may allow a grimace of pain to briefly pass across their face, but you couldn’t tell there may be one or several conditions they’re living with day in, day out. And you certainly couldn’t fully appreciate the widespread ramifications of these problems on all aspects of their life.
Someone not believing you are sick can be insulting and hurtful. It may be a family member, partner, friend, boss or a medical professional. The problem with the latter is that we have to rely on medical professionals if we’re going to get the diagnoses and treatments we need. We’re limited by finances and healthcare constraints, so there aren’t many options open to us. We might work our way across various doctors until we can hopefully find one to listen, believe us and take us seriously, but it could take years to get to that point. Of course this isn’t the case for everyone. Plenty of people have great experiences with doctors and their local healthcare providers. Sadly, far too many also do not.
If you need further help with specialists or surgeons, you face the possibility of fighting this same fight all over again. It’s tiring and demeaning. That’s also where medical gaslighting can also come into play. After some time of being fobbed off or told it’s all in your head, you might start to believe it. You doubt yourself, question yourself, wonder if it’s all your fault or if you’re making a fuss about nothing. You can go to a dark place mentally before you even get to the point of an initial diagnosis just because of the ignorance you come up against in seeking medical support.
Ironically, while mental health problems related to chronic illness don’t get much attention, it’s not uncommon for doctors and specialists to palm off patients by saying it might be anxiety or depression. There are far too many tales of people, particularly perhaps young women, going to the doctor with things like pelvic pain, migraines, fatigue or bowel problems, only to be told they need to work on stress management or to be given a prescription for anti-depressants. That ignorance leads to their physical problems getting worse and diagnoses getting missed. Alongside potentially irreparable harm to their physical health, it also sees mental health take a nosedive.
5. Financial Stress & Benefits
If you lose your job due to ongoing ill health or you find you can no longer work the role you did and the hours you used to do, money can become an issue. Finances being tight or pushed to their limits causes undue amounts of stress, but then you’re also adding medical bills, therapies, medications, supplements, care and so on to the list of outgoings. As inflation soars and the cost of living rises, the purse strings get tighter still.
If you can no longer work temporarily or for the foreseeable future because of illness, there aren’t many options unless you have a gloriously rich family, huge inheritance or the odd Salvador Dali painting idling in the garage that you can sell.
The only option then is government financial support. Starting up on benefits (social security) or trying to maintain those claims over time is a tremendous task. It’s complex, it’s nerve-wracking, it’s humiliating, it’s insulting. But the financial support system is there to help those who need it, who truly can’t work for whatever reason. There’s sadly just a bucket load of stigma and prejudice around benefits, and we can often we our own worst enemy here in judging ourselves.
6. Relationship Strain
Chronic conditions affect what we can do and how we do it, so the activities that made up a relationship previously may change. For instance, the nature of a romantic relationship may change if we can’t be as spontaneous, go out regularly, have the same sexual relationship and so on. Will our partner stay with us or grow tired? Will the health problems we face cause problems that can’t be overcome within our relationship? Will we feel guilty for our partners, or will our partners feel resentful? While many relationships can go the extra mile to last throughout chronic conditions, and perhaps even grow far stronger as a result, it’s sadly not always the case.
If we’re single, could we look for a partner in future? What if we lose so much time to being ill that we can’t socialise regularly or participate in the things couples do? If we can barely look after ourselves or we can’t have sex because of physical problems, then where does that leave us? We may feel hopeless and resigned to a life alone, believing nobody could or would want to be with us because of everything our chronic conditions entail.
Another trigger is how we might require more support from those around us. The simple matter of needing extra help, no matter how much or how little, can leave some people feeling like a burden. Loved ones will want to be there and to be supportive, though oftentimes they may not know what to do or say that will help. It’s not easy to ask for help, and over time the feelings of guilt, resentment, shame or dependence can feel overbearing.
7. Physiological & Neurological
Changes to our physical health can more directly affect our mood. For instance, hormone changes, nutrient deficiencies and other imbalances can tilt the scales of our mental health. Some conditions affect our cognition, like fibromyalgia, which might entail forgetfulness, depression, anxiety, poor concentration and “brain fog”.
Then there are medication side-effects, which could bring new symptoms or can more directly contribute to depression. Those without chronic conditions can experience this from pharmaceuticals, such as with depression and suicide rates with some contraceptive pills.
A range of potential physiological and neurological changes can play a role in our mental health, linking chronic illness and depression. That means that even if the circumstances in your life were happier, some physical symptoms were better managed and you go through CBT with success, your emotions and mental health generally can still be affected in ways that external changes won’t necessarily touch. It’s not always enough to change our thought processes. Depression can deep and colourful in its complex 50 shades of grey.
8. Sleep Cycles & Appetite Spirals
It’s unsurprising that sleep is an issue for so many. We all know how important it is, but getting enough shut eye is harder than it sounds. There’s only so much you can do to improve sleep hygiene. Sometimes your body just won’t comply, or you can’t get comfortable because of chronic pain. Whether you struggle to get to sleep in the first instance, often wake-up, get too little sleep or get too much, it can lead to a vicious cycle.
Less than adequate sleep can make us more grouchy and less able to manage our symptoms, increasing fatigue and irritability. It’s possible for illness, pain or depression to lead to periods of either insomnia or oversleeping. Then it’s a case of rinse and repeat with more poor sleep. It doesn’t help our bodies or brains to not have the quality sleep we need, and that can make depression all the worse.
Poor sleep, pain and sickness can affect appetite, putting us off eating for whatever reason or leaving us little energy to prepare food. Or it could have the opposite effect and potentially trigger comfort eating. Exhaustion and any digestive issues can impact what we’re even able to eat, so if we can’t get a nutritious, balanced diet, we may end up inadvertently feeling worse for it and that all plays into the same vicious cycle. Rinse and repeat.
♥ ♥ ♥
Chronic Illness & Depression : Complex Co-morbidities
Regardless of which came first, there’s no denying that chronic illness can negatively impact our mental health for a variety reasons. There can also be some benefits and silver linings in our lives from our experiences with chronic conditions. They’re probably not readily apparent and you may have to squint to see them, but there can be unintended positives even in the hardest of times.
The thing is, anyone can suffer from depression, chronic conditions or not. There’s often no rhyme or reason to it, no defining moment that triggers depression, no big show-stopping reason for it. It just is. You just feel the weight of it and you may not even know why.
For a person with chronic illness, much of the feelings of anxiety, hopelessness, frustration, agitation, detachment, numbness and depression can be directly attributed to the health issues and the way in which they’ve affected their life. If the health problems were improved, so too perhaps could the depression. But sadly, there’s often no cure for many chronic conditions and disabilities.
Not everyone with chronic illness has depression. There’s also a difference between being depressed, as a temporary state or one that you could class as being part of the human condition, and having diagnosable depression.
So what causes some to suffer from depression, while others don’t? Who knows. It could be one or countless interlinked factors. Perhaps a predisposition, perhaps brain chemistry or hormones, perhaps external influences, perhaps something we could never have an answer to.
Physical health and mental health can affect each other in both directions. The two can be intertwined in a viciously harmful cycle with their two-way relationship and the potential for widespread ramifications to all areas of our lives.
♥ ♥ ♥
I’m afraid I have no creative ideas, quick fixes or solutions for the issues outlined here. I just wanted to show some of the ways in which mental and physical health can relate, highlighting how mental health can be worn down or desecrated by the experience of chronic physical conditions.
The fight for those with ongoing health problems is complex and multifaceted. We spend so much time struggling to help our health, deal with the healthcare systems and manage the impact on the other areas of our life that mental health isn’t always considered and appreciated. Perhaps not by ourselves as much as it should be, and certainly not within our healthcare systems.
Have you struggled with new or worsened depression because of chronic illness, pain or other disability? Do you feel mental health when living with physical health problems is acknowledged enough?