Pain and depression: What came first?

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Recently, I was talking with a friend about the challenges that come with living with depression and chronic pain. I was mentioning how both have been a life-long struggle for me and how I was curious about what kind of person I might be if I did not have to deal with either one. She asked me which of the two I remembered first as being part of my life.

There is a belief out there that if you can identify the source of your depression and eliminate it from your life, your depression will go away. This is only true with some forms of depression. If you suffer from situational depression, changing the dynamic of that situation can clear your head and improve your outlook on life.

Changing a job, divorce, or becoming involved in something new that is stimulating are some ways people overcome situational depression. However, if your brain is simply wired differently than most others and you deal with chronic depression, when a situation triggers a depressive episode, you are often left feeling stuck with no choice but to ride out the mental and emotional waves that pound away at yourself.

If you suffer from S.A.D. (Seasonal Affect Disorder) and the shorter daylight hours of autumn and winter give you the blues, you may be able to beat them with something as simple as exposing yourself to more ultraviolet light. If there is a lack of sunshine, you might do well with the use of an ultraviolet light that you turn on while you sit at your desk and work.

What many people, who do not suffer from depression, don’t understand is there are many forms of the disease and like cancer, many degrees or stages to each. What the non-depressive often fails to understand is with depression comes a host of other challenges, one of which is physical pain.

It is understandable to become depressed after you have surgery or are injured and you are laid up with pain. As the pain subsides and you get more of your usual life back, your mood improves. However, what happens when the physical pain you feel is hard to describe, especially when you are just a kid? How do you explain to a parent or a doctor how your body hurts pretty much all over? The reaction can vary from empathy to “quit your complaining, you’re not hurt.”

I know this because it has been the hand in life I was dealt. It’s the hand many are dealt who struggle with depression and never know when it will flare up. Depression does not just mess with your head, it messes with your body just as pain plays havoc on you mentally as well as physically.

As the sixth of eight kids, there was not always a lot of time for my parents to devote to those of us with unique needs. I learned early to suck it up and live with what was bothering me, whether it was physical or mental. When I was suffering physically, I learned to use a heating pad or ice pack for my aching. I also learned doing so came with the usual teasing siblings do to each other. Inside, you take it because you know it hurts less than the physical discomfort you feel and all you want at that moment is for your pain to subside.

When I was growing up, depression and chronic pain were never talked about. How do you know you suffer from one or both if you do not know either exist?  All you know is that there are times you just want to curl up into a ball and be left alone, something hard to do when you share a room with a brother and a house with nine other people.

With depression comes anxiety. With anxiety comes anger and tenseness. Tension causes pain. With pain comes inflammation. With inflammation comes the fight or flight response. With all of this comes exhaustion, trouble focusing, and a general desire to just be left alone. When you are a kid, all you realize is you get more pleasure playing alone in your room with your Hot Wheels or electric football set or shooting hoops in the backyard by yourself than being around others. You do not invest heavily into a large circle of friends, but rather, you prefer a select few you carefully pick out as being people you feel good about being around.

So what came first in my life, depression or chronic pain? The answer is both. Events have a way of triggering one more than others, but as far back as I can remember, both have been intertwined with who I am. Unfortunately, it took me 55 years to realize this and to accept it.

The damage from both has been to others around me just as much as it has been to myself. I’d be lying if I said I never let either one control my life. It would be like an alcoholic telling you they do not have a drinking problem when everyone in their presence knows damn well they do. Like a classic depressed person, I often worked hard to bring joy and laughter to others while inside feeling like I was struggling to keep it all together. I learned to block out physical pain by soldiering on and playing through it. I did the same with mental discomfort.

Like any other disease, the more you work to hide it from others, the worse it becomes and eventually it catches up with you and brings you to your knees. In my case, it was a horrific bicycle accident in 2007 that nearly killed me and the aftermath of five years of physical therapy and constant pain that felt more like torture. I hit rock bottom in 2013 and had two simple choices, like an addict, admit I needed the help from others or die.

There was not going to be any more episodes. Each one was lasting longer and hurting more than just myself. No more sucking up the pain and pretending it was not affecting my marriage, family life, work, and even down time. If I was going to gain control over my life, I had to hand it over to others and trust them to help me.

A new primary doctor helped me find the right antidepressant, one that did not leave me feeling like a zombie. My inner fog cleared and I began to see life differently. I understood my past better and looked forward to the future more.

Talk therapy helped me understand the nature of my challenges in a way that allowed me to accept the fact that this is the hand I have to play at life’s table and it was my choice to decide if I go all in or drop out. I am happy to still be at that table.

Pain management, x-rays, MRIs, and a variety of treatments have allowed me to have a better grip on my chronic pain. I can spot the difference between pain coming from injuries to my spine from those coming from cold and damp weather or from old injuries from years of playing sports.

Acceptance helps me to understand there are going to be good days and there are going to be not so good days. I try to appreciate the good as much as I can and remind myself the difficult days are only temporary.

Today, the biggest challenge for me is with drugs. My pain and depression awareness has required me to decide what route to take when dealing with my multiple forms of depression and pain. Any decision the millions of people in my position make comes with consequences. There is no right or wrong choice as long as it is one you are comfortable with.

What does not help people like me who suffer from depression or chronic pain is to have others in their lives who are all too quick to say the two words we hate most, “You should …”

“You should” implies you know more about our problems than we know. It tells us we just need to do as our non-expert friend does to live a better life. I have heard all the “You shoulds” I care to hear. It is the most dismissive remark a person can make to anyone who suffers from anything because it simply tells the person you are done listening to them and want to move onto something less depressing to talk about.

I’d love to not have to take the meds I take, but I know what the consequences are if I don’t. I am fortunate to have a wife who empathizes with my challenges and who is not afraid of facing them with me. She encourages me to explore other avenues while knowing some do not work, some are cost prohibitive, and some are hard for me to incorporate because of old habits.

The end result is that I am now a person who is more even keel in temperament than he would like to be; one that makes some wonder whether or not I feel joy or sorrow like most others feel. I am a prisoner to structure because I know how much stress, whether good or bad, can trigger responses that do not set well with me. This makes me more boring than I might otherwise be. It requires me to look for ways to remain busy so my mind does not become my worst enemy and I do not have time to sit and feel my physical discomfort. However, those damn drugs can zap me of the energy needed to keep busy.

Like everything in life, there is a fine line to navigate to maintain the balance needed to maximize my life. I could dwell on all that I miss out on. I could complain to no end about being a victim. Or I can get on with life and play the hand I am dealt the best I can. I try to do the latter as much as possible. Sometimes I am more successful than others.

Going back to the question my friend asked, what came first, the pain or the depression? It no longer matters to me if there is a scientific answer. Why? I guess because what matters more is what lies ahead, turmoil or acceptance? I lived enough with turmoil to know acceptance can’t be any worse and most likely is far easier and healthier.

I have accepted my life. I have not given up on improving it, but I no longer need to know where the root cause of my pain/depression cocktail comes from because I realize it is just how I am wired. Like houses, people are not all constructed the same. My house may be wired a bit differently than most others, but it still provides me with the energy I need to live a full life.

In the last six years, I have done a lot of self-renovation. I have improved where I can and accepted what is not possible. My energy no longer goes toward hiding from what I used to feel ashamed of. It is not a crime to suffer from depression or chronic pain any more than it is a crime to have cancer, diabetes, or any other illness. I’ll take my challenges over those I see others dealing with.

What came first?  It doesn’t matter because now it’s time I focus on what comes next.