Depression: Bodily Illness

This is the final post built on Facebook comments when I came Out of the Closet to admit that I have lived through debilitating episodes of mental illness.

Sara wrote: “We speak as though mental illness is one thing, not many; not even depression is a single entity – and the same treatment certainly doesn’t work equally for even those with very similar symptoms.

“Also, mental illness is a full-body phenomenon and experience.  We know this, but we don’t really think or talk about it this way.”

The Age of Enlightenment left us believing our intellect to be in some sense separate from our body.  We have only recently had tools to examine how our brains work and we have barely begun to question our belief that the brain operates in isolation from other parts of our bodily system.

Liz pointed to an excellent article about how Mental Health May Depend on Creatures in the Gut.  Another friend who recommended The Emperor’s New Drugs convinced me that the antidepressant medication I credit with removing my symptoms did not do so in the way we imagine.

How could it not be true that our brains and guts are part of an overall system that governs our physical/mental health?  We just don’t yet know much yet about how it works.

Susan wrote: “I experienced severe depression after/as a result of cancer and its treatment 5 years ago.

“Anti-depressants for 9 months and encouragement from my insurer (!) to see a therapist, talking with him over the following three years, have helped enormously.  

“Every day is still a challenge, but I am also so very grateful for every day.”

We need to know more than that cancer makes us miserable.  We need to understand the mechanism.  Diagnosing and treating mental illness is still quite haphazard, especially because, as Sara points out, depression is not a single entity.

And even the existence of mental illness is often unrecognized.

Kelly wrote:  “Depression is very common among people with chronic illnesses, and often goes untreated.  I’ve always just assumed it was part of being ill, and tried to deal with it on my own.  

“Thank you for this post, Martin.  Along with the many comments, it has inspired me to talk to my doctor about treatment.”

Physical pain is almost certainly not the only thing someone with chronic or long-lasting illness is suffering.  They are most likely also depressed.  And the tragedy is, even if they recognize their depression, they will probably not seek treatment.

When we’re in a depressive episode we do not seek treatment because we feel it is the appropriate response to our situation.

When we get a respite from the physical pain, we don’t recognize that we should seek treatment for next time because we’re so relieved to be feeling better.

My depressive episodes were triggered by other situations, not physical pain, but the same dynamic applied.  I know from the same fundamental experience how unlikely it is that Kelly will in fact talk with her doctor about treatment for depression.

There are many stories of Buddhist masters who are impervious to pain.  One of my teachers whose serenity is truly amazing suffered an extremely painful illness last year.  “I thought I should be able to ignore the pain” he said, “but I soon discovered it was impossible, so I accepted the doctor’s recommendation and took the pain medicine.”

Pain is a call to action.  We must not ignore that call.

Both the source of pain and pain itself can be treated.  We don’t have to work on only one aspect of our illness.  It may take experimentation to find an effective treatment, and the same one may not continue to be effective.  We don’t consider that a reason not to seek treatment for physical illness.

So, if you know someone with chronic or long-lasting pain, please help them overcome their reluctance to seek treatment for every part of their suffering.

7 comments on “Depression: Bodily Illness

  1. From my limited experience I believe depression comes in many forms from mild to severe to completely debilitating with variants in between. Mild depression might come and go or it might be ever present without seeming to affect a person’s day to day functioning. It just might cast a slight fog over their life. Severe depression seems to cause a person to lose all motivation and requires time to recover. The more frequently these bouts occur the more it would affect a person’s ability to function, with debilitating depression incapacitating the individual.

    The two questions I have are:

    Is the cause of depression one or more traumatic events in a person’s life? Or are there other causes as well?

    And, how does one decide how to respond to their depression? It seems that often the response causes more pain than the pain of the depression.

    • I assume there is always something that triggers mental illness just as there is always a cause for physical illness. Sometimes we can identify the cause, sometimes not. We don’t know why most forms of cancer strike the individuals they do, for example.

      A neighbor was chatting with me yesterday about his time in Vietnam and after. He was there for a year, saw terrible things and did what was necessary to survive.

      He told me: “People ask me, how can you shoot an 8-year old child? My trainer told me, if they have a gun, they’re done! It doesn’t matter how old they are, what sex or anything else. An 8-year-old pointing a gun at you is going to kill you.”

      I didn’t ask for confirmation of what he had done. His point was that he had eventually come to terms with it. “Four of my friends committed suicide. They couldn’t forgive themselves for what they did, or maybe they just didn’t want to go on living in a world where people are made to do what they did.”

      He was saying the same events affect different people in different ways. When he came back, he joined a notorious biker gang, ran weapons to the port for shipment to the IRA, and worse things.

      That stage of his coping ended this way: “If you have any intelligence, you take a step back one day, look at what you’re doing and you say ‘no good can come of this.’ Then you fade into the background and move on.”

      His friends who killed themselves suffered from the mental illness we loosely call depression. My neighbor did not. All of them suffered terribly from essentially the same events.

      My neighbor who did not also suffer from mental illness went on to a degree in mechanical engineering and a good career.

    • The best response from my direct experience and my experience with others who suffer depressive episodes is kind and insistent encouragement to accept, provisionally at least, that they are suffering from a common mental illness that probably can be successfully treated.

      The fact that we do not yet understand how certain pharmacological treatments work does not mean they do not work. It means several methods may have to be tried before finding one that is effective for a particular individual.

      The other thing to keep in mind is not everyone’s mental illness is treatable. That again is the same with purely physical illnesses like cancer.

    • It is a common reaction, for sure, but I would not say it is normal because it is very unhealthy both for the sufferer and everyone in their world.

  2. Liz wrote: “This is an interesting piece, Martin. Indeed, as Sara says, “Mental illness is a full body experience and phenomenon.”

    I think that’s true of all of our illnesses. As the body affects the mind and the mind affects the body, we find ourselves IN an experience that is a gestalt: something that is more “the sum of its parts” than it is any part in particular, something lived in the flesh house we tend and carry, and something begging for meaning. Unfortunately, I think we often attribute meanings to our illnesses that aren’t helpful to us. Maybe that’s because in the free-fall of pain, we will grab at anything that we think will help us. Thus, we might label ourselves AS the illness or as the victim of the experience, and because of this, limit the uses to which our illnesses could be put as well as limit the compassion we extend to ourselves.

    Of course nobody wants pain and suffering and illness, and we must do whatever we can to alleviate suffering for ourselves and others, but there have been times in my life when a mental or bodily dis-ease has been useful (even when it’s been terrifying) and has been, ultimately, a good friend giving me a stern talking to: “Liz, this college major/job/lifestyle is making you depressed and anxious.” “Liz, this pain in your neck and back is a symptom of your pain-in-the-neck boyfriend. You want him off your back.” “Liz, you are feeling alone and hopeless and ill. Ask for support!” I’ve found that listening in and attending to the pain I’m feeling is very helpful to me–it gives me clues as to what the best “medicine” might be to alleviate the suffering, and interestingly, the compassionate interest in my own vulnerable Being seems to be a part of that medicine.

    I’ll recommend a book that I am only 50 pages into, but which I am quite enjoying so far. It’s by the physician/poet Dawn Garisch, and the title is Eloquent Body.”

  3. I replied: “Your comments are very wise, Liz. I said pain is a call to action but I should have said more. The call is not simply to anesthetize pain but to understand its roots, and uproot them.

    Depression is a mental illness that is, in my experience, triggered, an inappropriate response to a real event.

    If the response was not a depressive episode I could explore what led me to misunderstand or over-react to the trigger. But because I reacted with a depressive episode it’s impossible for me to conduct that exploration.

    What this means is, first I must eliminate the depressive response, then I can work on eliminating its cause.

    I’ll try to clarify in a future post what I’ve learned about the fundamental difference between depression and sadness. When we open our heart to joy, we open it also to sadness, The purpose of depression is to protect the heart from sadness, which means it also shields us from joy. So very sad…”

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