Binaries are deceptive, and the ‘mental versus physical’ division lends itself to that very concern. Everyday discussions on health tend to fit illnesses strictly into either of the two groups: Arthritis? Physical. Depression? Mental.
Such a simplified understanding of health issues is more often than not, dangerous.
The body and the mind work together. They experience pain together. Therefore, physical and mental symptoms are overlapping aspects of a bigger problem.
Michelle George and Divya Gulati* are two women diagnosed with chronic pain illnesses. Their experiences tell us just this: Break the Binary.
Mental & Physical Symptoms: Does One Follow the Other?
Their stories share some commonalities — they’ve both spent major parts of their lives in pain; it took them years to finally know what the problem was; and physical pain had always coincided with stress, anxiety and depression for both of them.
Divya was diagnosed with fibromyalgia after six years of experiencing unexplained pain. She consulted multiple doctors and went through numerous tests. The diagnosis was only concluded when all alternative explanations had been discarded.
When I ask her if she felt any mental repercussions of her ‘physical’ ailment, she almost instinctively says, “It is too frustrating to be in pain all the time. It’s mentally overbearing.”
“My pain is more or less invisible. Nobody can see it. And with fibromyalgia, it’s even worse because there is no single document or test that I can show to prove that I have a problem. So doctors end up telling me that maybe it’s not that bad. Maybe you just need to relax. But how can I relax when I am in so much pain?”Divya
Her pain is her constant companion. It’s there in everything she does. “I fail to do everyday activities when people my age are so active. Even washing my clothes in the washing machine is hard. The difficulties of the daily routine keep getting worse. You don’t know what to do, you cannot have painkillers everyday. After a period of time, when the pain refuses to go, it becomes a big load for your mind to handle.”
And this is only made worse because of the lack of empathy from people around.
“You tell people and they refuse to believe or understand.”Divya
She didn’t just have to deal with pain — but also with the stigma and unawareness surrounding it. Her anxiety and depression, in these terms, followed her physical ordeal.
For Michelle, her mental symptoms are a tell that her pain is about to aggravate. She has an autoimmune condition with symptoms similar to Celiac disease. For this reason, she tries following a strictly gluten-free diet. “My relationship with pain comes from joint pain, muscle pain, headache, and even symptoms of depression. Every time I get contaminated by gluten, all these symptoms come back together.”
“But the initial ones are psychological. Mood swings, irritability, refusing to interact with others. Even thoughts of wanting to kill myself cloud my mind. Only after two-or-three weeks do I start experiencing pain, weakness, stiffness and headaches, making it impossible to even step out of the bed. Gravity literally pulls me down.”Michelle George
She believes that her pain has diminished her cognitive abilities, including her memory. Whenever she is overworked and burdened, the aches kick in within two hours. In fact, she takes a painkiller as a precautionary measure before an important event or meeting, because it’s highly probable that the stress would bring back her pain.
Confusion, Stigma and Unawareness
“The fact that I didn’t know what was going on had an impact on my mental well-being.”
“The only way that people around me knew how to tackle the problem was to send me to a psychiatrist. My depression really stood out. I was diagnosed with generalized anxiety by the psychiatrist, even though I had been complaining about my physical and cognitive problems. I was put on anxiety medication, which failed to help me.”Michelle
It was only when she finally consulted a neurologist that she knew what had been happening to her. Imagine going through so much pain and not knowing what was causing it? How can it not affect a person’s mental health?
Divya went through a similar phase. The stigma surrounding her condition made her even hide it from others. “I even tried to cover it up. People don’t handle it well.”
“There’s a difference in how the society looks at arthritis, for instance, and how it sees fibromyalgia. There is more awareness about the former. Maybe a person who has arthritis is only in the initial stages of pain, and I am in my worst. Still I am told — at least you don’t have arthritis. You know, something that doesn’t come up in a test is treated as a pseudo-disease.”Divya
There is so much that still needs to be done and understood. She puts it rather beautifully, “Pain itself is restricting. The stigma and judgement only make it more restricting.”
‘I Could Only Deal with It When I Handled the Mental Aspect Too’
Counseling and cognitive behavior therapy is what really helped Divya, in combination with other things. She is currently on homeopathic treatment, along with physical therapy, exercises, acupuncture, floatation therapy, and a mild and customized form of Yoga. “Regular Yoga classes tend to be too vigorous for me.”
She explains that her counselor visits helped her change her perspective towards pain.
“Perspective is something that changes a lot when chronic illnesses inflict you. Talking to someone who tells you that your pain is real, gives you validation that you aren’t imagining it. That makes a lot of difference. It doesn’t make bearing pain any easier, it just helps you better manage it. So you can say that I only really dealt with my chronic pain when I addressed the mental aspect of it too.”Divya
On the other hand, Michelle hasn’t had a very pleasant experience with psychologists. “In my experience, the psychologists were never in tune with the other doctor or the neurologist I was seeing.”
“They tend to attribute all my physical symptoms to depression, and then suggest something that may not really be of any help to me. For instance, you can’t simply tell me to exercise to improve my mental health. I have muscle weakness, so exercise actually makes my symptoms worse. So I feel there’s a disconnect.”Michelle
She adds that if she does find a psychologist who understands her and is in tune with other doctors, she might not be able to get a wholesome treatment. Until then, she will just be focusing on her diet.
Dr Natasha Khullar is a neuropsychologist at Medanta, Gurgaon. In conversation with FIT, she brings out the importance of acknowledging both the mental and physical symptoms of chronic pain. “There is a lot of evidence to show that even with lower back pain, cognitive behavior therapy is equally effective as painkillers and physiotherapy.”
“The body and mind are intricately connected. Every time our mind is under some sort of stress, it releases chemicals in response to the stress. Simply by doing that, it stifles the muscles. So if you stay in stress for a long time, the body tends to stiffen up. Now imagine how bad it could get if this continues for a month or for years, as is the case with chronic pain.”Dr Natasha
She explains that it works in a loop — with no definite first. Your stress could cause your physical pain (or it could be the other way round) and then the pain could cause further anxiety. It keeps going on. Painkillers themselves are mood-altering substances, but their effect is short-term and they are addictive. So they’re not a sustainable option in the long-run.
“Along with treatment for the physiological problem, mental health needs to be addressed. It helps you to train your mind. It makes you accept that some days would be hard. So with medication, physiotherapy and neurogenic pain relievers, counseling must be considered.”Dr Natasha
A 2019 Lancet report focused on the way people with mental illnesses have an increased risk of physical disease. It stated, “The high rate of physical comorbidity, which often has poor clinical management, reduces life expectancy for people with mental illness, and increases the personal, social, and economic cost of mental illness across the lifespan.”
This brings us back to where we started: The urgent need to stop isolating mental and physical health. It only denies a person the necessary information to deal with all aspects of his/her problems. And it’s not just chronic pain. Almost all conditions affect mental and physical health significantly, if not equally.
Break the binary. It’s time.
(Chronic Pain India is a support group for chronic illness and chronic pain sufferers in India. If you are a pain sufferer or have a family member or spouse in pain, feel free to reach out.)