Depression

It’s All in Your Head:

The false dichotomy between physical and mental illness

It used to be thought that different illnesses were the result of demons and evil spirits. In the bible for example there are instances of epilepsy that are treated as demonic possession. As physical explanations were found for different disorders, the supernatural explanations were abandoned in favor of scientific ones.When it comes to mental health disorders however, physical explanations are harder to grasp and find. Not because they don’t exist, but rather because a lot of brain related research is either not possible with our current technology, or must be undertaken with great care for ethical reasons.  As a result, our society has created a separation between physical illnesses and mental ones.

On some levels, this separation make sense. When we think of physical illness or disability, we think of some physically embodiment. Take Crohn’s for example: with the right equipment one can point to the inflammation and ulcers in my intestines as an explanation of why I am feeling the way I am feeling. With mental illness, however, a lot of times we are dealing with something a bit more intangible: emotions and thoughts.

This separation is a false one however, that actually creates a lot of misunderstanding and harm. Because we see mental illness as dealing with something intangible like emotion, there is a social perception that mental illness isn’t real. That it is “all in your head”.

The truth is that mental illness is as much a physical thing as any other illness or disability. The brain is as much a part of the body as a leg or intestines. Depression, anxiety, and other such conditions may manifest themselves in part as emotions and thoughts, but those are expressed symptoms of underlying conditions in the same way that pain is an expression of inflammation or injury.

Moreover, it ignores the fact that all perceptions are “in our head”. If you consider pain, for example, while our bodies processes the injury causing the pain at the point of injury, the actual experience that we call pain is processed in our brains. This doesn’t mean pain doesn’t exist. In fact, we know that pain not only exists, but it is necessary for our survival. We know this because of individuals with CIP (congenital insensitivity to pain), a condition where people cannot feel physical pain. People with CIP need to consistently measure their body temperature and be very careful because it is possible for them to injure themselves, like break a bone, without realizing it.

Every tactile experience, every visual one, every auditory one is processed “in our heads”. If you say that mental illness isn’t real because it is “in your head” you are essentially saying that every experience we have isn’t real. Our whole lives are lived in our heads.

There are physical symptoms of mental illness as well. Many people who have depression experience joint pain, as well as fatigue. Anxiety can cause your blood pressure to spike, can cause chest pains, nausea, acid reflux, and a whole host of other symptoms. There is absolutely a physical component, so treating it as if it is something separate ignores important aspects of mental illness.

Moreover, treating mental illness as separate from physical illness or disability, ignores the fact that physical disabilities and illnesses often occur in conjunction with certain mental illnesses. Specifically, many people with disabilities have more risk factors for depression, anxiety, and PTSD. This can be the result of the imposed social isolation that many people with disabilities experience, or in some cases may be a result of their illness. For example, Crohn’s Disease, in addition to the pain and physical symptoms that can increase the risk of depression, the inflammation of the intestines can also lead to a lower absorption of Vitamin D which can result in depression.

Because physical and mental illness are treated as separate, those of us with disabilities are not given adequate access to mental health care. In an ideal world, every person with a chronic illness or disability would be given access to a mental health professional who would manage their mental health in conjunction with their physical health. The connection between the two would also make it easier to argue for social contact as an accessibility need.

The way the world is set up now, people with different types of disabilities experience social isolation as a matter of course. This can be as a result of symptoms, or often as a result of insufficient accessibility. Because mental health and physical health are seen as separate, the idea that disabled people are prevented from being able to socialize effectively due to barriers such as transportation or even just on-site accessibility, is not seen as a big deal. Government officials see closing down programs and businesses that encourage and enable disabled people to socialize as risk free. People feel the need to vandalize playparks that are set up to be accessible to disabled children.

The false dichotomy is actively harmful to all disabled people. It enables people to ignore the needs of the mentally and the physically ill. It is meant to divide and shame. It is meant to pit us in false competition with one another, in the hopes that it will distract us from the systemic ableism that is so ingrained in our society.

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HOW ADHD SHAMING ALMOST KILLED ME

TW: Discussion of Depression and Suicidal Ideation, descriptions of self-harm.

Just getting diagnosed with ADHD was a struggle. I remember the doctor I was seeing at the time giving me a lecture about drug seeking behaviour. When I pointed out that there were easier ways to get drugs than trying to get an appointment with a psychiatrist she relented but asked me why I wanted to be diagnosed if I wasn’t in school anymore.

The cultural perception of ADHD is that it is just a matter of too much energy. You hear all sorts of people extolling the virtues of good old fashioned exercise, or warning people about the dangers of giving children drugs similar to amphetamines. No one takes the time to think about how medications work. This is evident when they start talking about Ritalin or Concerta being the sit down and shut up drug.

ADHD changes the way you think. Not what you think, but rather how you think. It falls into the category of brain conditions that are considered neurodivergent.  It also has a high rate of comorbidity with autism. It’s not just “undisciplined” or “lazy” kids who need more exercise, it causes structural changes in the brain and can even impact how you react to different medications.

Most people however still have a hard time believing that the condition even exists.

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From the Ashes

Four years ago today, my house burnt down. I still remember the call. I was home sick, staying with Alex at her place near campus, when my roommate called me. At first I thought it was all part of some elaborate joke, before she started telling me that the roof had caved in, and that firefighters were still there trying to put it out.

The fire had started at our neighbours’, and then to our building. After hours of fighting a fire that ended up consuming three houses, they finally had to bulldoze the building to the ground. I lost everything.

In many ways I was lucky: I had a place to stay, I had a couple days’ worth of clothes as well as my laptop and charger from spending the weekdays at Alex’s. The university gave me a quick emergency grant and so I was able to buy some more clothing and replace the school books I had lost.

I had tenant insurance which helped me get a new apartment. In the meantime I had to make an inventory of everything that I had lost along with its approximate value.

Imagine that for a moment; losing everything. Imagine all the sentimental items you have, the photographs, your favourite book. There are things that can never be replaced that are gone forever. Just a few months earlier, my parents had taken the family to Poland to celebrate their 25 wedding anniversary. While there my aunt, who is an artist, gave me one of her paintings. I dragged it with us across Europe and back home. It hung on my wall for such a short time before it was lost forever. On the same trip my parents showed that they were becoming more accepting of my career as a writer by giving me a quill set. I had never even had the chance to use them.

I lost books that I had had autographed by favourite authors. Each of those had a story that went with it, like how I got to see Margaret Atwood talk about starting the Writer’s Union on someone’s front lawn. She said such nice things to me when we spoke and she signed my book. Or like Charles De Lint, who when my ex told him that I was a big fan brought a signed copy of his limited edition Yellow Dog. Those are keepsakes that cannot easily be replaced.

My yearbooks were all lost, as were the various awards I had won. Gone was the biology prize. Gone the various debating awards.

How do you put a price on all this?

In other ways however, I wasn’t lucky. Because of health related concerns and bureaucracy, I knew that in the next several months I would have to stop accepting aid for my parents. I had to save the majority of the check that eventually came in to pay for tuition for the next year. One doesn’t realize how much the various possession we accumulate over time add up until you suddenly have to replace them all at once. For years afterwards, even to this day, I have found myself missing some item, some tool, which I had had previously and been unable to replace.

A loss such as that, followed by years of poverty, can mean difficulty for a long time. Most of our furniture we found on dorm move out day, when people tossed the things they couldn’t bring with them. I don’t have a lot of clothing, and most of what I do have comes from Value Village.

The loss of my home sent me into a reawakening of my Crohn’s flares. Instead of getting better like I had been previously, I started getting worse again. I spiralled into depression which took me a long time to figure out. I absorbed the shock of the loss and became instantly numb, except that as time passed I couldn’t quite get feeling back. Numbness becomes oppressive after a while. You yearn desperately to feel again, but you almost can’t remember how. You laugh, but you don’t really feel joy. Tears fall from your eyes and you cannot stop them, but you don’t understand, because you don’t feel sad.

I wonder sometimes if I had been there, if I had seen with my own eyes, if it would have bestowed some form of closure, some acceptance of what happened. Even years later it sometimes feels like I just picked up and left everything. The fire ended up on Youtube, but it is still not the same. It is hard to believe that everything is just gone like that, and even four years later it doesn’t seem entirely real. I don’t know that I ever really grieved. There was never any time. There was always something more pressing. Maybe this is me grieving. And maybe someday I will be able to rise from the ashes, reborn.

YSI Excerpt: Disability and Mental Health

When struggling with pain, constant fatigue, nausea, malnutrition, loneliness, and a variety of other symptoms, it is not hard to believe that it is common for people dealing with chronic illness and disability to be vulnerable to depression. Whether this is because at times everything becomes overwhelming, due to circumstances influenced or worsened by your condition, or because of deficiency in necessary vitamins and chemicals, it doesn’t ultimately matter. The result is the same: depression.

With all the concern about managing your apparently more serious chronic symptoms, it can be tempting to simply ignore the mental health concerns. It makes sense that you are depressed. Who wouldn’t be if they lived like you? You already have all these other drugs, do you really mean anti-depressants. It’s not like you are going to hurt yourself, you don’t have the energy. And even if you did, would anyone care? You would stop being a burden. No one would have to worry about you anymore. It would stop the pain…

Just like that the depression becomes severe and cause for concern. At the worst moments during a flare, you might be stuck indoors for long periods of time alone. You might be in a hospital bed, your only human interaction the occasional visitor and the nurses, not to mention the person who comes to take your blood every morning. Regardless of whether you see a lot of people or not, you are stuck in one place for a long time. Imagine having to spend your entire day in a small, somewhat uncomfortable bed.  The only time you get up is to go to the bathroom, and to do that you have to push an IV pole that is attached to your arm.

Even if you aren’t hospitalized, the exhaustion can create the same results at home. After a while it starts to drain you even further. Your life starts to stretch out before you, and endless miasma of pain and boredom. You don’t even have the energy to watch TV. You just want to lie in bed, and wish you could get up the energy to have a shower.

What can further complicate the situation is that symptoms of many chronic conditions and depression overlap: fatigue, difficulty falling asleep, lack of energy, pain, and so forth. It can be difficult to tell when you are dealing with one thing or another. Are you unable to get motivated because your Crohn’s kept you up all night, or because your depression is making it hard to care about anything? Is the exhaustion mental or physical? Is my joint pain a physical response to inflammation or to psychological pain? Moreover, sometimes physical pain can cause the psychological pain. It all intertwines until it is almost impossible to tell.

Despite the frequent connection between disabilities, illnesses, and anxiety/depressive disorders, the medical community still has a hard time understanding the correlation. Frequently depression, anxiety, or any psychological diagnosis is treated very negatively. Even if you have a documented disorder that you are getting treated for, a diagnosis of any psychological condition could mean a decrease in the quality of care. Suddenly, every trip to the doctor or ER becomes suspect. Some doctors will wonder if you are faking your symptoms in order to score drugs, while others will assume you are over reacting or confusing mental symptoms with physical ones. It creates a situation where there is an incentive for people with chronic conditions not to seek help for their related psychological conditions.

I have seen this manifest personally. The usual procedure when I come into the hospital is to be given an anti-nausea agent and pain meds. Regardless of whether they think I need to be admitted or not, the usual assumption is that if the pain is bad enough for me to feel the need to come in, then controlling the pain is a concern. On one such occasion, I noticed a slight change in how I was treated. Usually there is an effort to reduce my pain symptoms as quickly as possible. This time around, it seemed that there was a hesitancy to do anything about it. I was offered some anti-nausea medication, but not once was there even a mention of anything to do about the pain.

When the doctor came in to see me, the first questions were not about why I was there, but clarifications about my last visit to the hospital being labeled “psychiatric”. I was confused, having never come to the hospital for anything mental health related.  I wracked my brain for every time I had been to the hospital in the last few months: visit with my gastroenterologist, visit with my rheumatologist, weight management clinic…. Bingo. It seems that the clinic that my GI had sent me to to see about getting help in losing weight with the difficulty of Crohn’s and arthritis, registered as a psychiatric visit on my hospital file.  In combination with my medication for anxiety and ADHD, they has assumed that I had come in to be treated for something else. The pallor of having sought help for a mental health problem changed how they viewed my physical health. I never was offered anything for pain, and I was sent home without any satisfactory aid for what was wrong with me. For the first time I was given the answer that it was “just Crohn’s”. A condition that had such a profound impact on my life was suddenly seen as no big deal because of one tick on my chart that might suggest that I also had depression. That the Crohn’s might be the cause of the depression was never considered. That a person can have two things wrong with them and have them be equally valid and serious was never considered. No clearly, despite the fact that I had a documented condition, depression, anxiety, or any other form of mental health disorder had to mean that the pain was all in my head.