I have always had troubles admitting to the emotional toll pain has on me. Something about that stoic facade I have gripped onto from years and years ago because some doctors are simply incapable of understanding that pain can cause emotional distress rather than say depression being the sole cause of all our ails. Plus there is this insane desire to not admit to weakness as if struggling with pain is a weakness. Especially when every year it is worse and treatment is never making it better and doctors don’t seem to get it… or anything. I did not even like to admit the emotional toll it was having to myself. I liked the denial and the comforting lies I told myself that helped me endure. It is easy to do when pain contorts your perception of time and hazes your memory so very well. I could have a Very Bad time enduring work and the stresses of having my employer threaten my employment or just make me feel guilty or worthless for being so damn ill, such that with all the pain I was enduring to just Survive I would magnify all those little bad thoughts into Big Bad Thoughts. But just for a small time frame. Never too long. The extreme intense pain passes and it is back to just surviving and small bad thoughts. And I would let myself forget how bad it was. Over and over again I would just… let it go, because holding onto such things is not good right? I would rationalize that everyone with that much pain enduring full time work would at times feel that horrid deep dark depression that comes with such horrid intense pain episodes. It is only natural. In fact, it is part of a migraine at times. Wait it out and then just forget about it. Until thoughts becomes actions and you can’t afford to lie to yourself about how powerful or frequent such things are… or how triggers like employers causing such stress can cause such profound emotion, because my day to day survival is difficult and beneath the facade it is strained and I am so very tired… such that any little thing can be quite devastating. Even though all my coping tricks to survive day to day worked fairly well in pushing back depression… because I knew how insidious it can be and how thoughts can curl up inside your brain and twist around in there… and I would not let them. But some intense pain… some additional stress and all bets are off.
I get that for the last couple of years the combination of a lack of hope, disillusionment with doctors and the inability to believe I can cope with pain during work for a long period has strained me emotionally such that my equilibrium was thrown off. My threshold for stress was thrown off. I lost my will to fight with my employer and doctors because I expected things would not go well for me because things did not go well for me. And I admit I was quite aware on some level that I was depressed because either I did not care at all about anything or the smallest things would trigger the most intense reaction. But I had suffered a bit of a trauma and I thought eventually I would shake it off and if I did not… did it really matter? Clearly I decided it mattered enough to see a psychologist because I was beyond the shock of it all to at least try and fight a little even if I did not honestly think it was going to make a difference. Which is what I am still doing.
So I am getting my doctor to fill our my long term disability forms and my psychologist believes it is a good idea to mention the depression because it might help with the claim. Because no one gets chronic pain apparently but they get depression. And the depression I have is directly correlated to the pain. I loath that by the way. I said one day that I did not understand why I could have such intense reactions to such small things… like my neuros rather brief and unhelpful email reply to my carefully structured email. She said it made perfect sense because of the chronic pain and the lack of sleep my serotonin is rather low and it takes very little to make it plummet. I loath it because it is irrational. You can’t out-think it. I remember when I was younger and had early FM I was depressed about it and not coping with the pain… I got out of that depression with some self cognitive therapy and that is how I try not to sink into a serious depression now on a everyday basis, pain corrodes that a little but there is still a framework for it to work. Anyway, migraines and acute pain can cause a depression that is profound, rapid and irrational. It is not the same thing at all. When the pain is managed it is a bit better. When I’m not working it is a bit better, which is why I fear work. It is clearly worse now, after my suicide attempt than it was before… because before I had these little blips and then pretended they did not happen and pretended I was fine and I had this sliver of hope and I thought if I just fought through the pain there would be a light at the end of the tunnel and I would do this repetitively until I was forced to go on short term leave and then start all over again forgetting how hard it had been the previous time… and after I realized my doctors could not care less, there was no hope, I would always fight this pain and it would always be this way and I could not even trust myself in one of those darkest moments of pain. And I can admit it makes a huge difference in how I see things. And I said to my doctor that my psychologist said I was depressed and she would be sending a letter to go along with my claim to explain the details. And he of course… recommended a anti-depressant. And then asked if I thought I would be ready to return to work on some sort of accommodation… I must say, I think he should have thought about that before saying it. But he said it. To my credit at least I said… no, don’t think that would be such a grand idea at this point in time. When in fact my anxiety actually went quite high at the very thought and then that sort of… dread. But clearly… he does not freaking get it.
Point being I get how I got to this point and fully appreciate the irony of it as well. And I am looking for a new doctor who perhaps comprehends the nature of chronic pain and how it can cause depression. But at the same time I hate admitting it out loud. Like saying it gives it power… power I denied it before by simply… denying it. Obviously denying it did not work. Obviously suppressing emotion and just surviving day to day eventually breaks a person… but after they are broken, what breaks them even more is having doctors who don’t get it at all and don’t put any effort in helping that person heal a little. But actually accepting the label and discussing it and so forth seems to just bring it out more… seems to give the pain more power. I want at least the illusion of strength and to wear a stoic facade. So I understand the nature of pain, migraines and brain chemistry and how it all came to be. I understand my positive coping strategies and how to avoid negative thoughts. And I understand nothing is simple. I understand I have to get my current doctor to understand to some degree the seriousness of the situation so he can fill out those forms properly and I understand that he does not. But admitting to be depressed, even if it is not a continuous depression but more dependent on pain levels and external stressors, just seems like I am ripping off that mask I always wear and exposing something that should be always hidden so that it does not consume me.