I’m not depressed!
And besides, wouldn’t you be if you were in pain all the time?
I know this conversation all too well. It is a conversation that takes longer than the 15 minutes we are given with our doctors. Why do doctors keep bringing this up? We worry that talking about our emotional state could label us. Doctos will assume it’s all in our head and our concerns and symptoms will no longer be taken seriously. These concerns are valid as I’ve, unfortunately, seen issues go unchecked in patients where too many assumptions were made. But despite this real concern, we shouldn’t dismiss the opportunity to investigate the way emotions may be impacting our symptoms.
A concept to consider
Our emotions can lead to physiologic changes within our body. We already know this. We readily accept this idea in multiple scenarios. Consider fear. When faced with something terrifying, we accept the racing heart and sweaty palms as a consequence of that fear. (This can be so strong, in fact, that merely thinking about what scares us can elicit these responses in the body) These real changes occur in our body because of an emotion. Consider sadness. We feel disconnected and have trouble concentrating. We experience a change in appetite; some more, some less. You undoubtedly felt this during your last heartbreak, We know panic attacks lead to chest pain, palpitations, and trouble breathing.
These are very real symptoms. They are tied to events, however, that are temporary, momentary. But emotions can also lead to long-term or chronic body symptoms. Chronic emotional states lead to ongoing physiologic changes in the body even if they can be harder to see. Headaches, migraines, stomach pain, pelvic pain, joint pain, fatigue, and brain fog can all be tied to long-term emotional states. It can be challenging to identify and make this association because the emotional state, even an unpleasant one, can become our normal.
Treating the brain & the body
Therapies these days focus on treating both the central nervous system as well as the peripheral, the brain and the body. This stems from an acknowledgment that, the brain is a part of the body (obviously). For many, to have success relieving medically unexplained symptoms, one needs to focus on both these areas. Effective medications with previously poorly understood mechanisms of action are now recognized to obtain their desired effect through the nervous system. And is not all about medications. Therapies used by humans for hundreds of years also do this. This includes meditation, yoga, walking in nature, hanging out with friends, having good social interaction, and creativity. These interventions impact both the brain and the body. We can’t separate the two when addressing complicated or difficult symptoms.
“Don’t call me depressed”
In my opinion, we are overly reliant on the word depressed. It is not nearly specific enough. When we think of a depressed person, we conjure up an image of Eeyore. Crying, blue, mopey. That’s not the way a lot of us feel. Using the word depressed can get the conversation off on the wrong foot. We need to be more specific. Anger, anxiousness, fear, grief. Being more specific about the emotion is the first step to acknowledging its impact on someone’s health. Once we know what the emotion is, we can then begin to investigate ways in which that emotional state might be affecting our physical symptoms.
I want to be clear. It is necessary and reasonable to do appropriate testing for all physical symptoms. At the same time, however, it is imperative we investigate how our emotional state exacerbates or produces those symptoms. They are BOTH necessary to provide comprehensive care. We cannot assume physical symptoms are solely related to our emotions. But we also cannot assume they don’t play a role. Regardless of the ultimate diagnosis, beginning to turn inwards and understand the impact our emotional state has on our body will only help us get back our health. This is true with every condition but especially with autoimmunity. It is well established that autoimmune symptoms can worsen with stress and other heightened emotional states. You can only benefit from beginning this inquiry early on.
Questions for your doctor
If this issue has come up and created a divide between your and your doctor, I have some questions you may consider at your next visit.
- I understand that my (insert emotion), could be contributing to my (insert symptom), however, to make sure that were not missing anything, are there any other tests or consults you would recommend I pursue?
- What strategies would you recommend I start to investigate to address this problem?
- Have you seen cases like mine?
A doctor’s experience with cases like yours can improve your chances of getting the care that you need. Asking your doctor about their experiences and their comfort level is not confrontational, it is compassionate. You are showing compassion to yourself and putting your health first.
Mental health = Physical health
Please remember that mental health is physical health and physical health is mental health. They are the same. A comprehensive and caring approach to any symptoms must include consideration of your mental health. We all, doctors included, need to expand our understanding of health and disease to make room for the idea that our emotional state drives certain symptoms and then incorporate that idea into our regular workup. Doctors and patients alike are comfortable with the typical bloodwork, x-rays, CT scans and various other testing necessary when investigating new symptoms. We should also become comfortable with and normalize an internal workup of our emotions.