How Depression Is Like Back Pain

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As a person with depression, I’m always thinking of new ways to describe it. Partially so that people who don’t experience it can understand what it’s like, and in the hope that these perspectives will help me treat it like a legitimate problem instead of beating myself up over feeling bad “for no reason.” It’s becoming common to relate it to physical illnesses like cancer and strep throat. Here’s a good one: chronic back pain.

(I don’t experience any severe chronic pain, so if I’m completely off the mark with any of this, feel free to correct me.)

Someone with intense back pain might have difficulty getting out of bed. They probably could get out of bed, even if in pain, but most people wouldn’t expect someone to push through that kind of agony unless there were pressing matters to attend to.

Some people with intense pain can’t even bring themselves to go to work every day (or at all, in some cases).

If they do go to work, they might be tired and/or sore enough to be unable to do dishes, laundry, or other house work when they get home.

Chronic pain comes and goes, and sometimes it’s more debilitating than others. One day might be bearable and the next day, even going to sit at the computer is a task of unimaginable difficulty.

It seems as though, by and large, these things are accepted and the person experiencing the pain is not shamed for not being up to the tasks before them. Unfortunately, some people do experience invalidation from others, especially if the pain is not the direct result of an injury. Then, it’s “just in their head.” Which is pretty much the attitude toward depression and other forms of mental illness.

The thing about depression is that it is painful at times. Emotional agony is just as real as physical pain. At the end of the day, it’s all just brain signals, and most people have a pretty firm knowledge of what feels good and what feels bad, whether skin sensations or states of mind.

Depression, like chronic pain, can go for periods of time in “remission,” can pop up for a couple days at a time or months on end, and can be triggered by other things. Someone with back pain might twinge something while lifting a heavy object and be stuck in bed for several days. Meanwhile, someone with depression might have a particularly stressful day at work or a heated argument with a friend or partner, thus cascading them toward depression even if they were feeling okay beforehand.

They’re both unpredictable. They’re both painful. And they’re both real. Invisible illnesses deserve as much respect as cancer or Ebola. (Though you can leave the panic at home.) Nobody should face stigma just because they’re sick.

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How Depression Is Like Back Pain
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33 thoughts on “How Depression Is Like Back Pain

  1. 1

    Not to link-spam or anything (ze said, link-spamming), but YES I AGREE. They are soooooper similar (speaking as someone with both) to the point where I think there are really useful concepts in terms of self-care and treatment that can be applied as easily for one as the other in a lot of cases.

    LINKSPAM!

    http://researchtobedone.wordpress.com/2013/06/09/depression-and-chronic-pain-are-more-similar-than-i-realized/
    http://researchtobedone.wordpress.com/2014/03/02/how-to-be-skeptical-of-your-own-brain/

    Also, totally true about the “just in your head” thing, which is particularly annoying because, well, anyone saying that doesn’t understand pain at all. I mean, technically, they’re right. My pain is in my head. ALL pain is in your head. If you lose a foot and your brain decides you should feel pain, you feel pain. If it decides you shouldn’t, you won’t. Literally all pain anyone has ever felt has been in their head. It does not come from the tissues that hurt. EVER. Danger signals can come from those tissues, and your brain decides if those signals matter or not and generates a pain experience or not accordingly. If someone thinks that makes it less real, then that person, by extension, thinks literally all pain ever is not real. It all happens because of the brain. It is literally impossible for it to happen any other way, and the brain can decide to make losing a limb painful or not as easily as it can decide to create pain where no injury exists.

    When someone says your pain is “just in your head”, they are telling you that they wasted money on their medical degree, as far as I’m concerned. You can’t say that as though it means something if you genuinely understand how pain physiology actually works. And if you feel comfortably expressing medical opinions you’re not qualified to have (because, say, you’re completely unfamiliar with the physiological mechanism behind the experience), you’re a shit medical professional.

    1. 1.1

      I love the rant about all pain being in your head. I totally agree! It’s even worse when doctors have the mentality that certain kinds of pain are less legitimate than others. x.x (Thanks for the links!)

  2. 2

    But that is not really the argument. I agree that treating depression do differently from chronic pain is bad, but are either of them real excuses? Should I get paid for not going in to work if It was raining, and rain is unpleasant? I I was pepper-sprayed every time I went to work would that excuse me from attending? These things do not make the task at hand more difficult, they merely reduce the motivation to enact them.

        1. That’s an extraordinarily reductionist way to look at how difficult a task is, as though one’s ability to complete the task doesn’t change the amount of energy needed to complete it. Like, yeah, a task takes as much physical effort, whatever. Totally ignores the fact that we’re biological entities and have differing output capacities at any given time.

          1. Biology is neither more nor less than a specific branch of applied physics. Physics is very clear, the energy required to complete a task is unchanged by one’s attitude to that task.

        2. Just wondering ” Meggamat ” whether your field is ‘Robotic Engineering’ because your values in relation to Biology are more on the level of Mechanics than Psychology & human Emotion. There is no taking of account for variables & factors governing performance outcomes such as with athletes affected by “attitude” ; producing different outcomes on peak physiology.
          The difficulty in performing a task ” does change ” ; if the mindset is negative, the decision making & resulting approach is flawed causing efficiency losses with more energy spent. Your dogma has little to do with the human condition ; only robots are programmed that way !

        3. My background is in the HealthCare Industry,,, mostly senior positions in Hospitals . What I’ve learnt over the years ; it’s mostly the more intelligent people that are inflicted with depression.
          The mistake many of them make is self analysis and treatment ; particularly when they have an incongruous personality driving them in the wrong direction . We are not good at everything & there comes a time , for everyone to seek directions and find the right avenue to be on…

    1. 2.2

      If you can compare the “unpleasantness” of chronic pain with not liking rain, you have absolutely no idea what the fuck you’re talking about. You have a deep, fundamental lack of understanding about what chronic pain is like and how it can impact your ability to operate.

      The rain analogy is the knowledge-level equivalent of “If we came from monkeys, why are there still monkeys?”

      Educate yourself first, then speak, because you have demonstrated beyond doubt that you are woefully unequipped to have an intelligent conversation about this topic, and until you actually do your homework on it, you’re going to stay that way.

    2. 2.3

      Yes, the literal energy required is the same, when lifting something heavy. But someone who lifts weights will be able to pick up something heavier than someone who is sedentary. The physical output required by the smaller person is greater than that of the large person.

      Depression and pain both actually take away from the pool of energy you have at a given time. It’s kind of like going all day without eating and then trying to exercise. It doesn’t fucking work. It isn’t about your attitude toward the task. It’s about how much energy is actually at your disposal at a time, and if you have a severe deficit, then yeah it actually does take an immensely greater amount of effort to complete a task that someone else might find easy.

      1. The amount of energy available to a human body is dependant upon the enthalpy difference between the glucose plus (times six) oxygen molecules in their bodies and their converted (post-respiration) forms. It comes down to chemistry. Look at the respiration equation, attitude does not appear in it.

          1. I do, but I, I did mention that in the past on this website, using this alias. You may posses advanced perceptive capacities, or you may simply be engaging in comprehensive research.

        1. Thanks for the literal breakdown of how humans use their calories. You’re missing the point I was trying to make, though. On a given day with depression, my access to my strength is stymied by the depression. It’s not because I don’t *want* to do a given thing, in fact sometimes I want so hard to exercise or go to the store or what have you. But my brain doesn’t work properly, and sometimes I try to do a pull-up on those days and can’t. Physically can’t. Even though I have eaten and slept well. I’m physically incapable of doing the things I normally should be able to do for no other reason than I’m having a bad depression day.

          And I’m really tired of arguing this point. It’s not about attitude. It’s not that I’m unwilling to do certain things because I’m in pain. Having depression and other painful illnesses changes your ability to tap into the energy of your body at a given time.

        2. Ok Meggamat ; I’m on this website for a very similar reason to everyone else . I have a personal problem that maybe assisted by understanding how others have handled a similar challenge . In saying that, I like to contribute & help where I can; others also think that way.

          We all have different strengths and one of mine is intuitive / perceptive capabilities & I equally empathize with the human condition ( opposite to those with Asperger’s ) . This particular area is your weakest & explains why you were using logic based formula to resolve human emotion. Not being able to place yourself in another’s situation makes your judging robotic.

          I’ve a friend with Asperger’s & very much a person of extremes ( super smart in some ways ). Likewise , when I’m in a situation of weakness, I hold back ’till I know I’m on the right path. I wouldn’t think major depression was a serious issue with Asperger’s ; I could be wrong.

          1. Admittedly, the information I posess regarding Depression is at least two degrees separate from personal observation, as I have never suffered from, nor encountered anyone (so far as i know) who suffered from the condition.

  3. 3

    ” Just in your head ” , is one of those old Cliche’s , like a casual throw away statement ( not at all professional ). Of course , Depression is deep within our brain & be an extension of our very Soul . The question as to whether it can be compared with back-pain misses the point ; “it only relates to the amount of Suffering”. Back Pain , often gets more respect due to it having a physiological reasoning but we all know the pain associated with Depression can be so debilitating ; it can drive one to suicide !

    There are more types of Pain associated with Depression than for Back-pain ; clearly there are differing degrees & duration for either but Back-pain is in ISOLATION whereas ; Depression extends to anything.
    Depression associated with Gender Dysphoria is even less understood by most of Society in that they have never suffered it ; can’t relate to it because the causation : ” lies within a disassociated domain”.
    Gender Dysphoria may not be the only form of Depression in relation to Transgender persons , but overall , it can exacerbate the affect & complexity in how to best deal with such a disorder !

    From my personal / own experience ; It’s not as bad as ” black dog depression ” ( a comparative Cliche ) however, it can be unrelenting & debilitating,,, without diversions or sufficient transitions in one’s life !
    When we look at the brain, we should also consider the Soul that is in conflict; because Gender issues cause a form of Pain resembling “water torture”; this flows on to affect the foundation of who we are !

    Every one is different ; in saying that , Depression generally has a root cause & there lies the solution.
    Problem is , few can face their true nature ; many are in at least “partial denial” of who they really are ; to them , they may perceive it as a weakness or a taboo subject ; preferring to push it to the very back of their mind . The Soul in now in conflict with the Brain ; this turmoil acts as a catalyst for Depression .
    Despite the person having done nothing wrong ; they can also suffer a form of ” guilt for living a lie “.

    Stress is a common factor with both Back-Pain and Depression ; One can stop lifting heavy loads for one and one can stop carrying a heavy burden for the other,,, to lessen the Pain ! Many of the great achievers in History suffered from all forms of Depression & their private lives were badly affected…
    When it comes to Respect for depressive disorders ; the worst injustice further comes from Health professionals that often display dissonance or are outright disparaging for the lesser known areas of Depression ; thereby adding to a persons Pain… I think we’re on the same page Lux… your thoughts ?

      1. When I think of Souls , I don’t mean from a Religious context ; more as one’s subconscious inner self. I should confess ; I don’t follow any organised religion,,, although I do acknowledge a spiritual side to life that’s quite separate from religion .

        There is another aspect with Back Pain & Depression ; with either, it is difficult to smile and find true happiness ” without some active relief “,,, Honestly , I would not be alive today without coping methods. My career & hobbies became my diversions for survival ; given all those years of gender dysphoria where there was no complete cure .

        It is clear to see that you are a very capable person Lux ; finding more coping methods that fit your competencies and interests ; maybe your solution – (ones that don’t conflict with you ). It is so very wrong , that good people suffer for just being different ; best wishes to you .

  4. 4

    Been there… It’s terrible how you are made to feel guilty for something so out of your control.

    I got out of it via a combination of CBT, stable life, better friends, better job, this article, and SSRIs.
    But you have probably tried all of them already.

    More to the topic, I wonder if rather than saying “depression” I say that I have “a serotonin imbalance in my brain” people will judge me less.

  5. 7

    Interesting post, and fascinating comments.

    I’ve had chronic pain my entire life – various ‘diagnoses’ have been thrown at it over the decades, and eventually one stuck – Ehler’s-Danlos syndrome, type III (Hypermobility). It affects every part of my body, from my brain to my toenails.

    I also had bouts of severe depression, which I realised only relatively late were related to gender dysphoria; once I’d gone through an early menopause after total hysterectomy in my thirties, it has never returned – despite vastly increased pain and disability.

    And I’m autistic.

    Meggamat, human bodies are not machines, even if machines can be used as analogies. So, keeping this in mind, I give you an analogy you might understand.

    The amount of energy available to do work with a human body rather than a machine varies continuously, because not all the energy we consume goes directly to our muscles the way fuel is available to the working parts of a machine; and, rather as engineers come in regularly to service machines, we need at least daily rest in order to repair damage (which accrues continuously).

    Our brains consume a disproportionate amount (mass for mass) of the fuel we take in. And if our brains aren’t working efficiently because of depression, then they consume more energy, leaving less available for work. Also, instead of resting at night, they continue to work – reducing time for repair and therefore reducing efficiency.

    Something similar happens bodies in chronic pain. Large amounts of energy are diverted to making running repairs and so are not available for work, and the brain continues to monitor the damage and generate pain sensations throughout the night instead of resting.

    Think of how you cannot do anything, even pleasurable things, when you have flu – the energy is being diverted to your immune system, and isn’t available for work; and although you sleep far more than usual, your brain is still tired from monitoring, and warning about, the disease.

    Many modern machines are equipped with sensors and over-ride systems which shut them down in the event of reaching critical states, to avoid permanent damage. No amount of button-mashing, key-turning, kicking or cursing will start those machines up again until the problem is fixed.

    Our brains have an over-ride system.

    When in the worst lows of depression or pain, the over-ride cuts in and refuses to allow us to risk further damage to ourselves by doing work – we simply cannot push through it, the over-ride won’t let us.

    ~~~~~~~~~~~~~~~~~~

    As for “It’s all in your head!”: my doctors have taken advantage of the fact that pain is perceived in the brain from signals generated by damaged tissues.

    I can no longer take any kinds of NSAIDs, because earlier this year my liver became damaged by them (fortunately, it is healing nicely after just two months). So, although I’m not treating the damage, my brain can be tricked into thinking that there is less damage, instead of more, by blocking some of the receptors with an opioid. So I have a patch which delivers a tiny amount of buprenorphine – 10µg/hr – continuously through my skin.

    And, of course, the effects of certain kinds of depression can be mitigated in some people by chemicals too, whether those be SSRIs or something else.

    So, the response to “It’s all in your head!” is now “Exactly. So what are we going to do about it?” =^_^=

    1. 7.1

      Love the analogy “Tigger” plus the plain speaking way of unravelling the working of the brain. Obviously you’ve been along a rocky road,, but it appears to be heading in the right direction. Bit by bit ” it’s all in your head ” mystery is one step closer to finding answers for depression…..

  6. 8

    This is pretty accurate, I have both. The depression comes and goes but the pain is forever.

    Being female, you get used to docs assuming everything is in your head, as in, made up, so they do nothing (I can only speak to my experience as a female, Im sure trans gets the same or worse).
    Add that to the insane regulations on pain meds (the ones that work), and you can be miserable forever, even IF you are “lucky” enough to have a condition and dx docs actually accept (just try to get treated for fibro or soft tissue pain, or a mental health issue that doesn’t fit neatly into a box).

    I also think depression is a response to the world we live in: The oppression, harassment, daily micro-agressions many of us face, the destruction of the ecosystem and our nasty capitalist system. Who wouldn’t be sucked dry by this???

    (I know this post is old but wanted to comment because it’s a topic near to me)

    1. 8.1

      #Solidarity on things being even more likely to be dismissed when you’re female (or perceived as such).

      My depression definitely gets worse when there’s shit going on in the world (thinking about police brutality makes for some sad days) but unfortunately it’s a disease that I’ll probably never live without, even if everything is hunky dory =/ SUCH IS THE WAY OF BRAINS

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