When Chronic Illness Feels Like Depression

Am I depressed or just sick? Am I depressed because I am ill? Am I ill because I am depressed?

The National Institute of Mental Health provides the following list as signs of depression:

  • Feeling sad, irritable, or anxious;
  • Feeling empty, hopeless, guilty, or worthless;
  • Loss of pleasure in usually-enjoyed hobbies or activities, including sex;
  • Fatigue and decreased energy, feeling listless;
  • Trouble concentrating, remembering details, and making decisions;
  • Not being able to sleep, or sleeping too much. Waking too early;
  • Eating too much or not wanting to eat at all, possibly with unplanned weight gain or loss;
  • Thoughts of death, suicide or suicide attempts; and/or,
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.

Think about that list. Most of the items, with possible exceptions of the final two, are fairly common in cases of chronic disease or illness. For the individual, this can create uncertainty regarding mental, or even physical, health. If the root cause is unclear, so too is the treatment plan.

What does this mean for the individual? I think it means that those of us dealing with chronic illness need to take it easy on ourselves when we can’t maintain a positive mental state. It doesn’t mean we should give up, but we shouldn’t feel so guilty.

What does this mean for caregivers? Patients with chronic conditions may need treatment for depression or they may need to be reassured that these feelings don’t necessarily mean clinical depression. Caregivers may need to spend more time talking to patients to get at the psychological and emotional issues, and maybe be prepared for some tears, or guilt, or anger.

What does this mean for family and friends? The person you care for may not be able to be as fun as you want, even during times when the illness seems to be under relative control. Your loved one may need you more mentally or emotionally than physically, but simultaneously may feel an abundance of shame about that. And you may, in turn, be angry or frustrated and need to find someone else to talk to about it.

The interaction between chronic illness/disease and mental wellbeing is complicated, like people are. We can’t expect it to be simple or easy, whether we are the patient or those offering support.

Yoga and Chronic Autoimmune Disease – Why It Really IS For You

I’ve talked before on this blog about yoga and pain, considering both the ways that pain can be eased into through yoga, and how I relate my practice to dietary choices and having rheumatoid arthritis.  In recent weeks, it’s been on my mind again, as I deal with some medical issues and all of the attendant doctor visits, tests, fretting, etc. and the physical symptoms as well.  The more I practice, and the more I think about it, the more convinced I am that yoga is not only appropriate for individuals with chronic autoimmune disease, but extremely beneficial and maybe even necessary.  In this post, I consider five primary reasons for this viewpoint.

First, yoga is a practice that can be completely adapted to individual ability and need.  Weight, fitness level, agility, flexibility, medical concerns, and so on – all are extraneous to the ability to do yoga.  There is a practice that will work for everyone, whether an asana practice, a pranayama practice, meditation, devotion, or some combination of these.  This is important for individuals dealing with chronic autoimmune conditions, as the abilities and needs of the body can vary widely due to such conditions, and change from day to day.

Whether a pranayama or asana practice, and regardless of the level of intensity, yoga can aid in strengthening the body.  This includes encouraging and supporting lung capacity, building muscle, increasing muscle elasticity, decreasing stiffness of fascia, and aiding in joint mobility.  Because many chronic autoimmune disease conditions affect these elements of the body, yoga can actually work to reduce or assist in management of physical effects.  In the case of rheumatoid arthritis, while yoga may not reduce the underlying inflammatory response that creates the joint problems, the strengthened muscles around joints and enhanced synovial circulation can ease the symptoms.

Dealing with chronic disease can be stressful; it is “dis-ease,” after all.  When attempting to manage the merry-go-round of medical visits, decisions, medications, and physical issues, it’s very easy to have the mind head (haha!) into a frenzied spiral of vrtti that just won’t slow down.  Questioning and reviewing the past (What did I do to cause this? Do I feel better or worse today than yesterday? Do I usually have this sensation in both legs equally or more one than the other?) is not only a common outcome but also a required part of answering the questions raised by caregivers.  Planning ahead  may also be needed (Ok, if I’m going to go to the mall later, I need to lay down for a while now), but can pretty quickly drift into an ongoing series of “if-then” thoughts about the future that can be scary and likely serve no purpose.  As one of the purposes and definitions of yoga is the control or stilling of the fluctuations of the mind, it can be extremely helpful for someone managing a long-term condition.

As I discussed in a prior post, I believe that yoga can alter the individual’s relationship with pain.  We are conditioned to view pain as a sign of danger and to flinch (mentally or physically) away from it.  That’s fine, but when an individual has chronic pain, there may be nowhere to go that the pain isn’t present.  If all pain activates the fight or flight response, and pain is constant, it can be very detrimental physically and mentally for the individual (and for those around him/her).  In a yoga practice, we are encouraged to really focus on the body sensations in a way that helps us to see the difference between full pain and discomfort, and to distinguish between the kind of pain that indicates damage being done and the kind that is just a feature of the pose.  Such understandings and reactions to pain can then be brought into the rest of life for the individual with chronic pain and help him/her to more quickly distinguish between the sort of pain that must immediately be attended to and calls for fight or flight and the kind that can be breathed through or relaxed into and then becomes more manageable.

Finally, and not finally because it’s least important, yoga provides a place to really “be.”  Given all of the issues discussed above, it’s awfully easy with a chronic medical condition to feel like you are never really in the place you are.  The mind is either spinning here and there planning, rehashing, and diagnosing, or the body is attempting to run or fight.  A yoga practice encourages us to be mindful – to be in the moment that we are in, fully experiencing that moment and all that it is.  That’s a lovely thing, even when part of that experience is discomfort.  In a 90-minute practice last night, even though I have been having a lot of discomfort this week, I spent probably 82 minutes really on my mat. I wasn’t thinking about medical tests or diagnoses; I wasn’t planning the future full of what-ifs; I wasn’t craving sleep as a way to escape from the pain; I wasn’t feeling angry about the situation or negatively assessing my uncooperative body.  I was just doing yoga, listening to my instructor, breathing, flowing in and out of poses, moving my body.  It was so good and felt like such a blessing.

For all of these reasons, I would argue that people with chronic autoimmune disease should embrace, not avoid, yoga as a practice and way of being in the world.  I can say with certainty that it has been good for me.