Introduction: Why tend to all three?

Because they seem to feed each other to create a perfect storm. That’s why I tend to all of them. It seems to be necessary. I’ve handled people for a few years now and it’s rare to see just one of the troubles. Looking at the entire problem is necessary to tend to these people – and it’s necessary to notice all three then.

Long term pain turns into chronic stress and depressive issues.
Depression is a constant stress and might have physical pain as a symptom.
Burnout comes from long term stress and can give both depression and physical pain.

Then there’s the interesting part – how does one reason when treating this stuff? Question everything is a great start. Ask “why?” again and again. “Why?”

This is the fun – and likely the useful part I love when tending to people. It’s pragmatic and it takes us to the core. Unless we treat the reason, the true problem, we’re not getting anywhere. One could do it the pill-way; try to remove as much symptoms as possible with pills, but I’m baffled by how much we try to do that when it’s so rare to see it work with these things, but that’s not the point here. It’s the interconnections between the three.

And well… To see the interconnectedness it seems to be enough to just look at the cases. There’s rarely just one of the three – and if there is just one of the three, people often say they’ve been bothered by some of the others more or less recently. One could question “Where’s the difference between the diagnoses?” as well. There’s an obvious difference between physical pain and the feelings of meaninglessness. Anxiety, inability to sleep and gastrointestinal troubles aren’t easily mixed together… However, some diagnostic criteria say that if you’ve got one you can’t have the other. It’s instantly disqualified. Burnout and depression interfere with each other, at least in Sweden, where people actually do get sick leave for long term stress once they get ruined enough. Sometimes not at all. Sometimes for years. Social “safety”-net. You’re not sure if it’s there.

Diagnoses are great. To bunch people and have standardized ways of solving their problems. Fracture – solve it like this, then do that. Done.

Perhaps we could just ignore what it’s called since it doesn’t matter… once it’s cured. When people gets caught up in the diagnoses, which actually seems to be a problem, it’s a waste of time. Do something about it is more my approach. I usually ask people about the situation, how they are and how they feel – that symptoms they have and so on prior to taking them on. That’s practically the same as what’s done before giving someone a diagnosis, but… without the label. If it doesn’t really matter anyway… why care? What’s the difference if I tell people they’re tired, depressed and everything hurts? When everything depends on the diagnosis in healthcare… and someone gets the diagnosis wrong – everything fails. When I don’t care about the diagnosis but I do care about the patient… things seem to work out quite well.

Let’s look at the starting-point for a couple of clients I’ve looked after. We looked at a woman in the introduction. She was bothered by fatigue, depression and pain to sum it up real short.

Christoffer came to me with a similar blend. Pain, fatigue and depressive symptoms.
Stress intolerance. Small things that used to work became a CRISIS!
A bunch of points when doing the MADRS test to quantify depression.
He lacked the energy he used to have. Partially as a result of waking up at night, but that wasn’t the entire story.
And! … Something more common the last couple of years: Social isolation as a result of the pandemic.
Bothered by pain in thoracic spine area, neck, throat and got headaches.Grinding teeth giving TMJ issues.Knee pain until he was limping.

A woman who wanted my help for “mainly depression” had “I want to be able to get up in the mornings and… function. I don’t want to open my eyes and ask myself why I should even bother continue breathing.” as her first goal. But then, among the sleep disorders and FATIGUE, there was quite a bunch of pain.

That’s usually what it looks like. A complete mess in several areas. Not an isolated one.The brain doesn’t really see any major difference between physical pain and mental misery. They are both stressful, so they both increase the stress-response.Depression and long-term stress decrease your tolerance to pain, which will make you more prone to feel pain once it’s there or interpret signals as pain. The stress also increase the passive muscle-tone which will increase the likelihood that you’ll feel pain.Depression is stressful. Life is stressful. Pain is stressful. Long-term stress increase cortisol, which seems to work more or less as a toxin to nerves when the dosage gets too high for too long. That seems to decrease the amounts of connections between neurons which is a common finding in both depressed and burned out patients.

This turns into a positive feedback-loop. The more time we’re doing something the better we get at it. The more this happens the more it continues to happen, unless there’s a thought through solution that you actively try to go for. Behaviors work the same way. Do something and you’ll likely do it more and more. The further you go on with behaviors the harder they stick and they get harder to change. Unfortunately it’ll work with pain, the thought patterns of depression, anxiety and most other things as well. Everything we do and practice are skills – so everything we do plenty of we’re getting better at. And you won’t get LESS pain, you’ll become a pro at feeling pain. You might get central sensitization and the brain gets even more sensitive. Emotions bothering you? Without changing anything there wont be less darkness. The gothic embrace will feel more natural and obvious over time and quite soon it’s the normal state where you don’t feel as if you’re in any darkness, but others are watching the world through some sort of pink glasses. You’re the objective one and the perspective changes to “this is how it is and this is how it will be”. Changing it as soon as possible makes it as easy as it gets.

Which takes me to something a client of mine told me a while back. Really, really empowering words from a physician… He said “You’ll hurt more and more and just keep degenerating until you die – but you know that already, don’t you?” What do you even answer when you’re told something like that? “Wow. Awesome. Thanks, doc!”? It’s especially lovely said when it’s regarding pain- and stress issues. It wasn’t even anything that supposed to be degenerative. Some things are, and… well. That’s the case for those diseases. But… Here? Someone’s stressed and they’re supposed to just lie down, degenerate and die? That’s not really a useful appointment for someone with half their expected lifespan left. They might of course end it prematurely after lovely doctor’s appointments like that one. If you’re hopeless, filled with anxiety and the prognosis is just about worse, rather than better… Well, when that’s the case, it’s not really a strange pick to end it right there. If you’re displeased with healthcare when you’re looking for help with these things I really do think you should try getting a second opinion before committing suicide, however. These are obviously matters that are handled in very different ways in different places. Simply pills in some places. Plenty of help in others. Some places will just tell you you’re fine when you’re a complete mess. If you’re on the brink of giving up – postpone it and give it a shot. Anything. Try just one more thing… And then another.

Anyway. I sure hope that makes it at least slightly more clear on how things go together. There could be a bunch more physiology in here but I don’t really think most people would care very much. One of the three seems to feed the other two. It’s not necessary to have all three, I’d prefer if none of them bothered you, but they all increase the chance of you getting another one – or all of them.

… Until next time. =)

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