Introduction: Why tend to all three?

“Why tend to all three?” A common question since it’s not the standard procedure. They seem to feed each other to create a perfect storm. That’s why I tend to all of them. It appears 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.

Long-term pain turns into chronic stress and depressive issues.

Depression is a chronic stressor and might have physical pain as a symptom.

Burnout comes from long-term stress and can cause both depression and physical pain.

Then there’s the interesting and exciting part – how does one reason when treating this stuff?

Questioning everything is a great start. Ask “why?” again and again. “Why?”

This is the fun – and likely the valuable part I love when tending to people. It’s pragmatic, and it takes us to the core. Unless we treat the reason – the actual problem – we’re not getting anywhere. One could do it the pill way; try to remove as many 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… It seems to be enough to just look at the cases to see the interconnectedness. 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 feeling of meaninglessness. Anxiety, inability to sleep, and gastrointestinal troubles aren’t easily mixed up… However, some diagnostic criteria for burnout and depression 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 get sick leave for long-term stress once they get ruined enough, in contrast to other places. Sometimes there’s no sick leave at all, and sometimes you’re excused for years. You’re not entirely sure if that social safety net is there before it’s time to use it.

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

In some cases, it seems as if we should focus less on diagnoses. When people get caught up in the diagnoses rather than the solution, it’s a waste of time. Just as any decent practitioner, I ask people about the situation, how they are and how they feel – what symptoms they have and so on before taking them on. That’s practically the same procedure you go through “before getting a diagnosis”, but I care less about summing those things up into a couple of words. Sure, things could “sound like this or that”, but in my case, it’s often more helpful to avoid summing it up into a diagnosis since that might cause unnecessary tunnel-vision.

With a lot of things, diagnoses work great, of course. Fractures, specific injuries to specific areas, actually pathological things where there’s a particular bacteria in a particular place, a virus doing its thing, or if there’s a genetic mutation somewhere causing specific symptoms or something else that is really specific – where the diagnosis really does say it all. In those cases, it’s great.

Another great point is that the diagnosis is excellent for summarizing people in a few words – until someone gets the diagnosis wrong, which happens as well. When that’s the case, you’ll get treated for the entirely wrong thing.

I’ve met people who’ve been tossed around in healthcare for years without any positive results. If people themselves know that they’re tired, depressed, and everything hurts, it might work to just treat them according to that rather than trying to summarize it into a diagnosis that won’t cover all of it anyway.

Let’s look at the starting point for a couple of clients I’ve looked after. That might very well clarify a little why I tend to all three – and why “just a diagnosis” really doesn’t help. Fatigue, depression, and pain usually come hand-in-hand… in-hand.

Chris came to me with just that. Plenty of fatigue, a list of depressive symptoms and pain in several areas. Except for that, he was bothered by:

• Anxiety
• Stress intolerance where small things that used to work just fine became a CRISIS!
• He lacked the energy he used to have. Partially due to waking up at night, but that wasn’t the entire story.
• Social isolation due to the Covid-pandemic (How do we medicate that…?!)
• Pain in the thoracic spine area, neck, throat, and headaches.
• Grinding his teeth caused troubles with the jaw, the joint and the muscles around it.
• Knee pain to the degree where 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 to continue breathing.” as her first goal. But then, there was quite a bunch of pain among the sleep disorders and FATIGUE.

That’s usually what it looks like. A complete mess in several areas. Not an isolated one.

The brain doesn’t really see any significant difference between physical pain and mental misery. They are both stressful, so they both increase the ststress 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 interprets signals as pain. The stress also increases the passive muscle tone, increasing the likelihood that you’ll feel pain.

Depression is stressful. Life is stressful. Pain is stressful. Long-term stress increases the cortisol level, which seems to work more or less as a toxin to nerves when the dosage gets too high for too long. That appears to decrease the number 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. Perhaps you’re stressed because you have to PERFORM at all times? Maybe you’re doing plenty of silly things. That doesn’t make them right.

Everything we do and practice is skills – so everything we do plenty of we’re getting better at. 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 won’t be less darkness. The gothic embrace will feel more natural and obvious over time. 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. The perspective changes to “This is it. This is how things are, and it’s how things will be”. Changing it as soon as possible makes it as easy as it ever gets.

This takes me to something a client of mine told me a while back. 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 was 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 just to lie down, degenerate, and die? That’s not really a helpful appointment for someone with half their expected lifespan left. They might, of course, end it prematurely after lovely doctors’ 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, I wouldn’t find it strange to choose 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.

These are matters that are handled in very different ways in different places. There is no help whatsoever, a scoff and a lecture about the fact that you’re “actually healthy” in some areas. You might be put on pills in some places – and then there’s plenty of help – with entire teams to aid you – in others. Some practitioners might just tell you you’re fine when you’re a complete mess.

If you’re on the brink of giving up – postpone submission and suicide for just a little while longer and give it one more shot. Try something. Anything you haven’t tried yet. Just try one more time. Try just one more thing if that’s what you’ve got the patience for.

Hopefully, that’ll give you the patience to try one more thing afterward.

Anyway. I sure hope this makes it slightly more straightforward on how things go together. The areas are complex, and there’s a bunch more physiology and psychology in here, but let’s skip ahead to get to something more pragmatic. Another good reason to leave it out, except for saving time and ink, is this: we’re not even sure about all the mechanisms in action. There are these three huge problems – and we’ve got a clue, a decent idea, and a hunch about them – but likely far from the whole picture. If we had a great idea, the pill solution could be good since we could poke just the right molecules, and we’d be fine. But that’s not the case today. We’re stuck with the fact that one of the three seems to feed the other two, which might lead to all three. If it does, we’ll have to treat all of them. To do that, you’ll have to know enough to treat all of them. You don’t necessarily have all three. I’d prefer if none bothered you, but they all increase the chance of you getting another one – or all of them – so I’m bunching the knowledge.