For many reasons, some of which will be mentioned here, a chronic condition, chronic pain and/or disability can be the cause of great depression and lonely isolation. These two conditions are mutually perpetuating and one can get trapped in this cycle. Somewhere this cycle needs to be interrupted and broken through.
Illness is normally associated with an acute occurrence. We fall ill and lose normal function when we get the ‘flu for example, a bacterial infection or when we sustain an injury. This causes a temporary interference and with rest and medication the previous healthy state eventually returns.
In a chronic condition though, an every-minute-of-every-day continued disruption is much harder to identify with, understand and accept.
Most times, the scenario runs more or less like this, with variations: at first you are aware of certain physical symptoms, fatigue maybe, or aches and pains, maybe dizziness, a feeling of general malaise. Naturally you think this is a temporary affair; after all, you have been rather busy, there have been stress and setbacks and how long ago since you had that last break?
But some rest and recreation, a change of life style and other support is not bringing any relief. ‘It’ somehow doesn’t want to go away.
This is reason for concern, and you want to know what is going on. Reluctantly, but driven by worry, you make a doctor’s appointment. A conversation, possibly followed by some scans, blood tests and other analyses reveal that no, this is not a passing issue. A name is presented and next, you are stepping out of the consulting room and into the street with a label. The world of the person who has come out the door is different from the world of the person who went in.
On the Threshold
Right then, your entire being is in turmoil. There is shock, disbelief, confusion, doubt, fear and numbness. Your psyche kicks in with its initial protection. “This can’t be” you think.
“Maybe there is a mistake. A mix-up of results. Happens all the time.” But you cannot deny that you are really not feeling well, so something is going on. “Well, I may have . . ., but surely it’s not as serious as with other people. In time it will pass.”
From this moment on, the battle between denial and acceptance will be the stage on which you find yourself. Denial comes from an inability to fit this information into your reality.
Denial is also necessary for hope to exist. And as we know, denial is considered to be the first stage in the deep, inner process we go through when confronted with severe change and loss. It is nature’s way of letting in only as much as we can handle. It also helps us survive.
The next days, weeks and months are spent attending to mental and logistic affairs. You learn as much you can about your ‘label’ and you carefully confide in those closest to you. You want numerous questions answered: how does this develop? What does it mean with regard to my future functioning? My work? Care for my family? Independence? You may contact someone who has a similar condition. And so, day by day, knowledge by knowledge, you fit the new reality in your world which is fundamentally changing.
Gradually, you experience other emotions. Anger for example. After all, what did you do to bring this on yourself? You are not a ‘bad’ person. You don’t deserve this ordeal. It’s not fair. Things are being taken away from you without your consent. You feel betrayed. This is wrong!
Yet all along, there remains the dire need for hope. “What if . . . I change my lifestyle completely? Work less? No longer eat . . . ? Maybe an operation. . . ? I’ll be kind and serve others and pray and . . . and . . .” With bargaining you hope to undo whatever cause there may have been to your condition. By becoming ’good’ or ‘better’ you hope to make things less so.
But as time goes by, there is no more denying, your anger turns inward and no deals can be made. There is a turning point in your psyche, and some people are able to pinpoint that moment almost to the day. This turning point is the unequivocal deep realisation that you have become a different person. It is the hollow agony of knowing that what was, will never return. The clock cannot be turned back. Now, the real and full loss descends into your very soul. No holding back. No barriers. This is it. And it plunges you in a hole.
You may live another five years. You may live another fifty years. But you know that each and every day of those five or fifty years will be marked by the effects of your condition.
Grief enters your life deeper than you ever imagined. It feels as though it will last forever.
If grief is a process of healing, then depression is one of the many necessary steps along the way. It is of essential importance to understand that this depression is not a sign of mental illness. It is the inevitable and appropriate response to a great loss. Loss of how you thought your future life would be. Loss of a sense of self. Loss of self-reliance. Loss of confidence. You withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on? Why go on at all?
Depression after a loss is too often seen as unnatural: a state to be fixed, something to snap out of. But again, it is a necessary inner stage. You need to grieve your losses. You need to let go of the person you once were.
When depression is this: the deep inner pain related to your loss and the confusion regarding a humane future, it is a necessary stage. After all, for our soul to come to terms with shocking change, we need to temporarily withdraw from a world where we no longer feel we belong. Lost on the dark waters, we need to reorient ourselves, consider the possibility of another course and slowly adjust our sails.
But there is a limit here. When the effects of depression make you isolate yourself for long periods of time, when the effects of depression make you neglect your self-care, dismiss your family members, stop you from eating, stop you from going outside and cause you thoughts of suicide, then the dynamic has gone beyond what is a healthy necessity. Then the depression has a detrimental effect on your motivation, your vitality, and your capacity for living with your condition.
It is very understandable and not to be judged when the effects of depression overwhelm you and make you want to give up. But this is also the point at which you may no longer be able to cope with things by yourself. This is the point where you need support in helping you through the bleak, hopeless moments and find renewed motivation.
Counselling is an essential aspect of that support. HEART AND SOUL counselling would complement whatever other help and clinical support you have chosen. It would be an aspect of your all-round, multi-modality support framework.