From a Washington Post guest essay by Adam Smith headlined “A congressman’s story of anxiety, pain, and struggling to get help”:
I was 48 years old, in my 16th year in Congress, when debilitating anxiety overwhelmed me in 2013. Chronic pain kicked in a little over a year later. I struggled just to keep going in the years that followed.
I represent a district in Washington state in the U.S. House, and my flights back and forth to D.C. became excruciating. My schedule had already been a mad juggling act — between the 2,500-mile commute, my family back home and the demands of my job in both places — and all of that seemed increasingly impossible as my mental and physical challenges continued to get worse with no end in sight. I worried constantly that if people figured out the mental problems I was having, I would lose my job.
It took me over six years to figure out the exact cause of these conditions and to find the right treatments — but thankfully I did.
There is plenty of science showing a connection between chronic pain and mental health disorders. Many doctors told me this during my battle. What they didn’t do a good job of telling me was what I could do about it. The information they shared often vexed me more than it helped me — like an oasis in the desert that turns out to just be a mirage, always drifting farther away as you try to move toward it.
It turned out that I had both physical and mental problems. I had major knee surgery at age 16 and never properly rehabbed from it. I favored one leg over the other for over 30 years. I had the genetic defect of impinged hips, causing limited flexibility. These things combined to cause back pain, hip pain, knee pain, etc. And I had unresolved trauma from childhood that triggered anxiety.
The physical pain ebbed and flowed in all these places pretty much all my adult life, only becoming completely debilitating when my hips started to go bad in 2014 when I was 49. I had suffered a brief bout of depression when I was 25, and a similarly brief bout of anxiety in 2005 before the anxiety came back in 2013 and wouldn’t leave. The stigma surrounding mental health made me do my best to hide my mental health challenges even as I was always open about the pain caused by my physical problems.
What didn’t help my pain
When I sought help, too often doctors suggested that my anxiety could be causing my pain without explaining what I should do about it. Patients don’t benefit from hearing the story about the construction worker who was screaming in agony because he thought a nail had gone through his foot only to discover the nail went between his toes and missed his body entirely. The point, of course, was that you can feel pain without there being an actual physical cause. Which, okay, fascinating, but how does that help me? For people like me, hearing that the pain was in my head was problematic on multiple levels. Yes, some people benefit from this realization, but a lot don’t.
I have had people tell me about their experience suffering from some chronic pain, most often back pain, and how it went away with the simple realization that it was coming from some mental issue, usually some form of stress or anxiety. I had more than one psychiatrist suggest this to me. Just go exercise and know that there is nothing physically wrong with you.
Presented with this option, chronic pain patients desperately want it to be true, but obsessing over a quick and easy solution can pose a major impediment to getting better.
There’s also a fundamental misunderstanding of what it means to say mental health issues are causing physical pain. This implies to most people that the pain doesn’t really exist. Pain doesn’t work this way. Pain caused by mental issues is real. It just has a different chain of causation.
Look for a listener, not a magician
In reality, many patients have both mental and physical health issues. The two may be feeding off each other, but the patient faces the stress of not just being able to pick one treatment path.
Beyond that, there’s the sheer complexity of what we know and don’t yet know about how mental health issues affect physical pain — and the unfortunate reality that doctors tend to be really bad both at navigating such complexity and at explaining things to their patients. These challenges smacked me in the face repeatedly during my battle with anxiety and chronic pain.
If you have chronic pain and a mental health issue, I suggest the following approach.
First, seek help from medical or mental health professionals. Don’t go looking for somebody with a magic answer. Look for somebody who will listen to you and communicate with you in a way you understand.
Second, get the best understanding you can of whether you are dealing with a physical issue, a mental issue or both. Trial and error will be required here most of the time. The answer won’t always be obvious. I still don’t know for sure the extent to which my anxiety contributed to my physical pain. I do know that I had significant physical problems that were the primary source of my pain. Once I found a muscle activation therapist who helped me get my muscles working properly after years of misuse, a process that took almost a year, my pain reduced dramatically.
Third, if you suspect a mental health component, don’t assume you’ll simply be able to move past it. You need to understand the sources of your anxiety or depression, honestly address them and train your mind to better process sources of stress going forward. This relieves pain coming from this source in the same way your bone healing relieves the pain from a broken arm.
I went through about a dozen psychiatrists/psychologists before finding one who guided me through 3½ years of psychotherapy that helped me address my unresolved trauma and eliminate my anxiety. I believe this, too, had at least a little something to do with the reduction in my physical pain.
This is all very complex, but please believe me on one key point: Help exists, and you can get better. There is a path for reducing chronic pain, anxiety and depression.
Adam Smith is a Democrat representing Washington state’s 9th Congressional District in the U.S. House. His new book is “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety.”
Speak Your Mind