Living with Pain: The Demon of Depression

Living with Pain: The Demon of Depression

I live with several diseases that cause insatiable chronic pain. Consequently, I live with a subterranean stream of depression that can flow freely on my surface before disappearing underground again.

It is often thought that depression is a symptom of chronic pain and that it’s nearly impossible to exist in chronic pain and not be depressed.

This can be seen as either a comorbid condition or as a unitary condition with more than one symptom, pain being one and depression the other.

TearIn both cases, pain usually has a cause, such as arthritis, diabetic neuropathy or some bodily injury.

But recent research and theory sees chronic pain as a disease in itself that separates itself from the underlying cause and takes on an entity of its own. Chronicity enters when this unhappy process occurs.

Not only will the person living with this calamity be treated for the underlying disease or condition, but the person will enter the dark realm of pain treatment.

I say “dark realm” because once a person enters it, the pain is separate from the underlying cause and it rarely resolves itself on its own or through medical intervention.

It’s easy to see the genesis of depression under these ghastly circumstances, if for no other reason than the tremendous loss. The person entering this realm suffers the loss of health and well- being, the bedrock of human existence.

This is not to say that once a person steps foot into this realm all is forever lost. As most people in pain have discovered, there are medical treatments that can help, if only on an intermittent basis, as well as non-traditional treatments that are helpful. It’s rare for a person to land on “9” on the 10 point pain scale and stay there.

But it’s this very intermittency of pain that so fiendishly affects us. As we rise out of the pain to a place that is tolerable, hope, however fleeting, takes wing even if we try to suppress it because we know what’s waiting around the corner.

When the voracious demon drags us back to “9” or worse, Winston Churchill’s black dog of depression isn’t far behind. It takes long experience and sturdy support for the return of the demon not to throw us into the pit.

But inevitably it does. Repeatedly.

Slipping along in its wake is the thought of suicide.

I want to focus on two possible underpinnings of not only suicidal ideation, but of the act itself. I understand that this is a sensitive topic and a bit off the beaten path, but it arises from my experience as a psychotherapist for over 20 years, treating people who were bedeviled not only by thoughts of suicide, but also attempts to end their lives.

This also comes from my own experience of living for years with the ever present thoughts of ending my life to escape the inevitability of stalking pain.

I understand, not from only my own experiences with this, but from the experiences of others living with this demon that suicide is the ace in the hole, the final way out if all else fails, the ticket for the yearned for nothingness, and the painlessness of death.

I truly believe that thoughts of suicide often comfort us as a way out when the pain becomes intolerable. There really is only so much that the human spirit can sustain. Knowing that by our own hands, we can end the torture that throttles us from time to time is not something I would want to take from anyone.

But there is something more to this. Something hidden, something symbolic and fearlessly human.

What I am about to describe is something that, like a coin, has two sides, but is of the same metal and because of its unity is understandable.

On one side of the coin is physical release from torture; on the other side is a certain kind of psychological healing. Thoughts of suicide can make concrete a death that has already happened.

Let me explain.

For ten years I treated a woman who was terribly, emotionally disturbed. I knew after a few years of treatment I had to prepare myself for her inevitable death at her own hands. This became crushingly clear after her older brother killed himself.

As I continued to work with her, she nearly killed herself on two separate occasions. That she survived was a miracle.

What I began to understand about her was that her attempts to end her life were attempts to make concrete the many deaths that had already befallen her. Not just her brother, but the death of her mental health, the death of an alcoholic father, and the death of every one of her dreams at the brutal hands of her mental illness. All of which she had found no way to mourn.

I understood it when I became ill and watched the deaths in my own psyche. The deaths of my athletic abilities, the death of being able to dance with my wife, the death of being able to pick up and hold my infant son, and the death of my manhood under the heavy blows of radical pain. Yes, one death upon the next, again and again.

Once I realized the deaths in my own life, I could comprehend the psychological deaths of my young client. As I fought to stay alive to the deaths in my own heart, I could help her become alive to the deaths in hers.

As that happened, she slowly, but inexorably recovered.

I’m not saying that the notion of killing ourselves in the face of unrelenting pain is the same thing. Far from it. But within that desire, I can’t help but wonder if we’re not doing the same thing as my remarkable client: Calling attention to ourselves the deaths that have already happened to us, the deaths we need to mourn, and the deaths we might mistakenly concretize by our own deaths.

Being in chronic pain demands, in order to live, that we mourn repeatedly.

If you or a loved one are in emotional distress, the National Suicide Prevention Lifeline has counselors available 24 hours day, seven days a week, at 800-273-TALK (8255). You are not alone. Help and hope are available.

Mark Maginn

Mark Maginn

Mark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here

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There are 7 comments for this article
  1. Carolyn at 4:04 am

    As the saying goes … “when the student is ready, the teacher will appear”. Or when you’re experiencing an epiphany around your pain, you walk into a book store, you see a book title that resonates with you, you open the book to a “random” page. A page that succinctly talks about exactly what you are currently experiencing. The same can be said of this article which I came across just minutes ago. It was only in the past few weeks that I have been able to put together the puzzle in my head and heart … in recognizing the enormous amount of loss that I have experienced since my diagnosis in 2007. Recognizing the almost overwhelming grief that I have living with, without truly understanding that it is indeed grief. That the thoughts that I have about committing suicide are quite frankly, the more realistic outcome of my life if I am to be continually hampered by laws, medical systems, uneducated and ignorant so called “professionals”, in their continuing efforts to blindly rob those of us who live “successful” lives thanks to the relief offered by our various pain medications and protocols. Those of us who do not abuse our medications, who comply, who stay in contact with our physicians and pharmacists and all who have any form of interaction in our world when it comes to our health. I am fed up to the teeth with the constant demand from others that we understand their position. Oh I understand your position/situation. Quite clearly. Now it’s time for you to understand mine. I will no longer tolerate your side eye looks when I come into your pharmacy, I will not tolerate the rude and ignorant behaviors of yourself, and of your staff whom you’ve clearly directed to behave in an unacceptable unprofessional manner toward me (and anyone of my “ilk). I will not tolerate attempts to shame and embarrass me in front of other customers, by your unprofessional conduct. I will not tolerate your moral judgement on me. I will not tolerate the change of tone when I identity myself on the phone, as to clearly indicate that you feel I am inconvenient. The list goes on. I feel partially that the feelings of isolation that I experience are not solely due to the ignorant behaviors of the physicians and pharmacists but to those of you who do not cry out loudly … I WILL NOT TOLERATE!! … those of you who will not fight … those of you who wait til myself or others put their own lives on the line … and wait silently to see what happens. Anyone who is silent, from where I sit, are as ignorant and irresponsible as those whom we are standing up to. We must speak up and out. Over and over. We must address ourselves to the medical system/schools to ensure that pain management education is a large part of the curriculum of each and every medical educational facility and institution, doctors, dentists, nurses included. We must strive to make the big pharma accountable in such a way that governments recognize who is really directing the game. Making those who are irresponsible, negligent and criminally responsible accountable. Not attacking but rather supporting those physicians who do know what they are doing, do support their patients responsibly and ensuring that their patients are being accountable. We all have to participate. Enough with this pointing fingers to avoid accountability and let’s get on changing a system that has been allowed to control us for far tooooo long. We have no excuses. Our lives are depending on us!

  2. Sara at 7:51 am

    Thank you, Mark. I wish I could relieve your pain.

  3. Richard Wheeler at 1:41 pm

    Thank you Mark for a very brave revelation of a very dark struggle that so many of us should share. I am 45 and was DXed at 19 with Charcot Marie Tooth-CMT, an inherited peripheral neuropathy. Though not obvious in my early years, looking back the disease was always there slowly torturing that child. That combined with “dysfunctional family” issues and an early experience with the suicide death of a favorite cousin caused me to consider suicide as young as 4 years old! Luckily an innately analytical mind and a strong relationship with God (with whom I argued with constantly in my youth) has kept from ever attempting suicide but I have always had to find reasons not to take that path. I look forward to experiencing the limits of my endurance!

  4. markmaginn at 3:57 pm

    I want to thank all 3 of you for your passionate comments. I’ve heard from lots of other people as well. Others here at NPR have also written on this topic and also received strong responses. Just want to let you know I’m working on a follow on column to this one and I hope it will help further the discussion of pain-depression-suicide.

    Again, thanks all of you, you’re the reason why NPR is here and why I write for this site. Please keep reading and commenting because those of us living with pain need your involvement.

  5. dave at 2:17 pm

    Mark= Kudos to you for having a forum where issues on pain can be discussed. If only government and medicine followed your lead and was willing to hear the concerns of people in pain then pain care would be better. All thos who care about people in pain have to work together to get government and the health care industry to hear and respond fully to the needs of people in pain. And you have done a good job in this regard.

  6. Stephen S. Rodrigues, MD at 9:02 pm

    This article begs for a solution to the cycle of pain, misery, depression, insomnia, fear, disbelief and abandonment.

    Why are so many people suffering in the dark and alone? Pain is not easily proved by modern technology and thus trust and disbelief gets in the way. “How can she be in so much pain, she looks OK”

    If chronic pain could be seen under the microscope, like cancer, it would be on the forefront of healthcare too. Patients would have a team of specialist, supporters, ancillary care givers, guardian angels and a societal acceptance that medications, therapy and medical care would be at your disposal. You would have sympathetic friends and neighbors even strangers who would recognize your situation and offer prayer and support.

    … not so much for this invisible killer.

    Hope and Help are the missing links in chronic pain. Chronic pain has to be treated like a cancer, aggressively in the very early stages or it will grow and metastasize into other areas of the body and then into the soul. For this to happen we need to understand that pain has to be treated with strong medicine in the form of “therapy.”

    I have posted here in the past … if you like you can do a search in the top right corner and follow the links for my opinions on therapy.

    http://nationalpainreport.com/living-pain-demon-depression-8821795.html

  7. Joy H Selak at 9:47 am

    Wonderful. Of course we get depressed, and of course we want to end it all. How beautifully you describe how to put those feelings to positive use.
    JOY