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.
In 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 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.
National Pain Report welcomes other opinions.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.