ST/CD, Chronic Pain and Depression
By Dr. James Auberle
Depression is one of the most frequent ancillary problems associated with any long-term illness such as spasmodic torticollis or cervical dystonia. It is most certainly not confined to these problems, but if you discuss these sensitive issues with anyone who suffers from a lengthy chronic illness they will tell you similar complaints. It does not matter if the disease is diabetes, cancer or acne; many of our emotional responses are the same. Just plug in disease "X" and listen to very similar stories.
There are several different varieties of depression depending on classifications. In one of those classifications there is a distinction between endogenous versus exogenous depression. Medical professionals often concern themselves with the endogenous type of depression. THESE INDIVIDUALS ARE SUSPECTED OF HAVING A CHEMICAL IMBALANCE OF NEUROTRANSMITTERS IN THE BRAIN . Everything in their life may be going well in terms of family, work etc., however, they remain depressed. These persons will need help in terms of medications, or, in extremes, electroshock therapy to help them regain some degree of normalcy.
Pain on the other hand has many different faces. Most of us focus in on physical pain such as the muscles hurting from long-standing contractions of muscles. However, there is also accompanying emotional pain, social pain or even spiritual pain. Often one can worsen the others. A small degree of neck pain and torticollis may lead to isolation, which in turn can lead to broken relationships or financial problems if you lose or can't do your job any longer. This then may lead to guilt and feelings of worthlessness and ultimately worsening of depression.
Perhaps the more common type of depression is the exogenous type. As the name implies there are outside factors that can be responsible for this depression. For example, the death of a beloved family member, losing a job that one enjoyed, or, as in this case, developing a chronic illness may cause a degree of depression. Medications may help this situation but more often a more successful approach is counseling. A good therapist can often help an individual develop coping skills that will allow a patient to work out their respective problems without the need for medications.
If a person's illness is so severe that they are contemplating suicide, get them to a mental health facility or person where they can be helped immediately! Do not hesitate. If someone is serious about such an action, they may have made plans for when they wish to "check out". It is best to move them out of the environment that may cause them to carry out those plans.
Although medications are helpful, in this short space we will not discuss them except to say that occasionally certain types of antidepressants and mood altering medications themselves can worsen dystonia. The use of certain of these medications may be used even if it worsens the dystonia if the risk of profound depression is not reversed in a timely manner.
What is the single best skill that we can teach you about how to deal with those issues of chronic pain and depression? The answer is to learn how to negotiate! You may wish to separate out torticollis from pain or use them both. If you are having a particularly bad day, then do not try to accomplish too much. If you can't even do that just simply go to bed and try again the next day. You probably need the rest anyway. In deference to Kenny Rodgers . you've got to know when to hold 'em and know when to fold 'em. On your good days, and you will have good days, then do the activities that you can accomplish.
Another technique in terms of negotiating with your disease or pain is to use visual imagery. This is especially good if you can use soft soothing music along with the imagery. For example, PRETEND that you are sitting in a nice quiet room at a table. On the table are a piece of paper and a candle. The paper is the sum total of all of your pain. Now for your exercise you tear off a small piece of the paper and place it in the candle flame until it is entirely consumed. Then your pain is a little less. You repeat this process until most of the paper is gone and you have significantly reduced your pain. Remember, this is pretend.
Over the years, I have found that video games are mostly a waist of time. However, several years ago there was a study of high-powered executives who were suffering from chronic fatigue, mild depression, hypertension and several other maladies. They took this group of volunteers and subjected them to a little experiment. After they completed work for the day, but, prior to going home, they were instructed to play at least 20 minutes of a particular shoot 'em up video game. After two weeks they were noted to have lower mean blood pressures and their respective spouses reported that they were much more pleasant upon arrival at home.
If video games are a little to high tech for you, I suggest that you take a picture or a photocopy of a picture and place it over a dartboard. I personally use a certain EXECUTIVE DIRECTOR , but the point is that the picture represents your pain or your torticollis or both. This way you are again visualizing your self as conquering the pain every time you hit it between the eyes. In addition, to the emotional lift that this provides, there are improvements in eye-hand coordination and visual special perceptions, all of which are great for a torticollis patient.
So we aren't done with the clichés yet. You can't give up. Failure is not an option. You must learn to negotiate with your pain and/or your torticollis. If you are having a bad day then consider a strategic retreat and fight the next day. Picture in your head that your neck is straight and that you have no pain! Here's looking at you kid!
