Wednesday, 10 February 2010
We think you ought to know, you're feeling very depressed
By coincidence, I'd been planning to talk a little about the 'D' word here when I ran across Andrea Pring's copy of email sent to the Telegraph which says a lot of what I would have wanted to.
I want to talk about depression and M.E. from a point of view I don't see voiced very often - the experience of people like myself who already suffered depression, and were undergoing treatment for it, and then later developed M.E. in addition. I can hear the psychiatric lobby already. "Aha, you see that proves it! She had one mental illness, so now anything she gets must be a mental condition! Score!" or the more insidious "So M.E. is just the latest form your depression has taken." And, guys, I'd just like to say - bullshit.
I was diagnosed with depression years before M.E. came along. It did not 'morph' into M.E. - it remains firmly in residence alongside it, the co-habitees from hell. I am not depressed 'because I have M.E.' - though it does make fighting the depression harder. I take anti-depressants because I am a depressive; was one before M.E., probably will be whether the M.E. goes away or not. Not because M.E. is a mental illness. OK?
It seems confusion between the two conditions arises because tiredness is a feature of both. But in my experience, the kind of tiredness is very different.
The tiredness and sleep disruption I associate with depression goes like this: I can't face getting up because the world is so black, what's the point, something awful will just happen and I don't have the mental strength to cope. Coupled with at the end of the day forcing myself to stay awake way into the small hours because, hey, I survived that day and until I give in and sleep, the next scary day can't begin.
Where as the tiredness I associate with M.E. is mental and very, very physical - sitting down for a rest halfway upstairs, having my arms ache from holding a book to read, 'I'd love to get up but my limbs feel like they have toothache, I'm dizzy, and the light hurts my eyes'. And then there is the hallmark of M.E. - delayed impact of 'overexerting', where you overexert on Monday and pay for it with illness on Wednesday.
When suffering from depression alone, I could also still experience 'good tiredness'. You know, the good-achey-buzz and satisfied feeling that comes after a spirit-lifting walk, or a session of gardening, even a spring clean! Physical exercise was one of my principal and most effective weapons against the Black Dog. God I miss it now. Because once M.E. came along, 'good tired' became a thing of the past. Exercise now = feeling bad. M.E. somehow sucks the 'up' out of exercise. It doesn't just make me feel tired. It makes me feel ill.
So - with depression, exercise can make your body and mind feel better. With M.E., it can (and usually does) make you sicker. Depression did not stop me walking 100km across Iceland for charity. M.E. stops me walking up the hill to the nearest bus stop.
When the (very supportive) doctor who diagnosed me with M.E. (and yes, she did mention it first - I don't know where the public impression of hordes of crazies demanding that they have M.E. comes from) cast about for things she could do to help me, it turned out that her only realistically available resources were a drug (amitriptyline) and CBT (Cognitive Behavioural Therapy). She agreed that seeing a dietician might well be beneficial, but that 'I could forget it if I wasn't diabetic, the waiting lists were years long'.
Amitriptylene was prescribed to help with rotten sleep patterns and myalgia. But of course it goes on your record as an anti-depressant. The doctor was very clear to me that she did not consider my condition a mental illness, but CBT was the only resource she could readily access for me. It was to help me manage the impact of the illness on my life (just as it is used in that way to help sufferers of other chronic conditions - as a supplementary treatment), not 'cure' it. But what goes on the record? Yep - treatment at a psychiatric out-patient centre. This, my dears, is how we get the label.
One of the accusations leveled at those of us who would like M.E. researched as the neurological illness WHO says it is rather than labelled a psychological problem, is that we 'just don't want to accept the stigma of being mentally ill'. So let's be crystal. I don't have any problem with 'admitting' I have a mental illness. I've had one for years and years; it is called depression. I do have a big problem with a physical illness being described as a mental one, because I have experienced the difference. Especially when it appears to be done with some fairly hefty ulterior motives.