The Link between Chronic Illness and Depression
‘Health and illness have been described as two countries: if lucky, we live most of the time in the world of health, but we all hold passports to the world of illness.’ - Susan Sontag
When we talk about chronic illness, we are talking about illnesses lasting for more than three months, rather than an acute condition which may be resolved relatively quickly. Common chronic diseases include arthritis, cancer, COPD, diabetes, lupus, MS and hepatitis C/HIV/AIDS. These last a very long time and usually can’t be cured completely, although some can be controlled or managed through lifestyle and certain medications.
I work as a psychotherapist in a general NHS hospital in a diabetes department, helping people cope with their condition, and I see first-hand the distress that living with a chronic condition can cause.
Sadly, chronic illnesses are common, and depression is a very common side effect. According to NICE, people who are diagnosed with chronic physical health problems are three times more likely to be diagnosed with depression than people without it.
There is a cause and effect relationship between chronic illness and depression. Serious illness can cause huge life changes and limit mobility and independence. A chronic illness can make it harder to do the things you enjoy, and it can erode self-confidence and hope for the future. In some cases, the physical effects of the condition itself or the side effects of medication lead to depression, too. Depression is connected to low motivation, low self-esteem and low self-worth, which leads to poor self-care, which doesn’t help if you have a long-term illness that requires you to take good care of your physical health.
Although any illness can trigger depressed feelings, the risk of chronic illness and depression gets higher with the severity of the illness and the level of life disruption it causes. Depression caused by chronic disease often makes the condition worse, especially if the illness causes pain and fatigue or it limits a person's ability to interact with others. Depression can intensify pain, as well as fatigue and sluggishness. The combination of chronic illness and depression might lead you to isolate yourself, which is likely to exacerbate depression.
It can be really helpful to see a therapist who specialises in chronic conditions, as an understanding of the physical illness can be important. If you already feel isolated with a condition it can be difficult if those you seek help from are unfamiliar with what you are going through. I still remember hearing a psychoanalyst saying of diabetes: “But its just a medical condition!”. I don’t think she got how much health can impact peoples’ lives, and often people don’t understand unless they have encountered illness themselves or in their own family.
I feel it can be really useful in looking at how we construct our beliefs around health and illness, and how they may influence how we respond to health and illness in ourselves and in others. Both illness and treatment can have a tremendous emotional impact on people’s lives.
Our beliefs around health or illness may come from our experience of our own health or illness, or from others around us or in our family. Unless you are ill you probably think of yourself as healthy. This belief is powerful - it helps define your general lifestyle and your day-to-day actions. When healthy people think of ill health, they tend to think in terms of acute or short term disorders. That is, that the symptoms will be present for a while, and recovery will then follow.
Beliefs around health through the ages have often been superstitious or shall we say, ‘of their time’. The root word of health is ‘wholeness’, and indeed ‘holy’ and ‘healthy’ share the same root in Anglo Saxon, which is perhaps why so many cultures associate one with the other.
Hippocrates considered the mind and body as one unit, and attributed illness to imbalance between the four humours in the body (yellow bile, phlegm, blood and black bile). Galen, another Ancient Greek considered there to be a physical basis for all ill health, and that the humours underpinned the four temperaments (choleric, melancholic, sanguine and phlegmatic) which contributed to the experience of specific illnesses. For example, he proposed that melancholic women were more likely to get breast cancer because high levels of black bile underpinned melancholia itself. I find it amazing that if you scratch the surface this ancient idea still exists in some forms today.
In the Middle Ages health became tied to faith and spirituality. Illness was seen as God’s punishment for misdeeds, or a result of evil spirits entering one’s soul. Treatment therefore called for self-punishment, abstinence from sin, prayer and hard work.
The Renaissance introduced more organic and physiological views on illness, with little room for psychological explanations.
Descartes proposed that the mind and body were separate entities, and that interaction between the two domains was possible. This is defined as ‘dualism’, where the mind is considered non-material, and the body as material. This dualistic approach underpins the biomedical model of illness – arguably which informs current Western medicine - in which a symptom of illness is considered to have an underlying pathology which medicine may (or may not) then treat.
Modern Western medicine has now ‘a dual aspect monist view’: those with this viewpoint would suggest that it can be perceived in two different ways: objectively and subjectively. For example, many illnesses have organic underlying causes, but they also elicit uniquely individual responses due to the action of the mind.
Having established that illness exists, we tend to try to explain what has happened. As we change from being healthy to ill, the meaning we attach to these terms alters, as do explanations of cause and blame. This means that we not only face illness, but a change in how we understand and explain life events.