November 27, 2010

The Diseased Chicken or the Anxious Egg?

I've just joined a brand spanking new Ning group: Una Vita Bella - A Beautiful Life, created by Amy Kiel.  Amy is a health activist for many issues, but her new group is focused on chronic pain sufferers and also the mental health issues we often face.  (I suggest checking it out, it's very new so there's a lot of room to help develop it into what you might see missing in other communities on the web.)

In her welcome, Amy points out that many people with chronic pain also live with mental health issues.  Sometimes the connection is (at least to us) obvious and logical - who wouldn't develop depression if every day included pain, and if yours is one of the many conditions without adequate treatment (and forget cures), well, I'd worry if you didn't get depressed.  Not to mention, that depression (accute or ongoing) isn't the only issue - anxiety, anger issues, and so much more comes with the territory, and some medications we take exacerbate things further.  Oy!

But, at least for some of us, can we definitively say that our pain or condition CAUSED our mental health problems?  I've started reading a book, "Why Zebras Don't Get Ulcers" (see it on Amazon here).  It discusses a theory I've heard before but hadn't explored: our bodies weren't made to withstand chronic stress.  When we subject ourselves to ongoing mental stress, our bodies have to manifest it somehow.  I think it's likely we all agree that mental and emotional stress has very real physical manifestations (I just blogged about my own stress-flare on WEGO), so this sounds quite logical to me.  The beginning of the book uses the zebra as an example contrary to humans: the zebra experiences intense stress - such as an attacking lion - and reacts immediately with the ever-popular fight-or-flight response, including plenty of adrenaline and specific muscular and synaptic processes.  Once it's gotten away, the stress is over, and the body can return to homeostasis.  Humans however, have the advanced mental capability to think abstractly, which means we can imagine "what-if"; we can ponder the future.  We can imagine the lion coming over the horizon while I'm at this watering hole...and therefore, we can worry. 

Physiologically speaking, this ability to worry causes a similar reaction to the immediate stress of a zebra fleeing from a lion...except it never ends.  We all know the old gags about stressed businessmen chugging antacids for their ulcers...but there's some scientific support for this connection.  And moreover, someone once pointed out to me that we now have so many treatments for ulcers (or perhaps our bodies just adjusted to this stress manifestation), that the stress-illness has to go somewhere else...and where more logical than a system in our bodies?  One that relates to sensory transmission?  Yeah, that's right, the same systems that convey pain.  (I suspect Miss Julia may have some technical information on this that I could never understand on my own - I'll have to check her back entries soon to see if she's touched this topic yet.)

So this brings me to my real question: which came first, my illness or my anxiety?  I was actually diagnosed with anxiety when I was in first grade (yes, I mean really diagnosed, not just people saying I was anxious).  I wasn't diagnosed with my chronic conditions until I was 15.  But then again, I had clearly related symptoms back to age 2...but on the other hand my conditions didn't really "bloom" until I was 14 (when the sun triggered my conditions).  And yet, I was diagnosed with anxiety at about age 7...but my mom has stories from my infancy about how anxious I was (even one about the nurse in the delivery room commenting on my "worried worried face").  So, was I anxiety-ridden or disease-ridden first?  Can I identify when exactly each my anxiety or my health conditions truly started so as to determine which came first?  If I wasn't so anxious, might my other conditions never have flared?  I didn't develop such serious conditions, would I have "outgrown" my anxiety?  And moreover...are all my questions only serving to increase my stress and ultimately perpetuate the cycle???

Of course, there's other background involved in the whole whole life has just been a big pile of stress - severe family disharmony, financial problems, my brother's Asperger's and its effect on my life, my parents' health problems, and so on.  So goodness knows I would have been stressed even without my own medical mess.  And there's a LOT of support for familial links for both the medical and emotional/mental health problems.  So I don't suggest dismissing these factors or placing all blame on one factor...but I think it bears discussing. 

So I pose the questions to anyone open to this discussion...did you have any mental health concerns before your medical issues appeared?  To what extent?  Do you have any additional information missing from my post?  And most interesting to me - what long-term effects do you think stress can have on humans?


  1. This is a brilliant point that my doctors, my support network, and myself have all discussed. My mother says that I've been high strung and anxious since I was a child. I was diagnosed with depression and anxiety in college officially, but anyone who knew me before then could have seen that coming a mile away. I used to get migraines and throw up for a week before exams, and in second grade the nurse thought I was making up my constant headaches to get out of class. Fortunately the school secretary's daughter used to get tension headaches when she was young, and she used to take me in the office and rub my temples til I felt well enough to go back to class. The pain started after high school, in varying degrees, but often related to my stress levels. It's not like I was particularly nurturing to my stressful tendencies, either. I worked multiple jobs during college, which I always attended full time, and I would pack my schedule so tightly that I had to schedule time to pee and would eat all three meals in the car. I endured years of stressful, unhealthy relationships, mostly because I was too stubborn to admit that he was a jerk and I was better off without him. We used to call what I now know were my early fibromyalgia flares a "crash and burn", because I would literally run myself completely out of fuel and would then fall completely apart for a few days. My mom always said it was my body telling me to slow down. I sometimes wonder if I hadn't ignored it for so many years, would things have turned out differently for me. Regardless, I have no question that my stress levels and anxiety play a role in my illness. My doctor even suggested a career change, because teaching is so stressful. I've found that subbing allows me to shake off some of the responsibility and a lot of the stress, plus, if I wake up feeling like crap, I don't hafta go in. But when I have stressful life events, Paul, my fiancé, can predict with astonishing accuracy when I'll pay the piper for it. He'll even plan for it because he can see it coming a mile away. I totally believe that theres a connection between my pain and my anxiety.


  2. Ah stress, what would we do without it. Everyone has pressure, but the way we deal with pressure becomes stress. I did not have mental health issues before I became ill, but I was going through severe financial stress at the time that I became ill, so what came first...the stress or the illness? My rheumatologist made the chicken/egg analogy when he diagnosed me with sjogren's last year..did my chronic fatigue syndrome and fibromyalgia cause sjogren's or was sjogren's the culprit all along? We'll never know. I also have found a link with stress and fatigue and the illness flaring, and when that happens my whole body suffers. I have digestive problems, my nervous system is out of whack, fatigue, sleep problems are all part of the crisis. It is easy falling into a flare, but so difficult to get out of and get better. In autoimmune disease, I've read that one may have a genetic predisposition, but something will trigger the disease, so it makes perfect sense that stress of some kind would make us sick.My personal theory is that a virus I caught that was treated numerous times with antibiotics and I never got rid of, is part of the culprit. And in regards to depression, I am on no meds for depression. I am not depressed, but the times where I am going through flares, I do get more fatigue and that makes me feel less energetic, and more mad at the world. I find when there is something bothering me, I deal better with it by dealing with it right away, and not keeping it in, and also tell myself that if something is out of my control, I just accept it. I don't feel guilt and anxiety over things I can't control or change, and that's become a sort of mantra for me and helps me dealing with stressors. Thanks Jenny for an intersting , insightful and important topic. I'm not sure if Julia has posted on this.


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