Mental illness is physical.
Today, I’ve decided to write to all the partners and caregivers of those ladies living with depression. Sometimes it’s hard to put words to how we’re feeling and it helps to be able to point to something and say, “Here, read.” This often applies to other mental illnesses as well, like chronic anxiety.
First, let me say this: I know it’s hard to live with and/or care for us. If you’re not walking on eggshells half the time, then you’re trying to talk with her about how she’s feeling and what you can do to help (I’m assuming you’re the supportive type).
What does not help is making her feel bad about herself for her physical symptoms of depression. In other words, pointing out her behavior as if she’s not already acutely aware of it.
She’s not mopey, lazy, or just in need of some good old fashioned exercise: she’s in pain. Whether she wants you to treat her as such is up to her.
Living with chronic depression is sort of like what I imagine childbirth as a first-time mother is like, except on repeat: you have no idea what you’re doing, your brain is yelling one thing while your body’s doing another, and at the end of the day, you have to care for not only yourself but an extension of you (the extension being a loved one or even your own sense of self).
If she’s living with depression, she’s doing this every single day. Some days are what I call Difficult Days, but the baseline is generally sh*t and goes up or down from there.
Muscle pain is one of the most common physical symptoms of depression. When we’re depressed, we generally either:
(a) slow down and stay sedentary, or
(b) stay sped up on adrenaline (because if we’re busy and distracted, we don’t have to feel).
Either way, we get super stiff and tight muscles that often cause tension headaches and shoulder and back pain, which in turn sometimes lead to chest pain.
I lived with more or less daily tension headaches from middle school until sophomore year of college. I met with a neurologist and, after an MRI came back clean, I started taking Baclofen. As the neurologist described it, my brain was essentially sending pain signals without a physical cause for it, stuck in a pain signal feedback loop.
I mention this because while I didn’t have a specific head trauma triggering the pain, I did have extremely tight muscles directly related to my mental illness.
When we’re depressed or anxious, our minds are often scanning our environment for threats in preparation for fight, flight, or freeze. What you have to understand is that this is our baseline. We are often on a pain score of like 4/10 on a good day.
There may not be a logical reason to be this way (anymore), but trauma or traumatic experiences have conditioned us to prepare for the worst (and physically internalize/store the trauma/traumatic experience).
Seriously, read The Body Keeps the Score.
This means we’re tense all the dang time. I’m talking tight jaws, teeth grinding, tight shoulders/neck, keeping hands in fists, pinched nerves, poor posture, pain in hips, butt, feet – you name it, we’ve lived with it. There’s a reason guided meditation walks listeners through releasing bodily tension (and yes, we’ve tried yoga).
So when she’s achy and takes hot showers or baths religiously and probably OTC painkillers more than she should, she’s not “weird,” “overreacting,” a “Debbie downer,” or making things up. She is in physical pain. If you’re tired of hearing about it, I guarantee you that she’s even more tired of living with it.
Which brings me to my next point.
Even if she isn’t formally diagnosed with insomnia and on a horse tranquilizer dose of sleeping pills (that are often habit-forming), she is simply exhausted.
I mean to the point where she may even wonder if she has chronic fatigue syndrome and questions her own sanity. This is one of the physical symptoms of depression that may come across as laziness, but I guarantee you it’s not.
Her mind is on overdrive at all times, sometimes even at night due to crazy dreams, which makes her even more tired the next day.
It is absolutely draining and maddening to have a brain that yells at you to hurt or kill yourself, that flashes self-hurting images at you (often while having a perfectly mild and unrelated conversation with someone), drowns you in guilt and shame over that thing you did or said 10 years ago, and sabotages you at every single turn.
She might have completed all her tasks for the day, but Trauma Brain tells her she’s a failure because she didn’t do more. She might want to actually put effort into her appearance (hygiene and presentation often take a hit), but Trauma Brain tells her there’s no point because she’ll never be beautiful or confident.
Basically, her mind tells her she’s a piece of sh*t no matter what she does and she has to battle her own mind every hour of every day. She is bone weary of having to fight battles on all fronts, so it would help if you would take things off her plate now and then.
Do the dishes and laundry, stock the fridge, make dinner, give her a 5-minute massage (per the above) – whatever you can do to take the edge off, do it. It doesn’t cost you anything but some effort, and it costs nothing to be kind.
We ladies often find ourselves spending time around people who validate Trauma Brain’s lies. Please don’t be one of them.
I’m filing cognitive issues and brain fog as physical symptoms of depression because they really take a physical and behavioral toll on our everyday lives.
This is separate from memory loss.
First, there’s attention span. We generally zone out to:
(a) escape our daily realities (we want to be anywhere but “here”)
(b) ruminate on a real or hypothetical scenario
(c) fight the endless barrage of tormenting commentary from trauma brain.
Then there’s mental fog. She might not remember what you just asked her, what she was even saying as she’s halfway through a sentence, why she stood up in the first place, who she was meant to call or what she wanted to write down.
This has serious consequences, in private life and (especially) at work, which she can lose overnight for not performing at 110% and thereby lose the health insurance and care that’s keeping her afloat. It often also means that if it’s not written down, it’s not happening.
It’s the “Insta or it didn’t happen” but depression version.
Living with depression means being hyperattuned to one’s body while disconnected from it (or numb) at the same time. It’s the physical variant of what Bessel van der Kolk says about memory in The Body Keeps the Score, namely:
“Traumatized people simultaneously remember too little and too much.”
She isn’t ignoring you. She’s not intentionally failing to prioritize you or show you she cares. She is living in a body-mind combo that’s operating at like 40% by default. Does that excuse poor behavior? No, mental illness doesn’t give a person a pass for being a jerk. But it does explain repeated dropping of balls.
She’s not perfect, even if she tries her damndest to be.
That body tension and mental readiness to fight/flee/freeze I spoke about in #1 above? Yeah, that’s why she holds her breath all the time and consequently sighs all the time.
She probably doesn’t even realize she’s holding her breath half the time. She might be sitting on the couch reading something or watching a show and suddenly realize, “oh, I’m holding my breath and a lot of tension in my body, let me take a deep breath and relax.” This leads to the sigh.
When we sigh, we feel our shoulders fall and our jaws loosen. Our nerves settle just a little (I like to use a lavender oil roll-on to help with this). We feel a little more human.
So if she suddenly inhales deeply and sighs, don’t ask her what’s wrong or freak out. She’s just regulating her nervous system. Nothing to see here.
I kid you not, it’s a thing.
Dry mouth is one of the many physical symptoms of depression because stress can cause dry mouth by decreasing saliva production. If she’s taking medications, they could also be causing dry mouth, which then leads her to drink a lot of water (which is especially important in the summer or in high-temp areas).
The natural result? Lots of trips to the bathroom.
I was a lifeguard in college and I would always have water with me on guard. This meant I’d always go to the bathroom every time it was my turn to switch out. One time, when I returned, one of the other lifeguards said, “You go to the bathroom a lot.” Thanks? I hadn’t noticed.
Ever heard of the 5-second rule? Sometimes it applies to behavior too.
Anyway, this is why, and it’s normal (for us). There’s no need to make her feel bad by pointing out how her body functions given her circumstances.
What is she gonna do, not pee?
Physical symptoms of depression and other mental illnesses make Dumbledore’s reply to Harry all the more poignant:
“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?”
The thing is, she’s probably all too aware of how her depression/other illness affects her behavior. She knows when she’s being short-tempered, rude, heavy or otherwise difficult to be around. You might get all the more frustrated when even she has no clue on how to make her feel better. Sometimes she just doesn’t have the answer, and in those times, you’ll have to show each other some humility and grace.
I’ll be sharing tips for her and other ladies on how to best communicate their situation and needs/limitations with their loved ones, but my overarching message is this: act with humility and grace and communicate (in words) how you feel.
The last thing either of you need is a guessing game.
P.S. Generally speaking, we don’t necessarily want to be pandered to or have people pussyfoot around us. We’re not fragile, but having a person care for us in ways that take our lived experience into account is incredibly powerful and validating. It makes us feel seen and understood.
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