I struggled to find an appropriate picture to accompany this post.  I find this curious considering how much stuff is floating around out there, and yet I have spotted a screaming black hole in the relentless services of Google images.  The intention of this post is to discuss the link between physical pain and mental health issues, yet all the internet seems able to provide visually are some cringeworthy memes which appear to place physical and psychological health issues in some strange kind of competition with one another, rather than accept that, in many cases, they are inextricably connected.  More disturbing still is the fact that this attitude is too often reiterated in real life, with medical professionals consistently failing to assess the impact of mental health issues on patients with chronic physical conditions and vice versa.

Life imitates art (or poor memes) so it seems, and despite my own physical and mental health issues which began long ago during my teenaged years, I only considered that there could be a possible connection between them over the past few years, several decades after both problems originated.  I perceived the physical problems which were developing within my leg to be completely separate from the psychological problems I was experiencing, which I made great efforts to hide or deny at that time.  Also, of course, physical problems were more visible and readily prioritised in those days, there was an unspoken fear of mental health services then and I really didn’t want anyone to know that I not only had a crappy leg but that my mind was a bit wobbly too.

A couple of weeks ago, I experienced another epiphany-of-sorts, which left me without a shred of doubt that my physical and psychological well-being are inextricably connected.  Not just a bit, but totally and completely.  The experience also served as a timely reminder of my own fragility, which I must learn to accept and modify my behaviour accordingly, and perhaps even swallow the bitter pill of accepting that I will never be as resilient as I think I am or would like to be.

As discussed in my previous post, the outcome of my most recent hip replacement surgery has been astonishingly good – even my consultant was absolutely gobsmacked at the progress I had made.  He admitted that he had serious doubts about performing a second hip replacement so soon after the previous one, and fully anticipated that my recovery period would be prolonged and difficult, but reassured me that the result was self evident – that despite both his and my own doubts about my overall health, I was in fact extremely physically healthy and strong to have come through this with such a positive result so soon.  By this time, I had managed to ditch the trippy overwhelming opioids after 4 weeks so was managing the pain using only anti-inflammatories, ice packs and my trusty hot water bottle.  But the progress which I felt was most significant (and surprising) was the fact that psychologically I felt ‘well’, possibly for the first time in a several years: I didn’t feel overwhelmed with depression and exhaustion on a daily basis, and I felt increasingly self-confident in my ability to organise myself and do things independently, not just physically but psychologically too.  In fact, I felt more confident and empowered than I had done for a long time, which was too long ago to even remember when all that shit even started.  It felt good, and I felt good.  For a couple of weeks I had so much energy, loads of it, so much that I didn’t know what to do with it; I got up early and was buzzing about doing cleaning, washing, sorting out cupboards, gardening, organising myself by trying to restore my living space into something which was manageable and positive rather than the shithole it had deteriorated into alongside my physical and mental deterioration, had several major clear-outs and trips to the tip, fixed broken things, put shelves up, did longer dog walks (without sticks – hurrah!) both alone and with company etc, in fact I did all the things I usually do when I’m, what I call, ‘re-inventing’ myself.  I realised that I was subconsciously preparing myself for a new life, a different kind of existence which was outside the house and back  in the real world again.

The epiphany occurred on one of these days.  It was sunny, I was up early, and I needed to walk the dog.  My newfound mobility had also instilled in me an obsessive desire to walk – for as long as I could manage, and at least daily; it was like an addiction, I guess because now it was something that I actually could do again.  My partner had gone away for a few days (hellfire, he certainly deserved a proper break away from me by this time, for the sake of his own sanity if nothing else) so I was home alone, and buzzing.  I live out in the wilds, so walking around here isn’t like walk in a municipal park.  We’d done a really lovely walk a few days earlier, one of my favourites, but one which I hadn’t been able to do for a long time due to rubbish joints and mobility problems.  It’s a really lovely walk up a steep valley where the river runs down, along the bottom and forms loads of pools which are perfect for paddling and swimming.  With school holidays only a few days away, I decided to do it that day, I figured it was my last chance while it was still quiet up there.  So off I went.  I never take my phone when I walk the dog, but for some reason that morning I did consider it, before quickly deciding not to bother – all the usual excuses: it’s just something else to carry, there’s probably no signal up there anyway, what could possibly go wrong, and even if it did, who would I call?!  Anyway, off I went with my lovely happy dog, and all went swingingly at first, but then suddenly, on the way back down the valley, the path gave way and I fell.

The fall itself was quite dramatic by my standards, and was certainly in a league of its own.  I’ve never had a fall like it before, usually I just trip or stumble, but this was something else entirely.  Even the dog looked mortified.  The path was narrow and I hadn’t realised that it had eroded below where I was standing, so it just gave way.  I fell down about 15 feet, walloping my back on a boulder on the way down, and ended up underwater in the river.  Well done me!  if you’re going to fall, do it with style!!  I managed to haul myself out, shuffle back to the car, and called in to see a GP on the way home, who said I’d probably broken a rib.

Once I got home, I had a total meltdown.  My head flooded with ‘what ifs…’  What if you’d banged your head & concussed yourself?  What if you hadn’t been able to get out of the water?  What if you’d broken something and/or couldn’t walk?  etc etc  But the real mother of a ‘what if…?’ was “What the f*ck would you have done if you’d dislocated that new hip, or even the other one?!?  Whatever were you thinking?!??”  Admittedly, at the time, it was the very first thing I thought of – if I can stand up, if I can walk, then presumably the hips are still in place.  I can only assume that the hips escaped damage because I landed in water – although finding yourself underwater after a fall like that isn’t ideal, I am absolutely certain that if I’d landed on rock at least one hip would’ve dislocated, so I should be grateful that the water saved me from that particular scenario.  Over the next few days, the reality of the situation started to sink in, alongside a few more ‘what ifs…’ and I began to realise that although it didn’t feel like it, I had actually been really lucky to have got off so lightly, physically at any rate.

Psychologically, I haven’t been so lucky.  I spent a few days feeling anxious (which is unusual for me, I don’t usually do ‘anxiety’) but predictably my mood plummeted and I plunged straight back into a major depressive episode which, two weeks later, is still with me.  I have lost my confidence, my energy, and the hard-won trust in my body and my belief in its ability to function properly, I am back in the Pain Zone yet again, propped up with endless painkillers to ease the rib and muscular pain which I have stupidly brought upon myself, and my head is a mess because I’m struggling with more trauma.  I have even wondered how much trauma can one body sustain within such a short period of time without giving up entirely?

During my consultant appointment, I remember him saying “It’s a totally different existence, isn’t it.” and he’s right – a life with constant pain really isn’t worth much at all, in my humble opinion, and I feel so angry with myself for putting myself back in there, and so soon after such a brief period of respite.  Right now, because I’m in pain again (although for completely different reasons, obviously) I feel like I’ve made no progress, or at the very least, one step forward and one step back.  I know that logically that’s nonsense, I know that once the rib is repaired and the muscular pain dissipates, my body should feel like it did before I fell, and I’m hoping that I’ll get that blast of energy and a more positive optimistic outlook once again.  But it’s so difficult to convince myself of that, especially now I know that it can disappear again so quickly and so completely.  If nothing else, this experience has served as a brutal reminder of how fragile I am and how my physical and psychological issues are so intricately and inextricably connected.  It feels bitter and harsh.  So much work post-surgery, physically and psychologically to reach a better and more manageable space, yet it totally disappeared again in an instant, probably before I even hit the water.

I’ve got nothing and nobody to blame for this, just myself.  It was a bad decision combined with extremely bad luck, but to happen at this particular point in time is infuriating.  I fell because I made the wrong decision, I stood on the wrong bit of ground, and actually that could have happened to anyone.  I didn’t fall because I was alone, I fell because I wasn’t paying enough attention – and even if someone had been with me, they couldn’t have prevented this.  What is also clear is that my fall was absolutely not related to anything to do with arthritis, my leg giving way or the joint failing – the fact that the new joint survived this fiasco in tact speaks volumes.  But it has to be said that it’s possible that I also fell because I was too excited, dazzled even, by my new levels of mobility and all this energy that was buzzing about inside my head.  I miss it and would like it back, but I think that might take some time.

I have to learn to be more realistic about my expectations of myself, and how any physical progress is inextricably connected to my psychological state.  Before I fell, I’d almost convinced myself that solving the pain and mobility problems was also the answer to my issues with depression and lack of energy – after all, as the post-surgery pain dissipated my mental health improved, so if I could get rid of the pain permanently I’d also rid myself of any lurking, lingering and persistent mental health problems surely?  However, this little experience has made it abundantly clear that it is not that simple, and never will be.  The fact that a relatively minor physical set-back has sent my depression levels plummeting is sufficient evidence to realise that there is no simple solution to all this.  There is a connection, certainly, but the whats, whys, wherefores and hows remain a mystery to me.  Right now, my priority is to give myself some healing time, and to stop the self-hate blame game from escalating even more.  I need to put the accursed hair shirt back on for a few more weeks, take the goddamned pills again,  and do very sensible dog walks in really safe places.