Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome

RSD(S)-CRPS Advisory
Facing the Storm: Pain and Mental Illness
Facing the Storm
Pain and Mental Illness
by Twinkle (EKV) VanFleet

Mental Health, a most fascinating area of study, but are all diagnosis’ correct? A diagnosis
relies on symptoms, or should I say, for a doctor to give a diagnosis, he must rely on
symptoms and underlying factors before making such a determination. Can a doctors
determination of said illness be based simply on assumption? How about a pre conceived
idea or notion that the symptoms are obvious to a specific illness or disorder? Perhaps you
know someone that experiences mood swings, altered behavior, or sudden changes in
personality with bouts of highs and lows without notable warnings and you probably never
even see it coming. This seems to be a tell tale sign of a widely known and diagnosed
disorder and before I mention it, many of you will already know where I’m heading.

Depression is defined as sadness, gloom, dejection. A condition of feeling sad or
despondent. In Psychiatry it is defined as a condition of general emotional dejection and
withdrawal; sadness greater and more prolonged than that warranted by any objective
reason. A disorder characterized by an inability to concentrate, insomnia, loss of appetite,
anhedonia, feelings of extreme sadness, guilt, helplessness and hopelessness, and thoughts
of death. Also called clinical depression. In Pathology, a low state of vital powers or
functional activity.

Mania is defined as excessive excitement or enthusiasm; craze. An excessively intense
enthusiasm, interest, or desire. In Psychiatry, manic disorder. A manifestation of bipolar
disorder, characterized by profuse and rapidly changing ideas, exaggerated sexuality, gaiety,
or irritability, and decreased sleep. Violent abnormal behavior. Insanity. Excitement of
psychotic proportions manifested by mental and physical hyperactivity, disorganization of
behavior, and elevation of mood; specifically : the manic phase of bipolar disorder. An
irrational but irresistible motive for a belief or action. A mood disorder; an affective disorder
in which the victim tends to respond excessively and sometimes violently.

Lets take a look at this again. Depression equals low and mania equals high. Common sense
would lead us to believe that a “normal” mood would be at the center of both and in
studying mental illness and Bipolar disorder, we would be correct. Imagine a pole, any pole,
even a telephone pole. At the top is mania, in the middle is an even stabalized mood and at
the bottom is depression.

Lets take a peek at hypomania. A mild to moderate level of mania is called hypomania,
which generally does not impair a persons daily functioning and includes an enhanced mood
and productivity.

A manic depressive is called Bipolar 1, the less severe form of Bipolar 1 is Bipolar 2, who’s
characteristics include hypomania, instead of full blown manic episodes and then there is
Unipolar, which by definition means that there is a depressive phase only.

Hmm! Wouldn’t that simply be depression? Lets review for a moment.  Bi means two, Uni
means 1. Bipolar 1 and 2 move up and down the pole, Unipolar means 1, it stays at the
bottom. It’s said that mixed episodes do not exist in Bipolar 2, on the contrary, they do
exist. It is but a mixed state of being, fluctuating, deflating and back again.

Have you wondered by chance where I might be going with all this? Let me introduce you
to pain.

Pain is defined as physical suffering or distress, as due to injury illness, etc. A distressing
sensation in a particular part of the body. Pain and ache usually refer to physical sensations
(except heartache); agony and anguish may be physical or mental. Pain suggests a sudden
sharp twinge. Agony implies a continuous, excruciating, scarcely endurable pain: in agony
from a wound. Anguish suggests not only extreme and long-continued pain, but also a
feeling of despair. A pang, twinge, stitch. afflict, torment; trouble, grieve. An unpleasant
sensation occurring in varying degrees of severity as a consequence of injury, disease, or
emotional disorder. Suffering or distress. A physical discomfort associated with bodily
disorder (as disease or injury). A state of physical, emotional, or mental lack of well-being
or physical, emotional, or mental uneasiness that ranges from mild discomfort or dull
distress to acute often unbearable agony, may be generalized or localized, and is the
consequence of being injured or hurt physically or mentally or of some derangement of or
lack of equilibrium in the physical or mental functions (as through disease), and that usually
produces a reaction of wanting to avoid, escape, or destroy the causative factor and its
effects. Basic bodily sensation that is induced by a noxious stimulus, is received by naked
nerve endings, is characterized by physical discomfort (as pricking, throbbing, or aching),
and typically leads to evasive action. A symptom of some physical hurt or disorder. A
somatic sensation of acute discomfort.

Now I’m going to propose a thought for others to think upon. When physical pain
developes in a person, at some point emotional distress will take over. This is not an
assumption, but fact. I don’t even need to get into information explaining the chemical
imbalances that play a part in mental illness. Of course, it’s true. What I want to discuss is
that when someone is in pain, acute, severe, mild to extreme, it takes so much energy inside
ourselves that mental dilemma’s will develop. This can happen over a short period of time
or a longer period of time. It might depend on strength, hope, the will to live, the ability to
fight off the discomfort, attitude and a minimal level of stress.  Stress increases pain, pain
increases instability, instability creates lack of peace of mind. Thoughts of no longer
wanting to live and exist expand and increase, however, there is a difference between
suicidal ideation and suicidal intent.

On a good pain day the individual may have their high, creativity, feel happiness, smile and
laugh, bounce around in a positive manner, demonstrate self esteem, feel excitement, desire,
feel optimistic with the emotion that “no one can hold me back”.  Mania?

On a bad pain day the person may feel hopeless, worthless, no longer have the will to live
that they had on their “good pain day”. Lose hope, cry, feel agony, sadness, have no drive
to get out of bed because either the physical pain or emotional pain has them beat. It is that
the physical and emotional has grabbed them up once again. Depression?

On a so so day, he or she may feel fatigued, but flash a smile, hurt, but want to survive,
their mood may be that of feeling “okay” considering what they endure through their day to
day lives and hope flows through them. A stabalized mood? The center of that pole!

I am at the belief that pain is misunderstood and since many pain syndromes currently have
no cure that many people are mis-diagnosed with a mental illness, namely Bipolar disorder
as a means to justify that which cannot be accepted or explained..

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