THAT'S MEN:Emotional wellbeing when ill is invaluable, writes PADRAIG O'MORAIN
WORRYING EVIDENCE has been emerging for some time of links between depression and heart disease. The links are not much written about, partly because of an artificial split in our culture between mind and body and partly because of a fear of creating even further distress to people who are depressed.
Yet until the links are recognised and acknowleged we will underestimate the value of maintaining our own emotional wellbeing and of providing emotional support to people who are unwell.
I read a dissertation recently by counsellor Cecilia Keogh, written for the Institute of Integrative Counselling and Psychotherapy, on this topic and it gave me plenty of food for thought – but it wasn’t comfort food.
The exact mechanisms through which depression influences heart health are not fully understood but it would appear that depression increases inflammation in the body and that inflammation in turn may stimulate further depression.
This increased inflammation seems to be linked to heart disease. The risk of depression appears to double after a person has a heart attack compared with the general population. But there is increasing evidence that depression may have been one of the factors that led up to the heart attack in the first place.
Depression has been linked to a reduction in the pumping ability of the heart muscle. Depression has also been linked with increased blood-clotting.
I should add here that Cecilia Keogh has a nursing background and sticks to scienific caution in her dissertation.
Heart disease and its treatment make for an intense psychological experience. After a heart attack your view of yourself and your world changes, I think it is fair to say, and you are thrown into a challenge you never wanted. If it was to happen to me I would expect to be hit by a cocktail of guilt, fear, anger and anxiety and I expect I would have a very high chance of falling into depression.
Sometimes treatment in itself can be emotionally challenging. Take the example of the insertion of an internal defribrillator to deliver a shock to your heart if it develops a dangerous rhythm. Many of these shocks go undetected by the patient but not all.
Sometimes the shock needs to be powerful and the patient notices. This, especially if it happens a number of times, can be distressing and can lead to anxiety and depression.
Counselling, according to Keogh’s research, can help the patient to change his or her self-image from victim to veteran or even hardy survivor. This change in self-perception has a positive effect in reducing levels of stress. But counselling is so often the last thing on anybody’s mind when coping with heart problems and Keogh says she found it quite worrying that people with traumatic symptoms did not always find it easy to get psychological help. Indeed, in research with nurses she found that counselling was often not available.
It’s odd that we don’t put a higher value on counselling in the treatment of physical health problems. It need come as no surprise to anybody, for instance, that strokes commonly lead to psychological disturbance such as depression or anxiety.
Psychological disturbance is linked to higher rates of mortality, of hospital readmission and of suicide. Indeed, one NHS report suggests that 30 per cent of stroke survivors suffer from depression but that much of this is not diagnosed. Also, reports suggest that psychological problems are common among the carers of people who have had strokes.
Anxiety, depression, grief and anger all get in the way of recovery and of wellbeing. Indeed, some stroke survivors would argue that the psychological effects of stroke are worse than the physical effects.
The take-home message? Mental and phsyical wellbeing are inextricably linked. Give your mental wellbeing the same esteem as diet and exercise. And if you suffer heart disease, put mental wellbeing very high in your list of priorities.
Any medical or technical mistakes in this column are my own and not Ms Keogh’s.
Padraig O’Morain (pomorain@ireland.com) is a counsellor accredited by the Irish Association for Counselling and Psychotherapy. His book, Light Mind – Mindfulness for Daily Living, is published by Veritas. His monthly mindfulness newsletter is available free by email.