Diabetes and depression

This is not about the link causal or otherwise between depression and diabetes; essentially, people who have diabetes are twice as likely to experience depression as the general population. No one knows why although there are theories.

No.

This is about the way we consider the two conditions.

I could have chosen asthma or angina – the key is a physical disease that doesn’t go away and becomes part of an individual’s life. Diabetes just alliterates well with depression.

I think in terms of what is socially acceptable in the early 21stCentury, diabetes is still the most readily discussed or expressed.

It is a sine qua non physical condition – whether caused by a malfunctioning pancreas (type 1 diabetes – often starts in youth, people frequently skinny; requires lifelong insulin) or cells that are resistant to the effects of insulin (type 2 diabetes – starts in later adulthood, mostly folk are overweight and have a strong genetic predisposition).

Type one and two diabetes are infinitely more complicated and the basis of professorships, departments and endless medical articles (2.7 million on Google Scholar alone).

I just want to establish that most regard diabetes as a physical condition, one that doesn’t necessarily have any major associations with good or bad, weak or lesser. It is what it is, take the medicine and get along.

Once you are started on insulin for treatment, you even get free prescriptions.

Depression is however quite different (three and a half million Google articles).

It is difficult to diagnose, measure and treat. It is an existential disease – something that is not isolated to a single organ, it permeates a person’s self, it run through every aspect of their being.

As with diabetes there is no cure* (not even a keto-diet equivalent).

Depression intermixes with personality, behaviour and self, making it difficult to distinguish from unhappiness, antisocial tendencies or rudeness.

Someone is observed behaving in a certain way; they are lazy, moody, rude, snappy, obnoxious, intolerant, boring, whatever; this is all different to someone having a hypo – quick fix; Kit-Kat and you are OK.

Depression is difficult to measure – you can’t do a quick blood glucose measure or HBa1C; there is no equivalent, after all, everyone has times of sorrow, tiredness, sadness – people don’t randomly have raised blood sugar levels. You are either diabetic or not. It is an all or nothing.

You don’t dabble with diabetes, most of us at some point will experience the cloud of depression; for the majority it will lift, for others, it will sit, black-dog like, waiting for something to happen.

I wrote a couple of days ago a poem about the perceived differences between physical and mental health.

If you dig deep into our bodies, into the organs which control either, you will find a physical basis; whether Serotonin or Noradrenaline receptors in the brain that are dysfunctional or pancreatic islet cells that are not following orders.

Anything short of this is just ignorance.

Is there a merit in taming or socialising depression?

Susan Sontag in her short book, ‘Illness as a Metaphor’ describes the evolution of cancer and TB and later in a subsequent book, ‘AIDS and its Metaphors‘ as first social then physiological diseases;

When I was growing-up, cancer was still discussed in hushed tones, ‘So and so died of…’, my parents would whisper, not daring to say the word out loud, maintaining anonymity, as if the deceased had an extramarital affair or was caught cheating on his taxes.

Is depression the current taboo?

‘I’d rather have diabetes any day.’

What does this mean? What is the value of this statement?

We keep many aspects of our health and wellbeing secret, private. It is such a big business (we call it clinical information governance) that the country is happy to exist with a dysfunctional health and social care system where computer systems do not talk to one another for fear of spillage, exposure.

Ironically, those working in mental health, tend to be the most meticulous when limiting information sharing.

You might think that a good thing. We don’t want everyone knowing about my OCD or Schizophrenia, but, is this not just an example of a perceived difference between physical and mental health – as if the two are separate.

The psychiatrist examines a certain part of your ‘self’, the physical doctor another and both pretend our bodies are modular.

You can write a letter about this or that disease, but you cannot share the file.

I don’t want to diminish the importance of this aspect of governance – it is critical, just odd that there are different standards. Either something is private, or it is not.

This same parsing cannot apply to our minds and bodies.

They are one.

And where does this bring us?

Certainly, the place of depression as a disease of modern-life, as a co-factor of living in a world of pressure and change is more accepted nowadays; in many instances it is an adaptive measure to the pressures around, equally, diabetes, when we are exposed to excess calorie consumption and inadequate exercise is an inevitable complication.

One too many bowls of pasta or pints of beer is a thing. We are not talking good or bad.

Over-sensitivity to noise, pressure, change or criticism is also a thing. It just is.

Once we start seeing depression and diseases like diabetes, asthma, psoriasis, rheumatism, cancer as states of being, without good or bad association or causation we can start with a mature conversation about why we are here and what we are doing and how to make the most of our allotted time.

susan sontag

*There is prevention – exercise, family, friends, meaningful occupation.

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