Dear Nancy -

We have all gone through what you are describing, one way or another. There are two saving graces we have going here. First, the psychiatric community has identified two brother/sister disorders as being specifically due to a medical condition, on account of which we can use these DSM codes for treatment without attracting the future scrutiny (or stigma) of whomever might be inclined to say "oh, you were treated for depression . . . ." They are actually handy tools that our doctors should be employing regularly when we get an "Axis I" Dx. Those codes are as follows, omitting some technical instructions to be used be the practioner in their utilization:

Mood Disorder Due to a General Medical Condition (DSM IV 293.83)

This Mood Disorder is diagnosed when the clinician believes a specific general medical condition causes symptoms suggestive of a Manic, Mixed, Hypomanic, or Major Depressive episode.

Diagnostic criteria for 293.83 Mood Disorder Due to...[Indicate the General Medical Condition]

A. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:

(1) depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
(2) elevated, expansive, or irritable mood

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Depressed Mood in response to the stress of having a general medical condition).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AND

Anxiety Disorder Due to General Medical Condition (DSM IV 293.84) [as of 10/01/96]

The diagnosis of this Anxiety Disorder is made when there is evidence that persistent anxiety symptoms, including Panic Attacks, obsessions, or compulsions have arisen out of a general medical condition.

Diagnostic criteria for 293.84 Anxiety Disorder Due to...[Indicate the General Medical Condition]

A. Prominent anxiety, Panic Attacks, or obsessions or compulsions predominate in the clinical picture.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Anxiety in which the stressor is a serious general medical condition).

D. The disturbance does not occur exclusively during the course of a Delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

From Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association

Secondly, to turn from matters of form to substance, the essence of what is commonly understood as "Buddhist phsychology" is that pain may be is unavoidable, suffering is optional. What's meant by that is that suffering is what we experience when we are presented with an objectively painful situation, and then devote our energies to either pushing away that which is (like it or not) or being attached to the way we otherwise want them to be. It was around this principle that Jon Kabot Zin, PhD. working out of the University of Mass. Medical School in the 1980's set up a program largely targeted on pain patients experiencing depression, called Mindfulness Based Stress Reduction (MBSR). It now has teachers around the country, including a number of some good ones (here) in LA. From the national homepage, including a directory to currently active teachers, many of whom are licenced psychologists, go to http://www.umassmed.edu/content.aspx?id=41252.

I was referred to a teacher in 2002 following a single 2 hour consultation with a high end pain psychoanalyst, after the so-called "pain pschologist" at the hospital where I was being treated told me that the outbursts of anger of which I was complaining, "went with the territory" of chronic pain, and ther was nothing I could do about it. After an 8 week course that meant for one evening a week, with taped guided meditations and yoga exercises for a sense of overall body awaremess, to be practiced every day in between, I was quite literally a new man. After a year and a half of struggling to practice law since I had become sick, and not being able to let go because of my egoic attachment to my professional identity - even though I had long stopped being able to net more than a few dollars a month from the practice - I was able to finally let go of it with some measure of ease, and direct my energies where they could be better employed. If you're curious, drop me a PM and I will be happy to give you the names of some very good teachers in town.

Along the same lines, is Shinzen Young (my teacher since 2003) whose Breakthrough Pain book and CD are designed to help you see to pain experience with enough concentration, sensory clarity and equinimity that you are largely free of it, or at least you are not identifying with the pain experience. One way he does this is by first having you ancknowledge where the pain is stongest in your body - if unbearable - and then finad another spot in the body which only holds a feint echo of the pain, but in which you can comfotably come to an intimate understanding of it's dynamics. The metaphor I use is standing behing a waterfall: you get a little wet from the mist, but you are by now means pulled into the vortex below. Breakthrough Pain can be obtained through Amazon. And if you want to read more about the man before investing your $20 or so, Shinzen's primary webpage, including freely downloadable reading material and YouTube videos is at http://shinzen.org/.

I hope that I you may find something of use in all of this. And that you know that there are many communities of friends, including this one, who are only too happy to make your acquaintance and be of service in any way possible.

Mike (in LA)