Intersectionality of Mental Health Including Addiction, and Chronic Illness
Basic facts
Addiction is a type of mental illness, not a moral failing.
Physical chronic illness is not caused by mental illness.
Physical illness can cause mental illness.
Healthcare fails people who have both mental and physical illness in unique ways
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Healthcare failure 1:
Specialist tunnel vision
This is most prevalent in modern western medicine. Specialists refuse to interact with patients who do not fit into their discipline completely. This fails the millions of patients who have comorbidities in numerous disciplines. For example, doctors often refuse to treat severe pain in patients with past addiction because they have decided the person has a mental health problem and assume they can't have physical problems.
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Healthcare failure 2:
Mind-body connection
Those who turn to alternative practitioners may often find a similar problem in a different light. The strong emphasis on mind-body connection often leads practitioners to assume a root diagnosis and then let everything else follow. For example, assuming that your PTSD is the root of all other health issues and therefore only treating PTSD when the patient also has arthritis, MS, etc.
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Intersectionality
As you can see having a mental and physical health condition together makes treating both harder. It is not as simple as having the same issues as just mental illness + physical illness, rather the combination makes getting treatment for both harder. There are new challenges that live in the overlap of mental and physical comorbidity.
These include:
-Difficulty accessing services
-Ammunition towards ableists
-Strengthened self-doubt
-Increased functional limitation
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Difficulty accessing services
Consider someone who uses prescription pain medication for a spinal injury and also has a substance use disorder. They may want to access rehab and learn to manage their SUD, but few programs differentiate between responsible use of pain killers and addiction. So they may have to choose between going without their necessary medication for months to complete a structured rehab program or trying to control their addiction without proper support and counseling.
Similarly, psych wards routinely deny basic medical accommodations to patients. A suicidal person with severe ME would not be able to safely access a psych ward. Increasing their risk of death.
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Ammunition towards ableists
Statements like
"It's just anxiety."
"You're not in pain you're just an addict."
"Of course you're depressed you're disabled."
All reinforce false ableist beliefs about disabled people. These statements hurt wherever they are applied but if you have a comorbid anxiety disorder, a history of chemical addiction, or severe depression they hit a whole lifetime of stereotypes and prejudice.
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Strengthened self-doubt
Anyone with chronic illness or mental illness has likely experienced ableism as above. We try to brush it off but it plants seeds in our head of self-doubt. "What if I really am faking?" "Is it really that bad?" etc.
However, if you suffer from both physical and mental illness, there is often a tiny link to a true statement in the massive turd of ableism that make brushing aside this self-doubt even harder. It's not just "what if this is anxiety" it's "what if this is my anxiety disorder? I mean I do get anxious..." It is important to remember that you know when something with your body is new and needs attention.
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Increased functional limitation
Finally, the functional result of having comorbid mental and physical health issues leads to far greater total functional limitation than the two combined.
An addict in recovery may be far more incapacitated by their chronic pain because the medical system denied adequate pain relief.
A person with Bipolar Disorder and MECFS may struggle to pace when they are manic and suffer even worse depression due to their inability to use exercise to stimulate endorphins.
Having mental and physical conditions creates challenges beyond the sum of their parts. Not only does current healthcare not acknowledge this, it actively makes it worse by enforcing ableist prejudice in clinical practice.
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Addiction does not make patients unworthy of pain relief. Chronic pain patients, Substance Use Disorder(SUD) patients, and Mental Illness patients are not 3 separate groups and it is time we stopped pretending the intersectionality of mental health and physical health doesn't exist.
I am not talking about "Mind-body connection" in fact that is yet another way these issues are brushed aside. What I mean is that physical and mental health are two equally important and distinct aspects of healthcare and that patients with mental and physical illness deserve the same quality of healthcare for both their conditions as people who fit exclusively into one category.
Unfortunately, this is not the case.
Prejudice against patients with chemical dependency or SUD is baked into our medical system. Chronic pain patients frequently face the stereotype that all chronically ill people are addicts. But even if a person with severe pain does have a history of addiction this still does not justify their suffering. They still deserve access to healthcare. After all, addiction is a disease. We would not deny patients healthcare due to any other comorbidity. We should not deny patients healthcare due to addiction.
Similarly, many patients with MECFS, autoimmune disease, invisible illness and fibromyalgia face stigma that their diseases are "all in their head" or mental illness. For patients with pre-existing psychiatric diagnoses, this stigma can be even harder to overcome. Their doctors may dismiss their physical illness as anxiety and depression even when they have lived with those conditions for years and not been debilitated but are suddenly housebound or bedbound.
On the flip side, getting consistent treatment for their chronic illness may require staying out of inpatient psych wards where they would be denied access to treatment. Or may prevent patients from seeking mental healthcare at all for fear their doctors will see it as a reason to stop investigating their physical symptoms.
In conclusion, the way our society pits mental and physical health creates new barriers specific to the intersection of mental and physical health leaving many without necessary services.
