Back pain doesn't care if you are a member of the US Congress, anxiety doesn't care if you chair the House Armed Services Committee.
American politician Adam Smith knows from experience. Fearing backlash, for years he kept his struggles and hopelessness a secret.
After seeing more than 100 doctors over 6 years, Smith finally found the right treatment for his physical and emotional pain.
He tells Jesse Mulligan that to get his body right, he had to get his mind right, too.
US Congressman Adam Smith Photo: Supplied
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Adam Smith is the author of Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety.
Although Smith says was highly stressed for a "good chunk" of his life, he was also, apart from three times, high-functioning.
"I had a bout of depression when I was 25, I had a bout of anxiety when I was 40. And then eight years after that the anxiety came back and wouldn't go away. And that's when I started seeking treatment.
“Then, of course, I also had a chronic pain problem that took me to a lot of physical therapists and chiropractors and a bunch of others, to try to figure out 'what's wrong with me?' and 'how do I fix it?'”
Initially, he was reluctant to seek psychological support.
“I had that bout of depression when I was 25. I didn't talk to anybody about that. It just went away after five or six months.
“And then when I had the anxiety, I kept that very close, saw one psychiatrist, kept that very quiet. It was really difficult. The only thing that ultimately got me to open up to people was I didn't think I had any choice when the anxiety came back in 2013.”
Smith says he discovered that self-honesty was essential.
“One of the keys to good mental health is being honest with yourself and being honest about how you're feeling.
“So keeping it in and trying to pretend that you're something other than what you are, that's the opposite of what you need to do to deal with a mental health issue.”
Eventually, he came to realise that the way he processed feelings was actually within his control.
“At the time, it wasn't helpful at all [to hear that] because I didn't believe it.
“I mean, think about it, whenever you or anyone's going through a period of high stress in their life, we always attribute it to what's happening; a new job, started in college or grad school, or maybe you're having a difficulty in your relationship, one of your children is going through a tough time.
“And you sort of point to it - this is what's coming at me and this is why I feel that way.”
Smith says he'd previously focused on shrinking the amount of stress in his life.
“When the psychologist told me in 2013 that it's more how you process stress than how much you have, that was completely outside of my frame of reference.”
Our brains, like our bodies, can be trained to cope better, he says.
"If you're not in great shape, and you're like 'I want to build up my cardio', you run, you swim, you ride a bike, do things that are going to build up the strength.
“Your mind strength can also be built up by better understanding how to deal with the emotions that you feel.”
In the United States, mental health treatment is too medication-focused, Smith says.
“I think the two big problems we have with mental health treatment in the US [are] number one, they're quick with the meds, with the antidepressants and anti-anxiety medication. Those are not nearly as effective, and some doctors seem to think they mask the problem."
Taking anti-anxiety medicine over time, the effects diminish, he says.
“The first time I took a benzodiazepine it worked brilliantly. It was an incredible experience, It was like anxiety gone. But then you build up a tolerance and it doesn't solve the problem.
“The second problem we have, in the US anyway, is we go right to Cognitive Behavioural Therapy (CBT). Cognitive Behavioural Therapy is really important and it's helpful. It basically tries to teach you to analyse what you're worried about, what are you really anxious about?”
The problem with this type of psychotherapy is that it doesn't tackle underlying problems, Smith says.
“If you have an underlying issue with your self-worth or you have trauma from your past that you haven't properly dealt with, Cognitive Behavioural Therapy really isn't going to help that much.
“Mostly, it just pisses you off, because they keep telling you, 'Oh, you know, you shouldn't be so anxious'. 'Okay, but I am. Alright, so what am I supposed to do about it?'”
Lost and Broken book cover Photo: supplied
Psychiatric medication and CBT have their place, he says, but understanding a patient's history should be the starting point of any treatment.
"'What's going on in their life? And then you can work through Cognitive Behavioural Therapy. And let me just say on the drug thing, I have no doubt that there are some people who have been enormously helped by medication.
“But I'm also 100 percent confident that in the United States, we way overprescribe those medications, make problems worse and don't help people in the way that we could.”
Smith says he gradually got on top of his physical pain through muscle activation therapy.
“I had major knee surgery. When I was a kid, a bone died in my knee, and I never properly rehabbed my right leg after that surgery when I was 16.
“So my body got out of whack. My whole life my knee hurt, my back hurt, my foot hurt, but it was all manageable.”
Yet in 2014, he says, the pain stopped being manageable.
“I was in pain all the time, I couldn't exercise. And so I spent a lot of time thinking 'Is it the anxiety triggering the pain?'
“There was a lot of research on that, it's not 100 percent clear. In my case, it was both, I had physical problems. Basically, my entire muscle system had sort of shut down because I had been misusing it for so long.”
Muscle activation therapy is still relatively new in the US, Smith says.
"The muscle activation people gave me the invaluable insight that muscles don't just need to be strong and flexible. They also need to be activated.
“It's weird but your muscles shut down if you use them wrong, and then they become not as useful to you and then you start compensating and that puts more pressure on your joints.”
Thanks to this technique, he now experiences less pain than ever before.
“It literally saved my life, it fixed my body and I'm in less pain now that I've been in since I was probably 20 years old. And so I had to solve both the mental and the physical problem.”
Healing from physical and emotional pain is possible, he says.
“I don't want to be too Pollyannaish about this, I know that there are people who have more severe problems than I did and maybe you don't get all the way back as far as I did. But you can get better, whatever situation you're in. There are ways that your mind and your body can get better and get you to a better place.”