For at least three decades, researchers have been gathering evidence that chronic stress pressures the body to constantly adjust to restore physiological stability. This process is known as allostatic loading and creates a cascade of toxic metabolic activities that cause wear and tear on the body.
Because of the deep-rooted stigma and implicit bias, people who suffer from chronic and unexplained pain are often characterized as complaining, simulating, and seeking drugs. (Shutterstock)
Allostatic load makes people vulnerable to various types of heart, gastrointestinal, endocrinological, immunological, neurological, metabolic and psychiatric problems.
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There is evidence that psychosocial and economic stressors influence health outcomes. But neither our doctors nor our health systems have the tools and methods to integrate these social and economic factors into our diagnoses or preventive care.
Here’s a personal example: I recently called my doctor to find out about new mysterious pains. The extensive research and note-taking that followed would have been very helpful if I had suffered a specific infection or injury, or if my blood test was imperfect. But I had symptoms that started slowly and increased with COVID and work-related stress.
The more I pressed to identify how, where, and when exactly my pains had begun, the more I felt guilty about my inaccurate condition. When I joked that I only needed a month to hang out with Freud in the Alps, he suggested that I be prescribed antidepressants. Going back to self-blame humor, “Maybe this is all psychosomatic,” I said.
Stigma of unexplained pain
Too many people have these experiences. The stigma and implicit prejudices against those who suffer from chronic and unexplained pain (such as complainants, simulators, and drug claimants) are deeply rooted. They are gender. They are also racial.
Although it is known that stress and social and economic disparities make people ill, doctors do not have the tools to address these causes of the disease. At best, along with medications, they can offer psychotherapy, which is still inaccessible and inaccessible to most. Our healthcare system is also not equipped to address the psychosocial determinants of health, which are situational and cultural, so they require more than a clinical approach to care.
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For example, research on the prescription of analgesics for racial and ethnic minorities shows that the pain of black patients is abused. This reflects a lack of confidence in the symptoms reported by those who may already be suffering from other forms of socioeconomic disparity. The death of Joyce Echaquan in 2020, suffering from untreated abuse and pain in a Quebec hospital, made it impossible to ignore the problem of health inequality.
How combative approaches create stigma
Nearly 20 per cent of Canadians suffer from chronic pain. For health care providers, pain is anything that the person experiencing it says is and exists whenever the person experiencing it says they are. (Shutterstock)
At least since the publication of the first epidemiological study in 1662, we have been trying to predict and minimize the causes of mortality. Science and technology are expected to help us win the battle against disease and disability. There is a particular structural worldview that shapes our current medical culture. It is a combative approach to the disease: the fight against cancer, opiate epidemics, depression, diabetes and other conditions.
Implicitly, combative cultures value and reward winners. When we praise heroes (e.g., 100-year-olds who enjoy an active life), we implicitly turn those who fail into losers. This is how patients and their caregivers jointly create the stigma and shame associated with chronic illness or even aging.
Fortunately, a shift towards epistemic justice has begun, which recognizes culturally appropriate practices and traditional knowledge, and patient-centered health care practices are emerging. Indigenous leadership in decolonizing health care will accelerate these efforts. For the healthcare system to start acting on these principles, a shift towards more flexible, qualitative and environmentally friendly research methodologies is needed.
Why it is important to play
In 1509, the Renaissance scholar Erasmus wrote In Praise of Folly to argue that play is an existential necessity that helps humans cope with the inevitability of aging and death by becoming forgotten and carefree. children).
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Therapists or hospices offer different forms of play to facilitate communication about difficult or terminal health conditions.
In Steps To an Ecology of Mind (1971), anthropologist Gregory Bateson offered play as an experimental space for learning communication and learning where people can simulate, interpret, and evaluate the results of their choices in a framed but flexible play space.
In fact, the game is a well-known research tool in developmental psychology, anthropology, economics, and military strategy.
In the context of a global push for digital monitoring and profiling of possible causes of the disease, my research colleagues and I have recently suggested that the game offers an alternative way to approach research and act in this digital ecosystem.
Prescription game
Imagine if the caregiving framework for me was a little more flexible to allow my doctor to prescribe a yoga regimen or to help me[exploreaconsciousnessprogram.(Shutterstock)
Twenty percent of people suffer from chronic pain. What do we do when we can’t “win” the battle against pain? Prescription drugs often offer the cheapest and fastest-acting remedies. But they do not always work and the side effects can be disastrous. That is why there is a growing consensus among members of the World Health Organization to invest in the search for alternative ways of caring.
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In Homoludens (1938), historian Johan Huizinga showed that play is an exclusively human tendency to create imaginative aesthetics and rituals that give different meanings to acts of satisfying biological needs such as shelter, food, and security.
In fact, the game can become a creative and knowledge-generating act. Creative art therapy or expressive writing can help track and control what causes pain.
Imagine if instead of pushing me to provide accurate numbers for the intensity and frequency of my pain, I would be allowed to use metaphors and have fun to explain my symptoms and needs to my doctor.
Imagine if the caregiving framework for me was a little more flexible to allow my doctor to prescribe a yoga regimen or to help me explore a mindfulness program.
Imagine if doctors incorporated indigenous ways of knowing to LISTEN to pain (language, individual, sharing, teaching moments, participating, and navigating).
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Imagine if public health officials did not wait until chronic stress made the population prone to illness, and instead invested in happiness policies such as those in the Netherlands, the country of Erasmus, and Huizinga.
Turning the game into action
When knowledge and care are lacking (for example, in women with endometriosis), social media becomes a space for knowledge generation. In Coping with Illness Digitally, health and digital communications researcher Stephan Rains illustrates that people connect to communities that provide information and care through shared experiences.
The COVID-19 pandemic illustrated the ability of social media to generate data on how to cope with stress. However, if we want to be governed by numbers, we need a playground where we are safe and not passively surveyed. In a real playground, participants are not under surveillance, but are engaged in generating knowledge about the psychosocial stressors that make them ill. Platforms like Patients Like Me offer a model to add to our narratives of stress-related illnesses and coping strategies.
Najmeh Khalili-Mahani, researcher, director of the Media-Health / Game-Clinic laboratory, Concordia University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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