For at least three decades, researchers have gathered evidence that chronic stress puts pressure on 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.
Due to stigma and deep-seated implicit biases, people suffering from chronic and unexplained pain are often characterized as complaining, abusing, and seeking drugs. (Shutterstock)
Allostatic stress makes people vulnerable to various types of heart, gastrointestinal, endocrinological, immunological, neurological, metabolic and psychiatric problems.
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Evidence is emerging that psychosocial and economic stressors affect 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 is a personal example: I recently called my doctor to report new mysterious pains. The thorough investigation and record-keeping that followed would be very helpful if I had suffered a specific infection or injury, or if my blood count was imperfect. But I had symptoms that started slowly and increased more often with COVID and work-related stress.
The more she insisted on identifying how, where, and exactly when my pain began, the more I felt guilty about my inaccurate condition. When I joked that it only took me a month to hang out with Freud in the Alps, she suggested prescribing antidepressants. Returning to self-accusing humor, “Maybe it’s all psychosomatic,” I said.
Stigma on unexplained pain
Too many people have these experiences. The stigma and implicit biases towards those who suffer from chronic and unexplained pain (such as complaining, malicious and drug-seeking) are deeply rooted. They are by gender. They are also racial.
Although stress and social and economic disparities are known to make people ill, doctors do not have the necessary tools to address these causes of the disease. In the best case, along with medication, they can offer psychotherapy, which remains inaccessible and inaccessible to most. Our health system is also not prepared to deal with 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 prescribing painkillers to racial and ethnic minorities has shown that the pain of black patients is inadequately treated. This reflects a lack of confidence in the symptoms reported by those who may already be suffering from other forms of socio-economic inequality. The death of Joyce Echaquan in 2020, suffering violence and untreated pain in a hospital in Quebec, made it impossible to ignore the problem of health injustice.
How combat approaches create stigma
Nearly 20% of Canadians suffer from chronic pain. For health care providers, pain is what the examiner says it is and always exists when the examiner tells him he is doing it. (Shutterstock)
At least since the publication of the first epidemiological study in 1662, we have been trying to predict and minimize the causes of death. Science and technology are expected to help us win the battle against disease and disability. There is a certain structural worldview that shapes our current medical culture. He has a combative approach to the disease: he fights cancer, opioid epidemics, depression, diabetes and other conditions.
Implicitly, martial arts value and reward winners. When we praise heroes (such as 100-year-olds who enjoy an active life), we implicitly turn those who fail into losers. This is how patients and their caregivers work together to create stigma and shame associated with chronic illness or even aging.
Fortunately, a transition to epistemic justice that recognizes culturally appropriate practices and traditional knowledge has begun, and patient-centered health practices are emerging. Local leadership in decolonizing healthcare will accelerate these efforts. In order for the health system to operate on these principles, a shift to more flexible, high-quality and environmentally friendly research methodologies is needed.
Why the game matters
In 1509, the Renaissance scholar Erasmus wrote Praise of Stupidity to argue that play was an existential necessity that helped people face the inevitability of aging and death by becoming forgetful and carefree (like children).
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Various forms of play are offered by therapists or hospices to facilitate communication in difficult or terminal health conditions.
In Steps To an Ecology of Mind (1971), anthropologist Gregory Bateson offers play as an experimental space for communication and learning from learning, where people can simulate, interpret, and evaluate the results of their choices in a framed but flexible platform.
In fact, the game is a well-known research tool in developmental psychology, anthropology, economics, and military strategy.
In the context of a global drive to digitally track and profile potential causes of disease, my fellow researchers and I recently suggested that the game offers an alternative way to approach research and take action in this digital ecosystem.
Prescribing a game
Imagine if the care framework for me was a little more flexible to allow my doctor to prescribe a yoga regimen or to help me[seethecareprogram.(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 remedies. But they do not always work and the side effects can be catastrophic. That is why there is a growing consensus among members of the World Health Organization to invest in exploring alternative care options.
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In Homoludens (1938), historian Johan Huizinga shows that play is a unique human tendency to create imaginary aesthetics and rituals that give different meanings to actions to meet biological needs such as shelter, food and safety.
In fact, the game can become a creative and knowledge-generating act. Creative art therapy or expressive writings can help track and control what is causing pain.
Imagine if, instead of forcing me to give exact numbers for the intensity and frequency of my pain, I was allowed to use a metaphor and be playful to explain my symptoms and needs to my doctor.
Imagine if the care framework for me was a little more flexible to allow my doctor to prescribe a yoga regimen, or to help me study a mindfulness program.
Imagine if clinicians included local ways of knowing HEARING about pain (language, individual, sharing, learning moments, engagement, and navigation).
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Imagine if public health officials did not wait until chronic stress made the population susceptible to disease, and instead invested in happiness policies such as those in the Netherlands, Erasmus and Heising.
Turn the game into action
When there is a lack of knowledge and care (for example for women with endometriosis), social media becomes a space for generating knowledge. In Tackling the Disease Digitally, health and digital communications researcher Stefan Raines illustrates that people connect with communities that offer information and care through shared experiences.
The COVID-19 pandemic illustrates the capacity of social media to generate data to deal with stress. However, if we are to be guided by numbers, we need a playground where we are safe and not passively monitored. In a real playground, the participants are not monitored, but are engaged in generating knowledge about the psychosocial stressors that make them ill. Platforms like Patients Like Me provide a plan to add to our stories of stress-related illnesses and coping strategies.
Najmeh Khalili-Mahani, Researcher, Director of Media-Health / Game-Clinic, Concordia University
This article was republished by The Conversation under a Creative Commons license. Read the original article.
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Read also: AAMSU appeals to Supreme Court to investigate “extrajudicial” killings in Assam
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