Capitalism and Pain Behaviors… What healthy people don't want to see.
Capitalism Doesn't Care If You Suffer
Capitalism is a system that values material output over human suffering. If your value is only in your productivity than a person with chronic pain is just as good as someone without chronic pain as long as it does not affect their functionality.
This value system is on full display in many "pain programs." As I have discussed previously, many pain programs abuse patients into lying that they have recovered from chronic pain. See #YouDidn'tCureUs and #BreakingCodeSilence to learn more about this sort of abuse.
But even if a program is not abusive, many still carry the belief that their true goal is not to decrease patient pain but rather to increase patient functionality.
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Pain Behaviors
A common refrain in abusive pain programs is "pain behaviors." These include
-Using heat packs and ice
-Staying in bed when your pain is too bad
-Walking with a limp or using mobility aids
-Talking about pain
-Moaning, cursing, crying, or outwardly showing pain
And may even include taking pain meds
These "pain behaviors" impair the person's ability to function as a "normal" member of society. But they do so in order to reduce the person's suffering.
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Keeping Invisible Illness Invisible
When pain programs, doctors, or society at large discourages "pain behaviors" it tells chronic pain patients that it is more important for them to look normal than it is for them to not suffer. We push these illnesses to be more invisible.
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Denial & Cognitive Dissonance
While some people do understand what is happening to chronic pain patients and choose to enforce the system anyways, most do not. The reason most people choose to believe that functional chronic pain patients cannot be in that much pain is simply cognitive dissonance.
If people really understood that chronic pain patients were in just as much pain as acute pain patients, they would not be able to sleep at night. You see this with many terrible things. For example, people who choose to believe a technological miracle will stop climate change because the alternative is acknowledging the irreparable harm we are doing to the planet.
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Epistemic Culpability
This is a fancy philosophical term that means you have to know something is happening in order to have any moral duty to stop it. For example: if you see a little kid drowning in a pool it would be morally wrong to ignore it. But if you couldn't see it, than you wouldn't be responsible for the kids death because you had no way to know you could have helped.
I believe that many doctors are walking a tightrope of epistemic culpability. They choose not to believe that chronic pain patients are in as much pain as acute pain patients. If they truly believe it, than they are not guilty of medical neglect.
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CBT, ACT, Mindfulness & Pain Management
One place I feel this is particularly present is in the area of psychological pain management.
Many psychologists help patients to be more functional living with chronic pain by practicing mindfulness, CBT, and ACT.
Many patients find these therapies very helpful.
But the way that patients are being helped is often not the way the psychologist believes they are helping.
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Management vs Improvement
If a patient has depression, therapy will make their depression less painful. They will start getting more out of simple pleasures of life. The therapy reduces their pain.
In contrast, many pain patients report that therapy helps them better manage their pain. This means being more able to do things they want to do, spending less time thinking about their pain, and having less disruption to their work, sleep, etc. This is great.
But I believe many psychologists mistakenly believe that this means CBT or similar therapies has decreased the patient's actual physical sensation of pain. This is not what I or many others experience. This can lead to the very dangerous belief that chronic pain that functional improvement and pain reduction are really one and the same.
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Patients Deserve To Choose The Balance Between Functionality And Relief.
This post is not arguing that functional improvements aren't important. I am incredibly grateful that I can function with high levels of pain. If I couldn't this post wouldn't exist.
But the choice of what "pain behaviors" to use to reduce our pain belongs to us. It belongs to the people in pain.
You see this in hospice care. Families asking that their loved ones not be put on too many meds so they can remain "coherent."
In this situation, most people can see that it is immoral to out the wishes of the family above the wishes of the dying person.
But the same applies to chronic pain patients. It is our choice whether to take drugs that might be sedating. It is our choice whether to do activities that lead to migraines or flares.
In the most recent survey by the US Pain Foundation, 24% of chronic pain patients said no side effect would stop them from trying a medication to control their pain.
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Key Takeaways
Chronic pain doesn't matter to capitalism as long as patients are functional. Therefore we need to find other ways to societally value relief of chronic pain.
Chronic pain patients are in just as much pain as acute pain patients often more.
Discouraging patients from "pain behaviors" does not decrease their pain.
Your value is not your productivity. Prioritize human happiness over material production.
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Capitalism doesn't care about pain it doesn't care about Quality Of Life it cares about functionality. So is it any wonder that so much of our pain management in medicine has been made to revolve around functional improvement as opposed to true reduction and control of chronic pain?
I have written before about how chronic Illness patients who suffer from severe pain on a daily basis hide it well. How our function pain tolerance is extremely high which allows us to look and act functional even when we are in extraordinary levels of pain and discomfort. This is in fact a good thing. Without it we would be far more disabled and debilitated.
But functional pain tolerance doesn't make the pain stop. It doesn't make us less worthy of pain relief and pain medication. The goal of treating chronic pain should not be functionality it should be quality of life.
The incredible account @thingsmayosays exposes many pain programs for the instruments of institutional abuse that they are. Punishing patients into hiding their pain. You didn't cure us simular to the troubled teen industry that has been exposed in breaking code silence these programs appear to produce results simply by punishing children into hiding their problems and pain. They explicitly label any functional deviation from normal behavior as a pain behavior and their goal is not to stop pain but to stop the appearance of pain. They don't care if their patients stop hurting as long as they stop crying.
But even regular "pain management clinics" often fall prey to these same beliefs. They prioritize "less invasive" treatment like CBT and mindfulness over medication, mobility aids, and other disruptive treatments.
It is a completely personal choice whether to prioritize functionality when seeking pain management. There are many people who would prefer less invasive options like CBT, who would rather learn to live with their pain than to take medications with or undesirable side effects. Or patients for whom medications work poorly anyways.
But this should be a personal choice, for now, it is not.
