Why is it so difficult to diagnose stress-related illness, and how might a patient-centered humorous approach help?


Chronic stress puts pressure on the body to constantly modify itself to restore physiological homeostasis, according to research dating back at least three decades. This is known as allostatic load, and it causes a chain reaction of harmful metabolic activity that wears out the body.

People with an allostatic load are more susceptible to cardiac, gastrointestinal, endocrinological, immunological, neurological, metabolic, and mental issues.

Psychosocial and economic stressors appear to have an impact on health outcomes, according to new research. Our physicians and health-care systems, on the other hand, lack the required skills and strategies to include social and economic issues into our diagnoses and preventative care.

Here’s an example from my own life: I recently called my doctor to report some strange new pains. If I’d had a specific infection or injury, or if my blood work had been off, the careful investigation and note-taking that followed would have been really helpful. However, I was experiencing symptoms that started slowly and became more frequent as a result of COVID and work-related stress.

The more she insisted on pinpointing how, where, and when my pains began, the more I felt bad about my hazy state. She proposed prescription antidepressants after I joked that all I needed was a month to chill out with Sigmund Freud in the Alps. “Perhaps this is all psychosomatic,” I remarked, reverting to self-blaming humour.

Unexplained aches have a stigma attached to them.

There are far too many others who have had similar situations. The stigma and implicit biases against persons who suffer from chronic and inexplicable aches (as complainers, malingerers, and drug-seekers) run deep. They’re divided into two categories: male and female. They are also racial.

While it is well understood that stress, as well as social and economic inequality, promote sickness, clinicians lack the essential skills to address these factors. They can, at most, give counselling in addition to drugs, which is still inaccessible and pricey to the majority of people. Our health-care system is also unprepared to address the situational and cultural psychosocial determinants of health, which necessitate more than a clinical approach to care.

According to studies on painkiller prescriptions for racial and ethnic minorities, Black patients’ pain is undertreated. This shows a lack of faith in the symptoms described by persons who may already be dealing with other forms of socioeconomic inequality. Joyce Echaquan, who died in a Qu├ębec hospital in 2020 after suffering abuse and untreated pain, made it difficult to overlook the issue of health inequalities any longer.

How confrontational tactics engender stigma

We’ve been attempting to forecast and minimise causes of mortality since at least the publication of the first epidemiological research in 1662. We expect science and technology to aid us in our fight against disease and incapacity. Our current medical culture is shaped by a certain structural viewpoint. It attacks cancer, opioid epidemics, depression, diabetes, and other diseases with a combative strategy.

Combative societies implicitly value and reward winners. We indirectly make those who fail into losers when we glorify heroes (for example, 100-year-old persons who live active lives). This is how patients and their caregivers work together to build stigma and shame around chronic illness and even ageing.

Fortunately, a change toward epistemic justice has begun, which respects culturally appropriate techniques and traditional knowledge, as well as patient-centered health-care practises. These initiatives will be accelerated by Indigenous leadership in decolonizing health care. A change toward more flexible, qualitative, and ecological research approaches is required for the health-care system to begin acting on those ideas.

Why is it important to play?

In Praise of Folly, Erasmus, a Renaissance scholar, argued in 1509 that play is an existential necessity that helps humanity accept the inevitability of age and death by making them forgetful and careless (like children).

Therapists and hospices use various sorts of play to help people communicate about tough or terminal illnesses.

Anthropologist Gregory Bateson proposed play as an experimental arena for communication and learning from learning in Steps To an Ecology of Mind (1971), where people can simulate, analyse, and assess the effects of their decisions in a structured but flexible playground.

Indeed, in developmental psychology, anthropology, economics, and military strategy, play is a well-known research instrument.

My research colleagues and I recently proposed that play offers an alternate way of addressing research and taking action in this digital ecosystem, in the context of a global drive for digital tracking and profiling of probable causes of sickness.

Playing prescription

Twenty percent of the population is affected by chronic pain. What are our options when we are unable to “win” the struggle against pain? Prescription drugs are frequently the cheapest and fastest-acting treatments. However, they are not always effective, and the side effects can be disastrous. This is why members of the World Health Organization are increasingly agreeing to fund in research into alternate forms of care.

Play is a uniquely human tendency to create creative aesthetics and rituals that provide distinct meanings to actions of meeting biological necessities such as shelter, food, and safety, according to historian Johan Huizinga’s book Homoludens (1938).

Play can, in fact, be a creative and knowledge-generating activity. Pain can be tracked and controlled through creative art therapy or expressive writing.

Imagine if, instead of being pressured to offer exact statistics for the severity and frequency of my pain, I was permitted to utilise metaphor and be humorous when describing my symptoms and requirements to my doctor.

Imagine if my doctor’s approach to my care was more flexible, allowing him to prescribe a yoga routine or guide me through a mindfulness programme.

Consider what would happen if clinicians used Indigenous methods of knowing to LISTEN to suffering (language, individual, share, teachable moments, engage and navigate).

Imagine if public health officials engaged in happiness policies like those in the Netherlands, the country of Erasmus and Huizinga, rather than waiting until chronic stress made people sick.

When there is a dearth of knowledge and care (for example, for women with endometrosis), social media becomes a platform for knowledge development. Stephan Rains, a health and digital communications researcher, shows how people connect to communities that provide knowledge and care through shared experiences in his book Coping with Illness Digitally.

The COVID-19 pandemic demonstrated social media’s ability to generate data on stress management. However, if we are to be ruled by numbers, we must play in a safe environment where we are not being passively surveyed. Participants are not under observation in a real playground; instead, they are creating knowledge about psychosocial factors that cause them to become ill. Patients Like Me and other such platforms give a framework for sharing our stories about stress-related illnesses and coping practises.