Blog 13: Politics, fear and pain.

The easy Donald Trump victory this last week in the US elections was predictable despite the polls that consistently suggested the opposite.

It was indeed my intention to write this piece last week before the USA election, but somehow the time wasn’t there and I suppose I figured that it may have been wasted in the event that the polls were correct and I was wrong. A diatribe on my personal political views is not, however, the intention of this piece. In fact I generally avoid using the internet to voice my political views and opinions on other such sensitive topics.

In addition to specific concerns on political processes that I share with many, I have also been troubled by the comparisons between political contests and aspects of my work in discussing models of care in relation to pain. There have been many theories offered as to how the Trump victory could have come to be, as there were similarly with the ‘Brexit’ vote and the rise of One Nation in the recent Australian elections. I’m sure that the reasons are many and complex but I suspect the following comments with respect to ‘fear’ and ‘messaging’ are also relevant.

Fear and messaging.

Quite simply, it appears that if the fear card is played and the messaging is kept as simple and repetitive as possible, those adopting this strategy stand a major chance of popular success. The problem is that not many things in life are indeed simple, and most worthwhile goals are achieved by the recognition, understanding and management of complexity. Similarly, just about any worthwhile achievement that I can think of involves a degree of courage and overcoming of instinctive fear responses.

simple answers

Fear and simple messaging may be effective tools to create populist behaviour change, but they are not things that are associated with greatness in human achievements. Quite the contrary is true in fact if we are to learn from history. The parallels between more recent political trends, ‘marketing’ methods based on fear / simple messaging and events leading up to the second world war are disturbing.

I have given many talks on pain literacy and why it is so important. I have a slide which asks the question – “What is the most influential emotion on animal / human behaviour ??”

There is certainly some variation in audience responses but the majority seem to agree with me that FEAR has the greatest role to play, especially in major behavioural effects. I discovered the following definition of FEAR on Wikipedia which seems to fit best with the point I am trying to convey both here and in my pain literacy message –

Fear is an emotion induced by a threat perceived by living entities, which causes a change in brain and organ function and ultimately a change in behaviour, such as running away, hiding or freezing from traumatic events. Fear may occur in response to a specific stimulus happening in the present, or to a future situation, which is perceived as risk to health or life, status, power, security, or in the case of humans wealth or anything held valuable … In humans and animals, fear is modulated by the process of cognition and learning.”

Hmmm … consider political strategies and in particular those that have proved so extraordinarily successful in recent times.

Consider also the brain’s pain equation discussed elsewhere on my pain literacy website.

When I compile lists of things that feed into the ‘danger’ versus ‘safety’ side of the brain’s pain equation with my audiences, it always seems to be easier to compile a longer list of danger messages than safety ones. In addition to the preponderance of fear sources generally (think of the definition above), there is also an ‘inconvenient truth’ in simple messages provided commonly by well-intentioned health experts that structural body changes are the cause of pain and will likely cause more problems etc. Such comments are made because of the fundamentally flawed belief that there is a good relationship between what is seen and what people feel. This is a perspective that essentially belongs in the realm of fiction and has little, if any scientific credentials if scrutinised beyond simplistic ‘flat earth’ like observations. Yet, it is a simple message that can, and does, ignite a fear fuelled fuse line that ends in predictable disaster in those who are psychologically and sociologically vulnerable. There are those who are permanently impervious to these sorts of messages, but there are many ‘swinging voters’ who may find themselves susceptible because of the timing of concurrent events and influences in their lives.

The somewhat more complex alternative to such simple, quick and easily repeated messages is to provide perspective, education, empowerment and facilitation of optimally re-adaptive ‘healing’ responses.

The aspect of my pain literacy crusade that I find most concerning is the resistance to the (not so simple) message. I don’t mean just from patients; most concerning to me is the resistance to meaningful change by health practitioners themselves. To make matters worse is the consistent observation that this occurs despite the message being well received! I have presented on this topic repeatedly and been given excellent feedback by my audiences. My website has been in existence for a long time now and by far responses have been praising and it has attracted generally constructive critical feedback only. The projects I have been involved in in the compensation arena have been based on a pain science model and have been objectively successful. Despite all this, very few have subsequently ‘gone into bat with me’ afterwards. Anecdotally, patient management using my new pain science prioritised approach has been so much more satisfying, in contrast to my previous musculoskeletal model ‘textbook’ management approach. Despite succeeding in turning many patients in seriously entrenched pain around and preventing others from taking this fork in the road, overall referral rates have actually declined since I transitioned from one model to the other.

In vulnerable people fear messages easily trump all others.

Complex messages, no matter how robust, struggle against slogans and ‘one-liners’ in politics and pain.

I must go back to the drawing board to think up strategies convincing people to fear the haphazard results really being achieved by the current flawed model of care more than they fear their scan results.

Back at that drawing board, I need to think up simple messages to try to create real change in a valid direction and then repeat it over and over and over again. “Know pain, know gain”, … “Let’s make pain not grate forever again” …

If you can’t beat them, join them … ???

*******

PS: A few weeks after originally writing this blog I discovered the following in a speech by Martin Luther King:

” Ultimately a genuine leader is not a searcher of consensus but a molder of consensus. On some positions cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, is it right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular but he must take it because conscience tells him it is right.

And another:

“The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.”

Now, THAT is leadership!

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kalfried

I attained Fellowship of the Australian College of Sports Physicians in 1995 and have gained extensive experience in this field both before and after that milestone. I worked for five years in the Victorian snowfields, before joining the Melbourne Football Club (AFL) in the mid 1990's. I was a medical officer there for a total of 15 years with Dr Andrew Daff, as well as another 2 years with the Collingwood Football Club in the VFL. I was appointed as the AFL Australian International Rules team doctor in 2011 and 2013. I have also supported other elite sporting teams including the Australian Diamonds netball team in 2012. My main current appointment is with the TAC and WorkSafe as a medical advisor on the Clinical Panel and on various projects, and I am also an Independent Medical Examiner. In addition to general sports medicine I have developed a particular interest in the neuroscience of pain, the potential to 'de-sensitise' persistent pain, the biopsychosocial management model and exercise & conditioning prescription.

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