My Body, My Pain: Chronic Pain as a Women’s Mental Health Issue//Kylie Steinhilber

Image retrieved from: University of Michigan, Michigan Health, https://healthblog.uofmhealth.org/health-management/cost-of-chronic-pain-infographic

           

            Living with chronic pain can cause one’s physical and mental health to suffer. Among those living with chronic pain, nearly 70% are women (Kiesel, 2017). Unfortunately, many are left without answers either because their disorder doesn’t have many known effective treatment options or because their doctors have “gaslighted” them. Whether or not you have heard this term before, if you are a person who has any type of marginalized identity, you may have experienced an instance of gaslighting in which a doctor makes you feel as though you should doubt your (well-justified) symptoms (Booth, 2018). Doctors may even minimize your symptoms to the point where you yourself can’t tell if the symptoms are real or in your head because no doctor you’ve visited has seemed to validate them. Unfortunately, gas lighting is perpetuated by gender-based stereotypes that women are just “more sensitive” and can be traced back to the days where women received a diagnosis of hysteria. These stereotypes contribute to the dearth of research on effective treatment options for women’s chronic pain, especially chronic pain due to reproductive health issues. Moreover, research on chronic pain typically uses male populations despite the fact that women are the majority of those who suffer with it (Kiesel, 2017). Disappointingly, it takes women multiple visits to the doctor’s office over a period of months to years to get proper treatment, if any. This is a health disparity we cannot ignore.

           

            We must also consider the effects that living with chronic pain can cause for women beyond their physical health. As someone who has dealt with chronic pain, I know first handedly how it affects one’s mental health. My own perspective is just one of many unique voices of those who live daily with chronic pain. For me, chronic pain has affected two major aspects of myself: my competence and my body image. This is not an uncommon experience. Chronic pain can make one feel as though their body isn’t home, at times distrusting one’s own body not knowing what symptoms will present one day to the next. Pain can limit one’s ability to perform tasks they previously were able to do with ease, or make tasks more difficult than they are for others without chronic pain. Unlike physically visible disabilities, chronic pain is invisible and can often make it especially hard to advocate for one’s self out of fear that others won’t believe them. Especially considering that this fear is sometimes reality, as in the case of doctors who gas light women’s pain, one can feel silenced. When your voice isn’t heard, it can become easy to feel as though your voice and your needs don’t matter. As a result, one may internalize this in the process of self-silencing in which one censures their own voice for the sake putting others needs above their own and limiting the relevant importance of their voice as compared to others (Swim, Eyssell, Murdoch, & Ferguson, 2010). Self-silencing is a common phenomenon in experiences of marginalization or objectification such as sexism (e.g., Watson & Groteweil, 2016). However, self-silencing is less studied in females living with chronic pain despite their common experiences with gaslighting which rests upon sexist notions that women’s pain isn’t real or that women are too sensitive. This can contribute to the feeling of incompetence, or the lack of control over one’s outcomes, including their experience of pain, their ability to find treatment options and their prognosis.

           

            In addition to hindering competence, chronic pain can have a negative impact on one’s sense of their own body. For example, studies show a relationship between chronic back pain and distorted body perception (e.g., Moseley, 2008, Flor, Braun, Elbert, & Birbaumer, 1997). These studies provide good evidence for neurological differences in how those with chronic pain perceive their own bodies, however, studies that examine body perception and chronic pain in terms of mental health (i.e. body image) are limited. Research has found that those with chronic pain perceive their pain-affected body areas to be enlarged in comparison to how they once were or in comparison to their other body parts (Bailey, Nelson, Lewis, & McCabe, 2013). Despite this and the fact that our society promotes the “thin-ideal” among women, I can imagine how many women struggling with chronic pain and the resulting feeling of body-part enlargement may also perceive their bodies negatively.

In my experience, chronic pain has caused me to feel as though my bottom half is numb and heavy and ultimately causes me to perceive myself as larger than I may appear to others. Combined with feeling a lack of control over my prognosis and treatment options, my body image has suffered while I figure out how to treat my pain in the meantime. So, apart from what I’m doing already to treat my pain, what can I do? This is a difficult question because the answer may necessitate a paradigm shift. For me, I’ve had to redirect myself away from the notion that women’s value is based on what they look like or how much they weigh. I’ve slowly shifted to self-defining positive body image to incorporate an acceptance-based stance that there are some things that I cannot change—my pain and the associated body perception problems—yet I can do my best to avoid mental suffering over it. Acceptance-based therapies such as Acceptance Commitment Therapy has also been proven to be helpful for others who have chronic pain (Musavi, Mujembari, Abharian, & Pashang, 2018).  In this process, I’ve also attempted to emphasize and prioritize my value in having as much health and low-pain days as possible, regardless of my weight, shape or size. This is a difficult process when we, as women, are told otherwise and that message is reinforced across different domains of life. It is also difficult when our pain is not validated.

The journey with chronic pain can be difficult in ways that extend beyond the distance of our pain itself. For many, this journey can also be long. I hope to keep exploring how to positively live with chronic pain and its effect on my mental health. To those with chronic pain who may be reading this: your pain is real, your struggles with your body are important, and I hear you.

Written by: Kylie Steinhilber   

References

Bailey, J., Nelson, S., Lewis, J., & McCabe, C. S. (2013). Imaging and Clinical Evidence of Sensorimotor Problems in CRPS: Utilizing Novel Treatment Approaches. Journal of NeuroImmune Pharmacology, 8, 564-575. doi: 10.1007/s11481-012-9405-9

Booth, S. (2018, September 05). Is Your Doctor Gaslighting You? Here's What to Do. Retreived from:  https://www.health.com/mind-body/is-your-doctor-gaslighting-you

Flor, H., Braun, C., Elbert, T., & Birbaumer, N. (1997). Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience Letters, 224(1), 5–8.

Kiesel, L. (2017, October 09). Women and pain: Disparities in experience and treatment. [Blog post]. Retrieved from: https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562

Moseley, G. L. (2008). I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain, 140(1), 239–243. doi: 10.1016/j.pain.2008.08.001

Mousavi, S.M., Mujembari, A.K., Abharian, P.H., & Pashang, S. (2018). Effectiveness of Acceptance and Commitment-Based Therapy (ACT Rehab) on Quality of Life, Severity and Duration of Pain in Women with Chronic Low Back Pain. Iranian Rehabilitation Journal, 16(1), 103-110.

Swim, J. K., Eyssell, K. M., Murdoch, E. Q., & Ferguson, M. J. (2010). Self‐silencing to sexism. Journal of Social Issues, 66, 493-507. doi: 10.1111/j.1540-4560.2010.01658.x