There has been a lot of focus during the pandemic on physically safe and healthy home working. But what about mental health, especially for those living with and managing chronic pain from a home-working setting, asks María de los Angeles Zapata Rodríguez?
The Covid-19 pandemic has exacerbated the debate regarding the necessity of having a proper workstation for those who work at home. This physical setting will typically be constituted by a good (if possible, ergonomic) chair, a desk, a computer, and many other elements. However, how many times do we discuss the most important workstation, our heads?
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This workstation is varied, complex, and the keystone to many work-related issues. For the sake of this article, mental health will be explored from the depression angle in people living in chronic pain.
Understanding chronic pain
Chronic pain is one of the major disabling conditions in the UK, 43% of the British population lives in chronic pain, and 61% of these consider themselves depressed.
But what is chronic pain? As the name suggests, it is feeling pain all days, all day (or at some point during the day). Chronic pain itself is a condition, but it can also be a result of other associated conditions. However, no matter the reason or where it comes from, chronic pain has vast consequences in people’s lives.
In biological terms, there is a connection between chronic pain and depression. They are in the same regions of the brain, and they happen within similar neurological functions. From this perspective, it seems that chronic pain could cause depression. However, this perspective only focuses on the biological component, which completely dismisses the environment, and where workplaces have something to say (or to do, or to deconstruct).
There is what is called “the collective worldview”. Basically, we’ve been all raised in some social and cultural settings where some features are more attractive than others. We do not need to think about them, we have ideas, (pre) conceptions on how the world should be (in more formal terms, the ontology of our worlds). In this ideal world, abled bodies are the norm, and are “superior” to those that are not. This the so-called ableism. Ableism is formed by the discrimination based on the ableness of bodies.
Ableism has conscious and unconscious facets. In other words, people might be aware or unaware of their ableist practices, behaviours, and reflections.
There are three places where this collective worldview can have an impact on the employee: management of pain, employer expectations, and employee expectations.
1) Management of pain. The management of pain, as with any disease, varies from person to person. No protocols have been established that can work in most of the cases (as, for example, in diabetes, where the usage of insulin has proven good results for a significant portion of diabetic people).
It will depend on the source of the disease (the cause), the specific symptoms (and associated ones), the affected system (type of tissue, bone, organs, muscles), age, sensitivity to medication, medical history, among others. But in any case, most people living in pain face challenging work experiences.
2) Employer’s expectation. An employer’s expectations accompany any job position. The employer is expecting some results or characteristics in their employees. This can be summarised by what employers have expressly said they want in their employees or by implicit agreements. In these scenarios, people living in pain will need to hide their pain sensations, uncomfortableness, that can lead to what is known as emotional labour.
3) Employee expectations. Ableist practices do not only live in those able-bodied people, but also in dis-abled people. People who live with chronic conditions want to be treated “normally”.
Although the debate about what the normality stands for could last forever, being treated normally means people do not like to be treated differently or stigmatised because of their condition. Hence, people living in with chronic conditions (including chronic pain) are not likely to disclose them, unless there’s some need of their employer to know, related to paid sick leave or adjustments.
Although expectations (from both sides) might be underrated, they have a great impact in work environment. Added to the management of pain, that become more difficult during flare-up periods, employees may find impossible to manage their workload and work responsibilities.
What can workplaces do?
Why the workplace has to come forward in this discussion? Because the person who lives in pain cannot alleviate the problem alone, or at least has not been able to do so yet. This leaves us with the option to modify (or evolve) workplaces. I propose three measures: reduce stigma, put mental health as a priority, and manage expectations. I’ll now look at each in turn.
1) Reduce stigma. It does involve a constant deconstruction process. In simple terms, managers and employers need to engage with more reflective practices regarding inclusion and no-discrimination. As previously mentioned, many practices or behaviours are not conscious. Questioning yourself why you decided what you decided in a daily basis. The question should come from a place of equal treatment and opportunities.
2) Make mental health a priority. Mental health must become a priority. Mental health is as important as physical health. As we encourage people to workout (from walking to going to the gym, or doing some yoga), we need to encourage each other to practice the mental health muscle.
Having more meaningful conversations can change the work environment. Encouraging workers to have more purposeful conversations. Change the motto to “it is okay not to be okay”. Accepting that not being okay opens the floor for many more diverse possibilities, where more real outcomes can be developed.
Having more meaningful conversations can change the work environment. Encouraging workers to have more purposeful conversations. Change the motto to “it is okay not to be okay”. Accepting that not being okay opens the floor for many more diverse possibilities, where more real outcomes can be developed.”
3) Manage expectations. Finally, it is imperative be clear about expectations. It is a two-way street. Both employers and employees have a set of beliefs, assumptions, and truths that are valid, but are not the only path. Hence, expectations should not be based in implicit agreements, but make more explicit ground rules, on workload, working hours, adjustments, management of conditions (even some internal arrangements at the institution), among others.
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From my experience interviewing people in chronic pain, reducing stigma, opening the floor for mental health discussions, and managing expectations looks like this: employees feeling they are in a safe environment to talk about their conditions. Those who had disclosed their conditions did it because they already knew their employers would be supportive. And how they knew they would be supportive? For the kind of treatment and conversations they had before their chronic pain started affecting their lives.
References
Fayaz A, Croft P, Langford R et al (2016). “Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies”, BMJ Open; 6:e010364. doi:10.1136/bmjopen-2015-010364
Munir F, Leka S and Griffiths A (2005). “Dealing with self-management of chronic illness at work: predictors for self-disclosure”. Social science & medicine, 60(6), pp.1397-1407.
Rayner L et al (2016). “Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs”. Pain, 157(7), pp.1472-1479.
Sheng J et al (2017). “The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain”. Neural plasticity, 2017.
