Focus on the human being, not on the disease.
Why it is crucial today to put people’s physical and mental wellbeing at the core of our reflection and actions.
Written with Maria Sole Chimenti, Medical Doctor, specialized in Rheumatology and President of ReDO (Italian Association of Women in Rheumatology) and Chiara Bodini, Purpose & Talent Agent.
People with chronic diseases.
Chronic diseases and neurotransmitters: what has changed in the assessment of the patient's status.
Let us start with the WHO definition of chronic diseases: these are pathologies that have symptoms that do not resolve over time. For a chronic patient it is generally possible to treat the symptoms but not to cure the disease. Another characteristic of the definition is that the symptoms do not improve and thus they have a significant impact on the emotional sphere of patients.
We will discuss extensively this second part of the definition of chronic diseases in this article.
Musculoskeletal pathologies are among the chronic pathologies and the rheumatological diseases are second, after cancers, in terms of impact on patient's disability and in terms of expenditure costs on the national health system. Rheumatological diseases have the symptom pain in common, a chronic and persistent pain that can involve every joint and every muscle and not only: these are pathologies characterized by a systemic involvement, potentially involving every organ and apparatus of our body.
The pain is caused both by the inflammatory joint damage and by various somatic sensations that give the pain a strong emotional component. At the basis of pain transmission are neurotransmitters that "send" the message from the muscle-joint complex to the central nervous system, which, in turn, through biochemical pathways, creates a series of responses involving the endocrine system (hypothalamus-pituitary-adrenal- cortisol, stress axis) and the immune system (inflammatory response with activation of leukocytes and lymphocytes). During the course of chronic pain there is a prolonged nociceptive stimulation which impoverishes and wears out the control by the neurotransmitters, altering the perceptual mechanisms and creating an abnormal perceptual condition. The result is that low painful stimuli are interpreted as painful (hyperalgesia), or normally non-painful stimuli are interpreted as painful (allodynia). Chronic pain is therefore a real disease, often underestimated and made invisible.
What has changed in the assessment of the patient's status?
We have different ways of measuring the activity of musculoskeletal diseases: systemic inflammatory index, tender and swollen joint count and pain intensity measurement using analog-visual scales. But these indices only partially include aspects related to the patient's wellbeing, the expectations and above all relating to the impact that the disease has on the life of the patient in the medical field. In recent years, we have had the need for other indicators of wellbeing by means of which patients can express the impact that the disease has on their life, on their profession and within the emotional sphere. This is because the severity of the disease and the effectiveness of pharmacological treatments must be assessed through a 360 ° overview of the patient and not only through the disease itself.
The emotional sphere in fact has a significant impact on the course of the underlying pathology and on the response to therapy: patients with anxious-depressive syndrome or with other pathologies of the emotional sphere, even less defined, have a reduced response to therapy. Therefore, it is now necessary to know and evaluate the emotional side and the patient's perception of the disease for a better outcome and therapeutic management.
For these diseases, and in medicine in general, a holistic approach should be used in which the patient is considered as a whole.
Medical Coach view
To succeed in this endeavor, it is necessary to rely on other disciplines including Medical Coaching.
Medical Coaching is a process that helps clients develop emotional, mental and physical resilience during a challenge or in a medical crisis.
By resilience we refer to a set of behavior, thoughts and actions that can be developed and learned by everybody.
Medical Coaching clients, patients for Doctors, find themselves having to manage an unexpected and painful health problem in both a physical and a mental way.
A disease has an impact in all areas of life which the client must learn to manage; it is a new, difficult and different temporal space, which interrupts and transforms the daily life customs.
With an illness everything changes: the relationship with the body, with family members, with social and professional relationship; many times, people tend to hide their emotions and their issues.
The decision of how to manage this moment is up to the Doctors as regards to the treatment but it is up to the client how to undertake this new path made up of multiple challenges.
In fact, two stories co-exist: the clinical one which overlaps with the personal narrative.
A Medical Coach listens to the personal story of their client: it is not a story of the disease but the story of the human experience of the disease made up of beliefs, myths, emotions and many thoughts.
The client must not identify with the illness but, through a different approach, succeed in overcoming the illness. In this way the relationship with the disease can be balanced and the client can start a journey to get better.
Medical Coaching becomes a path of discovery that has as its ultimate goal to regain wellbeing, balance and control over yourself to move forward day after day in daily life.
You can decide to survive centered on the disease or to live with your disease.
However, this debate is aimed at both people suffering from health problems and at healthy people: finding balance passes through self-care and self-love.
Only in a society where everybody decides to focus on mental as well as physical wellbeing, this will become a society where people have less stress and are truly happy with themselves.
The Purpose and Talent Agent view
Fundamental in this personal journey is the search for the purpose of life and accepting one's own peculiarity and transforming it into talent. Trying to make sense out from our life experience, according to Viktor Frankl, founder of logotherapy and author of the book "Man in search of meaning", directly affects our mental balance. This thesis was confirmed by few studies and published in the American Journal of Epidemiology in 2019.
Life is made of many different things, but there are always intrinsic priorities and hierarchies. Finding meaning and living well are among them.
Man, unlike the animal, learns through emulation, through the example proposed to him but above all through the search for meaning. This non-trivial difference distinguishes man from animal but above all explains the progress of humanity. If animals have not changed over time, it can be said that this has not occurred in humans. Today indeed it is a duty to remember that the meaning of one's existence and identity – our Purpose- is the engine that drives us to move forward, as individuals and as a community, associated with a wellbeing holistic approach.
The concept of wellness in fact must incorporate the entire “supply chain” of human existence.
The research starts from ourselves, consciously welcoming our true essence, placing it in the center of our actions.
Furtermore it is also important from a physical and mental point of view. The scientific literature demonstrates that allocating inner resources to a life purpose is the most efficient way to give us positive effects both on a physical, biochemical, and cognitive level. This efficient allocation consists in obtaining greater cognitive productivity and greater physiological activity and flexibility.
This search for meaning allows us to live our life although we may encounter diseases, this is life. But we can be very adaptive and reactive with a meaning of life. We must find the inner resources to continue what Martin Buber called the "Way of man”.