Body awareness and the health culture

OK. So the economic downturn is really, really bad. We’re worried about being laid off. We may have already lost our jobs. Even if we’re still employed we have financial worries. And hearing about it all the time on the news gets us down. We start to have physical symptoms of poor health: headaches, muscle aches, sleeplessness.
I know this will be small comfort, but the symptoms don’t necessarily mean there’s really something wrong with our health. What I mean is, the symptoms don’t necessarily indicate an underlying physical condition. It’s not that we’re imagining the symptoms — it’s more complicated than simply calling it a psychosomatic mind-body thing.
We all experience physical symptoms every day: fatigue, headaches, stomachaches, rashes, coughs, and let’s not forget the unpredictability of our bowels. Such symptoms are like background noise. Sometimes we ignore them. Sometimes they become the focus of attention.
Four things influence our awareness and interpretation of physical symptoms:
· Our immediate circumstances. For example, the deli boy who made your sandwich was sneezing, coughing, and had a runny nose, and now you’re on the lookout for the signs of a cold.
· What we believe is the cause of our symptoms. Do we assume it’s something benign or believe it’s truly ominous?
· The amount of attention we give our symptoms. Symptom intensity decreases when we’re distracted, like when we watch TV or play basketball or even talk on the phone.
· Our mood. Strong emotions actually produce physical sensations. An angry person gets red in the face. Plus, moods like anxiety or depression can make us more symptom-sensitive.

The more we look to our bodies for symptoms, the more symptoms we find. This may seem simplistic, but when we’re not distracted by our jobs or regular routines, we have way too much time to look for and be aware of symptoms.

The ‘worried well’

When epidemiologists study the health of laid-off employees they find an increase in physical complaints. They attribute some of this directly to the understandable psychological distress. It could also be that psychological distress lowers the threshold of awareness of physical symptoms. They speculate that the increase in doctor visits among the unemployed could simply be ‘illness behavior,’ not actual illness. (See Kasl and Jones below in Sources.)
Evidence for this comes from the specifics of the physical complaints, which are all over the map. Whenever symptoms include a very wide range of apparently unrelated conditions, it suggests a response to high stress levels.
Doctors, and insurance companies also, use this observation to categorize what they call the ‘worried well.‘ If a young to middle-aged man or woman seeks medical care and receives five or more unrelated diagnoses (low back pain, acid reflux, loose stool, migraine, chest pain), that’s a clue that the real problem may not be physical, but rather depression or somatization disorder (repeated complaints about various physical symptoms with no identifiable physical cause). With the computerization of insurance claims, it’s easy to write a program to identify these patients.
Our tendency to interpret symptoms as illness appears to be a historical trend. In surveys from the 1920s, Americans reported less than one serious, acute illness each year. (The actual number was 0.82.) When the same information was collected in the 1980s, the number was 2.12, an increase of 250 percent. Illnesses also lasted longer: 19 days vs. 16 days. (Serious, acute illness was defined as being disabled for at least one day or requiring medical attention.)
Yet another study: Nationwide interviews done by the University of Michigan found more reports of ill health in 1976 than in 1957. The researchers attributed this to several factors. There was more awareness of the body in 1976, along with a greater tendency to interpret bodily symptoms as indicating illness. Interestingly, there was less stigma attached to illness: people were more willing to tell an interviewer that they’d been sick.
This is one of the clues I’ve been looking for to understand changes in our relationship to health and the emergence of the “health culture” since the 1950’s: It appears we’re more willing to consider ourselves sick. That’s one of the things I want to explore in this blog.