The Tunnel Vision of Pain
Faced with complicated decisions that occur rarely and have high stakes, there is a strong probability we will choose poorly. Go a few nights without sleeping beforehand, and it’s likely we will do even worse. Priming with brief messages prior to a decision will influence behavior. We are not perfectly rational and don’t always act to maximize our own self-interest. These are some of the basic findings of behavioral economics, a branch of the social sciences that brings the viewpoint of psychology to economic decision making. Undeniably these brief descriptions will have some professional economists pulling their hair. Apologies.
What is behavioral economics?
Behavioral economics research is a complicated maze of arguments and studies. The umbrella idea, however, is a simple one: humans make predictable errors in thinking that translate into the decisions they make.
Recently I read of two authors who take these ideas in a new and intuitive direction: scarcity. Sendhil Mullainathan of Harvard and Eldar Shafir of Princeton, make the argument that “qualities often considered part of someone’s basic character—impulsive behavior, poor performance in school, poor financial decisions—may, in fact, be the products of a pervasive feeling of scarcity. And when that feeling is constant, as it is for people mired in poverty, it captures and compromises the mind.”1
Scarcity and deprivation
Extreme deprivation of something like food causes tunnel vision. People can become obsessive, thinking of nothing else. Relieving something like hunger becomes the most dominant theme of their minute to minute existence. When put in such simple terms, this may seem obvious and not worth an academic study. In their research using clever experiments and analyses, however, they seek to show exactly how scarcity affects behavior. The intention of generating this knowledge is to change policies that will help people make better choices. The driving factor is that scarcity can make any of us think or behave in ways we otherwise would not in a non-scarce situation.
The tunnel vision of pain
I believe pain similarly causes tunnel vision and changes in thought processes. And from here on I speak only of personal anecdotes and opinions. Pain does more than debilitate. Pain can be maddening. When one has high levels of pain, it is hard to think about anything else. Life will have to wait. Anything besides reducing pain is going to be low on the priority list.
How does pain affect behavior?
When one has been in pain for weeks, months, or even years, the way it affects thoughts and emotions surely must be profound. In rheumatoid arthritis, we talk about feelings of fatigue, depression, and brain fog as mental aspects of the disease. What is not often discussed, is the way it impacts minute to minute thinking and decision making.
As an example, recently while denied effective treatment by my new insurance for a month, I underwent a brutal flare that hardly responded to prednisone. I got pain tunnel vision just when I needed my mind most. Two weeks into a PhD program, I could think of little else than relief from the inflammation.
Reducing and avoiding RA pain
I’m not talking about casual thoughts of, “When is this going to end?” I’m talking a minute to minute focus on reducing or avoiding pain. "Where can I park to take less steps to the door? How can I lift my bag to avoid the strain on my wrist? Should I wear sandals in the rain to that professional meeting so my feet won’t be screaming in my shoes? If I move in my chair an inch this way, its better… no wait, the other way… no wait… it all hurts!" I kept functioning, and knocked out my coursework, but certainly not with the grace and poise I hoped for. The focus on reducing pain dominated my mental capacity.
A denied RA medication
The denied medication had given me much of my life back. Compared to previous drugs I tried and failed, it had few side-effects and worked the majority of the time. Though there are no magic bullets in treating my disease, for me, this drug comes close.
Without it I wondered what I would do. My doctor had given me a short list of other possible medications should we lose the appeal. For a week or more, I spent hours reading literature on these medications, how well they work, and the various published scientific trials. At some point, I convinced myself switching was in fact in my best interest, and that I should give up the appeal and start a new drug immediately. I emailed my doctor and requested to try something new, stating that I could swing by anytime if they had a sample. My building is right next to the medical center. Thankfully, before I heard back, I received a letter that we had won the appeal, granting coverage of the medication for the remainder of my time on the plan. Needless to say, the idea of switching vanished.
Pain affected my decision making
After winning the appeal and now looking back in my non-pain mind, making a switch at that point in time would have been irrational. Waiting one more week to see the process through was the smart thing to do. But the immediate need to reduce the pain affected my decision making. Pain compromised my mind. I thought and acted in ways I normally wouldn’t if pain-free.
Acting out of desperation
Some may say I was just acting out of desperation. This is in part true, however, my point is that desperation caused by persistent pain brought not just an emotional sense of urgency to escape it, but a cognitive sense of how I processed information about that escape. For those few weeks, nearly everything, from reading to writing, or even brushing my teeth, became harder to focus on and complete. It changed the way I thought about my own treatment, and the uncertainty and risk I was willing to take on.
For those without a chronic disease or ongoing pain, please keep this in mind before passing judgment. Similar to what is stated above about scarcity, living in pain may effect qualities generally thought to be part of one’s character or personality. Whether it is being more impulsive, quicker to anger, more prone to give up, constant indecision, inability to focus, or dropping all responsibility and retreating to a dark room to be alone, pain can make people think and act in ways they otherwise wouldn’t.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?