19. Painful Bodies at Work: Stress and Culture?
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19  Painful Bodies at Work: Stress and Culture? The objective of this chapter is twofold: to present data on significant cultural influences on pain-related psychosocial workplace conditions, which belong to the core issues of psychosomatic medicine, and to discuss the conceptual consequences for a cultural neuroscience of pain. To achieve this aim, we start with an introduction of the basic characteristics of chronic pain at work, including the current view on risk factors for such pain, and then discuss the influence of pain-related psychosocial workplace conditions. Chronic pain, as a common consequence of tissue damage, encompasses the experience of the pain sensation itself and a whole universe of related emotions, thoughts, pain behaviors , and suffering, which are at least partly visible to others in the environment. Remarkably, tissue damage is not a necessary precondition. The current biopsychosocial view on risk factors for chronic pain typically concentrates on intraindividual risk factors and includes genetic dispositions, injuries, and stressful life events, among others. However, an embodied approach emphasizing the “body being in the world,” which integrates cultural perspectives, seems more appropriate. In recent years, epidemiologic work has shown the relevance as well of group-level psychosocial risk factors for chronic pain, especially in terms of psychosocial workplace conditions . Lack of social support at work, injustice, high job strain, and effort-reward imbalance are especially important here. Nevertheless, even this group-level perspective does not capture all relevant differences: studies in different societies or cultures have shown significant cultural influences on the relation between psychosocial workplace conditions and chronic pain, from both an “etic” and an “emic” perspective. The current view on the link between culture and pain involves different aspects. Culturally shaped ways of world-making influence the interpretation and labeling of and the treatment strategies for distress; however, there is now, as a new component, sufficient knowledge on the relational biology of pain. This entails more than looking at the group-level social and affective neuroscience of pain processing; rather, on this level of investigation, there is also a cultural modulation of emotion and pain processing, which means that culture also Peter Henningsen and Heribert Sattel 380 P. Henningsen and H. Sattel determines the differences in neural processes underlying the same psychological phenomenon of emotion and pain experience. We discuss the consequences of these epidemiologic and neurobiological findings in the present chapter. 1  The Experience of Pain: A Common Human Condition Pain is an aversive and complex subjective perception, which—in its acute form—serves as a warning signal and usually elicits intentional states and behaviors, which in turn motivate or intend to bring about the termination of the assumed causes of pain. Withdrawing from pain-associated situations aims to protect against damage, helps to heal affected body parts, and intends to help avoid similar future experiences. The intensity of pain normally ranges from inconvenient to seemingly unbearable. The relevance of this in the context of working conditions and working persons is twofold: on the one hand, pain is often considered as a consequence of distinct distressing physical or psychosocial working conditions, and on the other hand, pain itself directly influences the individual’s work ability and performance. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP 2011). The last part of this definition expresses in a somehow cumbersome manner that tissue damage is not required for the experience of pain. Recently and consequently, a category called “functional pain” has emerged (Creed et al. 2010). However, the experience of pain is always a subjective/individual experience, even if its cause can be clearly objective and physical, such as a broken bone. As such, pain is influenced by a multitude of psychic factors. This underlines the outreaching associations and consequences of experiencing pain for the mental or psychological domain: pain involves cognitive sequelae as we anticipate and attribute these potential experiences. Moreover, it affects our social sphere through psychosocial processes, for example, when we try to share the experience with relevant others. Finally, cultural styles are likely to be shaped by specific attitudes and behaviors toward the expression of pain, which in turn influence the experience of pain sensations again (Bates, Edwards, and Anderson 1993). The simplistic but common medical assumption of a straightforward path from physiologic events, through bodily sensations and subjective experiences, to individual symptom reports, must be left behind when embodiment and culture...