It’s a great word, isn’t it?  Catastrophizing.  We all do it everyday.  One of the reasons that old horror films that don’t show any blood and guts or death can be so effective is because of humans’ tendency to catastrophize.  We can always imagine worse than reality.  Movies used to know that.  Now we are given exponentially raised shock value in movies just to get us to raise an eyebrow.  It’s because we don’t have to catastrophize at movies anymore – we can see it, it’s there, it’s not that bad.  Just, you know… red.

In health care, catastrophizing can lead to freezing.  People with fibromyalgia can grow to dread what could happen so much, we can imagine so vividly what might be, that we get stuck into a safe zone, and when we accidentally (or through a moment of physical defiance) stray from what’s safe, we can become like cats in a tree.  Really, just like a cat in a tree.  Literally.

A few years ago, my office decided to take an office picture outside near a tall wall with the name of our institute on it.  First one younger, athletic woman hops up on the wall to sit for the picture.  Pretty soon, others were being hoisted, pulled, boosted up onto the wall.  I was one of the them.  It wasn’t easy, but I was pretty proud to be up there.  In the meantime, the sensible people my age were on the ground looking up at us with a “you’re gonna regret this” grin.  Picture taken, and the young and fleet of foot started jumping off the wall.  I suddenly realized how HIGH it was.

I’m not a fan of heights anyway, but I kept seeing in my head my ankles snapping when I hit the ground.  If not snapping then spraining.  In my head I was hurting my knees, my back, hips, all the way up.  Whiplash.  It wasn’t a strong possibility – it was going to happen.  I froze.  I laughed, but I froze.  I couldn’t get down.  I told people to stop pulling me down, I’d fall on them and squash them, but in my mind, I could hear the bones in my legs breaking.  To my horror, I was the last person on the wall and there was a crowd of non-officemates gathered on the sidewalk with their phones out taking videos.  Meow.

Finally, I rolled over on my belly and nudged myself down off the wall.  Of course I later saw a picture of how large my butt really was up there on the wall, but at least I’m no longer up there.  The people with their phones wandered away.  Yes, I continued laughing the whole time.  No, I didn’t snap an ankle, but I also didn’t jump.

That, folks, is catastrophizing.

Being a Burden

One of the things we hear about all the time in healthcare is the financial burden of disease. Stay healthy so you’re not a burden.  People shouldn’t be obese or they’ll be a burden on the healthcare system with comorbidities like diabetes, etc etc.  Industries have blossomed overnight from society being told, stay healthy so you’re not a burden.  While I agree with the idea of being healthy – who can argue with that? – there is something underlying this line of thought that’s a little disturbing.

There becomes an “us” and “them” mentality.  Insurance companies already deny healthcare to people who do not live up to their standards.  For example, I spoke to a patient who was unable to get a liver transplant because insurance would not cover it.  Why?  Because he was an alcoholic.  This is an extreme case. However, I can eventually see (as the insurance companies run amok) the same reasoning applying to people with chronic conditions, such as obesity or fibromyalgia – or old age.  Medicare payments don’t cover health costs for the elderly, and supplemental insurance can be fantastically expensive. Will we reach the point of becoming a pay-as-you-go society for people who fall into a chronic condition category – if you can afford healthcare you can have it?

In looking at the financial burden on the healthcare system for fibromyalgia patients, I was surprised to find out that the greatest financial burden in fibromyalgia is from indirect costs, not healthcare system costs.  These are employment-related: losses in productivity, reduced work hours, absenteeism, disability payments, unemployment payments, and early retirement (see Skaer et al).  In addition, indirect costs to patients themselves are related to non-healthcare setting care expenses, people being paid to help with household and personal care, people coming to help but not being paid.  Obviously, putting 2% to 4.7% of the population back on its feet would significantly reduce these costs.

In the meantime, I watch commercials for medications and vitamins and supplements that promise everything but immortality (except in the quiet auctioneer voice at the end when death is threatened) which play off everyone’s fears of being useless and a burden and listen to the outcry against people who are a “burden” on society and just hope.  Hope for what? I’m not sure.