Millennial Maladies: Will the Pain Epidemic Get Worse Before It Gets Better?

 

Around the holidays, an 18-minute viral video made its way to my inbox via my friend and respected colleague, Dr. Louie Puentedura. It was an interview with New York Times best-selling author, motivational speaker and business consultant Simon Sinek, discussing Millennials in the work place. Louie posted it with the remark that it may help us better understand our students. Slam dunk, Louie!

After viewing the video twice (it is that good!), I asked my 15-year old for a unique Christmas gift: “Can you give me one hour of your time so we can watch this together and talk about it?” My kiddo begrudgingly complied, as last-minute shopping had not panned out for him. We watched Simon speak about the challenges our older students and young professionals face. The late-night conversation that ensued was enlightening, a little unsettling, and super cool in terms of mom-teenager bonding time.

My son confirmed that Simon was on the money, and he could relate to all of his points, which we’ll explore in a minute. While the video highlights concerns about the Millennial generation in the work place, it occurred to me that we as health care providers may need to prepare ourselves for some tough days ahead when it comes to treating Millennials with pain. Sinek’s comments struck a chord with things I’ve observed clinically, and I wonder if we may see our pain epidemic get a bit worse before we turn this thing around as a society.

The Millennial Generation, born in the early 1980s through early 2000s, have been characterized in some rather unattractive ways. Time magazine called Millennials the “Me Me Me Generation,” and they have also been referred to as the “Boomerang Generation” due to their propensity to move back in with their parents following college. They have been described as entitled, lazy, unfocussed, Narcissistic, materialistic and coddled. Many jump from job to job, desiring flexible work schedules and plenty of “me-time,” finding it disheartening when they are not making an “impact.”

To be fair, these labels are just that: sweeping generalizations describing a highly diverse, 75-million-people-strong group of individuals. And the descriptions aren’t all negative. Millennials are tech-savvy, team players, and open to change. They are on track to become the most educated generation in American History, they embrace diversity, and they are passionate about social justice.

In the “Millennials in the Workplace” interview, Sinek gives a good deal of grace and kindness to the Millennials. “Through no fault of their own…” becomes his mantra, as he eloquently discusses four contributing factors to the negative attributes and tendency towards job dissatisfaction that characterize this generation:

  • Failed Parenting Strategies
  • Technology Addiction
  • Instant Gratification
  • Environment

While these factors have a clear influence on workplace issues, I would argue they may also have a significant impact on Millennials’ ability to cope with pain. Let’s take a look:

Failed Parenting Strategies: Sinek describes a parenting style and culture that hyper-focusses on children from a very early age, rewarding every small accomplishment thereby creating an expectation for accolades, even when performance is lacking. The reality of corporate America is a far cry from this practice: we don’t get ribbons for participation at the office. This reality check upon entering the work force results in shattered self-esteem, rapid disillusionment, and an urge to move on to “a better fit.”

Closely related to child-centeredness and coddling is the concept of helicopter parenting: an over-protective, over-controlling, intrusive style of parenting. According to Boston University research professor Peter Gray, helicopter parenting has been shown to correlate with college students’ Narcissism, poor coping, sense of incompetence, greater depression, decreased satisfaction with life, and alienation from peers. Young adults who have been “helicoptered” demonstrate an increased likelihood to be medicated for anxiety or depression and greater use of pain medication for issues other than pain. Gray summarizes current research in an excellent post in Psychology Today, well worth the read.

These findings in the psychology literature should get our attention. The more “medicalized” our patients become at an early age, logically, the more we can expect them to seek treatment and expect intervention throughout the lifespan. Those interventions are often expected to be in the form of medications: a passive approach to health. The Millennials have grown up seeing more advertisements for medications than any generation in history. They are indoctrinated with the belief that it is not okay to hurt, have a stuffy nose, or feel a little stressed out, and that a pill exists to remedy every discomfort they may face. Everything we know about pain science tells us that it is the active approaches that actually work, and there is no magic pill to combat pain.

Technology Addiction: Sinek describes the addictive power of technology and its grip on the Millennial generation, stating the rush they get with a “like” on Instagram is literally the same little hit of dopamine humans get when we smoke, drink or gamble. We have age restrictions on smoking, gambling and alcohol, but no restrictions on cell phones, tablets or laptops. Millennials have grown up with devices in hand, and they have learned that if they feel a bit down, they can turn to technology for a lift, a distraction, or an escape. During their crucial developmental stages, they have associated comfort with technology, and from a neuroplasticity standpoint, this is quite alarming.

Technology addiction draws people away from true human interaction, nature, creativity, and movement. While social media breeds likes, re-tweets and followers, it minimizes true human connection. Many young people agree that deep meaningful friendships are sorely lacking among Millennials. When stressors arise, rather than seeking comfort from community, technology can become a nearly hard-wired, go-to agent for coping. From a pain perspective, we cannot underestimate the value of human connection: Remember the cuddle hormone? (http://www.evidenceinmotion.com/blog/2017/03/24/cuddle-hormone-little-known-secret-stress-response/.) Nature and creativity have long proven to be therapeutic, bringing balance and meaning to people across generations and cultures. And from not only a pain perspective, but from an overall health perspective, movement is life! I cringe at the thought of technology usurping human interaction, nature, creativity and exercise when it comes to coping.

Instant Gratification: Sinek cites several examples of cultural and marketplace phenomena that have contributed to an incredible sense of impatience among Millennials. From Amazon to Netflix to Swipe, we no longer need to shop in stores, watch commercial-laden TV episodes weeks apart, or even navigate the awkward social stress of asking a love interest out on a date. Unfortunately, job satisfaction and meaningful relationships simply don’t develop in an instant. According to Sinek, they are slow, meandering processes, and “there ain’t no app for that.” Millennials struggle with a tremendous disappointment when the careers they have studied so extensively for do not provide an instant sense of purpose, meaning and impact. Depression, disillusionment, suicide and anxiety are more prevalent among Millennials than any other generation.

Let’s apply this concept to pain. Consider the duration of time it takes a person with long-standing pain to climb out of the functional hole they have fallen into. Consider the process required: Incremental steps (graded exposure) over several months to begin to reclaim some of the activities that once brought joy and meaning to life. How well will our Millennials be able to stick it out through the process? Do they even have life-giving activities to return to? I often encourage patients in those early weeks of therapy, before they can see the gains I know are around the corner, to just “trust the process.” Those that do persevere and “do the work” reap the benefits. The journey out of the grip of pain is often long and arduous. Will this generation have the patience, motivation and trust to make the climb?

Environment: Finally, Sinek describes the environment our young generation is thrust into once they leave the nest: a corporate world that cares more about numbers, productivity, and short term gains than the long term lives of these human beings. The corporate environment has no interest in helping them learn how to connect with others, develop patience, joy or balance, and it often feeds Millennials’ technology addiction.

And what of our health care environment? Do we see a true commitment to caring for the individual holistically, over the entire lifespan? Or have we become so hog-tied by productivity requirements that patients (of all ages) are pushed through therapy, promptly “discharged” as soon as they are functional enough to stand on their own two feet? Can we create environments that foster human connection between us and our young patients, or do numbers trump nurturing? We have strong evidence to suggest therapeutic alliance correlates to improved outcomes in PT, but how will we be able to connect with patients who haven’t learned how to make meaningful relationships?

Opportunities for change: Sinek wraps up his talk by challenging the rest of us (Generation X and Baby Boomers) “to help this amazing, idealistic, fantastic generation build their confidence, learn patience, learn the social skills, and find a better balance between life and technology, because quite frankly, it’s the right thing to do.”

So as physical therapists, how will WE respond to this challenge when it comes to our Millennial generation patients in pain? Like Simon Sinek, I am typically an optimist. I WANT to believe we will be able to impact this generation when they seek care, and that we will continue to maintain a good success rate with them (NNT for pain 1:3, for function 1:2). But this is a really tall order. We are up against a long-standing and ever-growing “fix me” mind-set. There is more depression and anxiety in this generation than any other, and we know pain and depression are close bed-fellows. Media has society believing all pain is bad and needs to be obliterated. Big pharma has its fingers in every commercial break, including the forced ads on YouTube. The picture looks a little bleak…

To create sea-change in a culture of pain, do we spend our time an energy on damage control with the Millennials, and/or do we gear up to be pro-active with Generation Z, getting healthy messages regarding pain to elementary and middle-school kids? Are you ready to help Millennials navigate painful conditions?   Will things get worse before they get better? What is our best strategy moving forward to influence a generation towards movement, human connection, creativity, nature and balance as “the Fix?” I look forward to hearing your thoughts!

Image credit: http://blog.capital.org/wpcontent/uploads/2016/08/Millenials.jpg

12 responses to “Millennial Maladies: Will the Pain Epidemic Get Worse Before It Gets Better?

  1. Colleen L. says:

    Great post Jess. I have seen the video as well and shared some of your same thoughts, especially in regards to coping skills. Pain is obviously one aspect of the big picture. This is a tough one. The discussion needs to continue.

    1. Jessie Podolak says:

      Thanks Colleen. I hope the discussion does continue and that we can be aware that there are some aspects of generational diversity that may impact our treatment of pain.

      Jessie

  2. Sanket Gohil says:

    Can we please stop labeling every generation.baby boomers, genx, millenials. These things are characterization of a age group and not a generation. In every era younger people have been looked as entitled and oldeep people as someone who are resistant to change.Guess what that difference has existed since centuries. When books first came out society derided younger people adopting them saying the society will loose the art of conversation. Then there was TV, radio and now cell phones.Earlier there were hippies now there are hipsters. All these labels are just marketing terms. Everyone seems to be critisizing the younger people but I think we are the most open minded people and so will be the next generation. I was born in the 80s and my parents brought me up to focus on education, hard work and family. I was reprimanded when I didn’t have good grades and was asked to worked harder when I did. So please let’s focus on individualization and not standardization by labeling millions of people into one category. Keep your mind a blank slate when a patient walks in and treat them as you would like to be treated

    1. Jessie Podolak says:

      Hi Sanket,

      Thank you for your thoughts and for joining in the conversation. You make a great point as you remind us that whatever the generation, each patient that walks in the door is an INDIVIDUAL, and labels/preconceptions/etc. can create more barriers than insights. We can never go wrong with the golden rule, “treat others as you would like to be treated.”

      Part of the beauty of PT is that we have time to get to know our patients as individuals. When we hear their story unfold, we can get a picture of what might be influencing their thoughts, beliefs, and responses to pain, as well as their responses to our interventions. Generational characteristics are only one influence, and in many cases, they are a small influence. It does behoove us though, to be aware of some of the tendencies of certain cultures, generations, etc. Attitudes and beliefs are largely influenced by the culture in which we develop, including the ethnicity, family, region, decade and so on. And our attitudes and beliefs are the “layers of the onion” that we need to respect in order to best connect with our patients for an effective therapeutic alliance.

      For example, the generation born 1900-1945, the Traditionalists, IN GENERAL, tend to place a high value on hierarchy in professional situations, and they often do not question authority. If I observe this trait in one of my patients who falls in this age group, I might think twice before making suggestions that are odds with what a physician recommended. I may need to frame my advice to give PT a good, fair shot before proceeding with surgery in a way that they can receive well, versus coming across as disrespectful or second guessing.

      So, I hear your frustration about being lumped together with 75,000,000 other people born in the same 20 or so years as you. I too feel frustrated when generalizations are made about me as an American, as a woman, as a middle-class-soccer-mom… But we do need to understand that everyone has their own influences, and that some of these influences do not necessarily set us up for success when it comes to overcoming something as complex as chronic pain, which was the intent of the original post.

      I really appreciate your thoughts. Best wishes to you!

      Jessie

  3. Jarrod says:

    Jessie,
    Good post and insight. I really appreciate the part about technology addiction and instant gratification. I see it daily all around me and believe they go hand in hand. While millenials have grown up with technology more than any generation so far, I think anyone who uses technology/social media/ etc/ all the time can and does fall into the snares of its addition and instant gratification. The combo of these two often result in a lack of patience and can limit the openness needed to see a big pictures view of something as complex as pain. Thanks for opening the conversation of a potential challenge for healthcare providers. I look forward to seeing what others have to say..

    Jarrod

    1. Jessie Podolak says:

      Hi Jarrod,

      Thanks for the comment. You always provide balanced insights! I agree whole-heartedly that we are all vulnerable to technology addiction, myself and my fellow Gen X’ers included. In fact, I am grateful to have grown up without the seductive lure of the internet to take me away from playing outside, hanging out with friends, etc., because I now value those things and continue to pursue them, even when it’s inconvenient. At times, it’s so much easier to get lost in a screen than to get out moving! And I have noticed my own patience wane much quicker than I would like to admit when I have to wait for a book on the library’s wait list! :-)

      The worried mom in me is “extra sensitive” about this, because if you consider other addictions, such as drugs and alcohol, those that develop in middle school and high school (a “ripe” neuroplastic time in the brain) tend to be much more difficult to overcome. A craving develops for more and more of the drug of choice as those neuro-pathways get stronger (good ol’ Hebbian Theory). Perhaps the movie Wall-E hit too close to home and I’m just freaking out a bit here. But I really do think our culture as a whole (ALL generations) would be well-served to step away from technology from time to time and discover the beauty of nature and the joy of laughing out loud with someone next to us rather than “LOLing” at the silly meme we just saw.

      Thanks for being part of the conversation!
      Jessie

  4. Amy says:

    Great post Jessie!
    You did great job of relating nueroplasticity and pain to these characteristic traits. Yes, the video by Simon focused on millennials, but I think we can take value in his video and your post and expand it beyond just millennials to improve our patient care. I am a millennial. I will admit it. And I will admit that watching the video made a few defensive hairs stand up on my back. BUT, I am a “recovering millennial” with the newly found knowledge over the past few years about neuroplasticity that is absolutely fascinating. We are genetically coded and environmentally sculpted and have a simply fascinating neuroplastic brain! I would challenge anyone, particularly the millennials since they are the focus of this video and article, who find those defensive hairs that may stand up to dive into the wonderful world of neuroplasticity to seek wisdom about why people in our culture, no matter the generation, may be feeling and acting the way they are. As Simon said, “Through no fault of their own”. What great words to begin a conversation with a patient to help them feel optimistic about their ability to improve and change their neuroplasticity with our skilled care.

    1. Jessie Podolak says:

      Thanks Amy, for your candor and your insights. It’s funny, because as I watched the video initially, I saw the audience filled with young adults tracking with what Sinek was saying, nodding, chuckling, etc. It didn’t occur to me that those watching may feel defensive at all. My take away was largely the “Through no fault of their own…” theme. Sinek clearly cares about the generation he describes, as do I… heck, these are my kids, my nieces, my nephews, and MY FUTURE HEALTH CARE PROVIDERS! :-)

      The Gen X’ers and Baby Boomers created much of this environment as we sought progress and advancement, and no doubt, much good has come from technology, as Patrick described in his post. However, the way culture/technology/etc. has evolved in the last couple of decades has brought with it some unique challenges for those growing up in it. In parenting, I’ve had to have conversations about the perils of the internet that I never expected to have, and I feel badly that my teenage sons face temptations every minute they are in front of a screen that were MUCH less convenient to access when I was a teen. That is why, in parenting, we need to be engaging regularly with our kids, helping them navigate the virtual world they are drawn so strongly to, and finding balance with the real world they live in.

      I certainly don’t condemn or judge the Millennial Generation, and I agree with the traits listed as pros to describe them. But I do have concern for them, particularly when it comes to the technology piece and neuroplasticity (see my comments to Jarrod).

      I appreciate your openness to change, as well as your quest for knowledge (two “Millennial” traits that we could all benefit greatly from!!).

      Jessie

  5. Patrick says:

    This is a really disappointing article. I thought that this was going to be a little more balanced, and that you would share some of your child’s thoughts as well, but again this is just more millenial hate. Most of the points you raised here are the same recycled garbage used to deride the young people in this country for the better part of a century. However, I would like to offer some counter points:

    1. This is the most important thing to remember: YOU ARE OVERGENERALIZING EVERYTHING! Many of the things you wrote about millenials apply at least as well to Gen X and the Baby boomer generation, and because you are painting with a broad brush you miss the point. Specifically, there are people who are instant gratification, technology addicted, socially unadjusted snowflakes in EVERY generation. The things you described are not limited to the millenial generation, and I would argue are not even typical of millenials.
    2. Failed Parenting Strategies? I really don’t know who came up with this idea, but I have heard it repeatedly. Maybe you’re jealous my mommy loved me more than you? I really thought that this was a place for schollarly debate, but apparently now we’re telling momma jokes here. Seriously!?
    3. Technology addiction: Is there any evidence to support any of the claims you make here? Please provide it if there is. I would argue that if we looked at technology addiction across age groups we would likely see an increase in all groups since the advent of the smart phone age. I think the really interesting thing here is that most of the your statements about loss of social skills and real human interaction don’t really seem to be supported by anything either. Again if there is any evidence of this please provide. Technology is NEW way of creating real human interaction. For instance, facetime and skype provide millions of people the oppotunity to have face to face interactions across thousands of miles distance.
    4. Technology use: I would agree that millenials probably use more technology than older generations, but that their use of technology is probably much more meaningful as well. This is mostly because they actually know how to use tech.
    5. Instant Gratification: You said: “The Millennials have grown up seeing more advertisements for medications than any generation in history. They are indoctrinated with the belief that it is not okay to hurt, have a stuffy nose, or feel a little stressed out, and that a pill exists to remedy every discomfort they may face.” Is this an opinion, or something supported by evidence? Again, I would argue because millenials tend to be more educated, and make better use of technology, they are more likely to research and find alternatives to medication or surgery. Unlike previous generations, millenials have grown up knowing the importance of good diet and exercise in well being. Additionally, our skepticism of the establishment makes it more likely that we will not fall into the pain traps described above. As you stated several times, we want to be engaged and want to feel that there is value to what we do. What better than working hard for good health?

    I would really love to flip this on its head and try and spin it back on boomers and gen xers, but that wouldn’t be fair either. Just stop thinking that millenials are so different. In reality, we are just like previous generations, with only minor differences. The stereotypes that you listed above are not only incorrect, but are very insulting. This was not a very scholarly post, and I am a little disappointed that it was allowed on this forum. Again if there is any evidence to back up your claims please post.

    1. Jessie Podolak says:

      Hi Patrick,

      Thank you for reading the post and taking the time to put together your counter-points. You are absolutely correct in this respect: Any discussion on generational diversity can only be what you have noted here: a highly generalized, non-scholarly conversation. And that is exactly what this was intended to be: a conversation starter, for PTs of all generations, to better understand the cultural landscape in which young adults have grown up in, and to discuss whether or not this will impact their experiences when it comes to pain.

      A great blessing of today’s technology, specifically the internet, is that it allows us to engage in conversations with people around the globe, of all view points. In my opinion, not every blog post needs to be a scholarly pursuit, and even though this is EVIDENCE in Motion’s site, we can come together as health care providers to discuss pertinent social and cultural issues if they potentially have an impact on our professional interactions with patients, clients, peers, etc.

      The curse of online forums such as this is that sometimes the intent of the author(s) is misinterpreted. Hopefully, dialogue can ensue between all parties that remains respectful and seeks solutions rather than condemnation.

      Thank you again for your thoughts.
      Best Wishes,
      Jessie

  6. Paul Leverson says:

    Jessie…
    I enjoyed the article and plan to view the video by Sinek.

    I also hear the frustrations from the younger crowd in the feeling of broad generalizations…

    I was once just as they were. Now I’m not.
    No better or worse…Just changed.

    Every person at every age has any number of characteristics/traits that make them…well…them. We know this in pain science. Sensors are different. Nervous systems are different.

    And sensors change as do nervous systems.

    I watched a neuropsychologist once speak about how the brain changes with exposure to truth. It actually “fertilizes” certain neuropathways, creates new neurons to reinforce this new truth while letting other pathways/neurons “shrivel” or “shrink” and become less useful.

    Amazing.

    So, it becomes about Truth.
    And the pursuit of Truth…Absolute and Actual Truth.
    I think it’s amazing that the nervous system has been created to respond positively to truth.

    You can’t make that up. That’s no accident.

    Interestingly enough, that’s what TNE is all about…Truth. The recognition of it…the pursuit of it…the valuing of it.

    More valuable than gold, rubies, or buried treasure is wisdom.

    I’ve made it my purpose to help others find Truth.
    …In my work.
    …In my free time.
    …In the mundane activities.
    …In the important things.

    Pursue Truth.
    That’s what sets us free.
    No matter what letter is after your generation.

    It’s actually the most powerful force that can unite us…the pursuit of Truth.

    It requires the building of bridges. The exercise of patience. The forbearance of wrongs. The forgiveness of things.

    It seems to me that any of those things true about the younger of us — how they were parented, technologies, gratification, environment…etc. — or us as well, can be leveraged for the pursuit of truth.

    Thanks for the perspective reminder that not everyone sees things as I do. That’s a good thing to keep in front of me.

    Peace.
    Paul

    1. Jessie Podolak says:

      Paul,

      Thank you for your beautiful reply… I agree whole-heartedly that TNE is about truth. Your words are unifying and thought-provoking…

      Thank You!
      Jessie

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