E- ISSN: 2709-5533
Vol 4 / Jul - Dic [2023]
globalrheumpanlar.org
Columns
Virtuous Empathy
Autor: Fernando Neubarth: Especialista em Clínica Médica e Reumatologia. neubarth@terra.com.br
DOI: https://doi.org/10.46856/grp.22.et178
Cite: Neubarth F. Virtuous Empathy | Global Rheumatology Vol 4 / Jul - Dec [2023] Available from: https://doi.org/10.46856/grp.22.e178
Received date: July 11 / 2023
Accepted date: July 18 / 2023
Published Date: July 25 / 2023
María de los Dolores.
Of night pains,
of the pains suffered,
of the pain felt,
of the pains of loves that never lived.
But one day, Maria put an end to the evils.
María de los Dolores, from pain she died.
I was a doctoral student, undergoing training at the Hospital de Clínicas in Porto Alegre, when I wrote the above poem. It was at least four decades ago, on a notepad that accompanied me at the time. It came to mind instigated by the trajectory of actress Dani Valente and her coexistence as a patient of a poorly understood disease (fibromyalgia) and which we can know from the generous, didactic, honest and even therapeutic account that appears in her book “The Happiest Person in the World".
Fibromyalgia is a syndrome, a set of variable signs and symptoms, at the same time multiple and individual. The sensation of pain is greatly amplified: a simple touch, a hug, is immense discomfort. You may feel pain all over your body and tiredness, with difficulty sleeping or waking up as if you haven't rested. The patient may also have concentration and memory difficulties, anxiety, tingling, headache, dizziness, mood swings, depression, intestinal and urinary changes.
The diagnosis is essentially clinical, there are still no tests to prove the condition. For a long time it was discredited, both by those in the health area and by family members and patients themselves. Without finding "a cause", after an exhaustive and fruitless saga to different specialists, doubts persist - a discredit that imposes a brutal defeat on self-esteem. But the pain felt is real.
Currently, it is known that there is a lack of regulation of pain, partly due to changes in neurotransmitters, chemical substances that are produced by nerve cells - neurons. Some neurotransmitters act to lessen pain, and others intensify it. The interpretation of pain in the brain suffers from many influences, including those arising from emotions, and those with fibromyalgia feel the pain to a heightened degree.
Very usual fact: Dani took a while to receive a diagnosis. Like so many others, she came to feel a paradoxical relief in knowing that what she had actually existed. Fibromyalgia teaches us the importance of listening to the patient. It is necessary to know how to listen to their complaints, and the search for understanding causal and relief mechanisms and even more adequate pain measurement has involved researchers and generated a more attentive and understanding look. Maybe it's too late for that Maria from the poem, but it doesn't have to go on like this. This is what Dani also teaches us.
Behavioral changes are important and start with the perception of what we feel; can be worked with therapies and readjustment of habits. Appropriate physical exercises reinforce the body structures. Physical conditioning makes the body more resistant to pain, in addition to producing substances that improve mood and relieve discomfort. Among the recommended activities are aerobics (cycling, walks and light and regular runs, which help maintain weight and release endorphins), aquatic activities (swimming and hydrogymnastics), pilates (which acts on posture, breathing, flexibility, balance) and Tai Chi Chuan. Physiotherapy and acupuncture techniques can help. Analgesics and anti-inflammatories have little response, but drugs that regulate emotions and act on neurotransmitters can be useful, together and facilitating other care. Anxiety and depression are common in fibromyalgia. The expression mens sana in corpore sano (“a healthy mind in a healthy body”) is apt when talking about treating this disease.
Dani Valente is based on personal experience. But what impresses her is the commitment she demonstrates in seeking more knowledge. She was also inspired by Hippocrates, who for millennia advocated: "Let your medicine be your food and your food be your medicine". Today, she takes care of herself and others, encouraging good nutrition.
It accompanies science's effort to prove the relationship between eating habits and its influence on chronic diseases, including the so-called autoimmune ones. This is another merit of the author: she makes readers aware of the importance that is now given to the microbiota and epigenetics. A proper vision of human ecology and the perception of how much we depend on the balanced stability of this varied and immense population of microscopic crew members and passengers that we harbor in our gut - and that make us a metaphor for a kind of spaceship. Concepts that are renewed and are once again valued by scientists such as Paul Ehrlich (1854-1915) and Ilya Ilyich Mechnikov (1845-1916), both awarded the Nobel Prize in 1908. Ehrlich, an immunologist who helped to characterize antibodies, understood that the immune system would have protective mechanisms that would not allow him to turn "against himself". It is possible to predict that in the future there will not even be talk of "autoimmune” diseases, they would be caused by this imbalance. And Mechnikov was the first to study probiotics.
Dani Valente was already respected as an excellent actress and screenwriter, activities that depend on empathy and the ability to experience the feelings of others. In the role she now plays, based on her experiences, she seems to go beyond. It encourages changing life stories and gives new meaning to characters who seem doomed to pain and suffering. Admirable generosity, it deserves applause and our reading.
(Dani Valente, Brazilian actress and screenwriter, now lives in the USA and works as a holistic nutritionist. The book in which she tells her story, in a confessional and altruistic account at the same time, of how she learned to face her chronic illness, the fibromyalgia, was published with the title "The Happiest Person in the World" (A Pessoa Mais Feliz do Mundo), Maquinaria Sankro Editora, São Paulo, Brazil, 2022.)
