Below is an email to Robert Spillane. He's a thinker who agrees with lots of Thomas Szasz's ideas, and knows a lot about Popper and other philosophers. His book An Eye for An I: Philosophies of Personal Power covers many philosophical ideas. He wrote an article about Repetitive Stress Injury (RSI).
I share my experience with RSI. From my story, you can learn about RSI, and you can also learn how to think about, take responsibility for and solve one's problems.
I had RSI problems, which I solved by myself before reading Szasz. Before reading much of your perspective, I wrote down my existing thinking, below. After reading the rest, I see that we broadly agree. I believe my view adds something you don't say.
I liked your comment on the word "demoralised". I particularly agree with:
There are serious psychosocial consequences when people with discomfort in the arm are told that they may have a crippling disease which demands urgent medical treatment and cessation of physical activities.
And I found this especially horrible:
Personal activity is discouraged because insurance companies, facing large payouts, employed private investigators whose evidence, admissible in industrial courts, could prove embarrassing to plaintiffs. Faced with the prospect of jeopardising their claim, workers were inclined to adopt the patient role and assume a state of dependency
I'd be very interested if you think any of my account is mistaken or contradicts Szasz:
I had wrist pain which disrupted my computer use. I wasn't malingering. I wanted to use computers heavily. I didn't have a job at the time ("Occupational Overuse Syndrome" is stupid). I didn't spend much time interacting with doctors about it. I didn't find the doctors useful. I found better info online. I didn't use any RSI medicine beyond wearing wrist splints while sleeping. I could have gotten cortisone shots and probably surgery if I'd wanted to; that would have been a terrible idea.
Bodies have physical limits. My physical problem was real and was addressed with physical solutions: a better chair, ergonomic changes, stretching, breaks, and a temporary reduction in typing. My main problem was typing with bent wrists, which I ceased after educating myself.
I was scared by reading about how RSI could cripple me long-term. What people say about RSI is very dangerous. While learning standard RSI advice, I made myself fearful and stressed about whether my wrists would improve. RSI advice says you're largely helpless – you may be crippled for life with nothing you can do about it. I started worrying.
My physical problem was adequately solved after perhaps a few months, but I didn't notice. I had ongoing pain for several years! Because of my fear, I was oversensitive to minor pain and minor non-pain sensations, and I imagined some pain. I hated my RSI problem rather than benefitting from it.
What really scared me was the claim, which I accepted, that pushing past pain would make my injury worse. That was completely different than my attitude to sports. In sports, I routinely ignored minor pains because I had a rational understanding of which pain indicated a genuine danger and which pain was harmless. I'm good at ignoring pain that I don't consider dangerous.
I had a bad time with RSI because I accepted bad ideas about which pain is dangerous. After the initial physical improvements, I only had mild pain that I could have tolerated if I wanted to. But I was unwilling to because medical authorities told me that ignoring the pain could damage my body and cripple me in the long term. I could have toughened up, as I'd done with sports pains, but medical advice told me not to! I was trying to be responsible and conscientious...
My pain went away when I recognized what was going on and relaxed about it. I'd already solved the physical problem in the past. Introspection and changing my attitude then solved the mental problem.
I believe on principle and logic (without much direct evidence) that the pattern of my experience is common, minus the solution. But I couldn't estimate how common it is compared to other patterns like malingering. The pattern is:
- Have a real physical problem while psychologically fine.
- Learn about RSI and create a psychological problem.
- Take steps to solve the physical problem, which work.
- Have an ongoing psychological problem which you confuse with the original physical RSI injury.
Note this pattern explains the development of RSI over time, in contrast to the 8 scenarios you present which state the situation at a particular time.
So I think the standard advice and medical authority associated with RSI is doing immense harm. It scares people, and encourages them to be oversensitive to pain and therefore to exaggerate. Thereby, "medical" advice causes RSI!
I was fooled by bad, pseudo-medical advice to intentionally be sensitive to mild discomfort... The reasoning was that pain is a warning sign for injury, so if you try to be mentally tough about the pain then you will cripple yourself. I think serious physical injuries called "RSI" happen, but malingering, exaggerations and mental errors are way more common.