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? (https://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