Because It Feels Nice

By Jack Chew

I tell you what doesn’t feel nice. Making this argument. Most of my career and arguably most of my life I have found the appeal of things ‘feeling nice’ to be pretty empty. Whilst I’ve not been at all averse to doing things that feel nice, I’ve always felt that they came with trade offs that fundamentally led to moderation. Or at least that ‘right minded’ people would be inclined to moderate how much of something they do when it comes to important issues of health and healthcare. Sure, things feel nice but that’s the bottom of the barrel when it comes to justifications.

For example, I like beer. Mainly because it feels nice. It has its consequences though; namely that I get fat and lose much of the next day and so, at least these days, I drink in moderation. If that’s my health example, a healthcare example would be that when managing my own low back pain of approaching 20 years, I occasionally enjoy a massage. Mainly because it feels nice. It has consequences though, namely that it costs me money and I have to roll my eyes at the nonsense the massage therapist spouts about the causes of my pain. And so I have massages infrequently.

But in both examples I’m in a very privileged position: I don’t have an addiction to alcohol, or any social contexts that cause me to depend on it, and I have work that demands my cognition enough to minimise hangovers. I also have insights into pain and injury that most people don’t have due to my education and experience, therefore I know that I don’t NEED massages to help manage my symptoms, I might just occasionally WANT them. This difference between need and want should not be taken for granted. It is hugely impactful to my behaviours, actions and care-seeking that I don’t think that my back pain is due to me being damaged, fragile, malaligned or the existence of ‘muscle knots that are pulling on your pelvis and wearing it out’ (a recent fave explanation from a massage therapist when on holiday).

When someone wants something, sometimes it’s worth checking why. If it’s because they perceive that they need it, then investigate whether that is true and consider challenging it if that belief is limiting them. For my examples, if I felt that I needed alcohol, it would beg interesting questions about addiction. If I felt I needed massages, it might suggest I think that the massage was somehow corrective or curative. But if I wanted a beer and a massage because it feels nice, what’s the harm?

Quite rightly, we have become biopsychosocial thinkers, respecting holistic, multi-factorial causation which means that we can understand why something feeling nice could be helpful for someone’s health. Often though, if it feeling nice is explained to be the likely primary mechanism by which something is helping someone, they will resist the idea as if it diminishes its importance. Beer and massage are naff examples so let’s switch to vitamin water and acupuncture. If these are effective for health because they feel nice, the specifics of vitamin composition and needle placement might matter less. Perhaps the expertise of the people who recommended this heady combination of magnesium, GB21 and auricular shenmen is tied up in this specificity?

There are many fields in which ‘because it feels nice’ is a prevalent but contentious argument. An informative one is in the rhetoric of vegan animal rights activists. When someone declares a preference for a sausage over a veggie sausage or cheese over soya cheese, the activist may demean that preference by saying “is your mouth pleasure a good enough reason to exploit and kill an animal?” Whilst inaccurate and unfair in my opinion, it is a powerful rhetorical trick, in part because the reasoning of something feeling nice seems such a weak justification for anything. As I said earlier, it feels like the bottom of the barrel ethically. But what demeaning this argument does is limit the huge benefits that can come from something feeling nice. If doing something that feels nice leads to an individual doing something healthy, it can contribute to a net good.

Consequential ethics get messy of course, and we mustn’t use them to justify that anything goes just because it might just unlock something positive in the future. However in MSK, I think that the fine margins of success or failure are often down to very personal factors such as circumstances, timing, access, priorities and interest. I have come to the realisation that something that feels nice might include some of the things that I would previously discourage because they came with baggage. Now I check in on the baggage and if it isn’t too heavy or in the way, I encourage it. Much like we have anti-burnout buzzwords like ‘self-care’ and ‘me time’, the integration of these as a means of overcoming pain and injury could well be handy.

It took for me to get older, achier and busier to realise how therapeutic doing something purely because it feels nice can be. And as for patients, they don’t know what we know. They don’t have the security that comes from the knowledge that hurt ain’t harm and harm ain’t damage and damage ain’t destiny. So join me in giving more leeway…though maybe you were anyway and I’m catching up? Either way, being more understanding and open-minded might feel nice.