We are more than organ systems in isolation. How we move through this world impacts our health, performance, and wellness–a lot.
I’ve been thinking a lot about what scientists call “lived experience.” Lived experience is technically defined as “personal knowledge about the world gained through direct, first-hand involvement in everyday events rather than through representations constructed by other people.” It’s a critical aspect of qualitative research, which involves exploring lived experiences as a way to understand something from the perspective of the individuals involved. Yet, it is largely neglected in quantitative research, which I believe leaves women in particular wanting.
The lived experience is part of the biopsychosocial model, which is a medical treatment approach that believes that to understand a person’s medical condition, you need to take more into account than biological factors, but also consider the psychological and social factors that contribute.
This approach was conceptualized by internist and psychiatrist Dr. George Engel in a landmark paper in Science (1977) entitled “The Need for a New Medical Model: A Challenge for Biomedicine.” In it, Engel criticized the reductionist biomedical model of patient care. He believed that it reduced people to disease-based objects and ignored the possibility that the subjective experiences of patients are important for clinical care and research. He proposed a new model, the biopsychosocial model, to offer a holistic alternative encompassing the individual’s subjective experiences (from societal to genetic) as a means to empower the patient and facilitate transdisciplinary research.
But, as we know, this model is rarely discussed nor implemented across research, which is a significant contributor to the gender-data gap. Let’s look at the increased risk of women for the onset of dementia and Alzheimer’s as an example.
We know almost twice as many women have Alzheimer’s compared to men. Viewing this situation from a purely biomedical model, we concentrate our preventative efforts on estrogen exposure and genetic testing. And while those are certainly important and interesting areas of research, when we also apply the biopsychosocial model, we start to see a fuller picture with greater possibilities. Consider that old age is the biggest risk factor across both sexes. Up until quite recently, what has been the lived experience of millions of women? How were women traditionally educated (or, more importantly, not educated)? How have traditional gender roles impacted our career possibilities and lifestyles?
We know that having a full education and opportunities for lifelong mental stimulation helps to delay dementia in old age – something known as ‘cognitive reserve’. Historically, opportunities to go to university or work for many years in highly-skilled occupations have been less available to women, thus contributing to the sex differences in risk factors that are largely overlooked if we look through a biological lens alone.
Sport is no different. We are missing the mark in understanding the nuances of women’s health, wellness, and performance if we only view women through the siloes of biomedical research without also taking into consideration the sport environment (just look at the historical performances at the first all-women’s Ironman World Championship race in Kona if you want to see the impact there) and the female athlete’s full lived experience including coaching and societal messages and expectation.
I have been asked quite a bit in the past few months on how to increase practitioners’ awareness and education around the menstrual cycle, because the space has become crowded with mixed messages. Yes, there is the cornerstone of systematic research on which to base decisions, but the lived experience is so important to understand where a person comes from, what their views and perceptions are, how they grew up, and their exposure to certain situations.
We can’t take a blanket approach to education because the sociocultural dynamics are so critical. Here are two different cultures discussing perceptions of the menstrual cycle, one called Cycles and the other Running for Their Lives. The first has a very positive athlete voice, and the second is more of a warning. How would a coach take each of these messages and incorporate them into their methods? Most likely with their own lived experiences.
So next time you are listening to or reading a buzzy topic, take a step back and ask, “Does this apply across the board, or are there deeper nuances to be discussed?” Consider how real women might be experiencing what is being studied. If we don’t consider women’s lived experiences and take a more biopsychosocial approach to understand everything from the menstrual cycle to sports performance, we risk going backward in our comprehension rather than making the progress that is so greatly needed.
