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    6 views16 pages

    Jackson - Chroinic Pain and The Tension Between The Body As Subject and Object

    Uploaded by

    Krinka V Baković

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    Cambridge Studies in Medical Anthropology 2 Editors Ronald Frankenberg, Centre for Medical Social Anthropology, University of Keele Byron Good, Department of Social Medicine, Harvard Medical School Alan Harwood, Department of Anthropology, University of Massachusetts, Boston Gilbert Lewis, Deparomen of Social Anthropology, Univesity of Cambridge Roland Littlewood, Dspartment of Anthropology, University College London ‘Margaret Lock, Departmen of Humanities and Social Studies in Medicine ‘McGill University Nancy Scheper-Hughes, Department of Anthropology, University of California, Berkeley Medical anthropology is the fastest growing specialist area within anthropology, both in North America and in Europe. Beginning as an applied field serving public iat, medical anthropology now provides a significant forum for many jgent debates in anthropology and the humanities. ‘Medical anthropology includes the tudy of medical inetitutions and health eare in a variety of rich and poor societies, the investigation of the cultural construction of illness, andthe analysis of ideas about the body, birth, maturation, ageing, and death, ‘This new series includes theoretically innovative monographs, state-of-the-art, collections of essays on current isues, and short books introducing the main themes inthe subdiscipline. 1 Lynn M. Morgan, Community participation in health: the politics of primary care in Conta Rica Embodiment and experience The existential ground of culture and self Edited by ‘Thomas J. Csordas Gare Wentem Reserve Univesity CAMBRIDGE 1974 UNIVERSITY PRESS 9 Chronic pain and the tension between the body as subject and object Jean Jackson This chapter uses an “embodiment” approach to examine some of the ‘mysteries of chronic pain. An embodiment perspective “requires that the body as a methodological figure must itself be nondualistic, i-e., not distinct from or in interaction with an opposed principle of mind” (Csordas 1990: 8). I approach pain as something quintessentially lived and experienced in the body. As much as possible I assume the experiencer’s perspective of being-in-the-world (Merleau-Ponty, 1962 (quoted in Csordas 1993: 3)), specifically in the pain-full world. I explore the ways in which the experi- cence of chronic pain is simultancously sensation and emotion, neither preceding the other, and critically examine our model of chronic pain as first ‘caused (in either the body or the mind) and then experienced. ‘This discussion also looks at pain as preobjective, that is, not yet involved with a subject-object distinction, and explores the connections between language and pain: the role played by our analytic language, and the notion that @ pain sufferer speaks the language of a world different from the everyday world. This language, and pain sufferers’ opinions about successfully communicating about their lived pain are also considered, drawing on Schutz’s notion of multiple realities, in order to understand why people with chronic pain report feeling profoundly understood by fellow sufferers and profoundly misunderstood by non-sufferers. Introduction to the research. 1 draw on data collected during an ethnographic research project in an inpatient chronic pain treatment center in New England (here referred to as, the Commonwealth Pain Center, or CPC). The CPC, a separate twenty-one bed inpatient unit in a private nonprofit rehabilitation hospital, offers a ‘multidisciplinary one-month program geared to reducing chronic pain and teaching skills for coping with it. Treatment involves a team approach and {focuses on conservative, non-invasive therapies, including physical therapy (exercise, whirlpool, ice massage, ultrasound, transcutancous nerve stimu- lation); cognitive therapies (relaxation training, biofeedback); social services 20 202 Jean Jackson group psychotherapy; and one-on-one psychiatric therapy, Goals of this ccenter ~ like those of many other centers around the country’ ~ include Climinating the source of pain when feasible, teaching the patient his or her fimitations, improving pain control, relieving drug dependence, and treating underlying depression and insomnia. The CPC also attempts to examine issues of secondary gain, tries to improve family and commut support systems, and in general works at returning patients to functional ‘and productive lives, The majority of patients have lower back pain, Next in frequency are headaches and neck pain, followed by complaints of facial, chest, arm and abdominal pai “The staff sees some patients as entering with an acknowledged-by-all “zeal” problem with overlays of depression or “pain habits.”” Other patients ‘are admitted with a problem seen as originally organic (c.g. the result of ‘ar accident), but now including significant psychogenic elements. And many patients come in with mysterious pain problems which staff must ‘ring out into the open (asking what patients consider prying questions) in “order to arrive at a more comprehensive diagnosis. No patients are admitted ‘with “uncomplicated” chronic pain ~ pain due to arthritis or osteoporosis, for instance if the patient handles it as well a could be expected. “Ifaman ‘has pain from degenerative disk disease but doesn't complain about it, is ‘working full-time, and has a goud sclationship with his wife, he doesn’t need external contingency management” (Schaeffer 1983: 24) ‘All CPC patients not only have chronic pain but exhibit chronie pain syndrome to some degree, a condition in which pain has taken over a sufferer’ life. Chronic pain is defined as any continuing pain that has lost its biological function (Bonica 1976: 11; Black 1979: 34). Pain usually indicates nociception (the onset of a provoking or harmful condition) ~ that is, iis a Symptom rather than a disease, a “normal” indication of something abnor- ‘mal, Any chronic pain whose underlying pathology is not totally clear (as ‘with most patients at the CPC) confounds the common-sense notions of disease and health, Most clinicians agree that acute pain turns into chronic pain after the somewhat arbitrary cutoff point of six months,” but disagree bout the extent to which chronic pain is due to psychogenic, rather than ppysical causes, and the consequent implications for treatment. Research was carried out at the CPC from February 1986 to February 1987, which included eight months spent on the unit observing and inter- acting with 2 total of 173 resident patients. In all, T conducted 196 inter~ ‘views with 136 patients (60 of whom were interviewed twice) and inter- jewed 20 staff members as well. My main concern was to investigate ‘cognitive restructuring” in patients. The social context of treatment at the CPC, involving intensive interaction, results in patients creating new inter- subjective meanings of pain during their stay. I wanted to know if these The body as subject and object 203 changes in the way patients thought about pain correlated with self-reports about improvement. In addition, a majority of patients resented at least some ofthe policies and ideology of the program, and I was interested in tow pains dest wth hemscts ther psn, and tain seting of ch confrontation. Confusion is another characteristic of life at the center. This, as I have argued elsenhere (J. Jackson 1992), isthe result of (1) the nature ot pin itself (ts invisibility, its subjectivity, its challenge to Western mind-bodl

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