Session 2: The Language of Pain

1st Global Conference

Wednesday 17th February – Friday 19th February 2010
The Women’s College, Sydney, Australia

in association with the Faculty of Arts and Social Sciences, University of New South Wales, Sydney

The Clinical Conversation about Pain: Tensions between the Lived Experience and the Medical Model
Milton Cohen and John Quintner
St Vincent’s Campus, Sydney, Australia and Fremantle Hospital, Western Australia

Despite the application to pain of the biopsychosocial model of illness, the clinical path of the person in pain presenting to a health professional still leads to frustration for both.
The biopsychosocial model generated the “official” definition of pain, two major conceptual frameworks in pain medicine, and three putative explanatory models for pain. However, in the absence of a theory that explains the lived experience of pain as an emergent and unpredictable phenomenon, these progeny of the biopsychosocial model have been unable to displace biomedical reductionism or to transcend body-mind dualism. In particular, the implication that pain can be an object divorced from the body bears little relationship to the lived experience of pain. This traditional observer-dependent stance of the clinician results in marginalisation of the “patient”, compromises effectiveness of therapy and leads to reluctance of the clinician to engage with a potential clinical nemesis.

The lived experience of pain defies lineal reduction. Metaphysically it constitutes an aporia that denies us access to its secrets. However application of principles underlying the self-referentiality of living systems, such as autonomy and autopoiesis, opens a path to integrating the traditional somatic dimension of biomedical analysis with the dimensions of beliefs, emotions, behaviour and environment.

In the clinical encounter, pain may be grasped anew through the engagement of two autonomous self-referential beings in the intersubjective or “third space” with each influenced by similar sets of humanist factors but excluded from the same aporia. This framework supplants the current biopsychosocial approach by linking the different domains of analysis of pain, by not resorting to reductionism and dualism and by “levelling” the clinical “playing field” in order to generate new therapeutic possibilities.

Download Draft Conference Paper (pdf)

Inflecting Pain
Hildur Kalman and Naomi Scheman
Umeå Centre for Gender Studies/Dept of Social Work, Umeå University, Sweden and Women’s & Sexuality Studies, Philosophy Department, University of Minnesota/ Umeå Centre for Gender Studies, Umeå University, Sweden

Starting from the connection and tension between the expression and the acknowledgement of pain, we explore the interpersonal space between the two: how it is that pain’s expression and acknowledgement are always inflected by the space between the one in pain and the other, and how, in turn, pain’s expression and acknowledgement inflect that space. To inflect, grammatically, is to mark words—by gender, number, tense, mood, &c.—indicating a constitutive difference: our words are always inflected somehow or other. In this sense, the expression or suppression of pain, its being acknowledged or ignored, marks interpersonal space and is marked by it. Through some examples, we raise questions about what we learn about interpersonal space—when that space inflects and is inflected by pain. We are especially interested in the absence of expression and/or acknowledgement, in the ignoring of pain and the constraints on acknowledgement. Examples that will be discussed are:

Ignoring pain, love-making, and intimate space: We want to think about minor, incidental (non-eroticized) pain – that typically carries with it a determination not to express the pain, in order to avoid the distraction of its being acknowledged—the disruption of the space of intimacy.

Inflicting pain, professional caring, and professional space: Again, we focus on the (relatively) mundane and morally unproblematic—the pain inflicted, e.g., by a doctor’s cleaning a wound or by a physiotherapist initiating motion in an injured limb. The interpersonal space is one of professional engagement, and both pain’s expression and its acknowledgement are and should be contextualized by expectations of appropriate care.

Witnessing pain, face-to-face: Either professionally or by chance, one may become a witness to the newly bereaved. A risk here is an acknowledgement that collapses the interpersonal space where the pain calls for presence at a distance, respecting the aura of emptiness.

Download Draft Conference Paper (pdf)

Revelational Indicators: A Framework for Analysing Pain
Shona Hill and Shlinka Smith
Victoria University of Wellington and Civil Servant and Independent Scholar, New Zealand

In the West we exist in a culture where it is possible to detect weariness with both history and tradition. Despite this, Mellor and Shilling, exploring differing processes of reading and writing the re-forming Christian body, base their concepts in the understanding that every historical moment (its developing texts and traditions) has a dynamic all its own. In their book, ‘Re-forming the Body: Religion, Community and Modernity’ (1997), they suggest that history signifies the past allowing the future to come into being. They also suggest that tradition is the handing on and over of an historical story so that it may be told freely and creatively by each generation. From this understanding they develop ideal-type bodies consistent with Medieval, Reformation and contemporary epochs. Utilising these ideal-type bodies within Latour’s perspective that ‘the body is an interface that becomes more and more describable when it learns to be effected by many elements’ I create a framework for analysing the competing contemporary collective representations of pain. Specifically in this paper I focus on locating pain in three paintings that depict the killing fields of Golgotha and explore how these scenes of Christ’s crucifixion not only change over time but also shed light on the contemporary management of pain in everyday life.