Session 6: Health Care in 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
Journeys with Chronic Pain: Acquiring Stigma Along the Way
Amanda Nielsen
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Qld, Australia
Chronic pain has been identified as a major and underestimated health care problem, with extensive individual, social and economic ramifications. Recognition of pain as a multidimensional experience has contributed to the biopsychosocial model of health gaining substantial recognition in the pain management domain.
There is evidence, however, that the ‘promise’ of the multidimensional approach has not been realised in the daily lives of people with chronic pain. A relationship between stigma and chronic pain has recently begun to emerge in the qualitative literature concerning the lived experience of chronic pain. Drawing on a narrative study with twenty people with chronic pain, this paper will use the conceptual framework outlined by Link and Phelan (2001) to illustrate the social processes involved in the stigma acquired by people in their journey with chronic pain.
Link and Phelan (2001) outline five elements that need to co-occur for stigma to exist. These include processes of labeling, stereotyping, separating, status loss and discrimination, all of which need to co-occur in a power situation which enables these processes to develop and unfold. This paper will explore these components of stigma, with reference to narratives of people with chronic pain. While the impact of stigma may vary in degree amongst participants, it is concluded that stigma is a valid concept to apply to chronic pain. Further, stigmatisation is a social process that has significant consequences for the stigmatised which cannot be address at an individual cognitive level. This adds salience to the author’s contention that the social dimension of chronic pain needs to be further articulated and addressed at a policy and practice level, not only to ensure a more comprehensive response to chronic pain, but also to ameliorate the social suffering experienced by people living with chronic pain in our community.
Download Draft Conference Paper (pdf)
How to Listen to Chronic Pain Narratives
Mary Buchinger Bodwell
Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
Chronic pain—pain that does not respond to treatment—is problematic not only for the patient but also for the health care provider. Patients with chronic pain represent, to some extent, a health care system’s failure and, as a result, they can become both resented and stigmatized by providers; empathy wears out. In medicine, the restitution story—the patient is sick, treated, and gets better—is privileged. It is the story every listener prefers—a story of triumph and success, a story of progress, of restoration, of redemption—“all’s well that ends well.” But patients with chronic pain cannot tell a restitution story—despite the pressures from their audience, which includes health care providers, family, friends. Yet patients must and will tell their stories, and it is in the careful and empathic listening to those stories that care providers can prevent chronic pain from becoming true suffering. Health care providers are trained and poised to take action, to intervene, to do things. In the biomedical sphere, health care providers supply answers to needy patients. However, patients outside a restitution narrative pull providers into a different kind of relationship—one that is non-hierarchical, thus placing the provider in a less controlling and less guarded position. How to recognize and then honor this shift in the patient-provider relationship is not generally included in the medical professional curriculum. In this presentation, I will discuss the role narrative plays as a coping tool for patients with chronic pain as well as the kind of empathic listening these narratives require from health care providers. Specifically, I will address this topic from the perspective of one who teaches communication skills to future health care professionals, including nurses, physician assistants, and radiographers.
The Mind/Body Problem in Contemporary Healthcare
Gillian Bendelow
Department of Sociology, School of Law Politics and Sociology, University of Sussex
Health and illness are multi-faceted concepts which span a range of disciplines and have varied meanings in different societies (Helman 2002, Blaxter 2004). Since the nineteenth century we have witnessed dramatic advances in the understanding and cure of disease with, at least in Western countries, an unprecedented extension of both quality and length of life. Yet even as medical science has progressed, there has been a decline of faith in biomedicine and its dominance challenged by litigation, scandal, government regulation, lay expertise and social activism (Fox 2000, Scambler 2003). Social sciences associated with medicine, particularly medical sociology, philosophy/bioethics and health psychology, have shaped modern ideas about health and illness and over the course of the twentieth century formed a major challenge to the narrow philosophical grounding of biomedicine.
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