Session 8: Vicissitudes 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 Trajectory of Chronic Non-Cancer Pain in Six Patients: A Roller-Coaster Ride
Ruth Dubin
Kingston Family Health Team, Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
The diagnosis of chronic non-cancer pain (CNCP) is based entirely on patient self-report unlike conditions such as diabetes or multiple sclerosis. Objective tests, the sine qua non of the medical model, are not widely known outside of specialty clinics. Canadian family physicians are poorly trained to deal with this common and debilitating condition.
Using a novel graphic representation of the major themes raised during primary care visits, Dubin and Van Vlack (Pain Res. Manage., in press) discussed factors including mood disorders, financial concerns, conflicts with employers and insurers, and independent life events which affected healthcare utilization in six pain patients followed in Dr. Dubin’s general practice for 6 to 22 years. A locally-developed education/exercise CNCP self-management program seemed to improve patient function and reduce healthcare utilization in those whose major conflicts were behind them.
Physicians, insurers, lawyers and employers may be contributing to patients’ pain and disability by adopting a disbelieving and confrontational approach to CNCP sufferers. Terms such as “functional”, “malinger”, “drug-seeking”, and “sickness or pain behaviours” allow professionals to separate themselves from and “blame” their clients. At the same time, patients may be forced to use ever-more exaggerated verbal and non-verbal cues to communicate their distress to others.
This paper will present the chronic pain trajectory as a roller-coaster ride which engulfs the patient, family, employers, insurers and medical care-givers alike. Avoiding this destructive path requires a shift from the medico-legal models (purely scientific, allowing only objective findings) to ones that incorporate both patient empowerment and an expanded understanding of the pain experience. Professional training in chronic pain should be multi-disciplinary, and should include input from the Humanities and Social Sciences.
Download Draft Conference Paper (pdf)
Connecting Drug Use and Pain in GLBTQ Communities
Ian Flaherty
University of Sydney, New South Wales, Australia
The literature suggests that the prevalence of use of both licit and illicit intoxicating substances is much higher among the gay, lesbian, bisexual, transgender, queer (GLBTQ) community when compared with the non-GLBTQ community. Additionally, in qualitative studies of the GLBTQ community, incidences of trauma associated with sexual encounters figure more prominently in many ways when compared with the non-GLBTQ community. In many of these qualitative studies, the ‘self-help’ approach is presented as a mechanism through which people from GLBTQ communities might achieve both a resolution to the pain associated with traumatic sexual encounters, as well as a sense of a new identity – an identity associated with strength, resistance to pain and autonomy. This paper seeks to unravel these interconnected narratives. I seek here to connect with the paradox that has beleaguered the GLBTQ community since the events of Stonewall. Why does a favourite Sydney establishment for the GLBTQ community align itself so closely with the assuagement of pain of belonging to a minority group through the use of licit, and probably illicit, intoxicating substances? Why is it so widely reported in the GLBTQ community that people ‘truly find themselves’ once they have had apocryphal experiences with illicit substances? At least some of the answers lie, in my paper, in the interactions between experienced pain, of both a physical and psycho-emotional nature, the urgency to ‘discover oneself’, and the mechanisms commonly prescribed to accomplish this process. In this paper, an attempt is made to connect the narratives of a group of gay men in highly-modernised societies with more-widely accepted understandings of pain, and how the narratives of ‘self-help’ have influenced their decisions to use licit and illicit intoxicating substances. My hope is that an enriched understanding of the connections between the use of both licit and illicit intoxicating substances for pain, of varying sorts, for the GLBTQ community will be yielded.
Shooting Pains: Autobiographical Video as a Means of Addressing Illness-related Pain and Mortality
Broderick Fox
Film & Media Studies, Occidental College, Los Angeles, California U.S.A.
The worst thing about being sick in America is you are booted out of the parade. Americans have no use for the sick. Look at Reagan: He’s so healthy it’s hardly human, he’s a hundred if he’s a day, he takes a slug in his chest and two days later he’s out riding ponies in his PJ’s. I mean who does that? That’s America. It’s no country for the infirm.
–Roy Cohn in Tony Kushner’s Angels In America: Perestroika
I wish YouTube administration would ban stupid people from posting videos like this. It’s totally unobjective. You shouldn’t tell your problems to everyone on YouTube. Nobody cares. People don’t want to hear about tragedies.
–Comment posted about a YouTuber’s video diary recounting his battle with testicular cancer.
Despite a proliferation of new media technologies and interfaces for communication and exchange, around death and dying still place strong social proscriptions on the candid discussion of pain, illness, and natural death in Western Society. Mediations of illness have been superseded by discourses of wellness and anti-aging, which seem to equate acknowledging pain with weakness and illness or body failure as personal failures. In the American context, beyond action film torture scenes (or real-life Bush era torture scenes), the address of physical and emotional pain comes most pervasively in the form of television advertisements for the latest pharmaceutical product—“Ask your doctor if X is right for you.”
We live in a secularized age of psychoanalysis, where taboos surrounding birth and sex have been shattered. Procreation no longer even mandates physical copulation, but a (safe) sex life is part of a larger plan of healthy living prescribed by a medical community that, in the words of scholar Lisa Cartwright, “has subsumed organized religion as the major institutional molder of cultural death fears and immortality desires.” With natural death removed from the home, productive public discourse around pain and illness has largely become a privat-e/ized matter, ceded to the privileged gazes of the medical, pharmaceutical, and funerary industries.
In Home Movies and Other Necessary Fictions, Michelle Citron offers a history of home movie images in American culture. While the home technology evolution from Super 8 film to digital video camcorder has been dramatic, the strict code of “appropriate” home movie recording situations has experienced little change. We film Christmas dinner with family and friends, not the meal eaten alone; birthday parties, not the emergency room visits; births, not funerals. And yet a growing corpus of first person consumer videos since the early 1990’s have done precisely the contrary—using consumer video cameras and autobiographical acts of video diary, confession, and documentary as forms of pain management, coping, and self-exploration in times of extreme vulnerability brought on by personal illness.
This paper will look to works such as Silverlake Life: The View From Here (1991), Sick: The Life of Bob Flannagan, Supermasochist (1997), My Left Breast (2000) and emergent uses of social software sites such as YouTube to explore the possibilites of first-person media as a means of both subverting and transcending social proscriptions/prescriptions for managing, discussing, and even “performing” pain in the public sphere.
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