Welcome back to the Daily Dose!
Today, I am happy to present a fascinating book collection offering a radical, inter-disciplinary look at Dimensions of Pain. Pain research is still dominated by biomedical perspectives and the need to articulate pain in ways other than those offered by evidence based medical models is pressing. Examining closely subjective experiences of pain, this book explores the way in which pain is situated, communicated and formed in a larger cultural and social context. Today, I have asked the editor, Lisa Folkmarson Käll, to join us and speak a bit about this much-needed perspective.
Lisa Folkmarson Käll
Dr. Käll is an Associate Professor (Docent) of Theoretical Philosophy at Uppsala University and Research Associate in Philosophy of Medicine and Medical Ethics at the Center for Dementia Research (CEDER), Linköping University. Her research is located in the area of contemporary continental philosophy and feminist philosophy and she maintains a broad interest in questions concerning subjectivity and intersubjectivity. In her research, she focuses on the meaning of the “lived body” in the constitution of konwledge, understandings of the notion of situation and situtated knowledge, pathological and normative bodily self-objectification, the bodily constitution of sexual difference and sexual identity, empathy and the sharability of pain, constitution of bodily boundaries and the relation between selfhood and otherness.
Dimensions of Pain: Humanities and Social Science Perspectives
Dimensions of Pain explores the lived experience of pain, and questions of identity and pain, from a range of different disciplinary perspectives within the humanities and social sciences. Discussing the acuity and temporality of pain, its isolating impact, the embodied expression of pain, pain and sexuality, gender and ethnicity, it also includes a cluster of three chapters discusses the phenomenon and experience of labour pains.
This volume revitalizes the study of pain, offering productive ways of carefully thinking through its different aspects and exploring the positive and enriching side of world-forming pain as well as its limiting aspects. It will be of interest to academics and students interested in pain from a range of backgrounds, including philosophy, sociology, nursing, midwifery, medicine and gender studies.
[Routledge has generously offered a 20% discount for this book when you follow the blog link: Use offer code IRK70.]
1. As a medical humanist, I value work that crosses boundaries–and as managing editor of Culture, Medicine, and Psychiatry, I enjoy and encourage inter-disciplinary and culturally sensitive research. This collection really seems to span the gap, so to speak. Can you say more about how and why you chose to approach pain in this way?
Yes, the book is very much informed by a commitment to interdisciplinary work and the contributing authors are from diverse disciplinary backgrounds such as literature, social anthropology, philosophy, sociology, urban geography, medicine, science and technology studies, and gender and sexuality studies. For me, an interdisciplinary commitment plays a crucial part in contributing to a deeper understanding of texts, systems of thought and questions, and thereby actively resists philosophical and scientific dogmatism. The collection is guided by the conviction that pain as an object of study demands multiple and interrelated disciplinary (and non-disciplinary) perspectives in order to be adequately addressed. This is not something that is unique to pain but I think pain, because of the way it is so urgently present in life, as a part of life, is a topic that makes this demand in very strong terms.
More specifically, the interdisciplinary ambition guiding the work with Dimensions of Pain was to address the need to articulate pain also in other ways than those offered by evidence based medical models that tend to miss important aspects of how bodies in pain are subjectively lived and culturally, socially, politically and historically situated. When putting together the volume I wanted contributions from different disciplinary perspectives that would bring out this situatedness of bodies in pain and that would speak to the connections between questions of identity and pain. Many of the essays discuss how cultural and social norms and expectations regarding identity and behavior form how pain is experienced, expressed and received by others. The collection also has a strong focus on issues of gender and sexuality, which in themselves are interdisciplinary fields of study, and there is a whole cluster of chapters dealing with the pain of childbirth from different perspectives.
An interdisciplinary approach is also a way to put focus on the impossibility of final answers and the book in no way has the ambition (or illusion) of being exhaustive or offering a “solution” to the problem of pain. Aiming to approach pain from different perspectives, it also aims to see the horizons to which each new perspective opens up. It offers an invitation to raise further questions and forge new interdisciplinary encounters in order to generate continued creative interrogation and understanding of the lived dimensions of pain.
2. A lot of the pieces here seem to engage with language, with the ability (or inability) to articulate pain. It seems to me that we are always seeking to share pain, and yet often falling short. How do you view the relationship between communication and pain?
Yes, many of the essays do engage with language and all of them address different ways pain is expressed, communicated and given meaning in social and cultural contexts. At the same time, the volume takes seriously the well-established contention that there is something utterly private about pain that makes it incommunicable in essential ways. In her wonderful essay On Being Ill, Virginia Woolf writes poetically that when attempting to describe pain “language at once runs dry” (On Being Ill, Paris Press 2002, p. 7) and I think this is something most of us can recognize quite well. When in pain, it is difficult, sometimes impossible, to find words to describe it. The philosopher Hannah Arendt describes the experience of great bodily pain as “the most private and least communicable of all” (The Human Condition, University of Chicago Press 1958, p. 50). This tension between the communicability and incommunicability of pain is not a paradox to be resolved; rather, it testifies to both the privacy and the sociality of human existence and experience. It also testifies to the richness and creative power of different forms of expression. As much as pain is in many ways silencing and experienced as impossible to express in language, it is nevertheless often accompanied by a desire to speak in the attempt to find relief. And, to return to the question of interdisciplinarity, I think pain drives us to speak in different languages, the languages of science, of art, of literature, and of compassion. In the same way as pain might be said to push the boundaries of language, I think it really pushes the limits of disciplinary practices and ways of thinking.
A common point of departure for many of the chapters in the volume is Elaine Scarry’s classic and highly influential work The Body in Pain (Oxford UP 1985) in which she addresses both how pain resists language, even destroys it, and how pain gives rise to imagining and invention. In his chapter, David Biro addresses this creative power of imagining and language in discussing how pain is expressed metaphorically. In my own chapter I discuss how pain is communicated not only through language but also through other bodily expression. Scarry’s understanding of pain as crucial to the formation of the world is explored in Sheena Hyland’s chapter addressing the experience of everyday minor aches and pains as important aspects of creative world-formation. This is something that is brought out also in the chapter by Jillian Deri and Wendy Mendes on the artistic practice of aerial dance in which pain is transformed into pleasure. The tension between the force of destruction and creation that Scarry identifies as inherent to the experience of pain is brought out by Cressida Heyes in her chapter dealing with a pain that lies at the very origin of human life, that of childbirth.
While communication (and different forms of communication) is necessary in order for doctors to make diagnoses and administer medicine and other forms of pain relief, communication in itself, the very sharing as such may contribute to relieving pain. How pain is made visible and received will to some extent form the way it is experienced. For example, others’ doubt and silence may magnify a person’s suffering significantly and others’ acknowledgment and recognition may play a crucial part in easing her pain. Witnessing another’s pain can weaken its force by giving it recognition as something happening in a larger social world instead of reducing it to something happening only within the bounds of an individual private realm. This is, I think, especially the case with “invisible” pain, where there is no obvious sign on the body indicating pain, such as a wound, a displaced joint or a broken bone. Recognition from others can draw pain out of its invisibility and thereby also reduce risks of doubt and disbelief. Many people suffering from invisible chronic pain testify to the devastation of not being believed and to the relief of diagnosis. This is brought out clearly in Anna Gotlib’s chapter in the book where she discusses how explicit and implicit stigmatization and delegitimation of chronic pain seriously threatens sufferers’ sense of self. Of course, as we know well, neither communication nor diagnostics will necessarily lead to recognition, sympathy or being taken serious, something that can be seen with diagnoses such as fibromyalgia or different forms of migraine that are often subject to disbelief even though they typically involve excruciating pain.
Communication of pain also raises questions of social and cultural norms and taboos regarding what pains can be spoken about publicly, how and by whom. Not speaking about pain can be a way of retaining one’s sense of oneself, identity and integrity but it can also be experienced as an enforced silencing. In this collection, Renita Sörensdotter draws attention to the specific female pain of vulvar vestibulitis as being marked as private and shameful to talk about and at the same time forcefully expressed through affecting the whole identity of its sufferers, including their way of dressing, bodily comportment and sexual practice. Also Peg O’Connor’s chapter deals with pain often marked as shameful in different ways, namely pain and trauma of sexual abuse. These forms of pain that are difficult to communicate not only because of the privacy of pain in general but also because of being confined to a private realm and marked shameful, I think point very strongly to the urgency of nurturing creative and innovative ways of expressing pain.
3. As you know from my work on the Making Sense of Pain conference, I am particularly interested in widening the definition of pain to be inclusive, not primarily or only centered on the quantifiable. I appreciate this works’ breadth in that sense, but I also know this is part of an ongoing debate about what “counts” as pain–and whose narratives of pain are most “valid.” Can you speak to this debate? Have you encountered it in the production or reception of the work?
I think these questions concerning validity and what counts as pain are of imperative importance and quite urgent. On the one hand, there is the issue of how pain is made visible or invisible that I mentioned earlier. We all know well that pain is easily disregarded as existing “only in the mind” of the sufferer when it is not accompanied by recognizable external physical signs that indicate the presence of pain. We tend to recognize pain primarily when we see body damage or the weapon that caused the damage and we also tend to limit ourselves to specific damage that we can easily associate with pain. Also, these visible traces or signs of pain are not perceived in neutral ways; a bleeding wound, a bruise or a scar cannot be isolated on a patch of skin separated from the suffering body situated in a surrounding world. On the other hand, there is the issue of who and whose bodies are considered susceptible to pain and have the “right” to pain. It is well established that different categories of identity such as gender, sex, race, ethnicity, age, class, weight and ability in various ways influence how pain is conceptualized, lived, perceived, diagnosed and treated. Historically, different theories of pain sensitivity have set social expectations and justified unequal treatment. Such theories are often infused with contradictions and conflicts: women (and particularly upper-class, fair-haired and fair-skinned women) have on the one hand been commonly seen as the most sensitive of all creatures and on the other hand as naturally having the strength to bear the pain of childbirth. In Dimensions of Pain, Jenny Gleisner and Diana Mulinari show in their different essay how the expression of labor pains is in a contemporary context viewed as natural through highly normative notions of gender, race and nationality.
I think it’s also important to mention positive dimensions of pain and especially in relation to a dominant medical framework in which pain is indeed centered on the quantifiable. Modern western culture has to a great extent succeeded in persuading us that pain is something undesirable that we should try to avoid at almost any cost. I’m not saying that we shouldn’t avoid pain or relieve it but I do want to emphasize also a perspective that recognizes pain as belonging to the most fundamental of experiences and as a defining feature of human existence and of being alive. We also need pain in order to stay alive and in so far as it signals injury or disease, it has a protective function. Pain serves as a warning system that detects whether something is hostile or damaging and that motivates actions to avoid (and to remember) what hurts us and ultimately threatens our survival. Insensitivity to pain is a disaster for any living organism and people with the rare disorder congenital analgesia who feel no pain are at constant risk of suffering harm to their bodies without realizing it. They mutilate their tongues and lips by chewing, they suffer burns and fractures and they tend to die at a fairly early age. But the positive of pain is not only, and perhaps not even primarily, that it protects us from what might hurts us. It is also that pain gives us a sense of being alive; to experience pain is to experience being alive and that is by no means an experience that can be captured in quantifiable terms.
4. Lastly, where do we go from here? Are there additional projects in the works, either for you or for the nexus of authors in this collection?
The book was initiated and produced within the framework of the Nordic Network Gender, Body, Health that holds conferences annually in the different Nordic countries. The 2009 conference was on pain and that formed the starting point for this book, even though only 2 of the contributions to the book where presented in earlier versions at the conference. There are several people in the network working on issues related to pain and some of the essays in the volume are also part of larger projects that are continuing in different directions. Renita Sörensdotter’s chapter on vulvar pains, for instance, is part of a larger project and she has also been part of initiating an interdisciplinary network on vulvar vestibulitis. I am also working on a larger project on sharability of pain with a particular interest in cases where pain is not articulated explicitly in language but through other more ambiguous forms of bodily expression. I’m especially interested in pain accompanying age related dementias and how pain is expressed in different ways when many cognitive functions are deteriorating.
Thank you for joining us today, Lisa!