MedHum Monday Presents: OUCH–What’s With Physical Pain?

DailyDose_darkstrokeWelcome back to the Daily Dose and MedHum Monday! The medical humanities encompasses a wide field of inquiry, but at its core is a commitment to the human. It is also about communication, though, about narrative, and about story, and about the importance of sharing. Today, I’ve asked Joseph Watts, licensed orthopedic massage therapist, to talk to us about communication and pain. Not only does interpersonal communication serve as the backbone of human connection, but body communication (our body speaking to itself and to our consciousness) is a vital aspect of life and living. Welcome Joseph!

“OUCH”: What’s With Physical Pain?

By Joseph H. Watts

Why do our bodies hurt—sometimes, seemingly, for no reason? There are systemic conditions with such symptoms, like Fibromyalgia, but today I’d like to talk about something else: those sharp pains that seemed to come from nowhere, or the slow building pain that can creep up on the joints. The pain that plagues most Americans costs us billions in lost work and destroys our chances to do the fun things we have always done. What can we do?

To begin, we need to talk about communication, particularly interpersonal communication. (Trust me, this will all come together.) Communication is extremely important for survival. Beyond that, it is important for conducting business and fo effectively connecting with our families, friends, and neighbors. We all know the emotional pain of miscommunications, or worse, non-communication. Business fail when the communication fail. Families are split when they cannot effectively communicate, and many of us know the pain that occurs when communication is cut off completely. Often if one person in a relationship stops communicating, the other person will eventually start to plea or yell to open those lines back up. Do you see where this is going?

Woodcut of male with blood vessels Stephanus, 1545. Wellcome Images
Woodcut of male with blood vessels. Wellcome Images

Our minds and our bodies are intertwined; they are one, yet they are separate. The only way to keep both working together happily is if they are communicating. So understand this, your body is always talking to you. It is always telling you if something is not right. Something is a little off here, or something is a little tight there. Yet, we often ignore it. Actually, we are usually so distracted and busy we just don’t hear it. So the reason we have pain is because we haven’t been participating in this conversation. Pain is our body yelling at us that something is very wrong.

So back to that first question:what do we do about it? As an orthopedic massage therapist, I confront this everyday. I work hard to educate people about our wonderful bodies, and I have noticed that as people receive bodywork more regularly, they start to feel and indeed to “hear” their bodies again. People will begin to notice the small cues, and they can make corrections early on and avoid unnecessary pain. Adding something like yoga and mindfulness meditation to life also enhances our ability to listen to our bodies and rebuild that relationship. So the next time you feel that twinge in your back, realize that it might be time to quiet your mind and listen to your body.

To Your Health!

ABOUT THE CONTRIBUTOR
Joseph H. Watts, LMT, has logged more than 1000 hours of massage training. He has a passion for exploring the deep mystery that is the human form. He is a father, husband, brother, and friend who loves working with people, particularly aiding those suffering from chronic and intermittent pain. When he is not working as an orthopedic massage therapist, he spends his time in nature or his garden. (Also, he is a huge dork for Lord of the Rings–but who isn’t?)

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The Daily Dose Presents: Dimensions of Pain–Humanities and Social Science Perspectives

DailyDose2Welcome 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

lisaDr. 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.

9780415635752_p0_v1_s260x420Dimensions of Pain: Humanities and Social Science Perspectives
Routledge 2013

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.]

INTERVIEW

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!

Notes from Prague: the conference ends

IMG_9145editToday was the last day of our conference, Making Sense of Pain. An interesting point was raised during these last few sessions, and one that I think is well worth repeating. We have not necessarily “made sense” of  pain, but we have shared in it, share in the stories of pain, the language of pain. While our individual experiences of pain my differ, we are united in those very differences, a unique “body” collectively exploring and expanding the definition of pain, embodiment, and identity.

May 11, 2013

We began the day with cognition, and found once again that the papers built upon the previous days’ exchanges. Particularly, we were able to draw connections between cognition, metaphor and a new framework of experience for “moving through” pain.

Session 7: Painful Realities: Psychology, Cognition, and Suffering

Psychological Pain: Metaphor or Reality
David Biro
SUNY Health Science Center, Brooklyn, USA

“It’s not what happens to you, but how you think about it”: Exploring the Cognitive Processes Underlying Resilience Following Adversity
Karisha George
University of York, United Kingdom

Although Unseen, Chronic Pain is Real—A Phenomenological Study
Tapio Ojala
Faculty of Sport and Health Sciences, University of Jyväskylä, Finland

Session 8 also helped us to re-define pain, first in terms of its potentially positive political statement and second in terms of non-western ideas of pain. From these, we were reminded that experiencing pain and speaking about it can be varied within a single culture and context.

Session 8: Voices: Managing, Coping with, and “Celebrating”Pain

Celebrating the Pain – Female Singer-Songwriters and the Beauty of Gloomy Images
Daniela Chana
Independent Researcher, Vienna, Austria

Perspectives on Coping with Acute and Chronic Pain in Botswana: Patients Voices
Nicole Monteiro and Kagiso Thlabano
University of Botswana, Botswana

The diversity of “voices” continued with our last session and with our open business meeting, which was, in fact, a wrap-up discussion in which ideas for next year’s conference were promoted.

Session 9: Palliative and Pain: Disease, Diagnosis and Treatment

Managing Babies Pain: An Ethnography of Daily Care Practices inside a Neonatology Intensive Care Unit in Switzerland
Line Rochat Noël
University of Lausanne, Switzerland

Pain as a New Social Determinant of Health
Maria Stella Guadagnoli-Closs
Faculty of Health, York University, Canada

The Normal You: Tales of Malformations and Habilitations
Davide Ticchi
Tallinn University, Estonia (David is to be thanked for his flexibility in moving up to Session 9–his abstract may be found here).

I hope you will look for more of the fascinating work being done at IDnet–and please do stay tuned for the next Probing the Boundaries conference (starting tomorrow): Probing the Boundaries of Reproduction!

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