Pain in America

Pain ought to be simple. It should not require extensive thought, if it does require endurance. What could be more straightforward than a sudden injury, a brief, blinding flash that resolves and then is gone? Beyond the basics that seem to touch everyone, pain ought to befall only those who are old, noble, or have done evil, for protracted severe pain is an ultimate horror.
But pain is not simple. The medical literature--the architectural specifications of the house of pain--demonstrates that pain is riddled with paradoxes. Chronic pain is far more common than most people recognize. Yet a few people feel no pain at all, and they are unfortunate. Everyone claims to understand what pain is, yet there is no assurance that everyone feels the same pain sensation. Pain would appear to be among the most basic of physical sensations. Yet the experience of pain is so heavily psychological that the mind can sometimes deny its existence and sometimes create and sustain it long after an acute injury is gone. Pain is also so philosophical that the "problem of evil"--the problem of why pain befalls the innocent--is one of the central concerns of metaphysical thought. Such ideas about pain will be reviewed in the first three chapters of this book.
Another paradox is that in spite of all the advances that have been made in American health care, many transactions between those in pain and medical professionals, society, and their families are unsatisfactory. Arthur Kleinman wrote:
If there is a single experience shared by virtually all chronic pain patients it is that at some point those around them--chiefly practitioners, but also at times family members--come to question the authenticity of the patient's experience of pain. ... Reciprocally, chronic pain patients are the bete noire of many health professionals, who come to find them excessively demanding, hostile, and undermining of care. A duet of escalating antagonism ensues, much to the detriment of the protagonists.
Why do Americans and health care professionals do so badly with chronic pain? (For no behavior is without meaning.) What are the elements in culture, professions, and personal mental processes that interfere with coming to terms with it? Those questions will be addressed in chapters 4 through 9, as the focus turns to medical professionals, patients, and subgroups of patients and the specific concerns of American society with stoicism and addictions. What overriding patterns are apparent from all this, and can understanding such factors help with other problems that stand at the intersections of technology and philosophy, reality, and illusion? That is the concern of the final two chapters.
Why pain? This book began with a personal attempt to understand a mild but persistent pain problem that had me at least camping out on the grounds of the house of pain. (Those of a psychological bent will recognize intellectualization, and I hope they will remember late in the text that the discussion of defense mechanisms is done by a participant observer.) But as Elaine Scarry says. "Physical pain has no voice, but when it at last finds a voice, it begins to tell a story." In truth, it tells many stories and challenges its participants to create its story in their own terms. Presenting some of these stories is the purpose of this book.