Pain: A Political History

by Keith Wailoo

Pain touches sensitive nerves in American liberalism, conservatism, and political life. In this history of American political culture, Keith Wailoo examines how pain has defined the line between liberals and conservatives from just after World War II to the present. From disabling pain to end-of-life pain to fetal pain, the battle over whose pain is real and who deserves relief has created stark ideological divisions at the bedside, in politics, and in the courts. Beginning with the return of soldiers after World War II and fierce medical and political disagreements about whether pain constitutes a true disability, Wailoo explores the 1960s rise of an expansive liberal pain standard along with the emerging conviction that subjective pain was real, disabling, and compensable. These concepts were attacked during the Reagan era, when a conservative backlash led to diminished disability aid and an expanding role of courts as arbiters in the politicized struggle to define pain. New fronts in pain politics opened nationwide as advocates for death with dignity insisted that end-of-life pain warranted full relief, while the religious right mobilized around fetal pain. The book ends with the 2003 OxyContin arrest of conservative talk show host Rush Limbaugh, a cautionary tale about deregulation and the widening gaps between the overmedicated and the undertreated.

Genres: History, Politics, Nonfiction, Disability Studies, History Of Medicine, Medicine, Science

296 pages, Paperback

First published April 29, 2014

Reviews

[Sharad Pandian · Rating 5 out of 5]

"The questions of which kinds of pain are real, which warrant sympathy, and whose plight is deemed illegitimate have provoked constant political spectacle in the many decades before Reagan and since. Today, these remain powerful moral and political questions at the heart of American government. What to do about pain that doesn’t go away but lingers, especially in a prosperous nation where hard work, frequent injury, and aging are all common? Does pain caused by chronic disease warrant special consideration, long-term attention, and ongoing relief? Whose pains should we, as a society, be willing to carry for a lifetime and at whose expense? When is pain and relief merely a fraud?

Beyond pitting liberals against conservatives, the question of pain (as I have argued here) also refined the very meaning of “conservative” and “liberal” as keywords in the American political vocabulary. “Political words take their meaning from the tasks to which their users bend them,” Daniel Rodgers has observed. What it means to be liberal or conservative became ideologically solidified around the problem of pain. From the years immediately following World War II until today, the political Right railed consistently against certain kinds of pain, seeing public relief in particular as a symptom of a weak, coddled, and dependent society. As liberal government expanded to address the needs of people professing to be in pain, so too did conservative ire grow. For the political Left, just as consistently, compassion toward the pain of others— the disabled soldier, society’s elders, those injured at work, or people suffering from debilitating disease— underpinned an expansive view of government and a comprehensive ideology of what society owes to its citizens." (203

"A fundamental, vexing problem ripples through the history and politics of pain: Who should have the power to judge suffering— the patient or the doctor, the state or the federal government, the judge or the politician, the bureaucrat or the ideologue, the surgeon or the pharmacist? Who can detect true pain when they see it? Which of us knows whose pain is real and whose is being exaggerated or faked for so-called secondary gain? The pages above have shown how and why the skepticism about pain as fraud has shadowed sufferers, and they have also shown why questions about the nature of pain have had no easy resolution in the theater of politics and society. The question of pain has been politically, economically, culturally, and legally contentious over the past seventy years and will continue to be so. But just as contentious has been the issue of who has standing to judge and to speak for and about pain in America. One enduring aspect of this political theater is how much people in pain have had to fight to be heard amid the battles waged over them and on their behalf.

Pain, in this sense, does not belong exclusively to those who suffer; it also belongs to those who observe suffering. Here again, the insights of Talal Asad on pain prove helpful when he observes, “The ability to live sanely after a traumatic experience of pain is always dependent on the responses of others.” Surely, pain fraud exists, and there will always be skeptics who insist that too many people fit the caricature of the Jack Lemmon figure in The Fortune Cookie. But there is no need to add to the scrutiny of sufferers as deceitful; there is enough of that already. Instead I have focused on a broader world of deceit, false claims, fraud, and posturing. Pain fraud includes the artful quacks and drug makers throughout history, promising fast relief while fomenting anguish and dependence—a deceit worth examining. Another is the posturing of health and legal experts who theorize about the pain of others, their shifting theories often supported by sparse education, misplaced fears, and ideology. The poor state of medical education on pain is no fraud, but surely it requires skeptical attention and reform. Then there are the slippery and sometimes deceitful political claims about people in pain made in the name of liberalism and conservatism; this has been my focus. Instead of indulging in more skepticism about people in pain, this book provides deeper insight into those who judge— attention to their political motives, their hypocrisies, their claims of compassion, their attempts to implement meaningful relief, their agendas for the nation, and why they so often turn the pain of others into political theater. It is good to look critically and closely at those who would judge because they, like every sufferer, also live in a world defined by both virtue and fraud." (211-2)

[Anhhuy Do · Rating 5 out of 5]

Currently in Professor Wailoo's "The Cultural Politics of Medicine, Disease, and Health" seminar, and this was an incredibly fascinating read that makes you want to jump inside the mind of the author and imagine how they view the world. Admittedly, I did not get to close read it front to back, but from various excerpts across different chapters, Wailoo paints an extensive contemporary political history of the United States and its complicated relationship with notions of pain, learned helplessness, social welfare, and the pharmaceutical industrial complex. Definitely a great read for American political junkies.

[Sinthu Srikanthan · Rating 5 out of 5]

This book traces the politics of pain in America — following the swinging pendulum between liberal relief and conservative care. The author explores whose pain matters, whose claims to relief are legitimate, and what types of relief (market-based drugs or government-based disability entitlements and rights) should prevail. I appreciate the author’s focus on those who judge pain and connection of pain management to the courts, government policies, and dominant ideologies and discourses. I highly recommend this book — especially to those caring for people in pain.

[Diana · Rating 5 out of 5]

Excellent overview of the history of pain from a political perspective starting with WWII veterans and continuing to the present time. Explains how the determination of whether someone is experiencing disabling pain became the purview of the courts rather than of medical professionals and how shifting political points of view have affected legislation regarding pain.

[Annika Hansen · Rating 4 out of 5]

Definitely more of an academic book, but it is a fascinating history on how the American society has dealt with pain. I wish there had been more conversation about race.

[Saima Iqbal · Rating 3 out of 5]

a book that examines how debates over pain — be they abt disability subsidies or physician assisted suicide — both reflect and reshape an era’s politics. broad and sometimes difficult to pin down. (much like pain itself, ha.) it might’ve helped to dig further into particular legal cases or political controversies so as to clarify HOW ppl attempted to answer certain qs about pain and why. (i am ofc still interested in how scientists or philosophers might approach these qs b thats out of the purview of this book.) the structure and argument come thru clearest in the conclusion.

[sheilabeta · Rating 5 out of 5]

Excelentemente escrito.

[Mills College Library]

616.0472 W139 2014