28. Acute and Chronic Pain

Biomedicine seeks a cure to pain as though it is acute, but it frequently seems like it's epistemological doubt that these doctors seek to cure, and not me (Foucault, 1963/1994; Morris, 1991, 2000).

Identifying and assessing pain, like everything else, is preconstituted by preexisting ways of seeing in our classified world. Classificatory medicine presupposes an ideal, textbook configuration of disease (Foucault, 1963/1994). Classification, through ocularity and discursive representation, becomes essential to engaging with pain as it lays the ground rules of pain's being, as a workable object around which biomedicine can organize (Scarry, 1985).

Classification is not without its consequences, and the prevailing, troubling assumption in pain classification is that temporary and chronic pain evince the same symptoms, experiences, and articulations (Bowker & Starr, 1999). That, as with acute pain, a site-specific examination of the fibromyalgic body will identify the ailment — the swelling, the trigger point — and be able to reproduce the pain. That chronic pain is an aggregation of transient acute pain and should look similarly incapacitating (Morris, 1991). That pain is a roar that cannot be ignored, an alien presence inexorably commanding our bodily awareness; thus, it has to be visible (Halttunen, 1995).

It's an attitude that fails to consider how sensory perception and manifestation change when pain is a normal, ordinary feature of existence, one I can't make visible as often as I feel it without threatening my social and professional stability.

American society and Western biomedicine construct chronic pain like it makes passive, arhetorical victims or conquering superheroes, but to me, it's like a perpetual car alarm that isn't mine. I've had the worst headache of my life a thousand times, stabbing chest pains, all the warning signs modern medicine says not to ignore. In me, it's just the sound and fury of a disabled body that can't keep up with the demands of my social and professional worlds but is made to do so anyway. Before I learned this, I was repeatedly told, with heavy sighs, "It's probably another flare-up." The undertone was, Stop wasting my time. There are patients out there who are really suffering.

In other words, pain that is medically and socially appropriate — acute, curable, and visually accessible through face, gesture, and sound in keeping with bourgeois civility — admits nothing of my experience and understanding of pain, which is endless, erratic, non-apparent, and incurable. Morris (2000) calls the rise in chronic pain a crisis at the center of contemporary life, throwing into sharp relief the problems of contemporary medicine: the blurring of acute and chronic pain in medical discourse, failures to appropriately interpret and classify pain, the implicit quest for perfection, which must end with an objective marker and a vision of recovery, and which reflects poorly on the physician if it does not.

In short, I am not worth the effort. ↩