Monday, February 7, 2011

Pain as Private

In thinking about the notion of pain as private verses intersubjective (as put forward in scholarly dialogue between Crawford and Mowat), I recalled my last trip to the emergency room (about 2 ½ years ago) with what I would describe as serious pain that later resulted in an appendectomy. In my entrance interview, I was asked to rate my pain on a scale from 1 to 10, where 1 equaled fleeting and dull and 10 equaled the most pain I’ve ever experienced. I can’t remember what my response was, but in conceptualizing the experience of pain as private and personal, it seems as though it was the need for the biomedical system to place my pain in the context of a shared language for the experience (such that the appropriate treatment could be prescribed, in the form of medication or further physical evaluation) that ultimately left me feeling disheartened and poorly served. I’m left questioning, was I really able to describe my pain? Did the measure truly capture my experience?

It seems as though the intention behind the pain scale (as was the intention behind the MPQ per Mowat’s perspective) was to provide something that would establish credible evidence of the perceived, subjective qualities of my pain, when in fact the experience was composed of ‘‘an endless variety of qualities that are categorized under a single linguistic label.” While such a scale may have given me a language to which I was able to describe the intensity of my pain (a benefit of such a measure) in a way that would permit “proper” treatment (for benefit of the biomedical system), perhaps coining my own words would’ve given the physician a more objective account of what I was feeling.

Such a descriptor was likely constructed under the guise of being sound based on the administrator’s perception of my experience. While Crawford may argue that the MPQ (and other measures permitting a description of pain) “function to construct the qualitative dimensions of a language of pain,” I see little qualitative in the co-opting of my experience per the biomedical system’s language. Perhaps I’m a phenomenologist in this light, such that the lived embodiment of pain may perhaps preclude a shared language for which we’re able to describe what any one individual experiences. This doesn’t mean that “pain” is unsharable. Rather, in valuing the voices of those who live painfully, rather than imposing a particular discourse (whether that be biomedical, social scientific, literary critique, or otherwise) to describe their experience for them, we may cross our disciplinary boundaries to develop an intersubjective understanding of the private.


Sirisha said...

I agree with you, in terms of the various forms/types of pain being appropriated by the MPQ into few lingusitic categories, which might oppress or misinterpret the patients' intensity or degree of "private" pain. As discussed in the article "the inarticulacy/individuality of pain: a rejoinder to Mowart" MPQ may have given those patients "the permission to speak" but it might not have given the freedom to express the exact or the precise feeling in experiencing the pain. MPQ, for me is repressive in nature and as it limits the expression of the patient to the few or the list of words mentioned in the questionnaire. It doesnt allow the patient to explain pain in clear terms. No single word or few words sometimes cannot substitute a "whole lived experience of pain". For example If I say "its disgustingly painful" to describe a certain pain would this be understood in terms of the words listed in the list? Or sometimes when we are in pain we get confused between a burning sensation or a piercing sensation and will not be appropriate to fit under the categories certain to describe it. MPQ is helpful for the designers who are the medical specialists and does not serve the purpose of for whom it has been designed i.e the patients or amputees. MPQ is repressive and does not help in giving voices to the patients' feelinngs in experiencing pain. It is a tool for making the job of a medical practitioner easy.

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