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Lecture 4

ANTHROP 3HI3 Lecture Notes - Lecture 4: Headache, Biopsy, Biomedicine


Department
Anthropology
Course Code
ANTHROP 3HI3
Professor
Priscilla Medeiros
Lecture
4

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January 23rd: The Anthropology of Pain
Tuesday, January 23, 2018 6:58 PM
Pain + chronic pain as they apply to the two narratives
Anthropology frames pain/meaning of it within cultural, personal, biological and meaningful lens
Used to contextualize meanings around illness
Experience of pain are personal and subjective
Two ways of looking at pain behaviour: public and private
Somatization
Defining Pain
We generally think of pain as biological manifestation - biological is according to stimulus - fails to
show how pain is individualized and shaped by social and cultural factors
Pain is inseparable ie. Pain for Howard is result of stressful work pain, not being constantly on guard
or prepared to help vulnerable sides; upon returning from work - pain and it's meaning permeates
every aspect of his life
Likely most common symptom encountered in setting
Pain accounts for 40% of all patients seeking medical attention, 1 in 5 will experience chronic pain
once in life, over 6 bill in Canada spent on loss of productivity bc of pain
Many healing stuff requires physiological level of pain (ie. Biopsy or surgery)
Social, psychological, and cultural factors associated with it
The pain itself cannot be directly measured - seen with Howard pg. 72 for patients and family this is
deeply frustrating…
Removing the pain would be removing these hurtful experiences
Highlights experience of pain not only affects ppl suffering from pain but also family members etc -
challenges their understanding of pain, unable to be authenticated because of it's lack of
authenticity
Chronic Pain:
This is the type of pain both Howard and Rudolph are experiencing
Both H&R examples of this
H: gone through almost every available orthodox treatment to resolve chronic back pain
Feels hopeless and becomes skeptical
Interpersonal tensions may cause someone to develop chronic pain
Ie. R: his mother and father trigger his chronic pain (**she talks about interpersonal tensions but
what about intra- ? )
No single diagnosis or natural diseases even with patients with similar symptomology
Challenges biomedicine and objective knowledge of human mind - not as easily drafted up to be
black/white
Diff between chronic and acute comes down to duration of time - CP is ongoing and last longer than
6 months, pain becomes worst and reoccurring
CP can persist after injuries heal- goes into social and psychological realm
Acute is under 6 month threshold - pain directly related to soft tissue damage - often resolved
Classifying :
When that happens, private experience transition into public or social event
Often invisible, when it's lacking of visible it often brings into question legitimacy because of
presence of pain
Hard to get others to acknowledge or share their pain because it's invisible
Absence of pain behaviour doesn't mean absence of private pain - only those closest to individuals
suffering will know they are experiencing
Private: ONLY individuals closest to you - more non-verbal
Living in pain is often in silence, and isolation/frustration around family members
Public pain: seen as normal or abnormal pain for them
Abnormal pain: defs tend to be culturally defined, around body image and structure/function of
body
Ex. Man with psychosomatic pain had trouble with heart because he suffered loss of family
member
Cultural group expectations determines whether it is seen as clinical problem or solution
Required early in life as part of growing up in family - tend to change overtime
If there is a nonverbal expression of pain, someone can associate it with a condition
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The nature of our relationship determines where it is revealed, how, and whether it is classified in
realm of pain
Howard: public pain example: him carrying around pillow is outward sign of public pain- other
example: cane
Authenticating illness experience
If there is single experience shared with all chronic pain patients is that they're always trying to
show legitimacy/authenticity
Pg. 67 - how do we know it's as serious as he says if you can't see it?
These types of feelings contribute to exasperation of back pain for them - day to day life and
interactions
Often standardized by way of signaling - often take cues for visual aspect
This includes someone's immobility, growing, crying, screaming ..
That's how we evaluate generally: visual manifestation of pain (ie. In ER they say 1 to 10, gets
measured subjectively in that setting)
Pain is mostly invisible
We're not only using it to authenticate visually - those closest to him are doubting his experience
because it's been so long
Authenticity of pain:
This is what Kleinmann refers to as somatization
The primary symptom complained of will be weakness, breathlessness, pains to particular areas
(not just anxiety)
These manifestations can be worst than biological if not addressed
Depression, anxiety, serious family tensions are all signs of somatization
Pain is common manifestation of depression
We are always looking for visible pain within biological model - case here is that pain can be
invisible: does it make it less authentic? (hospital?)
Defining somatization:
Something each of us encounter in daily life - refers to act of us constantly scanning our bodies and
seeing whether or not we are experiencing something different (are there tingling or numbness in
feet, do you have headache, etc)
There is triggering factor to this experience
Our ability to constantly monitor these processes
Could be something invisible
Refers to manifestation of physical symptom from psychiatric condition ie. Anxiety
Families may help to confirm your suspicion that there's something to worry about - may disregard
it because of invisibility
Very normal human experience - see It everyday
Only we know what is different
Understanding Somatization:
Number of factors that could lead us to trigger these symptoms
All of us experiencing at a time
But when we're experiencing stressful events in our life, when these events have disturbed our
equilibrium - we notice and deal with them very differently
Process of worrying all the time we are actually adding to the experience
Page 71 - Howard's physician states pain problem getting him down, getting to fam and him too…
not dealing with disease but pain becomes way of life
His own thoughts within disease model not taken into consideration
Rudolph - his constant self-doubt and questioning lead to his manifestations of life - not just work
life but family life as well
Causes GI pain, provides him with treatment that actually work, he continues to experience this
chronic pain
Dealing with somatising symptoms are very difficult
Expectations of Pain:
A lot of language we have around pain is borrowed from medicine - person who says they have a
migraine they don't know how to describe - rely on biomedical language to put term to that
experience
Bigger question ie. Does it come when you climb stairs - importance of collecting illness experience
to set treatment plan in place
Newer things: use of internet - negative influence of language can lead us down to own cultural
understanding
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