Abstract
This essay is a kind of prolegomenon to an anthropologically informed phenomenology of chronic pain, and has the wider purpose of establishing the potential fruitfulness of a deeper dialogue between phenomenology and anthropology. On the one hand, although a number of the medical anthropologists who have studied chronic pain have, to some degree, actually been influenced by phenomenology, on the whole this influence is rather thin. On the other, phenomenology, as these anthropologists observe, generally pays scant attention to culture. Both parties to the conversation, I argue, have something to offer and something to gain. Medical anthropologists may learn that phenomenology has more to offer than simply a general directive toward attending to ‘patient experience’ and a critique of the ‘medical body’; phenomenologists may learn to acknowledge and elaborate cultural, social and political modes of bodily expressivity, and may even come to see the radical possibilities of cultural critique in their theoretical critiques of ‘objective thought’.
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- 1.
Earlier versions of this chapter were presented at the University of Hull, University College Dublin and the University of Warwick. I am grateful to the participants on all of those occasions for their comments. My principal intended audience is phenomenological rather than anthropological (although I hope that anthropologists will find it of interest as well); as a consequence I expend more effort explicating the anthropological than the phenomenological background and terminology. For the latter, I draw mainly though not exclusively on Merleau-Ponty, implicitly or explicitly.
- 2.
The word ‘despite’ is of course contestable, but once we allow ‘phenomenologies of…’ where the ellipsis is filled in by a non-universal type of experience, it would seem strange to ignore culture altogether.
- 3.
They add ‘usually this happens for psychological reasons’; see below.
- 4.
The essential features of somatoform disorders are seen by DSM-III as ‘psychical symptoms suggesting physical disorder … for which there are no demonstrable organic findings or known physiological mechanisms and for which there is positive evidence, or a strong presumption, that the symptoms are linked to psychological factors or conflicts’, and by DSM-IV as: ‘the presence of physical symptoms that suggest a general medical condition… and are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder’. DSM-V was published while this book was in press; there are no significant to changes to the diagnostic criteria for pain disorder.
- 5.
DSM-IV also relates pain disorder and its subtypes to the diagnostic axes developed in the IASP.
- 6.
Some chronic pain patients may receive a different diagnosis, ‘somatization disorder’, whose diagnostic criteria include ‘a history of pain related to at least four different sites or functions’ (DSM-IV). I ignore this complication in what follows.
- 7.
Some of these are full-fledged narratives that give a real sense of individual pain patients and the ways in which their chronic pain experience is embedded in their lives; others offer only ‘snippets from patient’s narratives that illustrate points which the author wishes to make’ (Finkler 2008). My own use of these narratives, I fear, falls in the latter category; in my defense, I am a philosopher and not an anthropologist.
- 8.
- 9.
Anthropology of the body is itself a relatively recent development; key theorists include Pierre Bourdieu, Mary Douglas, Michel Foucault, Marcel Mauss, and – yes – Maurice Merleau-Ponty. Scheper-Hughes and Lock (1987) played a major role in medical anthropology’s taking-up of the anthropology of the body.
- 10.
Older terms for psychiatric anthropology have been ‘cross-cultural psychiatry’ and ‘ethnopsychiatry’.
- 11.
Although this is seen as ‘a positive step toward greater cultural inclusiveness in otherwise ethnocentric diagnostic definitions’, it presupposes that cultures are themselves bounded entities, and it still largely assumes that ‘culture-bound syndromes’ are variants of universal psychiatric entities (Rebhun 2004: 320). Some anthropologists have gone down the route of identifying ‘culture-bound syndromes’ much closer to home. (Candidates include ‘road rage’, ‘shopaholism’, ‘sex addiction’, ‘stress’ and ‘ADHD’; see Helman 2001: 187.)
- 12.
- 13.
See Miettinen’s contribution to this volume for a discussion of Husserl’s ‘body politic’.
- 14.
Becker’s article (in the recent Encyclopedia of Medical Anthropology) comes under the heading ‘Medical systems’, which might seem odd were she not seeing phenomenology’s contribution in this light.
- 15.
A fourth widely discussed theme picks up Scarry’s (1985) principal thesis that pain ‘shatters’ language; full treatment of this is beyond the scope of this essay, though the considerations in Sect. 3 have some relevance. A further theme which space prohibits my elaborating is that of lived time: the idea that for some chronic pain patients, ‘inner and outer time’ seem ‘out of synch’, and ‘time itself seems to break down, to lose its ordering power’ (Good 1994a: 126; cf. 1994b: 41). Jackson (1994b: 215) ascribes this fragmentation of time to pain patients’ moving between two ‘worlds’: the everyday world and the ‘pain-full world’. Micali’s contribution to this volume has some discussion of the phenomenology of time. See also Toombs’ (1988) classic article on the phenomenology of illness.
- 16.
This conception is presumably implicit in Byron Good’s otherwise somewhat confusing description of his subject Brian: ‘his pain has a “world-destroying” quality. It shapes his world to itself … and threatens the structure of his everyday life’ (Good 1994a: 121).
- 17.
Kleinman is both a medical anthropologist and a psychiatrist, hence ‘patient’. If I focus more on this case study than on Kleinman’s others, it is because it is phenomenologically the richest.
- 18.
I presuppose broad familiarity with these terms. The terms ‘solicitation’ and ‘affordance’ have come into widespread usage among Merleau-Ponty commentators to characterise the qualities of the world which appeal to the body’s motor habits and skills or to which the body is ‘geared’; the term ‘affordance’ comes from J.J. Gibson and appears to be a direct translation of the Gestalt psychologist Kurt Lewin’s (1936) term ‘Aufforderungscharakter’, sometimes translated as ‘valence’. Lewin heavily influenced Sartre’s descriptions of the ‘hodological’ nature of the life-world. The term ‘obstacle’ is Sartre’s (1986: esp. 481ff.), the term ‘deterrent’ my own rendering of Lewin’s ‘negative valences’. Rietveld’s and Romdenh-Romluc’s contributions to this volume provide further elaboration of some of these phenomenological notions.
- 19.
This may be what Kleinman is getting at when he describes suffering as ‘the result of processes of resistance (routinized or catastrophic) to the lived flow of experience’ (1994: 174). He cites Scheler as the source of this conception of resistance, but could equally have cited Sartre.
- 20.
Young herself makes a broadly similar comparison in the opposite direction when she says that ‘[w]omen in sexist society are physically handicapped’ (1990: 153).
- 21.
This could be said to describe a breakdown in the kind of change of one’s world that normally comes with the presence of the other and which is the subject of Ratcliffe’s contribution to this volume. The anthropologists offer their own gloss on the word ‘everyday’ here, which also has some relevance for the interworld: when Good calls attention to his subject Brian’s absorption ‘not with the relevance of career, relationships, or other of the orienting rhythms of social life in North America, but … by the pain’ (Good 1994a: 125), he is indicating a cultural dimension to Merleau-Pontyan ‘inter-perspectivity’.
- 22.
Indeed the one good result of Howie’s back surgeries, on which ‘his overall judgement … is that they have made things worse’, is they have ‘created icons of his travail, scars that he can show people’ to convince them that his pain is real (Kleinman 1988: 68).
- 23.
TMJ is temporomandibular joint disorder; it is significant that TMJ falls between at least two stools in most medical systems, viz. medicine and dentistry, and that its status as a disease entity, like a number of other diagnoses of conditions that may involve chronic pain and chronic illness, is contested (see Garro 1994).
- 24.
Somatization is most carefully articulated in Kleinman 1980, but this is also the most phenomenologically dubious expression; some of its rougher edges are softened in his later work. For present purposes I focus on the earlier work. Low’s model is unclear and in places contradictory; what I present below is my own attempt at making sense of it.
- 25.
Cf., in some respects, Bordo’s celebrated analysis of anorexia nervosa (1993: 139–64).
- 26.
Molly was actually diagnosed with somatization disorder rather than pain disorder; see note 6. She was independently diagnosed with TMJ; see note 23.
- 27.
Although DSM-IV no longer explicitly refers to primary and secondary gain in pain disorder, it seems that many medics continue to think in these categories.
- 28.
In the ‘tough love’ (Jackson 1994a: 145) pain clinic described by Jackson, patients ‘are reluctant to state outright that a change in attitude has actually reduced the amount of pain they experience’: ‘articulating that one’s improvement is due to “motivation” or the “kick in the butt” has far-reaching implications for one’s original model of one’s pain problem’ (Jackson 1994a: 155).
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Morris, K.J. (2013). Chronic Pain in Phenomenological/Anthropological Perspective. In: Jensen, R., Moran, D. (eds) The Phenomenology of Embodied Subjectivity. Contributions to Phenomenology, vol 71. Springer, Cham. https://doi.org/10.1007/978-3-319-01616-0_9
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