Culture, Medicine, and Psychiatry

, Volume 36, Issue 1, pp 102–123 | Cite as

“Sticky” Brains and Sticky Encounters in a U.S. Pediatric Pain Clinic

  • Mara BuchbinderEmail author


In the U.S. multidisciplinary pediatric pain clinic where I conducted 18 months of fieldwork, a widely held explanatory model tied the neurobiology of intractable pain to certain features of pervasive developmental disorders (PDD) such as concrete thinking, an interest in details, and hyper-attentiveness. Clinicians used terms such as “sticky brains” and “sticky neurons” to describe the perseverative thoughts and quirky behavior that characterized a sizable subset of the program’s chronic pain patients who were believed to show signs of PDD, and consequently, did not respond well to treatment. Drawing on observations of clinical consultations, team meetings, and interviews with clinicians and families, I examine the meta-discursive processes by which clinical difficulties were inscribed onto difficult patients. Specifically, I demonstrate how discourse on sticky brains worked to re-classify challenging patients as psychologically abnormal, rationalizing their failed response to standard treatment. I argue that ‘stickiness’ provides an appropriate metaphor not only for a particular neurobiological configuration, but also for challenging clinical encounters. By illuminating the interactional processes through which clinical difficulties are managed, interpreted, and explained, the paper advances anthropological theorizing on the performative work of diagnosis and institutionalized misrecognition.


Clinical ethnography Chronic pain Autism spectrum disorders Diagnosis “Difficult” patients 



The research for this paper was supported by grants from the National Science Foundation and the Wenner-Gren Foundation for Anthropological Research. Mei Zhan provided useful comments on an earlier version of this paper at a workshop at the University of California, Irvine. I am also grateful to Linda Garro, Doug Hollan, Keith Murphy, Elinor Ochs, Merav Shohet, Jesse Summers, Jason Throop, and an anonymous reviewer for offering helpful feedback.


  1. American Psychiatric Association 2010 DSM-V Development,, accessed April 4, 2010.
  2. American Psychiatric Association 2000 Diagnostic and Statistical Manual. 4th Edition, revised. Washington, DC: APA Press.Google Scholar
  3. Aronoff, Gerald 1985 Evaluation and Treatment of Chronic Pain. Baltimore: Urban and Schwarzenberg.Google Scholar
  4. Bajwa, Zahid, Thomas Simopoulos, Joshua Pal, Jan Kraemer, Pradeep Chopra, Jyotsna Nagda, Umer Najib, James Celestin, Khuram Sial, Bilal Ahmad, Carol Warfield, Theodore I. Steinman, and Joshua Wootton 2009 Low and Therapeutic Doses of Antidepressants are Associated with Similar Response in the Context of Multimodal Treatment of Pain. Pain Physician 12:893–900.Google Scholar
  5. Baszanger, Isabelle 1998 Inventing Pain Medicine: From the Laboratory to the Clinic. New Brunswick, NJ: Rutgers University Press.Google Scholar
  6. Bates, Maryann 1996 Biocultural Dimensions of Chronic Pain: Implications for Treatment of Multiethnic Populations. Albany: State University of New York Press.Google Scholar
  7. Bourdieu, Pierre 1990 The Logic of Practice. Trans. R. Nice. Cambridge: Polity Press.Google Scholar
  8. Bowker, Geoffrey and Susan Leigh Star 2000 Sorting Things Out: Classification and Its Consequences. Cambridge: MIT Press.Google Scholar
  9. Buchbinder, Mara In press Personhood Diagnostics: Personal Attributes and Clinical Explanations of Pain. Medical Anthropology Quarterly.Google Scholar
  10. Carcani-Rothwell, Iris, Sophia Rabe-Hasketh, and Paramala Santosh 2006 Repetitive and Stereotyped Behaviours in Pervasive Developmental Disorders. Journal of Child Psychology and Psychiatry 47:573–581.CrossRefGoogle Scholar
  11. Carr, E. Summerson 2011 Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety. Princeton: Princeton University Press.Google Scholar
  12. Choby, Alexandra 2006 A Long Road to Truth: Diagnosing and Governing Epilepsy. Unpublished PhD dissertation.Google Scholar
  13. Coles, Robert 1984 Introduction. In The Doctor Stories. William Carlos Williams, ed. New York: New Directions. Google Scholar
  14. Corbett, Kitty 1986 Adding Insult to Injury: Cultural Dimensions of Frustration in the Management of Chronic Back Pain. Unpublished PhD dissertation.Google Scholar
  15. Daley, Tamar 2002 The Need for Cross-cultural Research on the Pervasive Developmental Disorders. Transcultural Psychiatry 39:531–550.Google Scholar
  16. Davis, Elizabeth 2010 The Anti-social Profile: deception and intimacy in Greek psychiatry. Cultural Anthropology 25:130-164.CrossRefGoogle Scholar
  17. Douglas, Mary 1986 How Institutions Think. Syracuse: Syracuse University Press.Google Scholar
  18. Dumit, Joseph 2000 When explanations rest: “good enough” brain science and the new socio-medical disorders. In Living and Working with the New Medical Technologies. M. Lock, A. Young, and A. Cambrosio, eds. pp. 209-232. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  19. Dumit, Joseph 2004 Picturing Personhood: Brain Scans and Biomedical Identity. Princeton: Princeton University Press.Google Scholar
  20. Eccleston, Chris 1995 The attentional control of pain: methodological and theoretical concerns. Pain 63:3-10.CrossRefGoogle Scholar
  21. Fagerhaugh, Shizuko and Anselm Strauss 1977 Politics of Pain Management. Staff-Patient Interactions. Menlo-Park, CA: Addison Wesley.Google Scholar
  22. Fordyce, William 1976 Behavioral Methods for Chronic Pain and Illness. St. Louis: C.V. Mosby.Google Scholar
  23. Gaines, Atwood 1992 From DSM-I to III-R; voices of self, mastery, and the other: a cultural constructivist reading of U.S. psychiatric classification. Social Science and Medicine 35:3-24.CrossRefGoogle Scholar
  24. Garro, Linda 1994 Narrative representations of chronic illness experience: cultural models of illness, mind, and body in stories concerning the temporomandibular joint (TMJ). Social Science and Medicine 38:775-788.CrossRefGoogle Scholar
  25. Goffman, Erving 1959 The Presentation of Self in Everyday Life. Garden City, NY: Doubleday Anchor Books.Google Scholar
  26. Grandin, Temple 1995 Thinking in Pictures: and Other Reports on My Life with Autism. New York: Doubleday.Google Scholar
  27. Greenhalgh, Susan 2001 Under the Medical Gaze: Facts and Fictions of Chronic Pain. Berkeley: University of California Press.Google Scholar
  28. Grinker, Roy Richard 2008 Unstrange Minds: Remapping the World of Autism. New York: Basic Books.Google Scholar
  29. Groves, James 1978 Taking care of the hateful patient. New England Journal of Medicine 298:883-887.CrossRefGoogle Scholar
  30. Hadler, Nortin 2003 “Fibromyalgia” and the medicalization of misery. Journal of Rheumatology 30:1668-1670.Google Scholar
  31. Heritage, John and Anna Lindstrom 1998 Motherhood, medicine, and morality: scenes from a medical encounter. Research on Language and Social Interaction 31:397-438.Google Scholar
  32. Hinton, Devon, and Roberto Lewis-Fernandez, eds. 2010 Trauma and Idioms of Distress. Special Issue: Culture, Medicine and Psychiatry 34(2).Google Scholar
  33. Jackson, Jean 1992 “After a while no one believes you”: real and unreal pain. In Pain as Human Experience: An Anthropological Perspective. M.J. Good, P. Brodwin, B. Good, and A. Kleinman, eds. Berkeley: University of California Press.Google Scholar
  34. Jackson, Jean 2000 “Camp Pain”: Talking with Chronic Pain Patients. Philadelphia: University of Pennsylvania Press.Google Scholar
  35. Kirmayer, Laurence 1994 Improvisation and authority in illness meaning. Culture, Medicine, and Psychiatry 18:183-214.CrossRefGoogle Scholar
  36. Kleinman, Arthur 1981 Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry. Berkeley: University of California Press.Google Scholar
  37. Kleinman, Arthur 1992 Pain and Resistance: The Delegitimation and Relegitimation of Local Worlds. In Pain as Human Experience: An Anthropological Perspective. M.J. Good, P. Brodwin, B. Good, and A. Kleinman, eds. pp. 169–197. Berkeley: University of California Press.Google Scholar
  38. Koekkoek, B., G. Hutschemaekers, B. van Meijel, and A. Schene 2011 How do patients come to be seen as ‘difficult’? A mixed-methods study in community mental health care. Social Science & Medicine 72:504-512.CrossRefGoogle Scholar
  39. Kotarba, Joseph 1983 Chronic Pain: Its Social Dimensions. Beverly Hills: Sage Publications.Google Scholar
  40. Kroenke, Kurt 2009 Unburdening the difficult clinical encounter. Archives of Internal Medicine 169:333-334.CrossRefGoogle Scholar
  41. Lakoff, Andrew 2005 Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  42. Lareau, Annette 2003 Unequal Childhoods: Class, Race, and Family Life. Berkeley: University of California Press.Google Scholar
  43. Leder, Drew 1990 Clinical interpretation: the hermeneutics of medicine. Theoretical Medicine 11:9-24.CrossRefGoogle Scholar
  44. Lester, Rebecca 2007 Critical therapeutics: cultural politics and clinical reality in two eating disorder treatment centers. Medical Anthropology Quarterly 21:369-387.CrossRefGoogle Scholar
  45. Lester, Rebecca 2009 Brokering authenticity: borderline personality disorder and the ethics of care in an American eating disorder clinic. Current Anthropology 50:281-302.CrossRefGoogle Scholar
  46. Luhrmann, T.M. 2000 Of Two Minds: The Growing Disorder in American Psychiatry. New York: Knopf.Google Scholar
  47. Mandy, William, Tony Charman, Jane Gilmour, and David Skuse 2011 Toward specifying pervasive developmental disorder not otherwise specified. Autism Research 4:121-131.CrossRefGoogle Scholar
  48. Mandy, William and David Skuse 2008 Research review: what is the association between the social-communication element of autism and repetitive interests, behaviours, and activities? Journal of Child Psychology and Psychiatry 49:795-808.CrossRefGoogle Scholar
  49. Mendenhall, Emily, Rebecca Seligman, Alicia Fernandez, Elizabeth Jacobs 2010 Speaking through diabetes: rethinking the significance of lay discourses on diabetes. Medical Anthropology Quarterly 24:220-239.CrossRefGoogle Scholar
  50. Nader, Rami, Tim Oberlander, Christine Chambers, and Kenneth Craig 2004 Expression of pain in children with autism. Clinical Journal of Pain 20:88-97.CrossRefGoogle Scholar
  51. Neill, John 1979 The difficult patient: identification and response. Journal of Clinical Psychiatry 40: 209-212.Google Scholar
  52. Nichter, Mark 1981 Idioms of distress: alternatives in the expression of psychosocial distress: a case study from India. Culture, Medicine, and Psychiatry 5:379-408.CrossRefGoogle Scholar
  53. Ochs, Elinor, Tamar Kremer-Sadlik, Karen Sirota, Olga Solomon 2004 Autism and the social world: an anthropological perspective. Discourse Studies 6:147-183.CrossRefGoogle Scholar
  54. Ochs, Elinor and Olga Solomon 2010 Autistic sociality. Ethos 38:69-21.CrossRefGoogle Scholar
  55. Pitts-Taylor, Victoria 2010 The plastic brain: neoliberalism and the neuronal self. Health 14:635-652.CrossRefGoogle Scholar
  56. Prince, Dawn Eddings 2010 An exceptional path: an ethnographic narrative reflecting on autistic parenthood from evolutionary, cultural, and spiritual perspectives. Ethos 38:56-68.CrossRefGoogle Scholar
  57. Rapp, Rayna 2011 Chasing Science: Children’s Brains, Scientific Inquiries, and Family Labors. Science, Technology, & Human Values 36: 662–684.Google Scholar
  58. Rhodes, Lorna 2000 Taxonomic anxieties: Axis I and Axis II in prison. Medical Anthropology Quarterly 14:346-73.CrossRefGoogle Scholar
  59. Rose, Nikolas 2006 The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the 21st Century. Princeton: Princeton University Press.Google Scholar
  60. Selkirk, Christina, Patricia McCarthy Veach, Fengqin Lian, Lisa Schimmenti, and Bonnie LeRoy 2009 Parents’ perceptions of autism disorder etiology and recurrence risk and effects of their perceptions on family planning: recommendations for genetic counselors. Journal of Genetic Counseling 18:507-519.CrossRefGoogle Scholar
  61. Shim, Janet 2010 Cultural health capital: a theoretical approach to understanding health care interactions and the dynamics of unequal treatment. Journal of Health and Social Behavior 51:1-15.CrossRefGoogle Scholar
  62. Silverman, Chloe 2008 Fieldwork on another planet: social science perspectives on the autism spectrum. BioSocieties 3:325-341.CrossRefGoogle Scholar
  63. Silverstein, Michael 1993 Metapragmatic discourse and metapragmatic function. In Reflexive Language: Reported Speech and Metapragmatics. J. Lucy, ed. Pp. 33-58. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  64. Stacey, Clare, Stuart Henderson, Kelly MacArthur, and Daniel Dohan 2009 Demanding patient or demanding encounter? A case study of a cancer clinic. Social Science & Medicine 69:729-737.CrossRefGoogle Scholar
  65. Tordjman, Sylvie, George Anderson, Michel Botbol, Sylvie Brailly-Tabard, Fernando Perez-Diaz, Rozenn Gaignic, Michele Carlier, Gerard Schmit, Anne-Catherine Rolland, Olivier Bonnot, Severine Trabado, Pierre Roubertoux, and Guillaume Bronsard 2009 Pain reactivity and plasma beta-endorphin in children and adolescents with autistic disorder. PLoS One 4:e5289.CrossRefGoogle Scholar
  66. Ware, Norma 1992 The delegitimation of illness experience in chronic fatigue syndrome. Medical Anthropology Quarterly 6:347-361.CrossRefGoogle Scholar
  67. Wendland, Claire 2010 A Heart for the Work: Journeys Through an African Medical School. Chicago: University of Chicago Press.Google Scholar
  68. Whelan, Emma 2003 Putting pain to paper: endometriosis and the documentation of suffering. Health 7:463-482.CrossRefGoogle Scholar
  69. White, Susan 2000 Accomplishing ‘the case’ in paediatrics and child health: medicine and morality in interprofessional talk. Sociology of Health & Illness 24:409-435.CrossRefGoogle Scholar
  70. Wilce, James 1995 “I can’t tell you all my troubles”: conflict, resistance, and metacommunication in Bangladeshi illness interactions. American Ethnologist 22:927-952.CrossRefGoogle Scholar
  71. Young, Allan 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press.Google Scholar
  72. Zandt, Fiona, Margot Prior, and Michael Kyrios 2009 Similarities and Differences Between Children and Adolescents with Autism Disorder and Those with Obsessive Compulsive Disorder: Executive Functioning and Repetitive Behaviour. Autism 13:43-57.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Social MedicineUniversity of North Carolina, Chapel HillChapel HillUSA

Personalised recommendations