Some Thoughts on the Social Construction of Pain

One of the most common critiques that I get is that, while people agree with me about the social construction of impairment to an extent, that pain isn’t socially constructed. This is something that has also come up in a few of my classes lately so I thought I would sit down and take the time to articulate my thoughts a bit better on this point.

I want to start by saying that I have a lot of pain a lot of the time. For me, most of the time, the question is not if I am in pain, it is how much pain I am in. It is one of the primary reasons that I don’t post more on this blog, the other being the aforementioned school (all I do is write!). Interestingly, these days, my pain isn’t as overwhelming most of the time as it used to be, which also means that I actually write less because I can do things like go out and go to school.

I also want to be clear that my saying that disability is socially constructed is not the same thing as saying that there are no material consequences attached to being classified as disabled. Similarly, while I frequently argue that gender and race are socially constructed, this statement does not erase the very real consequences of sexism, patriarchy, racism and white supremacy on the lives of women, trans people and racialized people.

What is a social construction? Wikipedia defines it as: “a concept or practice that is the construct (or artifact) of a particular group. When we say that something is socially constructed, we are focusing on its dependence on contingent variables of our social selves rather than any inherent quality that it possesses in itself.” In other words, they are things that are cast as real that would not exist, or at least be understood the way they are, if not through the social lens that we see them through.

Previously, I haven’t talked about the social construction of pain and have really stuck to the social construction of impairment, which pain may or may not be associated with. I have argued over and over that we need to make space for people to talk about the hard parts of disability while, at the same time, ensuring that these discussions happen in a context in which it is understood that everyone has trouble sometimes with their minds and bodies and this isn’t unique to being disabled. It is also the case that for some disabled people, there are no hard parts beyond subordination and everything that goes along with that.

I also want to be clear that while I am opposed to the many problems with the medical industrial complex and medicalization, I am not opposed to people accessing care or managing their pain with the help of doctors and other healthcare providers. I think it is important to both be critical of the healthcare system, and particularly the medical model of disability, it is also important for fight for healthcare justice. This means demanding and fighting for free and accessible healthcare for everyone. Healthcare justice in Canada means recognizing that just because something is called universal doesn’t mean that it is universal. People without immigration status and, because of recent Harper government cuts, recent refugees cannot access healthcare if they don’t have the money to pay for it. But healthcare inaccessibility also affects lots of marginalized groups because of discrimination, lack of physical accessibility, lack of funds to pay for prescriptions, etc.

The last bit of preamble, before getting into talking about the social construction of pain, is that we need to talk about what pain we are talking about. Are we talking about emotional pain? Many people will articulate their heart hurting or great distress and pain about something. I think, for this entry, I am going to stick to physical pain but acknowledge that the line between the two can be blurry at times. There have been a lot of advertising campaigns lately that report that depression causes physical pain. But, I think it is a lot easier to think about how emotional pain is socially constructed (my best friend isn’t talking to me or my dad is being an asshole to my mom, etc.).

Pain is both a social construction and a consequence of social constructions.

Language and Culture

The language that you use to talk about pain and the cultural context that you experience pain in are both socially constructed. We use language to describe and understand it. Indeed, all of our experiences are filtered through language and through our particular cultural understanding of pain. If I lived somewhere else, I might relate to or have a very different experience of my pain because of that cultural context.

In S/M subcultures, pain is desirable and sexy. Here, pain isn’t bad, it’s naughty. Folks who are engaged in S/M have a very different cultural understanding of pain than the normative one, at least within the context of sex.

In our society, we construct pain as always bad. This, however, isn’t always the case. Pain is also a teacher. When I was learning to walk, I put my hand on the oven door when it was turned on. My hand was very badly burned. That pain was an important lesson about walking and what was safe to touch and what wasn’t.

The social choice to devalue bodily diversity also works to devalue the specific knowledges that that diversity can bring. My pain has taught me how to be incredibly efficient, how to plan ahead in great detail and how to appreciate the world in slow motion. These are specific knowledges that are erased because pain is viewed in particular ways by society.
What if pain was viewed in a more complex, nuanced or meaningful way in our society? How would that change how I understand my pain? How would that change how I understand myself? How would that change how you understand me?
These are questions that I can’t answer because I just don’t have the cultural context to imagine those answers. But I believe that it is possible to create other possibilities for people who have pain.

Pain is also a consequence of the functions of society and particular cultural context.

Why does someone have pain?

Disablement is created through violence, war and poverty (which is also violence) and these are social.

Colonialism has resulted in dramatically higher levels of disability, many of which involve pain, in First Nations populations than in Canadians as a whole. The pain that is involved in this is the result of a genocidal campaign against the First Peoples of this land.

Poor people often have pain – hunger pain, pain from having to walk a lot, pain from sleeping in substandard conditions and so on. We also know that if you are poor, you are probably going to have dramatically higher rates of health problems and disability. Poverty creates pain in a lot of ways.
The origin of one’s pain may be rooted in social deprivations or social actions that have led to pain.

What interventions on pain does someone have access to?

We know that there are things that can reduce or eliminate pain in the short or the long term. Access to these things (physio, medications, changing your neural pathways, surgery, herbs, street drugs, baths, etc.) is all informed by social constructions.

So, let’s take a step back from the bigger theory and just talk about my pain for a bit and how it is socially constructed.

I have a lot of pain and we (me, my doctor, the world) don’t know why. Some of the theories involve being a survivor of violence (social) but I have it and I have to live with it. In the past few years, my pain has gotten less severe. Here’s how that happened:

While I was on social assistance, I started taking testosterone (“T”) because I am trans and I wanted to take it. Incidentally, it has helped build muscle mass which I believe (as do a number of medical researchers) helps to reduce pain for folks like me.

Then, I was able to find a job that was quite flexible, part time and had benefits (this is why we need unions!). I was able to start seeing a chiropractor and a massage therapist. They helped a lot. That job meant that I could switch the T that I was injecting into my thigh to the T that is a gel which had a big impact on my pain in my legs.

I also got prescribed some other drugs that I couldn’t get before because I couldn’t afford them. The key ones are a sleeping pill and a new painkiller. This painkiller, traumacet, is an opiate. There has been a lot of talk on the news because of the shortages of opiates, in large part because the US government has a scorched earth policy for farmers in Afghanistan who are/were growing poppy. The government burns the fields so they cannot grow the poppies because they have opiates in them. The possibility of purchasing farmers crops, leading to more security for people in the region than less has not been implemented.

My access to all of these things has deeply informed my experience of pain. The class privilege and additional medical care as a result has reduced my pain. The continued withholding of resources so that others can’t access the things that helped me or other approaches that they may find useful are very much a product about the decisions that are made about the (unjust) distribution of resources.

There are a lot more possibilities for pain that get erased by the culture we live in and how it constructs pain. Pain is individual. Pain is isolating. Pain is bad. These constructions simplify a complex physical and emotional response to something. Constructing it as an individual experience erases the shared experience that people have with and through pain. It also means, then, that the response would be an individual one rather than dealing with the social causes of that pain. While my pain and everyone’s pain is very real and has real consequences, pain, how I react to it and how I deal with it are also a product of the society in which I live. Justice, when we are talking about pain, is both about helping people minimize their negative experiences of pain (by both treating it and acknowledging its value) and by eliminating the oppressive structures in society that create pain.

~ February, 2013