Bioethics Blogs

Mara Buchbinder’s “All In Your Head: Making Sense of Pediatric Pain” by Joanna Kempner

All In Your Head: Making Sense of Pediatric Pain

by Mara Buchbinder

University of California Press, 2015, 256 pages


Pain has a famously intangible quality. To paraphrase Elaine Scarry, for the person in pain, “having pain” can be wholly consuming and experienced as concrete reality. But for all its “there-ness,” pain is difficult to pin down, measure and describe. This can be an isolating and lonely experience, made worse by the pervasive stigma that plagues those who have invisible disorders. All of which produces challenges for doctors asked to provide explanations for pain. Patients desperately need these explanations—they provide some order to what otherwise might be inchoate or disparate symptoms. Explanations suggest cause, dictate treatment, and attempt to prognosticate the future. And they are also infused with meaning, imbuing patients with judgments about their moral character. How responsible are patients for their symptoms? How deserving are they of their treatment?

The social production and cultural meaning of explanation takes center stage in Buchbinder’s beautifully written and provocative ethnography of an adolescent pain center. Buchbinder starts with premise that pain is not a wholly individual experience, but one produced in social contexts. Likewise, she argues, explanations for pain are never transparent descriptions of the body, but social creations—performances that provide legitimation for patients and practitioners, or rhetorical devices that serve to produce trust in doctor-patient interactions.

Buchbinder’s ethnography follows a variety of adolescent patients who are experiencing devastating, disabling pain as they receive treatment at “West Clinic,” an adolescent pain clinic. These patients live at home with their parents, and most have dropped out of school.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.