The Rashomon approach to dealing with chronic pain

Pain in the Vernacular: Psychological and Physical

A hermeneuticalphenomenological analysis of 42 narratives of pain in everyday life leads to the conclusion that psychological pain is pain. Psychological and physical pain have similar phenomenological structures. Both are felt bodily performances that entail at least temporarily a disabling of a potentiality for action. Pain is a performance of affliction of a person in a social situation. The category of psychological and physical pains arises from cultural conceptions of the nature of the person. This category reveals that pain can afflict the person in any aspect of existence. A categorization closer to the phenomena differentiates pains on the basis of what aspect of existence is afflicted. In conclusion, differences between pain and suffering are explored.

From pain to virtue: dysphoric sensations and moral sensibilities in Yap (Waqab), Federated States of Micronesia

This article contributes to the development of a medical anthropology of sensation through providing a thick ethnographic description of pain's significance in the context of a particular community's - Yap (Federated States of Micronesia) - understandings of subjectivity, social action, and morality. After first proposing an attentional-synthetic model of the patterning of sensory experience, the article goes on to describe in some detail the linguistic, moral, and cultural frameworks that serve as the semiotic, existential, and practical resources providing the background against which individual sufferers tend to interpret their dysphoric sensory experiences. Central to the article is an exploration of a local illness category maath'keenil' that is implicated in two, at times competing, models of ethical subjectivity. It is argued that through configuring their subjective experiences in light of these virtues individual sufferers are at times able to transform their experiences of pain from excruciating dysphoric sensations to meaningful, morally valenced, lived experiences.

Narrative research: a review of methodology and relevance to clinical practice

Using qualitative narrative research to explore how people proceed through cancer diagnosis and treatment may help clinicians render better care and consequently enhance the probability of optimal health outcomes. Narrative research can be defined as collecting and analyzing the accounts people tell to describe experiences and offer interpretation. Often, oncology clinicians use narrative methods to investigate issues such as clinical outcomes, coping, and quality of life. Narrative research provides an option to explore personal experiences beyond the boundaries of a questionnaire, providing insight into decisions involving treatment, screening or various health practices, which can help guide how health care services are developed and provided. The purpose of this article is to illustrate the use of narrative research methods to a clinical audience who may not be as familiar with narrative technique. Definitions of narrative research, examples of published research using narrative methods in healthcare, validity and data analysis will be addressed. A review of current literature from sociology, anthropology, nursing and psychology demonstrates that narrative methods are an effective research option that can lead to enhanced patient care.

Narrativas como técnica de pesquisa em enfermagem

O texto apresenta a narrativa como possibilidade de abordagem para pesquisas na enfermagem, especialmente como técnica de coleta e análise de dados, destacando seus aspectos teóricos e práticos. Inclui uma revisão do conceito de narrativa, por meio da compreensão dos autores de diferentes áreas do conhecimento: filosofia, antropologia, lingüística e enfermagem. Quanto ao aspecto prático de sua aplicação na pesquisa, introduz três diferentes tipos de narrativas, identificadas a partir das histórias que as pessoas contam: narrativas breves, narrativas de vivências e narrativas populares. Inclui, também, formas de apresentação das narrativas em textos científicos e seu processo de interpretação. Destaca que as narrativas criam um campo de ação coletiva e permitem aos profissionais de saúde a construção de conhecimento alicerçado na experiência das pessoas.

Liminality and breastfeeding: women negotiating space and two bodies

It is almost universally accepted that breastfeeding infants is nutritionally superior to bottle-feeding. However, despite this medical advice, in many countries breastfeeding rates remain low and in the UK, rates are relatively static. The literature on breastfeeding has discussed international rates and the broad socio-economic factors influencing these rates. Through an observational study of a group of breastfeeding and non-breastfeeding women in the United Kingdom, this research utilises contemporary theoretical perspectives on the body, space and rites of passage, and investigates the reasons why some breastfeeding mothers may be in a liminal period, and the breastfeeding event itself, at times, a liminal and marginalised act. The paper argues that, for the group studied, breastfeeding is sometimes discouraged by its medicalisation, and that breastmilk and breastfeeding are often considered by mothers to be embarrassing. Many of the women studied regarded certain public and private places to be unacceptable places to breastfeed and claimed to modify their behaviour accordingly. The paper demonstrates the value of conducting locally based qualitative research into breastfeeding experiences, and of using theoretical perspectives from post-medical geography to interpret women's experiences.

"Unremarkable" recoveries: normalizing adversity and cancer survival

Much of the existing popular literature suggests that survival from life-threatening diseases encourages a process of self-transformation. Seventeen long-term survivors of metastatic cancer were interviewed about the impact of a life-threatening condition on their life stories. Contrary to the existing literature, which suggests such an event greatly transforms the individual, nearly all of those interviewed for this study framed their unusual recoveries as being largely unremarkable. Traditional North American cultural values, which normalize adversity, appear to bolster the participants' beliefs that one can have control over one's health and can even resist a recurrence of cancer.

Dynamics of inclusion and exclusion: comparing mental illness narratives of Haredi male patients and their rabbis

By comparing versions of mental illness narratives - told by Haredi (Utraorthodox Jews) male patients of a mental health clinic in Israel and by their rabbis - this paper relates to two distinct, yet interrelated, theoretical questions: the place and agency of narrators, and the tension between experience and representation. A pair of narratives exemplifies a pattern in which the patients (Talmudic students) tell a narrative of a sudden breakdown related to a dramatic meeting with a non-human figure (often, a woman) or force. Their rabbis, by contrast, tell a narrative that emphasizes their students' mundane symptoms, "abnormal" and "immoral" behavior, and use a local adaptation of a Western psychological explanatory model. A dynamic of inclusion and exclusion emerges as students are seeking legitimization and avoidance of stigma, while their rabbis are silencing themes that challenge social and cultural orders. The different narratives are further interpreted in the context of the micropolitics of the interviews and of identity politics between the Haredim and secular Israelis. This social dynamics shows how differently placed social actors-narrators-interpreters construct differently contested and diverse cultural narratives of a seemingly shared reality.

Complaining about chronic pain

This paper examines how a group of working class people describes and experiences chronic pain. This hermeneutical-phenomenological study concentrates on the lived body of pain from three perspectives, drawing on interviews with 14 people who were attending a pain management program. First I consider the terms in which pain is circumscribed in the narratives, stories told in the context of learning to manage pain. These terms are polarities, ways of specifying and legitimating pain in relation to "mind" and "body." Pain, in the discursive polarities that define it, is the private property of an individual, who must in some fashion prove that pain exists in an objective manner. The speaker, in this discourse, stands as the one responsible for the production of pain. In the second part, the analysis turns to what this discourse reveals about pain as a lived body phenomenon. Here the analysis centers upon the torment of having to inhabit the intolerable, upon how pain unmakes the lifeworld of the sufferer, and how, simultaneously, people make pain. The place of pain is the body, as body-in-place. The place of pain is at the boundaries of human dwelling, a kind of non-place, expressed metaphorically as "prison" or "homelessness." Finally, after these considerations of how pain is described, in part three, I turn to the act of "saying" pain, that is, to the narratives as addressed to someone else. The participants were not simply dispensing information; they were saying something to me. The narratives had the form of complaints. The form of the narratives, in the context of the pain program, was a quasi-legal call to rectify wrongs.

Patients' and professionals' understandings of the causes of chronic pain: blame, responsibility and identity protection

A social constructionist analysis of how sense is made of the causes of chronic pain is reported. It is recognised that there is a multiplicity of stories available in any culture from which understanding can be reached. Q-factor analysis is used within a critical framework as Q-methodology. Sixty chronic pain patients and pain professionals completed the sorting procedure. Four factors were derived that account for the causes of chronic pain. These are reported as the patients' account, the professionals' account, the scientists account and the alternative practitioner's account. Common to all four accounts are the themes of responsibility, blame and the need to protect identity. It is argued that in all accounts responsibility is repositioned away from the sufferer or the healer. In all of the accounts blame is resisted or deflected away from individual ownership. Finally, it is argued that when pain is no longer useful as a symptom, identity is challenged, weakened and at risk for both chronic pain patients and pain professionals. Implications of this study for chronic pain research and treatment are discussed.