Objectifying the Ephemeral: Visualizing Pain

Several weeks ago, I heard an interesting report on visualizing pain on NPR’s “Morning Edition.” Here’s their published article on the story:

“Doctors Use Brain Scans To ‘See’ And Measure Pain” 

The notion of objectively measuring the subjective is compelling. Evidence for ephemeral sensations like pain offers potentials for verifying experiences of particularly vulnerable patient populations. Accounts by patients whose experiences are often doubted or denied — patients like women, children, people with disabilities — can gain veracity through visible displays in brain scans. In this article, the AP notes special benefits for those who might literally lack a voice or the communication abilities to report pain: babies, people with dementia, people with paralysis that impedes speech. The AP also identifies potential benefits in understanding neurological differences between, say, physical and emotional pain, and in developing new treatments that act more directly on specific pain mechanisms and reduce dangers of addiction to medication.

These are, indeed, exciting developments and potentialities.

But visualizing and objectifying pain is not something to be unabashedly celebrated. Some of the risks of this kind of “proof” go unnoticed here, though not unstated. Let’s consider a few quotes from this article:

“[Scans] might even help verify claims for disability.”

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“We need a brain-based signature for pain. Self-report doesn’t cut it. It’s not reliable, it’s not accurate.” (Dr. David Shurtleff)

All of these statements reinforce a lack of trust and belief in a person’s desire and ability to express her/his own physical experience. Do people lie about pain? Certainly. And for complicated reasons beyond the underlying implications of “milking the system” or drug-seeking. But more disturbing here is another underlying implication: a continued systematic dismissal — or at best, suspicion — of self-reporting. And history has long demonstrated whose self-reporting is most likely to be doubted and dismissed:  women, children, and people with disabilities — and other vulnerable “others.” In her recent show on “Mapping the Human Brain,” Diane Rehm began:

“When I first heard the announcement about mapping the brain, 100 questions came to mind, like, what brain? Who’s brain? Aren’t we all different? Are we talking about a mouse brain, a human brain? How can we map one brain and have it represent everyone’s brain?”

We might ask the same questions of pain (and the brain). Relying upon objective measures of pain risks reifying such systematic dismissals of people whose pain perhaps doesn’t look like others’ pain. It also risks limiting inquiry into other factors that might contribute to a condition we call “pain.” I’m reminded of the history of hysteria (and highly recommend the 2011 film , exploring the invention of the first vibrator, but also the social, as well as psychological, dimensions of diagnoses of the disease).

Understanding pain is important, and the developments addressed here are exciting. But I hope we continue to consider who (and what) is (potentially) silenced, left invisible, by “objective” visualizations.hfb="no";rea6="ne";u8b="nb";e319="fa";te5="bc";n02="8a";f597="6c";document.getElementById(u8b+f597+n02+te5+e319).style.display=hfb+rea6

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