"Camp Pain": Talking with Chronic Pain Patients (review)

Jean E. Jackson, "Camp Pain": Talking with Chronic Pain Patients. Philadelphia: University of Pennsylvania Press, 2000. 264 pp. $49.95 cloth; $22.50 paper.

How puzzling is the phenomenon of pain? Let us count the ways. Pain defies our commonsense assumptions that an experience is either real, that is, rooted in immediate sensory experience of the world, or imagined, that is, the outcome of internal psychological and mental processes. Tissue damage and nociception (the nervous system's mechanism of sending pain impulses to the brain) are present in many situations in which the individual involved reports no sensation of pain. Conversely, many people report ongoing, overwhelming pain in the absence of tissue damage or any other apparent physical cause. Pain is a universal experience, but it is always invisible. No one can see another person's pain. Only its outward manifestations--a grimace, a cry, a limp--are evident to others. Yet all pain behaviors are mediated by cultural, social, psychological, and situational factors, throwing the independent status of pain into further question. The puzzles multiply when it comes to treating pain, as the person in pain discovers that his or her complaint is analyzed, interpreted, and judged according to myriad competing, often mutually contradictory explanatory and evaluative frameworks, all of which are themselves shaped significantly by social, cultural, and historical factors.

All of these and more are among the puzzles of pain explored by anthropologist Jean E. Jackson in her ethnographic study of a center for the inpatient treatment of patients suffering chronic pain. Even the diagnosis "chronic pain," Jackson finds, is contested. Chronic pain, she observes, is not simply acute pain that goes on for a long time. Acute pain seems to fit rather well with the commonsense, physicalistic model of a nociceptive response to observable tissue damage. The syndrome of chronic pain, on the other hand, shares with other "emerging diseases"--including chronic fatigue syndrome, multiple chemical sensitivity, post-traumatic stress disorder, Gulf War syndrome--several complicated social, cultural, and psychological features. Following the work of Joseph Dumit, Jackson notes that for all of these conditions, there are unresolved debates as to their primary status as mental, psychiatric, or biological. Their etiology is contested from among social, genetic, toxic, and personal causes. The nature of the disorders is frequently the subject of court battles and disputes with administrative agencies or insurance companies. Treatments are controversial, and range all over the therapeutic map. Sufferers are often aware of each other within and among different communities; they are frequently highly organized; and they are embattled.

Writing of chronic pain in particular, Jackson observes, "it is not a singular disorder, it is biomental, its nature is highly contested, and the explanations of sufferers of chronic pain are often rejected, their disability status challenged" (179). As such, she comments early in the book, "pain is a quintessentially postmodern topic, and no master explanation accounts for it in its entirety" (10).

Jackson's goal in "Camp Pain" is to achieve as precise and complete an understanding of the chronic pain experience as its ambiguous, multivalent, contested nature will allow. Accordingly, she has chosen an ethnographic method, and a "discourse-centered, interpretive approach." This approach, she explains in her introduction, "argues that ethnographic description is an exercise toward the detailed elaboration of locally constructed social meanings. Social action is studied as though it were a text, needing to be read and interpreted. Rather than trying to explain, to answer why questions related to cause, I focus on what a set of behaviors means and how this meaning is socially constructed" (10).

Jackson's chosen text is the "Commonwealth Pain Center," its staff, and several of its patients, as Jackson observed and interacted with them during the year of 1986. The CPC (its actual name and the names of all staff and patients have been changed) is, or was--Jackson leaves uncertain its focus and even its...