- The Politics of Pain Medicine: A Rhetorical-Ontological Inquiry by S. Scott Graham
The contemporary moment in rhetoric studies is complex, marked by a number of powerful currents pulling scholarship in new directions. One of those currents is the deepening engagement with science and technology studies through rhetorical investigations of medicine, environmental policy, and science. Another is the increasing experimentation with qualitative methodologies, often called “rhetorical ethnography.” A third is the rapidly developing encounter with interwoven philosophies of speculative realism, object-oriented ontology, and new materialism (among other names). If you are interested in any of these, you should absolutely read Scott Graham’s The Politics of Pain Medicine. The title is overly modest given the breadth of what Graham accomplishes. His is the unusual book that substantially contributes to the study of its subject matter (pain medicine), to methodology, and to theory. [End Page 362]
Graham’s project is to explain how multiple realities of pain are constituted through medical practice, which is no small task. Pain is a profoundly variable and difficult condition to understand, which leads Graham to make the sensible, yet challenging, claim that pain is ontologically multiple. To explain its multiplicity, he conducted a history of pain and a multiyear ethnography involving several groups and institutions: the Midwest Pain Group (a collection of medical professionals devoted to advancing the understanding of pain), the American Academy of Pain Management, the International Association for the Study of Pain Management, and the Federal Drug Administration. The depth and rigor of the scholarship alone is worthy of admiration. Displaying extensive knowledge of his subject, Graham brings together “pain science’s biophysical model and rhetoric and STS’s [science and technology studies’] new materialisms” (7) in order to demonstrate that pain’s diverse materiality is “calibrated” (that is, sorted, arranged, justified) by multiple regimes of practices across institutions. As he makes this multiplicity visible to the reader, along with the tangled apparatuses that sustain it, he makes an energetic plea for improved dialogue between STS, rhetoric, and new materialism. It would be easy for such a complicated, multifocal study to jump the rails; however, Graham not only manages to keep the various purposes in contact with one another but also shows how they enrich one another. We have a better investigation of pain medicine, a better demonstration of methodology, and a better intervention into theory because of the synthesis he achieves.
The opening chapter provides a conceptual framing of why these strands of scholarship need each other, introduces the reader to the problem of pain in medicine, and previews his study. Chapter 1, “An Ontological History of Pain,” offers a fascinating cladogram (a branching diagram) of six metaphysics of pain that characterize Western medicine dating from classical times. Four were “staged by medical practices” and extant at the end of the 1970s: “(1) Pain as indexical sign was alive and well in much the same way as it had been since antiquity. (2) Pain as nociception [nervous response to harmful stimuli] . . . was easily the dominant object metaphysics. (3) Pain as statistical construct was in its infancy . . . [but] coming into its own. And (4) psychological pain was a constant facet of literary and philosophical discourse” (64–65).
Efforts to produce an adequate representation of pain’s reality led to a clutch of different explanations, each depending on a bifurcation of mind and matter, subject and object. This environment of multiple metaphysics created the conditions for new, nonmodern pain ontologies to [End Page 363] emerge at the turn of the century. One of these new ontologies is practical, developing from pain management, and the other is discursive, developing from pain theory. Provocatively, Graham contends that these new ontologies, rather than continuing the dependency on metaphysical bifurcation, are “always mental and physical, always subjective and objective, always hybrid.” What follows in the next five chapters is a study of how “multi-disciplinary medical professionals work to enact and legitimize their new pain ontologies” (65).
In chapter 2, “Praxiography of Representation,” Graham outlines his method, “a praxiography...