Pain: A Political History

1. The Trojan Horse of Pain

13 ONE The Trojan Horse of Pain But come now . . . and sing of the building of the horse of wood . . . led up into the citadel as a thing of guile . . . So there it stood, while the people talked long as they sat about it, and could form no resolve. Book 9, Odyssey For Lieutenant Colonel Henry Beecher, soldiers’ pain was a paradox . Treating men gravely wounded on the Italian war fronts in the mid-1940s and at the Anzio beachhead, Beecher, a medic who later became a renowned pain specialist, marveled at how “strong emotion can block pain.” Gravely wounded GIs (in fact, as many as three-quarters of them) did not request morphine, he found, despite being in severe pain and often near death.What allowed these badly injured men, subjected to almost uninterrupted shellfire for weeks, to show surprising optimism and even cheerfulness ? With this question fresh in mind, the war doctor came home understanding that pain was far more complicated than most people thought and that the capacity of men to withstand wrenching anguish was a profound mystery. In time, pain would become not merely a bodily paradox but also a profound political one. A decade later, Louis Orr viewed the GI through a different lens. Orr insisted that, once safely at home, the veteran had become a whiner, a complainer , and “a Trojan horse” opening the way for socialized medicine. As a prominent physician in the American Medical Association hierarchy, his pronouncements carried political force. The medical organization had successfully opposed President Harry Truman’s plan for national health insurance in the late 1940s, and it remained alarmed about any proposals to expand insurance and benefits—both to veterans and to the general population . Writing in the late 1950s, Orr saw the veteran’s complaint in this 14 PAIN political light, as an excuse for government encroachment into private health care. In the years since the war ended, he insisted, the GIs’ complaints of disability had grown out of proportion to their actual injuries. Orr alleged that the trend had been encouraged by veterans’ groups (such as the American Legion) lobbying Congress to liberalize disability benefits. The result was incessant coddling and crippling dependence on government, particularly within the Veterans Administration health-care system. These developments, Orr feared, were leading America to the brink of socialism.1 What had happened to shift the profile of the GI and his pain so dramatically from the hardened fighter on the Anzio beachhead in 1946 to the chronic complainer on the VA ward in 1957? Had the soldier’s marvelous endurance on the front lines been converted into a societal weakness by life at home? Was it true, as Orr and the American Medical Association contended, that expanding government benefits; creeping, coddling liberalism; and social indulgence were to blame? It was not just that memories of the soldiers’ heroism had faded in the intervening twelve years: the disability and pain debate of the 1950s concealed within it an ideological skirmish about liberalism and the legacy of New Deal policies, about social accommodations and postwar citizenship, about disability provisions for the general population, and about the future of the nation itself. The case of these soldiers (and the civilians they would become) sits at the core of this chapter in American pain and politics. As we shall see, the debate on the soldier’s complaint was a battle in the larger social conflict, one that would expand and transform beyond veterans per se and become a raging political war shaping American society for decades to come. Context mattered in assigning a meaning to pain; Henry Beecher knew this.There was something in war’s setting that gave a man a strange ability to tolerate long-bone fractures, penetrated abdomens, head wounds, and other severe injuries. For a civilian similarly injured in a car crash on his way to work, Beecher reasoned, the accident marked the “beginning of a grave disaster.” But war wounds were different. At first, fighters barely even notice injuries. Why? The soldier downplayed his torment because “his wound suddenly releases him from an exceedingly dangerous environment, one filled with fatigue, discomfort, anxiety, fear and THE TROJAN HORSE OF PAIN 15 real danger of death, and gives him a ticket to the safety of the hospital,” Beecher speculated. “His troubles are about over, or he thinks they are.” Removed from the immediate threat of death, “it...