Pain, Suffering, and Self-Reliance

The Atlantic has a good piece titled, "Who Has a Right to Pain Relief?" about the relationship between how we treat complaints of physical pain and politics, especially the politics of social welfare. As Rebecca Davis O'Brien writes,

Physical pain is not merely a private struggle.  Pain is also a problem of representation and trust, of rights and responsibilities, and a source of tension between individual and community. Perhaps not surprisingly, efforts to manage it give rise to a chronic American condition:  an intimate, unknowable experience co-opted by special interests.  Pain, in short, is political.

Courts embraced a liberal, subjective standard of "real" pain, rejecting the notion that discomfort was a fact of life; those who in earlier years might have been dismissed as malingerers were now guaranteed treatment and protection. Medicare and Medicaid were born, and a "bureaucracy of relief" grew throughout the 1960s and 1970s.

[Princeton historian of medicine and public policy Keith] Wailoo dates the modern era of pain politics to Reagan, whose acolytes saw in the welfare state "a failed and overliberalized society taken in by subjective complaints of pain." The time had come, they urged, for a "conservative restoration founded on objective criteria for measuring true need." ...The pain of the fetus and the pain of the taxpayer mattered most; the addict's pain was suspect, the housewife's pain imagined, the disabled worker's pain symptomatic of a weak society, Wailoo writes.

The great irony...is that deregulation and government retreat allowed the pharmaceutical industry to expand, virtually unchecked, to meet the demand for analgesia--in turn creating new clinical criteria for pain, new opportunities for treatment, and new markets for drugs. The pendulum swing was extreme, abetted by a growing sentiment in the medical community that...a crisis of undertreated chronic pain was at hand.

 This led me to consider how much of the idea of pain is a cultural trope that gets manipulated in various ways but ultimately functions as a complaint against the order of things.  Specifically, how much of what O'Brien writes about reflects a conscious or unconscious understanding by the guardians of the order of things that the cultural trope of pain imperils the overriding cultural trope of self-reliance?  Medicalizing pain segregates the idea of pain from the idea of the self-reliant individual so that pain cannot function as a complaint against the trope of self-reliance.  Once medicalized, pain can no longer reveal the trope of self-reliance to be false or problematic because it is located in the biological leaving any potential cultural failure or problem undiagnosed.

The dominant cultural myth of self-reliance and those interested in its perpetuation cannot countenance the possibility that visible evidence exists demonstrating that the myth is in fact just that, a myth, and that the myth causes much suffering.  Hence, suffering must be considered either a medical (and hence pathological) condition separate from the culture or as a failure of will and constitution.  This is true of both liberal ("rejecting the notion that discomfort is a fact of life") and conservative positions ("the disabled worker's pain symptomatic of a weak society").  In this way, pain as a complaint against society is dismissed.  To those suffering, the message is two-fold:  you are physically defective or you are psychologically defective.  Either way, the suffering is your fault, a failure of the individual and not of society.  The order of things cannot, after all, bear any blame or the order of things might actually change.  Heaven forbid.