Our November 2024 LMCC meeting took place on Wednesday, November 20 at 5:30pm in Greenlaw 509 (temporarily relocated from UNC’s HHIVE Lab, Greenlaw 524) and via Zoom.
We discussed All in Your Head: Making Sense of Pediatric Pain (U of California P, 2015) by UNC’s own Mara Buchbinder.
Specifically, we focused on the following:
- Introduction (pp. 1-32)
- Suggested reading: Any additional chapter(s) of your choice
If you missed the meeting, you can still access the text on the Readings page of this site!
You can also access the recording of our meeting here.
This was our final meeting for the fall semester! We will resume our meetings in January! All of our meetings for spring 2025 will take place at 5:30pm eastern time on the last Wednesday of each month in the HHIVE Lab (Greenlaw 524) with options for people to join via Zoom as well.
We’ll be posting information about our January meeting sometime in December!
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Buchbinder, Mara. All in Your Head: Making Sense of Pediatric Pain. U of California P, 2015. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/unc/detail.action?docID=2002087.
Meeting Notes (courtesy of LMCC Co-Director Mindy Buchanan-King):
- Thinking about pediatric pain; adolescents are another kind of vulnerable population
- Privacy and methodologies; introduction provides theoretical framework
- Camille: This was Buchbinder’s dissertation project; big contribution is personhood diagnostics, how clinicians elicit buy-in from patients; how Buchbinder meant it to be used—she did avoid opioid abuse; very idiosyncratic what she found, Buchbinder worried that it was too specific
- Paul: The issue of particularity; helpful to make that distinction—the question of whether the language is too specific (e.g., “sticky neurons,” “bottom of the funnel”)
- Camille: Personhood diagnostics and language used in clinics is something that is generalizable; Camille is starting to collect metaphors that clinicians use to encourage patients to buy into their own care
- Paul: Problematizing the idea that pain is isolating/individual; pain can be experienced socially, pain as a call for acknowledgement
- Camille: Buchbinder takes a relational approach to pain; it’s not the classical Elaine Scarry narrative of pain, that it’s an uncrossable bridge; saying “I’m in pain” is a claim, but how is that pain acknowledged? Buchbinder’s work gets into the politics of care. In the Conclusion, she challenges that advocating for self-care is not a neoliberal approach.
- Paul: Even when Buchbinder is breaking down the West Clinic, she’s very careful to explore the approaches to treatment (both negatively and positively)
- Camille: The response to the book was pretty positive
- Paul: The systemic issues that show up in the work, like lack of funding. Theme of how pain is acknowledged, and discussion of how biomedicine values the visible—what is not seen is not necessarily taken as real.
- Bri: On page 8, when Buchbinder is citing Hamdy re: patients looking for explanations outside of biomedicine, which feeds back into our reading re: hypochondriasis. The value placed upon vision is problematic in relation to music: Jonathan Stern and Tim Rice situate the optico-centrism in modernism writ large, which continues to prioritize the ability to see and assert realness. This removes previous ways of knowing, like tactile, listening to the body.
- Paul: Pointing out different ways of interpreting pain, and how you make meaning of that pain. Students in a previous UNC class were more interested in movies and visual art, not as interested when talking about sound.
- Bri: Trying to get people to engage with musical form is incredibly difficult; we’re used to seeing the form, but music—using sound to obtain knowledge—requires that you follow the form in time. It’s not a spatial dimension, it’s difficult to grasp all at once.
- Sterling: Introduction and who made up the clinical team; one of the members was a music therapist. How is music therapy used in that context?
- Bri: The history of music therapy: Music therapists are professional musicians who are specifically trained for clinical practice. They are hired to help with issues like therapeutic practices, including pain management. That explains why the West Clinic had one on staff. Others help work through PTSD: either through listening or practicing music, people can have a focused and embodied practice that helps them get in tune with their bodies. The history of music therapy as a professional field was a post-WWII development, to help soldiers deal with shell shock. There is a patient demand for it now.
- Paul: Certain of these therapies were deemed by insurance as more lucrative, pushing toward therapeutics that were more lucrative. A few years ago, Paul did a mini-ethnography of clinicians gathering together. Most clinicians present noted that kind of collaboration rarely happens.
- Camille: The landscape of pain management has changed since this book; Camille is tracing the genealogy of pain management. The model that Buchbinder talks about in terms of interdisciplinarity isn’t necessarily sustainable—it’s rare. Pain management was supposed to be interdisciplinary, and there were pain clinics. But that model went out of favor for various reasons; it’s primarily anesthesiologists who do pain management, so it’s intervention-based.
- Bri: Has the intervention method changed any, especially with the opioid pandemic?
- Camille: By intervention, she means closer to surgery/minimally invasive surgery. There is often a move to de-prescribe, leaving a gap in care. Primary care used to be responsible for opioid prescribing. Pain management had a hard time becoming legitimate (chronic pain management not taken seriously), and pain management was intervention-based, leaving prescriptions of pain medicine to primary care. But, primary care doesn’t want to touch it, and neither do the anesthesiologists.
- Sterling: Note that it tends to be females who experience the pain.
- Camille: There are gender gaps; functional disorders, like IBS, chronic pelvic pain, tend to be female gendered. The reasons behind that are complex and not well figured out.
- Paul: The introduction focuses on a female patient; curious to see how the other chapters explore the question of gender. That ties into our other meetings about the gendered nature of pain.
- Bri: A lot of the readings this semester, when there has been a gender gap, it seems to be negative effects go to women. Bellings’s work tends to break that mold, wherein hypochondria was historically assigned to men. That example has a nice resonance with what Buchbinder says about language. Page 14, touching on chronic pain and the failure to explain where the pain is coming from.
- Paul: Yes, the frustration with impatience of not being able to put a name to, provide an explanation for, or identify the use of the pain. We’re frustrated we can’t find that root cause or make meaning of it.
- Bri: Explanations may help, but how do you make sense of the use of the pain? What is the meaning of the suffering?
- Paul: The yoga instructor’s comment about the “realness” of treating patients; that was surprising, in terms of a kind of pushback that everyone’s pain is real.
- Bri: Interpreted an acknowledgement in the adolescent patient’s agency to trouble a path to an explanation to what’s going on. Another element raised is what is the clinic’s stakes in treating every patient’s pain as real? No one doubts the lupus patient, but there are other cases that may not be treated as legitimately. There are different pressures on clinics to treat issues they’re seeing in a certain way, that legitimates the pain.
- Paul: In chaper 3, it seems Buchbinder gets into the familial structure.
- Camille: In backstage areas, clinicians raised questions about parenting, as a site of blame for children’s pain; parents caring too much for their children were also criticized. The last chapter talks about societal stress; most of the adolescent patients were high-achieving, white, upper-class students. One patient in the study thought they were going to an Ivy League school, but pain may have provided them a new path. That gets back to pain as resistance; that can be a problematic approach, though.
- Paul: No matter what’s going on, there’s still real suffering that is driving reactions, experiences, behavior, stimuli, even if it is pain as resistance. Found this a productive read; the introduction was very detailed, not just laying out chapters. The question, too, of how Buchbinder separates herself as researcher from the study subjects. The family dynamic comes into play, and questions of consent and privacy.
- Sterling: Question for Camille: Does Buchbinder go into crip theory, in relation to pain?
- Camille: Buchbinder does not in this work; her focus is the morally gray areas in medicine—like abortion care, genetic testing, and physician-assisted suicide.
- Sterling: That would be interesting to see how crip theory relates to the question of pain; Sterling is writing a chapter about different types of pain: phantom pain, psychological pain, and physical pain.
- Camille: There’s a move in the literature on pain to think about boundary-making, and defining different types of pain.
- Reminder: We will look at Camille’s article-in-progress for the January 2025 meeting.
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Note: The Featured Image for this post is a cropped image of the cover of All in Your Head: Making Sense of Pediatric Pain (U of California P, 2015) by Mara Buchbinder.