Elaine Scarry, Susan Sontag, Emily Dickinson and Virginia Woolf have all lamented the ineffectiveness of language in communicating pain. In addition to the difficulties in articulating pain for practical purposes, there is the existential pain of aloneness created by this linguistic dearth. In depicting the experience of chronic pain to a larger audience, there is an opportunity for visual and print media to enlarge the vocabulary and highlight this underexposed issue. Fox's hit series House, for example, has created a highly controversial character in Hugh Laurie's portrayal of Dr. Gregory House: whether the viewer loves or hates House, the show likely alters her conception of a person in pain. Similarly, Melanie Thernstrom's recent book, The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering, provides the author's experiences as a pain patient alongside extensive anthropological and medical research. The Pain Chronicles and House work to relay important information about life in pain, but they do less to encourage the kind of social and environmental change which pain patients require. While Thernstrom's approach to embodiment complicates the relationship between pain patients and those attempting to help them, it is the problematic narrative devices in House which distort societal perceptions about chronic pain and its treatment.

A fundamental aspect of understanding life with chronic pain is recognizing its relationship to depression, a connection addressed by both House and Thernstrom. Advertisements often confuse facts about this issue: pharmaceutical campaigns (Eli Lilly & Co's Cymbalta® slogan, "Depression hurts," for example) manipulate this connection to blur the chicken-and-egg aspect of the relationship. Thernstrom notes that many people, even some physicians, hold a mistaken view on the "antecedent hypothesis"; she cites numerous studies proving that depression often follows pain, not the other way around. In fact, anxiety and depression are two significant pathological consequences of chronic pain altering the brain (156). House raises this issue in a season five episode ("Painless"), when Dr. Talb (Peter Jacobson) insists that a suicidal patient's enduring pain is entirely psychological. House disagrees, claiming that his patient "is depressed because he's in pain; he's not in pain because he's depressed."

Thernstrom exposes another myth about chronic pain in her chapters on narcotic and opioid medication, where she discusses the treatment experiences of select patients (several hundred of whom she interviewed personally, along with their doctors). She presents anecdotal and statistical evidence to show that most chronic pain patients are under-medicated, for a variety of reasons including patient and doctor fears about addiction. Thernstrom cites widely accepted studies finding that, when no history of addiction is present, only 0.19% of patients become addicted to opioid medication; when people with histories of addiction are factored in, the rate of addiction is slightly above 3% (160). However, frequent high-profile media reports of celebrity drug abuse and lethal overdose skew public perceptions about the efficacy and safety of narcotics. It is perhaps unfortunate, then, that the House producers chose to create House's relationship to pain medicine as an addiction. Although it is clear that House indeed had a history of addictive behavior prior to his leg pain, it is the visual image of Hugh Laurie popping pills irresponsibly that viewers remember. Such depictions perpetuate the misconceptions which prevent access to pain medication by people who need it, in misguided attempts to fight America's "War on Drugs" at the cost of patient relief.

As with most depictions of people with disabilities, the characterization of House employs what Snyder and Mitchell term "narrative prosthesis": that is, House's idiosyncrasies, character traits, and behaviors are expressed through a stereotypical conception of disability. House's antisocial behavior is often visually linked to the bottle of Vicodin in his hand or to his massaging his leg, indicating that his hostility is caused entirely by his injury and addiction. This causal connection is denied, however, by information about House's past: at the end of season one ("Honeymoon"), his ex-girlfriend Stacy (Sela Ward) tells Dr. Cameron (Jennifer Morrison) that, prior to his chronic pain, House was "pretty much the same as he is now." But to the viewing audience, House's cane becomes both a literal and narrative prosthetic device: it signifies his misanthropy in a way reminiscent of Ahab's wooden leg and perpetuates the historical stereotype of the curmudgeonly cripple. Thernstrom, though, discredits a singular picture of the pain patient, reminding readers that each person's chronic pain is uniquely contextualized by her own experience, personality, and temperament (16).

Considering social behavior and relationships is central to both House and The Pain Chronicles. At the beginning of her book, Thernstrom explains how she initially injured her neck and triggered a genetic condition which still causes her pain: she was unsure how to discuss the ways pain was changing her life with one unsympathetic partner and then another. Eventually, she meets a man who understands her practical needs and helps her realize an integrative future with children, work, and marriage. (It is a touching moment in the book when Thernstrom describes how, early in this relationship, her now-husband returned from Costco with cases of the stick-on heating pads which provide her some relief.) But here, Thernstrom is consistent with the evidence she has reported which shows that, while many chronic pain patients prefer to avoid the additional pressures of relationships (134), others find their pain reduced in the company of loved ones (202). Historically, House has largely avoided serious intimate relationships, but in the current (seventh) season, we find him in a budding relationship with Dr. Cuddy (Lisa Edelstein). House is "trying on" new behavior in an effort to please her: he attends social functions, volunteers in the clinic, and tutors her daughter. Many viewers will grant the possibility of change in a character, but as a disabled viewer and feminist I resent this shift being linked to a sexual relationship. Instead of recalling the Victorian notion that a female who is sick or disabled can be fulfilled or redeemed through marriage, the show feminizes House as a disabled man who can be made "better" — healthier, more virile, less depressed and pained — through his partnership with a highly sexualized woman.

Thernstrom relates her own relationship history in tandem with her pain timeline. She actually personifies her chronic neck and shoulder pain, referring to her life before and after "Pain" as if in the company of an uninvited guest (78). Kristin Lindgren has explained how this "before/after" dichotomy is related to disembodiment and a "self/other" conception of disability; and as Thernstrom's useful and tidy metaphor illustrates her existence as somehow separate from "Pain's" bodily intrusion, it embraces Cartesian dualism and devalues the embodied subject. The Pain Chronicles describes how "the illness changes the person" (16), using language to create what Lindgren calls a crisis in both health and identity (148). An embodied identity for people in chronic pain is also threatened when the medical field highlights only our physiological processes. Thernstrom's book discusses neurological science and imaging technology so extensively that brain functions become separate from the patient herself. House, too, divides person from illness: Strauman and Goodier note that, for House, the only relevant aspects of a patient are her symptoms as written on the diagnostic whiteboard (44). Paradoxically, it is the shift from a religious conception of pain (as necessary, righteous, and personal) to understanding the evolutionary directive of avoiding pain (impersonal) that Thernstrom credits with the development of pain science — the very shift which began to distance bodily experiences from the person having them.

Thernstrom's medical exposition underscores the urgent need for progress in treating chronic pain. Recent studies show that chronic pain can detract from the brain's cognitive abilities (128) and that chronic pain ages the brain, diminishing gray matter by 1.3 cubic cm per year — twice as much as the average loss caused by aging (187). The book's main thesis is that "Pain rewrites us," and analogizing the way pain rewires the brain to a faulty fire alarm (44) and a diverted river (139) illustrates the likely damage occurring when chronic pain becomes its own disease process. But while The Pain Chronicles offers a call to action in medical science, it largely ignores the need for social and environmental change. Thernstrom does track some of these important historical changes: a powerful section of the book deals with the paradigm shift caused by democracy and the ideals of individual rights; it was the realization that people did not need to suffer pain for any moral or physical "good" which eventually allowed for the acceptance of anesthetics in surgery and the development of analgesics (90). However, The Pain Chronicles is focused on efforts to eradicate pain while making no argument for accommodating pain: that is not to say accepting or ignoring pain — a cultural problem which Thernstrom legitimately argues against — but making societal changes which affect the daily lives of people in pain. We may have passed laws and made progress toward equal access in the marketplace and the workplace, but misunderstanding pain and its treatment still blocks full integration and success for many individuals experiencing chronic pain. Thernstrom ends her book with an optimistic anecdote affirming faith in medicine's eventual ability to ameliorate, if not eliminate, pain. But we are left to wonder what will happen in the meantime; until that point, we also need media-supported calls for action to embrace and support people in pain. We cannot allow House's antics to defer a greater understanding of the very real pain in people's lives.

Works Cited

  • Lindgren, Kristin. "Bodies in Trouble: Identity, Embodiment, and Disability." Gendering Disability. Ed. Bonnie G. Smith and Beth Hutchison. New Brunswick: Rutgers UP, 2004. 145-165. Print.
  • Mitchell, David T. and Sharon L. Snyder. "Narrative Prosthesis and the Materiality of Metaphor." Disability Studies: Enabling the Humanities, Ed. Sharon L. Snyder, Brenda Jo Brueggemann, and Rosemarie Garland-Thomson. New York: MLA, 2002. 15-30. Print.
  • Strauman, Elena C. and Bethany C. Goodier. "The Doctor(s) in House: An Analysis of the Evolution of the Television Doctor-Hero." Journal of Medical Humanities 32 (2011). 31-46.
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Copyright (c) 2011 Heidi Golesorkhi

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