About two years ago, Canada’s national newspaper, the Globe and Mail, reported that six to eight million Canadians live with chronic pain, that pain conditions cost the health-care system over $6 billion a year, and that medical students get five times less training on pain than veterinarians do (Walton).
According to the President of the Canadian Pain Coalition, pain patients are “treated as complainers, malingerers, and drug seekers” (Walton). Clearly, there is some need to rehabilitate the figure of the pain patient in medical and public contexts.
My focus in this project is on the person in pain, and this part of my research began with an interest in returning to an analysis Elaine Scarry proffered in the 1980’s. In “Willow Bark and Red Poppies: Advertising Remedies for Physical Pain,” Scarry noted a difference between pain-medication advertisements for physicians (in particular, the convention of portraying pain graphically for readers who are not actually in pain) and pain-medication ads in the popular press, directed at people in pain, who don’t need much graphic representation at all. Scarry used audience as a way to account for generically different appeals.
I wondered if, with changes in advertising platforms and policies, the representation of the pain patient had changed in thirty years or so.1 I discovered that, for the most part, Scarry’s contrast still holds: pain-medication ads in medical journals still typically feature a tormented-looking subject, while, for example, in mass-circulation magazines, a currently-running ad for the pain reliever Excedrin says only, “Relief starts in 30 minutes. Sufferers know how fast that is.”
Scarry’s analysis provides a starting place for an examination of the figure of the pain patient. Pain medication ads are interesting to rhetoricians because they are one means by which the pain patient is represented to him/herself and to others, in professional and public spheres. They are also a means by which suffering is measured and the need for pain medication is calculated.
Pain is inflected with cultural norms, and so it can be experienced differently according to local custom. Within local custom, it can be experienced differently according to, for example, gender, ethnicity, religion, and class. In this piece, I set aside those differences to focus on my more general question about public discourse and personal experience. See this article for more on pain control.
On the one hand, pain is an event or condition socially negotiated; for the same reason, the pain patient is socially constituted. On the other hand, pain is experienced individually and, in many ways, privately. How does public discourse affect the experience of the person in pain?
That pain is socially negotiated is a fact that pain-medication ads exploit and re-affirm. Pain is, in itself, invisible; it is, in any case, frequently concealed. Pain is not, on its own, contagious; there are no pandemics of pain. That is, outside the bounds of the pain-afflicted body, pain is not threatening, except to the social fabric—and to the economy.
In medical discourse and in pain-medication advertisements, the costs of pain to work and to family are proxies for the experience of pain. Medical journal articles on migraine, for example, take up the epidemiology of migraine, expressed not only in number of people affected but also in number of workdays lost and number of dollars correspondingly spent. In some accounts, lost revenue amounts to over $15 billion per year.
Ads for pain medications, both in professional journals and in public media, are aimed at getting the sufferer back to work—and back in the family picture: sometimes literally. In a recurring ad for the migraine drug Relpax (eletriptan), an un-medicated mom is photographed with dad and two children. She is horizontal and only partially in view; she is under a boulder of pain. A medical-journal ad for the migraine drug Imitrex (sumatriptan) pictures a woman and child and features the refrain, “I’m back!” A direct-to-consumer ad for the same drug features a distraught and disappointing mother, one who apparently has not yet taken her medication.
Because Scarry wrote before 1997, when legislation changed in the United States to loosen restrictions on direct-to-consumer advertising for prescription pharmaceuticals, the drug ads she compared in “Willow Bark” were not necessarily for the same products. In my own study, I examined about thirty ads in medical journals and compared them to about thirty in popular magazines—sometimes for non-prescription drugs like Tylenol and Excedrin but sometimes for prescription drugs like Lyrica (pregabalin) for fibromyalgia (mayoclinic.org) and neuropathic pain (theacpa.org).
In the case of each ad I examined, I asked a central rhetorical question, “Who is persuading whom of what, and what are the means of persuasion?” My main concern, however, was not the rhetoric of individual ads so much as the larger rhetoric of representation of the pain patient. So my investigations took me beyond advertisements and into the contexts of public discourse into which those ads are installed.
Mass-media displays of both moral anxiety and moral ambiguity have always been material for water-cooler conversation, or its online equivalent, but here the discussion can turn reflexive. That is, when we take a position on the use of unprescribed prescription drugs, we are, in some cases, taking a position on ourselves: we are, if we think about it, many of us, prescription-drug abusers ourselves.
How many drugs do we take, exactly, and on whose authority? Did we really need to finish the bottle of Tylenol 3’s the dentist gave us when we had that root canal? Have we neglected to dispose of the remainder of the morphine we brought home from the hospital after a recent surgery? In the midst of an anxious and ambivalent public discourse on prescription drugs, the pain patient may well wonder not only what to do and what to take but also how to see and judge him/herself.