1. PAIN EH Lecture 3 05-11-2002

2. PAIN Intensity, quality, context varies in what we label pain pain and pleasure are termed opposite in our culture pain and link to emotion is important in making a culture pain is not only a sensation, it is a self-conscious perception, pain behaviour relates to pain as self-conscious perceptions. Because it is a perception it is influenced by culture. Pain behaviour is related to pain as self-conscious perceptions pain is linked to emotional experience and cognition discourse on pain and animals, at what stage they feel pain? Can emotional and physical pain be differentiated? How? SCHMERZ refers to both, pain has a totalling effect pain has priority over other stimuli pain is an aspect in all human life, moments of transition: birth and death child experience of pain in vaginal or abdominal birth

3. Authors on PAIN I Seremetakis 1991: Identities in Pain: verbs and adjectives, imagery of pain, expressing fear of death, looking at pulses of death, pain in initiation rites, rites of passage RUA = initiation ritual in Kenia wedding, separation of family, causes pain Sternbach 1984: biological aspects of pain Kleinmann and Good: chronic pain is predominant in Western countries ( Illness Narratives): unemployment, increasing disabilities, IN tried to get closer to pain experience and was accepted by biomedicine work place quality often decides on return to work

4. SECONDARY GAINS Talcott-Parson 1950s: the sick role leads to secondary gains: - being treated differently, special role - given allowances - difficulties to relate to people in pain CRITIQUE: it is not fair to call is psychological only, implies that patient is the culprit, brain memory is functioning to explain amputated ‘phantom pain’ but: chronic depression: people are used to secondary gains, do not need to change pain killers may help in acute but not chronic pain what is the social reaction to pain? Pain is conceptualised in scholarly traditions

5. Authors on Pain II Zborowski 1952: different pain experiences in different cultures, GOOD’s critique: reinforced stereotype. But nevertheless it was a ground-breaking study in the 1950s, because it showed that culture played a role in pain expression Bendelow 2000: Pain and Gender (difficult says Hsu. Why??) Hsu says pain can be used as an instrument for making culture Scarry 1985: The Body in Pain: split between one’s own reality and the reality of the other person, torture has to do with making a culture. Through pain infliction the world of the other can be remade. Destroy the old person through pain and rebuild a new one( form the point of view of the torturer), political torture wants to break down the person Clastres 1973: L’Homme: De la torture dans les societies primitive

6. Irene Tracey: Imaging Pain in the Human Brain Works with magnetic resonance imaging in different research projects at Oxford there can be sensory, emotional, actual or potential tissue damage Pain messages pass through the brain stem to thalamus and cortex lateral pathway: sensory, discriminative motor medial pathway: effective - motivational Her research ( see web for details) shows that pain is taking place mostly in the mind.