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A Deep Dive into 'The Story of Pain' by Joanna Bourke

We had a brave and thought-provoking book club discussion on 'The Story of Pain' by Joanna Bourke at the end of March. This intriguing book took us on an explorative journey through the historical and cultural narratives of pain, providing a unique perspective on the subject/experience that as a community, we are focused on.

Lively debate

From the outset, Bourke's book sparked lively debate within our group. The narrative around pain in various cultures, religions, and age groups was particularly gripping. Bourke's exploration of how societies have historically justified certain behaviours or treatments, especially in medical settings, resonated with our group. She evokes a powerful image of the patriarchal medical gaze, its impact on pain perception, and the cultural biases that continue to persist in healthcare today.

What struck me most was the discussion around the notion of pain as a transformative experience, often linked to religious or spiritual practices. The idea that enduring pain can bring individuals closer to their gods, or even improve empathy, was a fascinating perspective. Yet, the dichotomy between this narrative and the instances of abuse often justified through such beliefs was unsettling.

“moving with the pain of the surgeons knife could be deadly”

The book also delved into how children are socialised into understanding pain, a discussion that had a profound impact on our group. The narrative that Bourke builds in the book discusses how stories and lessons around pain have been historically designed to keep children calm and still, especially during medical procedures where moving with the pain of the surgeons knife could be deadly, was both intriguing and disturbing. As well as the realisation that pain, injury and suffering was a regular experience for many children of the past. This led us to reflect on the experience of many children currently around the world experiencing conflict, war, hunger and dangerous working environments.

In the context of healthcare, Bourke's examination of the disparate pain experiences among different races and genders was a sobering reminder of the biases that still exist. This led to broader discussions about societal norms, the culture of healthcare systems, and the need for empathy and understanding in medical practice. We had a really interesting discussion about the ways that dehumanising groups of people and denying the sentience of babies and animals has allowed painful practices to become normalised in society and healthcare. We explored some current examples where this is still the case, such as less pain relief being offered at the emergency room to folk of colour and the denial or dismissing of endometriosis pain experienced by cis women, trans men and non-binary folk who menstruate.

Reading 'The Story of Pain' and participating in the subsequent discussion was a truly eye-opening experience. It allowed for a deeper understanding of the complexities of pain and the myriad factors influencing its perception and management. As healthcare professionals, the insights gained from this book underscore the importance of continually questioning our practices and striving to improve our approach to pain management.

The discussion of the book did not end with the exploration of these historic narratives. It went even further, discussing how the book's insights could be applied in our own practices. Bourke's work highlighted that, as healthcare providers, we should not just focus on the physiological aspects of pain, but also consider the cultural, societal, and personal contexts of our patients. She handles the issue and limitation of healthcare approaches, theories and research being underpinned by the philosophy of dualism and gives a wider historical and cultural context to the work of Descartes. Highlighting where perhaps modern readers of the work have misunderstood the role of religion in his philosophy.

“It was also a great reminder that narratives matter”

The conversations around empathy, in particular, were enlightening. The book emphasised the power of empathy in changing a person's pain experience. And this resonated with us, especially in the context of today's healthcare environment where a patient-centered approach is highly valued. It reminded us of the importance of treating our patients not just as cases, but as individuals with their own unique experiences and perspectives.

In the end, this book club discussion did more than just dissect 'The Story of Pain'. It made me and hopefully the group as a whole, reflect on our own views and practices, and how we can improve them. It emphasised the need for us to constantly question, learn, and adapt because our understanding of pain, like many other aspects of healthcare, is continuously evolving.

It was also a great reminder that narratives matter. They influence how we perceive and react to pain, and how we treat those who are in pain. By understanding these narratives, we can better understand our patients and provide them with more compassionate and effective care.

The book club discussion on 'The Story of Pain' was a beautiful, deep and enriching one and a great opportunity to share and learn with other pain-interested clinicians from around the world.

I love these discussions because they are not just an exploration of a book, but a journey of discovery, reflection, and learning.

For anyone interested in the study of pain, I highly recommend Joanna Bourke's 'The Story of Pain'. It's a compelling read that will make you think, question, and hopefully, understand pain in a new light.

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