Publications
APS Bulletin • Volume 10, Number 4, July/August 2000
Resource Reviews
John D. Loeser, MD, Department Editor
Camp Pain
Reviewed by John D. Loeser, MD
J.E. Jackson, University of Pennsylvania Press, Philadelphia, 2000, 281 pages, $22.50 (softcover), ISBN 0-81221715-2
This is an interesting account of a multidisciplinary pain treatment program and its staff and patients by an anthropologist who just happened to have been a patient at that center in the mid-1980s. The author’s ethnological approach, based on her experiences with nonliterate people of the Amazon, has provided her with analytic and conceptual tools that are not commonly found in the literature about pain. She has read widely, and the book is extensively footnoted, referenced, and indexed. It is a scholarly, rather than popular, approach to the wonders and warts of multidisciplinary pain management. Although there are enough clues to suggest the site of her fieldwork, this is quite irrelevant to the issues she discusses.
Although the focus is properly on the patients and what they experience before, during, and after the pain treatment program, Jackson also describes the concepts and emotions of many of the treatment staff and how they interact with each other and the patients. The healthcare providers all seem stressed by the socioeconomic issues that have engulfed this type of health care. Furthermore, the program seems to lack the kind of team-building activities and shared concepts and goals that characterize most good pain treatment programs of this type. Indeed, components of the program seem to be pulling in divergent directions. Another observation that concerned me was the extensive use of passive symptom-relieving therapies; my belief is that doing things to these types of pain patients is not as productive as teaching them how to make themselves better.
Jackson beautifully describes an array of chronic pain patients that is quite typical of those who frequent pain treatment programs. She illustrates how different patients make use of different aspects of the treatment program and how some patients make great strides yet others seem unable to ascend from the depths of their debilitating pain. I was struck by her observation that many patients had no idea what the program would consist of when they entered treatment; surely some pretreatment patient education would have been helpful and might have lowered the dropout rate.
Much of Jackson’s interest lies in the epistemological issues that plague those who use the word “pain.” She does not separate pain from suffering in her discussion of meanings. She correctly points out the perils of Cartesianism and the perniciousness of the mind-body dichotomy. Yet, she does not effect a synthesis that gives us new insights into the meaning of chronic pain and its treatment. I would be curious to know if the Tukanoan people, whom she studied in the Northwest Amazon, experienced chronic pain. If so, what was their explanatory model and how did they treat it? Would a cross-cultural assessment have given us new insights into this costly and dehumanizing experience in the developed countries? Questions like these come frequently as one reads her well-written text. This book offers an insider’s view on multidisciplinary pain management. I highly recommend it to those involved in multidisciplinary pain management. It is in narrative, not quantitative, style, which is refreshing.
John D. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.