Medical Practitioners as Pain Judge & Jury: Delegitimation of Chronic Pain and Contested Illnesses Part II
Medical Practitioners as Pain Judge & Jury:
Delegitimation of Chronic Pain and Contested Illnesses Part II
In Part I of Delegitimation of Chronic Pain and Contested Illnesses, I introduced why chronic pain narratives are commonly invalidated in the colonized west. This Part II installment discusses the role of the medical establishment.
The pressure to prove and justify one’s chronic pain as legitimate is immensely difficult even for people who have conditions that can be medically objectified through imaging or other diagnostics. For those of us whose pain falls into the category of “medically unexplained” or “contested,” how our narratives are medically and socially interpreted is exceedingly fraught (Welch, 2018).
In medical institutions, the legitimation of only certain narratives, and in turn only certain people’s pain, is as political as it is medical (Buchman et al. 2016). Even though people with chronic pain and illness are arguably the most qualified to narrate our experiences, clinicians are afforded nearly unmitigated rein as arbiters of whose pain is and is not real.
Given that the way clinicians interpret patients’ pain is profoundly influenced by media, sociocultural conditioning, and personal bias, validating certain conditions while contesting others is rampant in allopathic medicine (Morris, 2011). Medical providers are frequently prejudiced as much or more by a patient’s background and appearance as by the patient’s pains and illnesses.
This valuing of the reports of medical practitioners and establishments above and beyond our own narratives is termed “testimonial injustice” (Buchman et al., 2016, p. 32). The phenomenon of testimonial injustice is a product of explicit or implicit biases and prejudices causing a person to inaccurately diminish the validity of the testimonies and experiences of another person, or group of people. This power differential in which healthcare providers have nearly unimpeachable authority to discredit or deny our experiences, along with social impunity in doing so, systematically erodes both others’ trust and our own confidence in the veracity of our reports.
Disagreements among medical practitioners as to the legitimacy of contested illnesses such as diagnoses of fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), multiple chemical sensitivities (MCS), chronic lyme disease, and pelvic pain, which all predominantly impact women and people assigned female at birth, further marginalize our experiences (Welch, 2018). In addition to the idiom “wastebasket condition,” medical providers often disapprovingly label those of us with conditions falling into the above diagnoses as “thick folder” or “heart sink” patients. For many people who have chronic pain, however, dependence on the provider is the only option for hope of relief, putting them in a bind between not having access to treatment and surrendering themselves to healthcare providers’ prejudices. This bind traps many people in pain in a cycle of repressing our experiences to minimize the chances of our pain being doubted, denied, and disappeared instead of receiving adequate care.
When we consider the power that comes with the expert status of medical providers and the public regard for their judgment as irreproachable, it becomes ever more apparent that the assault on the veracity of our pain narratives violates our bodily sovereignty and autonomy.
By exposing the limits of biomedical power to “correct” or “normalize” every condition, chronic pain and illnesses threaten the status of the all-knowing medical healer and the promise of boundless illness interventions (Buchman et al., 2016). Discrediting people in pain becomes a protective measure against facing the vulnerability of medical constraints and fallibility. Medical institutions and their agents ostensibly intended to provide care and relief may instead become a danger to people in pain, inflicting more and deeper pain by pathologizing, denying, silencing, dismissing, and blaming us for our conditions, or withholding treatments and necessary legal and occupational verifications.
For people who are already marginalized and therefore more likely to be stigmatized, the regularity of medical injustice increases exponentially (Buchman et al., 2016). Women and people assigned female at birth; Black, Indigenous, and other people of color; and veterans are statistically more frequently disbelieved by medical providers in the United States and receive less adequate pain treatment. Other stigmatized groups are also subjected to increased doubt and disbelief, putting people already socially and structurally discriminated against—people with psychiatric diagnoses, fat people, poor and economically oppressed people, queer people, transgender people, people who have intersex conditions, disabled and neurodivergent people, people of a targeted nationality or religion, for example—at an even greater risk of encountering abusive medical responses when seeking chronic pain treatment.
These medical prejudices create severe and lasting emotional damage as well as irreversible health consequences due to mistreatment. Without necessary information for effective advocacy or family and social supports, many people with chronic pain and illness are unable to access medical providers who do believe and treat their conditions. In a circumstance in which being believed and supported may very well mean the difference between being deeply traumatized and enduring endless pain, or accessing early treatment and intervention, the importance of being medically and socially believed cannot be overstated.
Don’t forget to read Delegitimation of Chronic Pain and Contested Illnesses Part I.
For more of my original articles, check out these posts:
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Sources
Buchman, D. Z., Ho, A., & Goldberg, D. S. (2016). Investigating Trust, Expertise, and
Morris, D. B. (2011). Narrative and Pain: Towards an Integrative Model. Handbook of Pain and Palliative Care, 733–751. https://doi.org/10.1007/978-1-4419-1651-8_38
Welch, M. J. (2018). Decreased Visibility: A Narrative Analysis of Episodic Disability and Contested Illness. Scholar Commons. https://scholarcommons.usf.edu/etd/7378/.
