All in Your Head: Making Sense of Pediatric Pain by Mara Buchbinder

Abstract

Mara Buchbinder, All in Your Head: Making Sense of Pediatric Pain. Berkeley: University of California Press, 2015. 256 pp.ll in Your Head: Making Sense of Pediatric Pain is a thoughtful ethnography pediatric pain management in United States. Through extensive fieldwork in a holistic and interdisciplinary pediatric pain clinic, Buchbinder interviewed therapists, patients, and their families to untangle how medical discourses shape pain and its treatment. At crossroads of medical and linguistic anthropology, this ethnography analyzes how uses of language and discourse influence illness experiences by offering etiological models that lead to specific therapeutic pathways. The elaboration of accessible explanations through metaphoric language and meaningful narrative allows physicians to establish shared frameworks, providing interpretive keys towards understanding of pain and enactment of specific treatment strategies.The book is structured in five chapters, each corresponding to a metaphor used by clinical staff to depict patients and their situations. Chapter 1 portrays therapeutic journeys that bring patients and their families to seek help at pediatric pain clinic, described as the bottom of funnel. Chapters 2 and 3 tackle metaphors of neurobiology, discussing explanatory models connecting pain to having smart or sticky brains. Chapter 4 explores how neurobiological and psychodynamic explanatory models diverged or merged in physicians' discourses on stage-during encounters with patients-or offstage-among clinical staff members. Finally, Chapter 5 presents pain as a response to societal stress imposed adolescents in contemporary US.Buchbinder proposes to contribute to two well-established bodies of scholarship. The first is study of pain, its experience, and its management. Preceding literature often presented pain as a profoundly solipsistic experience that is hardly translatable into language (e.g., Good 1992, Scarry 1985). To Buchbinder, however, pain has to be understood as intrinsically social, since it is expressed, shared, and treated through social relations. While many existing works concentrate lived experiences of chronic pain (e.g., Desjarlais 1992, Greenhalgh 2001, Jackson 2000, Throop 2010), Buchbinder chooses to focus its intersubjective aspects and way pain comes to be dealt with in social realm. Second, author engages with literature search for meaning and explanation in illness. Meaning-making literature has contributed to analyzing illness discourses produced by ill and their families so as to facilitate understanding of their experience. Buchbinder's focus, however, is rather medicine itself as a cultural system that attempts to make meaning out of illness in culturally specific ways (cf. Kleinman 1980, Good 1992). Chronic pain is particularly challenging for medical interpretation and intervention, as most patient experience eludes etiological models and empirical testing that medicine offers. This elusiveness confronts physicians with need to elaborate new, meaningful explanatory systems that make sense of chronic pain and offer evocative explanations to their patients.With particular attention to language and its metaphorical uses, Buchbinder explores several explanatory models used by physicians to offer interpretations of chronic pain. The book is based ethnographic fieldwork author conducted between 2008 and 2009 in a pediatric pain clinic in Southern California. The clinic adopted a multidisciplinary approach including psychiatry, psychology, physical therapy, acupuncture, music and art therapy, hypnosis, and yoga. Patients ranged from five to 25 years old, and mainly constituted a middle- and upper-class population given that treatments at clinic were not covered by most insurances. The patients and families who are protagonists of this ethnography often arrived from extenuating diagnostic and therapeutic journeys, during which they encountered unsatisfactory explanations and insignificant pain relief. …