Pain: A Political History

Pain: A Political History By Keith Wailoo (Baltimore, MD: Johns Hopkins University Press, 2014) (296 pages; $29.95 hardcover)Pain: A Political History by Keith Wailoo is both similar to and different from his previous books. It fits securely within the genre of the history of medicine, but it also shows a more defined and nuanced reflection of the human experience shaped by the ideology of national politics. In this book, Wailoo presents a very sophisticated and compelling argument that pain-how it is defined, who gets to define it, how it is valued, and how sufferers are identified-illustrates the ideological divide between liberal and conservative political thought that exists today. In 2011, the Institute of Medicine report Relieving Pain in America1 placed uncontrolled pain as one of the most compelling public health problems of our time.Wailoo brilliantly chose pain as a vehicle for understanding the association of culture, politics, and the history of medicine. He situates pain as an enduring proxy for the political battles concerning how various legislative and legal entities defined deserving and undeserving sufferers, relief, and disability. He also situates pain as an innovative way to illustrate ideological debates over the size of government, free market constructions, and regulation politics. Pain, in this book, is a loosely packed concept that morphs like putty, depending on the sufferer and those responsible for relieving, defining, and documenting their suffering. In Wailoo's hands, pain becomes more than physical sensation; it is the Trojan horse that projects multiple meanings while distorting the reality of its impact, purpose, and function.The book also illustrates the foibles of attempting to strictly categorize political ideological forces into conservative and liberal, or Republican and Democrat. In Chapter 1, for example, he illustrates Republican President Dwight Eisenhower's struggle to support veterans (many of whom were considered to have legitimate pain), while trying to distance himself from the more encompassing disability legislation covering the elderly and other American citizens (some of whom were considered to have illegitimate or fraudulent pain). His lot was to reluctantly sign the 1956 Social Security Disability Insurance Law that provided benefits to both veterans and other American citizens. Some of his Republican colleagues never forgave him for liberalizing disability. Democratic President Jimmie Carter's administration began eliminating many people from the disability roles as a way to control costs and eliminate fraud. Many of his Democratic colleagues believed his actions were punitive and failed to reflect Democratic liberal sentiments. The Reagan administration, using Carter's policies as a springboard, continued this policy but with much more gusto, illustrating the porosity between strictly liberal and conservative ideas. Underlying the debates over worthy and unworthy sufferers were the historical dualities of deserving and underserving recipients, self-reliance and dependence, and weakness caused by social disparities and control.Throughout the book, Wailoo presents defining cases that illustrate the political ideology of pain. The fight for veterans' disability benefits (Chapter 1) shows how pain as a concept illustrated the dueling ideologies of liberal relief (e.g., the rights of the disabled and compassionate care) and conservative fears of socialism. The American Medical Association (AMA) illustrated these fears as it situated liberal pain relief policies as an infringement on the rights of others and an inability of those in pain to control their behavior. …