All in Your Head
Making Sense of Pediatric Pain
University of California Press 2015
As physicians, we cannot image or measure it, we can only try to locate within the lives and (sometimes) bodies of our patients. In All in Your Head: Making Sense of Pediatric Pain (University of California Press, 2015), an ethnography of a pediatric pain clinic, anthropologist Mara Buchbinder shows how continuing to treat pain as individual and isolated would not only be a mistake, it would miss how pain is actually experienced, treated and even generated. While the chronic pain of patients is hard to pin down, locate, diagnose and treat, it is most definitely not all in ones head, it is multifaceted and socially distributed. In many ways, the elusiveness of chronic pain syndromes makes it even more slippery, more likely to exceed the boundaries of private experience. To start, Buchbinder shows us how pain practitioners use metaphors to create a common language and experience of pain. Images of computer wiring and “sticky brains” are not just fanciful flourishes to engage the children with pain; they fundamentally alter how the patients relate to and experience their bodies; they give it life in social relations and language, in addition to reflecting contemporary views of the networked body. Moving beyond the clinic, she also connects the private experiences of pain to broader contexts, such as the family and school.
One of the greatest lessons of her work stems from the fundamental contribution of medical anthropology that suffering is social and so should its alleviation. Pediatrics—with its attention families, home and school life—tends to recognize this more than most. However, it is a worthy lesson to be learned for adult medicine as well. As Buchbinder explains, she felt the efficacy of the multidisciplinary clinic stemmed from how much it wrapped around its patients in a way that a single pill cannot. Then, perhaps our opioid crisis is many crises in one: a crisis of understanding pain in its social fullness and a crisis of care and meaning-making in medicine. All in Your Head charts one clinics attempt to navigate pain in a way that is unique and instructive.
Dana Greenfield received her PhD in Medical Anthropology from UCSF/UC Berkeley in 2015 and is currently a fourth year MD candidate at the UCSF. She will begin a residency in pediatrics at UCSF in June 2018. Reach her at firstname.lastname@example.org or on Twitter @DanaGfield.