IV.II First field study: pain talks
After I had decided to go into the field to find out more about the meaning of pain and how it is communicated, I first conducted interviews with three linguists who have conducted research on the subject of pain and language, and have also published a book on this topic: Professor Florian Menz and Dr Johanna Lalouschek from the Linguistic Institute of the University of Vienna, and Dr Marlene Sator, who is also one of the authors of the aforementioned book, Sprechen über Schmerzen (Talking About Pains).
Professor Menz explained to me that pain is idiosyncratic. There is no external point of reference: pain is an inner experience, meaning that language is our only means of access. He found that there are mainly two different ways or styles how pain usually is described: as an agent (the pain comes and goes, it attacks), or as a possession (I have this headache...). Dr Lalouschek stated that ‘there is no language of pain’; this expression (“language of pain”) is to be seen as a metaphor.
Dr Sator emphasised the constructive character of pain, and its quality to demand an attribution of meaning.Pain, she argued, is a communicative, interactive, culturally and socially influenced phenomenon. It is constructed in social situations, in talking about it with peers, family members, doctors, etc. It is while talking that meaning is attributed — which, to her judgement, is the central aspect of pain.
The next phase of my researchtook me to various institutions and experts in Vienna. I arranged interviews with Professor Sabine Sator-Katzenschlager, head of the Pain Clinic at AKH Wien (Vienna General Hospital), and with Dr Monika Gratzer, anaesthetist and psychotherapist in training, who offers a weekly therapy group for patients with chronic pain. I also made an appointment with Dr Wagner, who works as an anaesthetist and acupuncture therapist at the interdisciplinary Pain Clinic at Hietzing Hospital, and I was able to arrange a talk with the patient leader of a chronic pain self-help group in Vienna, Susanne Fiala.
Prof. Sator-Katzenschlager'sanswer to my first question, "What is pain for you?", came like a shot: "Mental suffering!’ When asked if she thinks that a world without pain would be desirable, she said: ‘Yes, of course. The insight pain offers can also be achieved with other means. We do not need pain to be aware of the value of life. We can find other tools and methods.
Dr Monika Gratzer told me that she thinks that we live in a ‘society of anaesthesia’: We all want to be young, healthy, fit, strong; pain has no place in this picture. She also told me that her patients are motivated to join her weekly therapy group by the possibility of sharing their pain, of talking about it, as well as find a community and a forum for social interaction, as pain tends to lead to social isolation.
Susanne Fiala, leader of a chronic pain self-help group, invited me to her apartment for a talk. She explained to me that pain for her is something that determines her whole life: everything else has to line up behind it. She told me: ‘All the things I want to do depend on how the pain is at the moment. So it is “a living in the now”; you can't plan anything. So pain is life-determining.’ She also said that pain is hard to put into words, but that she has a very vivid image of her personal chronic pain. She believed that the greatest issue for chronic pain patients was ‘being taken seriously’. The doctor should be able to listen, she continued, and he/she should take the patient seriously.
In the interdisciplinary Pain Clinic of Hietzing Hospital, I interviewed the anaesthetist and acupuncture therapist Dr Wagner. My first question was, as always: ‘What is pain for you?’, to whichhe answered: ‘suffering’. When I asked him if he thought that a world without pain would be desirable, his quick answer was: ‘Of course —’, pausing before continuing,‘But stop: this is one of these questions that seem to be simple, but if you think about it, they are not. What would my life be without the experience of pain? What would it mean for my personal development, for the trajectory of my life, if I had not made the experiences of pain that were part of it? I don't know. I really don't know. So my answer is: I am unable to answer this question.’
Brief summary of my conclusions from the PAIN TALKS
Pain is existential. It is an experience; it is always part of story. Pain is closely connected to our human condition; it is the feature of life that tells us we are vulnerable; we are fragile; we are mortal.
Pain is a force; it is something one cannot ignore; it is always a call to stop, to reflect, to question oneself; it makes us question life and the world.
Pain makes us humble, inducing sympathy and compassion for all living creatures. Pain shows us our limitations, but also our capability to go beyond our limits, to outgrow ourselves.
But pain can also be crushing, deeply distressing, putting us in a state of hopeless despair. Then the Others are in demand, then it is time for caring.
IV.III Second field study: pain observations
An important part of my pain research was the performance of observations in casualty departments (trauma departments) at two big Viennese hospitals (the AKH Wien, or Vienna General Hospital, and the UKH Meidling, or Meidling Accident Hospital).
For this endeavour, I made use of a method of ‘naturalistic non-participant observation’, a method that requires the observationof participants in their natural setting without interference by researchers. Researchers should be inconspicuous and do nothing to change the environment or behaviour of the participants. Before beginning with the observation the way of sampling has to be defined.
But, before beginning my observations, the way of sampling has to be defined. For these two experiments using naturalistic non-participatory observation, I used atime-based sampling method. The observations were limited to one hour in the morning on a weekday. In accordance with this time-based sampling, I also applied an event-based sampling method, focussing on non-verbal pain behaviours as defined and described in the CNPI.
The Checklist of Nonverbal Pain Indicators is a common tool for pain assessment in healthcare contexts. It comprises six categories:
- Vocal complaints: nonverbal (sighs, gasps, moans, groans, cries)
- Facial grimaces/winces (furrowed brow, narrowed eyes, clenched teeth, tightened lips, jaw drop, distorted expressions)
- Bracing (clutching or holding onto furniture, equipment or affected area during movement)
- Restlessness (constant or intermittent shifting of position, rocking, intermittent or constant hand motions, inability to keep still)
- Rubbing (massaging affected area)
- Vocal complaints: verbal (words expressing discomfort or pain, e.g. ‘ouch,"that hurts’; cursing during movement; exclamations of protest, e.g. ‘stop’).
The instruction says: ‘Score “0” if the behavior was not observed. Score “1” if the behavior occurred even briefly.’
As a result of these experiments, I obtained two observation protocols with entries following the requirements of the ‘naturalistic non-participant observation’ method, including the categories of the CNPI, in order to chronologically record these occurrences in trauma departments during one hour on a weekday.
But I also I conducted a third observation: This time I applied a method I designate ‘self-reflective observation in the mode of seeing/feeling’. With this term I draw on the notion of ‘empathic vision’, coined by art theorist Jill Bennett, who describes a ‘radical mode of seeing and feeling' that places empathy at the heart of affective responses to images of pain and suffering. The style of observation I suggest with this method takes into account the fact of being a living entity withfeelings, with a history, and the fact of being a human amidst other humans, a body among other bodies — gathered at a particular time in a particular place, and therefore taking part in a ‘collective event’. This latter fact makes it impossible to conduct something like a ‘non-participant’ observation.
In regard to the demand for objectivity in scientific thinking, and to pain as a medium of knowledge production, philosopher Friedrich Nietzsche noted:
We are no thinking frogs, no objective recording devices with numbed intestines – we have to give birth to our thoughts out of pain.
Accordingly, my method is based on being aware of both the outside and the inside world, and takes both into account simultaneously. It reflects all three factors described above (being a living entity with feelings, being an individual with a personal history, and being a human amidst other humans) during perception and processing of multimodal in- and outputs in a specific environment, under a specific focus, and during a defined period of time.
Next section: V. CUTTING UP – ASSEMBLING PAINS