Are there "liberal" and "conservative" views on pain that correlate with liberal and conservative views on other stuff?

"Pain is the most vivid experience we can never quite describe, returning us to the wordless misery of infancy."

-- Melanie Thernstrom, in The Pain Chronicles

by Ken

So you've had a great weekend, right? And you're just rarin' to get back to the workplace tomorrow for another week of stimulating and productive and of course generously compensated labor, right?

What better time could there be for some seriously jolly chat about pain?

I think it's a subject that's likely to be of interest to just about everybody, and when two people with both serious interest and serious credentials have a conversation about it, there's a good chance that interesting things are going to be said, which I think is the case with the conversation presented to us by The American Prospect, whose interest was drawn by the extension of the subject of pain into the political zone. So the piece comes to us under the title "The Politics of Pain," edited and presented by Amelia Thomson-DeVeaux.

I'm going to leave it to her to introduce us to the participants, as she introduces the edited version of the dialogue.

In the spring of 1992, as the contentious Democratic primary ground to a close, Bill Clinton was speaking at a rally in New York City when an AIDS activist accused him of ignoring the ongoing HIV epidemic. Uttering four words that epitomized his campaign style, Clinton told the activist, “I feel your pain.”

Clinton’s remark was widely mocked by conservatives who believed that bleeding-heart liberal policy, under the pretext of compassion, was creating a culture of dependence. In his new book, Pain: A Political History, Keith Wailoo argues that over the past 60 years, sparring over what constitutes pain, who can judge pain, and how the government should mete out treatment has elevated our maladies into fraught political concerns. Pain resists measurement, raising questions about whether sufferers can be trusted to evaluate their own distress. Conservatives worry that chronic pain is a symbol of underlying social maladjustment, while liberals seek to put the means of relief into patients’ hands. Should pain count as a disability? Does relief encourage fraud and addiction? Wailoo, the Townsend Martin Professor of History and Public Affairs at Princeton University, contends that the politics of pain has morphed beyond rhetoric into an enduring partisan divide.

In 2010, Melanie Thernstrom wrote about physical suffering in The Pain Chronicles, a book that is simultaneously a memoir of her own experience of chronic pain, an exploration of the scientific foundations of pain, and an expansive record of pain’s cultural meanings. She explores the paradox of pain: Impossible to articulate, it is a defining and unifying element of humanity. “Pain is the most vivid experience we can never quite describe, returning us to the wordless misery of infancy,” she writes. Whose pain is real—and whose pain can be cured—are questions that have reverberated for generations.

Wailoo and Thernstrom’s exchange has been edited for concision and clarity.

I'm going to leave it to you to decide how much you want to pursue this conversation, which I confess both intrigues me and leaves me unsatisfied. Officially both participants seem to be talking about physical pain, but in the discussion what I'm hearing seems to intermingle indiscriminately physical and emotional pain, which I expect the experts would tell us have similarities and differences, but those similarities and differences constantly leave me feeling that once the discussion veers into the political sphere, I'm not really confident that it really means what the speakers think it does.

That said, I thought you might be interested in two samples that are clearly of interest to anyone engaged in current-day politics.


FIRST WE HAVE AN OVERVIEW OF THE WAY
PAIN MAY BE REFLECTED IN POLITICAL VIEWS

MELANIE THERNSTROM: Your book traces the evolving politics of pain, suffering, and disability—how we as a society evaluate people’s pain, whether it’s real and worthy of treatment and social support, beginning with the story of wounded veterans from World War II. How do we think about pain in a political sense? What is the “liberal” or “conservative” attitude toward pain?

KEITH WAILOO: You can begin to understand that divide through caricatures that have developed over the years. Liberals believe in compassion toward others—they believe that subjective claims about pain ought to be taken seriously and endorse broad-minded approaches to relief. Conservatives believe in stoic, grin-and-bear-it approaches to pain. They believe people should push through pain despite discomfort in order to get back to work. They also tend to critique this bleeding-heart, overly compassion--oriented society as lacking objective criteria for judging the pain of others, which leads society in a terrible direction of increasing dependency and welfare. To some extent, these caricatures hold up. Liberal eras like the 1960s and 1970s did produce innovations like patient--controlled analgesics, which essentially said, regardless of whether you believe a patient is in pain, just hand them a morphine drip and have them determine what level of relief they deserve. But then sometimes they don’t. You have President Dwight Eisenhower, who’s a Republican and signs the first disability act within Social Security in 1956. Or you have President Jimmy Carter’s attempts to roll back the growth of disability benefits.

NOW WE HAVE THE INTERESTING QUESTION OF
HOW THE POLITICS OF ABORTION FIT IN, OR DON'T

MELANIE THERNSTROM: One interesting reversal from the stereotypes—that liberals are compassionate and conservatives aren’t—that you write about in the book is the conservative notion that a fetus can feel pain during an abortion. It’s hard to believe that this position can get anywhere, because there’s a strong scientific consensus that a fetus doesn’t experience pain in the way that people do. The parts of the brain like the limbic system that allow humans and other higher mammals to generate an experience of pain and suffering haven’t developed in a fetus.

KEITH WAILOO: So much of the discourse surrounding pain has limited scientific foundation, and the question of fetal pain is one of the best contemporary examples. That contention—that the fetus feels pain—is extraordinarily politically powerful. In conservative religious states, part of the effort to roll back access to abortion involves these requirements that women be told that the fetus can feel pain before they can proceed with the abortion. In the book, I explain where the idea of fetal pain originated. It goes back to the Reagan years. A film released in 1984 called The Silent Scream argued that the fetus screams—and feels pain—during an abortion. It’s that political contention that drives the fetal-pain debate. Certainly based on what we know about fetal development, neurological development, and the physiology of pain, there is no scientific basis for this claim. But little of this cultural politics of pain revolves around actual science. Here was a president who was being bashed by liberals for ignoring people in pain, and this allowed him to say that he did feel compassion for a particular class of “person” and a particular kind of pain. It became an important and effective political argument regardless of the scientific underpinnings.

I GUESS WHAT I KEEP THINKING HERE --

is that while the subject seems to be attitudes toward pain, it maybe would rather be about other things, things which drive those attitudes. Note, for example, that the "reversal from the stereotypes" reflected in the opposite liberal-conservative application of pain attitudes to abortion is strikingly similar to the reversal that's reflected in attitudes toward "life." Just as the only pain that seems to interest conservatives is fetal pain, the only "sanctity of life" they seem to revere is the fetal kind. Once the child is born, neither its life nor its pain seems to be of interest to the right-wing holier-than-thous.

It remains a fascinating subject, or subjects, this business of pain and suffering, and it's one that doesn't get talked about much. We have to start somewhere, and both of these authors clearly have a great deal to say about the subject, which might be interesting to explore in their own presentations.

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Paul Ryan-- The Prince Of Pain

I'm retired now. All the work I do is volunteer work. And the sun never rises before I'm up and working. Before I retired I was the president of TimeWarner's Reprise Records, home of Green Day, Eric Clapton, Joni Mitchell, Neil Young, Depeche Mode, Wilco, Fleetwood Mac, Morrissey, Lou Reed, Frank Sinatra, Barenaked Ladies, Cher, Enya, Josh Groban, Erasure, Rickie Lee Jones, Steely Dan, Chaka Khan, and dozens of other artists. I didn't work any harder then than I do now. And before that I started my own independent record company, 415 Records, which I eventually sold to CBS. That was hard work too.

I've written a lot about what I did before my days in the record industry. I have a whole blog devoted to my travels around the world and before I started 415 Records I was tamping around Europe, Asia and Africa for nearly seven years, right out of college. I spent time in Essaouira with Jimi Hendrix, smuggled kif out of the Rif Mountains into Spain so I could finance a trip to India, a trip that brought me to Iran, Afghanistan, Pakistan, Nepal, Sri Lanka and every corner of India. And eventually settled down in Amsterdam to work in a meditation center. I learned more-- and more useful stuff-- on that sojourn than in my 4 years at university. That trip, in fact, eventually, led to me winding up as president of Reprise, a job that paid 7 figures. But when I washed up in San Francisco in the late '70s my net worth was barely seven dollars.

Maybe I would have found food some other way-- scavenging? a life of crime?-- but without food stamps I would never have been able to start 415 Records and launch my career in the music business. That I know for sure. I've literally paid well over a million dollars in federal income taxes since then. A pretty good investment for the federal government.

Thursday, just after it passed the House by a surprisingly narrow margin, we looked at why the American Catholic Bishops have decried Paul Ryan's heartless budget as anathema to the teachings of Jesus Christ. It's a budget premised on the kind of pain conservatives feel compelled to inflict on poor people "for their own good." In Paul Ryan's world-- a world of grubby inheritance and corporate indulgence and sell-out-- pain will forge "them" into better citizens. In Ryan's world "the social safety net represents a moral threat to Americans’ character, as well as a fiscal threat to their country’s budget."

He’s incessantly warned of luring “able-bodied people into lives of dependency and complacency” and depriving them “of their will and their incentive to make the most of their lives.” In his latest budget, he introduced his cuts to Medicaid, nutrition assistance, and other support programs for low-income Americans with a warning that the safety net “can create a powerful disincentive to get ahead.”

Included in those cuts is a massive reduction in spending on the Supplemental Nutrition Assistance Program (SNAP). But the Center On Budget and Policy Priorities took a look at the employment situation of Americans who rely on the program, and the reality belies Ryan’s rhetoric:

Among households with children that include an adult who isn’t elderly or disabled, 87 percent of the households receiving SNAP in a given month include an individual who worked in the prior year or will work in the following year.

Ryan actually has an ongoing problem when it comes to honestly representing the SNAP program. Last year, he claimed it was “growing at unsustainable rates”-- a notion that fails to account for the effects of the recession, that fails to differentiate spending in raw dollars from spending as a share of the economy, and which utterly ignores the program’s projected path over the next decade.

Ryan’s budget would cut SNAP spending by $135 billion between now and 2023-- requiring either 12 to 13 million of the 44.7 million people currently on the program to be kicked off, or a reduction in benefits of $190 a month for the poorest of American families by 2019. Nor did the 1996 welfare reform law-- on which Ryan models his current budget proposals-- turn out to be the success he presents it as. In the aftermath of the Great Recession, welfare’s case load grew only 16 percent, even as the numbers of the unemployed increased by 88 percent; an utter failure to keep up with the needs of impoverished Americans.

As for the safety net as a whole, CBPP cites research from the National Bureau of Economic Research that one of every seven Americans would be poor without the safety net, but are above the poverty line because of it-- a total of over 40 million people.

But Ryan and the Republican Party do not believe in investing in the American people. They believing in protecting the gains of the wealthy few-- even though Ryan himself-- like his idol, Ayn Rand-- personally subsisted on government aid for many years when they needed it to scrape by.

Harriet Beecher Stowe's loss and Ian Welsh's pain

"When the couple's son Charley died, in 1849, at eighteen months, [Harriet Beecher] Stowe began, as [author David S.] Reynolds writes, her 'fixation on Jesus Christ as the humble sufferer, the grand symbol of the burdens borne by the lowliest members of society.' She explored this theme in a number of short stories and, of course, in Uncle Tom's Cabin, when she portrayed the title character, an enslaved man, as a Christ figure. She said that losing Charley made her understand 'what a poor slave mother may feel when her child is torn away from her.'"

-- Annette Gordon-Reed, in "The Persuader: What Harriet Beecher Stowe wrought," in the June 13 & 20 New Yorker

"When I was a young man I spent a lot of time really sick, and in a pile of pain. It’s not an exaggeration to say I’ve spent days screaming. It’s one of the reasons I have so little tolerance for anyone who excuses torture, or for anyone who stands in the way of effective healthcare, including effective pain medication."

-- Ian Welsh, in a June 2 blogpost, "Pain"

by Ken

I've been meaning for a while now to write about, or more importantly to direct you to, a remarkable post of our friend Ian Welsh. The nice thing about writing that engages meaningfully with the world around us is that it tends to age ever so gracefully -- as opposed to the psychotic blitherings of, say, Charles Krauthammer, which already reek of primordial ooze by the time he punches "send" on his word processor. And I had a feeling this post of Ian's, in which he relates some surprising and obviously painful (in a variety of senses) personal history would hold up pretty well.

And then I was reading Annette Gordon-Reed's review-esssay "The Persuader: What Harriet Beecher Stowe wrought," in the June 13 & 20 The New Yorker (unfortunately, only an abstract is available free online), taking off from David S. Reynolds's book Mightier Than the Sword: "Uncle Tom's Cabin" and the Battle for America.

Gordon-Reed begins with a provocative question:

What does it take to persuade -- to move people from one position to another, or to get them to care about an issue that has never stirred their interest? How do you get a critical mass of people to believe that a dispute affects their visions of themselves as individuals and the world in which they live?

She goes on to point out that however badly polarized American society is today, we've had it worse.

Between 1861 and 1865, Americans did more than hurl verbal brickbats across the political divide; they fired cannons and rifles, killing one another in astonishing numbers. And they did so, in part, because a large number of Americans had been persuaded that they could not live in a country that countenanced slavery.

Uncle Tom's Cabin, she writes, was "one of the most successful feats of persuasion in American history."

Stowe's novel shifted public opinion about slavery so dramatically that it has often been credited with fuelling the war that destroyed the peculiar institution. Nearly every consideration of Stowe mentions that Abraham Lincoln supposedly said when he met the diminutive New Englander: "Is this the little woman who made this great war?"

I'm not going to try to synopsize the tales Ian Welsh has to tell of his extended life of agony, which I hope you'll want to read for yourself. For the moment I'm interested mostly in the connection he makes in the part of the opening paragraph I've quoted up top between his own experience of extreme pain and his personal stake in opposing torture and supporting access to adequate health care.

"Pain is one of the reasons," Ian writes, "I believe there is no such thing as a personally interested omnipotent benevolent God,"

because what I know about pain is this: you can experience titanic levels of pain for far longer than you can experience the same level of pleasures. The idea that pain is entirely is adaptive is laughable, because pain very quickly gets to the point of incapacitation, and someone who’s incapacitated can’t help themselves.

He offers us four aphorisms about pain he wrote down when he was about 25:

No matter how much pain you are in it can always get worse.

Pain comes in infinite varieties: each type is different.

All other things being equal mental pain is worse than physical.

The human capacity for pain is infinitely greater than the human capacity for pleasure.

Ian has another large point to make, and that's about the management of pain, or rather the all too common failure to manage it. His surgeon during his hospitalization, for example, was convinced that he was "a malingering little shit" who was just trying to scam pain meds. And then one doctor sized up the situation correctly and took on the weighty burden of responsibility for providing medical relief.

’ve always known, since then, that some good people exist. There aren’t very many of them, most people are chickenshit, too weak to be good or even truly bad, but they do exist. And I know the price that good man paid, I heard him talk about his daughter, who he hardly ever saw, because he put his patients first, and I saw the regret he had. And that he understood that when someone was screaming in pain, crying brokenheartedly or puking up blood, you know what, they come first. And no, you can’t just assume someone else will do it if you won’t, because most people are weak, and most people won’t do it when push comes to shove.

But to come back to my original point, there's something unstated that caused Harriet Beecher Stowe in the agony of her loss and Ian Welsh in his just plain agony to relate their suffering to that of others. There are a lot of people, very likely most people, for whom, under such conditions, it would be all about them.

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