Last updated: Wed, Jun 26, 2024
Keith Wailoo's book "Pain: a political history" chronicles political issues surrounding pain primarily since the Second World War. If you lived through this period, I hope the review will remind you how pain has appeared in American political dialog. If you didn't, it should inform you that pain has been present in political discourse largely linked to issues of responsibility, cheating, and drug abuse. This summary can't approach the detailed panoramic view Mr. Wailoo presents. I recommend his book to you.
Pain was in the public eye prior to World War II. Modern anesthesia began in the 1840s with the use of ether and nitrous oxide. The new techniques created a popular stir and stimulated discussion about pain, race, and gender. The well-to-do, women, and Anglo-Saxons were said to have a higher sensitivity to pain, while Native Americans, the poor, and blacks were characterized as constitutionally less sensitive to pain.1
In 1926 an American doctor confirmed that prizefighters, Negroes, and American Indians, as groups, failed to react to noxious stimuli of intensity great enough to induce reaction of discomfort in the average white city dweller.
2 Hmm.
Political discussion of pain was energized by changing demographic and social conditions and legislative activity in the years following the end of World War II. The introduction of antibiotics during the war and the increasing success of vaccines following it began a gradual shift of medical concern from infectious death and damage to chronic disease. The post-war Democratic legislature was pushing for universal healthcare against conservative concerns about expanded government. The AMA was an often strident voice from the conservative side of this debate, in which the doctors had a direct financial stake. (See Pain, Will, and Responsibility)
The Bradley Commission on Veterans' Pensions, chaired by WWII general Omar Bradley, was chartered by President Eisenhower to look at the problem of the vastly increased cost of the Veterans' Administration. WWII veterans continued to age, and a new cohort of entitled veterans emerged from the Korean War. The number of veterans receiving disability payments or pensions increased from about half a million in 1945 to three million by 1960. In 1958, VA disability compensation cost $1.4 billion for two million veterans.3 The concept that the nation owed its veterans support for service-related disabilities was widely agreed upon. The role of pain in disability was not.
At this time pain science was primitive (the gate-control model wasn't proposed until 1965). Policy relied heavily on the ideas of doctors who had returned from the war with experience treating soldiers with severe acute injuries from battlefield and other service-related trauma. Many of these doctors had been surprised to observe soldiers with severe recent wounds who seemed cheerful, alert, and untroubled by pain. A common explanation for this phenomenon was that, while a civilian with a severe injury was suffering a misfortune, a soldier with comparable injury was experiencing his deliverance. Non-military doctors of this era freely voiced similar opinions, asserting a large role for the psyche in pain:
Speaking at a pain symposium in San Francisco in 1957, [California psychiatrist Henry Albronda] grouped migraine headache, cardiospasm, and low back pain with all these vague "problems of psychogenic pain."....Compassion only made people in chronic pain complain more, he insisted....."In most families," Albronda stated to his colleagues at the pain symposium, "the young child soon learns that his cries of pain bring solicitude, and later he runs to his parents for comfort whenever he is hurt." Whether in the family or in society, providing impulsive relief for every complaint was deeply misguided.4
The doctor advised his colleagues:
"Listen without anger to the patient's undue complaints and gain his confidence," Albronda urged. But also "understand that unwise probing, injecting, massaging...in trying to relieve pain that is psychically perpetuated serves to fix the neurosis and lessen the chances for cure."5
An epidemiologist proposed that "repressing" anger made men subject to arthritis.6 (Perhaps this was based on the clear evidence that arthritic men are angry?) As the 50s gave way to the 1960s there was increasing interest in the impact of social modeling (learning) on pain perception. Children could be spoiled by excessive sympathy or indulgence to have a permanently lowered threshold for complaint.7
The Bradley commission polled some 150 prominent medical doctors and found that the doctors' concerns extended beyond medical issues to issues of fairness and political philosophy. For a substantial minority (over 40 percent) of the doctors, accepting pain as a disability grated against their views on fairness, feasibility, and human duplicity as well as the male soldier's adaptability to hardship. Pain was easily feigned, and its features were 'vague, subjective, readily simulated [by deceitful claimants], and difficult to evaluate.'...Rather than accept immeasurable pain as a reality that might throw their commitment to medical objectivity into doubt, many chose instead to doubt there could be such a thing as disabling pain....'
8
In 1956 President Eisenhower signed into law the Social Security Disability Insurance (SSDI) program. By the time of the Reagan presidency, this new program would be seen by some as an invitation to dependency or a haven for cheats. Upon passage of SSDI, Dr. Louis Orr, chairman of the AMA's Committee on Medical Service, published an essay declaring that between the SSDI and the VA, political decision-makers had created a Trojan horse of ominous dimensions
which would lead to Socialized Medicine and Socialism by way of the Veterans Administration.
9
Medical critics of these programs pointed to studies that in their minds delegitimized compensation for large and apparently well-defined classes of ailments. Psychiatrist Henry Albronda claimed that studies showed the prevalence of psychosomatic backaches caused by anxiety and "nervous energy" in wartime. Other studies, he said, showed that all patients who complained of phantom limb pain had considerable psychopathic disturbances...Men who had dominant psychopathic traits and reacted poorly to their disability tended to be more demanding and complaining than those with sound personality before the injury.
Referring to chronic painful conditions in general, masochistic self-punishment underlies [the] chronic painful condition.
Over-mothering in childhood was the true cause of many pain complaints. The complaint might develop in the child who secretly enjoys seeing the punishment of siblings, then punishes himself by fantasy for enjoyment....
10