All In Your Head

by Mara Buchbinder, author of All in Your Head: Making Sense of Pediatric Pain


This guest post is published as part of a series of author interviews in relation to the American Anthropological Association conference in Denver this past November.

How can anthropology add to our understanding and engagement in the study of chronic adolescent pain?

One of the puzzles of pediatric pain is why its incidence rises so sharply during adolescence. Approaching this puzzle from a purely biological perspective can give us one set of plausible explanations. For instance, some have theorized that the hormonal changes that occur during adolescence contribute to pain etiology. But an anthropological perspective can open up a host of additional explanations, tapping into a range of cultural factors that make adolescence a particularly challenging life stage. For many middle-class Americans, adolescence is marked by mounting academic pressures, increasing extracurricular demands, turbulent peer relationships, engaging in risky behaviors, and sometimes troubles at home. Now, pain medicine has actually done a remarkably good job of acknowledging the wide range of factors that contribute to chronic pain; the “biopsychosocial” model has been a dominant paradigm in the field for many decades. However, anthropology offers a particularly valuable set of methodological and analytic tools for attuning our attention to how pain fits into everyday life. In short, anthropology can help to operationalize a biopsychosocial approach to the study of chronic pain by situating it within an ethnographic context.

How do you suggest we improve the language of how pain is explained to patients?

If anything, I think my research has taught me that clinicians are actually quite good at explaining pain through creative metaphors and explanatory models. Many of them don’t reflect on their explanatory approaches unless explicitly invited to do so, however—such as when prompted by a nosy anthropologist. Like many aspects of clinical medicine, explaining pain is something that is more like an art than a science, and is typically acquired through immersive experience. If there is room for improvement, I think it might come in making more of a clearly defined space for pain in medical school curricula. Pain treatment faces the challenge of not belonging to a single organ system, which makes it harder for particular curricular units to lay claim to teaching about it. (It faces a similar challenge, incidentally, with respect to research funding from the National Institutes of Health.)

What challenges did you encounter while conducting research and interviews?

As an anthropologist ‘at home’ in the field, one of my biggest challenges was in figuring out how to delimit the field. On days when I stayed home trying to schedule research visits or waiting for families to return my phone calls, it often didn’t feel much like fieldwork. It also took me a bit longer to recognize certain local events as critical to my research. For example, I launched my project in the fall of 2008, just as the subprime mortgage crisis was coming to a head. It didn’t become clear until later on how much the national economic climate was influencing the experiences of families in my study—not only to the extent that it affected their ability to pay for treatments that were not covered by health insurance, but also in shaping adolescents’ aspirations and senses of possible futures. Anthropologists often warn students to write everything down early on in a project because ‘everything is data’ and I would agree with this advice, but I have found that it can be harder to recognize certain experiences as data when one’s field site is also one’s long-term home.

Mara Buchbinder is Assistant Professor of Social Medicine and Adjunct Assistant Professor of Anthropology at UNC–Chapel Hill. She is coauthor of Saving Babies? The Consequences of Newborn Genetic Screening..