Book Review by Jennifer Bracken Scott
Edited by Deborah Padfield and Joanna M. Zakrzewska
UCL Press, 2021
Full text of book is available online at https://discovery.ucl.ac.uk/id/eprint/10120621/1/Encountering-Pain.pdf
Pain is an important indicator that something is wrong in the body. But pain is also invisible and immeasurable to anyone besides the patient; while an observer might gather from a visible injury or by someone’s movements, facial expressions, and utterances that they are experiencing pain, there is no scan or test that can tell a healthcare provider how much and what kind of pain a patient is experiencing. When there is no visible injury, treating pain is particularly challenging, in no small part because it can be difficult for patients to articulate the nature and degree of their pain through language, to render their experience legible.
Encountering Pain: Hearing, Seeing, Speaking attends to the difficulties of experiencing, understanding, and addressing pain, and it does so by bringing together perspectives from a variety of disciplines. Its contributors bring expertise from the medical humanities, art, history, health policy, anthropology, neurobiology, and more to investigate the personal, biological, and cultural meaning of pain. The collection shares with its readers the experience of participating in the Encountering Pain conference, a two-day event held at University College London in 2016. Through a combination of scholarly writing, artistic photography, poetry, and narrative, it suggests that we ought to use a variety of creative approaches to enable those with chronic pain to articulate their experiences, not only through verbal language but through images.
The case for a visual approach to understanding pain is largely made through discussions of editor Deborah Padfield’s Face2Face project, the findings of which strike me as the book’s most important contribution to conversations in the medical humanities. Through the Face2Face project, Padfield collaborated with several individuals with trigeminal neuralgia, a condition causing chronic facial pain, to create a collection of photographic images that visually represent the experience of pain. The fifty-four resulting images were made into a set of printed, laminated cards called PAIN CARDS and were used to study whether visual representations of pain might foster more productive, egalitarian conversations between doctor and patient. The notion here is that unlike more reductive representations of pain, such as a scale of one to ten, images are richer and more open to interpretation, and thus may invite deeper conversations about the nature and severity of a patient’s pain and its consequences.
To conduct their study, Padfield and her research team arranged for clinicians to film consultations with first-time patients, a group of whom were provided with the deck of PAIN CARDS before their consultation. These patients were asked to select any images that they felt accurately represented their pain experience. Members of Padfield’s research team analyze the results of the consultation in several of the book’s chapters. Art psychotherapist Helen Omand argues that the images function as transitional objects, occupying a space between the patient’s internal experience and the clinician’s understanding; she sees them “forming a middle ground between patient and clinician, where aspects of the patient’s self could be explored and thought about” (100). Elena Semino uses a combination of qualitative and quantitative linguistic analysis to observe that patients who used the PAIN CARDS spoke more and made deeper emotional disclosures than those who did not. Amanda C de C Williams’s study of nonverbal behavior in the interactions reveals that clinicians more frequently expressed empathy through their body language when the cards were in use. While the authors are careful to explain that more research will be needed to determine whether the use of PAIN CARDS results in better long-term outcomes for patients, the images seem to improve the quality of the initial patient-clinician interaction.
In addition to the chapters analyzing the results of the PAIN CARDS study, the collection benefits from including the voices of individuals who participated in Face2Face, allowing them to share their experiences with trigeminal neuralgia as well as their processes of creating images to represent their pain. These firsthand accounts provide important context to the project, a context that is often missing from academic research. Other noteworthy chapters include selections by well-known narrative medicine scholar Rita Charon, an insightful interview on the nature of pain with neurobiologist Maria Fitzgerald, and Preeti Doshi’s chapter on the unique challenges of addressing pain in India as its elderly population increases.
The collection may have benefited from a more comprehensive editing of the chapters; readers may notice some repetition between chapters as different authors explain the Face2Face project and the process of creating the PAIN CARDS. However, the collection does have a logical organization schema, and each selection makes a unique contribution to its overall goals. It is also worth noting that Encountering Pain is available as an open access text in PDF format, making its content widely available, though I personally found this version to be a little difficult to use. For those who don’t wish to navigate the PDF version, a physical copy of the book is available for purchase online, and a Kindle version—the version I chose to read for this review—is very affordable at a cost of less than five U.S. dollars. Readers who purchase a Kindle version will likely want to access the open-access PDF version to examine the images and visual components of the book in full color.
Encountering Pain is a thoughtful and thought-provoking text on the subject of chronic pain, and it makes a meaningful contribution to discourse in the medical humanities. Most importantly, it invites further research into strategies for integrating medicine and the arts for the benefit of patients and clinicians alike.
Dr. Jennifer Bracken Scott is an Associate Professor of English & Humanities at Shawnee State University.