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A Sociological Investigation of Pain Medicine and Pain Clinics in India

Kaur Bhangu, Ph.D. Scholar, Department of Sociology, SoHSS; Faculty Advisor – Dr. Deepak Mehta

This is an ethnographic research on the emergence of pain medicine in India. The study focuses on medical therapeutics of chronic pain conditions among industrial labourers in West Bengal. It attempts to understand the sociality of pain, its presentations and linkages with production of specific kinds of bodies, personhood (subjectivity) and communities (collectives). Language, knowledge systems, bodily practices, and the technical procedures through which biomedicine produces and addresses pain lie at the heart of the investigation.

In its myriad presentations and encounters, pain operates as a lexeme. While it appears under a veneer of inexpressibility and incommunicability which has repeatedly been stressed by some thinkers (most significantly, Scarry 1985), it offers itself fleetingly as fragments, glimpses despite appearing among multiple avenues in social life. It resists definitions as different social settings render it visible under different conditions and often granting it not only diverse but sometimes contradictory statuses. Its presentations are intertwined with production of specific kinds of bodies, personhood (subjectivity) and communities (collectives). We find discussions of pain spread across the spectrum of social life from religious rituals to studies on violence, torture, law, aesthetic and artistic production, medical systems, labour and bodies. From the onset, this research study has been interested in exploring the sociality of pain. However, given pain’s myriad presentations, it limited itself to an exploration of pain in biomedical centres and therapeutic practices where at first instance pain appears to be marked with an aversive character. By situating myself within a medical institution in Kolkata, the research focused on the medicalisation of pain and resultant therapeutics through three questions- What is the nature of the field of pain medicine & what forms the anthropological field of investigation? Second, how is pain constituted as an object in this field and what are the conceptual/social grids within which it is discursively located and how do we trace these? Third, what are the material practices (epistemological frames, diagnostic and therapeutic procedures) through which pain is produced?

The proposed study was informed by a three fold preliminary investigation of, firstly, the anthropological literature on pain medicine and pain clinics, and historical accounts of the emergence of pain medicine in the United States and Europe. Second, an archival study of medical debates attempting to define and assess pain. Third, pilot fieldwork conducted over the course of seven weeks in April-May 2015 at three hospitals- two private hospitals in Hyderabad and a public health research institute and clinic of pain management in Kolkata.

Subsequently, between September 2015 and December 2016, fifteen months of fieldwork was conducted among medical practitioners at a pain clinic in Kolkata. The efforts of these experts were extensively recorded as they struggled to provide therapeutic assistance to sufferers of chronic pain among Kolkata’s industrial labour force. Multiple sites were included in this fieldwork: OPD clinics of rheumatologists, psychiatrists, psychologists, neurologists, oncologists and pain specialists; physiotherapists and physiotherapy clinics; diagnostic facilities including pathology labs and scan centres; operation theatres and the work of OT staff; hospital wards and the work of nursing staff; work spaces (eg. jute mills) and homes of the patients; and, the experiences of family members.

While the nature of fieldwork has been expansive and challenged many of my assumptions about the practice of pain medicine and the experiences of chronic pain sufferers in the country, the work before me now is of analysing my fieldwork through the ethnographic writing stage. I hope to address the analytical, theoretical and anthropological questions about pain’s sociality through my fieldwork observations and experiences. The work of language, experts, bodily practices, and technical procedures through which biomedicine produces and addresses pain form some of the dominant themes of my thesis.