Pain is incredibly hard to discern and understand. Chronic pain is even perplexing, argues Sarah Zhang, because it persists after an injury seems to have already healed.

Such “pain without lesion” has puzzled doctors for centuries, while the technological advances of the 19th century only opened up a whole new era of controversy, says the bioethicist Daniel Goldberg. “Objective” instruments like the X-ray rendered previously invisible injuries visible and seemingly helped doctors to see the “whole picture.”

“X-rays and other ‘objective’ instruments influenced controversies about whose pain should be believed,” says Zhang.

In “Pain, objectivity and history: understanding pain stigma,” Goldberg discusses the history of pain. While it’s “not true that 19th-century neurologists widely denied their patients’ pain experiences,” he told Zhang, there is “good evidence that belief in people’s pain experiences did follow social strata.”

“If you were a wealthy white man, you were more likely to have pain complaints believed in the 19th century, just as you are today. If you were person of color in the 19th century, in the southern United States, your complaints were much less likely to be taken seriously.”

But in pain and medicince, Goldberg suggests, believing is not always seeing. There is pain that exists and yet defies objective modalities to locate and study it.

Read more of this fascinating interview at The Atlantic

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