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, 296 pages

11 halftones, 4 line drawings

April 2014



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A Political History

Keith Wailoo examines how pain and compassionate relief define a line between society's liberal trends and conservative tendencies. Tracing the development of pain theories in politics, medicine, and law, and legislative and social quarrels over the morality and economics of relief, Wailoo points to a tension at the heart of the conservative-liberal divide.

Beginning with the advent of a pain relief economy after World War II in response to concerns about recovering soldiers, Wailoo explores the 1960s rise of an expansive liberal pain standard, along with the emerging conviction that subjective pain was real, disabling, and compensable. These concepts were attacked during the Reagan era of the 1980s, when a conservative political backlash led to decreasing disability aid and the growing role of the courts as arbiters in the politicized struggle to define pain.

Wailoo identifies how new fronts in pain politics opened in the 1990s in states like Oregon and Michigan, where advocates for death with dignity insisted that end-of-life pain warranted full relief. In the 2006 arrest of conservative talk show host Rush Limbaugh, Wailoo finds a cautionary tale about deregulation, which spawned an unmanageable market in pain relief products as well as gaps between the overmedicated and the undertreated. Today's debates over who is in pain, who feels another's pain, and what relief is deserved form new chapters in the ongoing story of liberal relief and conservative care.

People in chronic pain have always sought relief—and have always been judged—but who decides whether someone is truly in pain? The story of pain is more than political rhetoric; it is a story of ailing bodies, broken lives, illness, and disability that has vexed government agencies and politicians from World War II to the present.

Keith Wailoo is the Townsend Martin Professor of History and Public Affairs and Vice Dean of the Woodrow Wilson School of Public and International Affairs at Princeton University. He is author of The Troubled Dream of Genetic Medicine: Ethnicity and Innovation in Tay-Sachs, Cystic Fibrosis, and Sickle Cell Disease and Drawing Blood: Technology and Disease Identity in Twentieth-Century America, and he is coeditor of Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine’s Simple Solutions, all published by Johns Hopkins.

"Physicians and social scientists are aware that individual pain is complex and elusive—an aggregate of physiology, cultural context, and idiosyncrasy. Wailoo has added a significant analytic dimension to this understanding of pain by incorporating the domains of ideology and politics as they are reflected in policy. A highly original and persuasively argued contribution by one of America's most prominent historians of medicine and society, Pain will attract a wide and thoughtful readership."

"Wailoo's ambitious volume tells post–World War Two American political history through the story of pain: its cultural meanings, economic costs, and bureaucratic management and its political uses and abuses. No other work I know of sustains such a macro-analysis while attending to pain's medical, moral, and media significances. And reading it hurts not—and for policy makers might even be therapeutic! Bravo!"

"At once capacious and focused, Pain expands on the cultural histories of this compelling topic by admirably developing the political construction of the elusive and yet ever-so-material experience of pain. The politics of pain, disability, medicine, and suicide emerge as Wailoo’s book ranges across the rhetoric of a 'bleeding heart' liberal to the conservative uses of rugged individualism in relation to the pharmaceutical industry."

"In this remarkable book, Keith Wailoo explores the long American struggle over pain. Liberals feel your pain. Conservatives fear entitlement and welfare. Wailoo traces the conflict from the battlefields of World War II to the rise of deregulation, from fetal pain to OxyContin. Beautifully written, broad ranging, deep, wise, unexpected, and endlessly fascinating."

"I wasn't sure what a palliative care doctor was doing reading about the political history of pain, but I soon found it hard to put down... Anyone who works in palliative care and has a broader interested in the political and legal aspects of pain management and physician-assisted suicide will enjoy this book."

"This book should be read by patients, clinicians and policy makers who wish to understand the recent past to guide future advocacy, public engagement and policy as we seek... to change the way chronic pain is perceived, managed and judged -- for the betterment of all."

"A deeply felt and provocative history of the political uses to which pain has been put in modern America."

"Will surely bring to mind the aphorism of Santayana, that those who ignore history are doomed to repeat it. But it does so much more: If we want to understand the origins of terms such as 'welfare queen' and 'entitlements for the undeserving' and 'givers versus takers,' we need look no further that Pain: A Political History."

"This well-rounded discussion of the politics of pain and pain relief in post WW II America is an approachable resource for readers from many disciplines and backgrounds... This book would be a good political entry point for scholars in sociology and medical humanities, and medical practitioners. Readers in political science and public policy will find this a good topical summary of pain management laws and movements."

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