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, 296 pages

11 halftones, 4 line drawings

April 2014



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A Political History

Keith Wailoo describes his book, Pain: A Political History, as part of the Robert Wood Johnson Foundation's What's Next Health Series

In this history of American political culture, Keith Wailoo examines how pain has defined the line between liberals and conservatives from just after World War II to the present. From disabling pain to end-of-life pain to fetal pain, the battle over whose pain is real and who deserves relief has created stark ideological divisions at the bedside, in politics, and in the courts.

Beginning with the return of soldiers after World War II and fierce medical and political disagreements about whether pain constitutes a true disability, 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, when a conservative backlash led to diminished disability aid and an expanding role of courts as arbiters in the politicized struggle to define pain. New fronts in pain politics opened nationwide as advocates for death with dignity insisted that end-of-life pain warranted full relief, while the religious right mobilized around fetal pain.

The book ends with the 2003 OxyContin arrest of conservative talk show host Rush Limbaugh, a cautionary tale about deregulation and the widening gaps between the overmedicated and the undertreated.

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 coauthor of The Troubled Dream of Genetic Medicine: Ethnicity and Innovation in Tay-Sachs, Cystic Fibrosis, and Sickle Cell Disease and author of Drawing Blood: Technology and Disease Identity in Twentieth-Century America.

"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 interest 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 than 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."

"In short, Wailoo argues, pain is an effective political issue. It just depends on whose pain you're talking about."

"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."

"Beautifully written, broad ranging, deep, wise, unexpected, and endlessly fascinating."

"An interesting and engaging read... It is refreshing to read about the need to find a middle ground when discussing pain in relation to the political forum... This book would be of insight to anyone with an interest in the historical management of pain."

" In Pain: A Political History, Keith Wailoo illuminates the social, political, and ideological lines along which our understanding of pain and our approach to treating (and paying for) it have been drawn."

"Pain: A Political History is a useful introduction to a study of the role of pain in postwar American legislation on disability, physician-assisted suicide and fetal pain."

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