Control and Community: The Role of Pain Narratives in Medical Training
Tyler Couch, Medical Student, UT Southwestern Medical School; Theology, Medicine and Culture Fellow, Duke Divinity School
The proper approach of the physician to the patient in pain is a subject of rapidly increasing interest across the United States. As the use and misuse of opioid narcotics reaches epidemic proportions, voices from both within and outside of the world of healthcare have raised significant concerns regarding how healthcare providers understand and respond to pain.
Despite this escalating concern, medical students continue to receive few resources that might equip them to frame a response to pain within an understanding of their broader task as physicians. This essay seeks to examine the manner in which the narratives invoked in the training of medical students contribute to an insufficient response to the pain of patients. Drawing on my own experience as a current medical student – as well as on the work of Jeffrey Bishop, Wendell Berry, and Gerald McKenny – I will suggest that medical training allows for very little understanding of patient narrative outside of those medical narratives that contribute to a sense of control over health and the body. Pain, I will argue, often does not fit well within these narratives of control; nevertheless, medical students have few other narrative resources within which to understand pain. Attempting to force pain – especially chronic pain that cannot be completely removed – into these control narratives, I therefore suggest, contributes predictably to an escalating reliance on the prescription of opioid narcotics. Having thus examined the predominant narrative mode of understanding pain within medical training, I utilize in the final part of this essay the work of Stanley Hauerwas to suggest that religious communities – and in particular the Christian Church – might offer for medical students, practicing physicians, and patients alike a source of communal narrative that can incorporate pain into an ongoing story without the need to subject it to narratives of control. In conclusion, then, this project highlights the dominant narrative modes of understanding pain within medical training and explores how the Church might provide both patient and practitioner a narrative that, rather than seeking control at all costs, is able to incorporate pain that cannot be alleviated into the ongoing vocational projects of the community.
Despite this escalating concern, medical students continue to receive few resources that might equip them to frame a response to pain within an understanding of their broader task as physicians. This essay seeks to examine the manner in which the narratives invoked in the training of medical students contribute to an insufficient response to the pain of patients. Drawing on my own experience as a current medical student – as well as on the work of Jeffrey Bishop, Wendell Berry, and Gerald McKenny – I will suggest that medical training allows for very little understanding of patient narrative outside of those medical narratives that contribute to a sense of control over health and the body. Pain, I will argue, often does not fit well within these narratives of control; nevertheless, medical students have few other narrative resources within which to understand pain. Attempting to force pain – especially chronic pain that cannot be completely removed – into these control narratives, I therefore suggest, contributes predictably to an escalating reliance on the prescription of opioid narcotics. Having thus examined the predominant narrative mode of understanding pain within medical training, I utilize in the final part of this essay the work of Stanley Hauerwas to suggest that religious communities – and in particular the Christian Church – might offer for medical students, practicing physicians, and patients alike a source of communal narrative that can incorporate pain into an ongoing story without the need to subject it to narratives of control. In conclusion, then, this project highlights the dominant narrative modes of understanding pain within medical training and explores how the Church might provide both patient and practitioner a narrative that, rather than seeking control at all costs, is able to incorporate pain that cannot be alleviated into the ongoing vocational projects of the community.