How Suffering Drives Politics

National Journal
June 18, 2014, 4 p.m.

Someone is al­ways in pain, and there’s al­ways someone else who thinks they’re fak­ing it. That ten­sion, ac­cord­ing to Keith Wail­oo, tells us a lot about the past half-cen­tury of do­mest­ic polit­ics. Wail­oo’s new book, Pain: A Polit­ic­al His­tory (Johns Hop­kins Uni­versity Press, 2014), uses suf­fer­ing — wheth­er it’s phys­ic­al pain or some oth­er form of an­guish — as a vehicle for un­der­stand­ing dec­ades of so­ci­et­al change.

(Keith Negley)As the coun­try grappled with the linger­ing wounds of GIs who had re­turned from World War II, Pres­id­ent Eis­en­hower was un­der pres­sure to cre­ate a dis­ab­il­ity be­ne­fit with­in what was then the Vet­er­ans Ad­min­is­tra­tion sys­tem. But he met steep res­ist­ance from doc­tors — the people you’d think would be most in­ves­ted in caring for the wounded. The Amer­ic­an Med­ic­al As­so­ci­ation ac­cused Eis­en­hower of “plant­ing the seeds of so­cial­ism” — a charge that has been leveled at every politi­cian who has sub­sequently at­temp­ted to ex­pand health be­ne­fits, from Medi­care to Obama­care. Many of the AMA’s mem­bers also ar­gued that dis­ab­il­ity wasn’t a real thing, that it would simply be a mag­net for lazy and disin­genu­ous vet­er­ans in search of a handout. This po­s­i­tion seems ab­surd now, but in the days when the AMA was fight­ing VA be­ne­fits, med­ic­al treat­ment of pain was poorly un­der­stood. Doc­tors of­ten truly be­lieved that their pa­tients simply needed to toughen up, and lo­botom­ies were a shock­ingly well-ac­cep­ted tool for pain re­lief.

Along with the cul­tur­al re­volu­tion of the mid-1960s and the rise of in­di­vidu­al­ism, a new and rad­ic­al the­ory of medi­cine emerged: Doc­tors came to see pain as unique to each per­son, and they em­braced treat­ments that were more tailored to each pa­tient. These cul­tur­al shifts con­sti­tute the most fas­cin­at­ing part of Wail­oo’s book. The chan­ging un­der­stand­ing of pain led the phar­ma­ceut­ic­al in­dustry to flood the mar­ket with new products (even as crit­ics ques­tioned wheth­er com­pan­ies were in­vent­ing ail­ments just to cure them); it also laid the ground­work for polit­ic­al change. Wail­oo ar­gues that the polit­ics of so­cial-wel­fare pro­grams gen­er­ally track slightly be­hind cul­tur­al at­ti­tudes to­ward people in pain. In oth­er words, the broad­er cul­tur­al lib­er­al­iz­a­tion sur­round­ing pain helped to make pro­grams like Medi­caid and Medi­care pos­sible.

As the heady days of the ‘60s and ‘70s came to an end, so did that era’s view of pain. Pres­id­ent Re­agan presided over a massive purge of wel­fare, dis­ab­il­ity, and Medi­caid rolls, cast­ing the pro­grams as mag­nets for fraud and “learned help­less­ness,” as well as a bur­den to tax­pay­ers.

Re­agan also helped ease reg­u­la­tions on the phar­ma­ceut­ic­al in­dustry — a move that fit with his gen­er­al skep­ti­cism of reg­u­la­tion and that over­lapped, even­tu­ally, with AIDS act­iv­ists’ push for faster ap­prov­al of new drugs. But the pen­du­lum later swung back to­ward reg­u­la­tion, amid wide­spread ab­use of drugs like Oxy­Con­tin and ser­i­ous safety prob­lems that led the Food and Drug Ad­min­is­tra­tion to pull block­buster products like Vi­oxx, a pain med­ic­a­tion, off the mar­ket.

The polit­ic­al his­tory of pain is largely a ques­tion of pri­or­it­ies. In the ‘50s and ‘60s, the fo­cus was on the phys­ic­al pain of sick people — first vet­er­ans, then the dis­abled, seni­ors, and the poor. Un­der Re­agan, the fo­cus shif­ted to the “pain” of tax­pay­ers who fun­ded wel­fare fraud, even as an­ti­abor­tion con­ser­vat­ives sim­ul­tan­eously came up with a new front in the pain wars — fetal pain. In short, Wail­oo ar­gues, pain is an ef­fect­ive polit­ic­al is­sue. It just de­pends on whose pain you’re talk­ing about.

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