Stabbing pain? A burning heart? Cultural variations in the experience of pain (AT)
Written by Agnes Raschauer
Text reference: Kohnen, Norbert (2009): Feeling and coping with pain in different cultures. In: Ruth Kutalek / Armin Prinz, eds. Essays in Medical Anthropology. The Austrian Ethnomedical Society after Thirty Years, p.321-328. LIT Verlag GmbH: Vienna.
Introduction
Generally, the experience of pain is either thought of as something purely individual or connected to biological processes that affect all human beings in a certain way. Thus, some people seem to have a high threshold for pain, while some people seem to have a lower one and might be considered oversensitive to pain. However, how humans experience pain and make sense of it, is not only subject to their individual tolerance level or simply given on the basis of biochemical reactions. Rather, experience of pain hinges on social ways of making sense of the world, which affect how bodily sensations are interpreted. In his paper, Norbert Kohnen delineates cultural variations in the concepts that underlie the experience of pain. Reviewing anthropological research, he gives a vast number of examples of how pain is experienced and processed in a culturally specific way.
Being unaware of variations in how pain might be felt and expressed in different cultures can have negative effects for a medical practice, for example when a doctor thinks that a patient is not in pain when actually what happens is that the patient’s experience does not fit with the doctor’s preconceived ideas about how pain is felt.
Anthropologies demonstrating cultural variations in the experience of pain
Kohnen explains that while there are few cultural variations in the “sensation threshold […] the lowest stimulus that results in tingling or warmth” (p. 321), the pain threshold is found to be highly variable. A very illustrative example is by Hardy et al. (1952), who reports that heat levels considered painful are experienced quite differently by people living in the Mediterranean and people living in Northern Europe. Heat levels the former define as “warm” are considered painful by the latter.[1]
The author further refers on the ground-breaking work of Mark Zborowski (1951, 1969)[2], who established that not only experience and expression of pain are highly variable and subject to culturally specific interpretations of the world, but also how communities deal with suffering members. He carried out anthropological research (interviewing, handing out surveys and doing observations on-site) in a veteran’s hospital ward, focusing on four patient groups: Irish Americans, Italian Americans, Jewish Americans and Old Americans. Zborowski concluded that while Irish American patients hardly talked about their pain and withdrew in isolation, Italian Americans tended to be quite outspoken about their suffering and in need of social contact. He also reported different approaches to pain in terms of how much weight a patient put on the fact that he was in pain and how much he trusted his own experiences.
“Cultural coping strategies”
Within anthropology the ways of handling pain that cultural communities develop are called “cultural coping strategies” (p. 323). These strategies build upon knowledge and traditions that have been passed down from previous generations and have long informed social practices of dealing with disease, pain and healing. They entail culturally accepted scenarios showing individuals how to act in the advent of pain and how to make sense of it. The “control beliefs” a cultural group holds on to be especially relevant for developing specific coping strategies. While the British, the Irish or people from Northern Europe are characterised as individual-oriented, with a tendency for an internal control belief, the Italian or the Turkish society are described as family-oriented with a tendency for an external control belief. This means that the former tend to focus on the individual when dealing with pain, keeping feelings inside and opting for social retreat. The latter, on the other hand, prefer the company of family members when suffering and also devise communal strategies for handling pain.
Kohnen describes five distinct coping strategies and attributes each to an “ethnic and religious group” that it is characteristic for, while stressing that “all named strategies will be found proportionately within every culture” (p. 323). Among others, Kohnen names fatal strategies of coping with pain which entail attributing the ending of pain to a higher entity. As a consequence, the suffering individual has little obligation to act, i.e. to seek a doctor and to do “the right thing” in order to alleviate suffering. Sometimes magical practices are carried out which may have an impact on how the pain is experienced. Religious treatment of pain, customary e.g. among Christians or Buddhists, on the other hand conceptualises pain as a trial an individual has to endure in order to demonstrate his/her faith. A third concept is a rational treatment of pain in which pain is examined, attributed to a specific body part, monitored and subjected to professional medical treatment. An emotional approach towards pain seems out of place.
Conclusion: Attention toward cultural variations in experiencing pain needed in medical practice
Kohnen argues that treating pain as a universal, single phenomenon is detrimental to quality care. Patients might express their experience of pain in various ways: by retreating, by rationalising, by crying and demonstrating emotional distress. No one expression of pain is more valid or more indicative of a true suffering than the other. Holding on to the idea that the experience of pain and even the pain itself, as communicated by the patients, has to manifest a certain way, leads to misunderstandings, frustration and maybe even maltreatment of the patients’ conditions. “Every patient is an informant, but not every informant is a good one. Whether or not a patient is a good informant really depends on the examining doctor and how well they understand their patient and how well they are able to broaden the horizons and experiences of the informant.” (p. 326)
[1] Hardy, James Daniel, Harold George Wolff and Helen Goodell (1952): Pain sensations and Reactions. Baltimore: Williams & Wilkins.
[2] Zborowski, Mark (1952): Cultural components in responses to pain. Journal of Social Issues 8: p. 16-30. Zborowski, Mark (1969): People in pain. San Francisco: Jossey-Bass.