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Mara Buchbinder, All in Your Head: Making Sense of Pediatric Pain. Berkeley: University of California Press, 2015. 256 pp.
ll in Your Head: Making Sense of Pediatric Pain is a thoughtful ethnography on pediatric pain management in the United States. Through extensive fieldwork in a holistic and interdisciplinary pediatric pain clinic, Buchbinder interviewed therapists, patients, and their families to untangle how medical discourses shape pain and its treatment. At the crossroads of medical and linguistic anthropology, this ethnography analyzes how the uses of language and discourse influence illness experiences by offering etiological models that lead to specific therapeutic pathways. The elaboration of accessible explanations through metaphoric language and meaningful narrative allows physicians to establish shared frameworks, providing interpretive keys towards the understanding of pain and the enactment of specific treatment strategies.
The book is structured in five chapters, each corresponding to a metaphor used by clinical staff to depict patients and their situations. Chapter 1 portrays the therapeutic journeys that bring patients and their families to seek help at the pediatric pain clinic, described as "the bottom of the funnel." Chapters 2 and 3 tackle metaphors of neurobiology, discussing the explanatory models connecting pain to having "smart" or "sticky" brains. Chapter 4 explores how neurobiological and psychodynamic explanatory models diverged or merged in physicians' discourses "on stage"-during encounters with patients-or "offstage"-among clinical staff members. Finally, Chapter 5 presents pain as a response to societal stress imposed on adolescents in the contemporary US.
Buchbinder proposes to contribute to two well-established bodies of scholarship. The first is the study of pain, its experience, and its management. Preceding literature often presented pain as a profoundly solipsistic experience that is hardly translatable into language (e.g., Good 1992, Scarry 1985). To Buchbinder, however, pain has to be understood as intrinsically social, since it is expressed, shared, and treated through social relations. While many existing works concentrate on lived experiences of chronic pain (e.g., Desjarlais 1992, Greenhalgh 2001, Jackson 2000, Throop 2010), Buchbinder chooses to focus on its intersubjective aspects and on the way pain comes to be dealt with in the social realm. Second, the author engages with literature on the search for meaning and explanation in illness. Meaning-making literature has contributed to analyzing illness discourses produced by the ill...