IIEMCA19: Keevallik, Weatherall, & Stubbe – Pain in GP consultations

Keevallik, Weatherall, & Stubbe will present at IIEMCA 2019, Jul. 3-5, Mannheim.

Being incapacitated by pain during medical consultations

In the introduction to a recent overview text on the science of pain Battaglia (2016) suggested that pain is fascinating because it is about the subjectivity of people’s sensory experiences and the impossibility to fully share them with others. Currently accepted definitions of pain acknowledge psychological, social and cultural factors influencing how pain is experienced. However, even the most holistic understandings assume the communication of pain basically reflects the individual’s pain experience. Discursive psychology and conversation analysis offer a distinctive approach to pain. Instead of viewing language and behavior as windows to individual experiences of pain they are conceptually understood as inseparable. Following that view, conversation analytic studies have demonstrated the social organization of pain displays, demonstrating systematic patterns in where they occur, for example, in pain elicitation sequences during physical examination in medical consultation (Heath 1986).

The present study examines 30 cases of displays of pain that are not clearly organized with respect to turn, sequence or activity In contrast to earlier conversation analytic studies that have demonstrated the social organization of pain, the current paper argues that the body can in fact intervene with progressivity of action, insofar as the speaker appears momentarily incapacitated by pain. Behaviours such as a sudden inbreath, a bodily recoil and a glottal stop happen in positions where they seem to display a completely subjective moment. We will demonstrate how these displays change the trajectory of talk: a patient may, for example, produce a repair or reformulation immediately after the pain display and the doctors regularly switch the topic of talk to the location and severity of pain. Both patients and doctors tend to abandon ongoing talk immediately upon the sudden pain display. Either self-inflicted by, e.g., putting weight on a painful hip, or triggered by doctor’s touch, a pain display is shown to maximally consist of three phases: a) the immediate reaction or reflex (sudden inbreath, recoil, glottal stop while speaking), b) a more or less conventionalized vocalization (uu, oh, argh), and c) a recovery of talk or embodied action accompanied by a stance marker (laughter, outbreath). We will also show how doctors produce empathetic pain cries (uu) that typically in the next moment after the pain reflex. Thus our work possibly pin-points a place where the subjective becomes intersubjective and where the possibilities of shared meaning, language and action begins.