With these scientific imaging techniques—stethoscopes, photographs, X-ray, microscopes—the point of all these is to locate the natural objects of disease. How do we know whether or not this particular illness complaint is true? The answer is we can connect the patients symptoms to material pathologies in objects that we can image. That's how we can distinguish truth from falsities.
Zhang: We have even better tools for imaging the body now, but patients still walk into clinics with back pain that doctors can’t explain. Where is there a change, if there is one, in which doctors realize their instruments are not objective and all-seeing, at least for locating a source of pain?
Goldberg: I know that some people will disagree with what I'm going to say. I think health-care providers are well aware that we have illness complaints that defy objective modalities. Of course there are! And they know in the abstract that doesn't make them less real.
But that cognitive knowledge—I don't think that necessarily translates into practice as well as we might like. The entire practice of health care is the anatomo-clinical method. What do we do? We objectify illness. We try to find using all sorts of objective tools—whether it's imaging, whether it's lab tests, blood draws—we try to find material pathologies that we can clinically correlate with their illness complaints.
Zhang: It strikes me that it’s not just doctors who want to find the physical source of pain. It’s patients, too. You have studies, where if a patient in an MRI machine can visualize activity of their brain’s pain center, they can better manage the pain.
Goldberg: Absolutely. Patients want medical imaging, especially people dealing with contested illnesses. Why? Because seeing it confirms the truth of the matter for them. These are the people experiencing it—they don't have the luxury of denying the reality of their own pain but they kind of do deny the legitimacy of it, especially when everyone else is denying the legitimacy of it.
That's how stigma works. When everybody else is stigmatizing you for something—day after day, week after week, year after year, guess what? You tend to internalize it. Seeing the image, the pathology, the object confirms the truth of the matter to them.
Zhang: A recent study of medical students and residents found that those who had false beliefs about the biological differences between blacks and whites rated the pain of black patients in mock cases lower. How do you trace these attitudes historically?
Goldberg: I thought that paper was phenomenal, in part, because it was an experimental study that showed the influence of our historical attitudes, practices, and beliefs about black bodies in the United States and its connections to contemporary pain management.
We know these beliefs are old. A really stark example of this is Samuel Cartwright. He was a Louisiana physician, and he was just a vicious racist, to be honest. He had all of these beliefs about the reasons why black people and black bodies were less sensible to pain. It had everything to do with 19th-century beliefs about orders of civilization. So white people, especially white affluent people, they were more civilized. And because they were more civilized, they had gotten farther away from a more primitive state. And because they had gotten farther away from a more primitive state, they were able to endure extremes a lot less than people who lived in states which subjected them to the these extremes.