How Suffering Drives Politics

National Journal

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.