The moral experience of the person with chronic pain

This post is the fourth in a series of posts on BiM about chapters in the edited collection, Meanings of Pain (2016, Springer).

What does the word ‘moral’ mean to you? These days it is often used to describe a person, or their actions, as being either ‘right’ or ‘wrong’. The ancient Greek thinker Aristotle had a different handle on it, suggesting that to be (or become) moral is a process of flourishing in community with others. Nice word – flourishing. It speaks of doing okay in your life, of feeling content and healthy, and of being at peace with yourself and with others, including having an interest in whether they, too, are flourishing or not.

People with chronic pain aren’t flourishing. They commonly feel disconnected from their former selves and lives; when, prior to their pain, there were times of hope and optimism about the future. There is also the uncomfortable tension between acknowledging their own interior and private pain experiences and the demands of maintaining some kind of public face acceptable to others. Because stigma always seems near in the assumptions made about them and painted on  by others like unwanted graffiti. People with chronic pain can therefore find it challenging to comply with the normative expectations of others about what it is to be a ‘good’ or ‘worthwhile’ person.

Interestingly, veterans of the wars in Iraq and Afghanistan who are sufferers of Post Traumatic  Stress Disorders (PTSD’s) have also become caught in a tension between their lived experiences (with the distressing feelings they evoke) and the need to meet the normative expectations of others in returning to their home situations. They often ‘feel morally tainted by their experiences, unable to recover confidence in their own goodness’ (Brooks 2015). Framing this suffering in terms of the moral dimensions of their experience, and not just the psychological ones, has become therapeutically relevant.

Many pain management programs encourage the person to develop active understanding and decision making capacities about their pain. These measures recognize the value of personal autonomy and agency in a person getting on top of the pain and addressing its myriad effects on their lives. One particular decision making capacity is to resume an intentional participation, not only in the activities of their own lives, but in the lives of those around them. To talk about the moral experience of persons with chronic pain is to understand the process of doing this in terms of a threat to the ‘self’ together with a need to learn how to flourish in community with others once more.

About Ian Edwards

Ian EdwardsDr Ian Edwards is a senior lecturer at the School of Health Sciences, University of South Australia. His teaching interests include ethics, clinical reasoning, musculoskeletal physiotherapy, sociology of health and qualitative research. He researches in the area of ethics; clinical reasoning; and the application of the biopsychosocial model in clinical practice.

References

Brooks D (2015) The Moral Injury. New York Times, 17th Feb, 2015

Edwards I. The Moral Experience of the Person with Chronic Pain. In: van Rysewyk S (2016) Meanings of Pain. Springer International Publishing.