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'Total pain', disciplinary power and the body in the work of Cicely Saunders, 1958-1967

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  • Clark, David

Abstract

Pain first emerged as an area of clinical specialisation in the 1950s, but more recently has attracted wider interest from social scientists and clinicians who seek to expand its understanding to incorporate ideas about meaning, embodiment and culture. So far there have been few empirical studies which focus on how ideas and practices about pain are changing in modern healthcare. This paper addresses these issues through a specific case study of the early writings of Cicely Saunders in the period 1958-1967. A professional training in the three disciplines of nursing, social work and medicine, coupled with a strong personal religious faith, provided the biographical context for the development of Cicely Saunders' concern with pain. Through these influences we find in her work with dying patients an emphasis on pain as a key which unlocks other problems and as something which requires multiple interventions for its resolution. From here the concept of 'total pain' is formulated, to include physical, psychological, social, emotional and spiritual elements. This concept, which proved so important to the development of hospice clinical practice, is shown to have paradoxical and conflicting implications. Adopting current ideas about the social theory of the body, 'total pain' may be formulated either as a nomenclature of inscription, or as a nomenclature of facilitation. It is suggested that both of these may be at work in the discourse of 'total pain' and that an appreciation of each enhances our understanding of the concept.

Suggested Citation

  • Clark, David, 1999. "'Total pain', disciplinary power and the body in the work of Cicely Saunders, 1958-1967," Social Science & Medicine, Elsevier, vol. 49(6), pages 727-736, September.
  • Handle: RePEc:eee:socmed:v:49:y:1999:i:6:p:727-736
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    Cited by:

    1. Ana Patrícia Hilário & Fábio Rafael Augusto, 2022. "Pathways for a ‘Good Death’: Understanding End-of-Life Practices Through An Ethnographic Study in Two Portuguese Palliative Care Units," Sociological Research Online, , vol. 27(2), pages 219-235, June.
    2. Karsoho, Hadi & Fishman, Jennifer R. & Wright, David Kenneth & Macdonald, Mary Ellen, 2016. "Suffering and medicalization at the end of life: The case of physician-assisted dying," Social Science & Medicine, Elsevier, vol. 170(C), pages 188-196.
    3. Chattoo, Sangeeta & Atkin, Karl M., 2009. "Extending specialist palliative care to people with heart failure: Semantic, historical and practical limitations to policy guidelines," Social Science & Medicine, Elsevier, vol. 69(2), pages 147-153, July.

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