Social science 36 years ago
bicoastal December 4th, 2006
This is from a foundational work in the sociology of medicine, written just over three decades ago:
‘[A]s a sociologist I am more interested in the evidence that responses to pain are predictable on the basis of group membership and that the social meanings ascribed to pain are shared by members of groups.
In a now classic study, Zborowski and his staff interviewed eighty-seven male patients, most of whom suffered from such neurological ailments as herniated discs and spinal lesions, and most of whom were of Italian, Jewish, and “Old American†backgrounds. Assuming that, since their disorders were all similar, the actual physical pain suffered by the patients would vary within fairly narrow limits, the problem of investigation thus became the determination of variations in response to pain. The hospital staff itself seemed to feel there were ethnic differences in such response. The staff believed that Jews and Italians were similar in being more sensitive to pain, and more prone to “exaggerate†the experience pain than were “Old Americans†and people of north European origins. The investigators explored such differences.
They found that Jews and Italians were quite similar in that, in responding to pain in the hospital, they gave free expression to their emotions and wanted to avoid being alone when suffering. However, the social context in which each expressed his pain differed. The Italian husband was more likely to be stoical at home, where he plays a masculine and authoritarian role prescribing stoicism; in the hospital, however, he tended to be rather emotional about his pain. In contrast, the Jewish husband tended to be quite emotional at home. Jewish culture does not seem to include stoicism among the attributes required of the patriarch—a fact supported by recalling the complaints of Job when he was covered with boils. Thus, the Jewish husband tended to be quite emotional both at home and in the hospital. However, he tended to use his expression of suffering as a device for manipulating others, including the hospital staff. Once in hospital, and once satisfied that adequate care was given to him, he became more restrained in his responses to pain.
In contrast to Jews and Italians, “Old Americans†seemed to try to conform to the medical notion of the ideal patient, seeking to cooperate with hospital personnel and to avoid being a nuisance. They tried to avoid expressing in public any emotional reaction to their pain. When being examined by the doctor they seemed to be trying to “assume the detached role of an unemotional observer who gives the most efficient description of his state for a correct diagnosis and treatment.†They would admit they were in pain, but when they could not repress moans and the like, they tended to withdraw in order to express them in private.
The patients also differed in their attitudes to pain. The Italians seemed to be more concerned with the discomfort of the pain itself, while the Jews were rather more concerned with the significance of the pain for the state of their health, the former complaining and the latter worrying. Consistent with this observation was another — that the Italians sought drugs for the relief of pain and stopped complaining upon feeling none. The Jews, however, were reluctant to take such drugs, concerned not only with the dangers of addiction, but also with the fact that the drug merely overcame the pain rather than cured them of the cause. Even after the pain had been masked by drugs, the Jews continued to worry. The Italians developed great confidence in the doctors who could relieve their pain, but the Jews maintained a degree of skepticism because the doctors had not yet actually cured them. The “Old Americans†were similar to the Jews in that they were anxious primarily about what the pain signified about the state of their health. They were different from the Jews in that they were optimistic about the powers of medicine and about the outcome.’
Eliot Freidson, Profession of Medicine 280-81 (1970) (citations omitted)
