My Wednesday reflection on service and my recent experience in the ER (from both sides of the curtain) got me thinking about pain.

Simply put my job as a physician can be boiled down to two primary objectives – 1. To treat treat/cure disease, and 2. To alleviate suffering. And, of course, in the application of each of these there is the ever present imperative to “benefit and yet not to harm.” Based on my observations thus far, there are three primary reasons people come to the ER – 1. They come for treatment, 2. They come for reassurance, 3. They come for pain pills.

PAIN PILLS: THE BANE OF AN ER PHYSICIAN’S EXISTENCE

It sucks to feel used, it is no fun to be lied to. It sucks to be in pain, it is no fun to be ignored. And thus the conflict that gets played out hundreds, nay thousands of times in American emergency rooms each day. The classic dilemma of distinguishing between those who are “drug seeking” and those who are in “real pain,” begs any number of questions. Who is to say they are different people? Whose right is it to determine or judge the level of pain another individual is experiencing? Is all pain bad? Does pain always need to be treated? Are narcotics over-used? Are narcotics under-used? Is it a doctor’s job to relieve patients of all pain and at what cost?

These questions and more have led me to a broader reflection on the meaning of pain in our culture. What follows is a collection of scenarios, quotes, and common sayings related to or inspired by pain. I am curious to hear what the topic brings up for you.

• “No pain, no gain.”

• Narcotics: Illegal, Prescribed, Controlled, Addictive, Pain-alleviating, Sleep-inducing, Potentially-lethal, Expected.

• The brand name of prescription narcotics and muscle relaxants are also household names: Vicodin, Percocet, Flexeril.

• Most people I know have been prescribed a narcotic for one reason or another at one point on their life.

• The juxtaposition of a sweating writhing man passing a kidney stone rating his pain at a 6-7/10 and a young woman with a sprained ankle resting comfortably in bed rating it at a 10/10 and demanding narcotics.

• “A lot of people run a race to see who is fastest. I run to see who has the most guts, who can punish himself into an exhausting pace, and then at the end, punish himself even more.” -Prefontaine

• An elderly woman is dying. Her disease causes her severe pain even at rest and makes her feel as though she is suffocating. Morphine could help alleviate both, but she refusing saying, “I don’t want to get addicted.”

• The husband of a young woman with chronic headaches threatens to kill an ER physician for not giving his wife more Dilaudid stating,”You are obligated to treat her pain.”

• “Cutters” – inflicting physical pain on themselves to relieve existential, emotional, psychological distress.

Merely the body’s messenger of injury and imbalance?

Perhaps a villian to be slayed at all costs?

Or is it a virtue to be endured and even relished?

Discuss.

Why are people in the U.S. so afraid of homosexuality?  [Anyone who doubts that people are afraid of gay should watch a few Brüno clips.]

Disclaimer:

1. I do not think that homosexual people are poop.  Rather, I think that this is the position the heterosexual matrix puts them in.  This is tragic and terrible.
2. However, I think this position can be described otherwise, and appropriated as a site of power from which to destabilize discussions concerning homosexuality.
3. Read on!

One possible answer to why many fear homosexuality, following Judith Butler, has to do with identity and social excrement.  So . . . Identity is not something innate.  Identity is formed through “regulatory practices” –the laws, interactions, and discourses that try to regulate social life.  One of these regulatory practices is “sex” (you know, binary, hetero, sex).

In order for “sex,” or lets say, “the heterosexual matrix,” to regulate identity, it has to define itself against something; it has to refuse what it is not.  So, homosexuality becomes refuse, excrement.  It is the necessary remainder, the deviation, the “outside” of the matrix.  In order to maintain a heterosexual identity, there must exist powerful forces that guard the constructed boundary between inside and outside, in this case, between hetero and homo.

The catch is that these boundaries are never absolute.  After all, we know that where there is excrement, there is orifice.  Where there is orifice there is the potential for things to both go out AND come in.  To follow the metaphor, there are many orifices, or weak points, that threaten to disrupt the heterosexual matrix.  On an individual level, for a “heterosexual,” this means that homosexuality is doubly threatening: 1) it threatens the person’s very identity 2) because, it undermines the entire matrix of practices that constitute heterosexuality.

In short, homosexuality is so scary because recognizing it means that the stuff you worked so hard to push out is coming back in, and that puts the whole system out of whack.

Recently I have started to read The Coming Insurrection (TCI), a revolutionary manifesto written by a french group named “the invisible committee.” I’ve been compelled by what TCI has to say about identity.  But first, a little context: TCI has been labeled a terrorist document by French authorities.  Recently they have arrested nine individuals on charges of terrorist acts, also claiming that this group authored TCI (check out the story at adbusters).  MIT press gives the following description of the work:

The Coming Insurrection articulates a rejection of the official Left and its reformist agenda, aligning itself instead with the younger, wilder forms of resistance that have emerged in Europe around recent struggles against immigration control and the “war on terror.”

I am currently working my way through the French version.  So far the committee gives some compelling diagnoses of some of the ills that plague capitalist society.  However, I find their call to a violent uprising simplistic and unimaginative.  When you start a creative nonviolent revolution, then you can count on me to throw my hat in the ring.  Back to identity.  One of the first worthwhile sections in TCI describes how capitalist society programs individuals to spend great quantities of energy maintaining their identities.  Here’s a taste (my translation):

If ‘society’ had not become this final abstraction, it would designate the ensemble of existential crutches that are offered to me for the price of my identity.  The handicap has become the model of the coming citizen . . . the pervasive injunction, “to be someone,” maintains this pathological state that makes this society necessary  (14).

Against this model of identity, where the self is the black hole that swallows one’s attention and keeps one reaching for new products, TCI proposes a net-worked view of identity, a worldly view:

The ‘me’ is not that which is in crisis within us, but the form that they seek to stamp on us.  They want to make us into “Me’s,” delineated, separated, classifiable and assessable by our qualities, in a word: controllable, when we are creatures among creatures, singularities among likenesses, living flesh weaving the flesh of the world.  Contrary to what we learn from childhood, intelligence, is not knowing how to adapt–or if this is an intelligence, it is a slave intelligence.  Our in-adaptation, our fatigue, are problems from the point of view of those who want to oppress us (17, 18).

I have become increasingly convinced that this is correct. Identity is something weaving and woven. We can only understand it in terms of systems.  The “I” is not autonomous or static, and it is not something that we accessorize.  The I is a fluctuating nodal point in a sea of overlapping systems.  I don’t think that this should lead us to attempt the “loss of self.”  But I do think it should push us to think of ourselves as more than just our favorite color, more than our actions, and more than our bodies (and less than the world).

[To check out TCI, you can download a French translation or a rough English translation here.  Or you can buy an english translation from Semiotext(e) here.]

Without spoiling the plot for those of you purests out there, let me say that Omega broaches a heady subject. What makes up the “you” of you? Assuming for a moment that we had the technological ability to store a matrix of information as complex as the human brain. If that information was uploaded from your brain and put into another one, would there still be a you? Would the upload itself be you? Or, would you be you if the upload was downloaded into another brain?

The first question we are tempted to ask in response to these questions is this. At what point does a change in structure preclude the structure’s usability? Is your favorite hammer still your favorite hammer if you swap it’s splintery wooden handle for a plastic one? Is it still your favorite hammer if you replace the head? At what point does a thing become another thing? This question is interesting, but it is the wrong question.

The right question is a bit stranger. And it’s answer stranger still. We know too well from the history of medicine that changing the brain means changing the person. Lobotomies, strokes, head injuries, they all may leave in tact memories and information, but may also significantly alter the identity of a person. On the one hand this could lead us to believe that the brain is just a storage facility, and that damage to the storage means damage to the persona who accesses the storage. But another possibility exists. The possibility that the youness of you is not just uploadable information, but architecture as well.

When I say architecture, I don’t mean just the network of neurons, but the whole event of you. The architecture of experience is less a question of attributes: can you play a Beethoven sonata on a toy piano? And more a question of resonant space. It’s more like asking: can you sing in a vacuum?

We take for granted the substance of air because it’s invisible to us. But it is this invisible substance that functions, quite literally, as resonant space. We cannot speak or sing without it. Neither has meaning, or possibly even existence without a space in which to discover their expression.

Is it the same with the youness of you? What is the data without a space in which to resonate? I’m resisting the urge to bring up Lacan and Heidegger and Husserl and Void. I’ll save that for future posts. Suffice it to say, when it comes to human beings and the architecture of our experience, there may be no such thing as a picture without it’s frame. The you that you know as you, may very well be inherent to your personal architecture.

Am I a capitalist in the bedroom? Consuming a product? Becoming a product? In which case, is my intercourse cascading into the simulacrum of the pornographic? Or, am I the triune layity of ego, superego, and id? Am I a kid playing playing games? An adult creating? A creature? An American? A caucasian male?

I know that these abstactions functions to estrange us from sex, but that’s just the symptom of a larger problem. One that can’t be solved without parsing the lack of a clear predicate.

And maybe that’s the problem. I don’t have sex any more. They do. Maybe it’s the fragmenting of the subject that makes the predicate so difficult. Maybe when my predicate flows easier (I am…), other predicates follow suit.

Does unity (or, perhaps better said, a lack of fracture) within the subject save us from estrangment?