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FAB Gab Ep 30 Karen Davis_mixdown

Kathryn MacKay25min

Kathryn MacKay

00:03

Hello, and welcome to FAB Gab. This is the podcast for the International Journal of feminist approaches to bioethics brought to you by FAB Network. My name is Kathryn MacKay. And today I'm joined by Karen Davis, from Lewis University in Romeoville, United States, to discuss her paper, which is entitled, 'interpreting pain: on women's embodiment and dialogical self understanding'. Welcome, Karen.

Karen Davis

00:26

Thanks, Kathryn. It's a pleasure to be here with you today.

Kathryn MacKay

00:29

Thanks so much for joining me, I'm really looking forward to discussing your paper. And to start us off, could you give the listeners a little overview of what your paper is about?

Karen Davis

00:40

I sure can. So the the main focus of the paper is a personal experience that I have with chronic pain. And this paper is really a sort of the culmination of many years of me trying to understand myself as a person in pain. And what that means. So the paper looks at sort of phenomenologically, what it's like to be in pain, how that affects a person's engagement with the world and their relationship to other people and to themself. It looks at specifically the experience of women who live in pain and some of their experiences with the medical field and getting help with pain. And then it sort of uses the resources of my field of study philosophical hermeneutics, to offer some suggestions for how we might help, particularly women in pain, move forward with that as sort of an integrated part of their self understanding, instead of sort of something that needs to be managed or mastered, but rather something that just could be reinterpreted. Could you say something about what in general philosophical hermeneutics is, is an approach for our listeners who might not be familiar? Sure. So the main proponent of philosophical hermeneutics, and the one that I focus on in the paper is Hans Georg Gadamer. He's a student of Heidegger's and very much of his work is about language and art. He believes in sort of dialogue and play as the models of how humans engage with each other and understand and interpret the world. He also writes about health. And as it turns out pain, he has a book called The enigma of health, where he sort of marshals the resources of philosophical hermeneutics, which is really a theory of interpreting, right, to understand what is health and what is a body? And how are we meant to understand those aspects of ourselves.

Kathryn MacKay

03:00

Mm hmm. And so I was gonna ask, you know, what are the motivations behind the paper, but it sounds like the motivations and and also, you mentioned this directly in the paper, that it's your, your reflections on your own experience, and, and the interpretation, I guess, of your experience of pain?

Karen Davis

03:18

Yeah, yeah. So it all started for me in grad school when I suffered an injury and have sort of experienced chronic pain of one sort or another since then. And it's something that for me right away, and I mentioned this in the paper, also, it was not just a problem of pain, it was a problem of self understanding, like, who am I now that this is my experience. And that also stems from sort of my training in existential phenomenology, which, which teaches me that, who I am depends on my possibilities to be and my choices and my actions and my living into my future. That's who I am. And so when my possibilities became limited by an injury, and pain, that felt like you know, to put it one way, it felt like an identity crisis. And it felt like I didn't just need medical help to manage pain I needed. I needed this and it took me years to discover this right. But what I needed is what I recommend in the paper, which is a certain kind of conversation partner who can help me understand myself again, as a person in pain.

Kathryn MacKay

04:39

I think that's one of the things that you really say in the paper is just how isolating pain can be. That it's, I think you're talking in the paper about chronic pain but a chronic physical pain, but I think maybe also this would apply to emotional chronic emotional pain or just emotional pain, like, grief, kind of emotional pain, where it's, it's just an isolating thing. It's hard to talk about.

Karen Davis

05:08

Yes, absolutely. And that's, that's really true. So I also should say, in part of my motivations, one of the the papers that I found that really put me on this path is a paper also in inch fab from Carolyn Culverson about women and depression. And, and that was really, that paper was really eye opening for me. And it's exactly as you say that, whether it's physical pain, or emotional pain, psychological pain, there is this way that women especially get isolated, and Carolyn speaks very clearly about this. That because and it's because of the ways that we interpret pain, in part, right. So there's a way in which physical pain or psychological pain is isolating, because there's no way that, like, I can try to explain it to you, but I can't bring you into my experience of it at all. Right? Like, you have actually no idea what I'm feeling when I say it's a stabbing pain, right? Or it's, you know, this or that, like, I can't actually communicate that to you, I can't share it with you. And so pain itself, whatever kind of pain is isolating. And then on top of that, we have these cultural expectations for women that are about putting others needs first, they're about suffering in order to provide you know, that kind of an and just sort of like, sticking it out, right, that that are doubly isolating, or women experiencing pain.

Kathryn MacKay

06:49

Yeah, absolutely. So with that kind of problem. Could you take us through the main points of the argument in your paper?

Karen Davis

07:01

Sure. Yeah. So so that is the main problem, right, as as I just described it, and because sort of my wheelhouse in philosophy is philosophical hermeneutics, I thought, you know, what, there's this field that believes in dialogue and playful engagement with other people in the world and intersubjectivity, that that is the way we, we humans, experience and interpret the world. Aren't there resources here in this field of study for understanding how a person could recover from an isolating experience of pain, right. And so I went to Gadamer, and I, what I found in Gadamer, was he he has an essay on pain, a lecture that he gave at a medical conference. And what I found in Gadamer, it broke my heart a little bit, because what he says is that pain management is a problem of self mastery. He says, the way he puts it, and I agree with this, he says, pain sort of shows us what is most our own in our experience, right? That it throws back on sort of the fundamentals of who we are. And I think he's right about that. But for him, the way he interprets that, is that the way we manage pain is sort of independently, he says that it's an issue of sovereignty or self mastery. And that what we can, where where we can find recovery is in the joy of succeeding, of controlling ourselves. And I thought, Man Gadamer, you got that one wrong. Like, yes, my experience of pain shows me what is basically human about my experience, but it's not that I'm in this alone to master myself. What it shows me is that who I am is deeply connected to other people in the world. And when I'm in pain, I need to find ways to reinstate that connectivity. Not find a way to master myself. That's the central idea of the paper is like, there are resources and philosophical hermeneutics that allow us to reinterpret our self understanding as people in pain. Gadamer doesn't quite get it right. And the exact piece that he is missing is the piece that feminism gives us: intersubjectivity, dialogue, relationships with others, which is also there in hermeneutics. It just wasn't there in his lecture on pain.

Kathryn MacKay

09:54

Yeah, just an amazing little side note. He gave that lecture when he was 100 years old. Yeah. That's incredible.

Karen Davis

10:04

Yeah, it is incredible like, man, the man never stopped working. But also, but also, that was one of my issues with him, because he very much associated pain, especially chronic pain with old age. And I thought, You know what, I got hurt in my 20s. And I've been in pain ever since. And I need someone a little bit younger than 100 years old to tell me with this.

Kathryn MacKay

10:31

Yeah, that's right. I mean, something that you mentioned in the paper, the way, because So full disclosure, I know nothing about Gadamer. But I thought that some of what you recount of what he says in your paper, connects with some other stuff around the idea of suffering, the idea that suffering, so pain, we can use the word pain to describe either acute, something acute and momentary, and therefore fleeting and sort of easily treatable, or something like that very connected to a physical thing. Or we can use that word to refer to something that's chronic or complex, and ongoing. And suffering seems to be something more than pain, because it includes not just the body, but also the spirit in some way. And it seems like when one is suffering, as Gadamer said, simple pharmaceutical chemical address is not actually going to be 100% effective, because what you need is some meaning making also happening because there's the spiritual side to suffering also. So yeah, I was thinking about suffering through here, even though you do talk about suffering a little bit, but it wasn't the word that was coming up the most, because the the more that was coming up the most was pain. And I was just thinking about how that seems, what he's saying about that seems quite true. But then as you say, maybe he's missing that step where he needs to we need - so how do we make sense of the suffering? Well, it's with others. Yeah. And for sure. He says somewhere, that the role of the physician in this is meieutic, what does that mean?

Karen Davis

12:20

So literally, meieutic is a word that means like a midwife. Yeah, he thinks that the role of the physician to be should be to draw out what's already in the patient, right? That's it, it's all linked together with what I was saying. Like, his idea is self mastery, that like the physicians role is just to help you to control your own self in a way that you already can. And, you know, the image of the midwife is meaningful to philosophers in many ways. But that, that felt like a certain kind of abandonment to me that that wasn't what I needed, in sort of a recovery or healing relationship. It wasn't that midwife guidance, it was something a little different, that it wasn't something within me that needed to be brought out. It was actually my connections with the world that needed to be reinstated, or reinvigorated. Right, that, that the pain had sort of cut me off. And I needed to reintegrate with other people and with activities in my life and with the ways I experienced the world. And that, that that actually was the emotion of recovery, not drawing out something that was within me.

Kathryn MacKay

13:53

And there's something in the paper kind of throughout, there's a sort of thread of this idea of authenticity, that there's something that I don't know, pain, challenges us in our authenticity, or it could be an opportunity to become a deeper, more authentic self. I'm sort of curious to know what you thought about the authenticity part kind of running through.

Karen Davis

14:23

Yeah, I'm flipping my pages real quick, so I can make sure I get this line because it's a good line. It's a place where Gadamer and I agree, but we just mean it differently. He says that pain is a reminder that calls us back to the the authentic dimension of one's life. Those are Gadamer's words, the authentic dimension of one's life. And, you know, there are different ways to understand authenticity. And so Gadamer and I agree on this, that pain can call you due to authenticity, or the authentic dimensions of your life, but for him that was, you know that that same idea of drawing out what's within you of sovereignty in yourself, sort of a certain kind of autonomy. And I think what, what feminism teaches us largely feminism, but also, you know, that it's it's many places is that what is authentic about my being is also intersubjective. It's in the ways that I don't exist in isolation. I am an integrated part of a world with relationships to others who make me who I authentically AM. So when God says that, like, he calls us to recover the authentic dimension of your life, I think that's true. I just think we need to keep he might need to be reminded, we need to remember that, that authenticity is, is about connection, and not just autonomy.

Kathryn MacKay

16:04

Very useful reminder. So, so what about women in pain? So what I guess I want to ask sort of like, what's the difference between women in pain and men in pain? And then what's the, why does the recommendation of having this really sort of inter subjective dialogical meaning making? Is that is that more for women? Or would that be for everyone?

Karen Davis

16:30

Great question. I think it's for everyone. That's the short answer. I'm not sure. I'm not sure that there are significant differences between women in pain and men in pain. But there are differences in the way that women's pain gets treated in healthcare settings. So and, you know, this is well established that women's pain gets dismissed or treated as psychological. Only in a sort of, again, in a dismissive way, women's pain gets treated differently in healthcare settings. And one of the the ways that it sort of shows up, and this is something that I focus on in the paper, is the question of the role of a diagnosis. Right? That there's, because women's pain gets dismissed in healthcare settings, there's sort of a search for legitimacy or validation, through the diagnosis. Seeking a diagnosis means subjecting yourself to a certain kind of objectification, which is a challenge for many women who are attempting a certain kind of escape from that sense of self. Right? So the problem of women's pain is this strange, at least as I experienced it, right? Is this strange kind of combination of wanting to be the author of myself, right, and to understand myself in terms of my possibilities to be, and not in terms of any kind of objectification or appearance, right? That that is like something I'm pretty committed to, and then I find myself in pain with doctors who don't believe that the pain exists, because they can't see it. And they can't find it on the scans. And then I, I subject myself over and over again, to a certain kind of objectifying gaze, just in hopes of being seen. You know, it's, it feels like a very strange position to be in. And I'm not sure that men in pain experienced that position in quite the same way.

Kathryn MacKay

18:54

Yeah, I think that's so interesting. And I really thought that there was a really great point that you make in the paper, which is that this case for the diagnosis can actually undermine a woman's case basically, that she has this pain because the more tests you do, that don't reveal a kind of physical, like physical damage or physical abnormality or something that a physician could point to and say, well, here is the mechanical cause. The more tests you have that have that result where it's, we can't find a mechanical cause, sort of the more you are in a sense pushed back against like you were saying like it's just in your head and blows my mind because well of Well yes, pain is something that is in my head that does not make it not real.

Karen Davis

19:47

Right, right. There's there's this very strange like knowing that pain is biopsychosocial, but also, if I if I can't see it, you know, objectively in the in the Medical, you know, the scans or whatever it is, then it seems to be Oh, just in your head, right? And you're like, you start to doubt yourself even you know, I've, I've gone through so many doctors and so many attempts at this point, I'm like, Well, is it just in my head? Which, which is like such a, it's like gaslighting yourself. It's wild.

Kathryn MacKay

20:25

On that note, were there any particular challenges that you face writing the paper? I mean, maybe because it's connected to your own experience?

Karen Davis

20:34

Yeah, yeah, that was certainly a challenge. Just sort of practically, I struggled with knowing how much to self disclose about my own story, I wasn't sure how much of that would actually be interesting or relevant. So I struggled with that. I have struggled to write the paper, I've attempted this paper with, you know, like different sets of philosophers like three times, you know, since the pain started. And you can probably tell from reading the paper, I've got a lot of influences sort of piled in there, because I've been thinking about this for many years. So organizing, all of that was a challenge. The other challenge that I discovered was sort of having to do a lot of research that was really outside my wheelhouse. So one of the things that thankfully, one of my reviewers and Trump pointed out was that a lot of this work, that the type of work that I'm recommending is already being done in discourse on patient centered care. And they said, Hey, check this out, we've got some references for you. And I, like took a deep dive into patient centered care and learned a ton about what that means to people in medical professions in the ways that, you know, all of the things that I'm concerned about are being handled in this discourse, but then also discovering some of the ways that what sort of started as a radical revolution in the way ways the ways that we imagine healthcare is getting implemented in sort of levels down ways that are sort of, well, don't forget to ask these questions in your 15 minute interview with the patient, right? Instead of a sort of radical revolution in, in healthcare, it, it's getting fit into the boxes, right? Yeah. So that was a challenge to was like, learning all this stuff that is actually outside of my field of study, and trying to domesticate that in a paper and also find a way to respond to it and say, Hold on, it's all cyclical thinking, still has something to offer. And it's a little different and sort of fitting those pieces together.

Kathryn MacKay

22:49

Mm hmm. Well, it's been such an interesting discussion. Thank you for talking with me. There's just one final question. And that's, what would you hope the reader or the listener would come away with learning from your paper?

Karen Davis

23:07

Good question. So I think it'll, it'll depend on my reader or listener a little bit, right. I think that there is a reader out there who needs to hear that talking about your pain helps. That is one message that one might come away from my paper with that surrounding yourself with people who reconnect you to the world and to yourself is a pain management strategy that I might recommend. But I think also, part of my message is, and I laugh, because this is like a conversation I had to have with the copy editor. Because the way I put it is like, we need new language and we need to reconceptualize doctor patient relationships. And my copy editor, who is a very thoughtful copy editor said, Who is this we write? And I said, I want to leave it ambiguous, because I want the reader to think am I part of we write because I think that's also the challenge to the reader is like, we all need to be thinking about what a doctor patient relationship that is actually focused on recovering a certain kind of self understanding would look like, and what part I might play in making sort of some of these systemic changes that are institutional and cultural and philosophical, and not just sort of on the level of what questions should my doctor asked me, for example?

Kathryn MacKay

24:42

Yeah, definitely. Well, thank you so much for speaking with me.

Karen Davis

24:46

Thank you so much for giving me the opportunity.

Kathryn MacKay

24:48

It was wonderful. And thank you for listening to this episode of FAB gab. You can find Karen's paper linked in this episode's notes along with the transcript. FAB Gab is hosted and produced by me Kathryn MacKay. You can find our other episodes on Spotify, radio public or wherever you get your podcasts of quality Thanks again for listening, bye.

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