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Pain, objectivity and history: understanding pain stigma
  1. Daniel S Goldberg
  1. Correspondence to Dr Daniel S Goldberg, Faculty, Center for Bioethics and Humanities, Associate Professor (pending), Department of Family Medicine, Fulginiti Pavilion—Room 205, 13080 E. 19th Avenue, CB B137, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; daniel.goldberg{at}


The primary claim of this paper is that understanding the stigma so commonly endured by chronic pain sufferers today in the USA and the UK is unlikely without proper appreciation of the history of pain. Ameliorating such stigma is an ethical imperative, and yet most approaches eschew even an attempt to trace connections between historical attitudes, practices and beliefs towards pain and the stigmatisation so many pain sufferers currently endure. The manuscript aims to help fill this gap by framing pain in the modern era in context of two crucial intellectual schemes that waxed in the 19th and 20th centuries: mechanical objectivity and somaticism. The analysis explains these frameworks and applies them to exploration of primary sources connected to contested pain conditions such as railway spine. By properly situating the historical roots of what it means to cite the ‘subjectivity’ of pain as a problem, the modern roots of stigmatising attitudes and practices towards chronic pain sufferers become much clearer. The manuscript concludes by suggesting that interventions expressly intended to target the root causes of such stigma are much more likely to be successful than approaches that proceed in ignorance of the historical forces shaping and driving pain stigma in the present.

  • Pain management
  • History
  • Health policy

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  • Acknowledgments The author would like to acknowledge the advice and encouragement of Joanna Bourke, Louise Hide, and Carmen Mangion during the course of The Birkbeck Pain Project (now The Birkbeck Trauma Project). Thanks are also owed to panelists Ian Burney and Christopher Hamlin for inviting me to present an early draft of this paper at the 2014 annual meeting of the American Association for History of Medicine, and to the audience for questions and feedback.

  • Funding The historical research undertaken in this manuscript was supported by an honorary fellowship with The Birkbeck Pain Project, funded by The Wellcome Trust.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.