Works of Illness and the Challenges of Social Risk and the Specter of Pain in the Lived Experience of TMD

Abstract

Temporomandibular Disorders (TMD) represent a particular form of chronic pain that, while not outwardly debilitating, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Our analysis, informed by an expanded “works of illness” assessment, draws attention to work surrounding social and physical risk. We refer to these as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Conflicting authorial stances in informants’ narratives are shown to be essential in maintaining a positive identity in the face of illness. While earlier ethnographic studies report TMD sufferers’ experience of stigma and search for diagnosis and legitimacy, we present a group of individuals who have accepted diagnosis at face value and soldier through pain as a fundamental aspect of their identity.

Social risk, stigma and space: key concepts for understanding HIV vulnerability among black men who have sex with men in New York City

“…Social risk has been conceptualised as the stigma associated with an illness or behaviour (Burris 2000; Herek, Capitanio, and Widaman 2003), and defined as a health-related strategy that presents a threat to existing and possible future relationships (Castaneda et al. 2010; Eaves et al 2014). Building on the work of Hirsch and colleagues (2009), we conceptualise social risk as the threat to culturally valued social resources that is associated with a decision or behaviour which also has health consequences; those health consequences may be immediate or in the distant future.…”

“Just Advil”: Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain

“…The “other”—the pain medication user—lacked the high pain tolerance and ability to “just handle it” that enable one to live up to cultural ideals of toughness and stoicism (Hay 2010; Eaves et al 2015a). The phrases “not one of those people” and “not that kind of person” were common.…”

“…Participants are well aware of the stigma and negative feelings directed toward people with chronic pain. They do not, however, categorize themselves as part of this group (Eaves et al 2015a). …”

“…Participants in this study similarly avoided talk about pain, not wanting to “burden” others or allow pain to interfere with social and family life (Eaves et al 2015a; 2015b). Many chose not to talk about pain with significant others or even with their primary care physicians.…”

“…Consumers perceive pharmaceutical medications as potentially harmful, yet desires for simple solutions and “fast relief” justify continued use (Vuckovic and Nichter 1997:1289; Martin 2006b). Despite awareness that a prescription for opioid pain medication places them into the stigmatized category of potential drug abuser (Eaves et al 2015a), the daily experience of pain makes avoidance of pain medications altogether an unlikely solution (Rouse 2009). OTC medications are appealing, therefore, for reconciling desires to live up to ideals of stoicism and self-sacrifice, while also obtaining relief from ongoing pain.…”