Pain

Pain

A Political History

KEITH WAILOO

© 2014 Johns Hopkins University Press

All rights reserved. Published 2014

Printed in the United States of America on acid-free paper

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Library of Congress Cataloging-in-Publication Data

Wailoo, Keith, author.

Pain : a political history / Keith Wailoo.

p.; cm.

Includes bibliographical references and index.

ISBN 978-1-4214-1365-5 (hardcover : alk. paper) —ISBN 1-4214-1365-5 (hardcover : alk. paper) —ISBN 978-1-4214-1366-2 (electronic) —ISBN 1-4214-1366-3 (electronic)

I. Title.

[DNLM: 1. Health Policy—history—United States. 2. Pain Management—history—United States. 3. Analgesics—United States. 4. History, 20th Century—United States. 5. History, 21st Century—United States. 6. Pain—psychology—United States. 7. Politics—United States. WL 11 AA1]

RB127

616'.0472—dc23      2013034071

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To my exemplary parents, Bert and Lynette Wailoo

Introduction. Between Liberal Relief and Conservative Care

1 The Trojan Horse of Pain

2 Opening the Gates of Relief

3 The Conservative Case against Learned Helplessness

4 Divided States of Analgesia

5 OxyContin Unleashed

Conclusion. Theaters of Compassion

Acknowledgments

Notes

Index

Pain

I
n the 1990s, talk-radio stars like Rush Limbaugh and Laura Schlessinger—the brash and arrogant voices of American conservatism—rose to fame by rejecting presidential candidate and later president Bill Clinton's liberalism. Like many tough-talking conservatives, Schlessinger singled out for special abuse four words Clinton had uttered during the 1992 campaign: “I feel your pain.” The phrase became a frequent object of scorn for those who doubted the liberal's ability to feel another's pain and who (in the name of conservatism) held an opposing political worldview. Schlessinger responded caustically to Clinton: “I'm not here to deal in feelings. ‘I feel your pain' is bullshit.” Limbaugh, who routinely praised the virtues of the individual and of the free market and decried the malfeasance of government, championed himself as a moral force against Clinton's liberalism. In 1996, Limbaugh's television program showed footage of Clinton leaving a memorial for his commerce secretary, Ron Brown, to illustrate liberal deception. The footage showed the president first laughing until, when he saw the camera, he became somber and even wiped away a tear. To the derisive laughter of his followers, Limbaugh warned, “This is the best illustration of the fake and phony characteristics of this man, the disingenuousness of him, and this says it better than most.” Behind such claims of compassion, Limbaugh asserted, lay a vast agenda of deceit with implications for policy and society: “Just keep this in mind, today it's the pharmaceutical manufacturers, the cable TV industry, insurance companies, physicians, and chief executive officers of major corporations [Clinton is] targeting. Tomorrow it could be you.”
¹
For such conservative commentators, the fraudulence of pain—that is, the fraud of people claiming to be in pain, the fraud of politicians claiming to
feel others' pain, and the charade of government programs claiming to help people when they only promoted dependence—was galling.

As political pundit E. J. Dionne wrote in 1996, it had become “easy to parody Clinton's willingness to translate ‘I feel your pain' into an eclectic and philosophically promiscuous mix of policies that play well in the polls.” In other words, these arguments (both Clinton's pain-speak and conservative portrayals) were not all rhetoric and political stagecraft—they informed policy. Indeed, from the mid-twentieth century, liberal government expansion had been informed by the goal of relieving pain in society, with compassion for disabled individuals driving the development of disability policy and concern for the elderly in pain driving Medicare politics. Pain and policy comingled. Meanwhile, the conservative movement ascended, using as political fodder the argument that liberal politicians' supposed concern for the pain of others was an elaborate fraud. Mocking Clinton and defending Limbaugh, one letter writer took issue with what he saw as the Left's code words and the harm done in the name of liberal compassion: “The left is so fond of accusing conservatives of using code words. ‘Civil rights' have become the biggest code words of all, standing for reverse discrimination, quotas, affirmative action, race-based set-asides … In this ‘I feel your pain' society, white males are the only group it is legal to discriminate against.” An editorial writer, Paul Taylor, similarly caricatured liberals as two-faced whiners: “In 1992, the whiners achieved the latest in a string of dubious political victories by electing a president who is forever reassuring them: ‘I feel your pain.' Naturally, this makes them whine even louder.”
²
Pain defined a fundamental political divide.

This angry caricature of compassionate liberalism as deceitful and destructive predated the 1990s. Indeed (as the pages following will show), the claims made about pain and about people in pain were central to the ongoing battle between liberals and conservatives stretching back to World War II. Long before Clinton, conservatives had alleged that excessive “bleeding heart” compassion and the government programs that supported it had led American society down the road to dependence, welfare, fraud, and fiscal wreckage. If pain afflicted America, they alleged, the liberals had indulged it or caused it. The political Left had built a robust system, for example, of taxpayer-financed government disability benefits catering to people who claimed pain as their primary ailment, they had encouraged a
culture of complaint and easy relief, and (so the argument against Clinton went) they had done this under the dubious guise of feeling the pain of others. That many in America believed in Clinton's compassion, voted for him, and elected him president, made the claim all the more infuriating.

Conservatives in the Clinton years were mostly refining old arguments on liberalism, pain, and fraud that had been honed in earlier eras. When Ronald Reagan became president in 1981, he too took a stand on pain. He assured Americans that “in this present crisis, government is not the solution to our problems, government IS the problem.”
³
By March 1981, people literally
claiming
to be in pain and seeking Social Security disability benefits for alleged chronic conditions found themselves in the crosshairs of the Reagan revolution. The president turned to Richard Schweiker, his secretary of Health and Human Services, to oversee a purge of half a million people from the disability rolls, “weeding out ineligibles.” Officially, the concern was not pain but pain fraud—benefits extended to people on the basis of their subjective complaints. Of course, the Reagan war on pain fraud was a war on liberalism itself; it was a policy response to the rise of disability benefits, the advent of Medicare, and the growth of a welfare state organized around misguided compassion. Reagan had spent decades insisting that government programs like Medicare and Aid to Families with Dependent Children (welfare) bred paralyzing dependence and that excessive regulation and taxation penalized hardworking people. The system, as built by liberals, undermined freedom and free enterprise. Nothing attracted more derision from Reagan than the claim that bloated government and the welfare state knew people's pain. Limbaugh's accusation, then, merely added another chapter in a long narrative, continuing a line of conservative skepticism about the excesses of liberal society.

Was this critique correct? Was it an accurate portrayal to say that liberalism originated in and expanded on the deceitful claim to compassionately feel the pain of others? Or was this critique merely a caricature? The pages ahead tell the story of liberalism, conservatism, and the politics of pain—not merely at the level of rhetoric but as ailing bodies, broken lives, illness, and disability that vexed government and politicians from the post–World War II era to the present.
⁴
Ironically, another Republican president, Dwight Eisenhower, had launched such debates by signing in
1956 a new Social Security disability law that created the groundwork for subjective suffering to be alleviated at state expense. Eisenhower's other challenge had been veterans' health care and disability benefits—with the American Medical Association (AMA) howling that the expanding Veterans Administration (VA) system was merely socialized medicine and the veterans' lobby countering that relief was the soldier's right. Even as early as the 1950s, the politics of pain was fractious.

This volume stands alongside other scholarship that convincingly argues that the mobilization of strong emotions underpinned historical shifts away from welfare-oriented policies and that in the liberal-conservative debate “it is not dependency that is the problem, but fear and hatred of dependency.” Building on this politics of emotion, this book traces how, over time, the powerful question of other people's pain became a recurring site for political battle. In those battles, as we shall see, theories of pain—medical, psychological, economic, and other views on aches and anguish—became weapons; often the courts would be the site of conflict and resolution. In looking at U.S. political history through the topic of pain, the book offers an approach informed by the history of law, medicine, and government, yet it is grounded in the history of the experiences of people. In looking at political history through pain, one can see how those experiences became ideological and political fodder. The book also advances a strong claim: that the complex interaction between liberalism and conservatism can be better understood by considering where politicians, lawyers, scientists, sociologists, and sufferers stand on this question of pain, compassion, government, and relief.
⁵
Over time, I argue, pain—and whether subjective pain is real pain—came to represent not just a clinical or scientific problem, but a legal puzzle, a heated cultural concern, and an enduring partisan issue.

In the end, the conservative critique of liberals' views on pain made artful, effective political theater—a damning accusation in the broader 1980s vilification of liberalism. Yet Reagan was correct in one sense: there was in fact such a thing as a
liberal pain standard
that had been developed within disability policy, in medicine and science, and in government during the decades before Reagan became president, and there was, in his own time, a severe backlash aiming to impose a
conservative standard
for judging pain. Looking beyond rhetoric and caricature, this book narrates
the drama of pain in America—a political history in which Reagan's presidency was a dramatic fulcrum.
⁶

This history of liberalism, conservatism, and pain contains many rich ironies. In 2003, police in Florida accused Rush Limbaugh of “doctor shopping”—that is, using his Latina housekeeper to obtain from multiple doctors hundreds of prescriptions for the painkiller OxyContin to feed a secret drug habit. For political commentators, it was a crime that seemed to undercut conservative beliefs at their core. Just as Clinton's “I feel your pain” had been Limbaugh's gain, now the tables were turned. Limbaugh had railed against bleeding-heart liberals as too soft on criminals and too concerned about the pain of others. In court, however, Limbaugh's attorneys embellished their client's own pain. Playing the victim card, they noted that “Limbaugh did not go to these doctors to seek pleasure. He went there to relieve pain. He had a serious hearing loss and went deaf. He had major surgery, and you'll see in these records the details of that surgery and the pain that he went through … He went to this other set of doctors because of his spine. In 1998 his coccyx bone was removed and it was found that he had cysts in his spine. He was being treated for the pain regarding these conditions.” Moreover, his attorneys shifted the blame away from Limbaugh himself—pointing to the drug to which he was addicted and the medical advice he had received as the problem: