“In the U.S., patients and practitioners usually imagine that pain is a thing, that one’s approach to it may change how one copes with it, but not the pain itself. This is connected to medicine’s insistence on a ‘view from nowhere,’ perceiving nature without changing it. Meanwhile, STS scholars have long taught us about looping effects between categories and the world. In this talk, I present ethnography on painful bodies in Thailand, where the idea of looping between category and reality is part of everyday cosmology. I share about: doctors who worry that giving ‘chronic pain’ a diagnostic code will bring it into being; monks who suspect that pain equals fear-of-death, leading them to induce near-death experiences; anesthesiologists with evidence that poor Thai patients need less anesthesia during surgery (because lifelong pain-as-necessity crafts brains with low-pain neurotransmitter profiles?); and patients who dream that pain is a reincarnated being and awake with different pain. Through this ontological adventure, I ask whether STS might benefit not just from ethically identifying co-constructionism as a sociohistorical force, but also from examining times and places where people work co-constructionism to their advantage as a matter of course.”

Scott Stonington is a medical and cultural anthropologist, and an internal medicine physician. His research broadly addresses the globalization of biomedical ethics and expertise. His first project in this area focused on decision-making at the end of life in Thailand, where individuals face a complex combination of ethical frameworks generated by high-tech medical care, human-rights politics, and the metaphysical demands of dying. Dr. Stonington spent two years accompanying Thai elders at their deathbeds, documenting their children’s attempts to pay back their “debt of life” via intensive medical care, as well as the ensuing “spirit ambulance,” a rush to get patients on life-support home at the last possible moment to orchestrate the final breath in a spiritually advantageous place. Dr. Stonington’s second project in this area focuses on global debates over the use of opiates for pain management. He spent a year accompanying patients in severe pain in Northern Thailand as they navigated their suffering within a fraught ethical environment, from Thailand’s brutal drug war, to its Buddhist-based value for pain as a spiritual path, to a broader global ambivalence about how best to treat pain. Dr. Stonington’s secondary research agenda addresses medical epistemology in the U.S., specifically how health practitioners decide what constitutes true and/or useful knowledge and how this affects patients. This work grows out of his ongoing practice as an Internal Medicine physician, both in the hospital and in primary care.