Tag Archives: Nursing

Just Behavioural: Pain, Psychiatric Patients and Possible Responses to Them (Part Two)

[For Part One click here]

Perhaps more than any of the bad pictures of “pain” Wittgenstein attempts to disentangle people from in the Philosophical Investigations, the above picture assimilates our knowledge of other’s pain to our knowledge of stuff, of features of the external world. Here “pain” is a feature of the world (albeit of that part of the world taken up by someone’s body), one which we can know about with a high degree of certainty, or if we are uncertain about it is simply because we do not yet have enough factual information to hand. (“I’m unsure if she is in pain, I’m still waiting on the results of the scan.”)

Yet it stems from the same kind of unease also leading to those pictures which Wittgenstein does address: the thought that if the question “Are they in pain?” is to have any kind of bite there must be something called “a pain” to exist “somewhere” (whether physically or mentally). The “medical” solution (the one I have discussed above) is a picture which does enable us to know someone elses pain, and yet in doing so robs pain of its phenomenological content (and many of the instances we would refer to as pain.) On the other hand attempts to situate this strange object called a “pain” in the realms of “the mental”, have the unfortunate effect of meaning that we can never know if someone is ever in pain at all. Both pictures, however,  “yoke” knowledge (of another’s pain) to “certainty”: knowing something is being able to gather the appropriate evidence for it,  to be “sure” about it. Continue reading

Just Behavioural: Pain, Psychiatric Patients and Possible Responses to Them. (Part One.)

It seems like a weird question to ask how you can know if someone is in pain or not.

Not that this has really stopped philosophers from continuously asking it, and many of them answering along sceptical lines; you cannot ever know another’s pain, you can only guess at or surmise it. (PI 246)  But this is not what I’m talking about. As my philosophy tutor, Bob Hargrave, used to say, the only possible response to a philosopher who claims they can seriously entertain the possibility that someone screaming and writhing under a torturer’s implements isn’t actually “in pain”, is to back away from them slowly. (This goes along with a certain, and largely justified, fashion of seeing most philosophical problems as being abstract and irrelevant to our lives: of course we constantly treat other people’s pain as something obvious and indisputable, whatever the philosophers decide between them is hardly going to have much bearing on that.)

What I’m talking about, though, are the kinds of situations I now encounter all the time. Where a patient on the ward is doubled up, clutching their stomach and the response of the nurses and doctors is simply to label it as “behavioural”-  the polite, medicalized way of saying “they’re just faking it to get attention.” Instead of responding to their pain, instead of comforting them (or offering some other kind of relief),  we simply have to work out how to manage their problematic behaviour. They very much look like they’re in excruciating pain, but we know that they’re not, so treating them as if they are is inappropriate. Continue reading

Striking, Nursing and Role Morality

Last week Dr Peter Carter (general secretary of the Royal College of Nursing) angered a large proportion of the nurses and support workers he is supposed to represent by urging them not to strike, since doing so would involve “abandoning their patients.”

One of the things he said in his speech to the RCN’s annual congress is less controversial; not giving NHS workers their 1% pay rise in line with the cost of living is obviously “insulting”, and as someone on the lowest rung of their pay scale, I can attest to the fact that what I earn is enough for a young, childless person to just about subsist on but not a lot more. And whilst striking is clearly at its most effective (and ethically defensible) when the individuals setting working conditions and wages are the ones directly harmed by the strike (i.e. corporation owners), public sector strikes  do often work, and can do so in a way which either does not harm, or only negligibly harms, the public (and may even help them.)

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