Buchbinder applied the “Page 99 Test” to her latest book, All in Your Head: Making Sense of Pediatric Pain, and reported the following:Page 99 of All in Your Head showcases one of my favorite ethnographic moments from my research on adolescents with chronic, unexplained pain. An 11-year-old boy, Abraham Rubin (a pseudonym) has landed in a pediatric pain clinic with intense, allover pain. Sensing that the boy has a number of behavioral oddities in addition to his chronic pain problem, the physician questions his parents about whether he has several behavioral attributes (argumentativeness, difficulty with transitions, particularity about clothing, maintaining collections), all of which lead her to a diagnosis of pervasive developmental disorder (PDD), a disorder on the autism spectrum. “Abraham did not fit the criteria for fibromyalgia; his aches and pains were just ‘perseverations.’ The Rubins had attributed Abraham’s irritability to his pain, when really it was the opposite.” As I write in the book, this diagnosis was grounded in a local explanatory model that tied the neurobiology of persistent pain to certain features of PDD, such as concrete thinking, an interest in details, and hyper-attentiveness. What I found particularly compelling about Abraham’s case is the extent to which this understanding of chronic pain claimed explanatory purchase for his family. While many parents resented being told that their child had a “sticky brain,” an idiom that indexically linked PDD to chronic pain by highlighting a feature common to both, Abraham’s parents were delighted. This demonstrates that, sometimes, an explanation for seemingly meaningless suffering can be just as important a therapeutic agent as a high-tech treatment or “magic pill”—one of the major themes of the book. More generally, it opens up a view of the social functions of diagnosis, another theme I take up and explore in the book.Learn more about All in Your Head at the University of California Press website.
--Marshal Zeringue
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