“We live in the future”: An ethnography of chronic pain in North East England

This thesis is an ethnography of chronic pain in North-East England. It is based on approximately 14 months of online and in-person fieldwork, undertaken during the Covid 19 pandemic. In it, I focus on the lives of women who 'live under' (Martin, 2007) the diagnosis of chronic pain in the North-East. The basis for undertaking this project was the documented 'pain divide' (Todd et al., 2018) which exists between North-East England and the rest of the country, alongside the many other embedded examples of health inequity which disproportionately impact the North-East. Throughout this piece of work, I focus on how my participants experience health inequity in their everyday lives. I take the stance that while these inequities are inherently structural in nature, they can be articulated through exploring different aspects of everyday life. In this thesis, I demonstrate how living with chronic pain alters a person's relationship to time. The main body of this work is split into three main sections; the past, the present, and the future. In the first I explore how chronic pain changes a person's understanding of their past, both in terms of understanding violent life experiences, and through the ‘diagnosis histories’ used to explain how diagnoses came into existence. In the second section I demonstrate some of the different facets of navigating the present while living with pain: clinical encounters, sex and gender, taking different substances, and navigating social welfare systems. Finally, in the third section, I outline how people who live under the diagnosis of chronic pain anticipate and hope for better futures. I draw three main conclusions from this thesis. Primarily, I conclude that living under a diagnosis of chronic pain changes a person’s relationship to time. Importantly, this altered temporality changes how people understand the aetiology of their diagnosis, and also how they understand their own biology in relation to this aetiology. Secondly, and linking to this first concluding point, I argue that medical anthropologists need to ‘take biology seriously’ (Wilson, 2015: 13) in their ethnographic analyses of chronic pain, and around understandings of illness more broadly. Finally, with all this in mind, I argue thinking about chronic pain and its treatment using this biological mindset can help medical anthropologists to combine perspectives from the anthropology of pharmaceuticals and the anthropology of drugs. I also offer some practical conclusions. Firstly, I argue that insights from structural violence could help to create systems of chronic pain care which are more effective. Secondly, this thesis highlights the contradictions which emerge when a person with chronic pain attempts to seek state welfare benefits. This thesis is oriented towards disability justice. As such, it provides evidence that theoretical and practical changes to the way disability is approached could provide better clinical and social care for people living under the diagnosis of chronic pain.