UC San Diego

This dissertation traces the history of pain research to tell a new origin story for the opioid crisis in North America. By charting the birth and afterlife of the most enduring theory of pain of the twentieth and twenty-first centuries, Ronald Melzack and Patrick Wall’s “gate control theory,” the dissertation argues that a holistic, post-Cartesian concept of pain made possible the overprescription of Purdue Pharma’s OxyContin and other opioids between the 1990s and 2010s. The dissertation begins with the scientific and political developments in modern Europe and North America that eventually destabilized a Cartesian concept of pain as a sensation of injury or disease. It subsequently shows how, over the mid-to late twentieth century, a new network of clinical and laboratory researchers concentrated in North America came to understand pain as an integrative experience of the entire nervous system, including a cognitive, emotional, and culturally enmeshed brain. Rather than just reduce the mind to the brain, these experts equated the material experience of pain with “the whole individual” and vice versa. Through this holistic concept of the body, a new international and interdisciplinary field of “pain research” advocated for long-marginalized patients, making their self-reports of pain, especially chronic pain, more visible than ever before. Yet, in its emphasis on the individual, this field also re-racialized pain. Turning away from an explicit language of “race,” its experts integrated “culture,” or “ethnicity,” into their holistic metaphysics to again mark bodies as categorically distinct and hierarchical in their experiences. By the 1990s, pain experts had mobilized their holism to pursue a campaign for expansive opioid prescribing for the chronic pains of implicitly white patients. Amid the war on drugs in the United States, a holistic metaphysics of pain carved out a new market for the pharmaceutical industry. In showing how pain became a personal experience, this dissertation explores what it calls neoliberal holism, or the “holistic” ideas, practices, and rhetoric through which the medical sciences have silently worked within neoliberal politics. In doing so, it considers alternative responses to the ongoing opioid crisis.