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Graphic Pain: A History of the Tools Mediating Pain Quantification


This project uses three histories of the graphic pain scale to demonstrate the medical and social construction of pain as graphic sign and as vital information. Indicative of the concurrent ascendance of data science and graphic design within the medical fields during the latter half of the twentieth century and the beginning of the twenty-first, the history of the graphic pain scale demonstrates a shift from pain medicine as a visual signifying practice and toward a paradigm of information, not representation. This dissertation traces this shift via a Visual STS framework to which theories of design studies and disability studies contribute throughout.

While the investigation begins with the canonization of Henry Beecher’s theories of pain as a subjective experience (rather than an objectively observable one) in the post-World War II West, the histories of each scale necessitate following genealogical trails that reach back as far as the end of the nineteenth century. By revealing the social, political, and economic layers of influence embodied within each of the three scales—the Visual Analog Scale, the body pain diagram, and the face-based pain scale—this dissertation suggests a number of material and conceptual implications which the graphic designs of the tools may have on the subject in pain. Throughout, it will be clear that researchers and practitioners have focused primarily on intensity and location—rather than the quality or origin—of pain when designing these scales, a product of their goals having been oriented towards creating efficient tools that could be widely applicable to produce valid data.

This project questions the motives and ramifications of these goals, especially in the context of a late twentieth century convergence of commercial pharmaceutical development, shifts in governmental appropriations for analgesic research, and a wholesale reconceptualization of the ways that pain presented in patients. However, rather than suggesting that western medico-scientific cultures might willingly adopt tools that jettison efforts to quantify, measure, and classify, I will eventually suggest and elaborate on the implementation of design methodologies that might create more just and inclusive scales.

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