Maureen Nickerson, Psy.D., is a 2016 graduate of the PsyD Program in Clinical Psychology at Antioch University, Seattle.
- Mary Wieneke, Ph.D., Committee Chair
- Phil Cushman, Ph.D., Committee Member
- Elin Bjorling, Ph.D., Committee Member
Critical Discourse Analysis, Discourse Analysis, Chronic Pain Patients, Opioid Use, Deservingness, Stigma, On-line Reader Commentary, Medical Discourse, On-line News Media, Chronic Non-Cancer Pain, Legitimate Pain Patients, Us and Them
Negative stereotypes about people with chronic pain pose a barrier in the delivery of care; contribute to worsening symptoms of physical and psychological distress; and play a role in policy decisions that adversely affect patients and providers. Pain-care seekers may be accused of malingering, laziness, mental aberration, attention seeking, and drug seeking. The propagation of stigmatizing attitudes was explored in this Critical Discourse Analysis of online-reader-comments responding to a series of pain-care policy articles published by a large metropolitan newspaper. Results suggest that framing pain patients as legitimate and deserving can inadvertently reproduce the inequities advocates seek to redress. Ascriptions of deservingness were associated with the locus of choice and agency. Assignments of blameworthiness were used to distinguish the legitimate pain patient from the illegitimate care seeker. Motivation for seeking pain care, as much as the effects of opioids, provided crucial determinants in evaluating legitimacy claims and blame ascriptions. Evaluations of deservingness were predicated on the valence of social regard. Compassion, empathy, respect and believability were rewards of positive social regard. The subjects of addiction and drug abuse were maligned to the detriment of people with pain and people with opioid addiction alike. The disease-entity model of chronic pain was associated with psychiatric discourses of mental illness through a narratives inaccurate reality perception. Loss of independence, rationality, and respectability were semantically linked to negative stereotypes of pain patients, drug addicts, and mentally ill groups. Medical discourses drawing on empirical materialist traditions assert taken-for-granted population categories (e.g. chronic noncancer pain patient) with little acknowledgment of confounding variables, lack of evidence, or their social impact. For the benefit of people seeking care, there is a critical need for moral, logical, and empirical analyses of predicating factors in education and care giving decision-making. The electronic version of this dissertation is at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/etd
Nickerson, M. (2016). The Deserving Patient: Blame, Dependency, and Impairment in Discourses of Chronic Pain and Opioid Use. https://aura.antioch.edu/etds/309