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Purported pain, dismissive politics – Tennessee Lookout [1]

['More From Author', 'February', 'Dahron Johnson']

Date: 2023-02-07

I’ve been a clinical chaplain in healthcare, involved for 15 years in the practical amelioration of peoples’ hurts—working with a patient, their community of care, and our team to address physical pain, material concerns, and any potential spiritual, existential, and emotional areas of disease with which folks might be contending.

And while such work has many challenges, there is one action, one simple switch to flip, that makes this work much easier: when people tell, or show, or demonstrate to you in whatever way in which they’re capable that they hurt, believe them.

That’s it; that’s all there is to it. If nothing else, you help build a relationship that’s founded on a certain level of trust. And when one doesn’t have much time—when the patient finds each word hard; or the caregiver is exhausted; and another person in need of care is waiting, likely also hurting, in the room next door—that trust is essential to get most effectively the information one needs to help.

People have very good genuineness radars, even when other capacities may be failing them. I have seen time and again that even if somebody doesn’t expect me to walk through the door, if they sense I’ve come there motivated by a genuine desire to offer care and support—that I take their report of their world and their feelings and their health as true—then the rest becomes a lot easier.

As you ask the follow-up questions needed to continue to assess and address the pain that’s reported, know that the answers you receive will be more honest and more helpful if the whole process starts with the basic assumption that people’s reports of the experiences of their own bodies—what they say about their times of hurt and occasions of relief—are true. After all, there is no test, no physiological measure, that can tell us someone’s level of hurt. Their report is our most accurate indicator.

Given all this, it shouldn’t be surprising that in reading through legislation before the General Assembly, one phrase in particular caught my attention: “purported discomfort or distress.”

One phrase in a legislative bill to deny gender-affirming care to minors stands out: “purported discomfort or distress.” We either take people at their word regarding their own distress, or we don’t. Their self-“purport,” as it were, is all we’ve got; our self-report is all anyone else has got.

This cold term of cynical art is used a half-dozen times throughout both HB1 and SB1— twinned bills proposing an outright ban on the provision of gender-affirming care for those under the age of 18. and supposedly so urgent they were the first to be filed in both chambers weeks before the term even officially began.

The bills themselves are riddled with inaccuracies, exaggerations, and red herring arguments: for example, despite the bills protestations to the contrary, there are indeed professional medical standards for gender-affirming care, for those both above and below the age of majority. These standards are considered so credible that they not only establish care practices medical professionals and healthcare organizations have implemented across the globe, they are also used by health insurance companies to create policy for what they will reimburse.

Insurance companies’ coverage is far from assured for transgender and gender-expansive residents of Tennessee: not only does our state pointedly exclude gender-affirming care from Medicaid coverage and the insurance options available to state employees, it has also created legal cover for private insurance companies to refuse to cover such care.

It’s useful to review some history of insurance guidelines for coverage of transgender health needs. As an example, my own provider’s guidance was last reviewed on Jan. 6 after initially being created in May 2002 — more than two decades ago.

Further, this guidance refers back to the regularly-reviewed standard-of-care recommendations issued by multiple professional medical organizations—important to note since both Tennessee bills dismiss gender-affirming care as “not consistent with professional medical standards.”

In an additional paradox, these bills state gender-affirming care hasn’t been subject to long-term review, even as they simultaneously note gender-affirming care has “changed substantially in recent years.” The science is available, and the standards have adjusted as more science has come to hand—exactly as one would hope, and regardless of whether one is undergoing chemotherapy; recovering from a shoulder replacement; or is receiving gender-affirming care.

But back to that troubling term, the one that dismisses people’s experience of their own bodies even as it names it, that of people’s “purported discomfort or distress.” I would first note that such cavalier disregard seems to directly contradict the bills’ stated need to “protect the health and welfare of minors.”

If one cannot plainly acknowledge the pain of another, regardless of whether they themselves feel such distress, how can they be trusted to protect anyone, minor or adult? This one phrase gives away how the bill’s authors and sponsors have willingly bound themselves to antiquated, discriminatory, ideas that rank one group’s pain as more reliable, more “true,” by diminishing or dismissing the reports of others as exaggerated; able to be better tolerated, as has been the stereotype of some ethnic groups); or from unreliable narrators (those portrayed as “unstable” or mentally ill. )

It is no coincidence that in each instance the bills use the term “purported discomfort or distress,” that in the very next sentence, they also deploy the phrase “asserted identity.” In so doing, they explicitly reinforce their diminishment of transgender and non-binary’s persons reports of pain, of discomfort, by dismissing those who report such distress as something other than real: imaginary, “purported,” “asserted.”

However, it is true that for every single one of us—trans- or cis- gender; gay or straight; no matter our race or ethnic background—pain is, first and foremost “always a personal experience,” as the International Association for the Study of Pain (IASP) puts it, and that there is no reliable test or measure that can determine our level of pain, outside of what we ourselves describe or convey.

This is why IASP guidelines go on to state that “a person’s report of an experience of pain should be respected.” All pain is “purported”— only available to us on the outside through the ways it is communicated by the person experiencing it.

We either take people at their word regarding their own distress, or we don’t. Their self-“purport,” as it were, is all we’ve got; our self-report is all anyone else has got. And so, if we really want to “take action to protect the health and welfare” of those under the age of majority, then the most important thing we can do is listen to them, and believe what they tell us, both when they are hurt and when they’re happy. That is what they trust us to do, and to do anything other is to tell these children that their pain, their joys, their existence, simply don’t count.

We have come to a sad point in our political climate when the most controversial statement I can say is this: Our state’s children, all of them, should be counted and cared for. The reality of their lives and experience—their chance to develop into persons of fullest flourishing—deserves nothing less.

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[1] Url: https://tennesseelookout.com/2023/02/07/purported-pain-dismissive-politics/

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