But what about its presence in Howie’s sense of self, in his relationship with his wife and mother, in the reactions of his children, in his work setting, in his doctor? The pain is the central idiom of a network of communication and negotiation. In constant fear that his back will ‘break’, Howie is hyper-vigilant, always waiting for the pain or avoiding making it worse, leading to a self-defeating cycle of fearful vulnerability, withdrawal, isolation and a frustrating anger and hopelessness which is transmitted over time to Howie’s family and physician. In The Illness Narratives (1988), a seminal text for the Medical Humanities, Arthur Kleinman tells the story of Howie, a police lieutenant in his fifties and decorated Korean war veteran – ‘six-foot seven inch, broad-shouldered’ – who has received every available orthodox and alternative treatment for his chronic lower back pain for twenty years. Reviewed by Josie Billington (University of Liverpool), Andrew Jones, and James Ledson (The Royal Liverpool and Broadgreen University Hospitals NHS Trust) Springer International Publishing, 2016, 401 pages, £126.50. Meanings of Painedited by Simon van Rysewyk.
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