Themes
Key
LitCharts assigns a color and icon to each theme in Dreamland, which you can use to track the themes throughout the work.
Pain Management and the Normalization of Narcotics
The Drug Business
Stigma, Shame, and the Opiate Epidemic
Community as a Remedy to Addiction
Summary
Analysis
When John Bonica, a pro-wrestler, sees the horrible pain his wife experiences in childbirth, he switches career paths and becomes an anesthesiologist. He eventually becomes Tacoma General Hospital’s chief anesthesiologist and he writes the textbook The Management of Pain. In 1960, while at the University of Washington School of Medicine, he opens America’s first pain clinic, which treats pain with a “multidisciplinary approach” that includes intensive therapy.
Bonica’s emphasis on therapy suggests that pain treatment should be about more than efficiency: opiates might offer a quick, easy solution to pain, but in the end, the success of pain treatment is measured by its effectiveness, not by efficiency alone. Bonica’s “multidisciplinary approach” to treating pain parallels Quinones’s emphasis on the importance of community in recovering from addiction.
Themes
Bonica retires in the late 1970s, and Drs. Bill Fordyce and John Loeser take over and expand Bonica’s pain clinic, keeping Bonica’s multidisciplinary approach and operating under the philosophy that chronic pain is as much “social and psychological” as it is biological. The pain clinic operates in opposition to much of the rest of the country, which adopts an attitude “fostered by the medical community and Big Pharma” that patients are “entitled to pain relief” and should be prescribed medication liberally. By the early 1990s, many other clinics latch onto Bonica’s multidisciplinary approach to pain treatment. However, they are met with opposition by insurance companies who refuse to cover the non-pharmaceutical components of treatments.
Quinones seems to suggest that patients who felt “entitled to pain relief’ also felt entitled to the easiest, quickest path toward painlessness. They—and their doctors—were less inclined to explore alternate methods of pain relief like therapy that address the “social and psychological” causes of pain, and that take more time, more money, and more effort to complete. The ultimate rejection of multidisciplinary approaches to pain relief suggests that insurance companies and doctors were more concerned with business incentives like efficiency and cost-effectiveness than the well-being of patients.
Themes
