Putting the Social in Biopsychosocial
As I’ve gotten back into providing care to people in pain, I’ve found that the sociologist in me is disappearing. This isn’t a shock. Back when I was getting my PhD, I noticed that few of my clients wanted to hear about how social theories of power shaped their pain. They just wanted answers. “What did you learn in the neuroscience lab?” they’d ask.
The biopsychosocial model is finally getting its time in the sun, especially when it comes to pain. The new IASP definition of pain and its accompanying notes include the term, and clinicians are increasingly trained to address the biological, psychological, and social components of pain in their patients. This is a significant improvement over earlier, more dichotomous conceptions of pain—where it was understood as either biological or psychosocial, either structural or neuroplastic. As someone who has both advocated for pain patients and been one herself, I’m relieved to see more room in medicine for complexity, multiplicity, and overlapping truths.
That said, I’ve long argued that the “social” in the biopsychosocial model remains under-theorized and, as a result, under-deployed. What does it actually mean to address the social components of pain? Those without exposure to centuries of sociological theory would be forgiven for assuming it refers primarily to social support or cultural context. These elements certainly matter—but “the social” also points to structural conditions: how power circulates, who benefits, and what prevailing economic arrangements make possible or impossible. The social draws our attention to the net we’re all caught up in—not with an eye toward assigning blame, but toward recognizing the constraints of the medical system and how they shape the experiences of providers and patients alike.
Without a robust theorization of the social in pain medicine, we miss how time constraints in the clinical encounter shape which kinds of pain are made intelligible. We neglect the influence of insurance categories on which pain is considered credible or treatable. And we overlook how productivity culture quietly infiltrates even the most well-intentioned narratives of recovery.
I’m writing this in part to remind myself of the importance of bringing a sociological perspective into the room. What can be known, felt, and experienced is socially shaped—not only by our upbringing or family conditioning, but also by the broader social fabric of the moment, which is always already laden with power, both repressive and productive.
What does this mean in practice? It means making space for possibility—for remembering that things could always be otherwise. What might our pain look like if structural conditions were different? How do cultural narratives shape the ways we relate to our felt sensations? And what degree of agency do we actually have to make changes in our lives, including changes in how we inhabit ourselves?
It also means acknowledging that while I believe deeply in our collective agency, individual agency is unevenly distributed. Time, resources, care, and hope are not equally available to everyone. When we lose sight of this, we risk recreating patterns of personal shame and clinical failure—mistaking structural limits for individual shortcomings.
