I'm writing a fantasy story and my main character has a chronic pain disorder, specifically CRPS, and he's had it for the past six years. The technology available is something circa 1910, which means (as far as my research has told me, please fo correct me if I'm wrong) the most likely treatment would be morphine or heroin. I want to avoid the harmful stereotype of people with chronic pain being drug addicts, but I also know both of these substances were and are highly addictive. What should I do? Any other advice for writing this character? Any advice I can get is welcome.
Hello! I think this is a very important question and I'm so glad you asked!
I'm not personally familiar with early 20th century medicine so I'm also open to correction, but I'll answer this using my knowledge of modern-day addictive painkillers and under the assumption that the medications you've identified in your research are appropriate for the context.
This is ultimately going to be more of a discussion on addictive medications, the way we understand them as a society, and the way they impact disabled people who do or don't take them, but I hope it gives you a baseline to start thinking about what you're comfortable depicting and some appropriate ways to do so.
I don't believe that a substance being addictive is by itself reason to not have a character use it for pain relief. There is, as you've identified, huge stigma against disabled people who rely on strong painkillers in their everyday life, which has direct impacts on how we're perceived by medical professionals and society. However, at the end of the day, most of us don't have much of a choice but to use what works and what's available, and sometimes that just happens to be an addictive substance. I don't think you need to automatically shy away from depicting any disabled characters using addictive medications and I don't think these portrayals are automatically harmful, but it does require thinking through the socio-cultural associations tied to heavy medication use.
Your character is probably not going to choose to be in pain all the time if they can reasonably avoid it, not only because pain, well, hurts, but also because constant pain has devastating long-term psychological impacts when left unmanaged. That's not to say that addiction to necessary medication is a non-issue, as it can cause problems if your body stops responding to it over time as your tolerance adjusts and you need to be taken off of it and switched to a new medication. Withdrawal is a very real and horrible experience--but so is severe chronic pain.
Sometimes there's no solution to our pain that's not going to create a different kind of pain. It comes down to weighing the risks and deciding for ourselves what we're able and willing to deal with. We know what we need, and sometimes that's going to lead to addiction. Sometimes addiction is objectively better than the alternative.
Yes, some of us will choose not to take certain medications because we've decided that we don't want to deal with the side-effects or the risks of long-term addictions we can expect withdrawal from. This is our prerogative, and shouldn't be used as a reason to deny this same medication to others who do need and want it. People who refuse addictive medications are not morally superior to those who take them, and vice versa. Different people benefit from different treatments based on their personal circumstances, and that includes access to medical and personal support systems as well as the severity of our chronic pain. A disabled character who refuses these medications should not be portrayed as more virtuous or "clean" by virtue of not taking them and should not think of themselves as superior to other disabled characters who do take addictive medications. They shouldn't be considered a "good disabled person" (as opposed to the "bad disabled people" with addictions) by abled characters in a way that is never challenged by the narrative.
Many doctors don't take patient comfort into account when switching medications around and changing dosages, which can cause people to go through unnecessarily severe withdrawal largely unsupported, or they'll sometimes refuse to prescribe a particular medication until all other options are exhausted for fear of a patient developing an addiction. Both are just different ways that disabled people and people with addictions alike are stripped of bodily autonomy and deemed incapable of understanding what we need. If you want to portray these sorts of doctor-patient interactions in your writing, I would very strongly advise paying a physically disabled sensitivity reader to give you personalized feedback and make sure you're on the right track and not reinforcing damaging ideology.
If you decide to touch on the nitty-gritty of addiction to painkillers in your story, including side-effects and withdrawal, I would just encourage you to treat this character humanely, and remember that having an addiction doesn't negate all the positive and human aspects of someone's life and personality. Keep in mind that addiction exists to treat something that the character has no control over. Addictions aren't evil, and in treating chronic pain they're often necessary.
I'd like to leave you and all other writers with the reminder that there's nothing fundamentally wrong with having an addiction on its own or portraying a disabled character with an addiction, but we're taught to believe that having one is an indication of moral or personal failure. Painkiller usage for disabled people is necessary and lifesaving, with or without subsequent addiction, and it's not appropriate for abled people to judge us for it. I see lots of solidarity between disabled people and people with addictions and hate to see people pose our needs as somehow at odds with one another.
My suggestion would be to treat this character's medications the same way as you would treat any other, and if someone gives this character grief in the story for their medication use, you can have them respond decisively that the alternative is worse. You could potentially scrap the societal stigma against addictions entirely and just have your characters accept the medication for what it is: a medical treatment used to manage pain that comes with some downsides, like many other common medications. You can incorporate the side-effects of the medication and, if relevant, withdrawal, into your character's life if you're aiming for a direct equivalency to real-world morphine and heroin--but you should still have this character and others recognize (either immediately or gradually) that it's preferable to unmanaged pain and not see his painkiller use as an inherently bad thing.
As always, this is ask open for input from others with chronic pain and/or lived experience with addiction to prescription medication(s).
-Mod Faelan
