How does one choose narrative strategy? One biographer’s experience

Gabriella Marie Kelly-Davies

‘How does one write a biography?’ Virginia Woolf wrote to Vita Sackville-West while writing a biography of the artist Roger Fry.¹ Nearly a century later, when I wrote the biography of Australia’s foremost pain medicine pioneer, Breaking through the Pain Barrier: The Extraordinary Life of Dr Michael J. Cousins,² I asked a variation on the same question: how does one select a biography’s narrative strategy when there are so many choices?

On 31 October 1982, as I cycled along a gravel road overlooking Magnetic Island in North Queensland, I revelled in the salty fragrance of the sea air and the fiery touch of the tropical breeze on my face. Suddenly, from the corner of my right eye, I glimpsed an arm thrusting towards me.

My next memory was a bright light.

It was a doctor at Townsville General Hospital peering into my eyes with a torch. ‘How do you feel?’ he asked.

‘Where am I?’

‘In hospital’, he said. ‘Some thugs in a passing car pushed you off your bicycle. You landed on your head and rolled along the road, pivoting on your neck.’

That day, my twenty-fourth birthday, heralded the onset of daily migraine attacks. It was also my entrée to the medical merry-go-round. After two decades of ricocheting from neurologist to neurologist and with escalating migraine attacks, my general practitioner referred me to the pain medicine specialist Dr Michael J. Cousins at Royal North Shore Hospital in Sydney. He greeted me in the pain clinic’s crowded waiting room.

‘Hello Gabriella, I’m Dr Michael Cousins’, he said. ‘Sorry I’m running late.’

Once in his office, we sat on opposite sides of his desk. ‘Please tell me what’s been happening’, he said, smiling warmly and looking directly into my eyes.

For the next twenty minutes, I related my struggle with migraine and the many failed treatments. He listened intently, nodding his head from time to time and writing notes on a foolscap writing pad, before examining me.

‘It would appear you have occipital neuralgia’, he said.

‘What’s that?’

Picking up a plastic model of a human head, he pointed to a network of red lines. ‘It’s pain in these nerves up the back of your head. Occipital neuralgia can trigger migraine attacks.’

Cousins suggested one option was to implant a neurostimulator at the base of my skull. ‘It’ll block the pain signals’, he said. He also recommended I join a multidisciplinary pain management program involving stretching and carefully paced exercise, meditation and psychological techniques. ‘It’ll teach you how to turn down the volume of pain signals racing through your nervous system’, he explained.

During my visits to the pain clinic, Cousins’s colleagues told me he had led the pain world in the late 1980s as president of the International Association for the Study of Pain. He also established two internationally acclaimed pain centres in Australia.

‘He’s a force of nature’, the head nurse said. ‘He put Australia on the map in pain medicine.’

A physiotherapist standing next to her beamed. ‘Many more patients can now access treatment because of him.’

I heard Cousins was a savvy political operator, formidable negotiator and relentless campaigner for the rights of people living with chronic pain. This intrigued me because it contradicted my experience of him as a kind, gentle doctor. It sparked my curiosity about who he was as a person and how he reconciled the conflicting aspects of his personality.

Outside of pain medicine circles, Cousins was relatively unknown, but his story is valuable to share because it holds lessons about determination and tenacity for aspiring leaders and reformers, irrespective of their field of endeavour. The emergence of pain as a field of medicine in the late 1970s and 1980s is an important aspect of Australia’s medical history, particularly because 3.6 million Australians live with chronic pain. Before Cousins’s political activism, access to pain management services across the nation was patchy, especially in rural and regional areas. This was my inspiration for writing his life story, although I knew some critics might dismiss it as just another archetypal ‘Great Man’ biography that glorifies a white, middle-class male. My goal was to craft a deeply nuanced, kaleidoscopic portrait that transcended the legend by examining the complex human being at its core.

In 2018, during a fundraising dinner for pain research, I asked Cousins whether I could write his biography. He agreed, with the only caveat that I allow him to correct any medical or scientific errors. Other than that he said the book was mine to write and he would not interfere.

To prepare for interviews, I read research articles from prominent journals such as Pain, the Journal of Pain and Pain Medicine, including many written by Cousins. I also studied Mosby’s Dictionary of Medicine, Nursing and Health Professions to help me grasp complex medical concepts and translate them into an accessible narrative for non-scientists. In January 2019, I began weekly conversations with Cousins at the mahogany dining table in his home on Sydney’s leafy upper North Shore.

‘Why did you study pain medicine?’ I asked during the first of eighteen months of interviews.

Cousins’s eyes brimmed with tears as he answered:

In 1964, when I was one year out of medical school, two little boys arrived at the hospital with burns to most of their bodies. They screamed and screamed because of their excruciating pain. I didn’t think they’d live so we kept a forty-eight-hour vigil by their bedsides. Back then the sole option for managing severe pain was morphine. But I could only give them tiny doses because of their age, so it didn’t ease their torment. Thankfully, the boys survived but their anguish haunted me. That weekend I dedicated my life to reducing suffering by improving the treatment of pain.

This story revealed deep insights into Cousins’s compassion and idealism. But I questioned the extent to which he decided to specialise in pain medicine that weekend as an emotional response to the boys’ agony or whether he became increasingly committed to the field as his career gained momentum. Had the story evolved over the years and become part of the narrative of his life, one he genuinely believed was true because he had told it so many times? I asked him, but he insisted his commitment to improving the treatment of pain medicine occurred that weekend.

A peril I strove to avoid was becoming attached to, and identifying with, my living subject. This was a risk because of our former doctor/patient relationship and the demands of loyalty to someone I admired and respected. To reduce the risk of writing a hagiography, I strove to maintain a professional distance, although it was challenging to change the way I related to Cousins. It was also difficult to adopt an attitude of scepticism during interviews because of years of implicitly trusting him as my doctor. Gradually, I detached from our earlier relationship and started questioning contradictions, ambiguities and inconsistencies.

To gain a variety of perspectives, I interviewed a broad range of individuals and interpreted Cousins’s character and behaviour on the weight of evidence rather than from my subjective perspective. While accepting that true objectivity is impossible to achieve because each biographer’s interpretation is influenced by background, experiences and prejudices, I felt a deep responsibility to represent the truth of my subject for the historical record.

Cousins introduced me to twenty-two pain medicine professionals in Australia and around the world, eight of whom had collaborated with him on projects since 1969. They all mentioned his sharp intelligence and passion for research and his patients. However, I knew if I just relied on the memories of his friends and supporters, I risked idealising him. By reading research papers and speaking with pain medicine professionals, I identified another twenty-eight colleagues, then interviewed them. Two of them from Flinders Medical Centre were venomous in their remarks about him.

For several months I wrestled with how to reconcile these criticisms because they conflicted with the opinion of the vast majority of associates, many of whom had collaborated with Cousins on projects for two or more decades. I reinterviewed his closest Flinders’ colleagues and asked them about their understanding of the discord. This enabled me to include the assertions, describe the context in which they occurred and present various critiques of the situation. Still, I felt uneasy because it was unclear to what extent the accusations represented the truth, a version of the truth or were a form of retribution, so I admitted this uncertainty to readers.

I also interviewed Cousins’s family members and ten patients; their observations validated my own experience of his commitment and compassion. By the end of 2020, I had consulted over one hundred individuals, some of them multiple times.

During 2019 and early 2020, I visited all the places in Australia that shaped Cousins, some of them with him, and conducted research in Australia’s principal pain medicine archive in Melbourne. In mid-2020, I was scheduled to study archives at the two Australian pain centres he founded—Flinders Medical Centre in Adelaide and Royal North Shore Hospital in Sydney—but this research was delayed by COVID-19 lockdowns.

Three months later, I was due to retrace his footsteps at McGill University, Montreal, and Stanford University, California, where he embarked on his pain medicine career in 1969. I had also planned four weeks of research in pain medicine archives at the University of California in Los Angeles and McGill. However, during the height of the pandemic, Australia’s international borders closed—indefinitely—forcing me to postpone the trip.

The choices

Before I started drafting the manuscript, I thought deeply about the style of book I wanted to write. To help crystallise my thinking, I read biographies of doctors and scientists and books about the art and craft of biography. One writer whose remarks resonated with me was Richard Holmes, who wrote The Age of Wonder, a history of eighteenth-century scientists such as the botanist Joseph Banks.³ ‘Science is always a story … a detective story, perhaps; a mystery story … but always a story of human lives’, Holmes suggests. He believes today’s readers long to learn ‘what makes scientists tick and what set them ticking’. They are curious about what drives researchers to make discoveries, how they respond to failure, and personal matters such as love and relationships. Readers perceive imaginatively written biographies as gripping, even electrifying ‘adventures of the human spirit’, despite the account being based on complicated medical or scientific information.⁴

Holmes’s commentary gave me the confidence to write creatively, basing the narrative on corroborated evidence from a myriad of sources. It also helped me to frame the questions readers might ask about Cousins, such as why he was driven to improve pain management when he faced so many obstacles, and what he was like as a person rather than as a prominent doctor.

In the biography’s prologue, I recreated a scene from Cousins’s description of treating the two burned boys. The setting is a Saturday evening in a hospital driveway during 1964. Cousins was waiting for the boys to arrive in an ambulance when he heard heart-wrenching screams from the end of the driveway. Turning towards the sound, he noticed two tiny, blackened figures limping up the path.

A young man with dark hair runs towards the boys. He wears a white coat and a stethoscope swings from his neck. As he gets closer to the children, he realises they are the two burned boys he was waiting for in the ambulance bay.

This young man is twenty-five-year-old Dr Michael Cousins. He notes the skin on the boys’ faces is black and the skin on their heads, torso, arms and legs looks completely burned off. The boys wail, and their blackened hair stands on end, making it look fuzzy.

Once the boys are inside Casualty, Cousins gently inserts needles into the backs of their burned hands. The needles are attached to drips. Their hands balloon and he is glad he got the cannulas in on time—any later, and the swelling would have prevented it. He runs tiny doses of morphine through the drips, then places oxygen masks over the boys’ scorched faces. But the morphine doesn’t work. The children’s piercing screams reverberate through the casualty department.

For the next forty-eight hours, Cousins and the hospital’s medical and nursing team keep a vigil by the boys’ bedsides. Thankfully, the boys survived, but the staff failed to ease their horrific pain.

Haunted by the children’s suffering, Cousins resolved to learn more about pain and its treatment.

This scene shows Cousins in action, conveys his thoughts and provides clues about his character, especially his empathy. It is a moment-by-moment account written in present tense to increase immediacy and heighten the drama. My goal was to enable readers to be inside Casualty with Cousins, seeing him in their ‘mind’s eye’ and feeling his compassion for his patients. I felt like a forensic investigator trying to corroborate Cousins’s version of this incident, but, after exhaustive attempts, I could not locate the burned boys or their parents. Hospital records were inaccessible because of strict privacy rules. Although a nurse who was in Casualty with Cousins confirmed his version of events, verified primary sources would have been more scholarly.

Recreating this scene involved multiple revisions because members of my writing group said early drafts sounded too much like Cousins’s point of view as a doctor-hero. They advised me to strengthen my narrative voice. Although I had a vague understanding of this elusive concept, I could not grasp its essence in a practical sense, so studied the academic literature and writers with a distinctive voice, such as Virginia Woolf and Helen Garner.

After several weeks of close reading, I finally grasped authorial voice as a theoretical concept, but I was still unsure how to strengthen it. The biographer Nigel Hamilton encourages authors to follow their instincts. ‘Your voice will emerge as you write’, he advises. ‘Start with the subject matter and your narrative design, and let your voice find itself. Biography is storytelling.’⁵ It was reassuring to learn my authorial voice would gradually emerge as I wrote the story; as writers, we often expect early drafts to be perfect.

During 2019, when I shared my narrative voice concerns with a friend, she suggested I imagine us sitting on the sofa in front of a roaring fire sipping a glass of wine. ‘Please tell me about Michael Cousins’, she said. The next day, imagining my friend was with me, I told her the story, recording it on an iPhone. When I listened to it, I could hear my natural voice emerging rather than Cousins’s autobiographical voice and academic language. During the following months, I dictated every paragraph into the iPhone, reflected on it, then edited the text. My authorial voice—and, importantly, my independent interpretation of the evidence—emerged.

Still, I knew a subject’s remarks illuminate character. I wanted Cousins’s voice to be present without it detracting from my authorial voice, so I weaved the most revealing of his comments into the narrative. During media interviews he often declared: ‘Access to pain management is a fundamental human right. What price can you put on a person’s quality of life?’ His colleagues said he frequently started meetings with this statement, so I included it to reflect his deep commitment to the concept.

During interviews I often asked: ‘What did you see?’, ‘What did you smell?’, ‘What did you hear?’, ‘Who else was there?’, ‘What did you do?’, ‘How did it make you feel?’ and ‘How did you respond?’ Then I listened to his descriptions in interview recordings, especially his vocabulary and the timbre of his voice, before visiting the places that shaped him.

Cousins accompanied me to the pain centre at Royal North Shore Hospital, the University of Sydney’s medical school, Palm Beach, his childhood homes and schools, enabling him to relive his experiences and share them with me; I was astonished by the level of detail he recounted in these memories, many of them from over sixty years ago. However, most buildings and their surrounds had changed significantly during the intervening years, so I searched for photographs and descriptions of them as they would have appeared to Cousins when he was younger. The following scene shows him as an idealistic, young anaesthesia registrar searching for a seminal textbook on pain:

At the crack of dawn, Cousins jolted awake, even though his last shift for the week had ended only a few hours earlier. That Saturday in 1965, he drove to Sydney University’s medical school, a Gothic sandstone building with stained glass windows. He stood outside the library’s highly varnished, dark wooden doors, checking his watch every few minutes.

On the dot of nine o’clock, a small woman with bobbed grey hair and round glasses opened the doors. Cousins smelled the familiar musty odour that brought back memories of spending long hours studying in the library. He headed straight to the catalogue; a series of wooden drawers filled with white index cards then looked up ‘B’. ‘Yes! He’s here’, Cousins gasped, barely able to contain his excitement. He had found Professor John J. Bonica’s magnum opus from 1953 The Management of Pain⁶—the only book that discussed everything known about pain and its treatment. Cousins made a beeline for the shelf that held the key to his future, hurriedly scanning the call numbers. His heart pounded as he glimpsed the bulky tome. He pulled it from the shelf and carried it to a desk. At the same time as he pulled out a chair, he opened the book and tried to read it. After checking the index, he opened to the right section, then ran his finger down each page, line by line.

To reconstruct this scene, I sat in the library for three hours absorbing its sights, sounds and smells and studied a text the university had published about the first 150 years of its medical school. I also interviewed the school’s archivist who had studied medicine at the university a few years after Cousins. By listening to interview recordings and studying transcripts, I was able to reproduce Cousins’s descriptions precisely, using his vocabulary and including his emotional responses.

One of the complexities of writing about doctors and researchers is converting dense, academic content into an enthralling story. My background was in physiotherapy, so I had a basic understanding of medical terminology, but I struggled to grasp complex aspects of the science of pain medicine. Cousins is a natural teacher and explained theoretical concepts to me in simple terms, but I still found it challenging to translate them for readers. My solution was to describe each term within the narrative then include a technical definition in the notes section at the end.

The following example shows how I explained the epidural space:

Story

Philip Bromage described how he had injected local anaesthetic into the epidural space—the space surrounding the outer membrane of the spinal cord—to relieve pain after patients had crushed their chests in an accident.

Notes

The epidural space surrounds the dura—the outermost and fibrous of the three membranes surrounding the brain and spinal cord. The dural sac, the pouch formed by the lower end of the dura, contains cerebrospinal fluid and spinal nerves.

It took me several months of revising to settle on the following description of the revolutionary Gate Control Theory of Pain after members of my writing group said early drafts were encyclopaedic and impenetrable:

In 1965, the McGill psychologist Ronald Melzack and neuroscientist Patrick Wall proposed that something occurred in the spinal cord and at other levels of the nervous system to alter the processing of pain signals. Contrary to most members of the medical profession, they thought pain signals flowed in two directions through the nervous system—from the injured area of the body up the spinal cord to the brain, then back down the spinal cord to the damaged tissues. This idea challenged widely accepted theories that viewed pain signals as flowing from the surface of the skin to a dedicated area in the brain.

Melzack and Wall suggested ‘nerve gates’ in the spinal cord controlled the flow of pain signals to the brain. Excitatory chemicals in the nervous system opened the gates, increasing the intensity of the pain, and inhibitory chemicals closed the gates, turning down the volume of pain. The two researchers thought if a person felt stressed or anxious, the nervous system released excitatory chemicals, opening the gates and intensifying the pain. But if a person was calm and relaxed, the nervous system released inhibitory chemicals, closing the gates and reducing the pain.

If correct, the Gate Control Theory opened several alternative treatment approaches for chronic pain because it considered psychological factors such as depression and anxiety that can alter the way the nervous system processes pain signals. Most doctors dismissed the mental health issues linked with chronic pain, classifying them as ‘reactions to pain’. They routinely labelled patients with persistent back pain as ‘crocks’ before sending them to a psychiatrist.

Later research, some of it by Cousins during 2011, validated this theory.

Focusing the story was difficult because Cousins was a prolific writer, and he juggled several academic, clinical and professional roles. As well as writing hundreds of letters, he published 180 journal articles, seventeen letters to editors and fifteen editorials. He also published six textbooks, 114 reviews and chapters in textbooks, a doctor of medicine thesis and a doctor of science thesis.

For four months, I experimented with ideas for narrowing the biographical scope, eventually deciding to emphasise evidence that represented deeply personal turning points and transformative moments in Cousins’s life rather than trying to represent the entire arc of his life and risk writing a tome. It was crucial to incorporate his life outside of scientific and medical realms to ensure the biography depicted the reality of a whole person rather than just a career and accomplishments. To show his reaction to meeting Michele, his lifelong partner, I recreated the following scene:

Cousins met Michele Old at a Christmas party in December 1966. Petite, with golden blonde hair and translucent blue eyes, she worked as a research assistant at Sydney University’s law school. Michele took one look at Cousins’ warm hazel eyes and friendly smile, and instinctively knew they would marry. Cousins felt the same way. ‘It felt as if we’d known each other all our lives. It was most peculiar, as it happened in an instant.’

To captivate readers, Holmes advises biographers to employ novelistic devices such as reconstructing scenes from a subject’s life and manipulating the pace and rhythm.⁷ The creation of a new form of pain relief by the Flinders Medical Centre researchers in 1979 provided an opportunity to employ these devices:

The first patient they tested with this technique was a middle-aged woman named Dora who suffered from severe upper back pain following breast cancer surgery. Early one evening, Dora lay on a bed in the recovery ward where Cousins had prepared her to receive an epidural injection of pethidine. Constantly wriggling on the bed to relieve her pain, she rated it as ten on a scale of one to ten. Two nurses scurried around tidying up before they left for the day while the head scientist, Laurie Mather, stood beside Dora’s right shoulder chatting with her about the procedure. Two male researchers dressed in crisp white lab coats hovered at the end of the bed.

Cousins taped a thermometer around Dora’s right big toe to measure any changes in her body temperature triggered by pethidine’s local anaesthetic action. Then he injected the analgesic into her epidural space.

He observed Dora’s facial expressions and body language for several minutes then asked: ‘How’s your pain?’

‘I don’t have any pain’, she said.

‘Do your legs feel numb?’ Cousins asked.

‘No. They feel normal.’

He instructed Dora to wiggle her legs. She did.

This response astounded Cousins because the pethidine had not caused the loss of feeling or movement in the legs that occurred whenever he injected a local anaesthetic into a patient’s epidural space. The Flinders researchers were ecstatic, realising an improved method of pain relief was seemingly within grasp!

‘Can it be true?’ they asked, shaking their heads in disbelief.

I reconstructed this scene from Cousins’s memories and those of his Flinders’ colleagues. Descriptions of the procedure in journal articles and textbooks enabled me to corroborate their accounts, which was crucial because of the four-decades gap between the study and our interviews. My aim was to translate a scientific study into a captivating narrative that made readers feel as if they were in the recovery ward with the research team. The dialogue is paced to show Cousins’s gradual realisation that the procedure, which is still considered seminal within pain medicine and anaesthesia circles, was successful.

The political biographer Robert Caro insists facts are the key to his authentic character studies and result from accumulating a trove of detailed information about people. Caro gathers evidence through hundreds of interviews, among other sources, admitting he has reinterviewed some people dozens of times, even though it sometimes annoys them.⁸ I mirrored Caro’s approach by interviewing over one hundred individuals and repeating interviews when contradictions appeared or I required further clarification, particularly of ambiguities. When Cousins’s colleagues became frustrated with multiple interviews, I explained the crucial importance of substantiating all evidence before I included it in the biography. Otherwise, I risked breaking my contract with readers to create an authentic account of my subject’s life. Most accepted this rationalisation, but one strident critic banned me from further questioning after a long interview and four rounds of emails, each of which raised more puzzling questions I needed to resolve. Understanding the views of a subject’s detractors is essential and can be more revealing than the memories of supporters, so this was disappointing and frustrating.

Midway through the project, Cousins was diagnosed with Parkinson’s disease, giving me a sense of urgency about completing the manuscript while he was still well enough to read it. Should I wait for the pandemic to end before completing the biography so I could include additional research? Or should I finish the book based on the wealth of evidence I had already accumulated? While wrestling with this decision, I achieved third place in a manuscript development prize in Australia and the publisher who organised the competition offered me a contract.

My original plan was to submit the biography to the University of Sydney as the creative component of my PhD, then to seek trade publication. But the publisher’s unexpected offer, my subject’s rapidly declining health, and uncertainty about when archives and Australia’s borders would reopen, prompted me to publish the book; by then the manuscript had been fact-checked by Cousins and three pain medicine scholars. However, I feared I risked missing vital clues to better understanding and portraying my subject. This troubled me because I knew the novelistic devices I employed must be grounded in facts sourced through rigorous scholarship.

In hindsight, I regret publishing the biography before hospital archives and international borders reopened because, once I undertook additional research, my fears were realised.

After returning to Sydney from McGill and Stanford in 1974, Cousins worked at Royal North Shore Hospital as an anaesthetist. Letters he wrote to the hospital’s medical superintendent in the mid-1970s show him as a compassionate young anaesthetist and pain researcher. But they also reveal him as extremely audacious and ambitious. His correspondence displays an extraordinary level of self-belief and a single-minded determination to pursue his agenda. It also shows a willingness to upset the status quo, regardless of whether it alienated his superiors and associates, characteristics I had not personally experienced as his patient or biographer, and ones his associates omitted during interviews, despite my probing.

I reinterviewed several colleagues, who confirmed they were strong features of Cousins’s personality, ones he would draw on throughout his career to overcome financial constraints, fierce opposition and systemic inertia. They insisted he was driven to improve pain management and his personal attributes enabled him to achieve his mission despite formidable obstacles.

More surprises awaited me in the Gus Fraenkel Collection at Flinders University where Cousins established Australia’s first multidisciplinary pain centre in the late 1970s. While studying correspondence and minutes of meetings, I felt the pressure boiling up inside him and his sense of despair as his efforts were frustrated. During five years of research, I had never experienced this level of empathy with my subject, possibly because I strove to remain detached to avoid hagiography.

I also witnessed Cousins circumventing Flinders University chiefs when he appealed directly to South Australia’s health minister to secure funding to build a pain centre. One of his colleagues had said: ‘Whenever Michael couldn’t achieve an acceptable outcome he went over people’s heads and rang someone more senior. He wasn’t afraid to go around people.’ It was revelatory to observe this behaviour firsthand in the archives.

Building plans for Flinders Medical Centre, which opened in 1976, provided me with a deeper understanding of the historical, social and political context in which Cousins operated. At his job interview for the role of foundation professor of anaesthesia and intensive care, he spoke at length about his plans to establish a pain centre based on the models he had witnessed in North America. He assumed that by appointing him, Flinders’ leadership team shared his vision. However, the hospital’s building plans did not include a pain centre nor was funding assigned to construct these facilities or operate them. Annual reports from the late 1970s and 1980s revealed the hospital exceeded its operating budget by $2 million every year. And minutes of meetings disclosed the pressure senior managers were under to reduce operating costs. Understanding this situation helps to explain why Cousins’s efforts were thwarted and why, in desperation, he appealed to higher powers.

Once Australia’s borders reopened, I spent four weeks researching pain medicine archives in North America and immersing myself in places of significance to Cousins such as the austere Royal Victoria Hospital in Montreal. Hundreds of letters and minutes of meetings disclosed his exceptional efforts in building the field of pain medicine in Australia and contributing to its advancement internationally. My greatest realisation was the extent to which his mentor, John J. Bonica, the ‘godfather’ of pain medicine and ‘a force to reckon with’ according to his colleagues, drove Cousins relentlessly. Until I read their correspondence, I had not appreciated the intense pressure Bonica imposed on his younger colleague or that Cousins’s priority projects in Australia were exact replicas of those Bonica implemented in America during the 1960s and 1970s.

I am now rewriting the published version of Breaking through the Pain Barrier as the creative component of my doctorate and incorporating these insights. My goal is to craft a much more scholarly biography than the published version, one that portrays Cousins in a deeply nuanced way and integrates his human story with the story of a crucial area of Australia’s medical history that illustrates how social, cultural and political forces influence health policy.

---