The Story of Pain: From Prayer to Painkillers, by Joanna Bourke, Oxford University Press, 396 pages, $34.95
Joanna Bourke is that rare bird, an academic who manages to combine erudite scholarship with a sharp wit and an accessible prose style. She also has a nose for the intriguingly sensational: fear and killing have been the subjects of previous acclaimed investigations, and her latest book, “The Story of Pain: From Prayer to Painkillers”, makes a fitting addition to this grim inventory.
Since not even the luckiest mortal can survive a life without some close acquaintance with pain, it must be a topic of universal relevance.
One of her earlier books was titled “What It Means to Be Human”, and experiencing pain is surely one significant ingredient in that recipe. While its alleviation has been a central quest for all societies, as she attests there has been very little written about the expression of pain and what variables may influence this.
Although the advance of medicine and the development of painkilling techniques have affected the frequency and degrees with which pain is experienced, it remains an inalienably subjective event and thus hard to quantify or evaluate from a scientific perspective. As Bourke puts it: “In clinical contexts only some ‘pain utterances’ are regarded as ‘physiologically real’: a woman, for instance, who claims she is in agony because a rat is chewing her stomach is put in a straitjacket, rather than given novocaine.”
In the heat of battle even the severely wounded may not feel pain if strong and diverting emotion is present. The author of “The Doctor in War”, writing during the First World War, suggested that serious wounds “carry for the most part most mercifully their own anaesthetics with them”.
On the other hand, individuals frequently fail to register physical distress because it is too ingrained in their everyday life to be differentiated, so aching muscles, headaches, stomach upsets or hunger pangs, for example, can become perceived as the norm. This is likely to be more often the case in certain environments — frequently, though by no means exclusively, economically straitened ones.
There is also the phenomenon of pain felt second hand by the sufferer’s intimates, leading to the willing suppression of expressions of pain — as in the testimony of a heroic husband who, having sent his wife out on an errand, explained to a nurse: “The pain’s terrible bad but I didn’t want to spoil Eliza’s Christmas.”
In this way pain can estrange individuals both from others and themselves, and divide cultures. As Bourke tellingly puts it, “being-in-pain is never distributed democratically”.
The book is divided into topics, some obvious: diagnosis, relief, sympathy; others more arcane: estrangement, metaphor, gesture, religion.
Bourke is especially fascinating on these latter categories, where her breadth of scholarship is displayed. One attractive feature of the book is its rich references. Bourke has read widely in pursuit of her topic and brings not only doctors and scientists to bear on her subject but also writers and poets, who are much the most effective communicators of what it is to be in pain. She quotes several academic authorities to demonstrate that pain, while a universal phenomenon, is neither described nor evaluated in universals.
More radically, she argues that physiology is itself “profoundly affected by culture and metaphor”. For example, the humoral theory, dominant pre-19th century, gave rise to Thomas Gray’s description of pains “wandering” throughout his “constitution” until “they fix into the Gout”. The temperament of the individual, food, the weather and personal relationships all affected the experience of pain, which “arise(s) in the context of complex interactions within the environment, including interactions with objects and other people”.
War, for example, has a long history as a useful metaphor before technological advances led to mechanical imagery supplanting it. Bourke cites John Donne’s “Devotions upon Emergent Occasions”, where illness is represented as a physical conflict between kingdoms. Donne’s fellow poet and divine George Herbert also used the metaphor of violent battle to describe psychological pain.
One of the most distressing chapters of the book is on the role of religion which, perhaps unsurprisingly, has an unedifying history of conscripting pain into its orthodoxy.
Pain’s role is to teach submission to the powerful, both in this life and the life to come. The woeful story of poor Joseph Townend, whose right arm became stuck to his body through the accident of a serious childhood burn, tells how he came to terms with a series of brutal “medical” interventions by reflecting on his “past wickedness in resisting the Holy Spirit” and by “weeping, singing hymns, reading the Scriptures and looking forward to the time when my feet would again stand within the gates of Zion”.
William Nolan, writing in 1786, exhorts the clergy to visit patients in charitable hospitals “to admonish them from a repetition of those irregularities, which perhaps laid the foundation of their present sickness”.
But pain was also the route to self-improvement. In 1777, after being hit by a runaway horse, the philanthropist John Brown wrote: “Do me good, oh God! By this painful affliction may I see the great uncertainty of health, ease and comfort that all my Springs are in Thee.” And Harriet Martineau, the great 19th-century social reformer, wrote: “I was patient to illness and pain because I was proud of the distinction of being taken into such special pupillage by God.”
It is now well established that sympathy is a powerful remedial agent, yet almost as disturbing as her account of religion’s relationship to pain is Bourke’s analysis of surgery and surgeons who, for most of our history, have had to practise their profession without benefit of anaesthetics or effective analgesics.
She alludes to the mastectomy performed without anaesthetic on the novelist Fanny Burney, which Penelope Fitzgerald, in turn, used as the basis of an account of a similar procedure in her novel “The Blue Flower”. Burney described in a letter to her sister “the most torturing pain” at which “I needed no injunctions not to restrain my cries. I began a scream that lasted unremittingly during the whole time of the incident. I almost marvel that it rings not in my Ears still! So excruciating was the agony.”
If this weren’t unnerving enough Bourke reveals that, pretty well throughout history, surgeons have been notable for their lack of sympathy, even exhibiting sentiments of cruelty towards their patients. According to the author of “Heads and Faces and How to Study Them” (1886), “good” surgeons were those “with stiff muscle and a firm resolve to use the knife effectively”.
But it is not only surgeons who are cavalier with pain. Both children and women have, historically, had their pain dismissed. A 2003 study showed that men suffering post-operative pain were significantly more likely to be prescribed optimal pain management. In a 1990 study at the UCLA Emergency Medicine Centre, Hispanics were twice as likely as non-Hispanic whites to receive no medication for pain. And most of us who have endured today’s hospital conditions will know that pain relief is all too often supplied only according to a timetable and not in response to expressed need.
It is perhaps churlish of me amid such a wealth of fascinating insights to complain that there is not enough in this book about psychological pain, the kind that our present state of civilisation is most apt to suffer. That notwithstanding, this is a bold and impressive book about an enemy that knows no historical or cultural bounds.
–Guardian News & Media Ltd
Salley Vickers’s latest novel is The Cleaner of Chartres.
