ArticlePDF Available

Abstract

What is pain? This article argues that it is useful to think of pain as a 'kind of event' or a way of being-in-the-world. Pain-events are unstable; they are historically constituted and reconstituted in relation to language systems, social and environmental interactions and bodily comportment. The historical question becomes: how has pain been done and what ideological work do acts of being-in-pain seek to achieve? By what mechanisms do these types of events change? Who decides the content of any particular, historically specific and geographically situated ontology?
Transactions of the RHS 23 (2013), pp. 15573 C
Royal Historical Society 2013. The online
version of this article is published within an Open Access environment subject to the
conditions of the Creative Commons Attribution licence http://creativecommons.
org/licenses/by/3.0/
doi:10.1017/S0080440113000078
WHAT IS PAIN? A HISTORY
THE PROTHERO LECTURE
By Joanna Bourke
READ 4JULY 2012
ABSTRACT. What is pain? This article argues that it is useful to think of pain as
a ‘kind of event’ or a way of being-in-the-world. Pain-events are unstable; they
are historically constituted and reconstituted in relation to language systems, social
and environmental interactions and bodily comportment. The historical question
becomes: how has pain been done and what ideological work do acts of being-in-
pain seek to achieve? By what mechanisms do these types of events change? Who
decides the content of any particular, historically specific and geog raphically situated
ontology?
Pain does not emerge naturally from physiological processes, but in
negotiation with social worlds. It is surprisingly difficult, however, to
define what is meant when people use that word ‘pain’. The English
noun ‘pain’ encompasses a host of phenomena that are incommensurate.
‘Pain’ is a label that adheres to scraped knees, headaches, phantom limbs
and kidney stones. It is assigned to heart attacks and heartaches. The
adjective ‘painful’ is so broad that it can be applied to a toothache as
easily as to a boil, a burst appendix and a birth. Pain can be inflicted by
knives or hula-hoops (as in the 1959 mini-epidemic of children diagnosed
with ‘hula-hoop syndrome’ caused by ‘excessive hooping’).1
Furthermore, even a cursory examination of the historical record
uncovers a headache-inducing range of theological, scientific, medical
and philosophical definitions of pain. In 1882, Friedrich Nietzsche
famously declared that ‘I have given a name to my pain’; it was
called ‘dog’. For him, pain was ‘just as faithful, just as obtrusive and
shameless, just as entertaining, just as clever as any other dog, and I
can scold it and vent my bad mood on it, as others do with their dogs,
servants, and wives’.2It was an apt analogy, even if rather insulting to
non-figurative dogs, servants and wives. However, if pain was a dog,
I am very grateful to The Wellcome Trust for supporting this research.
1Zafar H. Zaidi, ‘Hula-Hoop Syndrome’, Canadian Medical Association Journal,80 (1959),
71516.
2Friedrich Nietzsche, The Gay Science, trans. Walter Kaufmann (New York, 1974;1st publ.
1882,), 24950.
155
156 transactions of the royal historical society
it was a beast of gargantuan proportions. Nietzsche was adopting a
functionalist definition: his pain-Dog was defined by its function in
the great philosopher’s life. Such ways of conceptualising pain have
proliferated. For centuries, theologians have assumed that pain was a
kind of chastising communiqu´
e from a Higher Being; nineteenth-century
evolutionists contended that it was a mechanism to protect the organism
from harm; and many clinicians from the late nineteenth century onwards
have drained pain of any intrinsic meaning altogether, making it little
more than a sign or symptom of something else (a dis-ease). With brain
imaging technologies from the late twentieth century, the subjective
person-in-pain could be eradicated altogether, with pain morphing into
little more than ‘an altered brain state in which functional connections
are modified, with components of degenerative aspects’.3
Still others have diced pain using different scalpels. In innumerable
ways, philosophers and scientists have sought to pare pain back to its bare
skin and bones. Was pain the reaction of filaments and animal spirits
to noxious stimuli, as Ren´
e Descartes and his disciples believed in the
seventeenth century and beyond?4Was it caused by ‘too great irritability’
or ‘a want of sufficient irritability’, as the author of Asthenology (1801)
claimed?5Or was it more correct to say that pain was a sensation in the
sense that it ‘has a threshold, is localised and referred to a stimulus’?6In
the 1830s, Sir Charles Bell in England and Francois Magendie in France
focused on the biological nature of pain in the context of the motor and
sensory functions of the dorsal (Bell) and ventral (Magendie) roots of
the spinal cord. Johannes M¨
uller, Richard Bright, Maximiliary Von Frey
and A. Goldschneider fixed attention on the nerves, disagreeing fiercely
about whether specificity theory (the body has a separate sensory system
for perceiving pain) or pattern theory (the receptors for pain are shared
with other senses such as touch) best described the physiology of pain.7
In 19767, the International Association for the Study of Pain (IASP)
attempted to tame Nietzsche’s beast by calling together a diverse group of
pain specialists (including experts in neurology, neurosurgery, psychiatry,
3Silvia Camparesi, Barbara Bottalico and Giovanni Zamboni, ‘Can We Finally “See”
Pain? Brain Imaging Techniques and Implications for the Law’, Journal of Consciousness
Studies,18,910 (2011), 2578.
4Ren ´
e Descartes, ‘Meditations on First Philosophy’, trans. Elizabeth S. Haldane and
G. R. T. Ross, ed. Enrique Ch´
avez-Arvizo, Descartes: Key Philosophical Writings (Ware, 1997;
1st publ. 1641), 183,andRen
´
e Descartes, Tra i t´
e de l’homme (Paris, 1664), 27.
5Christian Augustis Struve, Asthenology: Or, the Art of Preserving Feeble Life; and of Supporting
the Constitution under the Influence of Incurable Diseases, trans. William Johnston (1801), 423.
6E. Guttmann and W. Mayor-Gross, ‘The Psychology of Pain’, The Lancet,20 Feb. 1943,
225.
7For summaries, see Ronald Melzack and Patrick D. Wall, ‘Pain Mechanisms: A New
Theory’, Science,150,3699 (1965), 9719, and Roselynne Rey, The History of Pain, trans.
Louise Elliott Wallace (Cambridge, MA, 1995).
what is pain? 157
psychology, neurophysiology, dentistry and anaesthesia) to adjudicate
definitively on the question ‘what is pain?’ Their definition is now the
most cited one in the field of pain studies. The IASP concluded that pain
is ‘an unpleasant sensory and emotional experience associated with actual
or potential tissue damage, or described in terms of such damage’. This
definition emerged directly from the invention in 1965 of the Gate Control
Theory of Pain, which introduced the idea of a ‘gating mechanism’ in
the dorsal horns of the spinal cord that allowed the perception of pain
to be modified. Crucially, the Gate Control Theory and, consequently,
the IASP’s definition insist that sensory, cognitive and affective processes
influence people’s experience of pain. As such, the definition is remarkably
flexible and it opens the door to social, psychological and physiological
explorations. This does make it very useful indeed to the historian.
However, as historians have consistently argued, it is extremely
problematic to overlay a late twentieth- and early twenty-first-century
understanding of pain on to earlier periods. Equally troubling, adopting
the IASP’s definition would have meant taking a particular position on
that long-standing, thorny debate about what some have dubbed the
‘myth of two pains’,8that is, emotional versus bodily pain. Although the
IASP’s definition may seem to side with those who seek to undermine the
distinction between the emotional and the physiological, in fact it does
nothing of the kind. It simply states that both are valid ‘pains’ (if a person
described her emotional pain in terms of tissue damage, it is allowed to
be called ‘painful’). The Cartesian distinction between mind and body
(and it may be noted that Descartes himself was not a fully signed-up
Cartesian)9is alive-and-well and does a vast amount of ideological work
for physicians, psychiatrists, psychologists, the pharmaceutical industry
and chronic pain patients today.
One useful starting point in beginning to define what is meant by
the word ‘pain’ can be found in the musings of a prominent Victorian
physician, Dr Peter Mere Latham. Latham had been born in London
in the year of the French Revolution and died eighty-six years later. He
was one of the most renowned physicians in London, working at the
Middlesex Hospital and then St Batholomew’s, and (like his father) was
appointed Physician Extraordinary to the Sovereign. Portraits show him
bedecked in robes, with a magisterial forehead, penetrating gaze and self-
assured smile. Given that his everyday routines were frequently shattered
by attacks of asthma, he clearly had thought a great deal about suffering.
8For the best discussion, see David B. Morris, The Culture of Pain (Berkeley, 1991), 9.
9For a discussion, see Jan Frans Van Dijkhuizen, ‘Partakers of Pain: Religious Meanings
of Pain in Early Modern England’, in The Sense of Suffering. Constructions of Physical Pain in Early
Modern Culture, ed. Van Dijkhuizen and Karl A. E. Enenkel (Leiden, 2009), 189219.
158 transactions of the royal historical society
What is most striking about Latham, however, are his thoughts on
bodily pain, published between the 1830sandtheearly1860s. He also
wanted to know the answer to that simple question: what is pain? Latham
recognised that pain assumed many guises. ‘There is a Pain which barely
disturbs the complacency of a child’, he noted, and ‘a pain which is too
much for the strength of a giant’. Are these two kinds of pain actually
the same, differing only ‘in degree’? Could it really be the case that
‘the smallest Pain contain[s] all that essentially belongs to the greatest,
as the minutest atoms of matter have separately the same properties of
their largest aggregates’, he asked? In everyday language, dramatically
different experiences of pain are spoken of using one word – ‘pain’. But
if we ‘suppose ourselves at the bed-side and within hearing, when Pain
raises its cry of importunate reality’, the likenesses of painful experiences
are exposed as nothing more than a linguistic deceit. The ‘things of life
and feeling’ – that is, each person’s unique encounter with suffering – are
‘different from all things in the world besides’.10
So, how did Latham seek to define pain? The correct response to
anyone who asks ‘what is Pain?’, he rather grumpily contended, was
simply to state that ‘he knew himself perfectly well what it was’ and he
‘could not know it the better for any words in which it would be defined’.
Hammering home the point, Latham insisted that ‘Things which all
men know infallibly by their own perceptive experience, cannot be made
plainer by words. Therefore, let Pain be spoken of simply as Pain.’11
Latham’s definition of pain – pain is what is spoken about as ‘Pain’ – is
one that many historians, anthropologists, sociologists and even clinicians
espouse. Anyone claiming to be ‘in pain’, is in pain; if a person describes
her experiences as ‘painful’, they are. For the purposes of historical
analysis, so long as someone says that they are suffering, that claim is
accepted. In Latham’s words, ‘The fact of pain being suffered at all
must always be taken on the patient’s own shewing [sic].’ Of course, like
Latham, we might admit that ‘there is such a thing as shamming Pain’,12
but that does not alter our primary definition.
This approach to pain has been highly productive. It is well suited to
the way many historians conduct their research. It is profoundly respectful
towards the ways peoples in the past have created and recreated their lives,
and it remains courteously neutral about the veracity of any specific claim.
It allows for multitude, even conflicting, characterisations of suffering.
Crucially, the definition enables historians to problematise and historicise
every component of pain-talk. It insists that ‘pain’ is constructed by a host
10 P. M. Latham, ‘General Remarks on the Practice of Medicine’, British Medical Journal
(28 Jun e 1862), 677.
11 Ibid.
12 Ibid.
what is pain? 159
of discourses, including theological, clinical and psychological ones. Done
badly, it can lead to literary practices that assume that ‘pain’ can be ‘read’
transparently from various texts; done well, however, this approach to
pain encourages subtle, deconstructive analyses of past experiences and
behaviours.
However, the definition comes up against a major limitation. The clue
to the problem lies in the fact that whenever Latham wrote about ‘pain’,
he capitalised it: for Latham, pain was Pain. In other words, there is an
assumption that pain is an ‘it’, an identifiable thing or concept. To be fair,
Latham recognised this problem. He was not convinced that ‘pain’ was an
‘it’, excusing himself on the grounds that his reifying (although he would
not have used that word) of ‘Pain’ was driven by pragmatic observations.
As he observed, ‘No man, wise or foolish, ever suffered Pain, who did not
invest it with a quasi materialism.’ In the throes of physical anguish, even
the most rational philosopher finds himself ‘outreasoned by his feelings’.
‘I have known many a philosopher’, Latham continued, ‘take to rating
and chiding his Pain, as if it were an entity or quiddity of itself.’ Therefore,
‘for practical purposes, we must often let people think and speak of things
as they seem to be, and not as they are, making a compromise between
philosophy and common sense. We must let them speak so of Pain. There
is no help for it.’
Ignoring Latham’s condescending tone, his basic point is a legitimate
one. Sufferers of pain are entitled to say ‘I don’t know what you mean
by pain, but Iknow “it” when I feel “it”’, and then go on to describe
their pain as though it were an independent entity within their body (‘I
have a pain in my tooth’) or an entity that attacks from the outside (as in:
pain is a weapon that stabs, a fire that burns, an animal that bites). But,
for the historian, there are many dangers involved in referring to pain
as though it were an entity. The chief one is that it risks giving ‘pain’ an
independent life. The ease with which we can slip into making this error
can be illustrated by turning to Elaine Scarry’s influential book The Body
in Pain (1985). Scarry argues that pain is outside of language, absolutely
private and untransmittable. Indeed, in her most often-quoted statement,
Scarry goes even further, insisting that ‘Physical pain does not simply
resist language but actively destroys it, bringing about an immediate
reversion to a state anterior to language, to the sounds and cries a human
being makes before language is learned.’13 This is an extreme version of
reification. As literary scholar Geoffrey Galt Harpham rightly observes,
such an argument
treats as an immediate and monochrome physical experience, a baseline of reality,
what is in fact a combination of sensations, dispositions, cultural circumstances, and
13 Elaine Scarry, The Body in Pain. The Making and Unmaking of the World (New York, 1985),
45.
160 transactions of the royal historical society
explanations, a phenomenon involving body, mind, and culture. She has, in other words,
misconceived the character of pain precisely by giving it a character, by treating it as a
fact – a brute fact, the first and final fact – rather than as an interpretation.14
In other words, Scarry has fallen into the trap of treating metaphoric
ways of conceiving of suffering (pain bites and stabs; it dominates and
subdues; it is monstrous) as descriptions of an actual entity. Of course,
metaphorically, pain is routinely treated as an independent entity within
a person, as in statements such as ‘he has a pain in his shoulder’, ‘the
pain went away, and ‘bleeding will get rid of the pain’ but, for Scarry, these
metaphors are literalised.15 ‘Pain’, rather than a person-in-pain, is given
agency. This is an ontological fallacy.
How can pain be conceived of non-ontologically? It is helpful to begin
from the premise that pain is not an object; it is a type of event.Painisa
way of being-in-the-world. Pain-events are unstable; they are historically
constituted and reconstituted in relation to language systems, social and
environmental interactions and bodily comportment.
What is meant by saying that pain is an event? By designating pain as a
‘type of event’ (I will discuss what I mean by ‘type of event’ shortly), I mean
that it is one of those recurring activities that we regularly experience
and witness that participates in the constitution of our sense of self and
other. Events are not entities or mental objects; they are ways of being-
in-the-world. An event is designated ‘pain’ if it is identified as such by
the person claiming that kind of consciousness. Being-in-pain requires an
individual to give significance to this particular ‘type of’ being. This word
‘significance’ is not being used in the sense of ‘importance’ (a pain can
be a momentary pin-prick) but in the sense of ‘recognised’ (a stomachache
rather than the gurgling of the stomach before lunch). It is never neutral
or impersonal. In other words, a pain-event possesses what philosopher
Paul Ricoeur called a ‘mineness’.16 A pain-event always belongs to the
individual’s life; it is a part of her life story. In this way, the person becomes
or makes herself into a person-in-pain through the process of naming.
An individual has to name pain – she has to identify it as a distinctive
action – for it to be labelled a pain-event. But how do people know what to
name as pain? If the words we use for sensations are private or subjective,
then how do we know how to identify them? How do people give the
label ‘pain’ to one subjective sensation and not another?
14 Geoffrey Galt Harpham, ‘Elaine Scarry and the Dream of Pain’, Salmagundi,130/131
(2001), 208.
15 For an extensive discussion of metaphor and pain, see my article ‘Pain: Metaphor,
Body, and Culture in Anglo-American Societies between the Eighteenth and Twentieth
Centuries’, Rethinking History (forthcoming, 2014).
16 Paul Ricoeur, Oneself as Another, trans. Kathleen Blamey (Chicago, 1992), 132.
what is pain? 161
In recent years, scholars exploring the senses have turned to the ideas
of the philosopher Ludwig Wittgenstein for stimulation. In Philosophical
Investigations, Wittgenstein turned his mind to the question of whether
there can be such a thing as a private language. How do ‘words refer
to sensations’, he asked? Like Latham, he acknowledged that people
routinely talk about their sensations. As Wittgenstein put it ‘don’t we
talk about sensations every day, and give them names’, so why the fuss?
Simply put, he continued, the problem is ‘how is the connection between
the name and the thing set up? This question is the same as: how does a
human being learn the meaning of the names of sensations? – of the word
“pain” for example.’ Wittgenstein modestly suggested ‘one possibility’,
that is, ‘words are connected with the primitive, the natural expressions
of the sensations and are used in their place. A child has hurt himself and
he cries; and then adults talk to him and teach him exclamations and,
later, sentences. They teach the child new pain-behaviour.’ He imagined
an interlocutor interrupting him with the question, ‘So you are saying that
the word “pain” really means crying?’ ‘On the contrary’, Wittgenstein
continued, ‘the verbal expression of pain replaces crying and does not
describe it.’17
Imagine, he mused, a world in which there were no outward expressions
of sensations – where, for instance, nobody cried or grimaced. In such a
world, how could a person know he was in pain? This man could scrawl
an ‘S’ in his diary each time he experienced a particular sensation. But
how would he know that it was the same sensation he was experiencing
each time? And how would other people know what ‘S’ stood for? This
diarist would have no criterion for knowing when he was experiencing ‘S’
and when ‘T’. To have any meaning, Wittgenstein concluded, words for
feeling-states like pain must be inter-subjective and able, therefore, to be
learned. In other words, the naming of a ‘pain-event’ can never be wholly
private. Although pain is generally regarded as a subjective phenomenon
– it possesses a ‘mine-ness’, to use Ricoeur’s term – ‘naming’ occurs in
public realms.
Wittgenstein clearly enjoyed imagining other worlds. On another
occasion, he invented a world in which everyone possessed a box, which
contained a beetle. No one was able to peer into anyone else’s box,
however. Because people only knew what the beetle was by looking into
their private box, it was entirely plausible that each person believed that
‘beetle’ referred to a complete different entity. Indeed, the ‘beetle in
the box’ might change regularly. The box might even be empty. But if
everyone believed that they possessed a ‘beetle in a box’, then the word
‘beetle’ was useful in communication. In terms of language, in other
17 Ludwig Wittgenstein, Philosophical Investigations, trans. G. E. M. Anscombe (Oxford,
1953), 89.
162 transactions of the royal historical society
words, the ‘actual content’ of the box does not matter. What is important
is the role of the ‘beetle in the box’ in terms of public experiences.
Now substitute the word ‘pain’ for ‘beetle’: it does not matter that I
have no direct access to your subjective consciousness, so long as we have
a shared language to discuss our various ‘pains’. For my purposes, this
‘beetle in the box’ analogy is not perfect – after all, my pain is not ‘in’
my body (although we often speak as though it is) in the same way that
a beetle is ‘in’ a box – but Wittgenstein’s language-game draws attention
to an approach to pain that can be very productive for historians. As
Wittgenstein succinctly put it, ‘mental language is rendered significant
not by virtue of its capacity to reveal, mark, or describe mental states, but
by its function in social interaction’.18 For historians, it is important to
interrogate the different language games that people residing in the foreign
kingdom of the past have played, in order to enable us to make educated
guesses about the diverse and distinctive ways people have packaged their
‘beetle in the box’ or pain in their lived-bodies.
My approach to pain also states that pain is a ‘type of event.Inother
words, it is useful to think of pain-events in adverbial terms. Philosopher
Guy Douglas has an interesting way of explaining this point. He points
out that there is a difference, for example, in saying ‘I feel a sharp knife’
and ‘I feel a sharp pain.’ In the first instance, the knife is what linguists call
an ‘alien accusative’ (that is, the knife refers to the object of the sentence)
while, in the second instance, pain is a ‘connate accusative’ (it qualifies
the verb ‘to feel’ rather than being a sensory object in itself). In the first
sentence, we are ‘describing a knife apart from the way it feels, while in
saying that pain is sharp we are describing the feeling’, that is, a sensation
similar to being injured by a sharp object. In other words, in saying ‘I feel
a sharp pain’, we are qualifying a verb rather than a noun.19
The other way of expressing this is by saying that pain describes the
way we experience something, not what is experienced. For example, we
say that a tooth is aching, but the ache is not actually the property of the
tooth but is our way of experiencing or perceiving the tooth. As Douglas
put it, ‘sensory qualities are a property of the way we perceive the object
rather than the object itself’. Pain is ‘not the thing or object that one
is feeling, it is what it is like to feel the thing or object’. Crucially, pain
is not an intrinsic quality of raw sensation; it is a way of perceiving an
experience.20 Pains are modes of perceptions: pains are not the injury or
noxious stimuli itself but the way we evaluate the injury or stimuli. Pain
is a way-of-being in the world or a way of naming an event.
18 Ibid., 188.
19 Guy Douglas, ‘Why Pains Are Not Mental Objects’, Philosophical Studies,91,2(1998),
12748.
20 Ibid., 12748.
what is pain? 163
The historical question, then, becomes: how has pain been done and
what ideological work do acts of being-in-pain seek to achieve? By what
mechanisms do these types of events change? As a type of event, pain is an
activity. People do pain in different ways. There is no decontextual pain-
event: so-called ‘noxious stimuli’ may excite a shriek of distress (corporal
punishment) or squeal of delight (masochism); there is no necessary and
proportionate connection between the intensity of tissue damage and the
amount of suffering experienced since phenomena as different as battle
enthusiasm, work satisfaction, spousal relationships and the colour of the
analgesic-pill can determine the degree of pain felt; and people have no
difficulty using the same word ‘pain’ to refer to a flu injection and an
ocular migraine.
Although each individual is initiated into cultures of pain from birth,
being-in-pain is far from static or monochrome, which is why it requires a
history. People can – and regularly do – challenge dominant happenings
of pain. Indeed, the creative originality with which some people-in-pain
draw on and transform language games, environmental exchanges and
bodily performances (or gestures) of suffering is striking. Of course, the
most dominant ‘doing’ of pain is to objectify it as an entity – giving it
independence outside the person doing the pain. It becomes important
to ask, therefore, who decides the content of any particular, historically
specific and geographically situated ontology? What is excluded in these
power-acts?
As historians, it is therefore possible both to let ‘people think and speak
of things as they seem to be’, as Latham expressed it (that is, conceiving
of pain as an ‘it’ or an entity to be listened to, obeyed or fought) and
to acknowledge that ways of being-in-pain involve a series of agents,
all of whom are immersed in complex relationships with other bodies,
environments and linguistic processes. It would be disingenuous to suggest
that Latham would wholly agree with this interpretation, but he seemed
to be gesturing towards such a position when he shrewdly remarked that
Pain, itself a thing of life, can only be tested by its effects upon life, and the function of
life. And whether it be small or great (so to speak), or of whatever degree, it is to its affect
upon life and the functions of life that we must look.21
In other words, pain is always a ‘being-in-pain’, and can only be
understood in relation to the way it disrupts and alarms, authenticates
and cultivates, the ‘states of being’ of real people in the world.
There are a number of advantages to adopting an events-based
approach to pain in history. The first one is that we do not have to
jettison Latham’s main insight that ‘Things which all men know infallibly
by their own perceptive experience, cannot be made plainer by words.
21 Latham, ‘General Remarks’, 677.
164 transactions of the royal historical society
Therefore, let Pain be spoken of simply as Pain.’ In other words, pain is
what people in the past said was painful. We are not required to privilege
one, historically specific meaning of pain over any other. Defining pain as a
‘type of event’ remains neutral about the ‘truth value’ of any philosophical
or scientific definition. Instead, it asks: what does the scientific content of
any particular, historically specific and geographically situated scientific
ontology tell us about the way philosophers, scientists and physicians have
sought to classify pain-events. As historians of science have reiterated time
and again, scientific practice itself is social action. We invent, rather than
discover, pain. Pain-as-event enables us to avoid reifying pain in terms of
a single incarnation.
If the first advantage in thinking about pain as a ‘type of event’ is
that it is historically flexible, the second advantage is that it is historically
complex. People perceive pain through the prism of the entirety of their
lived experiences, including their sensual physiologies, emotional states,
cognitive beliefs and relational standing in various communities. As a
consequence, the definition is sceptical of any pain-account that claims
that pain is simply a sensual response to noxious stimuli or – to put it in
the language used earlier – that Nietzsche’s pain-Dog only reacts to the
world rather than responds to it (which many philosophers believed was
what distinguished animals from humans).22 As mentioned earlier, the
most famous conceptualisation of ‘pain-as-ensation’ was that of Descartes.
According to him, pain occurred when fast-moving particles of fire rushed
up a nerve fibre in the foot towards the brain, activating animal spirits
which then travelled back down the nerves, causing the foot to move away
from the flame. In this model, the body was a mechanism that worked
‘just as, pulling on one end of a cord, one simultaneously rings a bell
which hangs at the opposite end’.23 Although nociceptive impulses and
endorphins were subsequently substituted for filaments and animal spirit,
Descartes’s basic, mechanistic model of pain-as-sensation has dominated
both scientific and ‘folk’ beliefs about pain into the mid-twentieth century.
Claims that pain is simply a sensual or physiological response to noxious
stimuli cannot account for the way that people in the world experience
what they call pain. The model of pain-as-sensation implies that a person
‘feels’ a noxious stimuli, after which affective, cognitive and motivational
processes ‘kick in’ – responding and interpreting the happening. However,
these things occur in dynamic interaction.
Conceiving of pain as a ‘type of event’ allows us to disentangle pain-
situations from pain-experiences. This is not to deny that a person dying of
the plague is likely to have an excruciating headache. But many aches and
22 For a discussion, see my book What It Means To Be Human: Reflections from 1791 to the Present
(2011).
23 Descartes, ‘Meditations on First Philosophy’, 183,andDescartes,Tr ait ´
e de l’homme,27.
what is pain? 165
pains are not caused by bodily damage. People can suffer, yet be lesion-
free, as in many chronic pain states. They can be in pain, yet not possess the
limb that is ‘feeling pained’, as in phantom limb sensations. They can be
in situations that self-evidentially warn of agony, yet be calm. As Edmund
Burke noted, Italian theological and astrologer Tommaso Campanella,
who was tortured on the rack, ‘could so abstract his attention from any
suffering of his body, that he was able to endure the rack itself without
much pain’. As Burke correctly concluded, ‘our minds and bodies are so
closely and intimately connected, that one is incapable of pain or pleasure
without the other’.24 Being-in-pain is multifaceted: attitudes, motivations,
belief systems and cognition all contribute to making or signifying the
event.
Another way of making this point is to argue that pain only exists in
the act of evaluating it. Not all ‘acts’ are ‘events’. Indeed, some acts
(having a limb blown off in combat, to take one example) may not
be designated pain-events by the person affected. A particularly stark
example of this can be seen in the context of the Second World War.
Lieutenant Colonel Henry K. Beecher, who served in combat zones on
the Venafro and Cassino fronts, was struck by the fact that many severely
wounded men did not complain of pain. Medical officers found that there
was no necessary correlation between the size and depth of any specific
wound and men’s expressions of suffering. Beecher decided to explore
this paradox systematically, questioning 215 seriously wounded men. To
his surprise, three-quarters did not report experiencing significant pain.
One third claimed to be feeling no pain at all, while another quarter said
they were experiencing only slight pain. Remarkably, three-quarters of
all seriously wounded men did not even ask for pain relief, despite the
fact that being asked the question would have served as a reminder that
relief was available. What was happening? Perhaps, Beecher speculated,
men who had been wounded were simply less sensitive generally. But
this explanation failed to account for the fact that ‘a badly wounded
patient who says he is having no wound pain will protest as vigorously
as a normal individual at an inept venipuncture’. Instead, Beecher
found, there must be a difference between wounds caused in civilian
contexts (a car accident, for example) and those caused during combat.
Perhaps the strong emotions aroused in combat were responsible for
the absence of acute pain. Pain might also be alleviated by the fact
that wartime wounding would release a soldier ‘from an exceedingly
dangerous environment, one filled with fatigue, discomfort, anxiety, fear
and real danger of death, and gives him a ticket to the safely of the
hospital. His troubles are about over, or he thinks they are.’ This was in
24 Edmund Burke, The Works of the Right Hon. Edmund Burke, with a Biographical and Critical
Introduction by Henry Rogers,I(1837), 60.
166 transactions of the royal historical society
contrast to civilian accidents, which only heralded in ‘the beginning of
disaster’.25
This is not to deny the importance of the sensory nature of pain – pain is
‘what hurts’. However, it is to insist that, by itself, the sensation approach is
much too narrow. The ‘sensations’ definition simply does not help explain
the vast number of different sensations that we place under that single
label ‘pain’ (a headache and a heartache). It also cannot help interpret
the lives of people who have been lobotomised – an operation performed
on people with intractable pain from 1943. These patients could still
claim to be in pain (and could discriminate between different degrees of
noxiousness) yet were completely uninterested and unconcerned about
the sensation.26 The event of being-in-pain is evaluative. It stands in
relation to the individual in an adverbial sense: pain is ‘not the thing or
object that one is feeling, it is what it is like to feel the thing or object’.27
Pain may be rendered significant because it is unpleasant but there is no
phenomenological state that is in and of itself ‘painful’, as any zealous
saint or keen sadomasochistic practitioner can attest.
The event-ness of pain also draws attention to the fact that different
emotional reactions adhere to pain-events. Depending on the presence of
other objects and people, pain-events can elicit distress (face-to-face with
a torturer), fear or panic (crashing through the car window), anticipation
or surprise (the moments after a heart attack). They can also elicit pride
(gout in the eighteenth century), relief (self-cutters) or joy (childbirth).
This can be illustrated by looking at the way Joseph Townend wrote
about pain in the middle of the nineteenth century. For this impoverished
manual labourer, pain was an event that adhered to some acts and not
others. It was not mentioned, for example, when he wrote about the
lingering deaths of four of his siblings (his father simply exclaimed, ‘Bless
the Lord, there’s another safe landed!’). Nor did he evoke pain when he
described extreme hunger or working (from the age of seven) seventeen-
hour shifts in the carding room of a Lancashire cotton mill. Rather,
Townend only summon the spectre of pain in the context of a severe
burn he suffered as a child, which resulted in his entire right arm being
25 Lt. Col. Henry K. Beecher, ‘Pain in Men Wounded in Battle’, Annals of Surgery,123,1
(1946), 96105.
26 Walter Freeman and James W. Watts, Psychosurgery. In the Treatment of Mental Disoerders and
Intractable Pain,2nd edn (Oxford, 1950), 550; J. W. Watts and Walter Freeman, ‘Psychosurgery
for the Relief of Unbearable Pain’, Jour nal of the International College of Surgeons,9(1945), 679;
Everett G. Grantham and R. Glen Spurling, ‘Selective Lobotomy in the Treatment of
Intractable Pain’, Annals of Surgery,137,5(1953), 602; W. Tracey Haverfield and Christian
Keedy, ‘Neurosurgical Procedures for the Relief of Intractable Pain’,Souther n Medical Journal,
42,12 (1949), 1077; Mical Raz, ‘The Painless Brain Lobotomy, Psychiatry, and the Treatment
of Chronic Pain and Terminal Illness’, Perspectives in Biology and Medicine,52,4(2009), 560.
27 Douglas, ‘Why Pains Are Not Mental Objects’, 12748.
what is pain? 167
fused to his side. Even in this context, the process of hurting was a positive
one: as he declared, ‘heaven must recompense our pains’.
For Townend, painful happenings constituted his place both in this
world and the next. In his narration, the most important event in hisentire
life occurred when he trudged all the way to the Manchester Infirmary to
have his arm cut free. The surgeon gruffly warned: ‘Now, young man, I
tell you, if when you feel the knife, you should jerk, or even stir – you will
do it at the hazard of your life.’ Anaesthetics like chloroform would not
be invented for another twenty-three years and no analgesic (like whiskey
or laudanum) was offered. ‘All was still’, Townend recalled, when ‘with
a forcible thrust, through went the knife, as near the pit of the arm as
possible, and close to my side ...the progress of the instrument I distinctly
heard’. The pain was ‘most exquisite’. As the ‘smoking wound’ was being
dressed and bound, Townend was left to reflect on ‘my past neglect and
wickedness in resisting the Holy Spirit’. He thought of the Methodist
chapel, attendance at which he had neglected. He ‘wept bitterly’: saying
his ‘mind [was] fully made up to be entirely the Lord’s when I should
return home’.
For Townend, bodily agony was a gift inflicted by a loving, heavenly
Father. But he was equally clear that the function of pain was to teach
him submission not only to hierarchies of power in the next life, but
also in this one. Townend had only praise for his surgeon but when he
attempted to thank him by shaking his hand – obviously, using his left
hand – the surgeon shouted at him: ‘Do you offer a gentleman your
left hand?’, then he grasped Townend’s right arm and dragged him off
the bed: ‘Immediately my leg and foot were covered with blood; and
on the web [of skin] being loosed, I saw that it was turned black: and
my poor side was drenched in blood, and smoked almost like a kiln.’
Another doctor observed that his wound was inflamed, forcing Townend
to admit that he had ‘partaken rather freely of port wine’. The doctor
was ‘very much grieved; and [so] he suddenly jerked up my shoulder,
which made me sweat with pain, and it cracked like the firing of a pistol’.
Townend’s only comment on this act of the doctor whom he called ‘easy,
kind, careful and communicative’ was ‘So much for wine.’ Pain was a
legitimate punishment for socially insulting a ‘gentleman’ and partaking
in alcoholic beverages.28
Pain performed two acts for Townend: it drew him into the exulted
embrace of God’s family while reminding him of his lowly status in the
family of Man. His being-in-pain was a world away from later, secular
beings, in which pain was no longer conceived of as an entity that had
to be passively endured or embraced. Rather, it was an ‘enemy’ to be
28 Rev. Joseph Townend, Autobiography of the Rev. Joseph Townsend: With Reminiscences of his
Missionary Labours in Australia,2nd edn (1869), 1618.
168 transactions of the royal historical society
fought and ultimately defeated. In the words of the anonymous author
of ‘The Function of Physical Pain’ (1871), now that pain had been ‘made
optional’ by anaesthetics, it ‘necessitates a complete revisal [sic]ofthe
theories of the purposes of bodily pain hitherto held by moralists’.29 When
the pharmaceutical possibility of eradicating acute pain was limited,
endurance could be valorised as a virtue: the introduction of effective
relief (at least for the kinds of pain that plagued the young Townend’s
life) made passive endurance perverse rather than praiseworthy. Stripped
of its mysticism and its history in foundational theological texts, pain
became an evil in itself, unequally distributed (afflicting the saintly as
carelessly as the sinner) and serving, at most, a rather limited diagnostic
function.
In other words, people in the past interpreted their pains not as
contained (in the Wittgensteinian sense of ‘the beetle in the box’),
isolated, individual bodies, but in interaction with other bodies and social
environments. Cognition also mattered. It made a difference whether the
person-in-pain conceived of the event as being inflicted by an infuriated
deity, due to imbalance in the ebb and flow of humours, an inevitable
punishment for a lifetime of ‘bad habits’, or the result of an invasion by a
germ.30 The body is never pure soma: it is configured in social, cognitive
and metaphorical worlds.
This discussion anticipates the third advantage to conceptualising pain
as a ‘type of event’: there is no such thing as a private pain-event. I have
already discussed this aspect from a Wittgensteinian point of view, but
here I mean something less philosophical and more historical. From the
moment of birth, infants were initiated into cultures of pain. What these
infants in the 1760s learned about the cognitive, affective and sensory
meanings arising from the interface between their interior bodies and
the external world was very different to what their counterparts in the
1960s learned. In the humoral physiology of the eighteenth century, for
example, bodies consisted of four fluids – phlegm, black bile, yellow bile
and blood. Linked to these humours were personality types (sanguine and
melancholic). There were also three kinds of spirits, which acted on the
humours: the natural, the vital and the animal. In this model – unlike
the biomedical one that was dominant until the 1960s – distinctions
between bodies, minds and souls were not clear-cut. Pain was the
result of disequilibrium or imbalance. Illness was the result of disrupted
relationships as much as disrupted physiologies. As a result, humoural
29 ‘The Function of Physical Pain: Anæsthetics’, Westminster Review,40,1(1871), 198200
and 205.
30 For an extensive discussion, see my article ‘Pain: Metaphor, Body, and Culture in
Anglo-American Societies between the Eighteenth and Twentieth Centuries’.
what is pain? 169
theory provided rich figurative languages of ebbs and flows. For example,
take John Hervey’s 1731 description of his sister’s suffering. She was
choked with phlegm, tormented with a constant cough, perpetual sickness at her
stomach, most acute pains in her limbs, hysterical fits, knotted swellings about her
neck and in her joints, and all sorts of disorders, consequent to a vitiated viscid [sic]
blood, which, too glutinous and weak to perform its proper circulation, stops at every
narrow passage in its progress, causes exquisite pains in all the little, irritated, distended
vessels of the body, produces tumours in those that stretch most easily, and keeps the
stomach and bowels constantly clogged, griped, and labouring, by the perspirable matter
reverting there for want of force to make its due secretions and evacuate itself through
its natural channels in the habit and the pores of the skin.31
Pain in this account was a blockage of natural flows. It pervaded all parts
of the body, and not just particular organs. This was a world away from the
body-in-pain of nineteenth-century biomedicine or twenty-first-century
neurology. Physiological models of the body draw attention to certain
things and not others, fundamentally affecting what is noticed –andgiven
meaning – and what is regarded as incidental. The physiological body is
constituted by the figurative languages that bring the body into the world.
Figurative languages ‘disclose’ our being-in-the-world.32
Once taught what constituted a pain-event, messages communicated
though language, facial expressions and gestures helped inform people-
in-pain how they ought to respond. There was a rich corpus of texts
explicitly instructing people how they ought to behave when in pain. These
‘comportment manuals’ or prescriptive pain-texts changed from the
explicitly hagiographical ones of the eighteenth and nineteenth centuries
to the more psychologically infused texts of more recent decades. More
subtle instructions were given through gesture. There is a vast literature
documenting the different ‘gestural styles’ in pain-instructions.33
These communicative acts were normative. They did not simply
document the various ways people-in-pain responded to their affliction:
they contained veiled instructions on how people should act. People-
in-pain sought to conform to these instructions for numerous reasons.
Correctly adhering to highly esteemed scripts might increase a person’s
confidence in an affirmative posthumous existence. Pain-performances
might be important in order to protect the witnesses, rather than the
sufferer herself. This was what was being conveyed in Rachel Betts’s
memoir of 1834. Betts was described as suffering ‘excruciating pain’, after
which she observed her sister weeping. Betts was mortified, admitting
31 John Hervey, ‘An Account of my Own Constitution and Illness, with Some Rules for
the Preservation of Health; for the Use of my Children’, in his Some Materials Towards Memoirs
of the Reign of King George II,III, ed. Romney Sedgwick (1931;1st publ. 1731), 971.
32 Ibid.
33 For a discussion, see my Stories of Pain: From Prayer to Painkillers (Oxford, forthcoming,
2014).
170 transactions of the royal historical society
that ‘I cannot help expressing how great my pain is’ since ‘it seems a
relief ’ to vent it. However, she added, ‘I do not wish to distress you.’ A
short time later, when her mother asked her if she ‘continued easier’,
Betts simply replied, ‘Quite easy.’34 Sufferers might also seek to conform
for non-reflexive reasons (this might be especially true of those figurative
ways of speaking about pain that were internalised from infancy or were
deeply embedded in language).
In this way, pain can be seen as a learned exegesis. As influential pain-
psychologist Ronald Melzack discovered in the 1970s, Scottish terriers
who had been raised in isolation from birth and protected from all
normal environmental stimuli, including painful ones, proved unable
of identifying and responding ‘normally’ to a flame or pinpricks when
exposed to it in maturity.35 They simply hadn’t ‘learned’ what it meant
to be-in-pain.
Of course, we do not need dogs (whether they belong to the scientist
Melzack or the philosopher Nietzsche) to show us that pain is social action.
Human bodies in pain are profoundly connected and communicative. Not
surprisingly, the social norms expected in the expression of pain differed
according to the gender, class, occupation and age of the person-in-pain.
They have changed dramatically over time as people-in-pain creatively
perform pain.
As a public ‘type of event’, being-in-pain was always political.
Both chronic and acute beings-in-pain could be the result of economic
deprivation (hazardous working conditions, lack of medical insurance,
the failure of physicians and pharmacists in poor areas to stock the most
effective analgesics) as well as the cause of destitution. The politics of gender
also adhered to pain-events: the exquisite sensitivity required of upper-
class men in the salons of Edinburgh in the late eighteenth century can be
contrasted to the burly hardiness of American frontiersmen. In Martin
Pernick’s insightful book A Calculus of Suffering. Pain, Professionalism, and
Anesthesia in Nineteenth Century America (1985), he correctly maps out the way
that American physicians ranked different people’s sensitivity to painful
stimuli: in that great Chain of Feeling, certain people (distinguished
by class, gender, ‘race’, religion, occupation and so on) were relatively
insensitive.36 What he does not explore is the contradictory assumptions
behind the Chain of Feeling. For instance, in nineteenth- and much of the
twentieth-century discourse, non-European peoples and workers could
be denigrated as possessing lesser bodies: their position at the lower
echelons of the great Chain of Feeling was due to their physiological
34 Rachel Betts, Memoir of the Last Illness and Death of Rachel Betts (1834), 22.
35 Ronald Melzack, ‘The Perception of Pain’, in Physiological Psychology,ed.RichardF.
Thompson (San Francisco, 1971), 223.
36 Martin S. Pernick, A Calculus of Suffering. Pain, Professionalism, and Anesthesia in Nineteenth
Century America (New York, 1985).
what is pain? 171
insensibility. However, often in the same text, they could also be designated
as inferior on precisely the opposite grounds: excessive or ‘exaggerated’
sensitivity. The alleged insensitivity of non-Europeans, immigrants and
workers was proof of their rudimentary nervous systems and thus humble
status, yet the profound sensitivity of these same people was also proffered
as evidence of their inferiority (they lacked strength of will).37 The fact
that both beliefs could be held simultaneously was responsible for the
appalling high levels of underestimation of the bodily pains of certain
groups of patients. Indeed, it took until the late twentieth century for the
routine underestimation of the pain of African-Americans, immigrants,
women and the poor to be deemed scandalous in the medical literature.38
Interestingly, this vast debate was conducted almost solely in terms of the
under-medicalisation of pain – a significant indicator about the ideological
labour being performed in clinical pain-narratives.
The instability of pain-events as refracted through social interactions
can also be illustrated by exploring the dramatic shifts in the Chain on
Feeling. It was not only a contradictory hierarchy; it was also volatile over
time. One illustration of this can be seen in medical discussions about
the sentience of infants, which shifted from an emphasis on the exquisite
sensitivity of infants in the eighteenth century to almost total insensibility
to pain from the 1870s and then back again to acute sensitivity from
the 1980s. The exquisite sensitivity of infants to painful stimuli was at
the heart of eighteenth-century debates within the professionalisation of
pediatrics – indeed, it helped perform the work of professionalisation.
In the 1780s, Michael Underwood (the first obstetrician to be appointed
to the Royal College of Physicians in London and the physician most
responsible for establishing paediatrics as a discipline in its own right)
argued that the chief reason that very young children had been neglected
by the medical profession was because they lacked the capacity ‘to give
account’ of their pain. As a result, their care had been entrusted to ‘old
women and nurses’. It was time that this changed, he insisted. After all,
infants displayed their aches and pains ‘plainly and sufficiently’ on their
faces. ‘Every distempter’, he continued, had ‘a language of its own’ and it
was ‘the business of a physician to be acquainted with it’.39 In Pye Henry
Chavasse’s textbook Advice to a Mother on the Management of her Children,
and on the Treatment on [sic] the Moment of Some of their More Pressing Illnesses
and Accidents, he further reflected on the ‘sympathy ... in the nervous
system’ between different parts of the infant’s body. When we consider
‘how susceptible the young are to pain’, he observed, ‘no surprise can be
37 For an extended discussion, see my ‘Pain Sensitivity: An Unnatural History from 1800
to 1965’, Journal of Medical Humanities (forthcoming, 2013).
38 This is addressed in great detail in my Stories of Pain.
39 Michael Underwood, A Treatise on the Diseases of Children, with Directions for the Management
of Infants from the Birth; especially Such as Are Brought up by Hand (1784), 4.
172 transactions of the royal historical society
felt at the immense disturbance and the consequent suffering and danger
frequently experienced by children while cutting their first set of teeth’.40
The exquisite sensitivity of infants to painful stimuli was disrupted
from the 1870s in particular. Experimental embryology, in particular,
was drawing conclusions about the biology of sentience. The work of
Paul Emil Flechsig was especially important. Flechsig had systematically
examined sections of the brain of foetuses, newborn infants and older
infants, showing that nerve fibres developed at different rates. At Flechsig’s
1894 address at the University of Leipzig (published the following year as
Gehirn und Seele), he argued that
The structures at the base of the brain, for the most part, and the cerebellum were
found to be myelinated before birth; whereas in the newborn infant the cerebrum
only exhibited isolated regions of myelination around the primary fissures – namely,
the central, calcarine, and the Sylvian; these are the regions of the primary projection
centres of movement and of the special senses. The remainder of the cortex is not
myelinated, and constitutes the association centres as yet unprepared for function. Upon
anatomical grounds, therefore, it may be postulated that a child at birth may have a
simple sensation.41
In other words, at birth, infants were not fully ‘wired’.
This pain-work was much more than a rhetorical or scientific exercise:
it justified giving children as old as ten inadequate pain relief – or
withholding it altogether. As the author of Modern Surgical Technique
(1938) claimed, ‘no anesthetic is required’ when carrying out even major
operations (such as amputations and heart operations) on young infants.
Indeed, ‘a sucker consisting of a sponge dipped in some sugar water
will often suffice to calm the baby’.42 As late as the 1970s, over half of
children aged between four and eight years who had undergone major
surgery – including amputations – in American hospitals received no
medication for pain.43 Dismissive attitudes towards the sensual worlds
of infants and young children only changed significantly from the
1980s – not coincidentally in the contexts of contestations of the acute-
pain model by women and ethnic minorities as well as debates within
pro- and anti-abortion movements.
Finally, the social also adheres to the physiological body itself. This is
the fourth advantage of conceiving of pain as a ‘way of naming an event’.
The act of ‘naming’ influences bodily responses. Anthropologist William
40 Pye Henry Chavasse, Advice to a Mother on the Management of her Children, and on the Treatment
on [sic] the Moment of Some of their More Pressing Illnesses and Accidents,9th edn (Philadelphia,
1868), 70.
41 Paul Flechsig’s lecture, summarized by Frederick W. Mott, ‘Cerebral Development and
Function’, British Medical Journal,1,3145 (1921), 529.
42 Max Thorek, Modern Surgical Technique,III (Philadelphia, 1938), 2012.
43 Joann [sic] M. Eland and Jane E. Anderson’s chapter in Pain. A Sourcebook for Nurses and
Other Health Professionals, ed. Ada Jacox (Boston, MA, 1977), 45376.
what is pain? 173
Reddy has called this ‘emotives’.44 Language does things to bodies. It
acts upon them. This is another way of saying that the body-in-pain is
not simply an entity awaiting social inscription (as in Wittgenstein’s ‘the
beetle in the box’ analogue or as implied in the ‘body as text’ metaphor)
but is an active agent in both creating pain-events and, in turn, being
created by them. The repeated recitation of particular way of naming a
pain, for example, can affect the physiological body. Figurative languages
can inform an individual’s autonomic arousal, cardio-vascular responses
and sensorimotor actions. Or, put in the language of the very different,
humoural physiology, metaphors can affect whether blood freezes or
gushes through the irritated, distended vessels of the body; they direct the
ebb and flow of phlegm, black bile and yellow bile. Naming can instruct
bodies how to respond. This concept of ‘retrojection’, or the means by
which ways of naming pain are mapped back into the flesh, is important
for any historian of the body. When a series of figurative languages or
concepts for pain are repeated time and again from infancy, they become
internalised and infused literally within the individual’s body.45 Through
retrojection, sufferers ‘infuse the imagery of cultural metaphors’ into their
bodies, thus, feeling ‘the power of discourse within’.46
To conclude: sentience is socialised. It is a state of being, constituted
within complex, temporal worlds. Pain is a type of event that involves
sensation, cognition, affect and motivational aspects. Meanings, history,
learning and expectations all influence ways of being-in-pain. As a type
of event, pain is always meaningful to the person experiencing it. There
is no pain-entity independent of the way it impinges on people’s being-
in-the-world. People often speak as though they ‘have’ a pain – and the
contrasting ways they ‘have’ it is important in mapping changes over
time – but the body-in-pain is a lived event. As a historically unstable
practice, pain-events are constituted and reconstituted in relation to
other practices, including language systems, social and environmental
interactions and bodily comportment. Contestations to this ideological
work is important. As Latham reminded his readers in the 1860s, the
‘things of life and feeling’ – that is, each person’s unique encounter with
suffering – are ‘different from all things in the world besides’.47
44 William M. Reddy, The Navigation of Feeling: A Framework for the History of Emotions (New
Yo r k , 2001).
45 I develop this argument in ‘Pain: Metaphor, Body, and Culture in Anglo-American
Society between the Eighteenth and Twentieth Centuries’.
46 Michael Kimmel, ‘Properties of Cultural Embodiment: Lessons from the Anthropology
of the Body’, in Body, Language, and Mind,II:Sociocultural Stuatedness, ed. Rosleyn M. Frank,
Ren ´
e Dirven, Tom Ziemke, and Enriqu`
eBern
´
ardez (New York, 2008), 99 and 101.
47 Latham, ‘General Remarks’, 677.
... Indeed, the extent of understanding of individual processes is limited and one would not be exaggerating to characterize the confluence of processes as quasi-mystical. The current level of thinking about the mechanism of pain, then, has returned to blending of "biles," "phlegm" and "animal spirits" and the blurring of a distinction between "mind" and "brain" [1,4]. Others have pointed out that the general definition of pain itself is a mercurial entity, a product of intangible social processes rather than quantifiable physiological processes [4]. ...
... The current level of thinking about the mechanism of pain, then, has returned to blending of "biles," "phlegm" and "animal spirits" and the blurring of a distinction between "mind" and "brain" [1,4]. Others have pointed out that the general definition of pain itself is a mercurial entity, a product of intangible social processes rather than quantifiable physiological processes [4]. ...
... Indeed, "pain" can be experienced in the absence of injury while those with significant injury sometimes do not claim to be in pain [5]. In addition, according to the definition, "emotional pain," without "tissue damage," would be as valid as the "unpleasant sensory experience" resulting from "tissue damage" and would, by extension, be as worthy of treatment [4]. ...
Article
Full-text available
Neuropathic pain is a chronic disability associated with a dysfunction of the nervous system, initiated by a primary lesion or disease. Even after resolution of the initiating pathology, neuropathic pain often persists, leading to a significantly diminished quality of life. A vast literature has documented alterations in the expression and distribution of various pain-related proteins in the peripheral nervous system following injury or disease. The current review examines pain-related molecules in the pathogenesis of peripheral nerve injury-induced pain and discusses potentially useful therapeutic targets on the basis of preclinical findings in rodent neuropathic pain models. There are indeed a number of cellular processes that are involved in maintaining the neuropathic pain state, but the current review will focus on transmembrane proteins, particularly the voltage-gated and ligand-gated ion channels, which modulate peripheral nerve function. Given the complexity of the process involved in peripheral nerves, clinical efficacy could be greatly enhanced if several of these targets are engaged at once. A key advantage of therapy directed peripherally is that penetration of the therapeutic into the CNS is not entirely necessary, thereby reducing the risk of adverse psychomotor effects. While a number of fascinating targets have been identified in preclinical rodent models, there is a need to confirm that they are in fact relevant to clinical neuropathic pain. Thus, the current review will also discuss the extent to which clinical data confirms the findings of preclinical studies.
... Moreover, it is estimated that between the 70-85% of the world population will suffer from this kind of pain once in life (Anderson, 1999). once thought (Perl, 2007;Bourke, 2013). Therefore, they promote a change into how pain is explained by reconceptualising it as a multifaceted problem with relevant factors ranging from a complex set of biological mechanism to social and psychological aspects. ...
Thesis
Full-text available
In this Master’s Thesis, I address current issues within pain medicine and defend the thesis that explaining pain as a complex phenomenon requiring a complex explanation has positive pragmatic implications for treatment and clinical practice, implications that a reductionist approach to the explanation of pain is missing. Moreover, by discussing in the last part the evidence related to good treatments of low back pain, I show that reductionism hinders the improvement and application of better pain treatments. This will help me conclude that the introduction of subjective factors, values, in clinical practice - that is: a closer-empathetic relationship with the patient - is not only a matter of a better and more ethical medical practice that aims to improve treatment, but it is also motivated by the acknowledgement of the importance of those factors in the explanation of pain.
... Pain-metaphors can also arise out of interactions within the environment, including interactions with other people. As I have argued elsewhere, there is no necessary and proportionate connection between the intensity of tissue damage and the amount of suffering experienced since phenomenon as different as battle enthusiasm, work satisfaction, spousal relationships, and the colour of the analgesic pill can determine the degree of pain felt (Bourke 2013(Bourke , 2014. The profound ways that the body-in-pain is influenced by the environment and social interactions is at the heart of debates about phenomena as diverse as mesmerism, placebos, psychosomatic disorders, and so on. ...
Article
Full-text available
This article explores the relationship between metaphorical languages, body, and culture, and suggests that such an analysis can reveal a great deal about the meaning and experience of pain in Anglo-American societies between the eighteenth and twentieth centuries. It uses concepts within embodied cognition to speculate on how historians can write a history of sensation. Bodies are actively engaged in the linguistic processes and social interactions that constitute painful sensations. Language is engaged in a dialogue with physiological bodies and social environments. And culture collaborates in the creation of physiological bodies and metaphorical systems.
Chapter
Chronic pain presents a rather unique design challenge. Unlike the traditional view of pain, in which it is often to be averted, chronic pain cannot be simply done away with. Thus, the emphasis of our approach is to address pain as revealed and expressed. We adopt a research by design approach for creating evocative objects for chronic pain management by developing solidarity. The paper develops on critical perspectives on pain and embodiment in conjunction with the design process to arrive at an evocative object. These objects enable supporting solidarity between the one who suffers and the one who seeks to understand the suffering.
Article
Full-text available
This article examines the well-known though contested stance of Elaine Scarry regarding the inability to express our pain. Reviewing the problem shows that certain practices (scientific, judicial, medical) communicate the pain objectively. But when transmitting our pain becomes challenging, one important solution is found in Scarry’s suggested use of linguistic agents. These agents represent the felt pain, whether in actual (a stabbing nail, an electric shock) or imaginative forms (‘like a ball that keeps falling down on you’), enabling us to convey an otherwise unconceivable torturous experience. As elements distinguished from the hurting body, they create a spatial separation that produces the necessary distance for safely projecting the pain on to something other than oneself. Historians strongly criticize Scarry’s ‘ontological’ account, but in drawing on experimental laboratory work for discussing this reality-conferring function of language, the article addresses clinicians, neuroscientists, and healthcare workers in order to expose new perspectives for pain research.
Article
en This article explores how pain ritually assists in producing Afro‐Surinamese Ndyuka Maroon understandings of subjectivity and the self. Ndyuka discourses conceive persons as composites of multiple human and spirit others. I describe how these discourses emerge dialogically during oracular interactions between possessed mediums and their patients. Beginning as inarticulate sensations, personal pain is ritually transformed into identifiable spirits who expose their hosts as embodiments of past and present social relations. Over the course of oracular interactions, the qualities of physical pain are made to communicate that the pain is both an identity and a vital part of the sufferers’ embodied self. In parallel to this process, spirit mediums perform pain in possession to establish the origins of their authority in relations with spirits. Ritually transforming pain into identities of relation, Ndyuka oracular mediumship persuades patients to re‐evaluate their subjective experiences as innate evidence of Ndyuka social ideology. Abstract fr Le collectif dialogique : médiumnité, douleur et création interactive de la subjectivité des Noirs marrons ndyuka Résumé Le présent article explore la manière dont la douleur aide rituellement à produire les compréhensions de la subjectivité et du Moi chez les Ndyuka, un groupe de Noirs marrons afro‐surinamais. Dans les discours des Ndyuka, la personne est conçue comme un composite de plusieurs autres, humains et esprits. L'auteur décrit l'émergence dialogique de ces discours pendant les interactions oraculaires entre les médiums possédés et leurs patients. La douleur personnelle, commençant par des sensations informulées, est rituellement transformée en esprits identifiables par lesquels leurs hôtes se révèlent incarner des relations sociales passées et présentes. Au cours des interactions oraculaires, les qualités de la douleur physique servent à faire passer la notion que la douleur est à la fois une identité et une part vitale du Moi incarné de celui qui souffre. Parallèlement, les médiums spirites mettent en scène la douleur pendant la possession afin d'établir la source de leur autorité dans les relations avec les esprits. Par la transformation rituelle de la douleur en identités relationnelles, la médiumnité oraculaire des Ndyuka persuade les patients de réévaluer leur expérience subjective comme une preuve innée de l'idéologie sociale ndyuka.
Article
Full-text available
This article traces the emergence of child abuse as a medical concern in post-war Britain and America. In the early 1960s American paediatricians and radiologists defined the ‘battered child syndrome’ to characterise infants subjected to serious physical abuse. In the British context, paediatricians and radiologists, but also dermatologists and ophthalmologists, drew upon this work and sought to identify clear diagnostic signs of child maltreatment. For a time, the x-ray seemed to provide a reliable and objective visualisation of child maltreatment. By 1970, however, medical professionals began to invite social workers and policy makers to aid them in the diagnosis and management of child abuse. Discourse around the ‘battered child syndrome’, specifically, faded away, whilst concerns around child abuse grew. The battered child syndrome was a brief phenomenon of the 1960s, examination of which can inform the histories of medical authority, radiology and secrecy and privacy in the post-war period.
Article
Full-text available
This essay examines medical and popular attitudes to cancer in the early modern period, c.1580–1720. Cancer, it is argued, was understood as a cruel and usually incurable disease, diagnosable by a well-defined set of symptoms understood to correspond to its etymological root, karkinos (the crab). It was primarily understood as produced by an imbalance of the humours, with women being particularly vulnerable. However, such explanations proved inadequate to make sense of the condition's malignancy, and medical writers frequently constructed cancer as quasi-sentient, zoomorphising the disease as an eating worm or wolf. In turn, these constructions materially influenced medical practice, in which practitioners swung between anxiety over ‘aggravating’ the disease and an adversarial approach which fostered the use of radical and dangerous ‘cures’ including caustics and surgery.
When Sri Lanka became independent in February 1948 it lacked a well-established party system and instead relied upon patronage and elite social relationships. Though it had a long pre-independence history of constitutional development and evolving democracy, party politics was not deep-rooted and political power continued to be wielded by an elite that had an almost feudal relationship with the masses. The convention based Westminster model Sri Lanka adopted engendered a local system that relied more on relationships than rules. Political parties and institutions were often unable to check and balance the Executive's conduct of power. Sri Lanka's elite operated British institutions in an anachronistic eighteenth-century manner such as in having a patronage-based Cabinet dominated by its prime ministerial leader/patron rather than by collegial attitudes or values. The weakness of party institutionalisation and the ambiguity in the constitutional arrangements laid the foundations for future political conflict and marginalisation of segments of society. The continuity of affairs of state from the colonial era and the known and reassuring leadership of D.S. Senanayake and his ‘Uncle-Nephew Party’ masked the democratic tensions and institutional fragility within the Sri Lankan state that would come to the fore violently only years after what was then seen as a model transfer of power.
Article
Full-text available
The assessment of chronic pain is a highly unmet medical need. Chronic pain is also the subject of a large and costly category of legal claims. Yet, with pain cases, the jury always face a doubt: is the claimant faking or malingering? How can we be assured that the claimant is 'really' in pain? Most recently, several new neuroimaging technologies are promising to solve these questions, by rendering pain visible, measurable and, to some degree, verifiable. The results of these advancements have prompted us to think of pain in a different way, i.e. as an altered brain state in which functional connections are modified, with components of degenerative aspects. But, does this imply the stronger claim that these technologies allow us to 'know', or to literally 'see', the pain of others? Is the pain being objectified by these techniques? And if so, what might the law do differently, or do better?
Article
Journal of Interdisciplinary History 33.3 (2003) 473-475 This is an exceedingly ambitious, complex, rewarding, and frustrating book. It has two basic parts. In the first, Reddy provides a masterful overview of psychological, anthropological, and poststructural views on emotion. It is a superlative introduction to a rich literature, but Reddy intends more. What he undertakes is a reconciliation of the psychological and cultural approaches, around a phenomenon that he ultimately terms emotives, which combine beliefs about emotions and their appropriate roles intertwined with display or concealment of emotions as expression. In the book's second part, Reddy sketches a broad history of two emotional regimes in France—the first in the eighteenth century, ultimately terminated by the excesses of the revolution, and the second characteristic of the nineteenth century. In the first regime, sentimentality held sway, dominated by assumptions that the whole self could be emotionally expressed and guided, even in the political domain. This view helped to prompt the revolution but also led to its undoing. In its stead, a more segmented type of emotional management developed, characteristic of bourgeois liberalism. Reddy persuasively argues that this new regime cannot be captured by such typical divisions as male-female or public-private. But it was characterized by an insistence on emotional flexibility and, in public, the subordination of emotion to reason. Reddy also sees the separation of art, as a safe sphere for emotional expression, as a key to this formulation. The system functioned well, providing a basic stability to French legal structures, but at cost of considerable emotional suffering and, of course, periodic political conflicts. It is easy to offer objections. In Part II, particularly the initial chapters, emotion is treated as part of intellectual history, of formal ideas about emotion and reason (spiced by a few more penetrating quotations). It is not easy to see how this treatment links up to the richer panoply of emotions discussed in Part I. Aside from a few references to love, specific emotions are conspicuous by their absence. From a more purely historical standpoint, the nineteenth-century regime is described in so much greater detail than the eighteenth that pinpointing the change becomes difficult. Notably, Reddy offers a highly original interpretation of court cases presented in the Gazette des Tribunaux (and attendant records), dealing with property and family litigation, rating them according to their emotional or dryness quotient. On the whole, the emotional incidence corresponds to his liberal schema. But without comparable cases for the eighteenth century, the nature and extent of change remain unknown. There is also, inevitably, the question of social class. Reddy is writing mainly about upper-class intellectual and political formulations, but he occasionally delves elsewhere, without any sense of representativeness beyond his apparent assumption that, in each period, emotional regimes became socially uniform. The opportunity to use history to add to the analysis of emotion is valid. The attempt to discuss the relationship between emotional systems and political development is valid as well, though it is immensely complicated. I worry about attributing too much French revolutionary causation to a particular emotional regime, until the emotional bases of other revolutionary outbursts elsewhere can be compared with it. Simply in its nuanced statement of the nineteenth-century system, however, this book is immensely valuable. The real question is, Can the approach be replicated to provide a fuller sense of the historical utility of the emotives concept and some additional case studies about emotional- political-legal links? I'm not sure of the answer. Peter N. StearnsGeorge Mason University
Article
Critique de la definition de la souffrance comme objet mental developpee par H. Langsam. Designant la peine comme une description adverbiale de la maniere dont nous percevons des etats sensoriels, et non pas comme quelque chose que nous percevons, l'A. montre que le conflit opposant N. Grahek et N. Nelkin releve d'une conception objective de la sensation et de la peine. Soulignant l'erreur liee a l'idee d'objet mental par comparaison avec les autres objets de l'experience, l'A. montre que l'intensite et la duree de la souffrance s'explique par l'information que nous avons sur l'esprit et sur le fonctionnement du corps humain
Article
Severe wounds in soldiers are often associated with surprisingly little pain. In order to get factual information on the incidence of pain, 225 freshly wounded soldiers were considered in five groups where the wounds were serious - component fractures of long bones; extensive peripheral soft-tissue wounds; penetrating wounds of the thorax; penetrating wounds of the abdomen; and penetrating wounds of the cerebrum. None of these men was in shock at the time of questioning. As nearly as possible consecutive cases were considered. Ten of these had to be eliminated from consideration here because they were not clear mentally, or were unconscious. Nine of these ten had penetrating head wounds. If the head wound group is entirely disregarded, only one patient out of the remaining 201 severely wounded was not alert and clear mentally. Of the various types of wounds considered, patients with penetrated abdomens have by far the most pain, possibly due to the spilling of blood and intestinal contents into the peritoneal cavity. Of all the patients considered only one-quarter, on being directly questioned shortly after entry in a Forward Hospital, said that their pain was enough to cause them to want pain relief therapy; three-quarters did not need such relief. This was the case notwithstanding the fact that the most recent morphine had been administered hours before. Evidence is presented to show that the difference between the one-quarter that wanted pain relief therapy and the three-quarters that did not, cannot be explained by differences in dosage or timing of the morphine administered. Data are presented to show that morphine is too often administered by rote and not according to the patient's need. The data carry the strong implication that morphine is too often used in the belief that severe wounds are inevitably associated with bad pain - clearly not the case. The use of morphine in the treatment of pain is considered in detail. It was observed that the excitement and hyperactivity occasionally encountered in the wounded had its origin in some cases not in pain but in cerebral anoxia, and more commonly in mental distress. Use of a small dose of a barbiturate provided great relief in the latter type of case. A small dose of a barbiturate in addition to a small dose of a narcotic will accomplish what large doses of either alone will often fail to do. Barbiturate sedation offers a real addition to the treatment of the wounded man. He often needs the type of mental depression produced by barbiturates in small dose as much as he needs the pain depression produced by morphine. The man in shock complains far less frequently of wound pain than he does of the great distress produced by thirst.