A microhistory of pain

Pain is the Sasquatch of science, never witnessed, only endlessly speculated on. We can't even agree on the species. Man or beast? A sensation or an idea? It doesn't help that ideas about the meanings of pain are double-barreled abstractions that soon drift away from the experience itself into an epistemological fog.

Our efforts to describe pain soon confront us with another small problem: How do we define the self? What particular nexus of mind, body, and soul is this modern "I" who feels the strange brew of modern pain?

I've been ruthlessly selective in this chapter, skipping over many names and entire centuries, to avoid disappearing down philosophical cul-de-sacs. But as I began to investigate the earliest ideas of pain, what struck me was that philosophy, medicine, and drama were once much closer in the way they viewed pain. It wasn't until Descartes came along in the seventeenth century with "proof" of the mind-body split, followed by the age of Enlightenment, that pain began to shed its emotional and social dimensions. One of the earliest definitions of tragedy, for instance, was human pain-as our exile into something that can be witnessed and pitied, but never shared.

Philoctetes, a play written by Sophocles in 409 b.c., is a story that pivots around the physical pain of its main character, who suffers from a wound that began as a snake bite. "Terrible it is, beyond words' reach" is how Philoctetes describes his condition. This inviolate, unspeakable aspect of human pain is what the drama tries to voice. "Philoctetes makes us feel the power of pain to reduce a life to utter emptiness and misery," author David Morris writes in The Culture of Pain. "It unweaves the self until the self is nothing but pain. The body in tragedy is not just something we possess like an identifying birthmark or robe or kingdom," Morris argues, "but what we are. It both defines us, and, fatally, limits us."

Aristotle was another astute observer of human dramas, including pain, and his writings on the subject turn out to have a rather modern flair. He defined pain as an emotion rather than a mechanical sensation. He characterized both pain and pleasure as "appetites" that drive us toward the objects of our desires and away from the things that hurt us. For Aristotle, pain was not only a sensory event in the body, but a subjective state, like longing and fear. He saw the human cost of pain, how it "upsets and destroys the nature of the person who feels it." Aristotle may not have understood physiology, but he accepted the idea that pain is an expression of who we are.

Our uncertainty about the province of pain is conveyed by the roots of the words we use for it. Pain is probably derived from the Latin word poena , meaning punishment, and the English word tends to connote physical pain. But the French word douleur , from the Latin dolor, refers to both physical and mental pain. The French word peine suggests punishment, but it can mean sorrow as well. Oddly enough, the Italian language has no word for ache, despite the fact that studies of pain expression in different cultures report that Italian women in labor are louder than women from other countries.

The concept of pain as punishment turns up most vividly in the biblical story of Job, a wealthy, upright man whose faith in God is tested by Satan in a series of terrible afflictions. First he loses his wealth, then he becomes an outcast from his community. Finally Satan pulls out all the stops and inflicts a "plague of boils" on Job. "He slashes open my kidneys and does not spare," says Job, describing Satan's work. "He pours out my gall on the ground." William Blake's illustration of this scene shows the figure of Job writhing on the ground, his hands arched back in pain, as a naked, burly Satan stands over him like a TV wrestler in triumph. Job's test of faith is the first example of the theme of bloody martyrdom that runs throughout Christianity. Pain is inseparable from faith and "the central Christian mystery of a being who suffers pain in order to redeem others," as Morris writes. It was the pain that Jesus Christ suffered on the cross that proved to us that God's son was human, too. Suffering pain is how faith is forged; transcending pain is a mark of sainthood. The image of St. Sebastian pierced with arrows, with upturned eyes, carries the message that a belief in a life beyond the body has the power to undo pain. The idea of pain as spiritual punishment is still deeply entrenched in our attitude that physical pain arrives as a kind of moral test of character and should be toughed out. The price of admission for being human, the story of Job reminds us, is this: expect boils.