Joanna Bourke, a British historian, has produced a
fascinating book on the subject of pain: The Story of Pain: From Prayer to Painkillers. She convinces us
that pain is an elusive quantity. There is no way of measuring it
directly. A physician must depend on the
description of the pain by the patient or draw her own conclusions based on
evaluating the signals of pain being expressed by the patient. It is well known that expression of pain is a
learned response that varies from one culture to another, from one gender to
another, and from one generation to another.
It is also well known that extreme physical injuries can be endured with
little or no pain, and extreme pain can be experienced with no discernible
cause. Given that background, Bourke
details how people have struggled with pain, both as sufferers and as
witnesses, and how the interpretations of pain and how it was thought to vary
by culture, race, gender, and age have evolved over recent centuries.
Bourke also addresses the meaning of pain as it applies
to human existence. What purpose does
pain serve? She limits herself to the English-speaking
world and the British and Americans in particular. Not surprisingly, initial thoughts on pain
were highly colored by religious beliefs.
“In Anglo-American societies,
religious dogma and practices have provided the most robust materials from
which the meaning of bodily pain has been constructed. Although significant Jewish, Muslim, Hindu, and
Buddhist communities have existed in Britain and America for centuries, the
most pervasive theological presences have been Catholic and Protestant versions
of Christianity. Their engagement with
bodily pain has relentlessly insisted that pain has a divine purpose. Deciphering that purpose has not been
easy. The unreasonableness of bodily
torment has unsettled theological minds throughout the centuries.”
The problem for Christians is the age-old issue of how to
explain why bad things happen to good people in a world micromanaged by an
all-seeing, all-knowing God. Scriptural
references provided constraints on any interpretation with respect to pain.
“In Christian doctrine, pain is
the consequence of sin. Biblical
passages are unambiguous: from Genesis 3:16 (which decreed that ‘in sorrow thou
shalt bring forth children’) to Numbers 12 (which portrayed pain as a
punishment for evil desires and a lack of faith), pain and transgression have
been inseparable. The Christian position
was summarized by John Wesley (founder of Methodism) in 1747. At creation, humans were wholly innocent, he
explained, and ‘as he knew no sin, so he knew no pain’. After rebelling against God, however, the ‘incorruptible
[bodily] frame hath put on corruption’ and the ‘seeds of weakness and pain’
became ‘lodged in our inmost substance’.”
Thus humans (and animals as well?) were condemned to a
life threatened by pain due to the original sin of Adam and Eve and also due to
any transgressions they might be guilty of in their own lives. This belief provided a framework within which
all things could be explained, although the logic could be quite convoluted. For example, the parental pain suffered with
the death of a newborn infant could be explained as God saving the parents from
some future sin of indulgence in the child at the expense of the piety expected
by God.
Since pain was an expected feature of life and the reward
for a life poorly led was everlasting pain suffered in the fires of hell, the
usually episodic pain experienced on earth came to be viewed as
redemptive. Suffer pain now as a way of
paying for your sins so that you may sooner enter into heaven.
“Whether sin was intrinsic to
what it meant to be descendents of Adam or a punishment for personal misbehavior,
Christians could be cleansed of its stain through the experience of pain in
this world, an intermediate world (for Roman Catholics) or the everlasting
world of hell. To avoid the latter,
purification through bodily suffering was necessary.”
If pain was inflicted on a believer, it could be
interpreted as God delivering a message informing the person that some changes
needed to be made.
“Pain was not only sent as a
reminder of the need to purge the soul of sin in anticipation of a fine ‘mansion’
in the next world: it was also intended to provide guidance on the conduct of
Christians here on earth. Bodily
distress was a formidable instrument of instruction. Its message was clear: pain informed people
that they were transgressing the laws of Mother Nature or the commandments of
that great architect of all things, God the Father.”
Pain perceived as an instrument of God could often be
more easily endured. However the
apparent randomness was always a problem for theologians. One had to jump through hoops to justify
extreme suffering when imposed upon small children.
This Christian view of pain as a necessary and
unavoidable feature of life was not helpful in encouraging the use of newly
discovered chemicals that could be used as anesthetics. These were around for decades before they
came into frequent usage. It would take
another century before the benefits of pain were discredited.
“….medical technologies
relieving earthly torments could pose heavenly dangers….As a consequence,
chloroform was nothing less than ‘a decoy of Satan’ that would ‘harden society
and rob God of the deep earnest cries which arise in time of trouble for help’
as one clergyman informed James Young Simpson (the first physician to use
chloroform to ease a woman’s birth agonies).”
As might be expected, it would be the women who would be
required to suffer the most. Male
physicians and male clergymen were convinced that birth without suffering was
unnatural and against God’s will.
It would be the mid-twentieth century before the link
between pain and sin (original or otherwise) would finally dissipate. Yet one constraint on pain relief continues
to this day: the fear that an analgesic might cloud the mind of a dying person
and prohibit her from whatever preparations were necessary to meet her maker. Consider this from a publication issued in
1956:
“Peter Flood (a Benedicine [Catholic])
began by insisting that people-in-pain must accept suffering ‘as permitted by God
for our betterment. More importantly,
pain was ‘our privilege, in union with the redemptive sufferings of Christ,
with whom we die in the security of unity and Christian hope’. For this reason, it was vital that every
opportunity was given to allow the person to die ‘consciously, to achieve
contrition for our sins, to seek forgiveness of God before it is too late’.”
It was allowed that conditions might arise when severe
pain might be counterproductive and threaten a loss of faith on the part of the
sufferer. Pain relief could be provided
but not without further exceptions.
“The main proviso was that the
patient should consent to the drugs, after being told that he was dying and
warned that the medication might shorten his life. Even in such cases, Flood insisted,
physicians might still withhold pain relief.
If the dying man was known to have led an ‘evil life and has not
repented’ (for example, if he was ‘a lapsed Catholic who has not received the
sacraments’), then it was forbidden under any circumstances to proffer relief….In
the final reckoning, the Catholic physician and his spiritual advisor were
authorized to withhold pain relief for a higher good.”
Is this type of directive still being issued to Catholics? It seems that it remains critical that people
be forced to face death awake and as alert as possible. Consider this quote from Palliative care from a Catholic moral perspective (April 17, 2015):
“Catholic moral teaching accepts
that although pain management can relieve physical suffering, it can also
result in the patient’s loss of consciousness. If unconsciousness or a
shortened life is not the intention of the pain medication, administering high
doses is morally permissible.”
Those millions of “lapsed” Catholics who think they have
escaped from the clutches of that religion might want to check on the faith of
their physician and find out who is running the hospital before checking in
with a major illness.
Bourke suggests that while religion has had trouble
dealing with the meaning of pain, science may have done little better. The current thinking is that pain evolved as
a means of issuing a warning that an activity or an injury was dangerous. Bourke suggests that there is little gained
by a Neanderthal whose tooth has decayed and is required to suffer pain
interminably. She hints that pain might
just be some kind of cosmic joke.
This brief comment by Bourke is rather intriguing. A Darwinian could see decayed teeth playing a
role in natural selection. It would be
necessary to assume that bad teeth, then as now, played a role in sexual
reproduction. Perhaps losing the ability
to chew was at that time a death sentence.
Bourke might still have a point. People tend to assume that wondrous evolution
through natural selection tends to optimized solutions. One only needs to look through a book with
pictures of the various breeds of dogs that have emerged to consider that cosmic
jokes are indeed possible.
In thinking about humans, evolution, and pain, an interesting
article by Ann Gibbons was encountered: Human Evolution: Gain Came With Pain. She
describes the conclusions arrived at by anthropologists in studying the sorry
construct known as the human body. In
their view it is not an engineering miracle but rather a hastily constructed
entity using whatever parts were available.
Since we began our existence on the chimpanzee branch and only diverged
a few million years ago, we had to utilize the materials we began with as best
we could. Our feet began as grasping “hands”
designed to hold onto branches. As we
decided to stand upright and walk on those “hands” they had to somehow become
proper feet. What was arrived at was
something functional, but much more complicated than necessary, and much more
subject to injury (and pain) than required by the functionality.
Perhaps the best example provided by Gibbons is the human
spine.
“Turning up the pain threshold a notch, anatomist and paleoanthropologist
Bruce Latimer of Case Western Reserve University in Cleveland, Ohio, limped to
the podium, dangling a twisted human backbone as evidence of real pain. ‘If you
want one place cobbled together with duct tape and paper clips it’s the back,’
said Latimer, a survivor of back surgery.”
“When humans stood upright, they took a spine that had evolved to be stiff
for climbing and moving in trees and rotated it 90 degrees, so it was
vertical—a task Latimer compared to stacking 26 cups and saucers on top of each
other (vertebrae and discs) and then, balancing a head on top. But so as not to
obstruct the birth canal and to get the torso balanced above our feet, the
spine has to curve inwards (lordosis), creating the hollow of our backs. That's
why our spines are shaped like an ‘S.’ All that curving, with the weight of the
head and stuff we carry stacked on top, creates pressure that causes back
problems—especially if you play football, do gymnastics, or swim the butterfly
stroke. In the United States alone, 700,000 people suffer vertebral fractures
per year and back problems are the sixth leading human malady in the world. ‘If
you take care of it, your spine will get you through to about 40 or 50,’ said
Latimer. ‘After that, you’re on your own’.”
As we age and
our experience with pain increases, pain is no longer a warning mechanism; it
is merely a sign of poor engineering.
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