Abstract
Pain is a universal human experience, part of the inevitable landscape of physical and embodied life. However, as with all aspects of embodiment, pain is also caught up in the net of social, cultural and political signifiers which give us the means to interpret and understand our lived experiences. In general, pain is cast as negative; it is pathologized and best dealt with and understood within the context of biomedicine. It signifies illness, dysfunction or injury, and a primary aim of contemporary biomedicine is to eradicate pain and its causes. However, when pain is considered primarily through ‘evidence-based medical models’ (p. 2), the subjective experiences accompanying physical and emotional pain, and their lived and phenomenological significance, are often effaced or overlooked. In its phenomenology, pain has an affective call, which is immediate, seizing one’s attention and often effecting an intentional disruption and a concomitant sense of isolation and self-reflection. One struggles to articulate one’s pain to others, it slips beyond the grasp of ordinary language. However, at the same time pain demands an interpretation and action: we are compelled to understand it so as to find a means to eradicate it.
To draw out some of the challenges of articulating pain within and outside of biomedical perspectives, the recently published collection Dimensions of Pain gives sustained attention to the experience of pain through a multi-disciplinary perspective. The aim of the collection is to illuminate the experience of pain in diverse case studies such as illness, psychological trauma, dance, labour and childbirth. Edited by Lisa Folkmarson Käll, this is the first volume in a new series entitled Routledge Studies in the Sociology of Health and Illness. The book consists of the Editor’s Introduction and ten critical essays from scholars working in a variety of disciplines, including medicine, midwifery, sociology, philosophy, anthropology and gender studies. The volume arose as a result of the 2009 annual meeting of the Nordic Network: Gender, Body, Health also entitled ‘Dimensions of Pain’ and includes essays from both participants and other scholars working in pain studies.
Elaine Scarry’s classical text, The Body in Pain: The Making and Unmaking of the World, serves as a point of departure for almost all of the essays in the collection. Scarry’s seminal work elucidates the difficulties in attempting to describe pain, its inherent inexpressibility and its ability to destroy language and collapse one’s world. Cited repeatedly in the essays, Scarry’s words frame the reflections on pain, metaphor, communication and language: ‘Pain causes us to regress to a state anterior to language, to the sounds and cries a human being makes before language is learned’ (p. 14). It transports us to a pre-verbal ‘world of cries and whispers’ (p. 41). The idea that the experience of pain transcends our linguistic capabilities is perhaps among the most important themes explored in the collection, and is taken up in several of the essays in diverse contexts, such as illness, chronic pain and childbirth.
In his eloquent essay ‘When language runs dry: pain, the imagination and metaphor’, David Biro, a physician and medical humanities scholar, describes his own experience of becoming a patient as a result of a rare blood disorder. The side effects of a bone marrow transplant left Biro in unbearable pain and gave him first-hand experience of ‘the silence surrounding pain’ (p. 13). He writes:
I had no desire for words. My pain was my pain. No one could ever feel it, or approach how I felt through any number of words. Silenced – by the pain and by the futility to communicate – I had never felt more alone in my life. (p. 13)
The inexpressibility of pain, Biro argues, deserves attention as the inability to express pain can have serious consequences within a medical context. He posits that the inexpressibility of pain arises because pain is untethered to an intentional object, an important insight from the 19th-century psychologist Franz von Brentano, which led to Edmund Husserl’s formulation of phenomenology and intentional consciousness. Without an intentional object, pain is ‘inherently formless and diffuse’ (p. 15). As a result, Biro posits the necessity of metaphor in the communication of pain. He writes: ‘metaphor replaces absence with presence. It illuminates aspects of existence that would otherwise remain in the dark…[it] is not merely an optional rhetorical device…but a powerful and necessary resource of the imagination’ (p. 16). Metaphor, Biro argues, extends the boundaries of the closed world of pain, and serves as ‘a bridge’ to lead back to the shared world of friends and family (p. 24).
The importance of communication and narrative in experiences of pain is further explored by Anna Gotlib in her essay ‘On the borderlands: chronic pain as crisis of identity’. In this chapter Gotlib elucidates a tension inherent for sufferers of chronic pain: while there is the need to communicate their experiences – this is essential both for treatment within a medical context and for building the ‘bridge’ to friends and family – the on-going nature of chronic pain means that this communication can, at the same time, threaten one’s connection with others. She argues that while acute pain:
calls us to a linguistic expression of something unwelcome and unexpected…chronic pain is often accompanied by complaints that, over time, begin to sound to others less like an alarm, and more like malingering, or, tragically, like a flaw in a patient’s character. (p. 41)
The on-going nature of chronic pain tries the patience of those around the sufferer whose experiences become increasingly invisible and difficult to comprehend.
In order to thematize the consequences that chronic pain has for one’s identity, Gotlib employs the concepts of loss and liminality. To be liminal is to be in an in between state: ‘seen and invisible, heard and silent, a member and an outsider’ (p. 53). As a result of the often non-treatable and interminable nature of chronic pain, one enters this liminal space, feeling estranged not only from others – family, friends, doctors – but, Gotlib argues, from one’s own identity and sense of self. Loss becomes a fundamental part of living with pain: ‘one not merely loses a sense of self, but a sense of a familiar and previously reliable self’ (p. 49). The familiar and predictable body becomes ‘baffling’, and with this comes loss: ‘loss of abilities, of freedoms and…self-worth’ (p. 48). Ultimately, Gotlib concludes with a call to narrative: communicating pain and one’s own story must remain in the fore as part of effective treatment; narrative can play an important role in preserving identity and establishing empathy. The result, she argues, of taking patient’s stories seriously could be ‘a shifting of the chronic-pain patient’s location from the liminal borderlands…to the shared moral universe where physicians and patients deliberate together about acknowledged and recognized pain’ (p. 56).
The communication of pain through narrative is the primary objective of the final essay in the collection, ‘Child birth: an aesthetic’, by Cressida J. Heyes. This chapter turns away from pathology and illness to childbirth, a simultaneously ‘everyday and extraordinary’ experience (p. 132). Reflecting on attitudes towards the pain of labour and childbirth, Heyes, a professor of philosophy, offers her own ‘birth story’, a first-person account of the labour and birth of her son (p. 132). Her aim is to attempt to express the inexpressible: ‘The more I try to write about giving birth, the more I also realise that my pain is mute, elusive, liable to evade representation’ (p. 133). What follows is a compelling phenomenological account of Heyes’s experience of her own body and the pain of labour, interwoven with reflections on the inadequacies of language to express the uniqueness of certain embodied experiences. She, too, evokes the idea of liminality, describing labour as a ‘limit experience’ that, ‘by virtue of its very intensity, fractures the self’s understanding and bursts the bounds of its hitherto imagined possibilities’ (pp. 137–8). The ‘agony’, the ‘mess of sensation’ and the ‘steely panic’ (p. 138) that Heyes describes transfigures into a ‘precious slice of enlightenment’ (p. 140), the ‘most excruciating’ yet also the ‘most joyful, profound and spiritually transformative’ experience (p. 133).
Indeed, pain is multi-dimensional. It not only has the capacity to shrink, or even destroy, one’s world, but it is palpably transformative: for better or for worse, we are changed by our pain experiences. The collection reflects this multi-dimensionality. The essays about pain as isolating, world-destroying and liminal, are complemented by others which aim to demonstrate its other more positive dimensions. Pain can be significantly intersubjective, world-forming and constructive. Lisa Folkmarson Käll’s essay ‘Intercorporeality and the sharability of pain’ demonstrates that, while disrupting our primary intercorporeality – or the shared relationality of embodiment – pain, ‘through exaggerating the boundaries between self and other’, actually makes more salient the ‘original bond’ that binds embodied subjects together (p. 38). In feelings of isolation and in the intense privacy of our pain, Käll argues, we realize our primary and necessary interrelatedness with the world and with others. Sheena Hyland, in her essay ‘Between health and illness: positive pain and world-formation’, likewise draws on the positive role that pain plays in establishing our sense of self and of the world. In this chapter she argues that ordinary experiences of ‘aches and pains’ (p. 84) are pedagogical in a primary sense, teaching us what our bodies can and cannot do. Drawing on the phenomenological writings of Maurice Merleau-Ponty and Iris Marion Young, Hyland describes how ordinary ‘everyday’ pain and discomfort implicitly sets the limits and conditions for our embodied relation to the world through shaping the sorts of habits and dispositions that we can acquire. In this vein, Jillian Dero and Wendy Mendes’s essay ‘Doing pain “right”: the pleasures of pain in aerial dance’ describes the constructive and necessary role pain plays in physical training such as for dance or sport. They argue that not only is pain inevitable in training, but its experience can be both pleasurable, ‘a gateway to deep embodiment and body awareness’ (p. 101), and creative, ‘a celebration of what is raw, grounded, corporeal and intense’ (p. 105).
Considering the variety of points of view about pain that this short volume offers, it is undoubtedly an important addition to the literature on pain, especially within the growing field of medical humanities. However, despite its scope, as Käll notes in the Editor’s Introduction, there is a great deal which falls outside of its considerations. Indeed there are many dimensions of pain which go unmentioned, for instance, torture, acute injury, historical accounts of pain, pain in animals, ritualized pain, to name a few. Furthermore, as all of the essays originate from researchers working in North America, Ireland and Sweden, the cultural lens through which pain is explored and elucidated is very limited. Perhaps the collection would have been enriched with cross-cultural comparisons that reached beyond the narrow cultural scope of these Anglo-Scandinavian accounts. However, despite these criticisms, there is a lot to learn from this short book and I believe it will be of interest to students and scholars interested in pain and for those working within medical humanities, philosophies of the body and illness, and in clinical practice.