The Story of Pain is an academic inquiry into the historical framing of this most unpleasant sensation. While Joanna Burke, professor of history at Birkbeck College, University of London, makes numerous compelling points in The Story of Pain, it isn’t a book you’ll reach for in times of headache. With early references to Wittengenstein and Nietzsche, the book quickly self-selects for an academic audience.
Bourke begins by taking issue with Elaine Scarry, whose 1985 book, The Body In Pain, has long been considered the seminal work in pain studies. Specifically upsetting is Scarry’s definition of pain as an independent entity, an overwhelming, all-consuming it. Bourke finds this categorization ontologically fallacious. Pain is instead a “type-of event”: “Pain is not an intrinsic quality of raw sensation; it is a way of perceiving the experience. It is a way naming.”
As such, Bourke argues, culturally agreed-upon linguistic expressions and signifiers are necessary not only to define pain, but to teach its expression to infants. Further, these signifiers and expressions differ in times and cultures. Pain, she writes, exists only in the act of evaluating it.
Bourke discusses the Gate Control Theory of Pain, largely used in Western medicine, and briefly covers physical versus emotional pain. Her stated goal is to classify the content of “pain-events” as examined by philosophers, physicians, and scientists through history. Of special interest is the linguistic difficulty inherent in communicating pain.
At this juncture, readers may feel Bourke is quite distant from the lived experience of suffering. But as The Story of Pain moves past the introduction, the book blossoms into a readable, engaging text. The first chapter, “Estrangement”, discusses pain’s peculiarly isolating nature. Prior to anesthesia, surgeries were horrifying events. Survivors were hesitant to relive their experiences—who could blame them?—not only to spare themselves, but their loved ones.
Interestingly, Bourke feels watching others suffer evokes compassionate in an individual or even community-level response. Online discussion groups are cited as a positive example of community response to pain. Bourke praises the example of “Jane”, who joins an online group of endometriosis sufferers. Jane’s boyfriend reads over her shoulder one day and is “blown away” by the what he sees. He has a new understanding of her suffering. (Though I wondered at a guy who understood strangers online better than his own girlfriend.)
“Metaphor” analyzes linguistic methods used to gain power over pain. Despite Bourke’s theory about “beings-in-pain”, many individuals attempt to control suffering by conceiving of it as a separate entity. Bourke points out the violent nature of pain metaphors: ‘stabbing’, ‘knife-like’, ‘cutting’, and ‘burning’ are all commonly used adjectives. Pain metaphors also reflect place, time, and society; Western pain sufferers invoked railroads to describe pain, while Asians spoke of ‘bear headaches’.
No comprehensive book about pain could be written without discussing religion. Believers past and present have eschewed pain relief, viewing their pain as religiously punitive, enlightening, cleansing, or all of the above. In other cases, surgeons or clergy have weighed in on the religious efficacy of pain relief. This battle becomes particularly pitched during end-of-life care. Some patients fear pain relief may impair thinking and the ability to meet one’s God at death, while others argue pain relief affords greater clarity.
The chapter on diagnosis illuminates Bourke’s profound compassion for those in pain. Like Melanie Thernstrom in The Pain Chronicles, Bourke demonstrates the ways social and racial disparities have long impacted diagnosis and pain treatment. Gender roles also play a part: women in pain are taken less seriously.
Also notable is the shift from speech to machine: the advent of sophisticated imaging techniques has all but discredited the verbal pain narrative. In fact, speak too floridly of your pain and risk dismissal by the medical community.
A dismaying point emerges through Bourke’s investigations: pain is widely misunderstood, widely disbelieved, and widely undertreated. As a class, regardless of color, gender, or social standing, people in pain are treated poorly.
The Story of Pain interested me because I am a chronic pain patient, secondary to a rare collagen disorder. Although a trained physician can recognize my illness, as a middle-aged woman, I’ve learned to minimize my pain narrative. In a doctor’s office, my words are carefully chosen. Nonetheless, I am usually taken as a drug-seeking malingerer, hoping for pills and pity.
I cannot say I share Bourke’s assertion that pain engenders a compassionate community response; just the opposite. I rarely speak of my illness to others, and then only in the most topical manner.
Books like The History of Pain are erudite, well-intentioned, and light-years from the lived daily experience of “beings-in-pain”. I hope readers who pick up this book, be they academics or lay people, make that connection without being sufferers themselves. I hope readers of this book realize there is a history of misunderstanding and thus mistreating of pain that continues to this day. Perhaps understanding the intent in The History of Pain is a step in the right direction.