Pain and Emotion in Modern History

Robert Gregory Boddice

• Publisher: Palgrave Macmillan
• Year: 2014
• Print ISBN: 9781137372420
• eBook ISBN: 9781137372437
• Topic: Geschichte
• Subtopic: Moderne Geschichte

Drawing on the expertise of historical, literary and philosophical scholarship, practicing physicians, and the medical humanities this is a true interdisciplinary collaboration, styled as a history. It explores pain at the intersection of the living, suffering body, and the discursive cultural webs that entangle it in its specific moment.

1

Introduction: Hurt Feelings?

Rob Boddice

Figuring pain

Pain and Emotion in Modern History is a rich exploration of the affective expression of pain, the emotional experience of pain (with or without lesion) and the experience of others’ pain as pain (sympathy, compassion, pity, tenderness).¹ Immediately it should strike the reader that ‘pain’ is at best a confusing label; at worst it is hopelessly inadequate. It must describe, at one and the same time, an appearance or surface, an inner (physiological and neurological) state and the reception of both these things as they are projected by another. This book goes a long way towards unpacking the polyvalence of ‘pain’. Essential to this project is a conviction that pain, in all its complexity, has been, is and can be expressed – bodily, orally, emotionally and linguistically.

What Elaine Scarry described as the inexpressibility of pain in her seminal work The Body in Pain understated human capacities for articulating their suffering on the one hand and implicitly overstated human capacities for articulating all other emotions on the other.² Jerome Kagan has highlighted ‘the inadequacy of most languages to capture the range of intensity and quality of frequent human experiences’, whether an experience is of joyous guilt or of angry shame.³ We translate emotions into verbiage imprecisely. Insofar as pain is an emotion – something for which the authors in this book argue strongly – then we translate that experience imprecisely too. But imprecision, clearly marked by an acute awareness that it is imprecise, tends only to heighten human efforts to enrich or deepen the confusion. As we translate bodily experience into words, grimaces and art – as we make metaphors of our inner experiences – we literally ‘figure out’ what we feel.⁴ These figures may lack definition, but they are no less evocative for that. And just as I ‘figure out’ how I feel, so my witness reads my figures, checks them against her own and, to some degree, understands. The degree of success in that process will depend on her knowing me, my context, my history and on our sharing a culture. As Kagan reminds us, ‘reactions of living things are always affected by their past’.⁵ The meaning is perhaps even more profound than he intended. For it is not just our individual or immediate pasts that affect us; the pasts of our families and societies do so too. We are, insofar as we are translators of biological states, cultural historical biological beings. It should go without saying, therefore, that what we make of pain – how we translate states of suffering – is also dependent on time and place.

Kagan can be usefully employed to clarify this point. ‘It is critical’, he says, ‘to distinguish between a feeling, which is a perception, and a semantic concept.’⁶ Feelings may be held in common, but they are described in different ways. In naming, in translating, we endow meaning. Even if emotions are, physiologically, changeable only over evolutionary time, what they mean changes far more rapidly than that. The biological sciences are not usually concerned with what things mean. Much of the squabbling over what constitutes pain and what constitutes emotion can be reduced to a perception among humanities scholars that scientists are confusing what emotions and pain are with what they mean, while scientists similarly suspect the humanities of confusing what emotions and pain mean with what they are. The nub of this problem is that we all share the labels ‘emotions’ and ‘pain’, but our referents are of entirely different orders. Kagan’s call for ‘a moratorium on the use of single words’ for emotions, and instead to ‘write about emotional processes with full sentences rather than ambiguous, naked concepts’, is at the heart of what this book does.⁷ While the authors all refer back to common labels – ‘pain’, ‘emotion’, ‘suffering’, ‘sympathy’ – they do so within a disciplinarily attuned context, leaving little room for confusion. We should have no problem admitting, between the humanities and the natural sciences, that we are often not talking about the same things, but merely about different components of an holistic knowledge, the parts of which must be commensurate if we are all to stand behind the respective truths of each discipline. We are blighted by a common language, but the solution lies in the training of the ear and of the pen.

Contexts of emotion

The investigation here concerns the emotional context of different kinds of pain and the development of an emerging concept of physical pain as intrinsically emotional/affective. The book goes beyond the typical spaces and parameters of pain, from the operating theatre or clinical office to the waiting room; from the moment of birth to its anticipation and its aftermath; from first-hand testimony to its reception; from the body in pain to the body in a culture of pain. Most importantly, it moves from the narrowly physical to the broadly emotional. The emotional component enables the enrichment of the medical history of pain, as well as setting a new agenda for medical history. Grief, anxiety, depression, hysteria, nervousness, despair and other ‘mental illnesses’ fall within its scope, and the historical mutability and efficacy of placebo or the ‘moral economy of hope’ (Moscoso) is given its due in the story of fighting pain. Pain and Emotion attempts, as Joanna Bourke puts it in this volume, ‘to distinguish the experience of pain from the pain of experience’. From judicial courts hearing war crimes evidence to the parent in the paediatric hospital, the book also deals with the problem of pain caused by bearing witness to, or by the imagination of, the pain of others.

To think of the Other in pain is a useful way of getting to the heart of human cultures of pain; to understand the value of pain, the fear of pain, and the stimuli to pity, tenderness, compassion and sympathy, all of which historically and literally have denoted the emotional pain, some of it enjoyable, of the witness to pain. Humans are involved in a never-ending process of bearing witness to pain or of choosing not to bear witness.⁸ The pain of infants, the pain of women, the pain of racial others, dubbed ‘inferiors’, the pain of the poor or uneducated, dubbed ‘degenerate’, the pain of the mentally ill, the pain of the old: each in its own way has been othered, sidelined, reduced, justified, condoned, condemned and mythologised. A long-running notion asserted that the more highly organised a being, the more sensitive to pain it would be, which has led on the one hand to a number of ingenious metrics for determining how organised an organism might be and on the other hand to an archive of apologies and excuses for pain, on the basis that some sufferers did not really suffer at all.⁹

The acknowledgment that pain is at least in part emotional is not new, but exactly what this means is still shrouded in uncertainty, and the implications for the medical definition and clinical approaches to the treatment of pain are in the relatively early stages of being worked out. The International Association for the Study of Pain’s definition of pain already contains this emotional element and a significant nod towards metaphor, where pain is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’.¹⁰ We can say with certainty that pain can no longer be reduced only to the location and management of a lesion, and we can admit the neurological existence of pain in the brain; we can, in a rudimentary way, authenticate the experience of pain without bodily injury and begin to approach an understanding of the emotional component of what makes bodily injury hurt.¹¹ As David B. Morris has pointed out:

postmodern pain is no longer officially divided along Cartesian lines and put into separate boxes labeled physical and mental. It is … a biocultural event, subject to both individual and transpersonal modulation, as variable across social boundaries as other events with mixed biological and cultural significance … Pain … has been remade as irreversibly open to the hubbub of human social and psychic life and thus open to an inescapable intersection with narrative.¹²

But how far has that openness penetrated and how far have its implications been apprehended? Lisa Folkmarson Käll introduces a recent multi-disciplinary intervention in pain studies with the following assertion: ‘Pain is the source of sorrow, suffering, hopelessness and frustration.’¹³ This book, which in some ways complements that of Folkmarson Käll, takes more than merely semantic issue with this assertion, arguing forcefully that pain is sorrow, suffering, hopelessness and frustration. Put another way, physical pain is not meaningful without some or all of these things or without some other affective component (even pleasure, joy or ecstasy). Nor is pain, insofar as the experience is concerned, really conceivable without these affective components. This book explores the historical failure to recognise the pain that is invisible to the observer, however plain it is to the sufferer; the pain that has been reduced to mere ‘suffering’, an emotional quality made distinct from pain. To understand, both scientifically and culturally, that suffering is pain and that pain is emotion – that feelings hurt – is vital if we are to relocate the human experience of pain and if we are to understand the violence of denial, of pain that doesn’t count.

Politics and meaning

The unifying factor among the authors here is the politics of pain, for always in question is the reason why one person’s pain is important and treated, while another’s is unimportant and ignored. How and why have sufferers been excluded from the realm of sympathy (and medical science) on the basis that their pain was merely an emotional problem (the shell shocked or the ‘hysterical’, for example) or because of a presumed dullness of nervous excitation or emotional capacities (babies, animals, ‘savages’), or, conversely, included precisely because of heightened emotional sensitivities (the civilised, the feminine)? To begin to answer these questions entails putting pain into cultural context, where the experience of the person in pain relates to socially instituted and culturally embedded systems of inclusion and exclusion, along lines of gender, age, class, race and species.¹⁴ Pain is only pain where it accords with tacit rules for the acceptable expression or the experience of pain. And to this end, the question of whose pain is authentic is a question of power. It is also a question of history, since constructions of authenticity never attain universal status. In historicising and deconstructing pain, and by revisiting those historical actors whose pain was valid and those who were invalid, Pain and Emotion not only sets a stark agenda for a new history of pain, it also sends a message to contemporary pain specialists, pain clinicians and pain managers to take a reflexive approach as to why pain is considered to be this but not that, here but not there, in the present. The purpose is not to redefine pain, but to lay bare its politics, ever changing and more or less subtle, but ever-present and always to someone’s disadvantage.

In order to understand pain and to give pain a history, we are automatically pursuing a cultural approach to pain; we are asking ‘what does, or what did, pain mean?’, both for sufferers and for the communities in which suffering takes (or took) place. To ask this question has the effect of appropriating the definition of pain from physiological and neurological descriptions of what pain is, which are really descriptions, or depictions, of how pain works in the body and in the brain. The shared fundamental premise of the contributors to this book is that without an understanding of what pain means, any amount of information about how pain works will not get us very far in our ability to understand, let alone manage, pain. Broadly, we follow the observation of Richard McNally:

A functionalist definition of pain would specify its input (for example, tissue damage), its output (for example, grimacing, verbal complaints, reaching for a bottle of aspirin), and its relation to other states. We might elucidate the neurophysiologic processes occurring as a person is writhing in pain, including performing functional magnetic resonance imaging (fMRI) of the person’s brain, and we might even program a robot to mimic pain. All of these procedures yield objective, publically observable data accessible to any third party. But none disclose [sic] what it is like for the person who is experiencing the pain itself.¹⁵

Therefore, we collectively ask: ‘What does pain signify?’ To look for meaning, for significance, leads us to the context of emotions. We find the meaning of pain in its expression, and whether that expression is a scream, a supressed scream, a stoic refusal to surrender to pain or a literary inquiry into the ravages of it, we find that pain is manifested in affective ways. Our encounter with pain, especially with the pain of others, is an encounter always with emotions, and it takes place always within a culture of pain: a limited, prescribed and unconsciously followed set of conventions that set out how, why and when pain can be expressed.

William Reddy’s seminal work on the history of emotions has done the most to develop a relationship between new research in human neurobiology and theories of social construction of emotions, which had previously inhabited seemingly intractably incommensurate points of view.¹⁶ The idea that our emotional utterances are acts of translation, processes of negotiation of how we feel (our biology) with how we are expected to express that feeling (our culture), surely has huge implications for the study of pain, especially when the emotions are now recognised as such an important component in the experience of pain. Indeed, Reddy’s claim that these processes – what he calls ‘emotives’ – are always to some extent a failure might help explain, in David B. Morris’ terms, just why pain can be such a ‘mystery’.¹⁷ Reddy demonstrates that the cultural delimitation of acceptable forms of emotional expression never quite match how we feel. We attempt to ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of Figures
• Acknowledgements
• Notes on Contributors
• 1 Introduction: Hurt Feelings?
• 2 Exquisite and Lingering Pains: Facing Cancer in Early Modern Europe
• 3 The Perception of Pain in Late Imperial China
• 4 Psychological Pain: Metaphor or Reality?
• 5 Phantom Suffering: Amputees, Stump Pain and Phantom Sensations in Modern Britain
• 6 The Emergence of Chronic Pain: Phantom Limbs, Subjective Experience and Pain Management in Post-War West Germany
• 7 A Quantity of Suffering: Measuring Pain as Emotion in the Mid-Twentieth-Century USA
• 8 Killing Pain? Aspirin, Emotion and Subjectivity
• 9 Body, Mind and Madness: Pain in Animals in Nineteenth-Century Comparative Psychology
• 10 Down in the Mouth: Faces of Pain
• 11 ‘When I Think of What is Before Me, I Feel Afraid’: Narratives of Fear, Pain and Childbirth in Late Victorian Canada
• 12 ‘The Agony of Despair’: Pain and the Cultural Script of Infanticide in England and Wales, 1860–1960
• 13 Imagining Another’s Pain: Privilege and Limitation in Parent and Child Relations
• 14 Observing Pain, Pain in Observing: Collateral Emotions in International Justice
• 15 Documenting Bodies: Pain Surfaces
• Select Bibliography
• Index