Thinking about pain

There is a secular viewpoint held by many (including anthropolo­gists) that would have one accept that in the final analysis there are only two mutually exclusive options available: either an agent (representing and asserting himself or herself) or a victim (the passive object of chance or cruelty).

When we say that someone is suffering, we commonly suppose that he or she is not an agent. To suffer (physical or mental pain, humiliation, deprivation) is, so we usually think, to be in a passive state—to be an ob­ject, not a subject. One readily allows that pain may be a cause for action (seeking to end the suffering, say), but one does not normally think of it as action itself. Pain is something that happens to the body or that afflicts the mind. Or so, at any rate, we tend to think. Yet one can think of pain not merely as a passive state (although it can be just that) but as itself agentive.

Physical pain is of course the object of passion—but also of action. In Paul Valery’s Monsieur Teste we have a remarkable account of the at­tempts by an ailing subject to control his bodily pain mentally. This in­cludes the use of metaphors. The most pervasive of these is the dark image of pain as a hostile alien thing within the body. Jean Starobinski points to the fact that Valery employs musical tropes, as when he writes that “Pain is due to the resistance of the consciousness to a local arrangement of the body.—A pain which we could consider clearly, and in some way circum­scribe, would become sensation without suffering—and perhaps in this way we could succeed in knowing something directly about our deeper body—knowledge of the sort we find in music. Pain is a very musical thing, one can almost speak of it in terms of music. There are deep and high-pitched pains, andantes and furiosos, prolonged notes, fermatas and arpeggios,..progressions—abrupt silences, etc....” Starobinski observes that here the musical metaphor is closely connected to a plan for control because “every metaphorization implies an interpretation, and every in­terpretation involves a distance between an interpreting power and an ob­ject interpreted—even if that object is an event taking place in ‘my body.’...

I offer, tentatively,, a slightly different conclusion. Using musical metaphors (or indeed music itself) to fix the body’s pain might be seen not exactly as giving meaning to brute experience but as a process of structur­ing that experience. I knew someone who found herself using numbers to anticipate and categorize her experience of pain. Although, unsurprisingly, severe pains were numbered higher, a less obvious structuration was also at work: only acute, irresolvable pains appeared as prime numbers. Further­more, the numbering varied according to the social context she was in: prime numbers were more likely when she was alone. Such structuration doesn’t necessarily make pain “meaningful”; it is simply a way of engaging with it. So the conclusion I offer contrasts with Elaine Scarry’s position in her influential study The Body in Pain, according to which “the utter rigid­ity of pain itself” is universally reflected in the fact that “its resistance to language is not simply one of its incidental or accidental attributes but is essential to what it is.”^[64] For although musical or mathematical structura­tion (both of which have to be learned) may not constitute “language” in the ordinary sense, it problematizes the idea of pain-in-itself as necessarily a private, thought-destroying event.

Scarry asserts that pain is necessarily a private experience, and pro­poses that the experience of “one’s own physical pain” is the very paradigm of certainty, and hearing about “another person’s physical pain” the para­digm of doubt—because it can never be completely confirmed.^[65] I suggest that this secular understanding of pain as inscrutable may arise in part from the experience of animal experimentation of the kind I discussed in the previous chapter, in which observable reactions of the flesh that is sub­jected to experiment constitutes “pain.” The question to consider here is whether this claim is true, and if it is, why it should apply solely to pain.²⁷ Whether one can be certain of another’s pain depends surely on who is expressing it to whom, how—verbally, for example, or through lamentation, or by facial signs, or by the way an agonized or impaired body is revealed— and for what purpose “certainty” is sought.

Of course error—and therefore doubt—may occur not only in the context of reports of pain but of reports of any feeling. (As Collingwood once put it, I can’t be wrong if I feel something—although I might be wrong, or simply lying, in saying that I feel it.³⁰) However, addressing an-

27. In their “Introduction” to Mary-Jo Delvecchio Good, Paul E. Brodwin, Byron J. Good, and A. Kleinman, eds., Pain as Human Experience; An Anthropo­logical Perspective (Berkeley: University of California Press, 1992), the editors re­veal an unresolved tension between two ideas. On the one hand, they regard pain as a prelinguistic experience that is to be represented (hence “pain resists sym­bolization”), and on the other, as an experience that is formulated in and through language ah initio (and is thus always “influenced by meanings, relationships, and institutions”), This paradox may be the result of assuming that there are two kinds of pain, psychological (mediated by the mind) and physical (objective, “raw”) pain, when these may in fact be two aspects of the same event—subjective and objective.

28. Ludwig Wittgenstein, Philosophical Investigations, Oxford: Blackwell, 1953, especially p. 100.

29. Scarry, p. 28.

30. Collingwood maintained that feeling as opposed to thinking is a sponta­neous state of passivity, to which the notion of failure doesn’t apply because it isn’t others pain is not merely a matter of judging referential statementsOSM about how a particular kind of relationship can be inhabited and enacted.^MH An agent suffers because of the pain of someone she loves—a mother, say; 1 confronted by her wounded child. That suffering is a condition of her re­lationship, something that includes her ability to respond sympathetically to the pain of the original sufferer. The person who suffers because of an­other’s pain doesn’t first assess the evidence presented to her and then de­cide on whether and how to react. She lives a relationship. The other’s hurt—expressed in painful words, cries, gestures, unusual silences (in short, a recognizable rhetoric)—makes a difference to her in the sense of being the active reason for her own compassion and for her reaching out to the other’s pain. It is a practical condition of who she and her suffering child are. (This applies equally, of course, to pleasures the two may share.) Only in law does the mother stand as an individual agent with responsi­bility toward the child regardless of her actual feelings.

It’s not that one’s own pain can never be convincingly conveyed to others, but that when one feels the urgent need to communicate one’s pain, and the communication fails, then it may come to be thought of—with intentional. Like suffering, one either feels or doesn’t feel something. Furthermore, feelings are essentially private in a way that thought isn’t. Although the act of think­ing something may or may not be an entirely private act, depending on how one performs it, that which we think (a particular thought) is always in principle di- recdy accessible by others, and therefore public (see R.

31. Veena Das has made this point more elegantly in her article on women’s suffering during the partition of India in 1947: “Following Wittgenstein, this man­ner of conceptualizing the puzzle of pain frees us from thinking that statements about pain are in the nature of questions about certainty or doubt over our own pain or that of others. Instead, we begin to think of pain as asking for acknowl­edgment and recognition; denial of the other’s pain is not about the failings of the intellect but the feilings of the spirit. In the register of the imaginary, the pain of the. other not only asks for a home in language but also seeks a home in the body”

- (“Language and Body: Transactions in the Construction of Pain,” in A. Kleinman, V. Das, and M. Lock, eds., Social Suffering, Berkeley: University of California Press, 1997, p. 88). See also her important essay “Witgenstein and Anthropology,” Annual Review of Anthropology, vol. 27,1998.

■gBi anguish—as unshareable. "In order to construct self-narratives,” Mfftes’Susan Btison discussing victims of tape and torture, "we need not P - only the-words with which to teh out stories hut also an audience ahle and willing to hear us and to understand out -words as we intend them. This as­pect of remaking a self in the aftermath of trauma highlights the depend­ency of the self on others and helps to explain why it is so difficult for sur­vivors to recover when others are unwilling [or unable?] to listen to what they endured.”³² The ability to live sanely after a traumatic experience of pain is always dependent on the responses of others.

How clear is the distinction between physical pain and psychological (or social) suffering? All feelings of pain involve physical changes that are not only internal to the body (muscular, biochemical) but also externally visible (voice, demeanor, gait) and culturally readable. This fact alone com­plicates the too-neat distinction between physical pain and mental pain. Distressing emotions, too, are connected to chemical disturbances in the body. And chemical imbalances—whether associated with trauma or ma­lignant cell growth—are as “physical” as torn ligaments. It may be that physical pain is typically located by the sufferer in particular parts of his or her body and that this is what distinguishes it from mental distress. But mental states—themselves closely connected to social circumstances—are central in the experience of physical pain.

It has long been known that tolerance to physical pain is culturally variable (I return to this in the next chapter). The latest research on the physiology of pain points to a more radical conclusion: physical injury to a specific part of the body is not necessary to activate the body’s pain sys­tem. The notorious phenomenon of phantom-limb pain is not, it now seems, a curious anomaly. Pain is not merely experienced in the mind, re­searchers say, but generated by it.³³ The brain is the locus of complex in-

32. Susan Brison, “Oudiving Oneself: Trauma, Memory, and Personal Iden­tity”, in D. Meyer, ed., Feminists Rethink the Self, Boulder, CO: Westview, 1997, pp. 21-22. (I am obliged to Susan James for this reference.)

33. Ronald Melzack, well known for his gate-theory of pain (Ronald Melzack and Patrick Wall, The Challenge of Pain, New York: Penguin, 1982), has now radically revised his view (see “Pain: Past, Present and Future,” Canadian Journal of Experimental Psychology, vol. 47, no. 4,1993). Because pain is generated teractions—including interactions between distressing memories, per­ceptions, and emotions—whose result is the experience and behavior of pain. The familiar distinction between physical pain as something that is typically experienced in a particular part of the body, and mental suffer­ing as a physically unlocatable experience, is not so clear-cut if we recall that in many cultures distressing emotions are experienced as being lo­cated in particular organs of the body (liver, belly, heart, and so forth).³⁴ Even in modern society people recognize that they can be “sick with anger” and “flushed with embarrassment,” and that these unpleasant ex­periences are at once physically located and socially anchored.

If research now indicates that the brain is the source and not the terminus of pain sensations, the latter can be thought of as actions that are sited at once in cultural and neurophysiological contexts. In an im­portant sense “cultural” and "physical” cease to be dichotomies, although for analytical purposes they can be distinguished. What a subject experi­ences as painful, and how, are not simply mediated culturally and physi­cally, they are themselves modes of living a relationship. The ability to live such relationships over time transforms pain from a passive experience into an active one, and thus defines one of the ways of living sanely in the world. It does not follow, of course, that one cannot or should not seek to reform the social relations one inhabits, still less that pain is in­trinsically “a valuable thing.” My point is that one can live one’s pain sanely or insanely, and (although ideas about insanity change) that the progressivist model of agency diverts attention away from our trying to understand how this is done in different traditions, because of the as­sumption that the agent always seeks to overcome pain conceived as ob­ject and as state of passivity. The secular emphasis on the integral human body as the locus of moral sovereignty makes it difficult to grasp the idea of pain as an imagined relationship in which such “internal” states as memory and hope mediate sociality.

I do not claim that the pain felt by a physically injured person can be in the brain independently of damage to the body, says Melzack, it can be “felt” in lo­cations of the body that do not exist. That explains the phenomena of phantom see­ing and hearing. See R. Melzack, “Phantom Limbs,” Scientific American, April 1992.

34. For cultures of antiquity, see R. B. Onians, The Origins of European Thought About the Body, the Mind, the Soul, the World, Time, and Fate, Cambridge: Cambridge University Press, 1951 (especially chapter 5).

Thinking about Agency and Pain 8$ experienced in the same way by an observer. There is always an irrepro- ducible excess in pain. I argue that that is not all pain is. Sufferers are also social persons (animals) and their suffering is partly constituted by the way they inhabit, or are constrained to inhabit, their relationships with others. Pain is not always an insufferable agony or a chronic condition. There are varieties of incommensurable experiences we collect together under the la­bel “pain” (or “suffering”) as though it were, like agency, a single thing, an ultimate vindication of corporeal reality. But as a social relationship pain is more than an experience. It is part of what creates the conditions of action and experience, as I will now try to show in some examples of pain from religious history and ethnography.