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More of a bane than a blessing

12 December 2014

Richard Harries on pain considered in its social context

The Story of Pain: From prayer to painkillers
Joanna Bourke
OUP £20
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JOANNA BOURKE is a prize-winning Professor of History at Birkbeck College, in London, and this is reflected in her approach to pain. She sees it, above all, as a social phenomenon, that is, a story told by the person in pain which will be integrally related to his or her whole life history and surrounding culture, and the attitude to pain of those around him or her. She does not, of course, deny that there is a physiological basis to the pain, which can, for example, be significantly mapped by MRI scanners; but it is the history of the wider social context which is the subject of her book. So it is that she looks at the changing language in which pain is discussed in chapters on estrangement, metaphor, religion, diagnosis, gesture, sentience, sympathy, and pain relief.

She tells some horrifying stories of pain before the invention of ether (1846) and chloroform (1847), but what is particularly disturbing is the way the understanding of a person's pain has varied greatly for a man or a woman, an adult or a child, a white or black, British or foreign person, a Christian or a Jew. There was often an assumption that some people simply did not feel pain in the way a British male did, or they were not brave enough to cope with it. These social categories have led to some people's pain being underestimated and even today not being given adequate painkillers.

The lesson for doctors is that they need to attend seriously to what the person says, while not letting any emotions detract from acting in a properly rational, professional way. There is a good chapter on sympathy, for example, in which the author shows how doctors have swung from an overemphasis on sympathetic identification with the patient to a total detachment through reliance on scientific diagnosis alone, leading to a better balance between the two today.

The chapter on religion contains a series of stories in which people accept that the pain comes from God as part of a general punishment for original sin, through which the person can learn some lessons and identify himself or herself more fully with the self-offering of Christ on the cross. Bourke tells of some people who refused all painkillers, as they did not wish to meet Christ all drugged up. Interestingly, she does not seem to mention that Jesus on the cross rejected a sponge soaked in vinegar, which may have been done for the same reason.

The examples she gives are mainly from Evangelical sources, and express an understanding of God which many find very difficult to accept today. It would have been good if she had also included stories of pain suffered, for example, by Deists at the time, as well as non-believers, to compare their coping mechanisms with those of the Christians she selects.

We have to accept that pain is part of a universe designed by God, but that is very different from accepting that particular pains are specially designed for the testing or educating of a particular individual. Pain in itself is not a good. When all else fails, Christians may indeed offer their pain to God in union with Christ; but Austin Farrer was surely correct when he wrote: "Good, even animal good, such as physical health or a moderate plenty, is a more fertile breeder of good on the whole - yes, even of moral good - than distress of any kind can be. Good breeds more good than evil can. It is a special revelation of God's divine power that he is able to bring some good even out of evil."

The Rt Revd Lord Harries of Pentregarth is a former Bishop of Oxford, and an Honorary Professor of Theology at King's College, London.

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