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Book review: Light to Those in Darkness: ‘Total pain’ and the communion of saints by Charlie Bell

14 July 2023

Robin Gill considers a study of ‘total pain’ and its Christian meaning

DR CHARLIE BELL is exceptionally well qualified to write a book on “total pain”. He is a qualified psychiatrist with a Ph.D. in diabetic research, a Fellow and Lecturer in Medicine at Girton College, Cambridge, and, recently ordained, serves as a curate in the Southwark diocese. His theology is still a bit raw (ducking out on key issues such as theodicy), but always intelligent.

The concept of “total pain” was developed by the pioneer of palliative care and the hospice movement, Dame Cicely Saunders. Bell explains: “The role of the physician (and other healthcare professionals) in total pain is not about management of pain as such. . . it is to recognize the integrated nature of the ‘beloved’ (Saunders’ term) and to work from this understanding towards effective ways of navigating an individual’s narrative, identifying and addressing the (often multiple) sources, as well as the ostensible manifestations, of the pain.”

Unlike the individualistic psycho-physical approach of most pain specialists, Bell maintains, following Saunders, that “spiritual” and cultural factors causing pain need also to be taken fully into account: “Total pain is not solely that suffered by the individual: it is a social phenomenon, as human beings themselves are social phenomena.”

Shockingly, however: “Those experiencing total pain often appear locked away — in hospitals, with therapists, shamed into avoiding polite company or overwhelmed with blame and feelings of worthlessness. . . The Beatitudes suggest that such people hold a particular place in the love of God. . . we might argue that not only should these individuals not be hidden away, but their experiences and perspectives should be valued, lifted up, and considered transformational.”

Theologically, Bell believes that koinonia and the communion of saints are vital: “communion is considered as a single organism with many parts, speaking in the imagery of Christ as found in both Colossians and 1 Corinthians. Pain suffered by one member inevitably affects the others. Developing the concept of total pain in this context might suggest that one form of pain or sickness that afflicts one part of the body of Christ may likewise affect the other parts, and the whole too.”

The communion of saints, he suggests, is a “family” that “stretches across time and space, meets under the headship of Christ, and shares in solidarity and responsibility, each member not only contributing to the whole but also participating in and walking alongside the other members, living and dead”.

And again: “The communion of saints provides the fount of relationship that accompanies the individual Christian on the journey towards the New Jerusalem. This journey, it appears, may continue beyond death, and given the inevitable impact of encounter on both persons in a relationship, those journeying in via, whether alive or dead, must make an impact on each other.”

He concludes with some practical advice to fellow clergy, urging us to accompany, but not preach at, those in total pain, to listen, and to be kind. Very well put.


Canon Robin Gill is Emeritus Professor of Applied Theology at the University of Kent and Editor of Theology.

Light to Those in Darkness: “Total pain” and the communion of saints
Charlie Bell
SCM Press £25
Church Times Bookshop £20

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