Communicating Pain

Exploring Suffering through Language, Literature and Creative Writing

Stephanie de Montalk

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429878671
• Edition: 1
• Topic: Langues et linguistique
• Subtopic: Écriture créative

Combining critical research with memoir, essay, poetry and creative biography, this insightful volume sensitively explores the lived experience of chronic pain.

Confronting the language of pain and the paradox of writing about personal pain, Communicating Pain is a personal response to the avoidance, dismissal and isolation experienced by the author after developing intractable pelvic pain in 2003. The volume focuses on pain's infamous resistance to verbal expression, the sense of exile experienced by sufferers and the under-recognised distinction between acute and chronic pain. In doing so, it creates a platform upon which scholarly, imaginative and emotional quotients round out pain as the sum of physical actualities, mental challenges and psychosocial interactions. Additionally, this work creates a dialogue between medicine and literature. Considering the works of writers such as Harriet Martineau, Alphonse Daudet and Aleksander Wat, it enables a multi-genre narrative heightened by poetry, fictional storytelling and life-writing.

Coupled with academic rigour, this insightful monograph constitutes a persuasive and unique exploration of pain and the communication of suffering. It will appeal to students and researchers interested in fields such as Medical Humanities, Autobiography Studies and Sociology of Health and Illness.

1The shirt of Nessos¹

An essay on the experience of writing about pain

Pain is an unpleasant sensory and emotional experience with actual or potential tissue damage, or described in terms of such damage.

The International Association for the Study of Pain (1979)²

We don’t like to talk about pain – are somehow ashamed by it and try to shrug it off. Well, enough with that. Pain is a crucial part of our medical tales. It needs to be articulated, then confronted – even if, sometimes, the pain is beyond words.

Dana Jennings, New York Times (2009)³

We are determined to raise the profile of pain. […] There is a lack of awareness that pain brings side effects and mortality. It reduces life expectancy. To do nothing is not an option.

Professor Richard Langford,⁴ President of the British Pain Society (2012)

A necessary preface

In 2003, I slipped and fell heavily on a marble bathroom floor in Warsaw, injuring my pelvis. As the acute pain of that accident turned first into the severe chronic pain of an obscure nerve entrapment, and then into the intractable neuropathic pain⁵ of nerve damage, I became aware of much awkwardness around, and reluctance to speak plainly about, physical pain – continuing pain, in particular.

Initially, there were commiserations – pain after an accident is expected. The expressions of interest and sympathy were followed by appreciative assumptions that the trauma, having been treated, had healed, leaving an inconsequential degree of discomfort. However, as the pain persisted, the sense of solidarity turned to inklings of disbelief and dismissal. I found myself struggling to describe the pain, and even to speak of it. Increasingly, I felt emotionally isolated – exiled in the realisation that pain’s forestalling of language was limiting understanding, fellow feeling and also, it seemed, compassion. I could admit that I, too, might once have been dubious about the severity of another’s invisible, ongoing pain. Although I had personally experienced a range of acute or temporary pain, and as a former nurse had cared for patients in pain, a state of non-cancer pain, for which strong narcotics were taken daily for years outside hospital settings, had rarely occurred to me. Neither had I registered the disparity between palliative end-of-life relief and control of unbearable pain when life must continue.

I encountered others whose chronic pain – that is, a continuous pain lasting six months or longer – was doubted. I read their anonymous blogs and postings – sufferer to sufferer – on Internet forums. I observed them in pain specialists’ clinics reading magazines and walking to and from the consulting rooms without obvious signs of physical distress. I saw them, uncomplaining, in the wider community, struggling to adopt the roles of supportive partner, attentive parent, sharing friend. And I perceived that, beyond the online listings of symptoms and the advent of storytelling as therapy, despite the prevalence of self-help texts and the growing interest of scholars, the ‘patient voice’ as a source of empathic disclosure – as, wrote nineteenth-century French author and sufferer Alphonse Daudet, a ‘solace and relief […] a mirror and a guide’ – remained in relatively short supply.

Why the inability, or unwillingness, to acknowledge continuing pain? Was it initiated because for many people, including those afflicted by pain, physical distress, like death, is threatening, beyond understanding?

Emily Dickinson wrote:

Pain has but one Acquaintance
And that is Death –
Each one unto the other
Society enough.

Pain is the Junior Party
By just a second’s right –
Death tenderly assists Him
And then absconds from Sight.⁶

Did the origins of this hesitance to speak about pain also lie in primitive mistrust of weakened ‘tribe’ members; societal expectations of stoicism; the paucity of reflection on bodily torment in literature? Was the linguistic derivation of ‘pain’, from the Ancient Greek poine, meaning ‘penalty’, and the Latin poena, meaning ‘punishment’, relevant? In which case, had a primal part of the public mind remembered that to be in pain was to have incurred suffering sent by the gods for wrongdoing? (I had not forgotten my mother’s accusatory, ‘I wonder what you were doing to deserve that’ when, as a child, I fell ill or had an accident.) How about the riddling nature of pain as unequivocally present for the sufferer, yet a cause for doubt in a bystander for whom another’s pain cannot be shared or confirmed? Or was the evasion principally related to a one-dimensional interpretation of pain based on the long-held model of acute pain – a response evident, I noted, even among health professionals?

‘The act of verbally expressing pain,’ said Elaine Scarry in The Body in Pain (1985),⁷ ‘is a necessary prelude to the collective task of diminishing pain.’

In 2010, I set myself the task of examining the lived reality of chronic physical pain as a PhD in Creative Writing entitled How Does It Hurt?: Narrating Pain. I hoped to bring visibility and a measure of clarity to the condition – to break the cycle of misunderstanding, silence, isolation. In particular, I wanted to confront the paradox of writing about personal pain, notwithstanding physical pain’s resistance to verbal expression; and to determine where the greater challenge lay: in finding descriptors for the ‘raw sensation’ of pain; or in communicating the emotional and mental implications that constitute suffering.

I stalled. Could I round out this complex and intensely personal territory and identify it as the sum of its physical sensations and psychosocial interactions? Could I research and write against continuous pain, lying down? What form should my thesis take?

‘The artist is extremely lucky,’ said John Berryman in a Paris Review interview, ‘who is presented with the worst possible ordeal which will not actually kill him. At that point he’s in business.’⁸

Should I write a novel or a pathography? Would the flexibility of a memoir or personal essay be most appropriate, as pain pushed me this way and that?

Difficulties and mysteries

Amorphous and abstruse, physical pain flickers at the edges of thought, communication and medical science, defying description and, when extreme, reducing verbal expression to a pre-language of moans and cries. Hidden deep within a network of cells and synapses, it can only be independently verified by a functional MRI (fMRI) of the brain, in which it may be seen as flares of light as it occurs. In an absence of precision treatments capable of targeting its transmission symptoms, it resists complete and enduring relief. When it does desist, it is likely to be recalled less for its sensory actuality than for the psychological response engendered by that actuality. ‘The mind is its own place,’ wrote Milton in Paradise Lost (speaking for Satan), ‘and in itself/Can make a Heaven of Hell, a Hell of heaven.’

The link between mind and body in the pain experience – a relationship surely integral to the understanding and verbal communication of pain – has proved as elusive as the parameters of consciousness. A key to uncovering this connection appears to lie not only in knowledge of the way in which pain-activated neurons, viewable on fMRI, connect with the felt and perceived experience of pain, but also the understanding of ‘the complex nuances of [the neurons’] language’.⁹ To date, as New York Times journalist and chronic pain sufferer Melanie Thernstrom pointed out in her work of personal narrative and reportage The Pain Chronicles (2010), all these scans offer is ‘a silent film of a concert’:¹⁰ a performance in which the musicians’ movements are seen, but the components of the music they are playing – the melody, harmony and balance, the contours, tensions and resolutions – are unknowable.

Increasingly, the inexpressibility of pain is seen to hinder medicine’s inability to manage it. In order to render a rounded account of physical pain, it may be necessary to ‘test’ ourselves, in the words of Michel de Montaigne, ‘in the thickest of pain’.¹¹ Yet, of such testing, Montaigne – born in 1533 and generally viewed as one of the first writers to fully explore pain autobiographically¹² – admitted that although when experiencing pain he remained ‘capable of speaking, thinking, and answering as sanely as at any other time’, he found that his abilities became less steady, ‘being troubled and distracted’. Consequently, and given the inconsistencies of his symptoms and the interruptions of his imagination, Montaigne found himself limited to assessing his pain state ‘only by actual sensation, not by reasoning’.¹³

The challenges of rationally and analytically communicating physical pain persist, notwithstanding advances in neurobiological pain research and the inroads scholars have made into the nature and meaning of pain: pursuits which demonstrate connections between the anatomical, physiological and psychological vocabularies of pain, and those of history, philosophy and culture.¹⁴ Despite, too, our current public preoccupation with wellness, and, in the thrall of the Internet’s encouragement of confession and storytelling, an unprecedented outpouring of the difficulties and mysteries of being in pain – the latter supplementing, even replacing, the face-to-face assistance of medical professionals, family and friends.

It is particularly striking that, by comparison with the reflections on the psychological anguish of mental and emotional distress that have played central roles in poetry, non-fiction and drama, literature’s contemplation of sustained physical pain has been marginal. While feelings of isolation, loss, grief and despair are an integral part of severe and chronic bodily suffering, non-scientific writers (autobiographers in particular) have focused on the transient effects of acute pain.

As I have found, it is impossible to share fully the sensory and emotional impact of chronic pain with anyone but a fellow sufferer. In this respect, the difference between acute pain and chronic pain is worth reiterating – for, regardless of significant developments in the science of pain since the mid-1960s, much societal, and even medical, understanding of pain remains based on what it is to be in acute pain.

Acute pain, the purpose of which is protective, is temporary: it warns of harm, attends healing and passes, having run a largely predictable course of hours, days, weeks or even months. It ranges from the mundane to the unbearable: from the discomfort of a sprained ankle to the agony of the rack. It is depicted in literature, dramatised in films, reported in the media. For sufferers who cannot articulate the acute pain of their injury, illness, surgery or childbirth, the failure of language, although perturbing, is transient.

Chronic pain, as we know, serves no obvious beneficial biological function. In The Culture of Pain (1993), David B. Morris characterised chronic pain as a state as different from acute pain as is cancer from the common cold.¹⁵ In The Pain Chronicles, Dr Clifford Woolf, a Harvard professor of neurobiology, described chronic pain as ‘a terrible, abnormal sensory experience, pathological activity in the nervous system’¹⁶ – confirming that chronic pain not only defies pain’s evolutionary warning and protective mechanisms, but also, in outliving its original function, becomes a pathological condition of itself. Unlike acute pain, writes Morris, the wearying constancy of chronic pain, upon both the sufferer and the ‘patience and goodwill’ of friends and carers, ‘constitutes a radical assault on language and on human communication’.¹⁷ This is a complex pain, personally, medically, socially....

Table of contents

• Cover
• Front Matter
• Half Title
• Series Title
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgements
• 1 The shirt of Nessos: an essay on the experience of writing about pain
• 2 Going nursing: an autobiographical prelude
• 3 At the end of the mind, the body: a memoir, 2003–2004
• 4 But at the end of the body, the mind: a memoir, 2004–2009
• 5 The vendor of happiness: an interview with French novelist Alphonse Daudet (1840–1897)
• 6 The consolator: an introduction to English social theorist Harriet Martineau (1802–1876)
• 7 Observatory: a narrative poem set in Harriet Martineau’s sick-room
• 9 How does it hurt? An epilogue
• 8 An imago: a contemplation of Polish poet and intellectual Aleksander Wat (1900–1967)
• 10 White train: a narrative poem
• Appendix of images
• Notes
• Bibliography
• Index