antiquity
06-01-2002, 10:13 PM
The big hurt
ByÂ*CATHERINE BUSH
Â*Â*
Â*Â*Saturday, June 1, 2002 -Â*PageÂ*D3
Pain: The Fifth Vital Sign
By Marni Jackson
Random House Canada
366 pages, $34.95
There are many problems with pain. Here are two.
Physical pain is very hard to describe. By nature it is resistant to speech. It is difficult to measure objectively. You know how bad your pain is, but try conveying that meaningfully to me, who am utterly separate from you. As theorist Elaine Scarry argued in her groundbreaking book, The Body in Pain, because pain is so hard to verify, no matter how vivid an individual's experience of it, doubt logically remains in the minds of others. I cannot know your pain.
Second, we here in the West live amid an epidemic of chronic pain. No matter how many pills we swallow (so many that residues end up in our drinking water), collectively our pain will not go away.
Traditionally, pain has barely been a focus of a doctor's education. Perhaps that's an understatement. In her insightful new book on this perplexing and endlessly morphing subject, journalist Marni Jackson states that many medical students receive "no more than one hour of instruction in pain management." Pain has simply been considered a symptom. It pointed to injury or disease. You treated the injury or disease.
Attitudes toward pain are undergoing something of a paradigm shift. The specific challenges of talking about and treating chronic pain -- as distinct from short-term, acute pain -- are stepping out from under the carpet. Witness a stream of recent newspaper articles on the subject. The very mysteriousness of pain is attracting attention as both a medical and a cultural phenomenon. (It sometimes seems easier to talk about S & M than chronic pain, which is pain that recurs or endures, sometimes without an obvious stimulus, and can ultimately end up transforming a person's neurochemistry.)
In Pain: The Fifth Vital Sign,Jackson takes her subtitle from the fact that U.S. hospitals are currently campaigning to ensure that a patient's pain, in addition to temperature, respiration, blood pressure and pulse, be charted. In 2001, the Joint Commission on Accreditation of Health Care Organizations in the United States implemented the first national standard for pain assessment and control in hospitals and nursing homes. Doctors are wising up to the dangers of undertreating pain. Acute pain can transform into chronic. Untreated pain can lay down such deep neural grooves that the slightest triggers may send the sufferer back into anguish.
Jackson admits to being drawn to the culture's largely unexplored and silent spaces, pain being one. Her first book, Mother Zone (1992), was a highly regarded and much-loved examination of another: the interior life of contemporary motherhood. She also acknowledges the difficulty of tackling as vast and mercurial a subject as pain, which, as soon as you fix on one aspect, tends to send you springing off in another direction.
In fact, Jackson's book might also be subtitled A Guided Tour of Pain, for it's conceived as a kind of journey, a zigzagging series of encounters with Jackson as our sympathetic guide. We meet sufferers of extreme pain, including a woman with trigeminal neuralgia, a ferocious condition that causes "intense, electric-shock-like pain" down one side of the face, where the trigeminal nerve runs, who says finally, "You simply have to make friends with the pain . . . otherwise you'll go crazy."
A once-fit man who can now barely stand straight describes his ongoing battle for workers' compensation. Jackson sits in on sessions with the feverishly multitasking Dr. Angela Mailis, who runs the multidisciplinary Comprehensive Pain Program at Toronto Western Hospital, jettisons white lab coats for little black dresses and advocates for the essential examination of the whole patient rather than solo symptoms.
In Vienna, Jackson attends panels at the Ninth World Congress of the International Association for the Study of Pain, including one in which back experts vie to decide who they would send in a hot-air balloon to succor a back-pain sufferer stranded on a desert island. (They end up voting on board a physiotherapist and bottle of malt whisky, but no surgeons.)
In Los Angeles, she visits UCLA's History of Pain Project and pores over the papers of Silas Weir Mitchell, the 19th-century U.S. doctor who published the first detailed studies of nerve damage, chronicling injuries among Civil War soldiers.
She converses with Frank Adams, a doctor pursued by the Ontario College of Physicians and Surgeons for prescribing high doses of narcotics to patients.
Charged by the college, Adams defends his approach as the time-consuming custom-tailoring of prescriptions to individual need, and echoes Cicely Saunders, the British founder of the modern palliative-care movement, who argues, based on her own research, that true addiction when using opiates for pain relief is actually very rare.
Jackson grounds her journeying in her personal experiences of pain -- migraine, endometriosis, mild depression, a very bad day at the dentist -- and that of various family members. She muses on such matters as the transfer of pain between generations and takes inventive approaches to the tricky issue of how to talk about pain, including a section in which pain is personified as a Scotch-swilling seducer, which I found appealing, if less convincing (painful?) as a figurative rendition of the experience.
Throughout, I found myself more distanced from the pain stories than I would like. Perhaps it's a quality of the conversational tone that Jackson chooses. Her own suffering comes across as inclusively ordinary rather than extreme and life-transforming in the manner of that of Andrew Solomon, author of a recent, similarly structured work on depression, The Noonday Demon.
One of Jackson's biggest bones of contention is with the dualism that still pervades popular thinking about pain. Since Descartes, pain has been considered a response to a physical stimulus -- or else all in the head. Current thinking places pain resoundingly in the head -- in the brain.
The phrase "pain is in the brain" rings through this book like a mantra; it's a view propounded most forcefully by McGill psychologist Ronald Melzack, who, along with spinal cord expert Patrick Wall, revolutionized thinking about pain in the 1960s with the gate-control theory, which posited pain as a two-way path of signals ascending to and descending from the brain.
Pain is, fundamentally, a form of consciousness, an experience rather than a sensation. There is no single pain pathway. Mental pain cannot be separated from physical. We create our own pain, drawing upon past experience and our genetic inheritance, while synthesizing the world around us. "You don't need a body to feel pain," Melzack emphasizes, only the brain's innate map of the body. You could be a brain in a jar and still feel it.
Most of us don't live in jars, however, but in a culture, and behind Jackson's wandering encounters pulses a compelling argument for putting culture back into our thinking about pain. As the phenomenon of pain has been taken over by the medical profession, and we concentrate simply on extinguishing it, we have lost a broader sense of its possible meanings. This may be dangerous to our collective health. Culture shapes our experience of pain. The stories we tell about our pain are essential to our understanding of it. Propelled by curiosity and a lucid and accessible intelligence, Jackson's book is a timely and necessary contribution to this important dialogue.
Catherine Bush, author of the novel The Rules of Engagement, is currently writing a novel about the experience of chronic pain.
ByÂ*CATHERINE BUSH
Â*Â*
Â*Â*Saturday, June 1, 2002 -Â*PageÂ*D3
Pain: The Fifth Vital Sign
By Marni Jackson
Random House Canada
366 pages, $34.95
There are many problems with pain. Here are two.
Physical pain is very hard to describe. By nature it is resistant to speech. It is difficult to measure objectively. You know how bad your pain is, but try conveying that meaningfully to me, who am utterly separate from you. As theorist Elaine Scarry argued in her groundbreaking book, The Body in Pain, because pain is so hard to verify, no matter how vivid an individual's experience of it, doubt logically remains in the minds of others. I cannot know your pain.
Second, we here in the West live amid an epidemic of chronic pain. No matter how many pills we swallow (so many that residues end up in our drinking water), collectively our pain will not go away.
Traditionally, pain has barely been a focus of a doctor's education. Perhaps that's an understatement. In her insightful new book on this perplexing and endlessly morphing subject, journalist Marni Jackson states that many medical students receive "no more than one hour of instruction in pain management." Pain has simply been considered a symptom. It pointed to injury or disease. You treated the injury or disease.
Attitudes toward pain are undergoing something of a paradigm shift. The specific challenges of talking about and treating chronic pain -- as distinct from short-term, acute pain -- are stepping out from under the carpet. Witness a stream of recent newspaper articles on the subject. The very mysteriousness of pain is attracting attention as both a medical and a cultural phenomenon. (It sometimes seems easier to talk about S & M than chronic pain, which is pain that recurs or endures, sometimes without an obvious stimulus, and can ultimately end up transforming a person's neurochemistry.)
In Pain: The Fifth Vital Sign,Jackson takes her subtitle from the fact that U.S. hospitals are currently campaigning to ensure that a patient's pain, in addition to temperature, respiration, blood pressure and pulse, be charted. In 2001, the Joint Commission on Accreditation of Health Care Organizations in the United States implemented the first national standard for pain assessment and control in hospitals and nursing homes. Doctors are wising up to the dangers of undertreating pain. Acute pain can transform into chronic. Untreated pain can lay down such deep neural grooves that the slightest triggers may send the sufferer back into anguish.
Jackson admits to being drawn to the culture's largely unexplored and silent spaces, pain being one. Her first book, Mother Zone (1992), was a highly regarded and much-loved examination of another: the interior life of contemporary motherhood. She also acknowledges the difficulty of tackling as vast and mercurial a subject as pain, which, as soon as you fix on one aspect, tends to send you springing off in another direction.
In fact, Jackson's book might also be subtitled A Guided Tour of Pain, for it's conceived as a kind of journey, a zigzagging series of encounters with Jackson as our sympathetic guide. We meet sufferers of extreme pain, including a woman with trigeminal neuralgia, a ferocious condition that causes "intense, electric-shock-like pain" down one side of the face, where the trigeminal nerve runs, who says finally, "You simply have to make friends with the pain . . . otherwise you'll go crazy."
A once-fit man who can now barely stand straight describes his ongoing battle for workers' compensation. Jackson sits in on sessions with the feverishly multitasking Dr. Angela Mailis, who runs the multidisciplinary Comprehensive Pain Program at Toronto Western Hospital, jettisons white lab coats for little black dresses and advocates for the essential examination of the whole patient rather than solo symptoms.
In Vienna, Jackson attends panels at the Ninth World Congress of the International Association for the Study of Pain, including one in which back experts vie to decide who they would send in a hot-air balloon to succor a back-pain sufferer stranded on a desert island. (They end up voting on board a physiotherapist and bottle of malt whisky, but no surgeons.)
In Los Angeles, she visits UCLA's History of Pain Project and pores over the papers of Silas Weir Mitchell, the 19th-century U.S. doctor who published the first detailed studies of nerve damage, chronicling injuries among Civil War soldiers.
She converses with Frank Adams, a doctor pursued by the Ontario College of Physicians and Surgeons for prescribing high doses of narcotics to patients.
Charged by the college, Adams defends his approach as the time-consuming custom-tailoring of prescriptions to individual need, and echoes Cicely Saunders, the British founder of the modern palliative-care movement, who argues, based on her own research, that true addiction when using opiates for pain relief is actually very rare.
Jackson grounds her journeying in her personal experiences of pain -- migraine, endometriosis, mild depression, a very bad day at the dentist -- and that of various family members. She muses on such matters as the transfer of pain between generations and takes inventive approaches to the tricky issue of how to talk about pain, including a section in which pain is personified as a Scotch-swilling seducer, which I found appealing, if less convincing (painful?) as a figurative rendition of the experience.
Throughout, I found myself more distanced from the pain stories than I would like. Perhaps it's a quality of the conversational tone that Jackson chooses. Her own suffering comes across as inclusively ordinary rather than extreme and life-transforming in the manner of that of Andrew Solomon, author of a recent, similarly structured work on depression, The Noonday Demon.
One of Jackson's biggest bones of contention is with the dualism that still pervades popular thinking about pain. Since Descartes, pain has been considered a response to a physical stimulus -- or else all in the head. Current thinking places pain resoundingly in the head -- in the brain.
The phrase "pain is in the brain" rings through this book like a mantra; it's a view propounded most forcefully by McGill psychologist Ronald Melzack, who, along with spinal cord expert Patrick Wall, revolutionized thinking about pain in the 1960s with the gate-control theory, which posited pain as a two-way path of signals ascending to and descending from the brain.
Pain is, fundamentally, a form of consciousness, an experience rather than a sensation. There is no single pain pathway. Mental pain cannot be separated from physical. We create our own pain, drawing upon past experience and our genetic inheritance, while synthesizing the world around us. "You don't need a body to feel pain," Melzack emphasizes, only the brain's innate map of the body. You could be a brain in a jar and still feel it.
Most of us don't live in jars, however, but in a culture, and behind Jackson's wandering encounters pulses a compelling argument for putting culture back into our thinking about pain. As the phenomenon of pain has been taken over by the medical profession, and we concentrate simply on extinguishing it, we have lost a broader sense of its possible meanings. This may be dangerous to our collective health. Culture shapes our experience of pain. The stories we tell about our pain are essential to our understanding of it. Propelled by curiosity and a lucid and accessible intelligence, Jackson's book is a timely and necessary contribution to this important dialogue.
Catherine Bush, author of the novel The Rules of Engagement, is currently writing a novel about the experience of chronic pain.