The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering

ITHE VALE OF PAIN, THE VEIL OF PAIN:Pain as Metaphor
DOLOR DICTAT
Mortals have not yet come into ownership of their own nature. Death withdraws into the enigmatic. The mystery of pain remains veiled,” the German philosopher Martin Heidegger writes. Does metaphor unveil pain to reveal its true nature, or is metaphor the veil that surrounds pain—and makes it so hard for us to see pain as it is?
Pain is necessarily veiled, David B. Morris writes in The Culture of Pain, because, to a physician, pain is a puzzle, but to a patient it is a mystery, in the ancient sense of the word—a truth necessarily closed off from full understanding, which refuses to yield every quantum of its darkness: “a landscape where nothing looks entirely familiar and where even the familiar takes on an uncanny strangeness.”
But “illness is not a metaphor,” Susan Sontag sharply asserts in Illness as Metaphor. “The most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, and resistant to, metaphoric thinking. Yet,” she complains, “it is hardly possible to take up one’s residence in the kingdom of the ill unprejudiced by the lurid metaphors with which it has been landscaped.”
How true this sounds! I read it again and again to feel its full weight—how helpful and clarifying it is. Sontag’s point seems to turn on what one might think of as the different resonances of the words illness and disease. While disease refers to biological pathology, illness opens the door to a world of wider meanings—the very meanings, Sontag says, that burden and confuse the patient. When the pathology of the illness is finally understood, metaphors will fade away, she asserts, in the way that consumption became TB. Cancer is not an expression of repression, it is a cluster of abnormally dividing and enduring cells; AIDS is not retribution for homosexuality, it is an immune deficiency. Pain is not a pen dipped in blood, scribbling on the body in illegible script, nor is it a mystery to be divined; it is a biological process, the product of a healthy nervous system in the case of acute pain and a diseased one in that of chronic pain.
True, true. Yet even when pain is understood this way, its metaphors endure. When pain persists, a biological disease becomes a personal illness. The illness changes the person, and the changed person reinterprets the illness in the context of her life, experience, personality, and temperament. A thousand associations spring to mind—personal, situational, cultural, and historical.
As soon as we reject certain metaphors, others immediately take their place. Foucault’s modern doctor may ask, “Where does it hurt?” but the patient will ceaselessly—idly and intently, consciously and unconsciously—contemplate the old question, “What is the matter with me?” and this wrongness cannot be illuminated by the word pain.
More, perhaps, than any other illness, protracted pain spawns metaphor. As has oft en been observed, pain never simply “hurts.” It insults, puzzles, disturbs, dislocates, devastates. It demands interpretation yet makes nonsense of the answers. Persistent pain has the opaque cruelty of a torturer who seems to taunt us toward imagining there is an answer that would stop the next blow. But whatever we come up with does not suffice. We are left like Job, bowing before the whirlwind.
On one hand, nothing is more purely corporeal than physical pain. It is pure sensation. Indeed, it oft en figures in literature as a symbol of illegibility and emptiness. As Elaine Scarry writes in The Body in Pain, pain is uniquely lacking in a so-called objective correlative—an object in the external world to match with and link to our internal state. We tend to “have feelings for somebody or something, that love is love of x, fear is fear of y…,” she explains, but “physical pain—unlike any other state of consciousness—has no referential content. It is not of or for anything.”
As Emily Dickinson puts it, “Pain has an element of blank.” Yet it is the very blankness of pain—the lack of anything it is truly like or about—that cries out for metaphor, the way a blank chalkboard invites scribbling. As soon as Dickinson tries to describe this great blank, she grasps for metaphor:
Pain—has an Element of Blank—
It cannot recollect When it begun—or if there were A day when it was not—
It has no Future—but itself—
Its Infinite contain Its Past—enlightened to perceive New Periods—of Pain.
You try to wake yourself out of pain—it’s not an infinite realm, it’s a neurological disease—but you can’t. You are in a dreamscape that is familiar yet horribly altered, one in which you are yourself—but not. You want to return to your real self—life and body—but the dream goes on and on. You tell yourself it’s only a nightmare—a product of not-yet-fully-understood brain chemistry. But to be in pain is to be unable to awaken: the veil of pain through which you cannot see, the vale of pain in which you have lost your way.
To be in pain is to be alone, to imagine that no one else can imagine the world you inhabit. Yet the world of pain is one that all humans must, at times, inhabit, and their representations of it pierce us through the ages. “Head pain has surged up upon me from the breast of hell,” laments a Babylonian in a story three millennia old. The agony of the ancient sculpture of the Trojan priest Laocoön and his sons as they are strangled by sea serpents still contorts the ancient marble, as does the very different agony of Jesus’ crucifixion in Matthias Grünewald’s Renaissance altarpiece.
Dolor dictat, the Romans said—pain dictates, dominates, commands. Pain erases and effaces. We try to write our way out of its dominion. How savage its practices, how dark its vales! we exclaim, this unhappy country on whose shores we have washed up after a voyage upon which we never sought to embark.
“I would have made a fine explorer in Central Africa,” the nineteenth-century French novelist Alphonse Daudet writes in his slim volume of notes about suffering from the pain of syphilis, published as In the Land of Pain after his death. “I’ve got the sunken ribs, the eternally tightened belt, the rift s of pain, and I’ve lost forever the taste for food,” he laments.
If only Daudet were in Africa, instead of in Pain, he would know that one day he could return home and leave his tribulations behind. His scribblings might then seem to be tall tales: Was he really pricked with a thousand arrow points while his feet were held in fire? But if others were skeptical, he wouldn’t mind. He’d no longer need anyone to walk in that lonely place with him. Indeed, he would hardly recall it himself.
But Pain is not a place easily left behind. We inhabit Pain. Pain inhabits us.
Dolor dictat.
We write about pain, but pain rewrites us. 
Excerpted from The Pain Chronicles by Melanie Thernstrom.
Copyright © 2010 by Melanie Thernstrom.
Published in 2010 by Farrar, Straus and Giroux.
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