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The Pain Chronicles
Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science Of Suffering
By Melanie Thernstrom Farrar, Straus and Giroux
Copyright © 2010 Melanie Thernstrom
All rights reserved.
ISBN: 978-0-86547-681-3
CHAPTER 1
THE 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 often 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 often 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 ofPain after his death. "I've got the sunken ribs, the eternally tightened belt, the rifts 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.
Pain Diary: I Keep a Secret
ONSET: When did your pain begin? Was there any triggering event or special circumstances that surrounded it?
In the beginning, it was secret.
It began when I was visiting my best friend, Cynthia, and her friend Kurt in Nantucket. Kurt had been Cynthia's boyfriend for many years, but that had been many years before. By the time of my visit, they had been friends longer than they had ever been lovers, and everything was easy. Their relationship was the kind of thing people say never works, but it did, so that was part of the fun, too.
Kurt lay on his back in the sun, reading Foucault, while Cynthia swam the perimeter of the pond. She was wearing a cardinal-colored bathing suit, her dark curls tucked under a cap. They were both academics, a decade or so older than I. Even though I was twenty-nine, I felt a bit like a child around them — bright, but slightly ignorant. Cynthia had adopted me when she was a seventh-year English Ph.D. student and I was a first-year creative writing one, and it had been my dearest hope that she'd become my friend. Kurt never would have paid attention to me, I knew, but for Cynthia. Her gaze always put me in the best light — a prettier, cleverer light.
I lay beside Kurt, covered by a frayed magenta beach towel. It's hard to recall how I felt about my body at that time, but it involved a dim sense of unease that led me to conceal it. I remind myself of this sometimes now: I didn't enjoy my body that much even before I got pain, so pain didn't ruin as much as it should have. I wonder now, if I had known that that afternoon was, in one sense, the beginning of pain and that henceforth my opportunities to take pleasure in my body would be numbered, would I have thrown aside the towel?
I wanted to swim straight across the pond, as I had as a child. Then, my father had always followed me in a rowboat, which I was glad about because I was afraid of eels. Cynthia climbed out of the water and stretched out on the beach.
"Would you swim to the other shore with me?" I asked Kurt. My heart beat as if I had propositioned him.
Kurt looked up with a lazy, skeptical glance. He gazed at the pond and wrinkled his nose. "It's too far," he said.
"Go with her," Cynthia said.
"Now?" he said.
We swam and swam, arms curving over heads, pausing to look up as the families on the far shore came into clearer view. Closer, breath, closer. The straps of my white suit tangled, and the top slipped down. I wondered whether my breasts, pointing down pale in the dark water, looked like eels' faces to the eels waiting below. Finally we flopped on the wooden dock, clean and hot and cold and wet, alone together — a pond away from where we began.
"We really went the distance, didn't we?" Kurt said later as we climbed back to the shore and collapsed, shivering, onto the warm sand at Cynthia's feet.
I looked up at Cynthia and saw something register. In a novel, this would be a tragic turning point: the older woman realizes that her young friend wants her former lover, and even though the woman doesn't want him anymore, even though the woman might have in fact — as Cynthia had — left the man years ago, there's always a price for desire: someone has to drown. Our story is so different, though, I thought, because Cynthia is different — I felt her generosity, her easy love, as she rubbed suntan lotion into my back. "You and Kurt are such matched swimmers," she said reflectively. And then: "You should go inside, sweetie. You're starting to burn."
Sunset fell as Kurt played guitar on the deck. The light changed on the water, and the shrubs sloping toward the sea darkened and merged into the hill. We drank and listened, and as I listened, pain set in.
It began in my neck and poured through my right shoulder, down into my arm and hand. It felt as if my right side were sunburned, but inside out, reddening and beginning to pucker and blister beneath the skin.
I usually drink wine, but I poured a glass of gin. It tasted as anesthetic as it looked, clear and cooling. But the pain seemed to be drinking, too, and as it drank, it grew bold and began to mock and turn on me.
"I think I am not feeling well," I announced, puzzled, and went downstairs to bed.
My right side refused to fall asleep. It throbbed, reminding me of a horror movie I saw once, in which a transplanted limb is still possessed by the angry spirit of its original owner. I slipped into Kurt's room to look in the long mirror. I turned at different angles, but my right and left shoulders looked the same.
The pain continued, lively through the night. I heard Kurt and Cynthia whispering in the hall, and the closing of doors, and then I went up to the living room and wrapped myself in a blanket on the couch and drank more gin.
I woke from a dream of terrible pain — of reaching for something you shouldn't and arriving to find yourself stranded in a place you never wished to be.
"Hey," Kurt said, puzzled, as he came up the stairs.
I sat up on the couch, cradling my arm, blinking, confused, waiting for the usual feeling of emerging from a nightmare. But the pain lingered, veiling the ordinary world.
"You look — What? Are you okay?"
"Yes — yes. I liked swimming across the pond with you," I said with unplanned passion. Why was I revealing feelings for him? Why was I concealing the pain?
He offered a mug of tea. I reached for it with my bad arm, as if to illustrate that nothing was wrong.
"Perhaps we could go again today," I said. But the cup was oddly heavy in my hand; I could barely bring it to my trembling lips.
POENA
Romantic and physical pain have nothing to do with each other, I firmly believed at that time, just as there is no likeness between a broken heart and a heart attack. A broken heart is a metaphor; a myocardial infarction is a cardiovascular event. Indeed, even as a metaphor, a broken heart seems antiquated now that we know emotion stems from the brain.
"How do you know the nature of your ailment?" my favorite grandmother — a Christian Scientist — used to inquire when I had a headache. "How do you know that it isn't a spiritual problem?"
"Because I know," I would say. "Because I'm not confused."
The feeling of Kurt and the feeling of pain had a certain similar emotional hue. And because they began at the same time, the narrative of pain and the narrative of the romance began to entwine and become a single story in my mind.
* * *
Three years later I lay in Kurt's bed for the first time, shivery and sleepless with the hope and fear that accompanies great change — and with pain, the same ghostly pain that had arisen for no reason that weekend three years before and then disappeared beneath the surface of my body.
That day, I had taken the train to Providence to visit Kurt, something I had never done without Cynthia. Cynthia — who had recently married and liked the idea of her two friends pairing — had actually arranged for the date. I had asked if we could go swimming that afternoon, in memory of the afternoon in Nantucket. We swam past scores of anxious parents bent on keeping their children from slipping under the white rope separating them from deeper waters, and then we lay on the dock on the far shore. It was so sunny, it was as if we were still swimming in the sun-air. We lay resting on the wooden slats, gauging each other's desire to lie there forever against the knowledge that the longer you wait, the harder it is to swim back. He was ready and then I was ready, but he closed his eyes again. I had just slipped into sleep when I felt his foot on my back, and I understood that we would sleep together that night.
I am not given to large romantic hopes — to imagining that a given boyfriend could be the last boyfriend — and I've never understood how that feeling seems to come so easily to most people. But that night, as I lay beside him in the dark, a sense of possibility began to dawn. The night I lost my virginity, I had stayed awake with the sense of irrevocable transformation, but since then, sex had all been erasable, like scribbling on one of those childhood magic slates that you can shake blank so the game can go on and on. Could this be different?
But I also had pain again. The old, eerie pain, familiar and strange. In the years since that day on Nantucket, I had felt a brush of this pain from time to time — a pointless ache in my neck and shoulders, which I dimly attributed to structural weakness in my body. I have a large head — poorly supported by a long neck and narrow shoulders — which I carry in a forward position, giving the impression at times that it is in danger of toppling off. I knew I should work on my posture, but it was on the list of boring beauty routines, such as working on my nails or my tan, that I had no real intention of undertaking. And the occasional achiness had become as normal as the sight of my unpolished nails and sunless skin.
Only once in that period had the pain been something odder and more urgent. I was at a roof-deck garden party on the Upper East Side of Manhattan when a forgotten friend handed me a gigantic baby — a baby I hadn't even known existed. I stood there alone momentarily, gaping at the baby, when pain sidled up and put a hand around my neck. I thrust the baby back into his mother's arms immediately, smarting, but the touch of pain tingled as dusk gathered and the air began to chill. I continued my conversations. I thought of it as a brush of mortality, a reminder that these parties could not go on forever.
(Continues...)
Excerpted from The Pain Chronicles by Melanie Thernstrom. Copyright © 2010 Melanie Thernstrom. Excerpted by permission of Farrar, Straus and Giroux.
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