The History of Medicine as the History of Pain

Article excerpt

Modern day obituaries often speak of illnesses 'bravely fought" but the history of pain, a defining and constant experience in lives throughout history, lacks a substantial literature, argues Joanna Bourke. Yet its expression is culturally determined and highly illuminating of society's attitudes.

In 1812 the eminent novelist Frances Burney lay down on a bed in her Parisian drawing room, spread a cambric handkerchief over her face and underwent a mastectomy. She was not given any anaesthetic.

In a letter to her sister she described enduring 'the most torturing pain: When 'the dreadful steel was plunged into the breast--cutting through veins--arteries--flesh--nerves', she wrote, 'l needed no injunctions not to restrain my cries. I began a scream that lasted intermittingly during the whole time of the incident--& I almost marvel that it rings not in my Ears still! So excruciating was the agony'. As a 'patron patient'(in the early 19th century, wealthy patients still larded it over their physicians), she also described the humiliation of being progressively stripped of her authority.

Burney's expressions of agonising bodily pain remind us of the centrality of suffering in history. As historians of medicine reiterate time and again, the alleviation of pain and suffering have preoccupied healing practitioners throughout history.

However, we still know remarkably little about how people actually experienced pain in the past--see Lucy Bending's The Representation of Bodily Pain in Late Nineteenth-Century English Culture (Oxford Clarendon Press, 2000). The alleviation of pain has been explored much more frequently than its expression. In the history of modern medicine, the prominence of phrases such as 'the conquest of pain' or 'the fight against pain' imply that the 'battle' has, essentially, been won. In fact, although the invention and proliferation of anaesthetics from the 1840s have resulted in dramatic shifts in the experience of pain, these shifts have not been universal (there are significant differences in provision, within local and global economies). Anaesthetics have encouraged physicians to undertake radical forms of intervention, many of which are inherently painful. More to the point, people continue to complain of debilitating bodily pain. Ten per cent of adults live in moderate to severe chronic pain and, according to the European Pain Network, Europeans with chronic pain suffer on average for seven years.

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Perhaps part of the reluctance of historians to focus on the history of pain is because it is such a subjective experience. After all, how can historians know what pain 'really felt like' in previous centuries? Elaine Scarry's reflections in her monumental book, The Body in Pain: The Making and Unmaking of the World (Oxford University Press, 1985) has undoubtedly exacerbated historians' reluctance. She argued that pain exists outside of language: it is essentially untransmissible and private.

While historians of medicine do acknowledge the profound sense of alienation often felt by people in pain, Scarry is insufficiently attuned to the fundamentally social aspects of pain and its ability to generate language, both in the past and today. …