The secret language of pain: Why our most agonizing moments defy explanation

Pain is singularly difficult to sum up in words—a fact that reveals some alarming truths about the human condition

Published September 6, 2014 8:00PM (EDT)

Laurence Olivier and Dustin Hoffman in "Marathon Man"         (Paramount Pictures)
Laurence Olivier and Dustin Hoffman in "Marathon Man" (Paramount Pictures)

Excerpted from “The Story of Pain: From Prayer to Painkillers.”

In Margaret Edson’s play, "Wit" (1999), a bald Vivian Bearing walks on stage in her hospital gown pushing an IV pole. She complains:

I have been asked ‘How are you feeling today?’ while I was throwing up into a plastic washbasin. I have been asked as I was emerging from a four-hour operation with a tube in every orifice, ‘How are you feeling today?’

I am waiting for the moment when someone asks me this question and I am dead.

I’m a little sorry I’ll miss that.

She went on to lament the barrenness of metaphoric languages available to patients experiencing stage four metastatic ovarian cancer. Instead of the opulent, dramatic theatrical language of the epic poem The Faerie Queene, her suffering generated a play embellished only by the ‘threadbare metaphor’ of ‘sands of time slipping through the hourglass’. As she acknowledged with bitter humour,

At the moment, however, I am disinclined to poetry.
I’ve got less than two hours. Then: curtain.

Bearing’s complaint about the ‘threadbare’ narratives open to those experiencing pain has been echoed throughout the centuries. How could people-in-pain answer that question,‘How are you feeling today?’ The difficulties in responding were observed as early as 409 bc. In Sophocles’ "Philoctetes," Neoptolemus asked,‘Why groanest thou thus, and callest on the gods? . . . What ails thee?’, to which Philoctetes replied, ‘ah, it pierces me, it pierces! O misery—O wretched that I am! . . . How canst thou help knowing. . . . Aye, dread beyond telling.’

The claim that intense suffering is ‘beyond words’ reach’ has continued to be a major theme in modern times. Writing in the 1840s after suffering years of excruciating pain, social theorist Harriet Martineau also mused on the inexpressibility of pain. ‘Where are these pains now?’, she asked. In the aftermath of sickness, she observed, agonizing sensations were

not only gone, but annihilated.They are destroyed so utterly, that even memory can lay no hold upon them. The fact of their occurrence is all that even memory can preserve. The sensations themselves cannot be retained, nor recalled, nor revived; they are the most absolutely evanescent, the most essentially and completely destructible of all things.

It made no difference how often pain returned,it could not be recalled. As Martineau continued,

This pain, which I feel now as I write, I have felt innumerable times before. ... And a few hours hence I shall be as unable to represent it to myself as to the healthiest person in the house.

Indeed, the difficulty of recalling sensations of bodily torment has become one of the clichés in pain-narratives.

In this chapter, I explore some of the barriers to communicating painful sensations to oneself as well as to other people. Clearly, the body-in-pain often seeks solitude and silence, instead of stories. Acts of communicating pain can be painful in themselves, and there is always a danger that witnesses to one’s own suffering may respond in profoundly negative, rather than nurturing, ways. However, the chapter concludes by briefly alluding to a theme that will appear throughout this book: communicative acts of pain are not necessarily destructive. The same people who declare their suffering to be ‘unspeakable’ or ‘absolutely evanescent’ may then go on to tell their story of pain in exquisite detail. As a result, pain-narratives can be productive: they have the capacity to unite people in exhilarating, creative ways.

The Demands of the Body-in-Pain

Most feeling-states are difficult to express in language. This is not unique to feelings of pain. People struggle to translate all strong sensations into words, including orgasmic delight and parental love. That said, painful bodies might be especially indisposed to acts of communion. In 1930, Virginia Woolf famously argued that people have the rich language of Shakespeare for love but only a thin one for pain. Lamenting the ‘poverty of the language’ of pain, she argued that

English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache. . . . The merest schoolgirl, when she falls in love, has Shakespeare and Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.

Attempts to translate pleasurable sensations into language may be halting, cliché-ridden, or recycled (drawn from Shakespeare or Keats) but they can still provoke a glow of recognition in listeners. In contrast, pain-narratives can plunge both the person in pain and witnesses into depths of wretchedness.

Why are distressing bodily states particularly resistant to easy communication? Obviously, many people experiencing acute pain do not possess an ‘after-state’ in which to bear witness to their sufferings. As one surgeon observed at the end of the nineteenth century, it was

somewhat difficult to obtain an accurate picture of pre-anæsthetic surgery from the patient’s point of view, probably for a similar reason to that indicated by the lion in the fable, when he criticised the artist for always representing a combat between lions and men in terminating in a human victory,—lions do not paint.

The ‘tortures of the victim’ in ‘an unsuccessful case’, this surgeon continued, consist of little more than ‘the gradual subsidence of agonizing cries hushed in the silence of death’.

People who survive their encounters with agonizing events face formidable challenges. Pain alienates sufferers from themselves. There is a disconnection between ‘me’ and ‘my body-in-pain’. What is this ‘thing’ and why is it betraying ‘me’? As one chronic pain patient attempted to explain,

Now its me with this bit that doesn’t fit, but its but its not me, it’s a part of my body which doesn’t belong. . . . Well it feels different, you know about it, it tingles and burns some times, back and down my legs so you can isolate it, you can tell the part that doesn’t belong to you, like its been infiltrated or something like at the dentist, not just the pain but all the tingling and numbness and the fact it doesn’t work as well, I can lift my arm, no problem but you have to work harder to get the legs to do stuff, you have to make them. . . . Yeah, kind of because they’re not me.

In no form of suffering is this disarticulation between ‘self ’ and ‘body’ more pronounced than in cases when another person is responsible for intentionally inflicting the pain. In particular, the suffering caused by torture renders communicating with others exceptionally difficult, if not impossible. In part, the reason is that torture deliberately sets the victim out of those human communities within which (as I observed in my introductory chapter) pain is communicable. As Elaine Scarry perceptively argues in "The Body in Pain," in torture, the sufferer’s body comes to occupy the entire world. It becomes the weapon itself, destroying the very language that could be used to objectify it. The extreme pain of torture ‘unmakes the real’.

Perhaps no one expressed this destructive process more clearly than Jean Améry, tortured by the Gestapo for his work in the resistance during the Second World War.He began by stating that it ‘would be totally senseless to try to describe here the pain that was inflicted on me’. The figurative languages available to objectify his agony were inadequate. Did one kind of pain feel

‘like a red-hot iron in my shoulders’, and was another ‘like a dull wooden stake that had been driven into the back of my head’? One comparison would only stand for the other, and in the end we would be hoaxed by turning on the hopeless merry-go-round of figurative speech. The pain was what it was. Beyond that there is nothing to say. Qualities of feeling are as incomprehensible as they are indescribable. They mark the limit of the capacity of language to communicate. If someone wanted to impart his physical pain, he would be forced to inflict it and thereby become a torturer himself.

The reason, Améry argued, was that torture destroyed the world as the sufferer previously knew it. One of the more ‘fundamental experiences of human beings’, he observed, was the ‘expectation of help’: hot-water bottles, cups of tea, analgesics are routinely given to those in pain. In contrast,‘with the first blow from a policeman’s fist, against which there can be no defense, and which no helping hand will ward off, a part of our life ends and it can never be revived’.

Torture is the extreme example of incommunicability. What about everyday pains? They, too, can be incapacitating. In the words of a 1737 poem,

Sad melancholy seiz’d my mind,
To books or converse disinclin’d.

As poet William Cowper wrote in a letter to his friend Margaret King, she would be justified in ‘discard[ing] me from the Number of your Correspondents’ since he had not written for a long time. However, he explained, he had suffered ‘much of Rheumatism. . . . Not in my fingers you will say—True— But you know as well as I that pain, be it where it may, indisposes to writing.’

Or, in the words of emigrant Anna Hay in a letter written in 1888, ‘the rheumatism became so bad my hands were so still & painful that I could not write’. Indeed, pain can literally take one’s breath away, as it did for a 21-year-old woman in 1873 who drank phosphorous rat poison after quarrelling with a friend. She spoke haltingly about the ‘sour choking smoke [that] took away my breath, and forced me to cry out’. She remembered nothing more, but a passing policeman found her ‘in a very excited condition in the middle of the kitchen floor, screaming and jumping, apparently in great agony. . . . She would not, or could not, answer any questions, and soon after she fell on the floor in a faint.’ Extreme agony shattered the possibility of speech.

As depressives like Cowper would have recognized, many forms of pain are inherently isolating, inciting a yearning for darkness, silence, and seclusion. ‘I was anxious to retreat from all intercourse with the world’, admitted a sufferer of toothache in the 1830s. In the throes of a serious headache, ‘one prays to be left alone in the utmost quiet’ and all ‘speaking or doing is a burden beyond bearing’, explained a physician-sufferer in 1872. Writing in 1904, an Italian neurologist elaborated: while ‘Joy makes us hurry from the house, pain makes us enter it. . . . Joyous, we seek light, movement, noise, men; unhappy, we want darkness, rest, silence, solitude.’ This was certainly the experience of an unnamed patient plagued with trigeminal neuralgia, as pain-surgeon René Leriche observed. His patient

tells you, with an air of resignation, that he has been forced to abandon all his outside activities, his social life, and his professional life. His whole existence is dominated by his pain: it means everything to him, and he is never allowed to forget it. He avoids anything that may cause it to return. He no longer washes, nor shaves. He is afraid to brush his teeth. He hardly even eats any more. He scarcely speaks, except with closed lips. Frequently he remains in semi-darkness, his head wrapped up in innumerable silk handkerchiefs—unkempt and hopeless.

Was it any wonder that trigeminal neuralgia was also known as the ‘Suicide Disease’?

Unfortunately, the presence of other people could simply aggravate the misery. ‘Well it’s rather difficult to describe really’, terminally-ill patient Mrs W. commented in 1962, but

I couldn’t bear anything near me[,] any vibration of the bed. I had an awful gnawing pain ... all the time. ... And I couldn’t bear any one to talk to me even my family and I love them all very much but I just felt I couldn’t. I couldn’t bear anyone anyone to come and talk to me.

She was equally vexed by the fact that ‘I couldn’t help showing the pain in my face’: in other words, her mute-communication of suffering was painful in itself. Influential neurologist Silas Weir Mitchell was more terse, writing: ‘torture clogs the very source of thought’.

As well as isolating people-in-pain from their families and friends, physical discomfort works against human exchange by blunting the higher senses and intellect.‘I have been miserable all night’, author Jonathan Swift grumbled in 1740, ‘and to-day [am] extremely deaf and full of pain. I am so stupid and confounded, that I cannot express the mortification I am under both in body and mind.’ Poet Robert Burns echoed this gripe half a century later when labouring under ‘the delightful sensations of an omnipotent toothache’. His distress ‘so engross[ed] all my inner man, as to put it out of my power even to write nonsense’.

Put in a slightly different way, painful sensations demanded that sufferers channelled all their attention towards the machinations of their own flesh. Poet Edward Young admitted as much in 1747 when apologizing to the Duchess of Portland for ‘not writing sooner’. His aches would not countenance any ‘rival’. Pain ‘entirely engrosses our Attention’. Poets less eloquent than Young made similar comments on this consequence of physical distress. In the words of Jane Winscom in ‘The Head-Ache, Or an Ode to Health’ (1795),

Through ev’ry particle the torture flies,
But centre in the temples, brain and eyes;
The efforts of the hands and feet are vain,
While bows the head with agonizing pain;
While heaves the breast th’ unutterable sigh,
And the big tear drops from the languid eye.

Winscom continued by conjuring up the image of a wife and mother who was incapable of fulfilling her duties because of her all-consuming headaches. ‘For ah!’, the poet exclaimed,

My children want a mother’s care,
A husband too, should due assistance share;
Myself for action form’d would fain thro’ life
Be found th’ assiduous—valuable wife
But now, behold, I live unfit for aught.

Journalist Louis Fitzgerald Tasistro agreed. People experiencing bodily pain, he observed in the 1840s, become so absorbed by their suffering that ‘the charities of life wither; its very delicacies, which are an instinct in the female character, are forgotten’ and ‘self—mean, miserable bodily self—opens, and spreads and covers everything’. It did not take much time, a surgeon commented a century later, for pain to transform ‘the brightest spirit into a being, haunted, driven in upon himself, thinking only on his disease, selfishly indifferent to everything and everybody, and constantly obsessed by the dread of recurrent spasms of pain’. The demands of the body-in-pain were intractable.

Excerpted from “The Story of Pain: From Prayer to Painkillers” by Joanna Bourke. Copyright © 2014 by Joanna Bourke. Reprinted by arrangement with Oxford University Press, a division of Oxford University. All rights reserved.

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