social perception pain
The word ‘pain’ is used frequently in Western society, yet it is difficult to define, because it covers so many feelings and situations. It may be physical or mental, acute or chronic, caused by body damage or created in the mind. It may be punishment (as in Hell) or perception (including the common slang usage that describes someone or some situation as ‘a pain’). It may be a symptom, an isolated feeling, an indication for treatment (lobotomies have been done for intractable pain, both physical and mental). It can be a treatment in itself, as it was in Benjamin Rush's ‘tranquillizing chair’, said to have been an adaptation of the Inquisition's ‘witch chair’, the revolving chair that drenched patients with more than two hundred pails of water at one sitting. More recently forms of aversion therapy and mental pain have been recognized in many psychiatric procedures.
Many aspects of pain are subjective, and therefore difficult to define and perhaps impossible to measure. There are also objective aspects. These include watching people in pain — and the idea that, since hell was eternal pain, heaven would be watching the damned burn. Watching executions was once a popular amusement (and still is, where they are held in public), indulged in even by so-called civilized people such as Pepys and Evelyn.
Pain can be inflicted for punishment, sport (stag- or fox-hunting), or amusement (bear- or badger-baiting, dog- or cock-fighting), or as an overt outlet for energy or sadistic gratification. Sadistic doctors (especially psychiatrists) are popular in fiction and films. They aren't supposed to exist in real life.
Pain of one sort or another is the commonest symptom for which people seek relief from doctors, either as a sign of body damage or as a ‘cry for help’ from a distressed mind. Doctors often try to solve the problem by turning it into an objective study. It can be an intellectual challenge, something to be reconstructed in a ‘scientific’ manner, reduced to something that can be measured. It can also be a challenge, a manifestation of power, part of some kind of progress, perhaps a gauge of medical progress or of civilization, or even a means of empire-building.
Michael Balint, who probably did more than anyone to teach general practitioners how the mind influences the body, wrote in his book The Doctor, His Patient and the Illness:
Every doctor has a set of fairly firm beliefs as to which illnesses are acceptable and which not; how much pain, suffering, fear and deprivation a patient should tolerate and when he has the right to ask for help or relief … These beliefs are hardly ever stated explicitly but they are nevertheless very strong.
Pain can also be studied as a historical phenomenon. There have been enormous changes in public attitudes to pain during the last two hundred and fifty years. This was so striking that, at one time, the American physician Weir Mitchell thought that the physiology of pain had changed during the nineteenth century. There was a marked shift in attitude, from the belief that pain was a punishment for sin and should be borne with fortitude with the aid of the Church, to the belief that it was something to be conquered and cured and that this conquest was for doctors to achieve. Some came to believe that this was the sole purpose of doctors, their raison d'etre, a belief and attitude that is common today.
Although there have been attempts to overcome pain as long as there has been civilization, there seems to have been no concerted effort to do this until the mid nineteenth century. This can be seen in the lack of interest in or acceptance of analgesia and anaesthesia, despite the fact that they were known. God put Adam to sleep when he created Eve from his rib. Opium was known to virtually all civilizations. Paracelsus prepared ether or some such anaesthetic, which he called ‘sweet vitriol’ and said: ‘… it quiets all suffering without any harm, and relieves all pain, and quenches all fevers and prevents complications in all illnesses’, but he dared not use it on humans for fear of offending the Church.
The Church was powerful in imposing attitudes towards pain. Christianity had no tradition of relieving pain. When chloroform was introduced it was bitterly criticized as immoral — because it relieved pain. Pain was not regarded as a physical malfunction but as part of the universe. It was what Dr Johnson called ‘the pain of being a man’, perhaps God's punishment. For some believers, such as Descartes, pain was a self-protective mechanism that taught the soul to avoid further damage to the body.
In 1800 Humphry Davy published the results of his experiments with nitrous oxide and suggested that it might be used for anaesthesia, both in alleviating the pain of inflamed gums and ‘during surgical operations’. Yet no one seems to have been interested in this for nearly half a century, despite the considerable increase in surgical knowledge and skill during that period. Even after anaesthesia had been accepted, it had little immediate effect on the practice of surgery or on the number of operations performed. The nineteenth century was an age of secularization and of increasingly humanitarian sentiments. Inevitably ideas about pain were part of these. In 1853 a medicine labelled as a ‘painkiller’ was marketed for the first time. Since then there has been decreasing emphasis on a world made bad by sin and increasing emphasis on a world made bad by suffering and pain. Progress in civilization has come to mean reduction of the sum of human suffering, even if the world does not comply. It may be because we can now envisage and even experience a pain-free existence (which would have been impossible before) that we are so horrified by the widespread infliction of pain in the modern world.
— Ann Dally
