The Pain Chronicles

by Melanie Thernstrom

  Sarno asserts that repressed negative emotions such as stress, anger, and anxiety are the major causes of TMS, decreasing blood flow to muscles, nerves, or tendons, resulting in mild oxygen deprivation, which is experienced as pain and muscle tension. He has subsequently revised some aspects of his theory, but the fundamental tenets remain the same: when the negative emotions are addressed, the tension and pain disappear. His treatment works on the same principles as Freud’s treatment of hysteria: acknowledging the underlying emotional problems causes their physical manifestations to disappear. Although Dr. Sarno concedes that sometimes testing may be necessary to ensure that the pain is not from, for example, a tumor or a fracture, once these are ruled out, he believes that other pain is psychosomatic and that its function is to distract the conscious mind from its true sources of stress. Even when the pain syndrome begins after an injury, Dr. Sarno asserts, “despite the perception of an injury, patients are not injured. The physical occurrence has given the brain an opportunity to begin an attack of TMS.”

  In Dr. Sarno’s work, patients are told that they must discontinue all physical treatments, such as physical therapy, medication, injections, chiropractic adjustments, acupuncture, or any other conventional form of treatment because these harmfully reinforce the mistaken notion that there is a structural causation for patients’ chronic pain when, he argues, “their physical condition is actually benign and . . . any disability they have is a function of pain-related fear and deconditioning.” Instead, they should resume all previous activities and the normal physical activity that pain had interrupted, while attending support meetings, writing about their emotional issues, and keeping a daily journal. Failing to acknowledge the psychological nature of pain is “to doom oneself to perpetual pain and disability.”

  “You must renounce all treatments,” Chuck said, “and believe that your pain is all in your mind.”

  “I know. But what if—” I said timidly.

  “It would show up in an MRI. But you don’t need an MRI. Don’t baby your neck, don’t take Tylenol, ditch the microwave wrap! Just chill out and have a good weekend. Let’s hit the beach.”

  In the months that followed, I faithfully scrutinized my life for repressed negative emotions: “abuse or lack of love,” “personality traits such as a strong need to be liked by everyone,” and “current life pressures.”

  Unfortunately, all that self-scrutiny about stress was itself extremely stressful. Was it my relationship with Kurt, or was it a problem within myself? My neck and shoulders looked the same as always, but perhaps inside, something had crumbled. I’ve always had a sense of a certain inner crippledness, of my character as less than fully sturdy. There were mistakes in construction, internal beams that are weak. I reinforce them as best I can, but most of them are inaccessible—too much of my personality is built upon them. I had been depressed before. I always thought of depression like misty rain, the way the gray blankets consciousness, making it difficult to see. Pain felt more like a thunderstorm. There was an edge of violence amidst the rain—as the familiar terrain of the body becomes eerily illuminated—and then the futile scramble for shelter.

  “Pain upsets and destroys the nature of the person who feels it,” Aristotle observed. The McGill Pain Questionnaire (the standard pain-assessment technique) asks sufferers about their pain using clusters of words that describe the sensory or affective dimensions of pain. Is the pain Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding? Or is it Sickening, Suffocating, Fearful, Frightful, Terrifying, Punishing, Grueling, Cruel, Vicious, Killing, Wretched, Binding, Nagging, Nauseating, Agonizing, Dreadful, Torturing?

  I had been given the questionnaire once years before, when consulting a neurologist about migraines, and at the time the questions had seemed laughable. My headaches throbbed, but they were not cruel. But now I understood. This new pain was cruel—Cruel, Vicious, and Killing.

  Time felt different. Pain, I realized, is not just every day, but every hour of every day. Every minute of every hour. When too many pain minutes pass, the hourglass balance between bearable and unbearable changes and the shape of self collapses. The more desperate I felt, the more I wondered if—as Dr. Sarno says—desperation itself was the problem. I remembered how I had stayed up late that night at my friends’ beach house reading Sarno’s book. But eventually, sleepless with pain, I crept back into the kitchen to heat my microwave wrap. The machine made a deep whirring noise; I pictured Chuck and Erin waking to hear me and thinking that I wasn’t ready to be well.

  THISTLES TO THEE

  Western medicine is one way to think about illness,” my grandmother Bea was fond of saying, “but it’s not the only way.” When I was a child, she gave me the central Christian Science text, Science and Health with Key to the Scriptures, a book I treasured, believing it contained the secret recipe to reality, a truth from which my secular parents were excluded (my father is an atheist and my mother a secular Jew). But although I love religion and sacred texts, the passion I once had for it—the sense that it held truths that might illuminate my life—had waned over the years, so that by the time I got pain in my early thirties, my interest in the subject was almost entirely academic.

  For some reason, my neck and right arm were hurting. When I woke exiled by pain from sleep, I reminded myself that the reasons for this were not clear, but surely it was not a test or a punishment, or a payment for sin or a bid for immortality, or a curse, or a spell or an ordeal, or an opportunity for self-transcendence, or anything of the like. Not at all, actually. Those ideas come from the world of religion, in which I did not personally believe.

  Whenever the thought of poena would suggest itself or I’d notice that the pain was surrounded by some other vague, dark cluster of thoughts, I would dismiss them. Again and again I dismissed them. And the thoughts were always there to dismiss.

  Why me? Why must I suffer?

  There is a curious teleological evolution of the meaning of pain in religions; indeed, the task of accounting for the presence of physical pain and suffering is so critical and so difficult that religions are defined by their various answers to that question. If I were a Hindu, a Buddhist, or a Jew, my faith would invest pain with a different meaning from the religions of ancient Egypt, Greece, Rome, and Mesopotamia. And if I were a Christian, a distinct conception of pain’s meaning would reside at the very center of my faith.

  In the most ancient religions, pain and suffering pose no theological problem, because the gods, like the universe, are cruel. The karmic religions of Hinduism and Buddhism, by contrast, posit the framework of a just universe. The doctrine of reincarnation neatly removes pain and suffering from the unreliable hands of the ancient Indian gods and satisfyingly reinterprets it as poena—karmic retribution for transgressions committed in previous incarnations. In the monotheistic traditions, God is loving, attentive, and just. But what about pain and suffering? The problem is explored through three central characters—Adam, Job, and Jesus—who grapple with different conceptions of pain.

  Physical pain comes into the biblical world with the Fall. Only after Adam and Eve steal godly knowledge and become self-conscious are they cursed, like animals, with pain and the struggle for existence. Both Adam’s and Eve’s pain are described with related Hebrew words derived from the same root. Adam uses the word ‘itstsabown (—“labor, toil, pain, sorrow, worrisomeness”), but Eve’s pain is described using the word ‘etsev as well. The pain and sorrow to which Adam is condemned concerns the struggle for survival, while Eve’s involves reproduction.

  The passage in which Adam is cursed in his struggle to draw subsistence from the ground employs not only images of toil but also of physical pain and the threat of wounds (“thorns also and thistles shall [the ground] bring forth to thee”). In Eve’s case, the sorrowful pain of childbirth stands as a metaphor for all pain, christening our very entrance into the world, as if setting the stage for a lifetime of suffering. The curse involves an exile from what one might conceive of as
a natural state. One might imagine that the most basic functions that allow for the species to propagate—eating and reproducing—should not cause pain and suffering. And pain feels unnatural; while we can’t imagine human life without hunger or thirst, it is easy to fantasize about a life without pain and to picture that life as one to which we could or should return.

  While embodying this fantasy, Genesis also seems to resolve it. Eating the fruit of the tree of knowledge created self-consciousness (“the eyes of them both were opened, and they knew that they were naked”). In biological terms, pain is indeed a function of consciousness, as the ability to suffer the former increases proportionally with the latter—with, that is, the complexity of the cortical development of a species. Do we really wish not to have tasted that fruit? Wouldn’t that be like wishing that we were still apes—or that we were a kind of creature who feels no pain at all, such as the centipede? Pain’s origin is thus justified in Genesis as the price of the consciousness that makes us fully human.

  Why must I suffer?

  Even if generally viewed as the price of consciousness, pain still seems unfairly distributed. Like the Righteous Sufferer in the Babylonian Poem, Job questions Genesis’s account of pain, asking not why does pain exist, but why does he, in particular, suffer from it?

  Job’s trial begins when Satan suggests to God that Job’s piety has no value, since he is constantly rewarded for it; perhaps, after all, it is the reward Job loves, not the Lord. The trial of Job is progressive. First his livestock is taken, then his servants and children. Yet these hardships prove insufficient; he accepts them as the will of the Lord, prostrating himself and declaring, “The Lord gave, and the Lord hath taken away; Blessed be the name of the Lord.” God then gives Satan permission to subject Job to the ultimate test: physical pain. Job’s pain is nothing if not visceral. He feels as if he is being crushed, shriveled, about to burst open, torn; his kidneys feel pierced, his intestines boiled, and his skin grows black and peels.

  As Job’s suffering continues, three of his friends insist that if he is suffering, he must deserve it and he should repent of his sins. The text refers to them as the three “miserable comforters.” Belief that suffering is deserved can be comforting, since a deserved sickness is just and curable by repentance. When people are casting about for explanations of sickness, they often point to sin because, after all, everyone has sinned. But Job hasn’t sinned; his case gives lie to the doctrine that pain is always poena and suffering is always divine retribution. Job’s wife believes that he has not sinned, but she shares the comforters’ theology. Unable to reconceive God, she becomes disillusioned and tells Job to curse God and die.

  Eventually, Job breaks down and reproaches God. Late in the story, a prophetic figure enters who, in contrast to the comforters, declares that Job’s sin is imagining that he can judge God and reproach him for making him suffer. It is this point of view that the story endorses. When God finally speaks, it is not to answer Job, but to tell him that he cannot understand pain any more than he understands other mysteries of nature. (“Where were you when I laid the earth’s foundation?” God asks.)

  The book of Job is not what one might expect from a theodicy. Although God explicitly condemns the theology of the comforters, He does not offer an alternate explanation for Job’s pain (or for why He is wagering with Satan). Job must bow before the whirlwind and accept that—although pain cannot be understood—its meaning somehow must not be incompatible with religious faith. The book of Job thus defines faith as that which is upheld in the face of inexplicable pain and suffering.

  The book of Job ends the same way the Poem of the Righteous Sufferer does, with the restoration of health. Job prostrates himself and repents of his arrogance in questioning God, and God restores Job to health and gives him riches, long life, and even replacement children. Seen from one perspective, Job’s passing the test reveals the test to have been unnecessary, indicating that his suffering was pointless and that God should not have permitted it to happen. Yet seen from another perspective, Job’s pain tests his faith, not only by causing him to demonstrate it, but also by creating it, in the way fire and hammering forge a sword. According to this model, pain is not extrinsic to faith, but rather is the ground from which faith grows and into which it sinks and extends deep roots—an idea that becomes the dominant conception of the New Testament.

  Why must I suffer?

  The Gospels reframe pain not as a problem for faith to overcome, but as faith’s central mechanism. The curse of mortality becomes the solution to mortality—the very means to eternal life. The God of the Gospels answers the problem of pain not by removing it from human life, but by sharing it, becoming human in the form of Jesus and paying his own poena. In so doing, he forever inverts pain’s significance. Just as God became man when Jesus shouldered Adam’s curse, man can become godly by accepting pain as Jesus did. By so doing, man transforms poena into passion, as Christ willingly submitted to crucifixion and its pain. In an era when people of many faiths wore amulets to ward off pain and disease, Christians began cradling an image of torture close to their hearts.

  JESUS’ PAIN

  The conception of pain and suffering in Jewish and Christian scripture had implications for medicine that were profoundly different from those in the theology of magic-based religions. In the latter, the right magical formula could eradicate a fever-causing demon as surely as the right plant leaves could ease a fever. The spell targeted an underlying supernatural cause, whereas the potion treated its manifestation in the natural world, but both had the same result. Magic is effective together with medicine. Medicine is effective together with magic. Replacing magical practices with religious ones, however, called for a more complicated internal response of repentance and prayer. This followed from the biblical premise that God cannot be manipulated through incantations or herbs to serve human desires (although God can play an opaque role in healing: paradoxically, once Job humbles himself, God restores his health).

  The New Testament departs radically from Judaism here. Christianity promises the faithful not physical health, but spiritual salvation—goals that are aligned in Judaism but actually opposed in Jesus’ story. Egyptian and Greek medical remedies imitated the gods’ remedies for the successful assuaging of their pains. The Christian ideal of imitating Christ, imitatio Christi, stands in contrast. Unlike Horus, who is rescued from the headache-causing catfish demon, Christ is not freed from the pain of crucifixion. Rather, he suffers unto death, showing Christians not how to evade pain, but how to welcome its redemptive possibilities.

  The canonical Gospels don’t describe Jesus’ pain during the crucifixion, although the Gospel of Saint Peter, one of the Gnostic Gospels, contrasts Jesus with the thieves being crucified by his side, saying he “was silent as one who experiences no pain.” But mainstream Christian theology asserts that Jesus did suffer pain; that to be fully human he had to do so; and that in doing so, he paid the price for humanity’s redemption. (After all, how much of a sacrifice is it for an immortal merely to painlessly shed the human body he temporarily inhabited and reassume his place in heaven?)

  Jesus suffered in what can be described as a peculiarly human way: torture by crucifixion is designed to take advantage of pain-sensing capacities specific to human anatomy. The universal eloquence of wounds to the hands and feet—the instinctive horror an image of them evokes—derives from the evolutionary importance of those parts and their consequential ability to feel pain.

  Since the human palm is not substantial enough to support the weight of a human’s body on a cross without the nails tearing out, some historians argue that nails were driven either through Jesus’ wrists, where they would have been held in place by carpal bones, or between the radius and ulna bones in his forearm, as is consistent with the one extant skeleton of a man crucified in that period. Regardless, nails through either the wrists or the hands would damage the median nerves that supply the hands, causing excruciating pain (from the Latin cruciare,
“to torment, crucify”). The pain of carpal tunnel syndrome can come as a result of the median nerves merely being compressed by surrounding tissue.

  Body parts are protected by nerves in proportion to their importance for survival. A cut to the lips, hands, or testicles—or the nerve branches that supply them—hurts more than a cut to the back or arm, where a wound is less likely to threaten a vital function. Wrapping around the top of the human brain is an area known as the sensory cortex, which functions as a map of the body and its sensations. Information coming from the sensory nerves is registered by the corresponding parts of this map: input from the hands is mapped to the hand regions of the sensory cortex. This cortical map is sometimes referred to as the sensory homunculus (Latin for “little man”). It can be thought of as “the body in the brain.” Thus, although we may experience pain as coming from our hands, what actually hurts are the hands of the homunculus.

  Since the parts of this body represent the actual body in proportion to the nerves it contains, rather than to its actual size, the homunculus has a giant head with swollen lips and tongue, large genitals, massive hands with big fingers and a giant thumb, and feet with ballooning toes. Human hands are so dense with nerves that a homunculus’s hands are bigger than the entire trunk of its body! Artistic depictions of the crucifixion in which Jesus’ hands, feet, and face are exaggerated can be thought of as renderings of a homunculus, rather than of a body, and are therefore truer to our experience of our bodies.

  THE MARTYR’S PARADOX

  The idea of pain as spiritual transformation offends me. It seems, in a word, perverse. Pain is useless to the pained, the Greek physician Galen said (dolor dolentibus inutilis est), and almost everyone today decidedly agrees. If we try to describe the particular terror of pain, it seems to lie in the way that it kidnaps consciousness, annihilating the ordinary self. Yet many religious traditions insist that this terrible annihilation opens the possibility of self-transcendence, since the self is, in many religions, what separates us from the divine. Pain is an “alchemy of the soul”—melting, purifying, and reshaping sin. Pain is a means of devotion central to ascetic traditions. Its devotees range from self-flagellating Christians and Shi’ites to Muslims who wage internal jihad against the raging ego of the sinful self. Certain painful meditation methods of Yogis (involving icy water or holding uncomfortable positions for long periods of time) are said to strengthen the spirit as well as the body. The training of shamans typically involves painful rites.