The History of Medicine as the History of Pain

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.

Illustration of the pain pathway in René Descartes

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, ‘I 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 lorded 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.

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. Even when suffering, people adhere to societal norms and rituals. They are often highly creative in expressing their suffering – sometimes in words, other times in images and art. For instance, the Wellcome Library for the History of Medicine (along with the image library) has thousands of first-person accounts of bodily suffering from ancient times to the present.

In fact the eloquence of people when they seek to convey their afflictions to friends, family and physicians is striking. In the words of Virginia Woolf in her essay ‘On Being Ill’, from The Essays of Virginia Woolf, ed. Andrew McNeillie (Hogarth Press, 1994), a person in pain is ‘forced to coin words himself, and, taking his pain in one hand, and a lump of pure sound in the other (as perhaps the inhabitants of Babel did in the beginning), so to crush them together that a brand new word in the end drops out’. Often, patients turn to metaphoric languages. Woolf described pain as rising ‘with rapid beats of the wings’. Others observed that their pain tied them into knots, rendered their heads like glass, or seared them as if with a white-hot poker.

More significantly, the ways people in the past have expressed pain are highly influenced by theories of the body that existed at the time in which they were writing. In 18th-century Britain and Europe, for example, humoural theory provided a language of pain that circled around words referring to hotness or coldness, sharpness or heaviness, moistness or dryness. This is in stark contrast to modern ways of talking about pain. Cultural factors are equally important. Thus, Latinos in North America distinguish between dolor de cabeza (headache) and dolor del cerebro (brain-ache). The Sakhalin Ainu of Japan complain of ‘bear headaches’ that ‘sound’ like the heavy steps of a bear, in contrast to either ‘deer or woodpecker headaches’. Chinese scholars have demonstrated how headaches were characterised by a painful dizziness that embodied the traditional Chinese medical category of imbalance as the cause of ill health.

Finally, pain is important because it is used to create a hierarchy of humanity. The ability to feel, both in terms of physical sensation, as well as inner sensibilities, have been ranked hierarchically with white men at one end and slaves at the other. This great chain of feeling remains important in pain-rhetorics into the 20th century. It makes a difference, for example, whether bodily suffering had been inflicted by an infuriated deity, was the means towards a greater goal such as childbirth, or was the result of stigmatised conditions such as alcohol poisoning. Pain was (and is) given meaning within culture: in this way, pain has a history.