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On Pain

March 22, 2012
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Through the course of my Medical Humanities module, we have explored the ways pain and illness are represented in literature. Some authors are needlessly pessimistic. Virginia Woolf, for example.

Finally, among the drawbacks of illness as a matter for literature there is the poverty of the language. English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache. It has all grown one way. The merest schoolgirl, when she falls in love, has Shakespeare, Donne, 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.

The problem with pain is not that it is inexpressible. Despite what Virginia Woolf said, there is a language for it. The problem is that when we do talk about it, we descend to arty, quasi-spiritual language. If we cannot penetrate the obtuse language employed, communication has failed.. If we have to communicate pain, it is imperative that we are understood. To say that there is no language for pain is a complete lie. We have the sum of the English language!

Our problem is that we give up describing pain too soon. We can’t fully describe France in a phrase; there is culture, geography, history, politics and values and so much more to talk about. Pain is no less multifaceted and so deserves an essay to express it.

But doctors do not have time to read long treatises on the subtle nuances of arthritis. Secondly, we are not all writers. Though we all have language, we may not all know how to craft sentences that can express our pain. in the same way, we can all use different types of paints but we can’t all produce a Van Gogh. (A slightly smaller problem is that though we have access to the sum of language, we may not know it. Coruscating is the perfect word for lightning arcing across the sky while rain falls on a tin roof – but how many people would use that word?)

The problem is not that there is no language for pain. We cannot express in words, either because we give up too soon or because words are not our medium. Would Virginia Woolf say that there is no art for pain? Of course not, that’s patently nonsense! If people can express their pain (And I know they do) through sketching, painting, photography, dance or music, and if they can express it best, better than words, then that is the medium they should use. In a way, they are all just different types of language.

Haiku, I find, is intriguing. Three lines, of five, seven and five syllables each, because the Japanese believe that 17 is the perfect number of syllables in a single breath. The harsh constraints seem to me to be more of an intellectual conceit than a poetical form. Hilary Mantel wrote that illness condenses you into metaphor. Haiku is something similar. When overwhelmed by the manifold nature of pain, haiku allow to distill and crystallise out the salient, the critical, the vital aspects of pain. With only 17 syllables to work with, you no choice but to concentrate on the most important aspect of pain. This may not be – probably won’t be – the physical dimensions of pain. The polar opposite to a complete expression of pain, a haiku may have to come after the more lengthy polemic. It may only be possible after thoughts and feelings have been expressed, examined, explored, excavated by long-hand prose.

I don’t want to extol the virtues of art therapy for chronic pain, or suggest that every patient dash out War and Peace for their trigeminal neuralgia. What I do know is that patients like it if you treat them like a person, not just an illness. Even in the confines of the consultation room, it is possible to acknowledge that a person’s pain needs more than paracetamol and codeine. This can only happen because, thanks to language in all its forms, pain is something that we can express and identify.

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