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What We Mean

by Pain

“Happiness is a fundamentally

negative feeling: the absence of pain.”

Gregorio Marañón

It’s midnight. Our first child, a premature baby boy only two months old, who we had just brought home from the hospital, wakes us crying. His diaper is dry. He doesn’t want the bottle. He doesn’t have a fever. His mother takes him in her arms, coos to him, trying to calm him, but he keeps on crying. He can’t say what’s wrong, and we, his first-time parents, don’t know how to interpret his cries. Indigestion? An ear infection? Just plain fear? Undressing him completely one more time, trying to find the reason for his crying, we notice a bulge that turns out to be an inguinal hernia. Not even the pediatrician could tell us if the hernia was the cause or the consequence of his crying.

Quite some time later, I awoke with a strange pain in my upper jaw up near my wisdom tooth or behind it. The pain, vague at first, became increasingly widespread and intense. I could not get a dentist appointment for several hours and my teeth had never hurt this way before. By the end of the day I no longer knew if I had a terrible toothache, headache, earache, or everything all at once.

Many years later, my wife, a happy and cheerful woman who spends her days singing, began to feel ill without being able to say exactly what was the matter.

“I don’t know what’s wrong. I don’t feel good, and I can’t say why. Could it be menopause? I don’t feel like doing anything. I feel exhausted, weak. Everything bothers me. I’m sad. Every little thing makes me want to cry. I just want to sleep, to get away from everyone and from myself.”

My wife couldn’t seem to put a name to her growing depression.

These three simple, personal experiences, among thousands of others that we could mention, serve as an example to illustrate how difficult it is to describe pain.

What is pain?

Although we all feel its sting in some way during our lives, it is not easy for us to define suffering. The experience of pain is very broad and extremely complex to convey because it affects our lives differently, experienced by each individual in a personal and unique way. Pain is, in reality, a mystery.

The term “suffering” has, in many languages, a double meaning that includes both the feeling of unhappiness or displeasure and the feeling of sorrow or grief. If in pleasure we enjoy the sensations of the body, in pain they become a disagreeable nuisance. In joy, we feel exultant; in pain, we know we are powerless. Facing pleasure, our whole being reaches eagerly for new experiences; facing pain, the body recoils as if to protect itself from an intruder. Health takes for granted “the silence of the organs”; physical pain is felt, to the contrary, like “a cry of the body.”1

If health is a state that permits us to live an independent, happy and full life, as much in the biological sense as in the psychological and social senses, pain upsets this state in all its dimensions.

A lot of ink has been put to paper to try to define the elusive contours of human suffering, without convincing results. The philosopher Spinoza defined pain in the 17th century as “a fundamental affect, contrary to pleasure.” The International Association for the Study of Pain defined it in our times as “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage.”2 But we no longer limit the definition of pain to the effects of an injury. This classical definition has been revised many times, with results not yet satisfactory for everyone.3

Pain and suffering

There are those who distinguish pain and suffering as two different realities. They argue that pain is organic, while suffering would be more psychological in nature. According to this thesis, what hurts is the body. Rather, suffering affects the spirit, our ability to think. In that sense pain floods the being, suffering faces it. The concrete nature of pain makes experiencing it doable and facilitates therapeutic action. Suffering, however, is expressed in a dark form and its innermost center remains in darkness, including for those who suffer from it.4

Science has the means to fight organic-physiological pain, but suffering is a more complex reality that can, although not necessarily, include the presence of pain, and whose therapy requires other treatments. So, a paraplegic has no reason to feel pain, but the patient can suffer from it beyond what is imaginable.

Cicely Saunders, founder of the Hospice movement,5 coined the term “total pain,” which includes, in addition to physical discomfort, emotional, mental, social, and spiritual suffering, because all these aspects are interrelated. Suffering is linked to the circumstances that affect us in our whole being and in that sense it becomes more all-encompassing that the pain itself. But the popular use of the terms pain and suffering make them almost interchangeable.6 They are concepts that often are intertwined and get mixed up. Here we will refer to them interchangeably.

Physiologists describe pain as a protective reflex designed to alert the person to avoid worse harm. According to them, pain would involve, in the first place, an alarm signal through which the body indicates that something is not right, warning of some form of aggression7 or approaching danger. The burning sensation that causes us to avoid fire prevents us from suffering more severe burns. A thorn prick keeps us away from thorns and prevents us from worse injury. And so on.

Although this positive definition of pain is valid in many cases, it is not applicable to all situations. If pain is capable of protecting us from destruction (for example, keeping us away from fire), it is also capable of destroying us. As it has been observed,8 for all those who in direct contact with the sick, pain is no more than a contingency, a harmful symptom, distressing and injurious, that often makes an already irreversible situation more grievous and unhappy. We should dismiss the idea that pain is beneficial in all cases. Pain is too often a grim gift. It debases us and makes us fill sicker than we really are. The professionals have the inescapable duty to prevent it, if they can.9

Friends or foes, pain and suffering always need to be taken seriously.

Pain, a personal experience

Although pain repulses us all, it has different effects on each individual. We don’t all suffer in the same way. It could be said that instead of kinds of “pain” or “suffering” there are people who suffer. My pain or that of any other person is always a personal experience. Perhaps there is no experience more personal than that of suffering. It affects the whole being: the body and the spirit. Whether physical or spiritual, pain reminds us of the fragility of our existence; it focuses our attention on our own discomfort and turns getting rid of it into the highest priority.

Pain and suffering are perhaps the human experiences that most isolate us from others. No matter how much we may have read about the subject or how well we are able to sympathize with those who are suffering, their pain will always be theirs alone, personal and unique.

In reality, there is no way to share pain.10 Our suffering is a circle that is closed to the outside. “You cannot feel the pain of any other, nor can any other experience yours […]. Holocaust, famine, pandemics…. It does not matter. Suffering always comes in individual packages.”11

Our difficulty in understanding pain is further complicated by the fact that, permeating all the aspects of our being, it affects our objectivity to a greater or lesser extent. Whether it comes upon us suddenly in an accident or we get forewarning with a chronic illness, we are never prepared for pain: it disrupts our lives and can paralyze it completely.

Each time pain comes crashing into our lives, we somehow become passive victims of what is happening to us. No matter how responsible we are for its causes, we always perceive it as an intruder attacking us.

How much does it hurt?

Pain is a very difficult sensation to measure. Measuring its intensity is still very random and differs considerably from one patient to the next and from one doctor to the next. Reliable techniques for measuring pain are very recent and are still not well-known or completely recognized.

Nor is it easy to compare some discomforts with others and assert that one kind of pain is worse than another. For example, an intense but short-term pain, like that in many natural births, kidney stones, etc., versus the rooted pain, much less intense, but much more persistent, of certain types of cancer or arthritis.

Chronic pain, albeit relatively moderate, can become unbearable precisely because of its duration. It affects a large percentage of patients for different lengths of time, during which it radically alters their lives.12 Chronic pain interrupts sleep, reduces mobility, impairs the ability to work and affects even the most daily routines like getting out of bed or going up and down stairs. Even walking can become an ordeal. Suffering from chronic pain without knowing the cause or without finding relief disrupts normal life and can even cause severe cases of depression and anxiety.

Reactions to pain

Attitudes toward pain are almost as varied as the people suffering from it. It is difficult to generalize on the subjective aspects of pain, because there are as many kinds and degrees of suffering as there are variations in sensitivity thresholds. Certain medical conditions can be borne incredibly well by those individuals who have suffered the most and particularly feared by those who have suffered less. Because of this, the assessment of suffering is very relative and varies by populations, individuals, and cases. In some wars, soldiers who went under surgery without anesthesia didn’t seem to feel more pain than that caused by their wounds. In certain ethnic groups, there are woman who give birth and go on working almost as if nothing special had happened.

Suffering transcends the personal circumstances of those experiencing it. As H.G. Wells wryly observed, “The Royal Crown cures not the headache.”13 This poses many interesting theoretical questions, though they are totally irrelevant from a practical point of view. Who suffers more, men or women? Adults or children? The young or the elderly? The well-informed or the ignorant? Believers or non-believers? And so on.

Because it affects us in such a personal way, when we suffer we tend to think that the adversity befalling us is unique, that no one else suffers like we do, or that our pain cannot be compared to any other. And that’s how it is, in a way.

Our developed societies have battled physical pain with undeniable success. Medicine and pharmaceuticals are changing the experience of pain into a technical problem. So they are to be blamed, fairly, for the risk of reducing pain to a mere malfunction of the body.14 But pain is a broader problem that affects the absolute uniqueness of human beings. In fact, no physiological law can entirely account for this experience.15 The privileged beneficiaries of what we call a “state of well-being,” we systematically resort to the healthcare system in our fight against pain, as if it were a fundamental right. Doctors prescribe us medications that take away our physical discomfort. Psychological therapies soothe our emotional problems. And if they don’t, drugs help us escape, even if momentarily, from our painful reality.

Today, in the West, the statistics on the use of painkillers and sedatives are on the rise. Other societies and other times have dealt with pain in ways that to us seem too resigned and cruel, attributing religious or spiritual dimensions that become more and more difficult for us to understand. They have regarded suffering and pain not as mere health or medical issues but rather as existential problems. But in our post-Christian world, the cures have ousted the curates. Medications and therapies have taken the place of fasting and prayer, and they have become the modern substitutes for what, in another time, depended heavily on personal strength, self-control, or faith.16

Is it true that no one wants to suffer?

Although in theory we all seek well-being and each one of us fights against pain in our own way, in reality suffering is also fostered. It is surprising to discover how determined we are to stay in situations that cause us suffering, and how much energy we are capable of exerting to maintain the causes of our problems.

Let’s look at a simple example. A child has a loose baby tooth that is about to fall out, but it doesn’t really hurt if he doesn’t touch it. Nevertheless, he feels the need to touch the tooth constantly (with his tongue or with his fingers), as if he wants to make sure that the pain is still there!17 At a much more serious level, countless victims of ailments that are a direct consequence of bad habits (diet, tobacco, alcohol, lack of exercise, etc.) would like to stop suffering, but they want to do so without changing their lifestyles. Instead of attacking the cause of their ills by changing their habits, they prefer to seek surgery or miracle cures that might free them from their undesirable consequences.

There are types of suffering that take forms similar to masochism. They are fostered by those individuals who gain some advantage through them. Many types of dependency, including forms of selfdestruction—some quick and some slow—“excuse” the patient from having to deal with unresolved problems, putting on others their own inability to solve them. There are degrees of illness whose seriousness silences any criticism or reproach against the one who is suffering, regardless of the cause of the situation.

That makes certain chronically ill persons acquire a kind of “dependency” that makes them less responsible than they would be if they were more autonomous. Through their behavior, by arousing pity, they get the help they want without having to ask for it.18 In some cases, their very suffering provides them with the perfect tool to punish someone—spouse, children, or parents—blaming that person indirectly for their own problems.

Moreover, as demonstrated by Dr. Sylvie Galland, there are many patients who repeat models of painful relationships that they experienced in childhood, which would often be inevitable. For example, the child of an alcoholic tends, more easily than someone else, to take on a painful role similar to the one her mother suffered because of her father’s problems, subconsciously predisposing her to put up with the behavior of a husband…preferably alcoholic! “Perhaps our competitive society has something to do with this. Honors and gratification belong only to those who succeed. But affection, compassion and general favor naturally go to those who suffer. As it is much easier to fail in life than to succeed and to be unhappy than to be happy, the tendency for some is to prefer the easy way.”19

To make matters worse, there are conditions that, for some patients, have a captivating, almost heroic aspect, whose intensity they would never find in the routine of their mediocre lives. An emergency physician friend told me about a homeless man who “had accidents” on a regular basis, to the point where the medical team believed that he did it on purpose, because he missed the excellent care that he received in the hospital each time that he was admitted for his recovery period. Obviously, this is an extreme case, but even to lesser degrees the nostalgia of suffering is not unusual. Some patients confine themselves to their problems as if they did not wish to leave a jail cell to which they had grown accustomed.

These kinds of patients have, in a way, resolved their situation in life. Regaining their health would mean rethinking work, personal, or family issues that they don’t have the courage to face. Their healing—or that of a disabled child, etc.—would obligate them to look for work, or allow their spouse to finally file for a divorce that the spouse does not dare file under the present circumstances. Nothing can cure an illness that the patient benefits from….

In these cases that are close to pathology, in order to begin to regain freedom, the patient would have to get to the point of being willing to give up certain present “benefits” and recognize that they are prolonging in some way a situation that they could overcome. The patient would have to ask themself seriously what would happen if the problems they suffered suddenly disappeared: How would I deal with this new situation? How would my loved ones react? Etc. But to reach that point of ideal clarity and liberating awareness, something more than maturity and intelligence is needed. Human nature is very complex. Taking on the responsibilities of one’s autonomy is never easy and even less so for the patient. In general, people who get stuck in these types of problems need a lot of understanding and professional help to overcome them.

1 . The World Health Organization (WHO), in its 1946 Constitution, defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

2 . See http://www.iasp-pain.org (updated 22 May 2012).

3 . See for example, K. J. S. Anand, D. Craig and D. Kenneth, “New perspectives on the definition of pain”. in Pain, Vol 67 (1), Sep 1996, 3-6. Cf. Jan Frans van Dijkhuizen, Pain and Compassion in Early Modern English Literature and Culture (Boydell & Brewer Publishers). 2012.

4 . Phillip Moffit, Dancing with Life: Finding Meaning and Joy in the Face of Suffering, New York: Rodale, 2008, p. 86, 91.

5 . Cicely Saunders began a revolutionary movement in 1967 in favor of care for the dying, in St. Christopher’s Hospice, located South London, England. Today the movement has transformed the treatment of the terminally ill in hundreds of hospitals around the world, based on the principle of integral care, meeting the patient’s physical, social, emotional, and spiritual needs. Their motto is: “You matter because you are you. You matter to the last moment of your life.” (See Cicely Saunders, “The Care of the Patient and His Family,” in Documentation in Medical Ethics, n° 5 (London Medical Group, 1975).

6 . David B. Morris, The Culture of Pain. Berkeley: University of California Press, 1991. Cf. by the same author, Illness and Culture in the Postmodern Age, Berkeley: University of California Press, 1998.

7 . Cf. W. J. Roberts, “A hypothesis on the physiological basis for pain”, Pain, nº 24 (1986), pp. 297-311.

8 . See Stanley Hauerwas, God, Medicine and Suffering, Grand Rapids: Eerdmans, 1990.

9 . Janice M. Morse and Barbara Carter, “The Essence of Enduring and Expression of Suffering: The Reformulation of Self,” in RTNP vol. 10/1 (1998), pp. 43-60. See further Joseph A. Amato, Victims and Values: A History and a Theory of Suffering, New York: Praeger, 1990.

10 . T. S. Eliot, “The Burial of the Dead”, in The Waste Land, I (1922).

11 . “Pain is personal, more private than thought (you can share thought but not your pain), and so not one of the billions in the world’s cauldron of disease and death ever suffered more than what each one, individually, could.” Clifford Goldstein, Life Without Limits, Hagerstown: Review & Herald, 2007, pp. 106-107.

12 . The International Association for the Study of Pain (IASP) defines the pain tolerance level as the maximum intensity of a pain-producing stimulus that a subject is willing to accept in a given situation. “As with pain threshold, the pain tolerance level is the subjective experience of the individual. The stimuli which are normally measured in relation to its production are the pain tolerance level stimuli and not the level itself ” (H. Meskey, “Pain terms: A list with definitions and notes on usage recommended by the IASP subcommittee on taxonomy”, Pain 1979; 6:249-252).

13 . Quote attributed to Herbert George Wells (better known as H.G. Wells, 1866-1946), author of The War of the Worlds.

14 . Lawrence W. Wilson, Why Me? Straight Talk about Suffering, Kansas City: Beacon Hill Press, 2005, p. 19.

15 . Viktor E. Frankl, Man’s Search for Meaning, New York: Washington Square Press, 1963, p. 166.

16 . Doug Manning, Don’t Take My Grief Away, San Francisco: Harper, 1979.

17 . Unless what he wants is to pull out the tooth as soon as possible to get a reward from his family members! (Cf. Sylvie Galland and Jacques Salomé, If Only I’d Listen to Myself! Resolving the Conflicts that Sabotage our Lives, Element Books, 1997).

18 . To say nothing of the “sick tyrant,” who doesn’t ask for anything, but never ceases to brag about it!

19 . S. Galland, “L’attachement à la souffrance”, ” [Attachment to suffering], Optima, nº 217, February 1992, pp. 27-28.