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This won't hurt a bit: the cultural history of pain

Speculation about the degree to which human beings and animals experienced pain has a long history.

Jack the ripper: three plates from Jacques Fabien Gautier d’Agoty’s Myologie (1746-48), the first full-colour anatomical atlas. Taken from the sick rose by Richard Barnett (Thames & Hudson, £19.95)

On 16 April 1872, a woman signing herself “An Earnest Eng­lishwoman” published a letter in the Times. It was entitled “Are Women Animals?”.

She was clearly very angry. Her fury had been fuelled by recent court cases in which a man who had “coolly knocked out” the eye of his mistress and another man who had killed his wife were imprisoned for just a few months each. In contrast, a man who had stolen a watch was punished severely, sentenced to not only seven years’ penal servitude, but also 40 lashes of the “cat”. She noted that although some people might believe that a watch was an “object of greater value than the eye of a mistress or the life of a wife”, she was asking readers to remember that “the inanimate watch does not suffer”. It must cause acute agony for any “living creature, endowed with nerves and muscles, to be blinded or crushed to death”.

Indeed, she continued, she had “read of heavier sentences being inflicted for cruelty towards that – may I venture to say? – lower creation”. She pleaded for women to be subsumed under legislation forbidding cruelty to animals, because that would improve their position in law.

Speculation about the degree to which human beings and animals experienced pain has a long history, but “An Earnest Englishwoman” was writing at a very important time in these debates. Charles Darwin’s Descent of Man had been published the year before her letter, and his Expression of the Emotions in Man and Animals appeared in 1872. Both Darwin and “An Earnest Englishwoman” were addressing a central question that had intrigued theologians, scientists, philosophers, psychologists and other social commentators for centuries: how can we know how other people feel?

The reason this question was so important was that many people didn’t believe that all human beings (let alone non-human animals) were equally capable of suffering. Scientists and philosophers pointed to the existence of a hierarchy of sentience. Belief in a great “Chain of Being”, according to which everything in the universe was ranked from the highest to the lowest, is a fundamental tenet of western philosophy. One aspect of this Chain of Being involved the perception of sensation. There was a parallel great Chain of Feeling, which placed male Europeans at one end and slaves and animals at the other.

Of course, “An Earnest Englishwoman” was using satire to argue for greater rights for women. She was not accusing men of failing to acknowledge that women were capable of experiencing pain. Indeed, that much-maligned group of Victorian women – hysterics – was believed to be exquisitely sensitive to noxious stimuli. Rather, she was drawing attention to the way a lack of respect for the suffering of some people had a profound impact on their status in society. If the suffering of women were treated as seriously as the suffering of animals, she insisted, women’s lives would be better.

Although she does not discuss it in her short letter, the relationship between social status and perceptions of sentience was much more fraught for other groups within British and American societies. In particular, people who had been placed at the “lower” end of the Chain of Feeling paid an extremely high price for prejudices about their “inability” to feel. In many white middle-class and upper-class circles, slaves and “savages”, for instance, were routinely depicted as possessing a limited capacity to experience pain, a biological “fact” that conveniently diminished any culpability among their so-called superiors for acts of abuse inflicted on them. Although the author of Practical Rules for the Management and Medical Treatment of Negro Slaves, in the Sugar Colonies (1811) conceded that “the knife of the anatomist . . . has never been able to detect” anatomical differences between slaves and their white masters, he nevertheless contended that slaves were better “able to endure, with few expressions of pain, the accidents of nature”. This was providential indeed, given that they were subjected to so many “accidents of nature” while labouring on sugar-cane plantations.

Such beliefs were an important factor in imperial conquests. With voyeuristic curiosity, travellers and explorers often commented on what they regarded as exotic responses to pain by indigenous peoples. In Australia, newly arrived colonisers breathlessly maintained that Native Australians’ “endurance of pain” was “something marvellous”. Others used the theme as an excuse for mockery. For instance, the ability of New Zealand Maoris to bear pain was ascribed to their “vanity”. They were said to be so enamoured with European shoes that “when one of them was happy enough to become the possessor of a pair, and found that they were too small, he would not hesitate to chop off a toe or two, stanch the bleeding by covering the stump with a little hemp, and then force the feet [sic] into the boots”.

But what was it about the non-European body that allegedly rendered it less suscep­tible to painful stimuli? Racial sciences placed great emphasis on the development and complexity of the brain and nerves. As the author of Pain and Sympathy (1907) concluded, attempting to explain why the “savage” could “bear physical torture without shrinking”: the “higher the life, the keener is the sense of pain”.

There was also speculation that the civilising process itself had rendered European peoples more sensitive to pain. The cele­brated American neurologist Silas Weir Mitchell stated in 1892 that in the “process of being civilised we have won . . . intensified capacity to suffer”. After all, “the savage does not feel pain as we do: nor as we examine the descending scale of life do animals seem to have the acuteness of pain-sense at which we have arrived”.

Some speculated whether the availability of anaesthetics and analgesics had an effect on people’s ability (as well as willingness) to cope with acute affliction. Writing in the 1930s, the distinguished pain surgeon René Leriche argued fervently that Europeans had become more sensitive to pain. Unlike earlier in the century, he claimed, modern patients “would not have allowed us to cut even a centimetre . . . without administering an anaesthetic”. This was not due to any decline of moral fibre, Leriche added: rather, it was a sign of a “nervous system differently developed, and more sensitive”.

Other physicians and scientists of the 19th and early 20th centuries wanted to complicate the picture by making a distinction between pain perception and pain reaction. But this distinction was used to denigrate “outsider” groups even further. Their alleged insensitivity to pain was proof of their humble status – yet when they did exhibit pain reactions, their sensitivity was called “exaggerated” or “hysterical” and therefore seen as more evidence of their inferiority. Such confused judgements surfaced even in clinical literature that purported to repudiate value judgements. For instance, John Finney was the first president of the American College of Surgeons. In his influential book The Significance and Effect of Pain (1914), he amiably claimed:

It does not always follow that because a patient bears what appears to be a great amount of pain with remarkable fortitude, that that individual is more deserving of credit or shows greater self-control than the one who does not; for it is a well-established fact that pain is not felt to the same degree by all individuals alike.

However, in the very same section, Finney made pejorative statements about people with a low pain threshold (they possessed a “yellow streak”, he said) and insisted that patients capable of bearing pain showed “wonderful fortitude”.

In other words, civilised, white, professional men might be exquisitely sensitive to pain but, through acts of willpower, they were capable of masking their reaction. In contrast, Finney said, the dark-skinned and the uneducated might bear “a great amount of pain with remarkable fortitude” but they did not necessarily deserve credit for it.

It was acknowledged that feeling pain was influenced by emotional and psychological states. The influence of “mental factors” on the perception of pain had been observed for centuries, especially in the context of religious torture. Agitation, ecstasy and ideological fervour were known to diminish (or even eliminate) suffering.

This peculiar aspect of pain had been explored most thoroughly in war. Military lore held that the “high excitement” of combat lessened the pain of being wounded. Even Lucretius described how when

the scythed chariots, reeking with indiscriminate slaughter, suddenly chop off the limbs . . . such is the quickness of the injury and the eagerness of the man’s mind that he cannot feel the pain; and because his mind is given over to the zest of battle, maimed though he be, he plunges afresh into the fray and the slaughter.

Time and again, military observers have noted how, in the heat of battle, wounded men might not feel even severe wounds. These anecdotal observations were confirmed by a systematic study carried out during the Second World War. The American physician Henry K Beecher served in combat zones on the Venafro and Cassino fronts in Italy. He was struck by how there was no necessary correlation between the seriousness of any specific wound and the men’s expressions of suffering: perhaps, he concluded, the strong emotions aroused in combat were responsible for the absence of acute pain – or the pain might also be alleviated by the knowledge that wartime wounding would release a soldier from an exceedingly dangerous environment.

Beecher’s findings were profoundly influential. As the pain researchers Harold Wolff and Stewart Wolf found in the 1950s, most people perceived pain at roughly similar intensities, but their threshold for reaction varied widely: it “depends in part upon what the sensation means to the individual in the light of his past experiences”.

Away from the battlefield, debates about the relative sensitivity of various people were not merely academic. The seriousness of suffering was calibrated according to such characterisations. Sympathy was rationed unevenly.

Myths about the lower susceptibility of certain patients to painful stimuli justified physicians prescribing fewer and less effective analgesics and anaesthetics. This was demonstrated by the historian Martin Pernick in his work on mid-19th-century hospitals. In A Calculus of Suffering (1985), Pernick showed that one-third of all major limb amputations at the Pennsylvania Hospital between 1853 and 1862 had been done without any anaesthetic, even though it was available. Distinguished surgeons such as Frank Hamilton carried out more than one-sixth of all non-military amputations on fully conscious patients.

This is not simply peculiar to earlier centuries. For instance, the belief that infants were not especially liable to experiencing pain (or that indications of suffering were merely reflexes) was prominent for much of the 20th century and had profound effects on their treatment. Painful procedures were routinely carried out with little, if any, anaesthetic or analgesic. Max Thorek, the author of Modern Surgical Technique (1938), claimed that “often no anaesthetic is required”, when operating on young infants: indeed, “a sucker consisting of a sponge dipped in some sugar water will often suffice to calm the baby”.

As “An Earnest Englishwoman” recognised, beliefs about sentience were linked to ideas of who was considered fully human. Slaves, minority groups, the poor and others in society could also be dispossessed politically, economically and socially on the grounds that they did not feel as much as others. The “Earnest Englishwoman’s” appeal – which drew from a tradition of respect and consideration that lays emphasis on the capacity to suffer – is one that has been echoed by the oppressed and their supporters throughout the centuries.

Joanna Bourke is a professor of history at Birkbeck, University of London, and the author of “The Story of Pain: From Prayer to Painkillers” (Oxford University Press, £20)

This article first appeared in the 11 June 2014 issue of the New Statesman, The last World Cup

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Shami Chakrabarti’s fall from grace: how a liberal hero lost her reputation

Once, it was trendy to say you liked the former director of Liberty. No longer.

It might be hard to remember now, but there was a time when it was trendy to like Shami Chakrabarti. In the mid-2000s, amid the Iraq War backlash and the furore over identity cards, speaking well of the barrister and head of the human rights campaign group Liberty was a handy way of displaying liberal credentials. She was everywhere: Question Time, Desert Island Discs, Have I Got News For You. A young indie band from Worcester called the Dastards was so keen on her that it even wrote a song about her. It included the lyric: “I turn on my TV/The only one I want to see/Is Shami Chakrabarti.”

The daughter of Bengali immigrants, Chakrabarti was born and brought up in the outer-London borough of Harrow, where she attended a comprehensive school before studying law at the London School of Economics. Her background was a great strength of her campaigning, and during the most authoritarian years of New Labour government she burnished her reputation.

Fast-forward to 13 September 2016, when Chakrabarti made her House of Lords debut as a Labour peer. Baroness Chakrabarti of Kennington wore a sombre expression and a rope of pearls looped round her throat beneath her ermine robe. It was hard to recognise the civil liberties campaigner who was once called “an anarchist in a barrister’s wig” by Loaded magazine.

Yet Chakrabarti has also been cast in another role that is far less desirable than a seat in the Lords: that of a hypocrite. On 29 April this year, Jeremy Corbyn announced that Chakrabarti would chair an independent inquiry into anti-Semitism and other forms of racism in the Labour Party. The inquiry was prompted by the suspensions of Naz Shah, the MP for Bradford West, and Ken Livingstone, for making offensive remarks that were condemned as anti-Semitic. On 16 May Chakrabarti announced that she was joining Labour to gain members’ “trust and confidence”. She said that she would still run the inquiry “without fear or favour”.

The Chakrabarti inquiry delivered its findings on 30 June at a press conference in Westminster. The atmosphere was febrile – there were verbal clashes between the activists and journalists present, and the Jewish Labour MP Ruth Smeeth was reduced to tears. The report stated that Labour “is not overrun by anti-Semitism, Islamophobia or other forms of racism” but that there was an “occasionally toxic atmosphere”. It listed examples of “hateful language” and called on party members to “resist the use of Hitler, Nazi and Holocaust metaphors, distortions and comparisons”. Many Labour supporters were surprised that the report’s 20 recommendations did not include lifetime bans for members found to have shown anti-Semitic behaviour.

Then, on 4 August, it was revealed that Chakrabarti was the sole Labour appointment to the House of Lords in David Cameron’s resignation honours. Both Chakrabarti and Corbyn have denied that the peerage was discussed during the anti-Semitism inquiry. But critics suggested that her acceptance undermined the report and its independence.

In particular, it attracted criticism from members of the UK’s Jewish community. Marie van der Zyl, vice-president of the Board of Deputies of British Jews, said: “This ‘whitewash for peerages’ is a scandal that surely raises serious questions about the integrity of Ms Chakrabarti, her inquiry and the Labour leadership.” A home affairs select committee report into anti-Semitism in the UK has since found that there were grave failings in the report for Labour.

Two further incidents contributed to the decline in Chakrabarti’s reputation: her arrival on Corbyn’s front bench as shadow attorney general and the revelation that her son attends the selective Dulwich College, which costs almost £19,000 a year in fees for day pupils (£39,000 for full boarders). She said that she “absolutely” supports Labour’s opposition to grammar schools but defended her choice to pay for selective education.

Chakrabarti told ITV’s Peston on Sunday: “I live in a nice big house and eat nice food, and my neighbours are homeless and go to food banks. Does that make me a hypocrite, or does it make me someone who is trying to do best, not just for my own family, but for other people’s families, too?”

This was the end for many of those who had respected Chakrabarti – the whisper of hypocrisy became a roar. As the Times columnist Carol Midgley wrote: “You can’t with a straight face champion equality while choosing privilege for yourself.”

Hypocrisy is a charge that has dogged the left for decades (both Diane Abbott and Harriet Harman have fallen foul of the selective school problem). The trouble with having principles, it is said, is that you have to live up to them. Unlike the right, the left prizes purity in its politicians, as Jeremy Corbyn’s squeaky-clean political image shows. Shami Chakrabarti started the year with a campaigning reputation to rival that of the Labour leader, but her poor decisions have all but destroyed her. It’s difficult to recall a time when a liberal icon has fallen so far, so fast. 

Caroline Crampton is assistant editor of the New Statesman.

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood