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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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Inside Syria's unending siege, civilians, not soldiers, are the victims

In Aleppo, civilian strife is just another tool of war.

Maria is a young mother who lives in Aleppo. She missed her opportunity to flee when the Syrian-Turkish border was closed to all but the seriously injured in early 2015. With her two children – Fadi, aged five, and Sama, aged nine – she stayed in the city.

Maria’s husband was killed by a barrel bomb that fell on their neighbourhood in 2014. After that, she took the children and moved in with her husband’s family. Her married brother-in-law asked her to be his second wife. She accepted the offer for the sake of security. This year he, too, was killed when a bomb fell on his shop.

Speaking to her on Skype, I referred to Aleppo as a city under siege and she quickly corrected me. “The city is not under siege,” she said. “We are human beings under siege.” Maria clearly felt offended by my words. She moved the conversation on to the images of a young Syrian boy, sitting in an ambulance, which have appeared on newspaper front pages around the world – a symbol of the human suffering in Aleppo. “What can I say? His silence and shock reflected all the pain of Syrians.”

Tearfully, she described her living conditions. “There are two widows, with three children, who live all together with our old mother-in-law. The good people around us try to give us food and clothing.”

She added: “Before, I used to cook a big meal for me and my family-in-law every day. My late husband was well off.” The children don’t go to school but they get some lessons at home – Maria used to work as an Arabic language teacher at a high school in the city.

The household’s other widow, Safaa, joined our conversation. “Since the first day of Eid ul-Fitr [the festival that marks the end of Ramadan, this year on 6 July], the siege began in Aleppo. There was no food or water. Children cried and could not sleep because of hunger.”

Safaa made food from pulses that she had managed to save, particularly lentils. As the area around the city is rich in olives and well known for producing za’atar herbs, the extended family depended on reserves of these for nutrition. “Al-za’atar al-akhdar [a dish of the herb, olive oil and a few other basic ingredients] has saved the reputation of Aleppo and its people,” Safaa joked, and both women laughed.

Then, suddenly, the Skype connection was lost and they both disappeared.

Another Aleppo native to whom I spoke, Ayham, described his desperation as he finished his engineering degree before fleeing Syria. “I am my mother’s only son, so I didn’t want to do military service, and I left, as I felt so insecure,” he told me. He had been living in Shahbaa, a neighbourhood controlled by Bashar al-Assad’s regime, while completing one application after another to study abroad. Eventually he was successful and he has now made it to a university in Europe.

Ayham’s parents were pushing him to leave because they knew that he was part of an underground anti-Assad protest movement. “There are two Aleppos,” he explained. “One is free and the other is controlled by Assad’s regime. Both are very unsafe . . . Living hungry was easier than living under threat.”

There are roughly two million people in the city, most of them women and children. Since the second day of the siege, there have been no fruit or vegetables available and only a few bakeries are producing bread. Compounding the starvation, the bombing has been intense, hitting hospitals, ambulances, blood banks and the Syrian Civil Defence base. Assad’s regime is targeting vital resources for civilians.
Even after rebel forces, in co-operation with the Islamist faction Jaish al-Fateh, managed partly to break the siege and open a new road into the south of the city through the Ramoussa area, they could not bring in enough food. The little that made it inside immediately sent prices soaring. Civilians could not use this road to escape – jets were targeting the routes in and out.

The eastern areas of Aleppo, which are still under the opposition’s control, are also still without aid, because of how risky it is to get there. All the talk coming out of the city today is about decisive battles between Assad’s forces and the rebels in the southern quarters. Civilians put the recent air strikes down to these conflicts – it has long been believed that when the regime loses ground, it intensifies its bombing as revenge, and to send a message to those who continue to resist.

People in Aleppo and the north-eastern territories of Syria are suffering and dying. They have no other choice. It seems that both Isis and the Assad regime are trying as hard as they can to destroy Syrian civilians, whether through direct attacks or by gradual starvation.

There is little information available, as both sides attempt to prevent the media from documenting life under siege. Isis accuses journalists of being agents of Assad, while the regime portrays reporters as terrorists. Pro-Assad social media accounts have alleged that Mahmoud Raslan, who took the footage of the boy in the ambulance, has links with terrorism. The same channels have yet to say much about Raslan’s subject – Omran Daqneesh, the five-year-old whom he showed, bloodied and stunned, after the boy was pulled from the rubble caused by multiple air strikes. Omran’s ten-year-old brother, Ali, has since died from injuries sustained in another attack.

After four hours, I heard back from Maria. She apologised for losing the connection and asked me not to worry about her. “All of us are fine. We did not die yet,” she said. Her daughter, Sama, has not been to school since last year, she told me, and now studies only Arabic poetry. They have no books, so she depends on the verses that Maria knows by heart. Sama misses her school and her friends, and though she remembers their faces she has forgotten their names.

Maria has made a doll for her out of scraps of fabric and they call it Salwa. Together, they sing Syrian folk songs for the doll, in particular one that goes: “Hey Salwa, why are you crying? I need a friend.” Maria is resigned. As she says, “We are back in the Stone Age.” 

K S is a Syrian journalist, based in Sweden since 2014

This article first appeared in the 25 August 2016 issue of the New Statesman, Cameron: the legacy of a loser