How To Read The Body in Pain

How To Read The Body in Pain** David B. Morris He has seen but half the Universe who never has been shown the House of Pain. — Ralph Waldo Emerson1 A quiet revolution beginning about 1960 promises to transform centuries of medical thinking about pain. From the time of the Hippocratic writings, pain has held die clear and secure status of a symptom. In effect, Western medicine has attributed a distinctive legibility to pain, as if pain were a more or less readable inscription diat die skilled physician might interpret for its revelations about processes hidden deep within the flesh: a message composed, sent, and delivered by illness. The physician dius serves, among other offices, as a professional reader of pain, and pain — despite its reputation for noisy inarticulateness — holds the physician in the peculiar intimacy characteristic of reading. They share a common but equivocal language ranging from open, unmistakable declarations of fact to delicate hints and subtle ambiguities. The medical revolution now under way does not seek to overthrow the ancient status of pain as a symptom. Radier, it introduces a radical change in perspective, which acknowledges that pain is sometimes completely illegible. This more or less unreadable pain no longer resembles a message that passes in between the physician and the illness. The message is die illness. "We treat pain as a diagnosis, not a symptom," explains anesthesiologist Michael Kilbride, founder of die Muskegon (Michigan) General Hospital's Pain Management Center, opened four years ago.2 This typical transformation of pain from symptom to diagnosis or syndrome — from * Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (New York: Oxford University Press, 1985). All quotations are from this edition and are cited parenthetically in the text. Copyright β 1985 by Oxford University Press, Inc. Reprinted by permission of Oxford University Press, Inc. t This work was supported by a grant from the Division of Research Programs of the National Endowment for the Humanities. Literature and Medicine 6 (1987) 139-155 © 1987 by The Johns Hopkins University Press 140 READING THE BODY IN PAIN the sign of illness to illness itself — is the conceptual change underlying a major realignment in the contemporary practice of medicine that might be called the emergence of the pain clinic. By recent count, there are close to one thousand private and public pain treatment centers in the United States. The two separate programs first established in 1960 by Dr. John J. Bonica (Seattle) and by Dr. Benjamin L. Crue, Jr. (Pasadena) have fostered within medicine a new growth industry. Faced with this sudden proliferation , patients do not always recognize that at different pain clinics the philosophies, goals, and methods of treatment may differ greatly, even as Drs. Crue and Bonica disagree about fundamental issues in the understanding of pain.3 Medical opinion about the value of pain clinics is far from unanimous. Still, the institutional signs of change are unmistakable. Two weighty medical journals now share the one-word title Pain.* There are national organizations, international conferences, and an entirely new medical specialty (algology) all devoted to the study of pain. Pain (with its accompanying issues, physical and metaphysical) now threatens to obsess the modern world much in the way pleasure (in its relations to virtue, reason, and the good life) preoccupied the ancients. From a literary point of view, what appears most striking about recent developments in medicine is that pain has acquired an unprecedented textuality. Its complications and elusive silences, which defeat simplistic or reductive readings, give pain something of the texture we recognize in complex novels or poems, where the physician who seeks to treat Macbeth or Lear must unravel a knot that ties body to mind, medicine to politics, nature to culture. For some researchers and clinicians, pain is better understood not in its traditional role as a sensation but rather as a perception, implying that it cannot be fully grasped apart from the vagaries of human consciousness. Non-conscious pain seems a contradiction in terms, and even the most unambiguously organic injury (if it hurts long and hard enough) eventually provides a site for the mind to brood upon. The "gatecontrol " model of pain developed by Ronald...