The Modulated Scream: Pain in Late Medieval Culture (review)

In her introduction, Esther Cohen, of The Hebrew University of Jerusalem, explains that The Modulated Scream is not about pain in the Middle Ages, but about the medieval response to pain (3). Using literary, ecclesiastic, medical, academic, and legal materials as well as philosophical and scientific writings, private correspondence, art, and other sources, Cohen knits together a wide array of viewpoints into a fine piece of history concerning the use, performance, and perception of pain in late medieval Europe.

Cohen divides her explorations by topic, which she has organized into two parts: “Manipulating Pain,” and “Knowledge from Pain.” Part I, “Manipulating Pain,” is about how people and institutions used pain as a means to an end, whether it was beggars in the streets using their illnesses as occupation, the civil courts using pain as a deterrent to crime and source of “truth,” or the Church using the threat of pain in hell as a way to gain converts or secure upright behavior. Part II, “Knowledge from Pain,” delves into the perception of pain in the Middle Ages. Observers of pain used specific language to describe this condition, whether the observer was the individual in pain or an outsider, to interpret and attach meaning to suffering. These observations also give modern readers a window into the understanding of this “social sensation” (260).

In the body politic and the Church, pain was seen as part of God’s plan for the world and was, moreover, to be accepted as both a reminder of God’s blessings by contrast and of hell to come for those nonbelievers and sinners. Many authorities in the Church taught that to suffer as Christ had suffered was good for the soul; therefore, an expression of pain, regulated and at times exploited (consciously or unconsciously) through performance, lent an air of holiness to some persons. Good Christians were to endure pain, not thwart its benevolent gifts of living closer to the life of Christ (Chapters 6 and 7). Likewise, as Cohen writes, “Pain became one of the cornerstones of hierarchic society: just as God maintained hell for sinners, so kings must maintain dungeons . . .” (6). Late medieval courts used torture, as earlier courts used the ordeal, to find the guilty. In both cases, pain figured prominently as a way to prompt the guilty into confession of their guilt in order for the courts to effect the correct punishment. Whether the medieval equivalent of “water boarding” or the simple use of stocks, torture was as much a deterrent and punishment as it was a means to gain information (Chapter 2).

The medical community looked at pain in a much different light (Chapters 4 and 5) and not perhaps in the same light as many in the twenty-first century would think. On the one hand, surgeons and physicians did use both analgesics and anesthetics for surgery and wound care but they used these mostly topical drugs to their own ends. As in the case of surgery, they used pain reduction as a way to keep their patients calm long enough to complete a surgery with as little loss of blood as possible, rather than for any humanitarian pain relief for the patient. On the other hand, the medical community viewed pain as a window into the health of their patients. A patient, who suddenly was without pain, was not always a good sign. “Quite the contrary, it could herald worse developments. Since pain could be the indicator of an ongoing process, . . . the disappearance of pain while the illness remained signaled the victory of corruption over the entire body” (148).

Cohen has had to do a bit of academic guessing, as do many scholars working on difficult topics that seem to fall between the cracks of neat documentation. Her choice of terminology in statements like—“The last statement [about pain as a source of power] was never openly made, but it can most certainly be deduced from the public actions of sufferers” (145), or...