Pain in Perspective, 1975

PAIN IN PERSPECTIVE, 1975 B. RAYMOND FINK* Pain, one might have thought, should be a prime topic ofconversation between the intellectuals and the scientists, the people of the two cultures who, according to C. P. Snow, have almost ceased to communicate. Certainly pain seems a more propitious subject than the second law of thermodynamics, Snow's original proposal, or molecular biology, his later suggestion [I]. What could be more conducive to mutual respect than shared insights into our growing understanding of the mechanism of feeling in general, and pain in particular? True, one might question whether pain is ripe for such recognition when perhaps the most eminent Soviet psychologist of our time can write an entire work on neuropsychology [2] without ever mentioning it. On the other hand, the urgency of at least planning a dialogue is clear now that two distinguished books [3, 4] have surveyed the gamut of scientific and clinical comprehension of pain yet passed over in silence its cultural influence and religious significance. As to the last, the poverty of apologetics, recent and not so recent [5, 6, 7], is a standing reproach to the insularity of both cultures. The meagerness of the philosophy of pain is astonishing when one considers the vast artistic, intellectual, and physical activities surrounding the sensations of sight and hearing. Yet, one cannot doubt that pain is a fundamental element in our social fabric. From our first day each one of us is united in suffering, or the fear of suffering, with the mother who gave us birth. Whether regarded as an occasion for compassion, punishment, or vengeance or for endurance, prayer, or therapy, the infliction and assuaging of hurt are two of the dominant influences in "civilized" human thought and action and apparently have always been so. Today more than ever they make up two of the largest industries on the face of the planet. In an epoch of unprecedented ethical dilemmas flowing from un- *Department of Anesthesiology, the Anesthesia Research Center and the Center for Research in Oral Biology, University of Washington School of Medicine, Seattle, Washington 98195. Supported by grants DE 02600-08 and GM 15991 from the National Institutes of Health, U.S.P.H.S. I am indebted to Dr. Richard G. Black, coordinator of the pain clinic at the University of Washington, for much stimulating discussion. 278 I B. Raymond Fink · Pain in Perspective imagined technological advances, pain may yet confront humanity with a more pervasive moral quandary than any it has yet had to face. At a time when self-gratification by electrical stimulation of the brain is an accomplished fact, a daily existence rendered universally pain free by artificial means seems a promise (or menace) realizable in the not-sodistant future. Suppose, as may yet be, that it were within the gift of science to abolish pain—to abolish physical suffering without other perceptual cost permanently, once and for all, for every person, at that person's decision. What would you decide? The background for a responsible answer to that question includes a clear understanding of the biology and the social functions of pain. Much ofthe former has become readily accessible in The Puzzle ofPain by Ronald Melzack [3], an important milestone in the expository literature of the subject, and in the less comprehensive but equally luminous Pain Patients [4], Sternbach's sequel to his The Psychology ofPain of a few years ago. These books epitomize the modern scientific understanding and ignorance of pain. But there is another type ofunderstanding or interpretation, religious or cultural in nature, and most familiar perhaps in the Judeo-Christian belief that suffering is divinely ordained retribution for evil deed and thought. Considering how intimately it has permeated western thought, the slender measure of its literature in recent times is striking. Faced with a sparsity of contemporary theological apologia for pain [7], we are forced to advert to books from well-intentioned laity. In Pain and Religion, Brena [5] gamely attempts to bring the two worlds of religion and science together; but they have never appeared more totally immiscible than in this opaque emulsion of noble aspirations and clotted language. Brena, who was at one time director of...