History of Pain (review)

Pain is one of the few truly universal human experiences; it is also among the least understood. Philosophers, poets, scientists, physicians, nurses, and pain sufferers have struggled over the centuries to understand, to explain, and to master pain; yet it remains deeply personal to the sufferer and always, to a greater or lesser degree, inaccessible to the most skilled and caring observer. Recently the problem of pain has come to the attention of historians and cultural scholars, most notably Martin Pernick (A Calculus of Suffering [1985]), Elaine Scarry (The Body in Pain [1985]), and David Morris (The Culture of Pain [1991]). This thoughtful work by Roselyne Rey, a noted French historian who died shortly after her book was published, examines the evolution of pain in Euro-North American thought from a philosophical-religious concept to a biomedical phenomenon.

Rey makes explicit the historical contradiction between the philosopher’s search for meaning in pain and the physician’s commitment to healing. The Stoics, for example, believed that pain was a bodily manifestation irrelevant to the noble and spiritual life, and was therefore to be controlled by the mind and endured without complaint. The Christian philosophers of the Middle Ages, on the other hand, argued that the physical experience of pain and suffering was a divine gift, to assist the devout in transcending the earthly body and achieving spiritual purity.

The advent of individualism in the Renaissance and of rationalism in the Enlightenment encouraged the redefinition of pain as an evil to be cured or avoided. But eighteenth-century medical practitioners, like their predecessors, found pain useful in diagnosis; moreover, the standard therapeutic regimes often required the physician to inflict pain to restore health. This period also saw the framing of a crucial medical debate over the nature of pain: was it a mechanical neural response to injury or other harmful stimulus, or was it a manifestation of the patient’s sensibility, of the vital life force, or the soul?

Rey devotes the largest section of her book to the “great discoveries” (p. 132) in anesthesia and neuroscience during the nineteenth century. While the introduction of anesthesia made complex surgical procedures possible, many observers, including physicians, questioned the ethics of invading the body of the unconscious patient. Johannes Müller’s theories of specific nerve excitability supported a mechanical concept of pain and the body, and were strongly supported by neurological studies—including the localization of certain functions in specific areas of the brain, and the identification of specific “pain points” on the skin by Max von Frey. Clinical descriptions of pain disorders such as neuralgia and causalgia, however, challenged the idea of specificity. An alternate theory of the brain’s summation of multiple intense sensory perceptions as “pain,” proposed by Albert Goldscheider (1898), was an early and influential attempt to reconcile neurological theories with the complexity of pain experiences.

There are some flaws in this excellent book: several passages seem rather convoluted in English translation, and the inclusion of so many themes and historical periods inevitably gives certain sections an encyclopedic flavor. Rey certainly realized this last hazard (although she could not fully avoid it), and she tried to circumscribe her topic. She limits most of her discussion of clinical medicine to France, while taking theoretical contributions from all countries into account; and she concludes her account on the eve of the Second World War, with pain redefined as a medical problem, but one that had engaged the interest of only a few researchers.

The postwar years have seen the development of an interdisciplinary field of pain studies, and a complex reformulation of the problem that treats pain as both somatic and psychic. There is work in progress on contemporary pain medicine, including a forthcoming book by Rey’s compatriot, Isabelle Baszanger. The History of Pain is a solid foundation for this and future scholarship on this fascinating topic.