Healing, as this volume once again indicates, and what we mean by “health” are seemingly straightforward yet complex issues with numerous and variegated implications. Notions of health, so seemingly natural, are in no small part determined by cultural specifics and hence shift over time, so that every attempt at defining what we mean by healing and health instantly gives rise to new sets of questions. The same holds true for one particular facet of health and healing, namely pain. Regardless of the manifold definitions of health and healing discussed in this volume, processes of healing share one common aspect: they are inextricably linked to pain. Indeed the old adage cited in the Hippocratic Corpus (ca. 430–380 BCE) still holds today, namely that “pain cures pain”; that “pain signifies” the locus of illness and is essential to diagnostics and the medical interventions necessary to effect healing.2 Yet, today notions of health, both physiological and psychological, presuppose levels of pain and its cognitive evaluation, suffering, which do not impair the well-being of the person concerned. Indeed, today health and to a large degree the process of healing involves patients who are ethical and juridical persons with the right to the greatest possible minimization and alleviation of “negative” pain and, ideally, suffering.3 Some advertisements promising “freedom from pain” to the contrary, minimization of pain does not mean to be pain-free. Complete absence of pain is itself an illness; what we wish for is “healthy,” normal rather than pathological pain.
Such observations — as will be discussed by John Efron in his volume as well — require some definition of what pain actually is, and therein lies the crux of the matter. The American Medical Association (AMA) and the International Society for the Study of Pain define pain as an unpleasant sensation resulting from tissue damage and respectively as “a particularly complex signal broadcast over nerve ends leading from the site of injury to the brain … until the injury heals.”5 Anyone knows, of course, that pain is far more than that. Acute and chronic pain, though recognizable as localized and specific, are sensations that profoundly affect the entire human being, body and mind alike. More to the point, pain is a sensation that has always and continues to affect all beings, human (and animal), throughout recorded history.6 All human beings at all times in every society have sought to alleviate pain and continue to do so: anyone who watches television knows that nearly half of the medications advertised promise to relieve pain — both physical and emotional, acute and chronic. A now dated study by the NIH from 1983 estimated that 90 million Americans suffer from chronic pain, and that the partial disabilities resulting from that caused the loss of 750 million workdays — but we also know that such figures shift according to levels of unemployment: the higher the competition for jobs the lower such figures.7 Further, such figures as a percentage of the total workforce shift dramatically from country to country. For example, the per capita consumption of painkillers in France is about three times that of the USA. Interestingly, a recently completed study conducted by the George Soros Foundation has found that 88% of the patients in the USA are consistently under-medicated for pain relief.8 Three observations emerge: (a) modern medicine has yet to reach a universally agreed upon, comprehensive definition of pain; (b) pain is a universal, human condition; and (c) the experience, perception and representation of pain is culturally determined.9My following remarks, since I am not a physician, will deal with aspects of the latter two observations.
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References
“Every living being from its very moment of birth seeks pleasure, enjoying it as the ultimate good while rejecting pain as the ultimate adversity and, insofar it is possible, doing his best to avoid it; he behaves in this fashion as long as he has not been conditioned and insofar as his very nature judges without corruption and with integrity,” cited in Roselyne Rey (1995) The History of Pain. Trans. by Louise Elliott Wallace, J. A. and S. W. Cadden. Cambridge, MA: Harvard University Press, p. 1.
Hipppocratic Corpus: Epidemics V and Aphorism II. 46; see also Celsus, De Re Medicina; Jacques Jouanna (1974) Pour une archéologie de l'École de Cnide. Paris: Belles Lettres; Rey, pp. 20–25. For further discussion of the Hippocratic Corpus see Oliver Primavesi in this volume.
Ariel Glucklich (2001) Sacred Pain. Hurting the Body for the Sake of the Soul. Oxford: Oxford University Press, p. 179.
David B. Morris (1991) The Culture of Pain. Berkeley, CA: University of California Press, pp. 9–18; Rey, p. 7.
Glucklich, p. 11; Morris, p. 1.
K. D. Keele (1962) “Some Historical Concepts of Pain,” in C. A. Keele and Robert Smith (eds.) The Assessment of Pain in Man and Animal. London: Duckworth, pp. 12–27.
Morris, p. 19; Mary-Jo Delvecchio Good et al. (ed.) Pain as Human Experience. An Anthropological Perspective. Berkeley, CA: University of California Press, pp. 3–7.
Barry Stimmel (1983) Pain, Analgesia, and Addiction: The Pharmacological Treatment of Pain. New York: Raven Press; Soros Foundation study as part of the “Project on Death in America,” http://www.soros.org with an excerpt of George Soros's inaugural speech, where he states that “doctors, nurses, and other health professionals need better training in the care of the dying, especially in the relief of pain. Health professionals also need training in alleviating the psychological, emotional, and existential suffering that may accompany dying. Physical pain is what people fear most about dying. A dying person in pain cannot think about anything else, leaving no room for coming to terms with death, for reviewing one's life, putting one's affairs in order, for saying good-bye. Therefore, pain relief must come first. Doctors often under medicate their dying patients for fear of turn in them into drug addicts.”
Rey, pp. 331–337.
Good, pp. 1–3 with bibliography.
Rey, pp. 132–260; Glucklich, pp.179–198.
M. Moisan (1989) “Les plantes narcotiques dans le Corpus hippocratique,” in P. Pottier, G. Maloney and J. Desautel (eds.) La Malatie et les maladies dans la Collection hippocratique. Quebec: Editions du Sphynx, pp. 381–392; see also Celsus, De Re Medicina, 4.13, 1–3; 1. 9 and 2. 7; Aretaeus of Cappadocia (1958), Carl Hude (ed.) On the Causes and Indications of Acute and Chronic Disease II 2 and 12. Berlin: Akademie Verlag; Galen, On the Use of the Parts, 8. 5–6; 5. 9; see Rosa Maria Moreno Rodrigez and Luis Garcia Ballester (1982) “El dolor en la teoria y la pratica medicas de Galeno,” Dynamis 2: 3–24; Rey, pp. 30–37. Galen was reluctant to use opium, which was to have an effect on later Galenism, Rey, p. 83.
Rey, pp. 44–131, esp. pp. 85–88. Opium sponges used in Antiquity to induce sleep fell out of use during the Middle Ages, but in the sixteenth century external compresses consisting of “stupefacients and narcotics,” such as henbane, hemlock, solanum, mandrake and opium, were used. Though known as a substance, ether's (“sweet vitriol”) anesthetic powers were not understood prior to the late eighteenth/early nineteenth century. See Niklaus Largier (2001) Lob der Peitsche. Eine Kulturgeschichte der Erregung. Munich: Beck, pp. 60–107, for medieval pain, especially in the context of flagellation and pp. 311–359 for the healing associated with that practice.
On laudanum and the first “Opium Wars” in seventeenth-century Europe see Rey, pp. 82–85 and pp. 125–129.
Glucklich, pp. 179–201; Rey, pp. 132–260. See also Stefan Willich in this volume. For an in-depth discussion of the debates surrounding the introduction of ether and chloroform see Martin S. Pernick (1985) A Calculus of Suffering. Pain, Anesthesia, and Utilitarian Professionalism in Ninteenth Century American Medicine. New York: Columbia University Press.
See also Ambrose Paré Dix Livres de la Chirurgie, avec le magasin des intruments, facsimile cited in Rey, 347 n. 29; also id., Traité de la peste, in Malgaigne (1840–1841) Œvres completes. Paris: J. B. Ballière, pp. 152–158, 172; Montaigne, Essais, 1. 14, pp. 56–59; Rey, pp. 50–70.
Elaine Scarry (1985) The Body in Pain. New York: Oxford University Press.
From an anthropological point of view the locus classicus are Mark Zborowski's studies (1952) “Cultural Components in the Response to Pain,” Journal of Social Issues 8 (4): 16–31, and Zborowski (1969) People in Pain. San Francisco, CA: Jossey-Bass, in which he demonstrated that “old Yankees,” Jews, Irish and Italian war veterans reacted differently to bodily pain. Though based on taxonomies today considered anachronistic, Zborowski's studies had enormous impact, because he opened the field to cultural comparisons.
H. Fabrega and S. Tyma's studies (1976) “Culture, language, and the shaping of illness; An illustration based on pain,” Journal of Psychosomatic Research 20: 323–337, and Fabrega and Tyma (1976) “Language and cultural influence in the description of pain,” British Journal of Medical Psychology 49: 349–371, illustrate the complex nexus of culture and pain through an overwhelming use of evidence ranging from neurobiology via psychosomatic medicine to philosophy.
“Despite its many individual, social, and cultural characteristics, pain is not an historical subject in the same sense as … hell, or purgatory. Pain is based on an anatomical and physiological foundation, and if there is one experience where the human condition's universality and the species' biological unity is manifest, pain is certainly it,” Rey, p. 5. See for example studies that observe the absence of pain experienced by men wounded in battle, e.g. in Henry K. Beecher's study (1946) “Men wounded in Battle,” Bulletin of the US Army Medical Department 5: 445–452 ; and Patrick D. Wall (1979) “On the relation of injury to pain,” Pain 6: 253–264. Such phenomena were already described by Homer, Iliad, 6 and 20; Mirko D. Grmek (1989) Diseases in the Ancient Greek World. Transl. by M. Muellner. Baltimore, MD: Johns Hopkins University Press, pp. 27–33.
Morris, pp. 74–78; Byron J. Good, “A Body in Pain — The Making of a World of Chronic Pain, in Goode et al., Pain as Human Experience, pp. 29–48; Linda C. Garro: “Chronic Illness and the Construction of Narratives,” ibid., pp. 100–137. Recent studies de-emphasize earlier correlations between chronic pain and low income levels (where persons supposedly somatize more), but it appears certain that chronic pain is germane to Western industrialized societies.
Glucklich, pp. 40–77; Morris, pp. 48–74, and pp. 164–168 on the “peripheralist” versus “centralist” debates between John J. Bonica and Benjamin L. Crue, both pioneering founders of pain clinics in the twentieth century. Today's pain clinics as well as the McGill University Pain Questionnaire published in 1975 and again in 1992 seek to evaluate pain in a more comprehensive manner, focusing on experiential categories like sensory, affective and evaluative responses to pain, and treating not only the damaged tissue but seeking to take a patient's entire lived world into consideration, Glucklich, pp. 44 and 209. See for example the self-description of the Stanford Pain Management Clinic or of the Marcus Pain Clinic.
Especially influenced by Elaine Scarry's work.
Though based on a different focus, the foundational work for this line of argument is Michel Foucault (1988) The History of Sexuality, vol. 3: The Care of the Self. Transl. by R. Hurley. New York: Vintage. The argument is then elaborated, based on Foucault, by Judith Perkins (1995) The Suffering Self. Pain and Narrative Representation in the Early Christian Era. London: Routledge.
Among the best discussions of due process and methods of execution are Jill Harries (1999) Law and Empire in Late Antiquity. Cambridge: Cambridge University Press, pp. 99–122; and Katherine M. Coleman (1990) “Fatal Charades: Roman executions staged as mythological enactments,” Journal of Roman Studies 80: 44–73.
Cicero, De natura Deorum; Rey, p. 68.
Robert Sallares (2002) Malaria and Rome: A History of Malaria in Ancient Italy. Oxford: Clarendon Press.
Dio Cassius 72. 14.3 mentions 2,000 deaths a day. Walter Scheidel (2003) Rome the Cosmopolis. Cambridge: Cambridge University Press, 158–176. Id. (2001) “Germs for Rome,” Death on the Nile: Disease and the Demography of Roman Egypt. Leiden: Brill, chapters 1 and 2; Grmek, Disease, Ch. 8 for leprosy; A. Scobie (1986) “Slums, sanitation and mortality in the Roman world,” Klio 68: 399–433; Brent Shaw (1996) “Seasons of Death: Aspects of Mortality in Imperial Rome,” Journal of Roman Studies 86: 100–138.
Glucklich, pp. 14–16.
Perkins p. 4–76.
Tomas Hägg (1983) The Novel in Antiquity. Berkeley, CA: UC Press; B. P. Readon (1991) The Form of Greek Romance. Princeton, NJ: Princeton University Press.
Brent Shaw (1985) “The Divine Economy: Stoicism as Ideology,” Latomus 64: 16–54, quote p. 17; James Francis (1995) Subversive Virtue. Philadelphia, PA: Penn University Press.
Hence, it was one principle aim of Stoic teachings to school the two principle virtues of any human being: toleratio and continentia, endurance and refrain (Aulus Gellius, Noct. Att. 17.19. According to Epictetus, the training of prohairesis, or the active, deliberate choice of the intellectual mind in its response to external factors was the essential task: “learning what is under our control and what is not, and the only thing under our control is prohairesis … but not under our control are the body, the parts of our body, possessions, parents, brothers, children, country (1.22.10). …” “Disease is an impediment to the body, but not to prohairesis, unless it [i.e. prohairesis] wills it. Lameness is an impediment to the leg, but not to prohaire-sis” (Handbook 9); Perkins, pp. 77–103; A. A. Long (2002) Epictetus. A Stoics and Socratic Guide to Life. Oxford: Clarendon.
M. Beard, J. North, S. Price (eds.) Religions of Rome. 2 vols., vol. 1, p. 73–166, 211–348; Susanna Elm (1997) “Isis' Loss: Gender, Dependence, and Ethnicity in Synesius' De Providentia or Egyptian Tale,” Journal of Ancient Christianity 1: 96–115; Joyce E. Salisbury (1997) Perpetua's Passion. The Death and Memory of a Young Roman Woman. London: Routledge, pp. 14–32.
Perkins, pp. 200–214.
Wayne Meeks (1983) The First Urban Christians. New Haven, CT: Yale University Press; id. (1993) The Origins of Christian Morality. New Haven, CT: Yale University Press; Dale Martin (1995) The Corinthian Body. New Haven, CT: Yale University Press.
Dorothy Hobson (1993) “The Impact of Law in Village Life in Roman Egypt,” in B. Halpern and D. Hobson, Law, Politics, and Society in the Ancient Mediterranean World. Sheffield: Sheffield Academic Press, pp. 193–219; John Nicols (1988) “Prefects, Patronage, and the Administration of Justice,” Zeitschrift für Papyrologie und Epigr 72: 201–217; Hartmut Galsterer (1986) “Roman Law in the Provinces: Some Problems of Transmission,” in Michael H. Crawford (ed.) L'Impero Romano e le strutture economiche e sociali delle province. Bibl. Athenaeum 4. Como: New Press, 1986, pp. 13–27.
A glance at the regional origin of some prominent early Christian writers is illustrative: Justin (Syria); Polycarp (Smyrna); Paul (Tharsos); Johannine Corpus (post 70 CE Asia Minor); Matthew (Syria); Irenaeus (Lyon).
Largier, pp. 29–59; George Duby (1992) “Réflexion sur la douleur physique au Moyen Age,” in Geneviève Lévy (ed.) La douleur. Paris: Édition des Archives contemp., pp. 36–57; Giles Constable (1982) Attitudes Towards Self-Inflicted Pain in the Middle Ages. Brookline, MA: Hellenic College Press; Adolf v. Harnack (1904/1905) The Mission and Expansion of Christianity in the First Three Centuries. Trans. by J. Moffatt. New York: Puttnam, p. 109, called Christianity a religion of the sick; Perkins, pp. 142–145.
Erich Gruen (1984) The Hellenistic World and the Coming of Rome. 2 vols. Berkeley, CA: University of California Press.
The literature on early Christian martyrdom is enormous. For a fairly recent bibliographical overview see Salisbury, pp. 209–222.
Coleman, pp. 44–73; Salisbury, pp. 119–134; Harries, pp. 135–152; Carlin Barton (1993) The Sorrows of the Ancient Romans. Princeton, NJ: Princeton University Press, pp. 113–175.
Scarry, p. 137; Michel Foucault (1977) Discipline and Punish. The Birth of the Prison. Transl. by A. Sheridan. New York: Vintage.
Acts of Polycarp 17.1; 19.2.
Eusebius, Historia Ecclesiastica 5. 1.24; Perkins, pp. 104–123.
For further discussion see Susanna Elm (1999) “Sklave Gottes – Stigmata, Bischöfe und anti-häretische Propaganda im vierten Jahrhundert.” Historische Anthropologie 8 (3): 345–363.
Ramsay MacMullen (1986) “Judicial Savagery in the Roman Empire,” Chiron 16: 147–166; Harries, pp. 118–131; Asko Timonen (2000) Cruelty and Death. Roman Historians' Scences of Imperial Violence from Commodus to Philippus Arabs. Turku: Turun Yliopisto.
Eus. Historia Ecclesiastica 8.6.2; 8.9.4; 8.10.8; Just. Dig. 22.5.3.1; Harris, p. 131.
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Elm, S. (2009). Roman Pain and the Rise of Christianity. In: Elm, S., Willich, S.N. (eds) Quo Vadis Medical Healing. International Library of Ethics, Law, and the New Medicine, vol 44. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-8942-8_4
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