Joanna Bourke, Professor of History at Birkbeck College, presents an in-depth analysis of the language of pain and its interpretation by sufferers and clinicians drawn from Western literature of the past three centuries. This book is not a physiological description of pain or a handbook of pain control. Who is it for? Anyone wanting a deeper understanding of pain and its meaning for them and their patients, for those involved in pain clinics, palliative care, and pain research.
The earlier chapters explore the difficulties of describing and defining pain. Love has a rich language, pain a thin one, although Bourke does a fine job in distilling what has been written. Using frequent quotes and illustrations she unpicks the struggle of communicating pain to others and the estrangement pain produces.
The use of metaphor to describe pain has evolved with militaristic, mechanical, and industrial metaphors replacing those from classical literature, nature, and rural life. Electricity entered early on into the language of pain and remains with us today in descriptions of neuropathies and neuralgias.
Religion is shown to interpret pain as being a consequence of sin and yet a force for personal improvement, as well as a path towards salvation. For many the invention of chloroform and ether anaesthetics and effective analgesics dealt a serious blow to the doctrine that pain was a spiritual good and a secular backlash to this view ensued.
The final chapter on pain relief deals with the advent of anaesthesia and morphine and the reluctance of the medical profession to employ these agents. Today the persistence of poor pain control, especially for patients with chronic pain despite the availability of powerful analgesics and supplementary treatments is perplexing. Bourke examines possible causes from both sufferers and clinician perspectives and concludes that:
‘Pain does not emerge naturally from physiological processes, but in negotiation with social worlds.’
Patients in pain are a constant feature of our professional lives and produce mixed emotions in us. This book helped me think more widely around the meaning of pain and is an encouragement to do better.