Pain Is Inevitable, Suffering Optional

Transcript

Pain is both a universal and a deeply isolating experience. It is perplexingly difficult to convey a precise description of it to another person. Yes, we call it hurt, ache, or even agony, but for something so ubiquitous, our vocabulary for discussing it is remarkably basic. Over the years, doctors have developed strategies for helping patients express their pain. They might ask us to point out the face of our pain on a chart or rank it on a scale of 1 to 10, but these measurements are ultimately just as personal as the pain itself.

Ruthie Lindsey: If I’m at a seven or if I’m at a five, that would be someone else’s like, oh my God, take me now. I can’t live any longer, you know?

Irene Tracey: I’m a total wimp. I took all the drugs, you know, as much as I could for my three childbirths. Absolutely. I was on that side of things.

Justin Wee: I mean, pain is such a personal experience, you know? So in our pursuit to try and have other people understand what we’re experiencing, there is a compulsion to want to compare it to something else, but the effectiveness of that is kind of debatable as well, you know? No one knows what it feels like when you broke your arm, you know, however many years ago.

Since time immemorial, art has been the ally of subjectivity, capable of expressing the ephemeral: love, beauty, and yes, even pain. In 1611, Peter Paul Rubens illustrated the pain of Prometheus, eternally bound to a rock and condemned by Zeus, the king of the gods to have his ever-regenerating liver picked upon daily by an eagle as a punishment for giving humanity the gift of fire. In 1873, Gustave Courbet depicted a trout hooked and bleeding from its gills as a representation of the agony he was suffering with alcohol induced liver failure. And in the early 20th century, Frida Kahlo expressed her experiences of chronic pain after a road accident left her with a fractured spine and pelvis. And so, as photographer Justin Wee also discovered through suffering chronic back pain, when words fail, images can prevail.

Wee: I visualize pain. If you would ask me to describe an ulcer, I would immediately think of something that was like very craterous and very treacherous, like the surface of the moon and like a golf ball. It’s the entryway into those crevices that feel so treacherous, you know, when you have an ulcer on your tongue and like you get a zip of lemon or something. That lemon enters the crevice of your ulcer and just kills you, you know!

Tracey: Seeing, hearing, tasting, smelling, you know, these are perceptions, they’re brain constructs, and pain is one of those perceptions. And so it’s something that’s yours. It’s private. It’s how your brain constructs it in the context in which you’re experiencing it and your particular mood and your cognitive state. So it will always be this subjective private thing.

Irene Tracey is the Director of Oxford University’s Nuffield Department of Clinical Neurosciences. She spent the better part of the past two decades earning her nickname, “The Queen of Pain” by examining the myriad factors that impact what pain means to each of us.

Tracey: I think what people sort of fail to remember is that when you’re developing to adulthood, your central nervous system, you know, your spinal cord and your brain, that’s putting together all these experiences that we perceive and feel, you know, that’s being wired up, that’s being developed, your brain is developing, it’s folding, it’s forming new connections. So, you know, as an adult, you end up with a brain that’s, you know, really a product of that nurture as well as the nature. And I think we’re only just scratching at the surface now with our brain imaging tools–and this is more broadly in neuroscience, not just pain–just how important that life’s journey is on the type of brain you end up with. In neuroscience and particularly in pain, you know, I think we’re recognizing just how important now that is.

And because pain is so formative to a person’s character, yet so internalized, it took Justin Wee a long time to understand that he was surrounded by people in pain.

Wee: I was just having a lot of conversations with my friends about, you know, the various types of pain that we were going through and it was very jarring to me because, you know, we all look to our friends as, you know, superheroes in our lives and I was baffled by the amount of pain that my friends were in.

And so in the hope of finding a better understanding, he asked these friends, all of whom are gifted visual storytellers, to interrogate their own interactions with the sensations and effects of pain.

Wee: So I put out a call out on my Instagram. One of the things that I asked them was if there was a color that you would attach your pain to, what would it be? If there was any sort of visual depiction of what your pain looks like, what would it be? What do you do when you experience the pain? And what do you do right after you experience the pain? Because pain is not just about the moment and the incident of it, it is about how you build your life around it as well and I really wanted the still lifes to not just be like a general representation of pain, but I wanted them to be a very specific representation of someone’s pain, you know, because pain is so personal. When I started the project, I was like, okay, cool, I’m going to do my own image on my own back pain and that’s going to be mine. And then my friend DMed me and she was like, oh, I also live with chronic back pain. And so I asked her to fill out the survey and the way that she described her back pain was so visceral and so, I mean, the language used was so stunning that I ended up using her words to create the image. And what I loved most about her particular experience was that I could never have articulated my back pain in the way that she articulated hers, but it was so deeply resonant.

Author Ruthie Lindsey has survived a great deal of suffering in the past 25 years. At age 17, she was involved in a car accident that left her with a broken neck, punctured lungs, and a ruptured spleen. After a spinal cord fusion, she was miraculously able to walk out of the hospital less than a month later. But a few years later, Lindsey found herself riddled with mysterious chronic pain and reliant on painkillers. She documents her experiences in a memoir called, There I Am: The Journey From Hopelessness to Healing, published by Simon and Schuster in 2020.

Lindsey: I was a shadow of myself. I could not experience goodness. Everything was dimmed. Like I didn’t notice flowers. I didn’t notice sunsets. I didn’t notice my partner, my friends, my family. I mean, my nieces and nephews were born in that seven years. I didn’t see them.

AJC: I know you had a spiritual upbringing. Did you have to unlearn the idea that pain is necessary for redemption or did that ever enter your head?

Lindsey: There’s a lot of things that I’ve had to unlearn. I was a part of a church that said I was a broken depraved wretch, and I believed it with every part of me. I thought I was, something was fundamentally wrong with me. I was taught original sin, which there’s no, those words are never in the Bible, and you know, because of that, I thought I was broken. Something outside of me needs to come and fix me.

And there are many more recent examples of artists and musicians exploring suffering through their work. Kurt Cobain, the leader of the hugely popular 1990s grunge rock band, Nirvana, suffered chronic undiagnosable stomach pain. When conventional medicine failed, he sought relief in illicit drugs. A heroin addiction would eventually lead him to take his own life at age 27.

And so for a lot of artists, their work has alleviated at least some of their suffering. This wouldn’t surprise Irene Tracey as she has continued to discover through her research much of our physical experience of pain is determined in part by what’s going on in our brains.

Tracey: You know, if pain is physically generated through a physical injury, we, again, society was slightly more comfortable with that and there is a bias towards that, well, that’s real pain, and then this other one that’s more generated by brain networks without an input is sort of second class and isn’t really serious and I’ve written very emphatically on this that that is not correct. You know, pain is pain. It is a brain based experience. It is produced by networks of brain regions coming together and I don’t care whether your pain has been generated by brain networks or been induced from inputs. It doesn’t matter. It’s important to know, because then you know where to target to switch it off, but pain is pain, and therefore it should be the both. They’re not first or second class. They’re both first-class pains. We’ve got to deal with them as equal.

But if pain is pain, then is that which is caused by emotional distress rather than physical injury the same thing? Irene Tracey says that science is not yet ready to answer this question.

Tracey: So some of the experiments that have been done by other great colleagues and teams, notably in the US, has been to look at say, let’s look at the say, emotional pain side and the non-physically induced pains, where they will look at how does the brain activate when it’s in an emotionally pained state, because you’ve induced a sense of being socially excluded, or you’ve looked at the brain pattern as I’m saying, looking at somebody, being stabbed with a thing, and I’m like having an empathic reaction towards that. And what you find is that whilst there really are very important differences in certain brain regions that are not active that you would expect to see active to if I just stabbed you with a knife, there’s an awful lot of overlap too, and the overlap tends to be in those areas of the brain, the more emotional parts of where the brain reacts to the emotional side of pain. So there’s this interesting overlap, but difference too, and those experiments are still continuing and refining our understanding of the extent of that overlap and that separation.

Recognizing the neurological link between the physical and emotional aspects of pain might also help us to understand the role that creative expression has to play in shaping our subjective experiences of pain.

Wee: We’re entitled to feel our hurt and our frustration, our sadness at the ways that our bodies are changing, our sadness at the things that, you know, have happened to us that have caused us this pain, and, you know, we should make space to feel those things, you know?

Lindsey: If you experience the beauty, you have to allow yourself to feel and experience the pain and trauma and it is, it’s brutal. It’s brutal. But it’s also, that is a full, whole-hearted life.

And so, as our understanding of pain expands, art may be a useful ally helping us to process our hurt but also offering the possibility that we might connect with one another in the open, engaging our pain fully, rather than hiding it away.