Throughout history, humans have experienced pain as punishment from the gods, a metaphysical struggle, or a simple biological process. Journalist Melanie Thernstrom, author of The Pain Chronicles, talks about the different ways humans have tried to conquer pain over the centuries.
Dr. Stieg: Today I'm with Melanie Thernstrom, a journalist and author of several books including the New York Times Best Seller, The Pain Chronicles. She served on the National Academy of Science Institute of Medicine's Committee on Advancing Pain Research, education and care in response to a congressional mandate to investigate the state of pain treatment in the United States. Melanie, thank you so much for joining me.
Melanie Thernstrom: Thank you for having me.
Dr. Stieg: In reading through your book, one of the things that I thought you did a superb job in describing was kind of the history of pain as part of the human condition. I think from watching Jurassic Park, we know that even the Tyrannosaurus rex experienced pain. It's a common phenomenon across all species. I'd like to spend a little bit of time going into that and can you tell us what you learned when you were looking at the pre-modern world, how they experience and express pain.
Melanie Thernstrom: I wonder if I should first address that idea that pain is common to all species pain in the sense of a pain reflex, a reflex that allows the creature to protect itself from tissue damage is common to all species. But in humans, pain is not just a bodily experience. It always draws on the meaning-making parts of the brain, and so pain is always a very profound experience that involves unhappiness, suffering, dread, anxiety, a whole cloud of human emotions. That is not something that the Tyrannosaurus rex experiences.
Dr. Stieg: So we'll take it to something a little bit more recent. A dog, a dog does suffer. I mean, they have the reflexive pain, but they also suffer. They demonstrate sad behavior. I don't want people to think that our animal pets don't suffer. How should the human, when they see the level of suffering that an animal can have, how should they cope with that? And is the animal pain taken on by the human as well? Then they both suffer?
Melanie Thernstrom: Sure. People who are attached to their pain are, are suffering with the animal. You know, may not be reflecting on will this infection kill me? You know, what is the meaning of my death? And the human may very much be reflecting on that and you know, worrying about the loss of the animal.
Dr. Stieg: So let's get back then to the earliest cultures, say Babylon, Ancient Egypt. Do the individuals in those cultures suffer differently? And we'll go through all the different periods, but how did they suffer differently than maybe we do today?
Melanie Thernstrom: That is a very profound question because pain sits right on this juncture of biology and culture. And so the question of to what extent pain is a universal human experience and to what extent it's influenced by the culture in which you live is a very deep one in the, what I would call the pre-modern view of pain. The ancient view of pain. Pain is not just a bodily experience. It was always understood to be a spiritual signifiers, fused with meaning, with metaphysical meaning and metaphors, and the oldest writing in the world. The cuneiform tablets of ancient Mesopotamia are very preoccupied with physical pain. Indeed every religion centrally addresses the question of why humans suffer pain and in ancient Mesopotamia as well as Ancient Egypt, Ancient India, pain is the result of a cosmological contest between demons and deities.
Dr. Stieg: So they really de-personalized it, is what they did.
Melanie Thernstrom: Yeah. That's an interesting way of putting it.
Dr. Stieg: What about if we move forward into the biblical period? Does the Bible, did it affect society so that they viewed pain or experienced pain in a different way? In contrast to the Mesopotamian population,
Melanie Thernstrom: Biblical pain is different because the gods of the ancient world are cruel and indifferent. Pain and illness can come as a result of the gods' displeasure, the gods' cruelty, the gods' carelessness, the God is enabling the demons to attack you. But in biblical pain because God is good and not powerful, you suddenly have this terrible problem of, well then why does he make humans suffer and why? Then are we in pain and Genesis centrally address his this as when Adam and Eve eat the fruit of knowledge and become self-conscious. With it, they are condemned to pain. Adam is condemned to thorns and thistles and toil and Eve is condemned to pain in childbirth. And this pain is seen as the Latin word. It's poena as punishment for for their transgression.
Dr. Stieg: But then with the New Testament, there is a transition into forgiveness, grace and hope and pain was experienced differently.
Melanie Thernstrom: Physical pain is addressed in the Bible and in these three central characters, Adam, Job, and then Jesus. And in Job, Job questions, the righteousness of painting inflicted on him of, you know, why should I be punished? I'm a just man. And pain is defined in Job as a central test of faith. Faith is defined as that which you have despite in explicable pain. And that's what God tells Job. And then Jesus goes a step further and really, really kind of inverts the meaning where God becomes human himself in order to embrace and accept physical pain. And physical pain is elevated in the Bible that the very center of Christianity as that which a faithful person must embrace, and that is actually the very root to salvation, that participating in Jesus's pain will be redemptive.
Dr. Stieg: So let's jump forward then to the 17th century with Descartes and his model for pain. Can you explain that briefly for us?
Melanie Thernstrom: Yes. In the 17th century and 18th century with the enlightenment, the view of pain as a spiritual signifier really changes and it is suddenly seen as a biological phenomena and Descartes sees it as a bell in the brain that's being tugged upon by ropes that are helped by the body and so it's no longer punishment, it's no longer redemption, no longer demon possession. It is this simple mechanical function.
Dr. Stieg: And how does that change then in the 19th century where all of a sudden the anesthesia becomes available?
Melanie Thernstrom: The 19th century really continues. This idea of pain as a very simple mechanical thing. In the mid-19th century with anesthesia being invented, there is a sense of mankind has finally conquered pain. This terrible thing, the pain of surgery is very hard for us to imagine surgery before anesthesia, where people would be held down, you know, screaming, writhing with six assistants and the operation would have to be as quickly as possible because they could never really immobilize the patient and then suddenly the pain alarm is still, the person is in this faux coma and the surgeon's able to explore the body and patiently fix the problem. It's this huge revelation in medicine and this led to the idea of, we will conquer all pain, but in fact that idea did not prove to be true.
Dr. Stieg: So I'm interested, as I was reading through the book, it historically has seemed to me that although pain involves suffering in the human experience, it was viewed possibly as something positive, as a message from God — versus now in the 20th and 21st century, we're going to extreme measures of pain avoidance, hence the opioid problem that we're having. Is that an accurate assumption on my part?
Melanie Thernstrom: Yeah. I think it's accurate that people very deeply do not want to suffer pain and that there is no longer seen as a justification for pain and life is much less hard, brutal, and painful in many ways. And so we feel much more put out that we still are subject to this basic, you know, human condition as pain.
Dr. Stieg: Because I'm interested in some cultures that actually seem to revel in inducing pain. You know, making somebody walk across hot coals as a symbol of, I dunno, loyalty to the culture or cutting processes and things like that. Where does that fit into this whole basis of pain throughout history and society?
Melanie Thernstrom: Right. I mean, I would make a big distinction between the way that we experience chosen pain and the way we experience unchosen pain. Because pain draws on the meaning making systems of the brain, the meaning of the pain really changes the pain itself. Chosen pain seems very foreign from a modern sensibility, but you know, not only are there pockets of the world, these pain-causing religious rights still exist, some of which I've actually witnessed. There's also in a secular context, we know some women elect to have childbirth without anesthesia and finding it a meaningful experience. They embrace the pain of childbirth. There are athletic feats: soldiers in battle, hazing. The pain of sadomasochism differs very differently from the pain of sexual abuse. So when a person wants to have pain because the pain is meaningful, the pain strengthens their identity rather than weakens their identity. It's a very different pain.
Dr. Stieg: That's what I've always been interested in. I used to have a friend that could go out and run a marathon with no training whatsoever. You know, I'd start training my hips and my knees would start hurting shortly thereafter and I'd never finish the marathon. How can some people do this? It can't just be the endorphins kicking in, you know? I mean there's something about the way they perceive their body that allows them to go through this thing that's painful. Or when I think about individuals that purge themselves, you know, they go on to this hot water, lemon, and ginger diet for a month and they don't eat. There is pain associated with that, you know, hunger, pain and they still do it.
Melanie Thernstrom: There is a pain perception system in the brain. There is also a pain modulation system and it's kind of an interesting thing. As a researcher said to me, we're all born with a dial to control pain. We just don't have control over that. And everybody's different. Everybody is different. We're all wired with the ability to control pain. And so marathon runners — the pain modulation does release a flood of endorphins and you're, you may be thinking, How can it be that powerful? But actually pain information comes in from the brain and the brain sends down on signals to enhance those and generate an experience of pain, or off signals to stop that pain information. And it's when the brain doesn't want the pain information, it stops it at the spinal cord level and it never even continues to come into the brain. And that's why pain modulation can be complete relief.
Dr. Stieg: So Melanie, could you go into some of the self mutilating rituals that you've observed in the process of writing your book?
Melanie Thernstrom: Yes, for the most part, self-flagellation self-mutilating has died out of modern religious practice, but I was very interested in the idea that it still remains in some pockets of the world. And I went to Kuala Lumpur to observe the Hindi festival of Thaipusam. And I was very interested in the question of how can the pilgrims bear to inflict pain on themselves and how much are they suffering? Because I had seen pictures of the way in which the pilgrims would have fishhooks threaded through their backs and sometimes spears through their lips and they would hang heavy weights on these and then they would journey up barefoot to the top of a mountain. And when I went and observed, what I was stunned by is that these pilgrims having these excruciating things done by priests actually did not appear to be in pain. Their faces were at peace. They did not seem to have the involuntary signs of pain there. As the fishhooks is being threaded through their skin, their eyes are not tearing up, they're not wincing. And I realized the truth of what I had read about pain, which is this idea that the pain changes the pain modulation activation in the brain. And because this pain was something they wanted, something that strengthened their sense of themselves and identity, their brain was shutting down the pain at the spinal cord level and they were not in pain.
Dr. Stieg: So what we're saying is that industry in science is completely focusing on the wrong thing by creating new drugs to ameliorate pain and we should actually be working on more cognitive therapies to alter our perception of pain.
Melanie Thernstrom: So I would make a distinction between acute and chronic pain. Chosen pain, like the pain of the pilgrims. This is acute pain that the brain can temporarily modulate if it wants to. I would distinguish that from chronic pain, which the brain cannot modulate and where current medical science is really inadequate to treat.
Dr. Stieg: Now that we've seen how humans have tried to understand and manage pain over the centuries, I look forward to delving into the science of pain, not only what is happening in our brains and minds, but also how we are treating pain today. Melanie, thank you so much for providing us with the history of humans understanding and management of pain and the difference between acute and chronic pain.
Melanie Thernstrom: Great. Thank you for having me.