The Pain Chronicles (7 page)

THE PLACEBO DILEMMA

A friend of my mother’s told me he had a Q-Ray bracelet that warded off his knee pain with magnetic rays. Previously hobbled by pain, he could now run for miles. He had researched the bracelet and was dismayed to discover a study showing it to be a placebo, which he didn’t believe. Once, he took the bracelet off and realized he had forgotten to put it back only when the pain caught him by surprise.

“Perhaps your subconscious knew,” I suggested.

My mother gave me a look.

A woman in my building showed me the copper bracelet that had cured her arthritic elbow. She wore the homely piece of metal every day along with her art deco cocktail rings and diamond tennis bracelet.
What do you think the connection between copper and arthritis exactly is?
I started to say, but thought better of it. Why spoil it for her? Was I jealous of her relief?

One night, I stared at a candle and had the impulse to burn myself and remind my body what normal pain was—the kind that could be bandaged. I tried to understand pain through psychoanalysis. (Why my
right
side? Is it connected to
writing
, since I’m right-handed?) Was I looking for a subconscious excuse to avoid work—to feel literally pained when I did it? That was how the Victorian affliction of hysteria worked.

I tried positive visual imagery, using a workbook on illness and positive thinking, but the blue, celestial light with which I tried to imagine my pain turned to an evil, ashy gray. I tried acupuncture, massage, and herbal remedies.

“I’ll take all of them,” I told the surprised salesman in the health food store after listening to all his recommendations for pain relief remedies.

I had always been skeptical about natural remedies because, in addition to not having been tested for efficacy or safety, they aren’t natural. Although they
derive
from plants they are actually formulations of compounds isolated from plants and presented in hundreds or thousands of times the concentration in which they are found in nature.

But if I took these remedies with a dose of skepticism, would they definitely fail? I didn’t understand how placebo works at a physiological level, but I had heard many times that if you believe you are being relieved of pain, you will experience (deluded?) pain relief. Yet I always got stuck on what I thought of as the Placebo Dilemma: Knowing that the relief was a result of placebo, how could I believe in it? In order to work, didn’t placebo require precisely
the belief that the treatment was something other than placebo
? Yet, if the effectiveness of the placebo testifies to the transformative reality of belief, shouldn’t that make it easier for me to believe? I felt like doubting Thomas asking Jesus to remove his unbelief.
In order for God to save me, all I have to do is believe He exists.

There is a story about a famous physicist who put a horseshoe on his office wall. “I thought you didn’t believe in that kind of thing,” remarked a puzzled graduate student.

“They say you don’t have to believe in it for it to work,” he replied.

If I wore a copper bracelet, was I revealing my desperation, my willingness to forsake the person I used to be, who knew that copper doesn’t penetrate skin (luckily, as it is poisonous), or was I demonstrating to the universe that I was open to being healed in any way, including ways I didn’t believe in?

I kept flashing back to a conversation I once had on a reporting trip in Addis Ababa, on a day when I was wandering around stricken by inexplicable pain. On a street corner I had seen a leper whose arm was dissolving. His right hand was dripping off like a melting candle; in his left, he held a mango. He seemed to understand my question, as he laughed shyly and said he was “okay.”

“No pain?”
I repeated, staring at him amazed, and then went back to the hotel, ashamed, and got a massage. As the therapist put her warm hands on my shoulders, I closed my eyes and remembered how the leper ate the mango and laughed at me.

REPRESSED NEGATIVE EMOTIONS

I arrived to visit friends at their beach house for the weekend in a daze of pain. Although I didn’t want to explain, I had a neck wrap in my suitcase that I was longing to use.

“I have this—uhh—stupid pain,” I said. “I have this wrap that is heated in the microwave—”

“Chuck used to have back pain!” Erin said. Her husband’s back pain, she told me, had melted—
melted—
away when he enrolled in the treatment program of Dr. John Sarno, a New York physician whose bestselling book,
Healing Back Pain
, they still had in the house. He had told our mutual friend Daniel about the book, too; Daniel went to the bookstore to check it out, hunched over with pain, but by the time he walked to the cash register—having read only a few chapters in the aisle—he was standing straight.

Sarno explains that the major cause of most back, neck, shoulder, and limb pain is a syndrome that he terms
tension myositis syndrome
(TMS), which is a controversial notion. By assigning their pain a medical-sounding term (which means—more or less—tense, painful muscle syndrome) people can feel validated with a medical diagnosis. However, people with TMS pain are also reassured that (unlike for most medical conditions) the cure lies entirely within their control.

Sarno asserts that repressed negative emotions such as stress, anger, and anxiety are the major causes of TMS, decreasing blood flow to muscles, nerves, or tendons, resulting in mild oxygen deprivation, which is experienced as pain and muscle tension. He has subsequently revised some aspects of his theory, but the fundamental tenets remain the same: when the negative emotions are addressed, the tension and pain disappear. His treatment works on the same principles as Freud’s treatment of hysteria: acknowledging the underlying emotional problems causes their physical manifestations to disappear. Although Dr. Sarno concedes that sometimes testing may be necessary to ensure that the pain is not from, for example, a tumor or a fracture, once these are ruled out, he believes that other pain is psychosomatic and that its function is to distract the conscious mind from its true sources of stress. Even when the pain syndrome begins after an injury, Dr. Sarno asserts, “despite the perception of an injury, patients are not injured. The physical occurrence has given the brain an opportunity to begin an attack of TMS.”

In Dr. Sarno’s work, patients are told that they must discontinue all physical treatments, such as physical therapy, medication, injections, chiropractic adjustments, acupuncture, or any other conventional form of treatment because these harmfully reinforce the mistaken notion that there is a structural causation for patients’ chronic pain when, he argues, “their physical condition is actually benign and . . . any disability they have is a function of pain-related fear and deconditioning.” Instead, they should resume all previous activities and the normal physical activity that pain had interrupted, while attending support meetings, writing about their emotional issues, and keeping a daily journal. Failing to acknowledge the psychological nature of pain is “to doom oneself to perpetual pain and disability.”

“You must renounce all treatments,” Chuck said, “and believe that your pain is all in your mind.”

“I know. But what if—” I said timidly.

“It would show up in an MRI. But you don’t need an MRI. Don’t baby your neck, don’t take Tylenol, ditch the microwave wrap! Just chill out and have a good weekend. Let’s hit the beach.”

In the months that followed, I faithfully scrutinized my life for
repressed negative emotions
: “abuse or lack of love,” “personality traits such as a strong need to be liked by everyone,” and “current life pressures.”

Unfortunately, all that self-scrutiny about stress was itself extremely stressful. Was it my relationship with Kurt, or was it a problem within myself? My neck and shoulders looked the same as always, but perhaps inside, something had crumbled. I’ve always had a sense of a certain inner crippledness, of my character as less than fully sturdy. There were mistakes in construction, internal beams that are weak. I reinforce them as best I can, but most of them are inaccessible—too much of my personality is built upon them. I had been depressed before. I always thought of depression like misty rain, the way the gray blankets consciousness, making it difficult to see. Pain felt more like a thunderstorm. There was an edge of violence amidst the rain—as the familiar terrain of the body becomes eerily illuminated—and then the futile scramble for shelter.

“Pain upsets and destroys the nature of the person who feels it,” Aristotle observed. The McGill Pain Questionnaire (the standard pain-assessment technique) asks sufferers about their pain using clusters of words that describe the sensory or affective dimensions of pain. Is the pain
Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding
? Or is it
Sickening, Suffocating, Fearful, Frightful, Terrifying, Punishing, Grueling, Cruel, Vicious, Killing, Wretched, Binding, Nagging, Nauseating, Agonizing, Dreadful, Torturing
?

I had been given the questionnaire once years before, when consulting a neurologist about migraines, and at the time the questions had seemed laughable. My headaches throbbed, but they were not cruel. But now I understood. This new pain
was
cruel—Cruel, Vicious, and Killing.

Time felt different. Pain, I realized, is not just every day, but
every hour of every day. Every minute of every hour.
When too many pain minutes pass, the hourglass balance between bearable and unbearable changes and the shape of self collapses. The more desperate I felt, the more I wondered if—as Dr. Sarno says—desperation itself was the problem. I remembered how I had stayed up late that night at my friends’ beach house reading Sarno’s book. But eventually, sleepless with pain, I crept back into the kitchen to heat my microwave wrap. The machine made a deep whirring noise; I pictured Chuck and Erin waking to hear me and thinking that I wasn’t ready to be well.

THISTLES TO THEE

Western medicine is one way to think about illness,” my grandmother Bea was fond of saying, “
but it’s not the only way.
” When I was a child, she gave me the central Christian Science text,
Science and Health with Key to the Scriptures
, a book I treasured, believing it contained the secret recipe to reality, a truth from which my secular parents were excluded (my father is an atheist and my mother a secular Jew). But although I love religion and sacred texts, the passion I once had for it—the sense that it held truths that might illuminate my life—had waned over the years, so that by the time I got pain in my early thirties, my interest in the subject was almost entirely academic.

For some reason, my neck and right arm were hurting. When I woke exiled by pain from sleep, I reminded myself that the reasons for this were not clear, but surely it was not a test or a punishment, or a payment for sin or a bid for immortality, or a curse, or a spell or an ordeal, or an opportunity for self-transcendence, or anything of the like. Not at all, actually. Those ideas come from the world of religion, in which I did not personally believe.

Whenever the thought of
poena
would suggest itself or I’d notice that the pain was surrounded by some other vague, dark cluster of thoughts, I would dismiss them. Again and again I dismissed them. And the thoughts were always there to dismiss.

Why me? Why must I suffer?

There is a curious teleological evolution of the meaning of pain in religions; indeed, the task of accounting for the presence of physical pain and suffering is so critical and so difficult that religions are defined by their various answers to that question. If I were a Hindu, a Buddhist, or a Jew, my faith would invest pain with a different meaning from the religions of ancient Egypt, Greece, Rome, and Mesopotamia. And if I were a Christian, a distinct conception of pain’s meaning would reside at the very center of my faith.

In the most ancient religions, pain and suffering pose no theological problem, because the gods, like the universe, are cruel. The karmic religions of Hinduism and Buddhism, by contrast, posit the framework of a just universe. The doctrine of reincarnation neatly removes pain and suffering from the unreliable hands of the ancient Indian gods and satisfyingly reinterprets it as
poena
—karmic retribution for transgressions committed in previous incarnations. In the monotheistic traditions, God is loving, attentive, and just. But what about pain and suffering? The problem is explored through three central characters—Adam, Job, and Jesus—who grapple with different conceptions of pain.

Physical pain comes into the biblical world with the Fall. Only after Adam and Eve steal godly knowledge and become self-conscious are they cursed, like animals, with pain and the struggle for existence. Both Adam’s and Eve’s pain are described with related Hebrew words derived from the same root. Adam uses the word
‘itstsabown
(
—“labor, toil, pain, sorrow, worrisomeness”), but Eve’s pain is described using the word
‘etsev
as well. The pain and sorrow to which Adam is condemned concerns the struggle for survival, while Eve’s involves reproduction.

The passage in which Adam is cursed in his struggle to draw subsistence from the ground employs not only images of toil but also of physical pain and the threat of wounds (“thorns also and thistles shall [the ground] bring forth to thee”). In Eve’s case, the sorrowful pain of childbirth stands as a metaphor for all pain, christening our very entrance into the world, as if setting the stage for a lifetime of suffering. The curse involves an exile from what one might conceive of as a natural state. One might imagine that the most basic functions that allow for the species to propagate—eating and reproducing—should not cause pain and suffering. And pain
feels
unnatural; while we can’t imagine human life without hunger or thirst, it is easy to fantasize about a life without pain and to picture that life as one to which we could or should return.

While embodying this fantasy, Genesis also seems to resolve it. Eating the fruit of the tree of knowledge created self-consciousness (“the eyes of them both were opened, and they knew that they were naked”). In biological terms, pain is indeed a function of consciousness, as the ability to suffer the former increases proportionally with the latter—with, that is, the complexity of the cortical development of a species. Do we really wish not to have tasted that fruit? Wouldn’t that be like wishing that we were still apes—or that we were a kind of creature who feels no pain at all, such as the centipede? Pain’s origin is thus justified in Genesis as the price of the consciousness that makes us fully human.

Why must I suffer?

Even if generally viewed as the price of consciousness, pain still seems unfairly distributed. Like the Righteous Sufferer in the Babylonian Poem, Job questions Genesis’s account of pain, asking not why does pain exist, but why does
he
, in particular, suffer from it?

Job’s trial begins when Satan suggests to God that Job’s piety has no value, since he is constantly rewarded for it; perhaps, after all, it is the reward Job loves, not the Lord. The trial of Job is progressive. First his livestock is taken, then his servants and children. Yet these hardships prove insufficient; he accepts them as the will of the Lord, prostrating himself and declaring, “The Lord gave, and the Lord hath taken away; Blessed be the name of the Lord.” God then gives Satan permission to subject Job to the ultimate test: physical pain. Job’s pain is nothing if not visceral. He feels as if he is being crushed, shriveled, about to burst open, torn; his kidneys feel pierced, his intestines boiled, and his skin grows black and peels.

As Job’s suffering continues, three of his friends insist that if he is suffering, he must deserve it and he should repent of his sins. The text refers to them as the three “miserable comforters.” Belief that suffering is deserved can be comforting, since a deserved sickness is just and curable by repentance. When people are casting about for explanations of sickness, they often point to sin because, after all, everyone has sinned. But Job
hasn’t
sinned; his case gives lie to the doctrine that pain is always
poena
and suffering is always divine retribution. Job’s wife believes that he has not sinned, but she shares the comforters’ theology. Unable to reconceive God, she becomes disillusioned and tells Job to curse God and die.

Eventually, Job breaks down and reproaches God. Late in the story, a prophetic figure enters who, in contrast to the comforters, declares that Job’s sin is imagining that he can judge God and reproach him for making him suffer. It is this point of view that the story endorses. When God finally speaks, it is not to answer Job, but to tell him that he cannot understand pain any more than he understands other mysteries of nature. (“Where were you when I laid the earth’s foundation?” God asks.)

The book of Job is not what one might expect from a theodicy. Although God explicitly condemns the theology of the comforters, He does not offer an alternate explanation for Job’s pain (or for why He is wagering with Satan). Job must bow before the whirlwind and accept that—although pain cannot be understood—its meaning somehow must not be incompatible with religious faith. The book of Job thus defines faith as
that which is upheld in the face of inexplicable pain and suffering.

The book of Job ends the same way the Poem of the Righteous Sufferer does, with the restoration of health. Job prostrates himself and repents of his arrogance in questioning God, and God restores Job to health and gives him riches, long life, and even replacement children. Seen from one perspective, Job’s passing the test reveals the test to have been unnecessary, indicating that his suffering was pointless and that God should not have permitted it to happen. Yet seen from another perspective, Job’s pain tests his faith, not only by causing him to demonstrate it, but also by
creating
it, in the way fire and hammering forge a sword. According to this model, pain is not extrinsic to faith, but rather is the ground from which faith grows and into which it sinks and extends deep roots—an idea that becomes the dominant conception of the New Testament.

Why must I suffer?

The Gospels reframe pain not as a problem for faith to overcome, but as faith’s central mechanism. The curse of mortality becomes
the solution to mortality
—the very means to eternal life. The God of the Gospels answers the problem of pain not by removing it from human life, but by sharing it, becoming human in the form of Jesus and paying his own
poena.
In so doing, he forever inverts pain’s significance. Just as God became man when Jesus shouldered Adam’s curse, man can become godly by accepting pain as Jesus did. By so doing, man transforms
poena
into passion, as Christ willingly submitted to crucifixion and its pain. In an era when people of many faiths wore amulets to ward off pain and disease, Christians began cradling an image of torture close to their hearts.