Professor Joanna Bourke’s ninth book tackles the history of pain, and is meticulously researched, interesting, and well written. Dr Peter Mere Latham wrote in the mid-19th century that “every man smarts with his own pain”. The acceptance that if a patient says they feel pain then they are suffering is one that is still a basic tenet of pain control.
Bourke examines some of the reasons why it is not easy to communicate pain. Sometimes language is inadequate to express it. Talking about pain may remind the individual of their suffering. Patients may be reluctant to distress care-givers, a sentiment recognised by the economist Adam Smith. Those in pain often spurn communication. The Scottish philosopher Dugald Stewart believed, in 1828, that expressing pain was rude. Bourke looks at the stigma associated with some kinds of pain, especially venereal disease, and, to a lesser extent, chronic illness, where the source of pain may not be visible.
Bourke discusses how in the past, pain was seen as God’s will, with sufferers being told that their pain was due to improper behaviour. In a chapter on diagnosis, Bourke mentions how sometimes any diagnosis is better than none, and cites the example of Henry James’s sister, Alice, who had suffered pain for 20 years and was relieved when she was finally diagnosed with heart problems and incurable breast cancer.
There is a fascinating section on doctors judging patients. In the past, doctors assumed patients from other cultures could not experience pain as acutely as the British could. One doctor even suggested that British women experienced more pain menstruating than African or Asian women did in childbirth. There are anecdotes that will raise eyebrows or snorts, such as one doctor’s pronouncement that pregnant British women should abstain from physical activity – except for housework.
There is a chapter dedicated to the subject of the insensitivity of some doctors. This is partly due to the maintenance of professional detachment. Bourke is frequently entertaining, as when discussing the 17th-century belief in an Organ of Destructiveness, purported to be particularly large in surgeons and butchers.
My only quibble is that in the introduction, Bourke occasionally lapses into the language of academia, and risks losing readers. But on the whole, this is a compelling history of a great source of human misery.
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