Chronic Pain, Medieval and Modern

As of October 2016, I am embarking upon a new research project, entitled 'A Certain Suffering: Chronic Pain in Medieval France and England, c. 1100-c.1400'. My home for the next year is UCL's Institute of Advanced Studies, where I am one of two Junior Research Fellows interrogating the broader theme of 'Sense and Sensation'. Below, I sketch out the contours of the project, including some key areas of investigation I hope to probe. Over the next few months, I'll also be conducting a variety of research-led activities, including a Reading Group, Twitter chats with chronic pain sufferers, a medievalist conference, and a workshop for pain sufferers, academics, and medics. I've created this new 'Chronic Pain Project' section of the blog to corral all posts relating to this research, and I'll be posting details of all such events - so watch this space! 

 Harald – 'Pain!' (Via  Flickr ;  CC BY-SA 2.0 )

Harald – 'Pain!' (Via Flickr; CC BY-SA 2.0)

Project Outline

Pain is a universal human experience. We have all hurt at some point, felt that inescapable sensory challenge to our physical equanimity, our health and well-being compromised. Typically, our agonies are fleeting. For some, however, suffering becomes an artefact of everyday living: our pain becomes ‘chronic’. Chronic pain is persistent, usually lasting for three months or more, does not respond well to analgesia, and does not improve after the usual healing period of any injury. Following Elaine Scarry’s (1985) seminal work The Body in Pain, researchers from various humanities disciplines have productively studied pain as a physical phenomenon with wide-ranging emotional and socio-cultural effects (e.g. Boddice 2014; Cohen et al 2012; Davies 2014; Morris 1991; Moscoso 2012). Medievalists have also analysed acute pain, elucidating a specifically medieval construction of physical distress. Pain could be viewed as a positive, even welcome, experience in the Middle Ages (see e.g. Cohen 1995, 2000, 2010; Easton 2002; Mills 2005; Mowbray, 2009). Equally, pain loomed large in spectacular medieval punishments that concretised mechanisms of social control (see e.g. Merback 1999). In almost all such scholarship – modern and medieval – chronic pain has been overlooked. My research remedies this oversight, focusing directly on depictions of chronic pain in medieval texts.

The project’s central research questions are: how is chronic pain depicted in medieval narratives? What stories do chronic pain sufferers tell to make their pain relatable, even shareable? What stories do those around the sufferer tell in order to understand the pain they witness? Are such narratives different in the medieval period, in comparison to those utilised in the modern period?  Pain affects all human subjects across time, resisting any easy classifications of ‘medieval’ and ‘modern’ by its nature as a universal physical experience. The ways in which we conceptualise and express the experiences of pain, however, are definitively linked to the cultural and social frameworks inhabited by a sufferer in a given era. This study, then, dissects universal and temporally-specific experiences of chronic pain.

The new field of medieval disability studies has also neglected chronic pain as a primary object of study. Instead, disability scholars in the main focus on ‘visible’ and ‘mainstream’ disabilities, such as blindness, paralysis, and birth defects (see, e.g. Eyler, 2010; Godden and Hsy 2013; Metzler 2006, 2013; Pearman 2010; Wheatley 2010). Indeed, disability historian Beth Linker argued in 2013 that ‘[m]ore historical attention should be paid to the unhealthy disabled’, including those in chronic pain (526). I emphatically concur. My project directly addresses chronic pain and those who suffer from it, thereby pushing scholarship beyond current limitations. In this research, I engage with modern and medieval theoretical models of incurable pain – its causes, effects, and management – to uncover points of contact and divergence. It will enable us to rethink chronic pain in medieval culture, and hence to re-evaluate current attitudes to the phenomenon more generally. Furthermore, recent research by psychologists and pain specialists has demonstrated the central role of emotions in the incidence and management of chronic pain. Emotions directly impact on physical sensations. For example, a low mood will make pain feel more severe (Tang et al 2008). My research disentangles the interactions between emotions and medieval chronic pain experiences, thereby also developing the new field of the history of emotions. 

 Jef Safi - 'persistence of silliness and cynicism . .' (Via  Flickr ;  CC BY-NC-ND 2.0 )

Jef Safi - 'persistence of silliness and cynicism . .' (Via FlickrCC BY-NC-ND 2.0)

Beth Linker (2013) also seized upon an important facet of chronic pain: its capacity to destabilise the categories of illness, well-being, and disability (see also Brookoff 2005; Wendell 2001). Chronic pain is a ‘disease-less disease’, symptomatic of a ‘misfiring’ sensory response – there is no physical damage, yet the body still feels pain. Studying this phenomenon, then, forces us to consider questions of bodily and intellectual agency in the midst of physical discomfort. Can you ever feel ‘healthy’ when in chronic pain? Can you experience well-being whilst feeling that pain? Can that pain even be empowering? Such questions are particularly important to consider given the high incidence of chronic pain in the UK today. In 2008, the British Chief Medical Officer Sir Liam Donaldson estimated that 7.8 million Britons live with chronic pain (34). This number is ever increasing: each year over 5 million people develop chronic pain, but only two-thirds will recover. The National Pain Audit, conducted 2009-2012, demonstrated that chronic pain sufferers ‘endure a very low quality of life’ compared to sufferers of other conditions (British Pain Society and Dr Foster Research Ltd. 2012, 40). Moreover, 41% of the Audit’s participants felt that their local pain specialist did not help them in managing or understanding their pain (35). Greater understanding of chronic pain is desperately needed to improve individual experiences and broader medical practices.

Revealing the ways in which medieval sufferers attempt to share their pain narratively – and the kinds of narratives they are offered by social structures including medical practitioners, the Church, romance ideals and so forth – will better enable key stakeholders to listen to modern sufferers on their own terms, and ultimately permit all parties to talk more directly about improving patient care. Interrogating chronic pain allows us to speak to a wide variety of illnesses, as the phenomenon is often a symptomatic component of many diseases, including arthritis, IBS, and cancer.

Why turn to the Middle Ages to better understand modern chronic pain? I maintain that medieval frameworks for living with chronic pain have a lot to offer us. Specifically, in the Middle Ages, the experience of chronic pain was considered a valid – and potentially deeply positive – marker of social identity. Further, pain was represented as a shareable entity, quite literally travelling from body to body. For example, a medieval saint could take on the purgatorial sufferings of another individual to ‘work them off’ in their own body (Spencer-Hall 2015). How can we harness this approach of share-ability in the modern context to improve patients’ lives?

Pain is a fundamentally subjective and isolating experience; an individual cannot directly share in another’s physical pain, and pain itself often exceeds normal language. To transmit the essential nature of their experience to others, however, pain sufferers often turn to imaginative language and evocative narratives. Fictional texts capture these inventive articulations, showing the ways in which pain is linguistically constructed by and for sufferers, and the narrative frames of reference on offer for those in pain. With this framework, modern criticism that demonstrates the ways in which individuals suffering from illnesses deploy specific linguistic forms and narrative motifs will offer a potent heuristic with which to reconsider medieval depictions of chronic pain (see e.g. Frank 1991, 1995; Garro 1992; Jackson 1999). I do not intend to borrow anachronistically the contextual outcomes of modern theories. Instead, I borrow their questions, using the voices of modern sufferers that are embedded in such scholarship to talk back to, and with, medieval suffers. 

 Jef Safi - 'in-between the penultimate leeway still saying . . oOops !' (Via  Flickr ;  CC BY-NC-ND 2.0 )

Jef Safi - 'in-between the penultimate leeway still saying . . oOops !' (Via Flickr; CC BY-NC-ND 2.0)

Against this broader project backdrop, I am currently concentrating on two issues in particular: gender and temporality. Studies of medieval pain in a religious context almost exclusively focus on cases of suffering in the lives of holy women. I hope to offer a welcome corrective to the holes in present criticism, by studying the phenomenon of chronic pain in biographies of medieval holy men. Do holy men suffer differently than holy women? Are men subject to different kinds of (mis)treatment because of their pain? To what extent does gender play a role in the medieval experience of pain, in a religious context? Or is gender secondary to religiosity - i.e. the accepted holiness of a sufferer - in terms of the experience of chronic pain? 

Modern scholarship of chronic pain brings to the fore the temporal effects of the experience of disability and chronic pain, which often leads to sufferers feeling ‘out of step’ with ‘normal’ time (Godden 2011; Hellström 1998; Hellström and Carlsson 1997; Morris 2010; Toombs 1990). The temporal ambiguities provoked by chronic pain lend additional analytical productivity to a methodology based on combining modern and medieval materials. For example, do chronic pain sufferers exist – at least narratively – on a separate timeline than ‘normal’ individuals? In this, then, do medieval and modern chronic pain patients actually have a significant shared temporal/existential stance? Does my methodological approach, bringing modern theories in touch with medieval theories, mirror the inherent structure of chronic pain sufferers as community across time?

 

References

Boddice, Rob, ed., Pain and Emotion in Modern History (Basingstoke, UK: Palgrave Macmillan, 2014)

British Pain Society, and Dr Foster Research Ltd., ‘National Pain Audit Final Report’, British Pain Society, (2012) <http://www.nationalpainaudit.org/media/files/NationalPainAudit-2012.pdf> [accessed 8 January 2016]

Brookoff, Daniel, ‘Chronic Pain as Disease: The Pathophysiology of Disordered Pain’, in Expert Guide to Pain Management, ed. by Bill H. McCarberg and Steven D. Passik (Philadelphia: American College of Physicians, 2005), pp. 1-34

Cohen, Esther, ‘The Animated Pain of the Body’, The American Historical Review, 105.1 (2000), 36-68

Cohen, Esther, The Modulated Scream: Pain in Late Medieval Culture (Chicago: University of Chicago Press, 2010)

Cohen, Esther, ‘Towards a History of European Physical Sensibility: Pain in the Later Middle Ages’, Science in Context, 8 (1995), 47-74

Cohen, Esther, Leona Toker, Manuela Consonni, and Otniel E. Dror, eds., Knowledge and Pain (Amsterdam and New York: Rodopi, 2012)

Davies, Jeremy, Bodily Pain in Romantic Literature (New York: Routledge, 2014)

Donaldson, Liam, ‘150 Years of the Annual Report of the Chief Medical Officer: On the State of Public Health 2008’, UK Government Web Archive, (2008) <http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_096231.pdf> [accessed 12 January 2016]

Easton, Martha, ‘Pain, Torture and Death in the Huntington Library Legenda aurea’, in Gender and Holiness: Men, Women, and Saints in Late Medieval Europe, ed. by Samantha J. E. Riches and Sarah Salih (London: Routledge, 2002), pp. 49-64

Eyler, Joshua, ed., Disability in the Middle Ages: Reconsiderations and Reverberations (Farnham: Ashgate, 2010)

Frank, Arthur W., At the Will of the Body: Reflections on Illness (Boston: Houghton Mifflin, 1991)

Frank, Arthur W., The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995)

Garro, Linda C., ‘Chronic Illness and the Construction of Narratives’, in Pain as Human Experience: An Anthropological Perspective, ed. by Mary-Jo DelVecchio Good, ‎Paul E. Brodwin, ‎Byron J. Good and Arthur Kleinman (Berkeley: University of California Press, 1992), pp. 100-37

Godden, Richard, ‘Getting Medieval in Real Time’, postmedieval, 2 (2011), 267–77

Godden, Richard, and Jonathan Hsy, ‘Analytical Survey: Encountering Disability in the Middle ages’, New Medieval Literatures, 15 (2013), 313-39

Hellström, Christina, ‘Subjective Time and Temporality in Conditions of Pain’ (PhD thesis, University of Gothenburg, 1998)

Hellström, Christina, and Sven G. Carlsson, ‘Busy with Pain: Disorganization in Subjective Time in Experimental Pain’, European Journal of Pain, 1.2 (1997), 133-39

Linker, Beth, ‘On the Borderland of Medical and Disability History: A Survey of the Fields’, Bulletin of the History of Medicine, 87.4 (2013), 499-535

Jackson, Jean A., Camp Pain: Talking with Chronic Pain Patients (Philadelphia: University of Pennsylvania Press, 1999)

Merback, Mitchell B., The Thief, the Cross, and the Wheel: Pain and the Spectacle of Punishment in Medieval and Renaissance Europe (London: Reaktion, 1999)

Metzler, Irina, Disability in Medieval Europe: Thinking about Physical Impairment during the High Middle Ages, c.1100-1400 (London: Routledge, 2006)

Metzler, Irina, A Social History of Disability in the Middle Ages: Cultural Considerations of Physical Impairment (London: Routledge, 2013)

Mills, Robert, Suspended Animation: Pain, Pleasure and Punishment in Medieval Culture (London: Reaktion, 2005)

Morris, David B., The Culture of Pain (Berkeley: University of California Press, 1991)

Morris, David B., ‘Intractable Pain and the Perception of Time: Every Patient Is An Anecdote’, in Evidence-Based Chronic Pain Management, ed. by Cathy Stannard, Eija Kalso and Jane Ballantyne (Oxford: Blackwell, 2010), pp. 52-58

Moscoso, Javier, Pain: A Cultural History (Basingstoke; New York: Palgrave Macmillan, 2012)

Mowbray, Donald, Pain and Suffering in Medieval Theology: Academic Debates at the University of Paris in the Thirteenth Century (Woodbridge, UK: Boydell and Brewer, 2009)

Pearman, Tory Vandeventer, Women and Disability in Medieval Literature (New York: Palgrave Macmillan, 2010)

Scarry, Elaine, The Body in Pain: The Making and Unmaking of the World (Oxford: Oxford University Press, 1985)

Spencer-Hall, Alicia, ‘Christ’s Suppurating Wounds: Leprosy in the Vita of Alice of Schaerbeek († 1250)’, in ‘His brest tobrosten’: Wounds and Wound Repair in Medieval Culture, ed. by Kelly DeVries and Larissa Tracy (Leiden: Brill, 2015), pp. 389-416

Tang, Nicole K.Y., Paul M. Salkovskis, Amy Hodges, Kelly J. Wright, Magdi Hanna, and Joan Hester, ‘Effects of Mood on Pain Responses and Pain Tolerance: An Experimental Study in Chronic Back Pain Patients’, Pain, 138 (2008), 392-401

Toombs, S. Kay, ‘The Temporality of Illness: Four Levels of Experience’, Theoretical Medicine, 11.3 (1990), 227-41

Wendell, Susan, ‘Unhealthy Disabled: Treating Chronic Illnesses as Disabilities’, Hypatia, 16.4 (2001), 17-33

Wheatley, Edward, Stumbling Blocks Before the Blind: Medieval Constructions of a Disability (Ann Arbor: University of Michigan Press, 2010)