How do we convey an experience of pain to others? This question – which has long fascinated scholars in the medical humanities – is addressed in a new book, reviewed here by Susanne Main.
Communicating Pain examines the experience of living with chronic physical pain and is adapted from Stephanie de Montalk’s PhD in creative writing. The text raises the issue of what can be said or written about chronic pain that can truly be understood by another person, together with the question of whether it is possible to ‘successfully’ convey pain using language. This itself raises a question of what it is to convey pain successfully, and how this can be assessed, which is also touched upon in the monograph.
While persistent pain may exist through congenital or late-onset health conditions, de Montalk’s semi-autoethnographic creative writing text opens as many narratives of pain do, with the relating of an accident. For de Montalk, the onset of long-term pain followed a heavy fall onto a marble bathroom floor, leading to nerve damage. Ensuing difficulties with social interactions are described, such as lacking the energy to socialise and being too uncomfortable to do so. The transition from receiving expressions of interest and sympathy (following her accident) to a growing sense of isolation, being disbelieved and dismissed, is a common one among people living with chronic pain and is given a light but powerful touch by de Montalk. There follows an overview of how pain is discussed in creative forms, history and through the social sciences. Scarry’s argument that pain ‘shatters language’ (1985: 5) has been cited widely in academic pain literature. This is increasingly being challenged by literature around chronic pain and it is refreshing to encounter a text which explicitly sets out to explore whether it is possible to tell a personal story of chronic pain, within the ‘imaginative framework of literature’ (de Montalk, 2019: 5).
The second chapter describes de Montalk’s entrance into nursing, touching upon learning to how to deliver care to patients. Doubtless this career will have influenced de Montalk’s experience of receiving care and living with pain. It would have been interesting to see greater use of this biographical detail in an explicit way in the text. Instead, the chapter alludes only briefly to the author’s experiences of nursing patients with pain, and of being on the medical provider side of interactions, before becoming a patient with chronic pain.
Moving on, experiences with pain at different ages are relayed. As chronic pain naturally cycles through flares and remissions in severity, it is common that symptoms may not be severe when a healthcare appointment is attended. In de Montalk’s case, she is informally advised to do her best to exacerbate the condition, to aim for at least a 3 out of 10 on the pain scale, in order that she will meet the criteria for treatment. Those of us who have been through the process of seeking diagnoses and treatment will empathise with the irony and frustration of this. De Montalk’s exploration of ‘cures’ of various scientific merit, which she pursued with differing levels of belief and expectation, are related without such depth as to become tiring but serve to effectively demonstrate the path so commonly followed by many of us living with chronic pain.
Subsequent chapters use creative writing to imagine some experiences of pain lived by various famous thinkers. These include an imagined conversation with French novelist Alphonse Daudet (1840-1897) who wrote of his own pain (Daudet, 2002), and an historic overview of the life of social theorist Harriet Martineau (1802-1876), followed by a narrative poem set in her sick-room. These are followed up with a ‘contemplation’ of Polish poet and intellectual Aleksander Wat (1900-1967), interspersed with interludes about the author’s contemporary life, providing an innovative connection between author and subject.
The subjectivity of pain can create tensions for someone living with pain, as it often leads to concern about not being believed. Positioned in the medical humanities field, Communicating Pain provides an effective and successful exploration of what it is to live with, and write about living with, chronic physical pain. As someone who lives with pain, I empathised with the discussion of what it is to understand someone else’s pain and how this is possible, if at all. Knowing that there are others in similar situations, de Montalk was motivated in part by her hope to do for others what Daudet’s text had done for her. As Daudet wrote, there is ‘astonishment and joy at finding others who suffer as you do’ (Daudet, 2002: 31-32). Additionally, de Montalk had set out to raise the ‘common understanding of chronic pain’ (2019: 188) and to explore the paradox of writing about personal pain, given pain’s resistance to verbal expression. In exploring these ideas, de Montalk asks whether the expression of pain can only be understood by those who also live with chronic pain. The issue of authenticity – of the need for texts to authenticate themselves by drawing on the author’s lived experience – makes for a thought-provoking read. This discussion raised questions for me: should a text written about pain, by someone who does not live with it, be described as lacking authenticity? If the expression of pain may only truly be understood by someone experiencing it, can a text about pain achieve credibility if it is not written by a person living with the condition? Linked to this, de Montalk asks which was a greater influence: the language and storytelling of the writers she had read, or the fact that she was also in pain (de Montalk, 2019: 190)?
As I write, I am aware of my own pain and the extent to which I was able to recognise the truth in de Montalk’s text and so I find myself asking the same question of it. I feel that de Montalk successfully conveys the difficulties of writing about pain, while in pain. However, the success of her representation may be more apparent to me because I live with the same (or similar) difficulties and so I identify with what she describes. A reader without such lived experience might feel that they do not gain greater understanding of chronic pain. This is an unresolved (possibly, unresolvable) question in de Montalk’s work and in the field of chronic pain more broadly.
Communicating Pain sets out to explore the possibility of whether a chronic pain narrative can be told within the discipline of creative writing. When contemplating her success in this task, de Montalk’s doctoral supervisors asked her, ‘What haven’t you said?’ [sic] (2019: 190). This question is not answered but I think it speaks to the nature of trying to explain pain; it can feel that there is so much to say but also so little. As a reader, one’s feelings about whether de Montalk succeeds in communicating pain may be determined by one’s own personal experiences with pain. However, for me, de Montalk has provided a compelling engagement with the question of what it means to live with chronic physical pain, and the puzzle of trying to communicate this experience to others.
Daudet, A., 2002. In the Land of Pain. London: Jonathan Cape.
de Montalk, S., 2019. Communicating Pain: Exploring Suffering through Language, Literature and Creative Writing. London: Routledge.
Scarry, E., 1985. The Body In Pain: The Making and Unmaking of the World. Oxford: Oxford University Press.
Communicating Pain: Exploring Suffering through Language, Literature and Creative Writing by Stephanie de Montalk was published in 2019 by Routledge.
Susanne Main recently completed her PhD, Exhibiting Pain: Using creativity to express chronic physical pain with The Open University. The research exhibited creative representations of people’s own lives with chronic physical pain. Audience responses to the works were analysed using a reflexive approach that acknowledged Susanne’s own chronic pain experiences. The works can be viewed at: https://exhibitingpain.wordpress.com/. At this time, Susanne works as an Associate Lecturer with The Open University and is developing her doctoral research for publication. Research profile: https://www.researchgate.net/profile/Susanne_Main
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The Illumination by Kevin Brockmeier (Pantheon Books, 2011) is another fictional take on pain, but one in which he explores how we might react to the pain of others through a series of six individual, but connected stories. The Illumination (light emanating from the body site of the pain) is the fictional analogue he uses to give pain, injury, and pathology an undeniable and observable form. It allows everyone to see the pain of others and everyone to see how we react to it. I elaborate more on what this book tells us about pain and how people react to it or ignore it here: https://www.accordingtothearts.com/2020/01/27/the-illumination/.