Knowing Pain: Book Review

Fran Cettl reviews Knowing Pain: A History of Sensation, Emotion and Experience by Rob Boddice (Polity, 2023), bringing his text into dialogue with the medical humanities’ exploration of pain.

Rob Boddice’s latest volume is not an ordinary history of pain, rather, it is a transdisciplinary tour de force.

Figure 1: Cover of Knowing Pain by Rob Boddice

Spanning from antiquity to the contemporary, Boddice forcefully resists reduced definitions of pain as merely a physical response to stimuli by illuminating the interconnectedness between knowing pain and experiencing pain in any given historical context. The author ties these disparate historical and disciplinary threads together through what he terms his “sustained denial of universality” of pain (Boddice, p.2). Instead, Boddice understands pain in this volume as “specific, particular, mediated, and contingent; body-minds whose agonies are connected to the cultures they inhabit; brains that produce pain that makes sense only in and through the context of its experience; authorities that make and disseminate the situated concepts of pain, through which suffering is made meaningful; historical politics of the medical and moral valuation of pain; pains that count, and pains that are invalid” (Boddice, p.1).

Despite its ambitious scope, Knowing Pain does justice to its approach, not least due to the effective decisions about content division and structuring into thematic chapters, as well as succinct yet telling chapter titles and subtitles that signpost the reader throughout. Having said that, at times it might feel like the frequent jumps between numerous examples across different historical periods could have been avoided in favour of focusing on fewer case studies developed at greater length. However, the seven thematic chapters consistently build up the line of argument, while the Preface and the Epilogue, albeit brief, offer an additional, deeply personal take on pain—the author’s own experience of long-term living with pain, and his reflection on the (im)possibilities for empathy in the world saturated with spectacles of pain.

The opening Chapter Scripting: The Politics of Knowledge traces the medical conceptualizations of pain, unfolding the theory of humoral flows throughout Greek antiquity and medieval Arab world, only to present us with a break in this history marked by the modern, Cartesian framing of the body in strictly mechanical terms, which has persisted to shape the more recent electrical and cybernetic metaphors. While humoral theory encompassed both physical and mental aspects of pain, the Cartesian approach has dramatically narrowed these parameters in western medicine, thus limiting the possibilities for healing too, though recently the paradigm might be slowly shifting towards more holistic, biopsychosocial models of pain.

Chapter Two Experiencing: Objectivity versus Subjectivity goes on to deconstruct the scientific rationalist and objectivist search for the universal measure of pain as well as its facial expression. The author traces this history from the 17th century French artist Charles Le Brun’s drawings to the 19th century French neurologist Duchenne de Boulogne’s photographs of the archetypal faces of pain, to the 19th century Italian phrenologist Cesare Lombroso’s use of the algometer to measure the subjects’ sensitivity to stimuli. Boddice effectively unpicks how the photographed models simply played to the prevalent expectations around painful expression while the device unsurprisingly confirmed the pre-existing assumption that ‘the criminal type’ is less sensitive to pain. Nevertheless, this search for the universals has unfolded ever since, all the way to Paul Ekman’s recent transcultural theory of emotions, whereby any ‘oddities’, such as that people in pain often smile, are simply explained away.

Fine pencil drawing on cream paper of a bald head with a furrowed brow and open mouth, expressing pain with  'Extreme Douleur Corporelle' [Extreme Bodily Pain] written above.
Figure 2: Charles Le Brun, Extrême Douleur corporelle (1702), Metropolitan Museum of Art           
Close-up photographic portrait of an older man frowning to the camera with wire sticks attached to his temples and chin.
Figure 3: Duchenne de Boulogne, Pain and Despair (1854-6), Metropolitan Museum of Art                    

In contrast to such rationalist attempts, the next chapter Worlding:  Expressing and Managing explores how the medium of art has allowed for painful experiences to materialise into alternative meaningful expressions.  For example, Louise Bourgeois’ deconstructive and performative take on the ‘hysterical body’ challenges its classical representations that were made famous by the 19th century psychologist Charcot at the Salpêtrière in Paris. The chapter also gives us an insight into how making pain and suffering meaningful has remained at the heart of different religious and secular worldviews. Some of them include the erasure of the world of flesh in favour of transcendent spirit in Christianity, or the evolutionary positioning of pain as useful for the survival of the species. A particularly interesting and important point that Boddice briefly raises and which would be worth exploring further, is the modern medicalization of childbirth and the associated elimination of pain in childbirth, that has left us with lost knowledge and fears over this natural process.

Figure 4: Louise Bourgeois, The Arch of Hysteria (1993), Museum of Modern Art.

The chapters on Suffering: Chronicity and Pain Syndromes, and Contextualising: Pleasure and Punishment both reassert the embeddedness of any pain experience in its historical context by showing us how chronic pain is meaningful as a specifically modern phenomenon, or how negative experiences such as torture need to be understood within their political framing. The author emphasises the critical potential of the concept of ‘crip time’, as introduced in disability studies, to refer to the lived experiences of non-normative relationship with linear time. In the case of chronic pain patients, such experiences foreground and inevitably disrupt the never-stopping, cost-reducing ticking of the capitalist clock.

Chapter Five Commiserating: Sensing, Feeling, and Witnessing the Other in Pain might possibly be the most controversial, in terms of challenging the concept and experience of empathy with the suffering of others as the universal ground for common humanity. In deconstructing empathy, the author draws on Susan Sontag’s diagnosis of contemporary media as so saturated with violence and death that we have no choice but to become indifferent to others’ suffering, and also points out the historical limitations and exclusions of the Enlightenment universalist appeals to sympathy. Boddice ends up arguing that if history has taught us anything about empathy, it is that humans have consistently misunderstood or failed to recognize the suffering of others, especially those who do not share the same circumstances, and animals even more so, as their experiences remain inaccessible to us. However, it could be argued that the Buddhist worldview, which the author briefly mentions in Chapter Three as positioning pain and suffering in meaningful ways, offers an alternative perspective on suffering and empathy with all beings, in the words of His Holiness the 14th Dalai Lama:

“All sentient beings, human beings included, want happiness and do not want suffering (…) Therefore, it is important to lead a life in which we try to benefit others as much as possible or, at least, restrain ourselves from doing harm”.

His Holiness the 14th Dalai Lama, “Happiness from a Buddhist Perspective,” p. 5.

Opening up a constructive dialogue here with the Buddhist tradition when it comes to the link between suffering and empathy, but also more widely, seems to me like an auspicious research avenue within medical humanities.

Finally, Boddice’s last chapter Embodying: Placebo/Nocebo focuses on the phenomena of placebo and nocebo, as a belief that healing will work, and a belief that something will have negative consequences, respectively. The author effectively dismisses the few historical views that would easily discount the entire pre-modern medical history as placebo in the sense of quackery or pseudoscience, by pointing out insightfully how the very power dynamics between doctor and patient in any medical encounter already works as a form of placebo (something I believe all of us have experienced). This chapter in many ways reads like the beginnings of a history of the placebo and the nocebo phenomena that is yet to be written, and I for one very much hope to see Boddice’s further work on this.

Until then, Knowing Pain is a very lively and insightful contribution to medical humanities that will be of interest to both scholars in the field and wider audiences.

About the Author

Dr Fran Cettl is an Academic Skills Tutor with Durham Centre for Academic Development. Her PhD research focussed on the intersections of science fiction, Gothic fiction, and biopolitical theory. She is co-editor of Pulse: the Journal of Science and Culture.

References

Boddice, Rob. Knowing Pain: A History of Sensation, Emotion, and Experience, Polity, 2023.

His Holiness the 14th Dalai Lama. “Happiness from a Buddhist Perspective,” Journal of Law and Religion 29, no. 1 (2014): 5-13.

Sontag, Susan. Regarding the Pain of Others, New York: Picador, 2003.

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