Reviewed by Jim Young
Published by Oxford University Press
The evocation of the experience of pain is the fulcrum of the lever used by sufferers, carers, and physicians to understand the phenomenon of pain.
How pain is perceived by these parties is a product of the expressions used to describe pain, the etymology of which is driven by the contemporary psychosocial mores unique to each milieu.
This book employs uncompromisingly academic reasoning to explore these mores and asks what pain is? Does it exist as an external entity? Or is it endogenous? For both the sufferer and the observer the question arises: are the perceptions of- and the associated attitudes to pain unavoidably subjective?
An etymological approach to the description of pain was an unexpected inception – but then again why should it be? The words, analogies and metaphors that were used constitute the historical signposts that describe and reflect contemporary understanding of physiology and of developments in society.
But it is not only the etymology of the words used to communicate the experience of pain “as an event” that is explored in Professor Bourke’s book, but also the irrepressible need to communicate the experience of pain. The corollary of which is the changing perception by the physician as to how much of a free-flowing pain narrative really needs to be expropriated for diagnosis and treatment to be optimised; and this perception is continually changing as “scientific” diagnostic procedures evolve.
The book is not a medical history as such but an all-encompassing elucidation of the history of the interpretation of experience of pain. It explores the dynamic interconnections between language and culture that colours the perception of the sensation of pain and the cognition that ensues.
The discursive discourse is replete with historical quotations from philosophers, physicians and from people in pain. The influence of the ubiquitous effects of religious belief and the perceived role of sin in pain, and the subsequent secular backlash, are not omitted.
The perception of pain as an essential compass for diagnosis is examined alongside the gradual diminution of the importance of the pain narrative as a diagnostic tool. A fascinating proposal is floated that the role of the pain narrative is shrinking and may be eliciting less trust by the physician. Starting from the time when sympathy was all that a physician could offer, the book pans to the present day where MRI scans, drugs, or surgery provide diagnosis and effective treatment, and where the psycho-therapeutic effect of a sympathetic demeanour, in response to an effusive narrative of pain may be reduced.
The book is exhaustively annotated and offers a large bibliography.
Although my first exploration of the unexpected parameters of the experience of pain was enthralling, I intend immediately re-reading the book in the expectation that the experience will be enriched from the perspective gained from my first excursion through this intriguing Story of Pain.