Pain-silencing dynamics

February 14, 2013

In The Body in Pain, Elaine Scarry explains why social pressure to hide pain can be so profound that in a tragic drama like Alkestis, the bereaved husband can be imagined suppressing his fresh heart-break because of the presence of an unexpected house guest. He hides his loss out of sheer terror that making his unhappiness known would bring his household into disgrace.

Would you like it better if I drove my guest away?
I’d look like I don’t know the rules of civility!
It would just add another layer of pain,
to have my house called inhospitable.

Scarry’s focus is on phenomenology, and how pain violates the barrier between ‘inside’ and ‘outside’ the body in disturbing ways that invoke the social anxieties of public/private dualism, loaded with suspicions of secrecy and misdirection. At the same time, she reveals how pain-silencing habits are unthinking responses.

We tend to shush people in pain impulsively, irrespective of the circumstances. This can be a comfort to the person so reassured that the fear behind their cries is needless now, but in chronic pain it is an effort to stem constancy and move the subject away from regrets.

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Early in the book, she rattles off various kinds of ways in which we silence one another’s expressions of pain – many of them unwritten rules, but taken together, a terrifying system of redundancies warning us forcefully not to cry out. Separated into a bullet list from the paragraph in question, these pain-silencing dynamics include:

  • Pain is a feeling that an “enemy” force has been internalized, violating the self’s integrity and making expression of pain a self-betrayal; to admit to feeling pain is a corruption of the will to resist defeat
  • Pain’s internal location implicating one’s own body in the cause of suffering; to believe in the existence of psycho-somatic pain is to fling skepticism in the face of every sufferer (e.g., ‘why don’t you try to take your mind off it?’)
  • Pain that does not let up is totalizing, a distraction from both the self and the environment, while pain that is “chronic” will return whenever your guard is down even if at times you can take your mind off it
  • Pain is unreal to others, in the sense that it is unshareable unless it is separately reproduced for the observer’s benefit (which they would not exactly welcome), and when its reality is held in doubt by observers, this doubles the aversiveness of hurt with the psychological aversiveness of being disbelieved
  • Pain can subvert the ability to communicate at all, monopolizing language in desperate complaint, or even overwhelming the psyche to the point that it is no longer verbally articulate
  • Pain expression that is convincing is obscenely humiliating, because it conflates the privacy of felt-experience with the utterly public experience of disability, handicap or complaint about punishment; the sufferer may expose his feelings to others, but this does not change the fact that they frankly prefer not sharing these feelings he has exposed, and if confronted about this, they offer recriminations like “misery loves company”

You could probably add scar-jealousy to this list, too; the listener’s suspicion that tall tales about a scratch have been embellished out of pride. Think of the scene in Mountains of the Moon when the great explorers strip to show their scars with jealous pride. But for all the good humor in theatrical bursts of enthusiasm for glory, like Henry’s Saint Crispin’s Day speech, pain is a grim topic even as the evidence behind “very true adventure” stories.

This makes the topic of pain silencing a sharp comment on complacency about a particular category among the “frontiers of justice” Martha Nussbaum identifies as intrinsic to neoliberal ethics, the disability stigma that reinforces any socioeconomic disempowerment that physical or intellectual disability entails for the injured, or otherwise crippled.

Silencing of expressed needs is a common element between the disability group and other frontiers of justice she identifies, such as childhood, animal status in an environment controlled by humans, and dependency on savings or “social security” in old age. It is the mutually reinforcing system of norms in neoliberal society that renders these frontiers weak in egalitarian principles and regressive in politics. In each group, status before a justice system that deters cruelty from violence and from neglect is jeopardized by monetary destitution or vulnerability to it.

As Richard says in The Legend of the Seeker, “if there’s one thing I learned from Denna, it’s how to suffer in silence.” It works, in some sense. Pain silencing isn’t the sort of discipline even a redeemed Mord Sith like Cara makes a consistent effort to unlearn. She’d know that would be inefficient, if not suicidal considering the amount of danger their quest is always putting them in.

Compared to competent resolve, maudlin self awareness is petulant unless you couldn’t have known better, and still the prelude to disaster, if so.

To have to assert pain in self-expression is thus a sign of desperation, risking every level of social rejection, from the casual to the insistent.

And even among helping professionals fully aware of the risk of misalliance in empathy and sympathy between care giver and recipient, a conceptual grasp of the danger of furthering the problem one offers to resolve may not make any difference.

Scarry’s book draws attention to the puzzling problem of ‘pain skepticism’ among medical professionals, deep-seated and difficult to square with modern standards of ‘compassionate care’. Strange that doctors, of all people, are characteristically unable to credit self-reported pain. But they, too, tend to chalk it up to a question of efficient use of emotional energy, a need for stamina and cool-headed precision when they make their evaluations.

She suggests they might also be thinking wistfully that a machine’s biomarker readings are unsullied by the voices of those bringing them to moral exhaustion in crying competitions, each trying to insist “me first!”

Doctors have few drugs besides mildly noxious placebos, and built a regrettable reputation with opiates a few hundred years ago, so today’s care givers are more cautious to suspect patients of attention-seeking, though not all that much different from Phaidra’s nurse in the age of Euripides. They feel that many people beset with loneliness and despair come to meet them for personal reasons, and submit to being given a physical exam or having their blood drawn for the courtesy of being introduced.

This makes it tempting to reduce all complaints that result in a second visit to the same doctor to the category ‘psychosomatic pain’ rather than reassessing one’s introductions, already difficult to remember by the time the patient is seen again.

tokyo_bunny

This may not follow from the knowledge that the nervous system’s pain-signaling apparatus is inseparable from the ‘subjective’ experience of pain in the mind, even if it is not obvious how the pain-signal was mechanically produced.

But if the typical patient stops coming back for additional efforts to address the same complaint from the physician, whatever one has been doing for the patients lately seems to have worked.

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