If you’ve seen my Angry Chronic Pain Thread on Twitter, you’ll know that I’m a chronic pain sufferer, and that I have a great many opinions on the matter. Chronic illness is something that is so stigmatized that ‘experts’ are praised for teaching their patients to ignore their body’s warning systems and drive them into a dissociative state. In our supposedly enlightened, advanced society, we still view pain and suffering as a weakness, somehow the fault of the sufferer. I want to talk about why that is.
Pain in the Ancient European World
“Healing is a matter of time, but it is sometimes also a matter of opportunity. However, knowing this, one must attend to medical practice not primarily to plausible theories, but to experience combined with reason.”
– Hippocrates, Precepts
Both the ancient Greeks and Romans were deeply interested in studying the causes of pain and methods of treatment. The body, for them, had to be cared for and celebrated as a thing of beauty and strength. But pain was a fact of life in those times just as it is today, and beauty and strength didn’t always come into it. Both empires were known for their military prowess, and war always comes at a cost of pain. Caring for the heroes of battle was vitally important for the Romans, who gave them severance pay and land to live on. This was both morale-boosting for all citizens and also useful strategically, since the veteran colonies were a first line of defense for the outlying Roman settlements. The coloniae had hospitals staffed with competent physicians for whom researching and managing chronic pain was a large part of their job. During the time of Galen, Roman medical research and public health standards reached their zenith. Use of analgesic medicines and foods to relieve chronic pain was widespread throughout the empire. The Romans learned from their predecessors, the Greek and Egyptian medical traditions that blended religious philosophy with psychology and science.
For the Greeks before them, katharsis – the ability to release difficult emotions at theatrical performances – was essential to a healthy life. But not all pain could be explained by emotional disturbance or alleviated by tears at the end of a tragic play. The ancient Greeks had different words for different kinds of pain. Pathos, emotional pain, was the kind that could be relieved by katharsis. Management of chronic physical pain (algos, odyne, or ponos) required the use of painkillers and emollients. This is reflected in Greek mythology; the staff of Asclepius is still the universal symbol for medicine in the Western world (although the caduceus, the messenger staff, is often used in error due to the similarity of appearance between the two).
Pain to the ancient European world was not usually considered the fault of its sufferers. The gods were known to be capricious, violent, often cruel – who knew why they visited pain on the mortal realm? However, just because the gods might cause something, it did not mean that mortals could not fight it. Even though religious belief certainly played a large part in trying to explain why people suffer, Greek and Roman society did not leave it at that, but worked hard to find physical causes for the pain and manage it with medicine.
Given this ancient tradition of medical research and treatment, what happened?
Pain in the Christian Era
“Pain insists upon being attended to. God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains.”
– C.S. Lewis, The Problem of Pain
The early Christians had a lot to deal with. Hunted down, tortured, and driven underground by the increasingly paranoid, declining Roman Empire, they were certainly justified in the enormous grudge they bore against the ancient pagan world. However, this natural antipathy led them to swing rather too far in the opposite direction. They saw the Romans as hedonistic, selfish, so focused on the material realm that they could not see past their own Patrician noses to the glory beyond. For the early Christians, any focus on the human physical body smacked of paganism, so they abjured the mortal flesh as being worthless and fixed their eyes instead on the spirit realm, the unseen. Physical pain was not only to be endured but to be embraced. Pain was God’s way of reminding them that their life on earth was temporary, their flesh-and-bone bodies merely the ugly caterpillars waiting to become angelic butterflies in His own heavenly home.
Pain was, in fact, God’s will for humans. And unlike the Greeks and Romans, who questioned and fought the cruel whims of their deities, for a Christian to question God was anathema. God’s will was absolute, his perfection infallible, his justice complete. If God’s creation “groaneth and travaileth in pain”, there must be a good reason for that. Pain, therefore, to the early Christians, was not something to be healed in this life, but to be endured and rejoiced in. It stood to reason that if God’s will was pain for humanity, the more pain you were suffering, the closer you were to fulfilling God’s will. You hoped for the miraculous release of all suffering that awaited you in heaven.
Just take a look at St Paul’s analysis of Proper Christian Pain:
“For the creature was made subject to vanity, not willingly, but by reason of him who hath subjected the same in hope, because the creature itself also shall be delivered from the bondage of corruption into the glorious liberty of the children of God. For we know that the whole creation groaneth and travaileth in pain together until now. And not only they, but ourselves also, which have the firstfruits of the Spirit, even we ourselves groan within ourselves, waiting for the adoption, to wit, the redemption of our body.”
– Romans 8:20-23
As Christianity grew in size and influence, its doctrines became more and more widespread across Europe. Monks in the Middle Ages followed the examples of their saints and mortified their sinful flesh with practices that in any other context would be considered torture. Pain was not only God’s will, but a way for a devout Christian to be one with Christ, who suffers infinitely for the sins of the world. Suffering was a major part of Catholic doctrine – everything hung on the afterlife, but even death did not guarantee a painless immortal existence. Intercession for the dead was necessary to release them from the purification of Purgatory, and baptism and last rites were vital to avoid the eternal torment of Hell.
The Pain of Being a Protestant
Early Modern Protestantism took the existing Catholic doctrine and went in rather a different direction with it. Purgatory did not exist, only the black-and-white dichotomy of Heaven and Hell – however, pain was still important to show one’s devotion to God. The suffering of martyrs was a mirror of the painful process of reformation, and rather than pray for relief, the zealous Protestant welcomed pain as a chance to prove their faith and endurance. Unlike the early Christian and Catholic saints, the last moments of a Protestant martyr were not glorious through miraculous analgesia and visions of healing light, but through proud, defiant fortitude to the bitter end. The violence and torture of the Reformation were not to be escaped or lamented but to be glorified and even revelled in. Pain and torment, whether due to illness or martyrdom, were visible manifestations of the suffering of Christ for humanity’s weakness, a public version of Purgatory for the mortal world.
From those early days of fire and brimstone, however, things began to change. Puritan ideology took things in an even more austere direction, with extreme self-denial being the only way to receive divine approval, but more mainstream American Protestantism settled into itself and developed a curious ideology that is now known as the Prosperity Gospel. The basic principle behind this ideology is breathtakingly simple:
If God approves of you, he will bless you with wealth, happiness, and good health even in this life.
This may seem like a perfectly harmless belief, until you flip the coin and see the other side. The only logical conclusion is that if a person is poor, unhappy, and/or suffering from chronic pain and illness, God does not approve of them.
The pendulum of Protestantism therefore swings from one extreme to the other – at one end is the ferocious defiance that glories in pain as a test of faith; at the other is the implicit disapproval of anyone whose life has not been visibly blessed by God’s grace.
Modern American Attitudes to Pain
We have now reached the point at which we can look back at the history of pain theology and follow the progression from Hippocratic science through to extreme Christian views of pain, and we can see the results of this complicated series of philosophies on our modern attitudes.
At first glance, American medicine seems to be modelled after ancient Greek and Roman medical philosophy. Doctors take the Hippocratic oath. Science and medicine are firmly intertwined, and research is funded and backed by governmental orders as well as pharmaceutical companies. However, once you strip away the scientific façade, the attitudes of many people, including healthcare professionals, are actually still mired in 19th-Century prosperity theology.
Chronic illness is seen as a result of personal weakness. How many times have you heard someone say things that begin with “just” in response to your health?
Just do more exercise, and you’ll feel better.
Just eat more healthily.
Just snap out of it.
Just try yoga/positive thinking/drinking this detox tea.
This is a part of daily life for people with chronic pain or other illnesses, including mental health problems. Our constant companion – our pain, in whatever form it takes – is tailed by a host of well-meaning platitudes that all focus on what we should be doing to heal ourselves. If you can’t exercise or do yoga, or you don’t want to drink their tea, people stop caring about your pain. The view seems to be that if we can’t be bothered to fix ourselves, we don’t deserve sympathy or even to be heard.
Doctors regularly dismiss the experiences of chronically ill people, especially if those people happen to be female-presenting (that’s a subject for a whole different blog post). Our suffering is, basically, our own fault because we are weak and we don’t try hard enough to be healthy.
Even though many people with this attitude would be deeply offended and probably angered if it was pointed out that their beliefs mesh nicely with American Protestantism, the fact remains that the basis for the attitude is the same in both cases: if you’re chronically ill and/or poor, you must be doing something wrong. Further, if, after already suffering the consequences of your own laziness/weakness/
sinfulness you have the temerity to complain about it, you are not showing the proper spirit of fortitude and cheerful endurance (sound familiar?) and therefore sympathy is pretty much wasted on you.
People who suffer chronic pain are routinely ignored, fobbed off, and even subjected to further pain by doctors and nurses, people who are supposed to be trusted experts in their field. Many of us are misdiagnosed or undiagnosed for years. Certain types of chronic illness have only recently been recognized and are still denied by some professionals who refuse to admit that their patients’ pain might not be ‘all in their heads’. Outside the medical environment they endure similar attitudes from family and friends who don’t understand that chronic illness just can’t be fixed by the power of positive thinking.
Conclusion: What You Can Do
I am aware that a lot of people are probably going to be upset with me at this point, and say things like:
I’m not like that!
I don’t believe that!
Not all doctors/nurses/healthcare professionals/parents/people…
I know. I know not everyone has these harmful attitudes. But far too many people do, and often without realizing it. If you’re feeling defensive right now, maybe your conscience is trying to tell you something. It’s almost impossible for a person’s attitudes not to be influence by the major trends in society. We are all guilty of this at times. It’s important to self-reflect and own our complicity in society’s mistreatment of the chronically ill. And then to do something to change that, even if all that involves is listening to people without judging their pain or trying to make them fix themselves.
I know that you probably don’t mean to cause your chronically ill family and friends harm. I know that you think you’re helping. But constantly bringing it back to what they should be doing to heal themselves just reinforces the message they get from their doctors – that they are ill and in pain because they aren’t trying hard enough, that it’s their fault for not being ‘virtuous’ (in this case not necessarily religious virtue, but the modern virtues of physical fitness and mental strength evidenced by unbreakable cheerfulness).
Being in constant pain is hard enough without having to deal with a barrage of messages that you aren’t good enough to be healthy. Our mental health is often fragile as a result of enduring pain that most abled people can’t even imagine.
So, I have a mission for you, should you choose to accept it:
The next time your chronically ill friend tells you something about how they’re feeling, please just listen with empathy. Remember what they are battling against every single day. They don’t need judgement, and usually they have tried everything you’re going to suggest. Be there for them, because they need you.
Sources on ancient medicine and the Reformation:
Pain: Aspects and Treatment in Greek Antiquity, Fradelos, Fradelou, & Kasidi
Chronic Pain Management in Roman Coloniae, VJ Belfiglio
The Spectacle of Pain in Protestant Martyrology, Efterpi Mitsi