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When I called a physician friend for advice on an adverse reaction to anesthesia after minor surgery, he made the offhand comment, "You know, veterinarians don't have that problem. They measure out the dosage, give the injection, and the horse or dog or whatever responds according to the book." That simple observation could serve as a summary of what prompted Harvard conveners to bring together molecular biologists, neuroscientists, pain clinicians, psychiatrists, anthropologists, musicologists, and scholars of religion for the conference that spawned this book. Physiologically, pain in humans may resemble that of horses and dogs, but there the similarity ends. In many ways, culture trumps biology.
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Consider the phenomenon of Couvade, documented in many places worldwide. In some societies in Micronesia and the Amazon Valley, for example, the mother shows no indication of suffering during delivery. She may break from work a mere two or three hours to give birth, then return to the fields. By all appearances the husband bears the pain: during the delivery and for days afterward he lies in bed, thrashing about and groaning. Indeed, if his travail seems unconvincing, other villagers will question his paternity. A journalist or anthropologist who tried to explain, "Sir, there's no reason for you to feel pain because, after all, it was your wife who bore the child," would doubtless meet a hostile reaction. For months the father has struggled with such symptoms as nausea, weight gain, constipation, headache, and other signs of distress, not to mention the agony of the "delivery" itself. For him, the pain is as real as it is for the Manhattan socialite demanding her epidural.
Before attributing this cultural phenomenon to a primitive, unscientific world view, remember that placebos, nothing more than sugar pills and saline solutions, work well in developed countries. Around 35 percent of cancer patients report substantial relief after a placebo treatment, about half the number who find relief from morphine. Both cases, negatively with Couvade and positively with placebos, demonstrate that pain does not fit the Cartesian stimulus-response model that once prevailed.
Pain and Its Transformations reflects an admirable attempt to bring together experts who look at pain from the bottom up (neuroscientists, biologists) and those who look at it from the top down (anthropologists, scholars of religion). The Harvard conference, assembling 23 contributors from various disciplines, came as a climax to a two-year seminar series on the topic. The book includes fifteen main chapters as well as a series of discussions in which the other contributors get to respond. As in every compilation, quality varies. Some authors rely on the jargon of their specialty, whether science or theology. Mercifully, both points of view have presenters who can cut through the jargon and write in plain English.
One more complaint: Like most books on pain, this one gives a mere nod to pain's essential role in protecting from injury and turns quickly to the problems it presents (the root word for pain means "punishment" or "penalty"). To the contrary, I learned a high appreciation for pain's warning function while collaborating on three books with Dr. Paul Brand, the missionary surgeon who discovered that all the disfigurement that makes leprosy such a dreaded disease traces back to the loss of pain sensation. Theologians blithely attribute pain to the Fall, ignoring the marvelous design features of the pain system. Every square millimeter of the body has a different sensitivity to pain, so that a speck of dirt may cause excruciating pain in the vulnerable eye whereas it would go unreported on the tough extremities. Internal organs such as the bowels and kidneys have no receptors that warn against cutting or burning—dangers they normally do not face—but show exquisite sensitivity to distention. When organs such as the heart detect danger but lack receptors, they borrow other pain cells ("referred pain"), which is why heart attack victims often report pain in the shoulder or arm. The pain system automatically ramps up hypersensitivity to protect an injured part (explaining why a sore thumb always seems in the way) and turns down the volume in the face of emergencies (soldiers often report no pain from a wound in the course of battle, only afterwards). Pain serves us subliminally as well: sensors make us blink several times a minute to lubricate our eyes and shift our legs and buttocks to prevent pressure sores. Pain is the most effective language the body can use to draw attention to something important. The principle applies equally to animals, an aspect of pain for which C. S. Lewis had no satisfactory explanation.
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