Learning to Lament Part Two: Our Changing Relationship with Pain.
Sorry for the long delay in the follow up to the previous post: I've had this more or less mapped out and written for nearly two months, but had a hard time competing it in a way that I feel comfortable sharing. I realized pretty quickly that this topic needs a lot more attention than a few simple blog posts can explore. Also, I have become keenly aware that my life up to this point has been fairly pain free--I don't suffer from any conditions that require regular medication, my life has not been affected by major tragedy, so it feels a bit superficial for me to take on such a task based mostly on theoretical knowledge, but here we are. The following is a combination of what was supposed to be two independent posts. While I feel like I left out a lot of what I wanted to say about this subject, I feel like I need to put the topic to rest for now, though I hope to be able to return to it some day.
Pain is ubiquitous. We generally avoid it as much as possible, but it is always there: physical pain, emotional pain, pain we indict upon ourselves, pain inflicted upon us by others. We are all hurting and we would all like it to stop. Yet pain also seems to be an important part of our emotional, spiritual and physical development. In the same way that singed fingers teach kids to respect fire, emotional pain teaches us empathy and the importance of kindness. Pain is also often a catalyst to seek deeper meaning and spiritual truth.
It is this growth inducing aspect of pain that has led to so much theological and philosophical inquiry. As enticing as it is would be to live in a world without pain, one has to consider what type of world that would ultimately be, what its inhabitants would be like, and if they could ever know or be “good.”
In the fifth century, AD. Augustine of Hippo contemplated the nature of pain, suffering and evil in an ernest effort to see if they were compatible with the the idea of an all good, all powerful, all knowing God. Augustine’s brilliant and soulful contemplations have largely shaped the past 1500 years of discussion about pain, suffering and the problem of evil. According to Augustine, Evil reveals goodness by exposing its absence; the same way that we don’t fully grasp health without knowing sickness. Ultimately, understanding evil not only helps us know good, it ought to compel us to pursue it, thus encouraging us to become more good.
Until very recently such thought was relatively hypothetical in nature. Philosophers have been reflecting on the nature of pain for thousands of years, but only fairly recently have doctors been able to really control pain effectively. It’s not that we humanity is any more pain averse than we were 1500 years ago, we just happen to be whole a lot better at it. Not that it has eliminated the reality of pain in our lives. It cant. People are still hurting and their hurt is very real. We simply have many more resources to manage pain (both physical and emotional) than we did even a generation ago.
Medicine has changed humanity's relationship with pain. Nobody is doubting weather living a longer, healthier, and less painful life is a good thing. I certainly don't want give up aspirin, let alone anesthesia, but I do wonder if our changing relationship with pain will give way to a chaining relationship with ourselves. While I am sure it is impossible to measure or quantify, it bears questioning what such a changing relationship with pain will do to our character.
One of the largest public health issues of our day has to do with changing dynamic. Without suggesting any causality, I would like to look at it as an interesting case study.
In 1995 Dr. James Campbell, a physician and president of the American Pain Society, wanted to advocate for patients suffering from chronic pain and raise the level of awareness for emerging treatment options for managing it.
Dr. Campbell, along with the APS launched a campaign to call pain “The Fifth Vital Sign.” The idea of the campaign was to train physicians to monitor pain with a similar level of attention they pay to the most basic medical data points: blood pressure, pulse, temperature and breathing.
Of course, pain is not really like the other vital signs. True vital signs can all be precisely monitored, and are all necessary for life to continue. Pain on the other hand, can only be described subjectively, its absence does not always guarantee perfect health, nor does its presence always indicate severe danger.
The campaign, aided in part by generous contributions from Purdue Pharma—makers of OxyContin, gained momentum and influenced the way the medical community approached pain management.
Having doctors attentive to pain levels and generously prescribing powerful pain killers was good news for people suffering from chronic pain, though the benefit of hindsight has forced us to reconsider such an aggressive approach to pain management. In 2017, the US department of Health and Human Services declared a public health emergency over the use of prescription pain medicines and their nonprescription counterparts. That year 11.4 million people misused opioids, 47,600 people died of opioid drug overdoses, while 28,466 died overdosing on synthetic opioids such as Fentanyl and another 15,482 died from their illegal, non prescription cousin, heroin. Just recently, Purdue Pharma agreed to pay the state of Oklahoma nearly $275 million to settle a lawsuit over misleading and underreporting OxyContin’s addictive properties. Over 40 similar lawsuits exist in other states as well as hundreds of other similar lawsuits.
At some point in time, the well intended and entirely human desire to make pain avoidance as important as breathing has led to tens of thousands of deaths and enumerably more ruined lives and devastated families. Undoubtedly, no small part of this problem has to do with the addictive nature of the drugs themselves, yet it is worth looking deeper and asking if we are not also addicted to our own comfort and the myth of total prosperity.
I have never lived with chronic pain, and I do not want to belittle anyone who uses medication to cope with it—I certainly will next time I have a headache. However I do wonder if we set a dangerous precedent when we start telling ourselves that all pain is foreign to the human condition and should be treated the way we use antibiotics to kill off an infection.
Pain is a normal, natural part of human existence. If we tell ourselves that all pain is bad, avoidable and should be treated aggressively, we create for ourselves the unrealistic expectation that our lives can be pain free. When we inevitably experience pain again, we are will turn to whatever substance takes it awy. Not just because we are addicted to that substance, but also because we are addicted to the illusion of our painless existence.
As I continue to reflect on sadness, loss and pain and learn to lament, I wonder how many parallels can be drawn from the world of physical health into the worlds of emotional and spiritual health.
How often do we treat physical and emotional pain as something that we should avoid, ignore or disguise?
Does aggressive pain avoidance detach us from important truths about suffering and mortality?
If pain is a catalyst for character growth, does can pain avoidance stunt our personal growth?
Pain is inseparable from life—the more passionately you live and the more deeply you love, the more you expose yourself to pain, rejection, loss and eventually, death. Maybe on an existential level, Dr. Campbell’s description of pain as vital sign is appropriate—maybe pain is merely a sign that we are alive.
Check out this NPR article about Dr. Campbell’s campaign, there is a longer podcast available too. https://www.npr.org/2019/03/08/701656196/how-our-cultures-thinking-on-pain-has-changed-over-the-last-five-decades
Here are some more facts about opioid use:
One of hundreds of articles about current litigation against drug companies companies
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