Pain: A Very Short Introduction

Very Short Introductions #528

by Rob Boddice

What is pain? Has the experience of pain always been the same? How is pain related to the emotions, to culture, and to pleasure? What happens to us when we feel pain? How does pain work in the body and in the brain?

In this Very Short Introduction, Rob Boddice explores the history, culture, and medical science of pain. Charting the shifting meanings of pain across time and place, he focuses on how the experience and treatment of pain have changed. He describes historical hierarchies of pain experience that related pain to social class and race, and the privileging of human states of pain over that of other animals. From the pain concepts of classical antiquity to expressions of pain in contemporary art, and modern medical approaches to the understanding, treatment, and management of pain, Boddice weaves a multifaceted account of this central human experience. Ranging from neuroscientific innovations in experimental medicine to the constructionist arguments of social scientists, pain is shown to resist a timeless definition. Pain is physical and emotional, of body and mind, and is always experienced subjectively and contextually.

ABOUT THE SERIES: The Very Short Introductions series from Oxford University Press contains hundreds of titles in almost every subject area. These pocket-sized books are the perfect way to get ahead in a new subject quickly. Our expert authors combine facts, analysis, perspective, new ideas, and enthusiasm to make interesting and challenging topics highly readable.

Genres: Nonfiction, Science, Biology, Psychology, History, Medical

133 pages, Paperback

Published October 17, 1970

About the author

Rob Boddice (PhD, FRHistS) is a Senior Researcher at HEX, Tampere, Finland. He has previously held positions at Harvard University, McGill University, the Max Planck Institute for Human Development, and Freie Universität Berlin, and has been funded extensively by the Deutsche Forschungsgemeinschaft and the Horizon2020 programmes of the European Commission. Boddice has published widely in the history of medicine, the history of science and the history of emotions. His recent books include The Science of Sympathy: Morality, Evolution and Victorian Civilization (University of Illinois Press, 2016), Pain: A Very Short Introduction (Oxford University Press, 2017), The History of Emotions (Manchester University Press, 2018), and A History of Feelings (Reaktion, 2019). With Mark Smith he has written Emotion, Sense, Experience (Cambridge University Press, 2020), and his Humane Professions: The Defence of Experimental Medicine, 1876-1914 (Cambridge University Press) will be published in 2021. Boddice serves on the editorial board of the history-of-emotions book series at Bloomsbury Academic, and on the editorial board of Emotion Review. At HEX he is beginning an experiential history of placebo and completing a four-volume set on scientific knowledge production in the long nineteenth century called Experiment, Expertise, Experience (Routledge, 2022).

Reviews

[Bruce Graham · Rating 4 out of 5]

An acquaintance told me of the niggling pain he had with his shoulder, after breaking his collarbone. "Pain reminds us that we are alive," I said, somewhat facetiously.
He told me he often thought of my line when he was in pain.
Thus, it was with some surprise that I read this in Pain: A Very Short Introduction

Pain, to put it in plain terms, keeps us alive.

Rob Boddice has provided us a panopticon of pain, insisting that it be viewed with multiple lenses. The book met my expectations in that it surprised, which is Claude Shannon's definition of information. We learn, for example, that the signals sent to the brain are 'injury signals' rather than pain signals. And that the crushing pain we feel from a broken heart is just as real as that of a broken leg.
Unfortunately, we are more likely to encounter language like this,

the words we use are only an epiphenomenon of a much broader array of gestures and utterances we use to signify our plight.

than nuggets of aphoristic wisdom.

[Soph · Rating 5 out of 5]

Really comprehensive (especially for its size) and has such a multi-disciplinary approach to pain, which as Boddice himself points out, is sorely (no pun intended) needed when examining it. A great read!

[Seth · Rating 2 out of 5]

As is typical for the VSI series, this entry on pain is interdisciplinary, covering history, sociology, philosophy, psychology, and medicine (and if, like me, you're mostly interested in modern science and medicine, you'll be disappointed by how much space is devoted to history and religion). I want to harp on focus on the philosophy, since it's important and also the area I'm most qualified to comment on. Particularly, this passage:

Pain has been conceptualized as always a malign experience that should be reduced or eliminated. Yet, as we have seen, many cultures and traditions have the pursuit or acceptance of pain as a central part of virtuous existence, from asceticism to the ultimate extreme of martyrdom. And from a functional point of view too, there are compelling reasons why pain is essential and helpful. Without pain, as anyone with congenital analgesia will attest, we are at enormous risk. Pain holds us in check when there is something wrong, causing us to protect injured parts. Limping on a twisted ankle isn’t a sign of injury but a sign of recovery. If we did not feel the pain we would make the ankle bear our load and the ankle, without being guarded, would soon deteriorate. Pain is necessary, from an evolutionary and individual standpoint, for it aids survival. This is not so much the story of our acute reflexes to painful stimuli as it is the story of our ongoing protective reflexes to enduring states of pain after injury. In this most fundamental sense, the potential for dysfunction notwithstanding, pain is an unmitigated good.

This account, conveniently concise and colloquial for common consumption, is inconsistent. It conflates and equivocates. J'accuse: chicanery! Its confident conclusion clearly constitutes a copious quantity of complete uncontaminated copium. Copium's comfort comes at a cost: complacency. The consumer becomes an accomplice to that most callous of concepts controlling the corporeal in this cosmos, that cold culler of critters, that crimson claw, which cares exclusively for copying (commonly accomplished via copulation), considering conscious creatures only qua chromosome carriers and conquerors of computational complexity, never qua containers of contentment or its complement. Consequently quietens the call to overcome the crummy conditions it creates, which I cannot countenance. Quoting Caustic Casanova: "You cowards, you're cowed!" Call me quixotic, citing claims of certainties concerning capabilities and quality of life? Contrarily, consider concrete counterexample called Cameron, currently cooperating with experimenters, including Cox. CRISPR'd conspecifics coming? Could be! Cattle comes first, according to keikaku.

Am I perhaps being unfair to Rob Boddice, in mocking him with memes, and railing against him while alliterating for a whole paragraph? I don't think so. He literally says "pain is an unmitigated good", and I see no way to interpret such a ludicrous statement that comes anywhere near philosophical soundness. The "potential for dysfunction notwithstanding" caveat doesn't help (and not just because he's basically saying "pain is an unmitigated good except when it's not"). He doesn't elaborate on this, but from context I suppose 'dysfunction' must refer to pain that does not correspond to bodily harm, i.e., phantom pain. Very well, is phantom pain bad? I don't see how it possibly could be bad in any way that wouldn't also apply to functional pain and mitigate its alleged goodness. So, pain must at least be neutral in all cases. Seems like Rob should against analgesics (for functional pain, if not all pain), which, going by his treatment of them in the sections on medicine, he isn't.

In order to get off the ground at all, Rob's "pain is an unmitigated good" requires the premise that genetic propagation (or survival, if you prefer) is good and the experience of pain is not bad, which with no argument to back it up (none is offered), is simply committing the philosophical sin of assuming that as things are, so they should be. Now, this might come as a surprise to Rob, but even granting that pain is beneficial in certain situations, this does not entail that pain is good simpliciter, and it's entirely possible to hold that pain is bad actually while acknowledging that there are Darwinian reasons for its existence. (Consider that what we learn from pain, mainly, is how to avoid additional pain. Pain is functional precisely because it is bad.) Is that what he's trying to do by saying "In this most fundamental sense"? If so, he's done a piss-poor job of expressing himself clearly. "Most fundamental" sure looks like endorsement. But I doubt that's what he was trying to do anyway. Elsewhere, he explicitly declares himself opposed to utilitarianism for much the same reasons. He really wants to shill in favor of pain. Still seems like Rob should be against analgesics.

And even if he had distanced himself from shitty axiological assumptions, "pain is an unmitigated good" would still be an utterly idiotic thing to say in that context. If pain were an unmitigated good as far as Azathoth is concerned - literally no downsides at all - there'd be no selection pressure to prevent phantom pain, and I expect it'd be more of a normal experience.

As for the bit about cultures and traditions, they do a lot of shit that we can and should be critical of.

Should I at least give him a pass on saying that congenital analgesia is always maladaptive, considering this book predates scientific interest in Jo Cameron? Again, don't think so. If someone confidently claims that X is always the case and then an example of ~X appears, I count their lack of epistemic humility as a failure. In this case, even before Jo Cameron's condition was discovered, it wasn't that hard to imagine that with our language and learning faculties, and our rapidly advancing medical tech, maybe we could eventually do away with (unwanted) pain altogether without undue risk.

Now that we do know about Jo Cameron, this book is due for a second, hopefully less philosophically terrible, edition.

[Pramod Pant · Rating 4 out of 5]

In about one hundred and twenty pages, you are unlikely to get as good a book on the subject as this one by Rob Boddice. Very well organised and articulated.
The only ‘pain’ after reading this book, for me at least, is to find a medical treatise to go deeper in search of the pleasure of understanding pain.

World is a strange place, isn’t it ? :)

Please get this book, and follow me into medicine ! Well, just joking; such an endless pursuit is madness. You needn’t. :)

[Zahra El Morabit · Rating 5 out of 5]

I don’t think I’ve ever given a non-fiction book 5 stars, but as far as this book goes, it does exactly what it says it will: it’s a short introduction to the subject, it’s very organized, takes you in a historical journey and it’s perfectly comprehensible, even if you don’t know anything about the subject. It has left me with the curiosity to read more about the experiences and the history of pain.

[Bjørn · Rating 5 out of 5]

Enjoyable overview

Good overview taking a reader from old age to the modern neuroscience-psychiatry-medicine-busy society and showing that the pain, no matter the century, is still a mystery.

[Rex Libris · Rating 3 out of 5]

Somewhat of a disappointing book. Too much sociology, too little real science.

[Ryo · Rating 4 out of 5]

這系列的書有幾本很不討喜，這本是其中一本，主要是因為它探究的概念令人難以捉摸。 什麼是「痛」？ 這是每個人都有過的經驗，可以說是習以為常，更不用花時間解釋。我們似乎都能理解什麼是疼痛，但若要精確描述它，確是一件不容易的事。痛的性質如此的難以預測，而且沒有測量的標準，我對於被針刺的感覺一定和你對此的體驗感受不同，那要如何精準形容「痛」呢？

除了對於痛覺的探討，本書也談到關於痛的歷史及現代醫學針對痛所做的研究，還有對於同情心與同理心的知識，這些都是為了理解痛的本質不可或缺的。

[Matheus e Silva · Rating 4 out of 5]

Interessante introduçã0 para os historiadores que pretendem estudar a dor e os sentimentos.

[Iñaki Tofiño · Rating 2 out of 5]

I expected a more cultural approach to pain, but the author has chosen to provide a medical insight. Interesting, but not to me.