Torture lessons

With irresistible detail, a surgeon explores the cultural and scientific universe of the body in pain.

By Annie Murphy Paul

Jun 12, 2000 | A few days ago, I went to the hospital to visit a friend who'd just given birth for the first time. After admiring her peacefully sleeping baby, I leaned closer.

"How was it?" I asked. I knew she had been dreading childbirth almost from the moment she conceived.

Her eyes widened. "It was worse than I ever could have imagined," she whispered.

Extreme pain -- like that produced by childbirth or, say, limb amputation -- is fascinating precisely because it's at once alien and familiar. We all know what it's like to hurt, and yet some hurts are so profound as to surpass human understanding.

It's this paradox that's exploited by neurosurgeon Frank T. Vertosick Jr. in his new book, "Why We Hurt: The Natural History of Pain." Chapter by chapter, Vertosick introduces us to some of the more excruciating forms of pain, from the misery of migraines to the ache of rheumatoid arthritis. If this sounds about as fun as a trip to the dentist, the book will surprise you. With a humane and generous sensibility, Vertosick explores not only the nerves and neurotransmitters that direct pain, but how culture and belief shape the very experience of it.

In his view, for example, my friend violated an ancient social taboo when she told me the truth about her labor. Women throughout history and all over the world have developed methods, Vertosick writes, "for hiding the pain of childbirth from impressionable young females." When they could, mothers-to-be "sought to give birth alone or with the aid of older (and often postmenopausal) women." When crowded conditions made such withdrawal impossible, they cultivated a stoicism that made birthing look as effortless as blowing one's nose. They even managed to fool many Western experts, who marveled at the ease with which "primitive" women popped out their babies. Childbirth pain, they concluded, was "an invention of pampered, out-of-shape white Europeans and could be cured by stripping them of their high society soft-headedness."

Though this seems a bit shaky as anthropology -- most women throughout the ages, after all, have not had much choice over whether or not to bear children -- the theory is characteristic of Vertosick's efforts to look beyond the physical manifestations of pain. Delivery is so painful, he reminds us, mostly because the birth canal must accommodate the human infant's large head -- the same head that houses our uniquely complex and brilliant brain. Likewise, it's our powerful opposable thumbs that make us susceptible to carpal tunnel syndrome, and our improbably upright spines that expose us to the risk of ruptured discs.

To be human, in other words, is to hurt -- or more precisely, to suffer, which Vertosick describes as the melding of biological pain with psychic pain. Because we can anticipate pain and its consequences (six weeks out of work, no more mountain biking), its effect is multiplied; because we can feel empathy for others, their pain becomes our own; because we can learn from our mistakes, pain imposes on us an inexorable discipline. I hurt, Vertosick might say, therefore I am.

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