What’s Pain Got to Do with It? In Art, It’s Everything

    Pleasure and pain, and that which causes them, good and evil, are the hinges on which our passions turn.  

— John Locke, 1690

This is a quote that opens the book Understanding Pain—Exploring the Perception of Pain (2012) by Fernando Cervero, professor of anesthesia at McGill University in Canada, where he is the director of the Allan Edwards Centre for Research on Pain. My review of this book follows at the end of this article.   

Eric Kandel, the Nobel neurobiologist, echoes this sentiment from a scientific point of view:

Beauty and ugliness in a face being portrayed parallels that between pleasure and pain. Beauty does not occupy a different area than ugliness in the brain. Both are part of a continuum representing the values the brain attributes to them, and both are encoded by relative changes in activity in the same areas of the brain… From happiness to misery, we use the same fundamental neural circuitry.

The Croatian artist Mladen Stilinovic  exhibited his work, Dictionary—Pain (2000 – 2003) in which he replaced the definition of every word in a dictionary with the word pain, in the 2003 Venice Biennale. With an art practice born of political turmoil, first in Yugoslavia under Tito, then Serbia and Croatia, which he experienced firsthand growing up, Stilinovic’s art also addresses the current march to market of the new former socialist bloc’s art world, eager to follow the West. A life-long dissident and outsider, embracing unpopular ideas like destabilizing any established symbols, pain is an apt metaphor for his art, which packs a deep punch.

Friedrich Nietzsche (1844 – 1900), the German philosopher, in The Birth of Tragedy (1872) spoke of the later Greeks and their craving for beauty as superficial and as a symptom of decline, of lack, of ‘the anarchical dissolution of the instincts’. He asked:

What would be the origin of the opposite craving that occurred earlier in time, the craving for ugliness, the good rigid resolve of the older Greeks for pessimism, for the tragic myth, for the image of everything terrible, evil, cryptic, destructive and deadly underlying existence; what then would be the origin of tragedy? Perhaps joy, strength…

Jacob Golomb of the Hebrew University of Jerusalem, in his book In Search of Authenticity (1995), interprets Nietzsche’s Apollonian order vs. Dionysian instincts: *

The subjugation by Apollo of the unrestrained drives of the Dionysian barbarian is the source of art in general. The synthesis provides the ‘metaphysical comfort’ which allows men to affirm existence despite its horrors. By this process he himself is transformed into an object of art.

Pain is a necessary ingredient of life. No pain, no brain (no one could paint or write under anesthesia, or even strong pain killers). That’s why it’s such a stuff of art and literature, philosophy and religion.

 

* In today’s terms, Dionysian vs. Apollonian would be (roughly):

In art viewing – Experience vs. Interpretation
In psychology – Unconscious vs. Conscious; Non-judgment vs. Judgment
In philosophy – Illogical vs. Logical
In cognitive psychology – Instinctual vs. Cognitive
In memory – Implicit vs. Explicit
In learning – Learning How vs. Learning What ; Doing vs. Thinking
In biology – Body vs. Brain; Body-brain vs. Prefrontal Cortex (Executive brain).
In neurobiology – Right Brain vs. Left Brain (very generally)

 

By Fernando Cervero
The MIT Press, Cambridge, London, 2012
172 pp., illus. b/w. Trade, $24.95
ISBN: 978-0-262-01804-3

Reviewed by Cecilia Wong                                                                                                  Independent writer, Los Angeles                                                                                            Web address: Eyes-wide.com
ccsouk@yahoo.co.uk

Virginia Woolf had this advice for how to read a book: “Do not dictate to your author; try to become him. Be his fellow-worker and accomplice”.  My advice in reading Understanding Pain is the same – just read on, something will ring – one does not need to know every word to get the story. You’ll be vastly rewarded by the humor and humanity in this book about pain. There’s good pain and bad pain and the book explains them all, with historical anecdotes and current neurological understanding; and not least pain’s entwined affair with philosophical and religious beliefs.

Equating the study of pain with that of memory and consciousness is an important point in this book. Pain, like consciousness, is a subjective perception, and cannot be independently measured, like body temperature. We could also feel no pain with injury if our body does not have the right cellular receptor for it – like ultraviolet ray from the sun (the pain the day after is the result of tissue damage from the burn). The author has included the latest research – sadly, no bibliography is included or work attributed. It would have allowed interested readers to look further, and more importantly, the author could have spared us many of the anatomical details that only a neurologist would know. To its credit, this book can be of equal interest to medical students, or general readers who could come away with an appreciation of its complexity and intricacy.

Being a clinician and a professor of anesthesia (at Canada’s Magill University), Cervero is able to give vivid examples illustrating the causes and origins of many types of pain, like phantom limb, where the patient continues to feel pain on an arm that has long been amputated; or visceral pain, which tends to wander from its original site of insult because the message hitches a ride with other nerves and the brain gets confused. From here, Cervero goes into brain systems, involving multiple neural networks. This is where my beginning warning comes from: for the general reader, do not be derailed by such detail. And hence I think it would have been helpful if there is a brief recap at the end of each chapter, summarizing the main ideas and conclusions.

One compelling story that tells the close relationship between pain and consciousness is his chapter on pain perception in the brain, and how pain ceases to become suffering. He cites the once popular surgery of lobotomy in which the patient’s main cognitive area, the frontal lobes are severed from the rest of the brain. Rosemary Kennedy, the sister of President John F. Kennedy, had lobotomy at age 23, and spent the rest of her life incapacitated. For gone with the pain of mood disorder and suffering was also a patient’s capacity to feel, think and learn.

My main discomfort arises in the final chapter called A Pain Free World which is really meant as a question, a hope. Here an overview of the various tactics for dealing with pain is discussed, including a comprehensive list of drugs available to the patient, with pros and cons – there is no good drug for chronic pain: long term use requires increasing doses and results in addiction; while placebos work equally well in many cases. His discussion of complementary (‘alternative’ is used here) medicine is almost dismissively brief, even as he points out the psychological investment of the patient, suggesting that chronic pain is a form of bad memory, or habit, often unconsciously reinforced by its sufferer; and that certain image-guided therapies are effective for phantom limb syndrome.

The information in this book undoubtedly predicts the present success of integrative care, an approach that includes integrative physicians, psychologists, acupuncturists, and an array of therapies from yoga to massage to energy practitioners and more. Each patient follows his or her own combination of treatments. See report from BraveNet, a free access article from Biomedcentral.com.

Under the 2010 Patient Protection and Affordable Care Act (ObamaCare), the Institute of Medicine is charged with examining pain as a public health problem. The institute suggests that among the “steps to improving care, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and self-management of pain should be promoted”.

Dr. Cervero’s own accounts confirm the potential of such an approach, emphasizing the patient’s own expectations and beliefs in curing pain. In that sense, this is a valuable resource for understanding pain from which we could indeed embark upon the journey to a pain free world, empowered by our own belief in our consciousness, with its learning and remembering abilities.
 

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