You’ll never forget the first time a doctor gave up: when they tell you they don’t know what to do—they don’t have more tests, no treatments to offer—and that you’re on your own. It happened to me at 27, and it happens to many others with chronic pain.
I don’t remember what movie I was going to see, but I know I was at the Oaks Theater, an old art cinema in the suburbs of Pittsburgh, when the pain stabbed me in the side. This was followed by an urgent need to urinate. After I left for the bathroom, I felt better, but a band of tension passed through my thigh. As the hours passed, the pain turned into needing to pee again, which woke me up at 1 or 2 am, and I went to the bathroom – but, as if I was in a bad dream, peeing didn’t make any difference. The ring of sensation remained, unaffected by the reactions from my body. I had a night of hallucinogenic insomnia sprawled out on the bathroom floor, urinating from time to time in a desperate attempt to turn off my physical stimulus.
My primary care doctor guessed I had a urinary tract infection. But the test came back negative — as did more detailed tests, including cystoscopy in which an apparently teenage urologist inserted an old-fashioned cystoscope through the urethra in painful increments, like a radio telescopic antenna. I definitely sensed that something was wrong, but the doctor found no visible injury or infection.
What followed were years of fruitless counseling, the most recent of which was a description of chronic pelvic pain—which means what it sounds like and doesn’t explain much—and a discouraging outlook. The condition is poorly understood, and there is no reliable treatment. I live with the buzz of pain as background noise, and bouts of fits that disrupt sleep from time to time.
This pain may seem bad to you and is too obvious to require scrutiny. But as a philosopher, I find myself asking Why It’s too bad – especially in a situation like mine, where the pain I feel from day to day doesn’t put me down. To my relief, I am able to function well; Sleep deprivation is the worst of it. What more can be said about the harm of feeling pain?
Virginia Woolf may have invented the common thing in which language struggles to express pain. “The English language, which can express the thoughts of Hamlet and the tragedy of Lear,” she wrote, “has no words for shiver and headache.” Wolfe’s quote was developed by literary and cultural critic Eileen Scarry in body in painA book that has become a classic. “Physical pain – unlike any other state of consciousness – has no reference content,” she wrote. “Not From or for anything. It is precisely because it does not take away anything that it, more than any other phenomenon, resists reification in language.
But as someone who has lived with pain for 19 years, I think Wolf and Drunk are wrong. Physical pain has a “reference content”: it marks a part of the body as being damaged or endangered even when, as in my case, it really isn’t. Pain can be deceiving. And we have a lot of words for that: beatAnd the burningAnd the contract All are good words for me.
This pain represents the body in distress, helps us focus on it, and helps us better understand why it is hurting. Pain disrupts what philosopher and physician Drew Lieder calls the “transparency” of a healthy body. We are not usually concerned with the body itself; Instead, we interact with the world “through it,” as if it were a transparent medium. The feeling of pain blurs the physical glass. This is why pain is not bad in itself: it hinders one’s access to anything good.
This explains one of the delusions of pain. Sometimes, I think I want nothing more than to be free of pain – but once the pain is gone, the body recedes into the background without appreciation. The joy of being free from pain is like an image that disappears when you try to look at it, like turning on lights to see the darkness.
Philosophy illuminates another aspect of pain – in a way that has practical consequences. This has to do with understanding persistent pain as more than just a series of small sensations. The temporality of pain changes its character.
Although I don’t always have noticeable pain, I never know the onset or relief of the pain. By the time I realized he had disappeared from the attention radar, he was quiet for a while. When the pain is severe, it seems to have been there forever and will never go away. I cannot imagine a future without pain: I will never be physically comfortable. Leader, who also suffers from chronic pain, traces its effects on memory and anticipation: “With chronic suffering, the painless past is forgotten. While we intellectually know that we have never been in pain, we have lost the physical memory of what we felt. Likewise, the future may be Painless is unimaginable.”
We can draw two lessons from this. The first is that we should focus on the present, not on what is to come in the future: if you can process pain as a series of independent episodes, you can reduce its power. I try to live by what I call “Kimmy Schmidt’s rule”, after the sitcom heroine endured 15 years in an underground shelter with the motto “You can stand anything for 10 seconds”. My time units are longer, but I try my best not to overshoot. You can have a good day while you are suffering from pelvic pain. And life is just one day after another.
The second lesson is that what philosophers call a “separation of persons” is less than it might seem. Moral philosophers have argued that caring for others not only accumulates their harm. If you have to choose between the agony of one person or a mild headache for many others, you have to choose the types of headaches, no matter how many. The relief of simple pain in many people cannot eliminate one’s suffering, because pain affects people with distinction and separate. They do not add.
Do such trade-offs make sense in one’s life? Philosophers often say they do, but I think that’s a mistake. If what I was experiencing were just a series of small pains, with no effects on memory or anticipation, I don’t think it would make sense to replace them with short-term pain – three hour surgery without anesthetic, for example, any more than would make sense to replace a million headaches Mild pain for one person. If you choose to undergo that surgery, it will be because of the time effects of chronic pain, and the shadow it casts on the past and future.
Much has been said of the inability of pain to share, and how it sets us apart. In fact, the pain is no longer shareable over time. My mother-in-law once asked, rhetorically, “Why can’t one man pee for another?” But you can’t pee on yourself in the past or the future either. As we bridge the gap between them, Currently And the and then To empathize with ourselves at other times, we also sympathize with the suffering of others. Self-compassion is not the same as self-compassion, but they are not as different as they seem. There is solace in solidarity, in sharing the experience of chronic pain, in the power of compassion to break the boundaries that separate us from others, and from ourselves.
This article was excerpted from Kiran Setia’s new book, Life Is Hard: How Philosophy Can Help Us Find Our Way.
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