Tea and Sympathy

The English are supposed to be experts at tea and sympathy. In my experience, and I say this as an insider, they're pretty bad at both.



Let's get the tea out of the way first. It's still a point of some debate how to make a cup of tea in England, the controversy chiefly hinging on when in the procedure to add the milk. These days, hardly anybody bemoans the teabag, described to me once by a Dane as a sachet of dust. In any case, the visitor to England is no more likely to get a good cup of tea there than anywhere else, and might only reflect on the significance of the fact that 180 million cups of the stuff get drunk everyday in the British Isles. It is a minor addiction, perhaps, or else little more than a warm, and distinctly unchallenging, comfort. If you're not convinced, look to the outrage of George Orwell, no less.

Sympathy, meanwhile, has become a rare bird. In political and civil discourse of late, it's been hard to detect. Society has become acrimonious, relations antagonistic. The views of others are not looked into but shut down, ably abetted by a monstrous media that exists seemingly only to foment discord. We might be forgiven, therefore, for thinking that the sympathetic streak has been lost.

I'm not convinced it was ever there, or that anybody ever really knew what they meant by it. At best, the sharing of troubles over tea was perhaps just a variation on breaking bread, the communal sharing of one another's company as a reminder of shared humanity. Problems were never really broached, let alone halved or solved.

My own research on the meaning and practice of sympathy in British history suggests a strongly fluctuating concept, ranging from a deeply self-serving pity (the well-spring of charity de haut en bas) to a clinical calculation about how best to stave off the weak and preserve the strong for the sake of the English 'race'.

Those two extremes overlapped at the end of the nineteenth century, and the latter point is perhaps the most shocking observation of the history of sympathy in England. For the sake of putting an end to social suffering, otherwise well-meaning individuals contrived a social policy of eugenic breeding and framed it in the name, in the feeling, of sympathy.

It did not come to pass, or at least, not there, and not then. But the evidence of the link between sympathy and eugenics is compelling, and has a long reach. This particular story caps a much longer tale, which I'm happy to report now exists in the world.

The Science of Sympathy is published by the University of Illinois Press, and is available now in paperback.

On Sympathy

There are only about six weeks left before Science of Sympathy is unleashed on the world. I’ve been living with this book for years and waiting impatiently for the publication machinery to grind slowly towards its end. My fifth book, it’s certainly been the most interesting from an editorial and production point of view. I’ve nothing but praise for the old-fashioned professionalism on show at the University of Illinois Press. In general, the world of academic publishing has out-sourced copy editing, loaded editorial burdens on to the authors themselves, given up on marketing, and adopted pricing policies that make academic books unaffordable for anyone save well-endowed university libraries. This publishing model can boast success if a title sells 150 copies. Publishers make their profits. Authors make nothing or next to nothing. A standard academic contract for a monograph has a royalty rate of between 0 and 2.5% for the author.

Happily, Illinois is publishing a hardback and a paperback of Science of Sympathy at the same time, hitting that university library market at the same time as making the book affordable for everyone else. Every step of the way I’ve dealt with different in-house employees responsible for copy, marketing, artwork, production, website, and so on. Most impressive from my point of view was the production of the jacket blurb. The vast majority of text you read on the back of books, talking about how innovative and brilliant the contents are, is written by the authors themselves as part of pro-forma marketing questionnaires. It’s tough to do. When you’ve spent seven years putting together a complex argument, it’s often difficult to sum it all up in one paragraph, let alone to find the distance to say why it is good in pithy prose. To my amazement, the person responsible for marketing copy at Illinois actually read my book and wrote the blurb for me. What a strange feeling to have someone else sum up what your book is about and what it does. This is serious, professional, almost lost editorial practice, and I’m a fan!

I’ll post some bits and pieces about the book in the coming weeks, but for now, here’s that blurb:

In his Descent of Man, Charles Darwin placed sympathy at the crux of morality in a civilized human society. His idea buttressed the belief that white, upper-class, educated men deserved their sense of superiority by virtue of good breeding. It also implied that societal progress could be steered by envisioning a new blueprint for sympathy that redefined moral actions carried out in sympathy's name.

Rob Boddice joins a daring intellectual history of sympathy to a portrait of how the first Darwinists defined and employed it. As Boddice shows, their interpretations of Darwin's ideas sparked a cacophonous discourse intent on displacing previous notions of sympathy. Scientific and medical progress demanded that "cruel" practices like vivisection and compulsory vaccination be seen as moral for their ultimate goal of alleviating suffering. Some even saw the so-called unfit--natural targets of sympathy--as a danger to society and encouraged procreation by the "fit" alone. Right or wrong, these early Darwinists formed a moral economy that acted on a new system of ethics, reconceptualized obligations, and executed new duties. Boddice persuasively argues that the bizarre, even dangerous formulations of sympathy they invented influence society and civilization in the present day.

Science of Sympathy is available for pre-order here (US) and here (UK).

The History of Emotions: Foundations

Every now and again I run into a wall. Great and sustained bursts of writing resolve themselves into deep depressions of inactivity. The marathon runner in me knows the importance of rest and recovery after a hard slog, but that knowledge makes the days of low productivity no less easy to deal with. It’s always a bit of a mystery to me how the spark gets to be reignited. I think one has to look for inspiration, not wait for it to come.

At the moment I’m trying to come up with a rigorous justification of, and outline for, the history of emotions. At the same time I am documenting the modern origins of the notion that emotions are historical. It seems, of late, that every time I think that emotional historicism is gaining some traction among emotions scholars, someone comes along and hits me over the head with the most rank essentialism. I am mining rich seams of historical evidence for emotional change over time; others simply point to their endocrine systems, spilling their guts about biological determinism. The experience is dispiriting.

It is, therefore, somewhat joyous to find an historical source to break me out of a funk. George Henry Lewes – life partner of George Eliot, critic, private experimentalist, radical, polymath – foreshadowed the debates that preoccupy emotions scholars as long ago as 1879. He saw the essentialising tendencies in psychology and physiology; he understood the links between emotions and morality. He was, perhaps better than most of his contemporaries, well versed in evolutionism and sensibly critical of it, though he recognised that humans were humans wherever and however one found them. Is not the passage below an elegant and still relevant statement of both the historicity of emotions and a compelling justification for studying the history of emotions? 

Because Psychology is interpreted through Sociology, and Experience acquires its development mainly through social influences, we must always take History into account. It shares with Society the distinctive character of progress. It is for ever germinating, for ever evolving. The physiologist recognises the same organs and functions in the savage and the civilized, in Greek, Hindoo, old German, or modern European; but not the same thoughts and sentiments. The brain of a cultivated Englishman of our day, compared with the brain of a Greek of the age of Pericles, would not present any appreciable differences, yet the differences between the moral and intellectual activities of the two would be many and vast. These are not to be assigned to the organism and its functions. The co-ordination of sensory processes in the brain of the Greek was doubtless as perfect as that in the brain of the Englishman; but the quality of the moral feelings and the range of conceptions, so far as we could test them objectively, would be very different…. Thus, while the laws of the sentient functions must be studied in Physiology, the laws of the sentient faculties, especially the moral and intellectual faculties, must be studied in History. The true logic of Science is only made apparent in the history of Science.

George Henry Lewes, Problems of Life and Mind, 

3^rd series, 1 (London: Trübner & Co., 1879) 

Pain: The Forgotten Emotion

[Transcript of a paper given at the University of Melbourne, Australia, November 18, 2015]

Today I want simply to give you a brief insight into the work I’ve been doing over the past few years on the subject of pain, its history and its present, with a few suggestions for the potential practical relevance of the history of emotions for contemporary medical practice. This work began life in 2011 within the framework of the history of emotions, as part of a postdoc at the Languages of Emotion Excellence Cluster at Freie Universitaet Berlin, in conjunction with what has turned out to be a long stay at the Centre for the History of Emotions at the Max Planck Institute for Human Development. I was, ostensibly, working on the history of sympathy and compassion at the beginning of that project, having previously carried out research on the history of cruelty and pain in animals. But I was obliged to make some connections that weren’t immediately obvious to me when Joanna Bourke invited me to be a Pain Fellow at the Birkbeck Pain Project in London in 2012. The focus there was supposed to be bodily pain, but I quickly realised that a mind/body dualistic approach wasn’t going to work, and that the work I’d been doing on sympathy was in fact a close and informative bedfellow of pain.

What has followed has been a bit of an adventure, which has taken me out of my modern-historian comfort zone in a number of different directions. I’ve engaged many different disciplinary approaches to pain, gone back through the ages to examine the wealth of historical literature on pain, and scrutinised many more recent historical and contemporary medical journals than I’d ever thought likely. I’ve talked with anaesthetists, plastic surgeons, bioethicists, art practitioners, lawyers and anthropologists in a bid to try and join up the thinking on pain.

The first result of all this was an edited volume that came out last year, called Pain and Emotion in Modern History, which makes one titular compromise that I would now like to undo. I’d like to swap out the ‘and’ and replace it with ‘as’. As it stands the book attempts to collapse the distinction between physical and emotional and to reassess some well worn historiographical paths by taking seriously historical claims that feelings hurt. I think I’m right in saying that for modern historians at least, this was novel and unexpected, and came with a heavy burden of proof. But I was aware that for early modernists and medievalists these claims were perhaps already in the mainstream, and indeed for some within contemporary neuroscientific research the emotional nature of pain was driving experimentation. What I couldn’t see – at all – was any sense that any of these distinct fields were aware of each other, let alone talking to one another. I saw huge potential in reassessing the historical narrative in the light of some of the latest neuroscientific research, and indeed reassessing some of that neuro-research in the light of the historiography.

That led me to take on another project, which I’m finishing up in Melbourne, to write Pain: A Very Short Introduction, which rather terrifyingly is to cover the history of pain from antiquity to the present, and to include an analysis of contemporary medical and scientific understandings of pain, all in 35,000 words. What you’re getting today is sort of a precis of the argument in that book, and I hope to at least convey my main points: first, that pain is an emotion or, if that is too stark, that pain is meaningless without emotion; second, that if emotional experience is historical, contextually contingent, mutable, then so must be the experience of pain; third, if this is true, then pain necessarily resists a definition, and treatment and management must be carried out with an attention to any sufferer’s subjective appraisal of their own pain and the cultural context in which pain is expressed.

Why do I call pain a ‘forgotten’ emotion? Well, as I combed the historical record I found that, with remarkable consistency across time and place, people seemed instinctively to know that bodily pain and emotional pain were of the same order, and while historians have carefully pointed out this fact they have done so through the lens of modernity, which has been characterised by a dualistic approach that has mechanised pain in the body and made pain of the mind a distinct kind of disorder. The effect: historical actors’ own conceptualisations of pain have been treated as novel and re-constructible on the one hand, but exotic, unfamiliar and wrong, strictly speaking. At the same time, the neuroscientific research that is convincingly demonstrating how pain is contextually and emotionally experienced has no connection whatsoever to this long view. Ostensibly, neuroscientists are confirming what the colloquial expressions of ordinary people suggest was already known – in fact continues to be known in everyday experience – but which had been forgotten in scientific and academic bowers since the time of Descartes. Meanwhile, current medical approaches to pain in clinical settings are largely disconnected from both these strands of research, still underemphasise the substantive interrelationship of body, brain and society in the construction of meaningful experiences of pain, and therefore still tend to treat people in pain according to presentations of bodily lesion or mental disturbance. If medicine could be inspired to remember that pain is an emotion or made meaningful only through emotion, then pain management would radically change.

I begin the book with a conceptual analysis of pain in history, examining how the language of pain has tended to conflate body and soul, body and mind, and physical and emotional. These are common expressions of pain that betray a fundamental fuzziness of the category of pain. The ancient Greeks had a number of words for pain and suffering that tended to overlap. Chief among these terms was άλγος (algos), which denoted physical pain as well as woe, ill, or misery. The Greeks did have a way of isolating bodily pain, if necessary, although it was only ever a short elision to a more general concept of suffering. In the Iliad, talk of όδύνη (odune) is never far away from the general state of anguish that undergirds the epic, and the same is true of the famous Herculean scream in Sophocles’ Trachiniae. The poisoned robe that slowly kills the hero in a prolonged fit of agony puts Heracles interchangeably in bodily pain and woeful misery (όδύνη and άλγος). 

The Greek term πάθος (pathos) denotes suffering or experience and, in its original meaning, the adjective ‘pathetic’ was an appeal at an emotional level. In Aristotle’s rhetoric, pathos causes pleasure or pain in an audience, as well as in its producer, depending on which emotions are mobilised. The possibility of pain without injury is clear, and it is closely entangled with affective states. As a central element of the rhetorical triad that included ethos and logos, we can assume that through pathos the potential for the feeling of painful woe was built into rhetorical emotional appeals. Aristotle goes so far as to say that the person who is angry ‘suffers pain’ (λυπεῖται). Here we see the elision of grief or vexation with bodily pain in the word λύπη (lupé). If we pursue this further, finding the Latin derivation of pathos, through πάσχειν (pashein), in the word passio, we see the continued conflation of the emotional and the physical, of suffering and pain. If the Romans emphasised the emotional level of pain through passio, they also, like the Greeks, had a generally holistic approach to the concept of pain that included what we have tended to divide into mental and physical categories. The Latin dolor is preserved in the French douleur, the Spanish dolor, and the Italian dolore. Originally, it could stand for physical pain, as well as grief, anguish, sorrow and resentment. To some extent, this conflation has been preserved in the vernacular.

The categorical vernacular conflation of old is not limited to Western civilisation. In Late Imperial China, for example, there is a rich overlapping of physical, emotional, sensational and moral categories, with an interplay of characters such as 痛 (tong), 苦 (ku), and the portmanteau 痛苦 (tongku), denoting respectively ‘painful’, ‘suffering’ and together, something like ‘anguish’. In India, the Hindi word दर्द (dard) stands for a raft of different degrees of suffering, from uneasiness to torture and from mental distress to grief to anguish. A correlate would be the word दुःख (duḥkh), which often translates as sorrow or grief, but which can signify pain just the same. It has ancient roots in Sanskrit, connoting suffering on a spiritual level, but when deployed in compound terms can indicate the whole range of pain from a cut to a cramp to a calamity. I begin with this semantic journey to emphasise both an enduring conceptual continuity in the understanding of pain, and to highlight the seismic rupture in this understanding that radically altered what it meant to be in pain, to be treated for pain, and to treat for pain (medically) in modernity. That rupture indicates an historical separation of vernacular knowledge of pain from medical specialism about pain.

Before reaching that separation I will say a few words on pain in the religious and theological context of medieval and early modern Europe up to the time of the rupture. Ecce Homo – behold the man – are the words associated with Pontius Pilate upon presenting the bloodied, tortured and pained body of Christ to the assembled masses, prior to crucifixion (John 19:5). The images associated with this scene became emblematic of virtuous suffering, and of the theological importance for humans to endure bodily pain. The representation of Christ’s passion in this moment has been preserved by the art world in the figure of the vir dolorum, or the man of pains, which has reached us variously in Europe as the ‘man of sorrows’ or the Schmerzensmann, which depicts a hurt beyond the mere physical. The wounds, the blood, the instruments of torture are all figures that invite reflection on a suffering that goes beyond the mortification of flesh.

Pain was a central pillar in Christian religious practice from the Roman world to the Counter Reformation, and arguably beyond. As Javier Moscoso and others have pointed out, pain was foundational for medieval and early modern piety, as part of an ascetic quest to imitate the ultimate pain in Christ’s passion. It was a pain not merely to be endured, but to be sought after, enhanced in any way imaginable, and, sometimes literally, sanctified. The imitation of the passion was celebrated in the lives of the Christian martyrs, whose placid countenances in the face of horrible tortures served as proof of the intervention of the saints. Meanwhile, such tortures informed medieval and early modern systems of justice and punishment. Long before pain came to be considered useful from an evolutionary point of view, pain was considered useful from moral, spiritual and judicial points of view. Religious life was dominated by the meaningful fact of being and coming to be in pain. No human pain could reach the extent of Christ’s suffering on behalf of humanity, but to embrace pain after the fashion of Christ was to offset sin and therefore reduce the amount of suffering after death. In this sense, pain was considered by many to be a blessing, or an unmitigated good, since it promised a swifter route to redemption in the afterlife. It would have been heretical, given this view, to seek to desensitise oneself to pain. Instead, people were to steel themselves to live with and through pain. As Esther Cohen has pointed out, this theological stance was the only way to resolve a tangible and all too readily observable ubiquity of suffering with the notion of an omnipresent Providence.

Doubtless this narrative is familiar, but I hope you acknowledge that already we have an account of pain that differs markedly from the kind of mechanistic or utilitarian discourse that would have all pain be bad or unpleasant, and reducible to the nervous system. I contend that the experience of being in pain in this context must have been completely different to the experience of being in pain in a secular, modern, medical context. Neuroscience is providing us with extremely convincing evidence to suggest that what pain feels like – that is, the meaning ascribed to being in pain that defines how pain is experienced – is affectively constructed. We should seriously entertain the notion of pain as ecstasy, pain as piety or a feeling of closeness to God, and pain as pleasure. When such things crop up in the historical record they should be entertained at face value and not merely as rhetorical. I’ll say more about this in a couple of minutes.

The rupture in conceptual understandings of pain is usually ascribed to Descartes, but I want to do him some justice before condemning him. Descartes’ human was, in fact, not a separable entity of body and soul so long as the body was alive, but a union of body-mind or body-soul, which could not be reduced to its components. True, in his Meditations, Descartes insisted that the thinking thing (res cogitans) did not depend on a body, but when Descartes’ body was affected by pain, he felt it; that is, at the level of the rational soul – a thinking thing – there was a disturbance (of thought), caused by the disruption or injury of the body with which the soul was conjoined. He talked of an ‘admixture’ (permixtione) of mind and body when it came to the senses (e.g. hunger or pain). The human body in pain was not merely a reflex mechanism akin to a bell on the end of a rope, but a body-mind that only felt pain because the mind was inseparable from its corporeal seat. If it were otherwise, according to Descartes, the human thinking thing would look upon bodily injury (lesion) as the pilot of a vessel would look upon a damaged boat. This account is complex, rich, and useful.

But. This image, added to the Meditations later, in combination with what Descartes said about animals being like clocks or soulless automata, prevailed. A simplistic reading of the image, contrary to what Descartes actually wrote about pain, has been enormously influential in modern medical science, beginning the search for a mechanical pain pathway. It rests on the assumption that injury = pain and that reactionary movements away from the cause of pain are the results of nervous stimulation, like a bell on the end of a rope suddenly being pulled. As science became increasingly secular and as the soul retreated into the background, so the primacy of physical pain emerged. We have lived with this vision more or less ever since. Ironically, science’s loss of interest in the soul allowed animals into the realm of beings that feel pain, but when physiologists recognised that pain was an unpleasant experience in humans and animals alike, they nevertheless set out on Descartes’ path to find the ‘wheels and springs’ that made pain work.

Modern biomedical theories of pain were preoccupied with the ‘pain pathway’ – the specific mechanism by which pain is detected in the periphery and transmitted, via the spinal cord, to the brain. It was based on assumptions that intensity of injury directly correlated with intensity of pain, and that certain nerves were specifically involved in sending pain messages to the brain. There is a kind of comfortable intuitiveness about such assumptions, but they have been conclusively found to be completely incorrect. Essentially what we see in modern medicine is the parceling out of physical pain related to injury and mental pain, which really did not belong to biomedical concerns. Even though this began to change in the 1960s, we are essentially still living with this dualism in the way medicine is practiced. It has been to the detriment of countless millions of people suffering with chronic pain syndromes and, throughout the twentieth century, saw the moral fibre or character of the war wounded called into question as they continued to suffer from the traumatic effects of combat, whether physically injured or not. Pick up a standard medical text book on pain and you will still find, as a sort of rhetorical Cartesian hangover, a tendency to label nerves that detect injury as pain detectors, which send pain signals to the brain. Such rhetorical slippages have been unsupported since 1965, but they persist and they continue to affect medical practice.

What happened in 1965? Ronald Melzack and Patrick Wall published their new theory of the ‘gate control mechanism’, which in turn fostered neuroscientific research that revolutionised understandings of what pain is. Here is the circuit-board in the spinal cord. But the mechanism was coupled with a fuzzier idea that promised the reintroduction of something immaterial, or beyond the human, to make sense of the variability of pain experience. The gate control is essentially a processing centre in the spinal cord that processes signals coming from the periphery in conjunction with signals descending from the brain. It determines what signals make it to the brain to be interpreted as pain. Crucially, the receipt of injury signals from the periphery are only allowed through the gate in conjunction with evaluative cognitive and emotional involvement. The social context and an appraisal of threat determine how pain feels: what it meaningfully is. Pain is indistinguishable from the fear, anxiety, anger, or ecstasy that comes with it.

            
This has been confirmed by study of those people with rare cases of pain asymbolia, or congenital analgesia. This is a genetic condition that renders its ‘sufferer’ unable to ascribe any meaning to painful states. Injurious stimuli are perceived plainly as pressure, cutting, cramping, etc., but the person who perceives these things is indifferent to them. Research has shown that so-called ‘pain centres’ in the brain do, in fact, ‘fire’ in these people when given painful stimuli, but their ‘affective centres’ do not. It is precisely because there is no emotional context to the physical problem that the pain does not register as a problem. Far from being advantageous, people with congenital analgesia tend not to live very long, precisely because they are indifferent to the pain that comes after injury. If there is an evolutionary benefit for pain it is in restricting movement and in protecting those parts that need time to heal. A person with congenital analgesia does not limp when wounded in the leg, and would indifferently go on throwing a ball with a broken arm. This failure to conserve an injury – an affective failure – has the effect of wearing out bones, joints and muscles at a much greater rate than somebody who could feel pain in a ‘normal’ way. Pain, to put it in plain terms, keeps us alive. It depends, when ordinarily perceived, on what the neuroscientists call affect.

Neuroscientists have provided further evidence of this by demonstrating that specific brain activity typically observed when painfully injured roughly corresponds with brain activity when feeling ‘social pain’. Despite some worthy and necessary scepticism about what we are seeing when we look at an fMRI scan of a brain, there can be no question that parts of the brain strongly related to affective or emotional behaviour are involved in pain states, and that these parts of the brain are also involved under stimuli that replicate the affective conditions of pain, but which do not involve any physical harm. In other words, the thing that gives pain meaning – that makes pain painful – can be observed in situations where the body is completely uncompromised. In a now famous test Naomi Eisenberger tested the effect of social exclusion among a peer group. Using a computer game of ‘cyberball’, in which players passed a ball to each other while being scanned, Eisenberger was able to show that being excluded from the game caused brain activity similar to what one would expect to see in conditions of physical pain. Those who felt excluded went through an emotional ordeal that looked, for all intents and purposes, the same as physical pain. The meaning-making processes that are part and parcel of experiencing physical pain are the same when experiencing such things as exclusion, bullying, grief. A broken heart – the archetypical cliché of emotional pain – turns out to be painful in the same sense as a broken leg (although with different consequences, of course). If hurt feelings have been, since time immemorial, a colloquial commonplace, contemporary medicine has started down the road of providing neuroscientific verification of this fact. Ronald Melzack has, much more recently, pushed the implications of his research even further, and coined the neuromatrix theory of pain. Key to this theory is the insistence that experience is not present anywhere, but is created in the brain.

Pain is output of the brain, not input from the periphery. Melzack forcefully states that injury is not pain. Pain is a quality produced in the brain, and is not reconcilable with, or reducible to, injury per se. The neuromatrix theory posits the production of a neurosignature of the whole body – an internal neuro ‘image’ or ‘pattern’ of the body understood as the self – which is ever-present. While the particulars of an individual’s neuromatrix may be genetically programmed, it is nevertheless plastic, being formed and informed by a number of factors that together produce a sense of the self: sensory inputs, including aural and visual, are components; affective and emotional states, which are themselves forged in the crucible of culture, play a part; the meanings and values attached to body parts, proportions, postures, and movements – some of it instinctive, some of it culturally prescribed – are factored in. All these inputs are processed and, in Melzack’s analogy, ‘arranged’ into a symphonic output that equates to the body-self. A cut in the leg may or may not be painful, but I know it is a cut in my leg because of the neurosignature imprint of my neuromatrix. The neuromatrix promises the collapse of both Cartesian dualism and the distance between biomedicine and phenomenology. The brain is not merely a machine, an automaton, or a computer. The brain is plastic, subject to change, and influenced by the world in which it is situated.

This research, I think, casts the history of pain – replete with seemingly inaccessible allusions to religious ecstasy, sexual pleasure and agonies of the soul – into a new light. What might seem like metaphor or rhetoric on face value might actually be a faithful recording of the experience of pain from distinct historical and subjective perspectives. The history of pain is so rich – I’ve barely skimmed the surface of a tiny fraction of it here, that I think it bears re-visiting with a commitment to embrace the unfamiliar as, for want of a better word, authentic. Moreover, that rich history should be sufficient for biomedicine to give up its quest for a definition of pain. It is emotional, historical, contextual. This observation thrusts the emphasis back on to the subjective experience of pain. Doctors’ most reliable source for what their patients are going through is not an fMRI scanner, a prescribed pain questionnaire, or a premeditated search for a lesion, but lies in who the patient is and in what they say and do, combined with an appreciation of their circumstances and the societal prescriptions for what can and should be expressed and what cannot. In short, doctors need to become literate in the pain practices – which is to say the emotional practices – of the people around them. Maybe historians of emotion can help with that.


Pictures: Bernard Picart, The Death of Hercules, 1733; Lucas Cranach the Elder, Christ as Man of Sorrows [Schmerzensmann], before 1537; The pain pathway, from René Descartes, Traite de l’homme, 1664; Gate Control Mechanism, Melzack and Wall, Science, 1965; ‘Social and Physical Pain Produce Similar Brain Responses’, Eisenberger, Lieberman and Williams, Science, 2003; ‘Pain and the Neuromatrix’, Melzack, Journal of Dental Education, 2001.

Dr Jenner's Dead Cut

In the summer of 1808, the already famous Gloucestershire doctor, Edward Jenner, was in London, having a miserable time. The inventor of vaccine inoculation against smallpox was stuck in the City, waiting on the interminable bureaucracy of Parliament to finalise the details for the National Vaccine Establishment. He had many enemies: anti-vaccination pamphleteers who thought his ideas were eyewash; other vaccinators who coveted his glory; and personal nemeses who seemed to block his every move. Holed up in a place he abhorred, Jenner appealed to his friends for succour, but found them wanting. He perceived his opponents, ‘by the most abominable falsities’, endeavouring ‘to ruin my private character’. So much he could bear, ‘but when I find that no friend has step’d forth even to hold an Umbrella over my head it makes me feel miserable’. He went home at the end of the year, only to find out that events had unfolded to his distaste. The new Establishment was to nourish his enemies, and to dishonour Jenner himself. In desperation, he solicited advice: ‘I may most piteously exclaim, what shall I do?’ he asked Thomas Pruen. Pruen’s reply was dismissive: ‘I am sorry for your situation, but can afford you no kind of assistance’. Jenner felt this as a ‘dead Cut’ and told Pruen so:

Dr Jenner's Lancet, Science Museum London, Wellcome Images

What if a Man had met with an old Friend who had tumbled into a Cellar or any other kind of pit & had broke his bones & had pass’d by heedless of his moanings, saying I am sorry for you but cannot stay to help you out, because I have a pressing engagement, that I must attend to in another quarter? Would this have been balsam to his Wounds or a Caustic?

A month later, after some cooling off and some mollifying correspondence, Jenner announced that ‘the Cut is heald’.

Until recently, such talk would have been filed under metaphor and left at that. Jenner was miserable, but not in pain. The ‘cut’ wasn’t real. Recent studies on the ways in which pain experience is managed by the brain have begun to change our approach, casting new light on the affective pain utterances of historical actors. We’re now in a position to say, at least tentatively, that Jenner’s misery hurt.

How so? The turn towards affect in both historical studies and the neurosciences has foregrounded the importance of emotions in giving meaning to, or in defining, painful experiences. In fact, without stimulation of the affective centres of the brain, there is no experience, only pain. On the one hand, studies of people with the rare condition of pain asymbolia have found that without affective involvement, pain is meaningless. People with this condition are fully able to sense pain, but completely unable to interpret it. Bodily injury elicits no fear, no anxiety, no compulsion to flee or fight. A hand is put into the flame and it burns, but there is no reason to withdraw it. On the other hand, there are people who have no bodily injury whatsoever, but who feel the effects of, for example, social exclusion, as physical pain. Brain imaging has discovered that brain activity in affective centres under such conditions accords with what you would expect to see in a person suffering a physical injury. In sum, physical pain requires an emotional component in order to be experienced as pain, while certain ‘negative’ emotions are experienced physically as painful.

What’s the point? The science of pain is finally catching up with what sufferers have known all along: when they communicate that their body is in pain, they’re not making it up. But the specifics of the communication are contextually grounded, culturally formed. To take such utterances seriously is to entertain new potentialities in the history of experience. Much of the emotional suffering of the historical record – hysteria, melancholia, nostalgia, for example (to all of which Dr Jenner was prone) – has been under-treated by the history of medicine, in accord with twentieth-century medicine’s dualistic predilections, where pain is physical and suffering is only emotional or psychological. To enter into the historical experiences and meanings of suffering is to open up the possibility of understanding and interpreting the emotional and physical worlds of historical actors. Both the history of the body and the history of mentalités become united in a monistic history of experience that sets out to understand the dynamic relationship among emotions, their expression, bodily sensations and bodily practices.

This post first appeared on Emotions in Dialogue. You can pre-order Edward Jenner here and here. 

Bestiality in a Time of Smallpox

The news is rife with fear. Influenza is abroad. Worse still, measles is said to be making a big comeback. But disease is not the only problem. The flames of fear are being fanned by the opponents of vaccination. Measles, for example, is entirely preventable, but remains among us because of concerns that the vaccine prophylactic is worse than the disease. The thoroughly debunked notion that the MMR vaccine causes autism is still at large, and with it a cluster of nebulous fears of Big Pharma conspiracies and the risks of contaminating children with manufactured diseases. Yet such fears are not new. The fear of vaccination is as old as vaccination itself. Edward Jenner’s method for preventing smallpox summoned the spectre of sinful flesh. Vaccination was akin to bestiality; the vaccine itself was a beastly sexual disease.

The original ‘vaccine’, named after the cow from which it came, was a massive step forward in smallpox prevention. Until then, children were commonly inoculated with smallpox itself, which usually resulted in a light dose of the disease. Inoculation, however, killed many who underwent it, and left the rest fully contagious. Nevertheless, when Jenner’s Inquiry into the matter finally appeared in 1798, explaining how an animal disease would prevent a human one without resorting to dangerous inoculation, it attracted as much odium as it garnered support.

Wellcome Library, London

James Gillray’s popular 1802 print of the bestial effects of cowpox  strikes the modern viewer as ridiculous: cows emerging from heads, trunks and limbs. Jenner stands centrally, penetrating the arm of a terrified patient with ‘vaccine pock, hot from ye cow’. The patient has previously been ‘opened’ by a special brew. To the right, those already vaccinated undergo a series of horrors caused by contamination with animal disease. The image is shot through with innuendo about sexual transgression (communing with the beast) and venereal disease (syphilis).The pregnant hag on the extreme right seems at once to vomit and give birth to bovine progeny, while behind her another matron sprouts the satyr-like horns of the beast. The breeches of a bumpkin are breached. The faces of others are marked by monstrous eruptions of ‘the pox’.

The image reflects the intensity of the debates and fears around vaccination. Gillray’s caption directs us to the publications of the ‘Anti-Vaccine Society’: not a formal body, but a reference to Jenner’s principal opponents. The prominent physician Benjamin Moseley was the culprit in chief, responding to the ‘Cowmania’ in 1800 with a series of concerns. While Jenner had styled cowpox Variolae Vaccinae, smallpox of the cow, Moseley called it Lues Bovilla, bovine syphilis, with all the long-term mental and nervous consequences of the human ‘pox’. He asked:

Can any person say what may be the consequence of introducing the Lues Bovilla, a bestial humour – into the human frame, after a long lapse of years? Who knows, besides, what ideas may rise in the course of time, from a brutal fever having excited its incongruous impressions on the brain? Who knows, also, but that the human character may undergo strange mutations from quadrupedan sympathy and that some modern Pasiphaë may rival the fables of old?

His classical reference might pass us by, but the invocation of bestiality would have been obvious to the educated in 1800. Pasiphaë, cursed by Poseidon, had copulated with a bull. Having built a wooden cow and covered it with cowhide, she had hidden inside it in order to receive her desired mate. She later gave birth to the Minotaur. Moseley played not only on the taint of venereal disease, but also on the fragility and sanctity of the human, warning of a hybrid and brutal progeny. Vaccination was not only dangerous, it was immoral.

Wellcome Library, London

The search was on for proof of the bestial consequences of being inseminated with animal disease. In 1805 Dr Rowley, who derived his living from the impugned technique of inoculating with smallpox, claimed to have found it and to have showed it to Moseley. Moseley marked the animalistic transformation and Rowley published exaggerated portraits of Gillray-esque figures, supposedly drawn from life. The ‘Oxfaced boy’ was presented as tangible proof of the brutal result of bestial infection. Beware the ‘modern chimera’, went the cry.

Vaccination did not properly shake the fear of bestial venereal disease until the end of the nineteenth century, with some still adamantly claiming an identity between cowpox and syphilis. From 1853, responsibility for administering the vaccine in England was put in the hands of the Poor Law Guardians. The association of vaccination with the workhouse caused a resurgence of the syphilitic fear among the well-to-do. Jenner’s innovation helped fuel concerns. After an initial vaccination from the cow, he realised that it could then be carried on from arm to arm. The matter from one vaccination pustule could be collected and inserted into the arm of the next child. What respectable mother would take her child to be contaminated with matter drawn from the arm of a ne’er-do-well? Cowpox was one thing, but what about all the other diseases that riddled the poor? The class system relied on bodies being kept apart. The State’s insistence on bringing them together seemed to risk the fabric of civilisation, even if the risk of disease was actually minute. While most doctors believed that cowpox was not related to syphilis, how could they be sure that the vaccine wasn’t tainted with the diseases of the immoral when incubated in the arms of the poor? Better to risk smallpox than to invite syphilis into one’s children.

The fearful kept their children away and a preventable disease continued to rage, often to epidemic proportions. The form taken by fear reflects the preoccupations of the society that produces it. In our times it is a fear of corporate medicine and its reckless advocates, forcing unknown risks upon our children. For early nineteenth-century anti-vaccinists, cowpox vaccination was a sordid and unholy communion, the embodiment of an immoral trinity: animality, bestiality and sexually transmitted disease. 

This post first appeared on Notches. To order Edward Jenner click here or here.

Historical Heroes: Edward Jenner

Goodness, it’s been a while. For anybody wondering where I’ve been, I promise I’ve not been idle. On the contrary, expect to see three books from this author in the next year. Better still, expect them to not be too big a burden on your pocket books. Covering a range of subjects, they nevertheless speak to a number of the themes that have cropped up on this site over the years. I’ll keep you updated, okay? First up, a short biography of the father of the vaccine, Edward Jenner. Here’s a taste of what you can expect.

Edward Jenner, a country surgeon from Gloucestershire, England, was incurably curious. Mentored by the great surgeon, collector and experimenter, John Hunter, Jenner learned to see about him a natural world to be conquered, controlled, brought under the command of the human intellect. Such was the peculiar genius of Enlightenment science and medicine.

Activated by local talk of the powers of a minor disease contracted from the udders of cows, Jenner set about experimenting with cowpox to see if it really did protect a person from the deadly ravages of smallpox. Jenner’s innovation was, first, to infect a person with cowpox from the pustules of another person who already had the disease. This would prove that cowpox was transferable among humans. This he managed to do in 1796: the first vaccination, from vacca, the Latin for cow. His second innovation was to test the power of the vaccine by attempting to give the vaccinated person the smallpox. Lest that sound horrific, keep in mind that until Jenner pioneered a safe way to protect people from the smallpox, most children had been deliberately infected with the ‘speckled monster’ itself, in the hope that they would get away with a light dose of the dreadful disease. Often, those hopes had been dashed.

Jenner had essentially pioneered the clinical trial. While there was still a way to go before the vaccine was fully understood, Jenner’s experimental spirit and his indefatigable campaign to promote his discovery had a substantial impact. Despite fierce resistance in England that would outlast his own life, Jenner’s vaccine quickly made its way around the world, going viral courtesy of empires French, Spanish and British. Death rates from smallpox rapidly tumbled. Jenner is estimated to have saved some ten million lives. This medical victory came despite repeated attacks on the Jenner’s honour, his intellect, and his humanity from his own countrymen.

In 1980, after a concerted global campaign to spread the vaccine Jenner had devised to every corner of the world, the World Health Organisation declared smallpox extinct. It is, to this date, the only human disease to have been completely eliminated from the globe. Is that not the most heroic conclusion to a most heroic career?

Edward Jenner is published in the Pocket Giants series by The History Press this November. It is available for pre-order here and here.

Remembering the Civilian Cost of War

There is a raking light and a hint of frost in the air. Nobody has bothered to rake the leaves among the grave stones. The moss growing over the footpaths suggests desertion, a return to nature. A few early twentieth-century mausoleum facades stick out here and there among the hoary branches, fraktur engravings signalling a sense of self-importance that died with Weimar. One or two of the living are titivating, laying a winter rose for their family stone with cursive script. Death here is well organised. At the entrance to the graveyard is a florist. Directly across the street, a grave stone merchant. Adjacent to that, a large old-people’s home.


In the middle of this large suburban graveyard, a row of diminutive stone blocks hides among the fallen leaves. Nothing about them invites you to investigate. They are black, unadorned, inconspicuous: ignorable. But if you kick away the autumnal detritus you will discover that each stone bears the same date: April or May 1945. These people, mainly civilians, some of them without names, all perished during the fall of Berlin. Perhaps they met with disease, starvation, or a stray bullet. Who knows what privations they endured before the terminal date?

Remembrance Sunday in Berlin simply isn’t. Despite all of the recent moves to make the annual marking of the armistice about the general cost of war, the triumphalism of the victors still casts a pall. In any war, innocence is a grey area. People are caught up, swept along, killed, maimed, forgotten. Whatever their stories, the why of their deaths is filled with a futility that ought to move us. Wars, we expect, have a military cost. But among the celebrated fallen and the vanquished enemy lie the rest. I, for one, would like to remember them.

Edward Hyde is Everyman

I recently read Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde (1886), and knew that in its pages there was something of value for Beingmanly. But the moral was lost in the chimera, and in my closeness to the text I could not unravel it. I therefore sent a letter to an historian friend of mine, who thinks about these things, and occasionally has a sensible word to say on such matters. With his permission I submit to you his reply, unedited, and with his wish to state the opening proviso in full:

My dear VB,

Your letter finds me between one article and another, and thinking about things far removed from the subject you present. In answering you I must confess that I have had a drink or two, and am in a somewhat altered state. But often the way to divining one’s real thoughts on a matter come in such moments, and since I do not have time to give serious thought to the matter you will have to make do with this.

The chemically induced alter ego of Dr. Jekyll is far too well known for me to shed any further light on Stevenson’s exemplary novella. I’m sure you of all people aren’t too lazy to look after this yourself. But since you crave something useful for your odd little blog, I might say that the Strange Case could well illuminate our own lives to a degree uncomfortable to admit. Taking away the extraordinary excesses of Mr. Hyde, we are left with the statement of Dr. Jekyll that lends the story verisimilitude. For in this statement, civilised men will recognise themselves:

And indeed the worst of my faults was a certain impatient gaiety of disposition, such as has made the happiness of many, but such as I found it hard to reconcile with my imperious desire to carry my head high, and wear a more than commonly grave countenance before the public. Hence it came about that I concealed my pleasures; and that when I reached years of reflection, and began to look round me and take stock of my progress and position in the world, I stood already committed to a profound duplicity of life.

I will not dwell on Freud. Lord knows, enough people have done that. Nevertheless, here we have a description of the internal schism, of propriety and gratification, that blights the lives of men. We measure other men by their adherence to the former, and by the degree to which they fall from this standard. Moreover, men measure themselves in this way, wreaking guilt, anxiety, shame, and so forth, upon themselves.

Our contemporary American Macho type of man, about which you have written, and which is represented, needless to say, across the civilised world, overcomes this schism by simply paying no heed to the marks of civilisation that have, in a roundabout way, produced him. On the contrary, he listens only to the democratic culture – in the Platonic sense – that has fostered his freedom to be licentious, promiscuous, ill-tempered, ill-spoken, and indulgent. The specific manner of this man depends largely upon his access to money, but the differences are of degree rather than of kind. Striking out for himself, he is not gnawed by guilt or anxiety. He is not riven by an internal schism. No, he is already fully realised as civilisation’s Edward Hyde, devoid of conscience, on the make, leaving no avenue of gratification unexplored.

This is one solution to the shackles of propriety. If everyone ignores the restraints we may merrily go the way of the beast. For some, life will be a cruel victimhood. For others it will be nasty, brutish and short. And for yet others it will be an epicurean delight. Let the dice fall as they may.

I would humbly submit that we are not all fighting, internally, against propriety. We shall only be faced with an eternal demon if we give credence to the duality within us. I doubt not that men’s passions overflow on occasion, but this is not our internal other, beating down our public face. We are one, whole, complicated certainly, but ultimately intelligible. Propriety need not be the external force from which we are alienated, but the embraced standard by which men can live. Like the man who tells a lie so often he comes to believe it, propriety can be truly felt. A man must give himself to civilisation, not secretly fight it. He will then find his gratification through his propriety. His desires and his standards will fall into line. He will shake off this Victorian curse and live, contentedly, among the civilised.

Such is the limit of what I can presently communicate on the subject. The whiskey bottle has scarcely enough in it to merit leaving for another occasion, so I will adjourn with it and return to serious thinking. Trusting you will not embarrass me, I shall remain

Your humble servant,

PRB

P.S. There is such a thing as too much tweed, you know. You’re at risk of becoming a bore, if not a boor.

Remember, Remember; or, Forget Completely

Across England there will be conflagrations. Accident & Emergency centres will be on standby for their busiest night of the year, waiting for one idiotic teenager after another to explode through the doors with firework related injuries. Effigies of England’s most notorious Catholic will be burnt without a second thought, while delighted nippers will get sick on bonfire toffee and toffee apples. What fun!

For my American readers, which accounts for most of you, tonight is Guy Fawkes night, or if you prefer the euphemism, Bonfire Night. It’s a tradition that’s been suffering in recent years because of the rise of the infinitely more commercial Hallowe’en, which is an abomination of a festival in the eyes of this author. The proximity of the two events rather tires the public, who traditionally gave a ‘penny for the Guy’ (more on that below), but who are now held to ransom on their doorsteps a few days earlier by adolescents threatening to vandalise their property unless some money changes hands. Such is ‘trick or treat’ in England.

My childhood reminiscences about Guy Fawkes night are in the mode of innocence. Building a bonfire, watching the fireworks, making and then burning the Guy – it was all such a terrific wonder. The great taboo – fire – was once annually the licensed preoccupation of school children. It was an excitement akin only to Christmas morning. And it came with a song, which everybody knew and repeated, lest we should forget:

Remember, remember the 5^th of November,

Gunpowder, treason and plot.

I see no reason why gunpowder treason

Should ever be forgot.

And so we sang it, having not much of a clue why we were supposed to remember it. Sometime in the 1980s, the health and safety brigade made the ‘remember, remember’ motto into a cautionary tale about ‘The Firework Code’, with pictures of little Johnny’s burnt hand, and the girl who had a firework go off in her face. I’m pretty sure that this put the very idea into the heads of many a scoundrel.

Round the neighbourhood we would go, dragging a lumpy representation of Guy Fawkes, the manufacturing costs of which were to be met by the village folk. The burning of this effigy was to honour the real burning of Guy Fawkes, who in 1605 attempted to blow up the Houses of Parliament in a Catholic plot to get rid of King James I. We vaguely knew this. We also vaguely knew that Fawkes had been caught in the act, tortured until he confessed, taken to the gallows, from which he jumped and broke his own neck. He was then drawn and quartered, and finally chucked on a great pyre as an example to any other Catholics with big ideas (there is some confusion about this last part). Somehow or other, it became a legendary victory for democracy.

The Conspirators

So, in short, a religious extremist took umbrage with the status quo and, in a desperate act of terrorism, tried to assassinate the representatives of government. That government, terrified and reactionary, used torture, killing, and rites of public humiliation to assert its authority. The public, raised to fever pitch with hatred and intolerance, smacked their bloodthirsty chops and carried out representative acts of torture and burning, so as to make their allegiances clear.

Oddly enough, it’s always been told as a story of just punishment for treason. In 1605, doubtless it was.

Any of this sound vaguely familiar? Funny, because while we’re all busy ‘remembering’ we seem to have forgotten completely.

Tonight I’ll be introducing the tradition to some Germans in a little village near Potsdam. There will be children, eyes sparkling at tales of historic gore, who will be instructed to remember. But as a good historian, my exhortation will have more to do with what seems to have become the moral of this story: what goes around comes around. Be vigilant.