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Although not dwelling on pain's contribution, everyone in this volume acknowledges the complexity and mystery surrounding our experience of pain, which provides a common ground for discussion. The reductionists describe how a stimulus at the most basic level—a cut finger or stubbed toe—begins a cascade of biochemical reactions which are then filtered through the spinal cord and referred to the brain. In a recent development, functional MRIs can even detail the brain activity responsible for phenomena such as phantom-limb pain, which involves no external stimulus. The brain has a representation, or mental picture, of individual body parts based on their sensory history, and interprets reality based on that picture; an amputation dramatically alters the representation, confusing the brain. Or, in the case of someone who has undergone a frontal lobotomy, the patient can describe intense pain in precise detail but have no emotional reaction: "Yes, the pain is acute and nearly unbearable," she says with a broad smile.
To its credit, this collection provides a wide variety of cultural models for understanding and managing pain. A Harvard professor describes an operation in Shanghai in which a woman has a tumor removed from her thyroid with no anesthesia or medication, only traditional chi gong therapy. At one point the sheet covering her shoulder irritates her and has to be adjusted, but when blood spurts across the room onto the white coat of a surgeon, she gives no reaction. The devout in Sri Lanka dangle from hooks, and Shi'ites in Iraq flagellate and slash themselves with swords, giving no indication of pain sensation. In a fascinating section, two musicologists describe the analgesic quality of music and trance in Finland and Bali, Indonesia.
Religion, of course, plays a crucial role in ascribing meaning to the pain experience. At the risk of oversimplification, I might suggest the following pattern: acceptance (Islam, Hinduism, Buddhism), mastery (advanced practitioners of Hinduism and Buddhism), and protest (Judaism). Christianity at various points reflects each of these streams. Early in its history martyrs sang in the flames, stylites sat on poles exposed to weather, and desert monks lived on a diet of bread and water. Later, fatalistic Christians argued against inoculations for smallpox, which would interfere with God's will, and warned against relieving the God-given pain of childbirth. Sarah Coakley, one of the editors of this volume, contributes a chapter examining the relationship between pain and contemplation in the spirituality of two 16th-century Carmelites, Teresa of Avila and John of the Cross. She admits that in some ways these two reflect a strand of valorization of pain—a tradition familiar to parochial school students drilled on martyrs' tales. Yet, paradoxically, meditation also offers its own analgesic possibilities, as Dr. Herbert Benson has long maintained. Perhaps most important, the Christian mystics presume that no pain is devoid of spiritual meaning. It can serve a redemptive purpose, and in that sense pain can be transformed.
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