The results of my Investigations into the Meaning of Pain are made accessible in the form of an assemblage, consisting of different types of texts:
- Clippings from the protocols I obtained from my methodical observations in hospitals;
- Questions from pain questionnaires;
- Poem lines;
- Passages from my diary concerning my personal pain experiences;
- Interviews with experts on pain;
- Philosophical essays;
- Studies published in scientific journals.
These texts unfold different perspectives on pain that are connected and put in relation to each other by the logic that emerged in the course of the project.
Image tableaus are also integrated into the following assemblage, each reflecting on the pain categories I generated from my literary pain research.
They are described in detail in II. PAIN CATEGORIES – IMAGE TABLEAUS — section two of this exposition.
a) It is the act of thinking emotionally, of thinking and feeling at the same time that reverses, that dissolves time, as D. H. Lawrence has described it.[1]
It is event-time,[2] as Brian Massumi calls it, in-between time, rather than everydaytime.
| b) |
Pain — expands the Time — Ages coil within |
| c) | Take me within, within, up there, three Pain-Inches above the floor (Paul Celan)[4] |
1) An old woman is lying in a bed that stands behind the waiting zone; she coughs; threeclinic staff are gathered around her bed; I can feel fear, discomfort; I sense that something serious is going on, that something is wrong.
d) Brian Massumi stated in an interview with Joel McKim (2008): ‘Affect for me is inseparable from the concept of shock. It doesn’t have to be a drama. It’s really more about microshocks, the kind that populate every moment of our lives. For example, a change in focus, or a rustle at the periphery of vision that draws the gaze toward it. In every shift of attention, there is an interruption, a momentary cut in the mode of onward deployment of life.’[5]
e) Europe in Pain: According to a big survey, ‘Pain in Europe’(for which more than 46.000 people in Europe were questioned),[6] every fifth adult in Europe suffers from chronic pain. The biggest part of sufferers was found in Norway, Poland and Italy. More than a quarter of the questioned adults in these countries reported having chronic pains. The lowest frequency of chronic pains was registered in Spain, where 11 percent of the surveyed adults reported chronic pains.
2) A teenage boy stands near the reception of the department for trauma; he shakes his right hand, walks up and down in front of the registration counter.
[7]Nonverbal Pain Indicator Number four: Restlessness
(Constant or intermittent shifting of position, rocking,
intermittent or constant hand motions, inability to keep still)
3) He is accompanied by a woman; she fills out a form, standing at the desk with the registration forms that are kept in different boxes, separated by different language labels, below the desk.
| f) | Are words actually of any use to describe what pain [...] really feels like? Words only come when everything is over, when things have calmed down. They refer only to memory, and are either powerless or untruthful.’ (Alphonse Daudet)[8] |
g) Hearing words that describe pain — such as ‘excruciating’ or ‘gruelling’— activates the areas of the brain that process the corresponding sensation. At least this is what the publication of a study conducted by researchers of the Friedrich-Schiller-University in Jena, Germany, suggests.
‘The findings show that words alone are capable of activating our pain matrix (emphasis added),[9] says psychologist Thomas Weiss. He and his colleagues point out that the findings may be especially significant for people with chronic pain disorders who tend to speak a lot about their painful experiences with their health care providers. They say those conversations may intensify the activity of the pain matrix in the brain and intensify the pain experience.
h) ‘The main motive of patients with chronic pains to join the encounter group is to be together with other affected people and be able to share their pain. […] Years and even centuries of pain have restricted the social life of many of these patients, so the group is a social event for them: they get out, out of isolation, they meet others, and they talk about their — painful and joyful — experiences. And according to my experience, this is exactly what meets one of the main needs of patients with chronic pains.’ (Monika Gratzer, MD, anaesthetist)[10]
4) Two male teenagers sit in front of me; one has drawn his left foot half out of his shoe, there is no sock on it.
Uncovered by cloth, exposed to all eyes, its nakedness gleams white and red under the dazzling lights, exposing the vulnerability of the human flesh.
5) He wrinkles his forehead, narrows his eyes and twists his mouth.
Nonverbal Pain Indicator number two: Facial Grimaces/Winces
(Furrowed brow, narrowed eyes, clenched teeth,
tightened lips, jaw drop, distorted expressions)
i) Much of your pain is self-chosen... (Khalil Gibran)[11]
6) There is another man with an injured left foot who sits in the same row as the boy. He wears a jogging suit and the left leg of his jogging trousers is rolled up. He does not wear a shoe on his left foot; only the toes and the front part of his foot are covered with a grey sock.
I notice a swollen part in the area of his left ankle, and the skin is red.
| j) | The tulips are too red in the first place, they hurt me. Even through the gift paper I could hear them breathe Lightly, through their white swaddlings, like an awful baby. Their redness talks to my wound, it corresponds. (Sylvia Plath)[12] |
7) The bed with the old woman who had been coughing is brought back; it is now in the same position as at the beginning of my observation; the man who has moved the bed says to the woman ‘Alles Gute, gell!’ (All the best! Right?) and leaves. The woman lies with her mouth open, there is something very fragile and unprotected about her, something very insecure, at least this is my impression: insecurity, confusion, fear.
k) ‘Everyone experiences painful situations at some point in their lives. [...] We are interested in the types of thoughts and feelings that you have when you are in pain. Listed below are thirteen statements describing different thoughts and feelings that may be associated with pain. Using the following scale, please indicate the degree to which you have these thoughts and feelings when you are experiencing pain:[13] 0 – not at all, 1 – to a slight degree, 2 – to a moderate degree, 3 – to a great degree, 4 – all the time’:
When I’m in pain...
|
6
|
☐ I become afraid that the pain will get worse. |
|
7
|
☐ I keep thinking of other painful events. |
|
8
|
☐ I anxiously want the pain to go away. |
|
9
|
☐ I can’t seem to keep it out of my mind. |
|
13
|
☐ I wonder whether something serious is going to happen... |
8) Behind me sits a boy, the palm of his right hand is bandaged, the tip of his right finger is swollen, and the area where the nail begins is blue.
l) A human being sustains on average 124 minor injuries per year.[14] Assuming a life span of 81 years, this means that about 10.000 injuries will accumulate over a single life time.
9) The girl holds the cool pack to the back of her left hand, to the back of her left fingers. Now she tries to take off her jacket, the woman at her side helps her, she exclaims: 'Ow!'
Nonverbal Pain Indicator number 1:
Vocal complaints: nonverbal
(Sighs, gasps, moans, groans, cries)
m) Ogino at al. (2007)[15] conducted a study where they confronted ‘ten healthy subjects’ with images from the International Affective Picture System: a database of images showing painful events, and those evoking emotions of fear and rest. ‘They were instructed to imagine pain in their own body while viewing each image showing a painful event. Using functional magnetic resonance imaging, we compared cerebral hemodynamic responses during the imagination of pain with those to emotions of fear and rest.’
The results indicate that the imagination of pain — without an underlying physical injury — ‘engages the cortical representations of the pain-related neural network’, and, according to the researchers, this was not the case with images evoking emotions of fear and rest.
10) Somebody is calling: ‘Hallo, ich habe es sehr eilig!’ (Hello, I am in a big hurry!) — the voice of an old man. Nothing happens, and five minutes later he calls again: ‘Ich habe es sehr eilig.’ His voice now is a little weaker and quieter than it was before. Ten minutes later he only says ‘Hallo!’ and nothing more. I cannot see him, so I don't know what is going on, or if there is something happening with or to him.
I try to put myself in his position: he must feel neglected, not being taken seriously, not getting the attention he — according to his point of view — ought to get. I don't know what he needs, what he misses, and why he is in a hurry.
I wonder if he understands the system of this clinic, the mode of registering, then waiting until one's name is announced in connection with a room number, indicating the examination room you are expected to go to. Maybe he feels his case is more urgent than others, maybe he is convinced that his case requires immediate attention, immediate intervention.
-------------AAAAAAAAAAAAAAA---------AHHHHHHHHHHHH-----------------EEEEYOUUUCH !!AAAAHHHHHHAAAAAAA------AFGGHH-----------------IEEEEEE------------------------------ARRRGHHH!-----------AWK!!----UGGH!!--------AWK!!----------OUCH!-----OW!!!----AU!!-----AUWEH----AUA!!!!!-------AAAAHHHHHHAAAAAAA------AFFFFFFFGGHH---------IEEEEEEHHHH--------WOOOOOOOOHHHHHH
11) An older man is carried in on a stretcher to the area between the waiting zone and the examination rooms. Now he is transferred from the stretcher to a bed on rollers. The old man wears a cap like a fisherman’s cap, his face is calm, and his posture expresses composure, even detachment. He is asked if the way he is laying on the bed is okay; he nods. I notice that from time to time he touches the brim of his cap; it seems to be a confirming gesture, assuring him, that the cap is still there, on top of his head, and so probably inducing a feeling of comfort, of security.
12) The young girl who holds her left hand in a rigid position is constantly moving her feet; the steps resemble dancing steps; then she starts kicking the air.
n) In the land of pain is the title of the English translation of a book by the French writer Alphonse Daudet, who lived in the second half of the 19th century. He suffered from neurosyphilis during the last 15 years of his life. The chief manifestations of the illness in his case were locomotor ataxia,a degeneration of the spinal cord that produced violent spasms of the limbs, weakness, and flashes of blinding pain.
'Pain, you must be everything for me. Let me find in you all those foreign lands you will not let me visit. [...] The walks I used to take around this land of pain. Could still find it in myself to laugh.'[16]
| o) | I lose myself when lust or pain is projecting me beyond a sphere where I only have one meaning: the sum of the answers I give to the requirements of utility. I lose myself, when at the end of the possible I push towards this that will knock me over, so that I will be pleased by the thought of death — and so that I will laugh at my delight in death. (Georges Bataille)[17] |
Bataille followed this notion of laughter as a means to cope with the adversities of life: he stated that what frightens us is what we can laugh at, and that on a para-philosophical level all laughter is laughter about death.
13) Now I notice a certain smell in the air; it does something to my stomach. It is a clinical smell, it makes me feel nauseous. There is also a beeping noise that irritates me. I feel the urge to leave this place, I oppress it. The beeping does not stop; I am unable to identify its source. But suddenly it’s gone.
14) A man in a jogging outfit comes back from the examination room. A bandage, or maybe it is a plaster cast, covers his left foot and ankle. Only the toes are left bare. He walks on his crutches to the counter and lines up. He keeps his injured foot behind him, resting it on its naked toes.
Nonverbal Pain Indicator number three: Bracing
(Clutching or holding onto furniture, equipment, or affected area –)
p) McGill Pain Questionnaire,[18] group E - evaluative pain descriptions/ category 16:
q) Do words hurt? As soon as we hear words like ‘tormenting’, ‘gruelling’, or ‘plaguing’, areas in the brain are activated which process the corresponding pain. Psychologists from Jena University examined this phenomenon in a study,[19] using functional magnetic resonance tomography (fMRT). ‘We could observe a clear activation of the pain matrix in the brain by pain-associated words’, Maria Richter states. Other negatively connoted words, however, do not activate those regions. Comparable activity patterns, in fact, could not be found in response to either neutrally or positively connoted words.[20]
| r) |
Yes, we are going to suffer, now; the sky (W. H. Auden, emphasis added)[21] |
15) Is this real? I ask myself. Is here the reality? Am I part of it? This ‘department of trauma’ reality, the reality of people having accidents, injuries, and going to the hospital, waiting for help, for care, for cure, for the pain to go away, for the damage to be repaired.
s) The Russian psychologist Lev Vygotzky indicated that there is ‘a law of the emotional reality of the imagination’. It says that all forms of creative imagination include affective elements. According to Vygotzky, ‘this means that every construct of the imagination has an effect on our feelings, and if this construct does not in itself correspond to reality, nonetheless the feelings it evokes are real feelings, feelings a person truly experiences.’[22]
16) Am I part of this as I am watching this? How real is this? What does my presence in this room mean, my presence as an observer? Here, now, I am the observer, but I have been a patient, too; I know how it feels to be in pain, to wait for an examination, an explanation; for help, for care, for cure…
t) Michel de Montaigne (1574) wrote in an essay about the force of imagination:
'I am one of those who are most sensible of the power of imagination: everyone is jostled by it, but some are overthrown by it. It has a very piercing impression upon me [...]. The very sight of another’s pain materially pains me, and I often usurp the sensations of another person. [...] I do not at all wonder that fancy should give fevers and sometimes kill such as allow it too much scope, and are too willing to entertain it (emphasis added).'[23]
u) Affect contagion, according to communication theorist Anna Gibbs, is the bio-neurological means by which particular affects are transmitted from body to body.[24]
17) Now it is nearly an hour that I am here. I am not injured. My body is intact; its skin does not open up for the world.
18) Someone is sighing and I feel all the worries of this place expressed within this sigh; this insecurity, vagueness, this exposure of your bodily fragility; this reliance on somebody who is in charge of the parts of your body that are out of order, out of normality...
v) Philosopher Teresa Brennan developed a theory in her bookTransmission of Affect.[25]
At the core of this theory was an assumption of constant communication between individuals and their physical and social environments. This notion challenges Western individualism and its understanding of emotions and energies as contained within the body of the individual.
In Brennan's definition, affect is fundamentally an energetic force capable of permeating the skin of other bodies. In regard to the social consequences of her theory, Brennan declared:
What is at stake with the notion of the transmission of affect is precisely the opposite of the sociobiological claim that the biological determines the social. What is at stake is rather the means by which social interaction shapes biology. My affect, if it comes across to you, alters your anatomical makeup for good or ill.’[26]
w) In his interview with Joel McKim (2008), Brain Massumi explained the notion of affective attunement as follows: ‘Say there are a number of bodies indexed to the same cut, primed to the same cue, shocked in concert. What happens is a collective event. It’s distributed across those bodies. [...] However different their eventual actions, all will have unfolded from the same suspense. They will have been attuned — differentially — to the same interruptive commotion. “Affective attunement” [...] is a crucial piece to the affective puzzle.’[27]
19) While leaving the clinic, I think: Somehow it is all about what to do next. What should one think about pain, how should it be dealt with? Who knows what should be done? Who knows what is best? Who is going to tell me what to think, what to do? What steps to take, what measures to take, and what to expect from the future?
| x) | ‘Pain is the sign for something not answered; it refers to something open, something that goes on the next moment to demand. What is wrong? How much longer? Why must I/ought I/should I/can I/suffer?’ (Ivan Illich)[28] |
y) ‘In affect, we are never alone’, said Brian Massumi in an interview with Mary Zourzani for her book on hope.[29] ‘That's because affects in Spinoza's definition[30] are basically ways of connecting, to others and to other situations. They are our angle of participation in processes larger than ourselves. With intensified affect comes a stronger sense of embeddedness in a larger field of life — a heightened sense of belonging, with other people and to other places.’[31]
LIST OF IMAGE TABLEAUS (in order of their appearence in the text)
Image Tableau TIME PAIN II, pain category "Pain As A Temporal Phenomenon" (Collage by Barbara Macek)
Image Tableau TIME PAIN I, pain category "Pain As A Temporal Phenomenon" (Collage by Barbara Macek)
Image Tableau TIME PAIN IX, pain category "Pain As A Temporal Phenomenon" (Collage by Barbara Macek)
Image Tableau EXISTENTIAL PAIN III, pain category "Existential Pain" (Collage by Barbara Macek)
Image Tableau PAIN ANIMAL I, pain category "Pain Animals" (Collage by Barbara Macek)
Image Tableau ANIMAL PAIN VII, pain category "Pain Animals" (Collage by Barbara Macek)
Image Tableau DARK PAIN II, pain category "Wild Pain, Dark Pain" (Collage by Barbara Macek)
Image Tableau SPACE PAIN III, pain category "Pain As A Spatial Phenomenon" (Collage & Poem by Barbara Macek)
Next section: BIBLIOGRAPHY
+++ Now there is an asymmetry; his face is out of balance. This is what pain does: throwing you off balance, making the world fall apart +++
+++ Pain is a critical comment of the body on the world, pain is a sign of rebellion against the current conditions of existence +++
+++ The pain comes from the body. And the body is me:
the right shoulder, the right neck, that's me.
The pain in the right shoulder, the pain in the right neck, is me. It is part of my current situation, sensation. But I have more on hand, there still is more.
I feel, I think – I am more +++
+++ I am here. I am in the middle. Everything happens. Pain takes place. It is here. And I am here. In the middle of it. Always. Because time ceases to exist +++
+++ I don't know what pain is. My, your. My pain: is it mine? This nauseating, searing, squeezing sensation? Yes, it is my pain; the pain of these days. Pain of existence, pain of detachment +++
+++ Pain inscribes itself into the flesh, leaving signs of distortion, of monstrosity. It forces the flesh to abandon its borders, to open up to the outside world +++
+++ Pain invokes anger, makes you aggressive: provoking the feeling that the world is against you. So you start to resist and fight back +++
Pain Cut Bone Blood
Green white walls
Voices without bodies
A clinical smell making me nauseous
A beeping noise driving me insane
Flesh Cut Blood Bone
I perceive gestures of insecurity
Gestures of pain
Tensions, Constrictions
Stiffness, Weakness
Deranged bodies
Asymmetries
Flesh Cut Pain Blood
I sense losses of order
Losses of words
Pain cuts flesh,
Bones
Blood starts talking
(Barbara Macek)
I wonder if he understands the system of this clinic, the mode of registering, then waiting until one's name is announced in connection with a room number, indicating the examination room you are expected to go to. Maybe he feels his case is more urgent than others, maybe he is convinced that his case requires immediate attention, immediate intervention.