“We must remain absolutely silent on what we cannot talk about.” Wittgenstein’s interdict would surely apply to the mystery of human suffering; at certain intensities, pain becomes literally as well as idiomatically unspeakable. Even to allude to the educative value of pain is to risk an inhuman glibness, a cold-blooded reduction of the specificity of suffering to chill, abstract formulae. We must begin by confessing the ultimate intractability of the problem. Against pain and death we fight a losing battle; and the mystery, always insoluble, has, if anything, become more agonizingly problematic in our own time. Caring for the chronically and terminally ill has always been intensely difficult; in the modern world, technological advances notwithstanding, it has become immeasurably more so.
A world without anesthetics would be a hell; deprived of analgesics even so routine an event as a visit to the dentist would be something to be dreaded and shunned. To avoid or to minimize pain is an instinctive natural reflex; deliberate search for suffering is a perversion to which we give the name masochism. Yet it is equally true that a world without pain would be calamitous. Pain is essential to survival—without it we would perish. It is an early warning system, a defense mechanism, vital in preventive medicine against incipient and impending evil. Without pain teeth would rot insensibly in our gums, limbs quietly crumble to ash in flames or be mangled beyond repair in machinery, cancers placidly proliferate in our bodies. Once bitten, twice shy. The adage crystallizes the argument that pain educates, teaches us to avoid certain courses of action harmful or destructive to us. There are erstwhile professional footballers hirpling around as a direct consequence of repeated painkilling injections that enabled them to play when nature forbade—if they are crippled today it is because they were prevented from feeling pain. When nature communicates through pain we should listen; drugging her into silence may be a short-term gain, but it is a long-term folly.
But even here our consent is grudging; reason may compel us to acknowledge the value of pain, but the flesh instinctively recoils. A Lawrence of Arabia deliberately placing his fingers in a candle flame, training his body to endure pain, strikes us as abnormal, even perverse. Yet we know many perfectly normal people who seek pain as the route to excellence. Marathon runners tell of a pain barrier that must be gone through, a wall of pain toward which they knowingly run. People who could be sitting comfortably at home are on the road, in raging heat or freezing cold, hearts pounding, lungs exploding, limbs aching—suffering a pain they have willed because without pain there is no overcoming; pain is the ultimate indispensable proof and attestation of courage and skill. For the muscles to grow they must first be fatigued. There is no progress without pain, no achievement, mental or physical, without self-sacrifice, and throughout history people have been willing, even eager, to suffer, sometimes excruciatingly, for the sake of some cause, the love of some principle, some end or good prized above their personal comfort.
Such pain has meaning and purpose. When pain is meaningful, it cannot only be borne, it can be embraced. To comprehend pain is to tame it. If we know why we suffer, if, above all, we know the purpose of our pain, the higher good to which it ministers, we have already mastered it. Every day women give birth in pain and think it worthwhile; willingly, they endure a long period of inconvenience, discomfort, pain—perhaps severe, often dangerous—in order to bring life into the world. If it were not so, human life would have vanished from the planet once the nexus between procreation and pain was established. Death itself can be chosen when there seems good reason for it; if it were not so, there would be no heroes, no martyrs, no Leonidas at Thermopylae or Crockett at the Alamo. It is undeniably terrible to be condemned to death, but it is not necessarily unendurable. What is unbearable is to be condemned to death for nothing, to be a martyr to senselessness. Here is the inanity explored so powerfully by Kafka in The Trial. At the close of that dark text the protagonist dies supplying his own intolerable epitaph: “Like a dog!” But precisely here is the heart of the mystery, for a human being cannot die like a dog, cannot, at least, consent to a dog’s death without protesting the imbecilic injustice of such an end.
What is peculiar about human beings is not their suffering—all animals suffer—but their questioning of this suffering. The problem of suffering rises precisely from man’s refusal to acquiesce in its inevitability; he alone among the animals demands an explanation. Wittgenstein notwithstanding, we cannot but insist upon knowing why we suffer and die—which is, of course, not at all the same as being able to name the disease that is killing us: to name is a necessary but not a sufficient cause of understanding. Anguish must be contained within a matrix of meaning if it is to be endured, mastered, and, greatest triumph of all, made purposive, fruitful. It is pain without purpose, neither educating nor correcting, leading nowhere but the grave, that is intolerable; such lunatic torment is an atrocity not to be borne, an obscenity not to be endured.
Today we are vulnerable, as no previous generation of healers and sufferers ever was, to the scandal of senseless suffering. The human demand for an explanation of pain meets today an embarrassed silence; pain is not for anything—the question that human beings cannot help but ask is now regarded as pointless and misplaced. This is especially true in the matter of chronic or terminal suffering, where the sole prospect is of ever-increasing agony ending in squalid death, “like a dog.” We increasingly believe that pain is the worst of all evils and that incurable pain is totally bereft of any value, dehumanizing to all concerned—victim, relatives, and carer alike. Our sinister modern expression “the quality of life” reveals this mentality: the notion is of human life as a commodity, a product rolling off a conveyor belt and subject to a system of quality control; when the product is defective, its quality impaired below a certain minimum level of acceptability, we bring it to a compassionate close in the name of kindness, we discard it as an inferior item.
The ineffable evil of pain lies at the core of 1984. Winston is struck on the elbow with a truncheon: “He had slumped to his knees, almost paralysed, clasping the stricken elbow with his other hand. Everything had exploded into yellow light One question at any rate was answered. Never, for any reason on earth, could you wish for an increase of pain. Of pain you could only wish one thing: that it should stop. Nothing in the world was so bad as physical pain. In the face of pain there are no heroes, no heroes, he thought over and over as he writhed on the floor, clutching uselessly at his disabled left arm.”
The enormity of gratuitous anguish brings King Lear to a close. The good man, Edgar, still striving to keep the dying king alive, is rebuked by Kent, Lear’s steadfast servant: “O let him pass. He hates him / That would upon the rack of this tough world / Stretch him out further.” There could be no more potent argument for euthanasia. When the world becomes a torture chamber, with Lear cruelly elongated on the rack of his anguish, what sensitive, compassionate person would wish to keep him alive? Edgar means well, but his kindness is really cruelty. Lear will live on simply to undergo pointless, irremediable pain. “O let him pass.” How often today is this prayer wrung from some anguished bystander at the protracted pain-bed of a terminally ill patient. End the obscenity, have done with the torment, victim’s and onlooker’s alike: to what possible end serves such pointless pain?
Winston and Kent summarize the contemporary conventional wisdom on pain: all pain is evil; purposeless pain is an abomination to be ended when it cannot be cured. That other ages have held totally different views strikes us, when we consider it at all, as irrelevant, as proof of their intellectual backwardness, their superstitious attitude toward life. Aeschylus in the Agamemnon insists that “man must suffer to be wise.” Shakespeare in King Lear tells us that “nothing almost sees miracles / But misery,” and the play confirms this. Not till Gloucester has been blinded does he see true, not till Lear has himself become a homeless wretch does he learn that other people suffer too: “Poor naked wretches . . . / O, I have ta’en / Too little care of this!” The storm-lashed heath is Lear’s schoolroom, suffering is his education, and, far from being the worst of evils, pain is the means of his regeneration, the agent of his redemption. The loving father who dies of a heart attack at the play’s end is a far better man than the selfish autocrat of the opening scenes, and pain has been his tutor, has been, paradoxically, “good” for him. It is an insight not wholly lost to modern literature; the eponymous hero of Saul Bellow’s Henderson the Rain King discovers that truth comes from blows, that “suffering is about the only reliable burster of the spirit’s sleep.”
But such modes of thought as the educative or reformative value of suffering, such concepts as the spirit asleep in a comfortable body, run counter to the grain of the modern world. The old idea that suffering can purify (the idea that sustains the tragedy of the Greeks, Shakespeare, and Racine); that it may be a test of virtue or patience (Job is here the exemplary figure); that no suffering is pointless if it is the means of sanctification and rescue (the Suffering Servant Isaiah and Christ are the exalted embodiments of such teaching): none of this affects the modern consciousness. The latter part of Bacon’s antithesis—that prosperity is the blessing of the Old Testament, adversity of the New—seems to us mere gibberish. In the ages of faith, Job was of key importance as the recourse-figure when trying to comfort the innocent sufferer, the blameless victim. By any human calculation. Job gets a raw deal. Yet, in his totally undeserved affliction, he steadfastly exhibits a saintly fortitude. He rejects his wife’s advice to curse God as the author of his calamities—”though he slay me yet will I trust him”—and instead turns his suffering to creative account. At the happy end he is rewarded for his endurance—an image of the heroic overcoming of suffering.
Christ’s invitation to take up his cross gave a dignity to pain, presenting it as an election rather than a curse. Into your hands I commit my spirit: his dying words taught the sufferer how to comport himself when his own Calvary came round. Gethsemane revealed the striking simplicity of the Christian attitude toward pain. If pain can be avoided, avoid it—let this chalice pass; there is to be no masochistic traffic with anguish. But if pain cannot be avoided—thy will, not mine—then it must not only be borne but made fruitful; one thinks of how Mary Craig’s handicapped children led her into dynamic participation in the work of the Sue Ryder homes. “Even if my Father chastises me, I am ready for scourges, because my inheritance awaits me”: St. Augustine’s assurance arrests the modern reader. “I reckon that the sufferings of this time are not worthy to be compared with the glory that is to come which shall be revealed in us”: St. Paul, who had suffered much, dismisses his pain as trifling when set against his final felicity. Present pain could even be desirable—woe to him, warns Augustine, who pays none of his debt in this life. The underlying idea is that there can be no complete evasion of suffering, that you have to suffer somewhere, if not in this world, then in the next; you can be spared now or later—much better to pay now. The gospel text repeatedly used to illustrate this was the parable of Dives and Lazarus—the rich man now damned in hell for his life of pleasure on earth; the beggar, one of the wretched of the earth, now at peace in Abraham’s bosom.
The truth-content of such teaching is not the issue. Neither Marx nor Freud deny the consolatory power of religion; they simply dismiss it as untrue. But even allowing that it is illusion, compensation, wish-fulfillment, this still leaves the possible efficacy of such beliefs concerning pain intact, both for the victim trying to come to terms with his suffering and for the doctor trying to sustain a patient through the hell of his affliction. Marx talks revealingly of religion as “the opium of the people,” but it is a mistake to read this as mere denunciation. Marx has no wish to deprive suffering humanity of its painkiller before the proper remedy—the socialist reconstruction of society—has been found: why operate on people without anesthetics? Religion may be a crutch, but we should heal the limb before we throw the crutch away. Freud is, admittedly, sterner, more stoical, acting what he preached; he reprimanded the doctor who, in defiance of his categorical command, administered a painkilling drug to him during an especially severe bout of pain while he was dying of cancer. But it is Freud who is untypical here, with his insistence upon consciousness even if it entails agony—he wanted to feel his dying. The great difference between Marx and Freud is that the former is a Utopian optimist, the latter a stoic tragedian. For Freud, suffering cannot and should not be avoided if the price is the suppression of consciousness: we must learn to live without opiates. “The abolition of religion as the illusory happiness of the people is required for their real happiness”: Marx is, assuredly, not recommending, with Freud, a stoic acceptance of pain. In his optimistic scenario, we will reject illusion and eliminate pain simultaneously. Marx will have no truck with what American psychologists refer to as “no-end grief,” by which they mean living with a heartbreaking set of circumstances that are unalterable, unending, and ever-demanding: chronic pain, terminal illness, psychological despair. Nowhere is Marx more transparently a great alternative religious leader, a heretic of the Judaic-Christian tradition, than in his dream of an end to suffering and the establishment of a kingdom of peace and justice—he differs only in the matter of its location.
The erosion of religious belief in our time, the increasing and apparently irresistible secularization of society have made it commensurately more difficult to recruit such religious teachings concerning pain in the treatment of the chronically or terminally ill. Ours is a post-Christian, post-religious age: the reassurances, promises, consolations of religion are less available, less potent today than in any previous historical period. Our expectations are totally different, our world view completely other. Technology has given us control over our environment in a way unknown to our predecessors. Our mastery of nature creates in us a pervasive expectation: the technological abolition of all suffering. For the first time in history people are being born who do not expect to suffer. From ancient Greece to the end of the 19th century, pain was regarded as an inevitable component of human life to be accepted, endured, embraced, because it could not be avoided. The flat truism that we are born to suffer, announced again and again in the art of the West, so inseparable from its religion, has now for the first time been challenged and rejected, decried as shameful, obscurantist nonsense.
Schopenhauer remarks that we do not really experience health but rather its absence. Possessing it, we take it for granted, like the air we breathe; health is like paradise—while it is ours we treat it with cavalier disdain, prizing it only when it is lost. The fact that we know health only through privation convinced Schopenhauer that suffering is our natural, our normal condition. Accepting the same data as Schopenhauer, we reach a diametrically opposite conclusion: that illness is unnatural and perverse. Accordingly, we resent pain as an impertinent intrusion, an affront and an outrage, something that ought never to have happened. Psychologically, we are akin to the man who, on his first day in the death-camp, complained to the guard that in his case a mistake had surely been made. In a multitude of the condemned he protests his individual condemnation; in a world of pain each person is scandalized at his own personal suffering. Even the suffering and death of relatives and friends fail somehow to convince us that they are simply our trailblazers.
In The Death of Ivan Ilyich, Tolstoy shows a survivor rejecting the thought that Ivan is his Baptist, anticipating and preparing his way: “‘Why, it might happen to me all of a sudden, at any moment,’ he thought, and for an instant he was terrified. But immediately, he could not have explained how, there came to his support the old reflection that this thing had befallen Ivan Ilyich and not him, and that it ought not and could not happen to him, and that to think that it could meant that he was falling into a melancholy frame of mind.” The Lenten reminder of the dust from which we came and to which we must revert can only seem morbid to such a mentality.
At the same time as we attempt to disguise doom as mere accident, the development of anesthetics, analgesics, and narcotics has helped us to dull the sensitivity in us that bears affliction. We demand not only that we shall not suffer, but that the sufferings of others—carried beyond a certain point—shall be removed from our gaze. Wordsworth in his poem The Old Cumberland Beggar speaks of the beggar’s value to the community in providing an opportunity for the exercise of charity and compassion, but our definition of value is more strictly economic. Kafka’s Metamorphosis is a terrifying parable of how compassion turns into indifference, as Gregor Samsa’s family adjusts to his hideous transformation and gets on with its everyday life. But no one has more penetratingly charted the process by which pity can turn into revulsion than Herman Melville in his presentation of Bartleby, the pale young scrivener, “forlornest of mankind,” who first moves his employer to compassion before becoming a “millstone,” an “intolerable incubus,” someone who must somehow be got rid of. “Up to a certain point the thought or sight of misery enlists our best affections; but, in certain special cases, beyond that point it does not. They err who assert that invariably this is owing to the inherent selfishness of the human heart. It rather proceeds from a certain hopelessness of remedying excessive and organic ill. To a sensitive being, pity is not seldom pain. And when at last it is perceived that such pity cannot lead to effectual succor, common sense bids the soul be rid of it. That I saw that morning persuaded that the scrivener was the victim of innate and incurable disorder.” This discovery precipitates the lawyer’s resolve to separate forever from his incurable clerk. True, he cannot bring himself to “commit his innocent pallor to the common jail,” but he is pleased to let others do it for him. The “wasted” Bartleby is led off to die in prison; suffering is made invisible, taken where the sensitive lawyer need no longer see it.
In Samuel Butler’s Erewhon this process is carried to its conclusion in the criminalization of illness, with pity replaced by condemnation. In Butler’s imaginary land suffering has become a matter of culpability. “You were convicted of aggravated bronchitis last year,” says a magistrate to a consumptive defendant, “and I find that though you are now only twenty-three years old, you have been imprisoned on no less than fourteen occasions for illnesses of a more or less hateful character.” Even if illness is not the patient’s fault, it is unquestionably a fault in him. The idea, prevalent in older cultures, that sickness may be linked to sanctity, that the sufferer may be the special child of God, demanding respect or even veneration, has no place in Erewhon. “That dislike and even disgust should be felt by the fortunate for the unfortunate . . . is not only natural, but desirable for any society, whether of man or brute.” Beneath the satire Butler is as serious as Nietzsche undoubtedly was when he denounced Judaism, Christianity, and socialism as dysgenic forces, making for unhealth in their perniciously misplaced concern for the suffering, the weak, and the downtrodden.
The hints abroad today veer toward the Erewhonian rather than the religious view of suffering. The image of successful humanity increasingly held up by society is of healthy, confident, active people. Our sick are sequestered in hospitals, to be encountered only on “visits.” We educate people for health and happiness; we have no equivalent disciplines for a training in pain; for the first time in human history the concept of the educative value of pain is at risk of being culturally lost. Contrasting sharply with the domain of successful humanity is the domain of suffering humanity, of sick, failed, inadequate people. There is that ominous expression about the quality of life—those who, in whatever way, fall short of this quality are to that extent judged to be less than human. Implicit here, reluctant though we may be to admit it, is a secret conviction that those who suffer pain are somehow diminished, that, at certain levels of intensity, suffering is incompatible with being human. Such sufferers, having lost their own value as human beings, cannot possibly have anything of value to offer to others.
Prior to the new developments in technology and aesthetics, the chief lesson of our culture concerning pain was how to bear it with patience and fortitude. The impotence born of technological ineptitude found its corresponding ethic in a view of pain as the normal, the expected human condition; to live is to suffer—those who dream otherwise inhabit Cloudcuckooland. Now all is changed: how much so can be illustrated by certain widespread reactions to the current epidemic of AIDS in the Western world. The platitudinous observation that certain lifestyles or modes of behavior tend to expose their exponents to a high risk of infection provokes fury in certain quarters, along with a demand that actions shall not have consequences, that new technologies, serums, drugs shall be instantly found to evade and frustrate the penalties of nature. We control nature: some such conviction is at the root of much modern thinking on the question of pain. Of course, we must search for antidotes and cures, but, until such time as these are discovered, it might be wise to amend, so far as we can, the practices that science has identified as helping to spread the disease. An older wisdom warned that as a man sows, so shall he reap. A modern faith in medical technology persuades us that we can act with impunity, with science always at hand to bail us out. All suffering is theoretically avoidable: we need not suffer. The result is that when suffering ineluctably comes, it strikes us like a betrayal, a brutal reneging on promises made and unreservedly trusted. Those who have been educated solely for health will be helpless before hardship. The dual vocations of healer and sufferer, medical advances notwithstanding, are harder than at any remembered period in our past; never has it been more difficult to endure pain or to comfort the victim.