It will not come as a surprise to anyone that Johanna Bourke, whose previous work has focused on the history of emotional and subjective experiences, such as fear or sympathy, has now undertaken the study of the cultural and historical variations of pain and suffering. This superb book, based on an extraordinary variety of sources and written with Professor Bourke’s characteristic wit and dexterity, will be a delightful read for anyone interested in the history of pain, as well as for those concerned with the theoretical difficulties triggered by the new historiography of emotions. To the always difficult issues related to the access of sources, Bourke has added a new conceptual framework for the study of the cultural dimension of human suffering.
The book begins by claiming that our physical sufferings cannot be thought of as an object or entity. Instead, Bourke argues that pain should be understood as a kind of event. In the wake of all those scholars who, inspired by Wittgenstein’s language games, have considered emotions in terms of highly dynamic cultural practices, Bourke defends the view that being-in-pain requires a moment of awareness, either from the sufferer (which seems obvious) or from the witness (which is very often forgotten). From this philosophical tenant, Bourke reaches the conclusion that ‘pain describes the way we experience something, not what is experienced’ (p. 7. her emphasis). There are a number of advantages in adopting this events-based approach to pain and its history. First of all, we may simply assume that ‘pain is what people in the past said was painful’ (p. 9). This will enable us to avoid reifying pain in terms of a single incarnation, and to acknowledge that the ontology of pain is never stable. It also becomes clear that pain is an evaluative event, in the sense that it only exists in terms of meaning and assessment. Finally, Bourke reminds us that as a public ‘type-of-event’, pain is a political practice, permeated through and through with the politics of powers (p. 19).
Armed with this theoretical framework, Joanna Bourke writes a very powerful and thought-provoking book that reflects the cultural dimension of human pain, far beyond the realm of medicine or medical practices. In all of its nine chapters, she strives to show how pain not only emerges from physiological processes, but also in negotiation with social worlds and cultural mindsets. The book explores how pain can be communicated, or the ways in which it creates sympathetic communities (Chapter 1). It further investigates the extent to which changes in expression of pain may also indicate changes in sensations and experience (Chapter 2). The normative forms to deal with the pain of others, in religious contexts for example, are the subject matter of Chapter 3. Especially interesting in this account is the discussion of children’s pain, with its related values of what Peter N. Stearns could have named the emotional standards of pain, like resignation and calm. The duality between verbal and gestural forms of representation, mainly in relation to diagnosis, is explored in Chapters 5 and 6.
While these first six chapters emphasise the way in which cultural settings affect both experiences and expressions of pain, the following three focus on the social evaluation and understanding of the pain of others. Though we may assume that pain is what people in the past regarded as such, the book contains plenty of examples in which first person testimonies and the politics of power collide. The story of pain forces us to unfold the Gordian knot that results from the entangled testimonies of those who suffer and those who watch, including among this latter group the viewpoint of historians and other external observers. Only thus may we reach the conclusion that part of this story deals with pain which has been deliberately denied or silenced. This is fully discussed in Chapter 7, ‘Sentience’, regarding the alleged sensitivity of pain of individuals grouped according to ethnicity, class, gender, age or occupation. In its final chapter, Bourke’s book emphasises how the pain of hospitalised children was usually underestimated, or how patients from the working classes or ethnic minorities often found their pain dismissed or ill-treated. Bourke’s discussion of pain in children and foetuses is also particularly telling, since we must also take a stand with regard to issues in which those principally affected by pain have no direct way to communicate their sufferings. The same restrictions also apply for the wonderful discussion of the role of sympathy in the management and treatment of pain. The paradoxical nature of fellow-feeling, and the extent to which there is no such thing as a general theory of cruelty, allows Bourke to call into question the emphasis on narrative medicine that is so fashionable nowadays within the medical humanities.
In brief, this is a wonderful and impressive book on one of the most pressing subjects of the new cultural history. As could not have been otherwise, the book could have covered some other issues (like animal pain, for example) or given more attention to other phenomena (like mental suffering). It is, however, an outstanding piece of work that, both in terms of the historical material it uncovers and the theoretical discussion it contains, will be a very rewarding read for anyone interested in the cultural and historical modulations of human pain.
