Pain, Anguish, Suffering and Marginal Life

At our recent Third International, Ecumenical Congress on the Meaning of Human Suffering, Ms. Virginia Harrison, PhD Cand. gave as her presentation A Biologist's Views on Pain, Suffering and 'Marginal Life'. Virginia is Associate Professor of Biology at Webster College, St. Louis, Mo. Among the courses she teaches are Medical Genetics, Neurobiology, Developmental Biology, Advanced Physiology and Biomedical Ethics. Virginia was born with spina bifida, and as a result, has had to use a wheelchair and crutches throughout her life. In 1963, she helped found a world-wide spiritual movement run by and for persons with handicaps, known as Victim Missionaries. The following is a condensation of that presentation, which was well-received by our participants and triggered many lively discussions throughout the Congress.

Before we begin to discuss marginal life, let me share with you how most biologists view life itself-simply life. How do we view it? With awe, with glee, with wonder and, somehow with peace. We see life in a tremendous variety of organisms. Life can look like almost anything from a walking stick, to a peacock. It can exist almost anywhere: the South Pole, boiling springs, searing deserts. It changes more often than not; now it's a caterpillar, two weeks later, that same parcel of life is a soaring butterfly. Life has a rhythm, a propriety to it: those changes generally occur in a predictable order. At each stage, they can do those things proper to their time of life. Tough as life is, enduring as it is, life is also fragile, composed of delicately balanced processes, each very complex, each in harmony with the other.

Do Biologists Ever View Life as Marginal?

In twenty years of studying biology I have never seen one reference to any life form or any living system that was called or considered "marginal". When you realize the delicate balance of life, the luxury of labeling any of it "marginal" simply does not exist. In the social scientific sense of the word, marginal denotes individuals who are not contributing members of the group. In biology we look for function but we don't use it as a prerequisite for life.

Pain, Anguish, and Suffering

Each human life is valid and can only be judged from within the circle it creates. Interdependence is a mark of human life. Therefore, rather than marginality, in the rest of this paper we will be dealing with "marginalization", the process by which people are put out of the mainstream of society and, sometimes, beyond life itself. If fetuses, persons in pain, persons who are lonely or limited in some aspect are indeed both alive and human, why do we marginalize them? Why do they allow themselves to be marginalized? The answer, I think, lies in pain, anguish and suffering.

Pain

Pain is relatively easy to define. Animals feel pain-yes, even the little cockroaches I used to work on felt pain. It is a very unpleasant sensation. It can be physical, emotional or mental (though it's probably only physical in cockroaches). If a sensation causes you to weep, to cry out, to moan, and your first response is to try to get away from it-that's pain. Animals have pain and so do we, in about the same way.

Fast and Slow Pain

We know now that there are two kinds of pain carried by two kinds of nerve fibers which make different connections in our brains. Each gives rise to different sensations and perceptions of pain. There are "fast pain" fibers which come mainly from the skin. They signal sharp pain. These connect almost directly with the cerebral cortex where we perceive exactly what part of our body hurts and how to get out of harm's way. This "fast pain" sensation has a very small emotional component. You can cut yourself, say "Oh my!" and rather dispassionately inspect the damage. If there is residual damage from the injury as in a cut or burn or if the pain is in deep tissues, the other pain system is activated. This system uses "slow pain" fibers which do not go directly to the cerebral cortex. We have a much harder time locating the pain and the emotional component of this slow pain system is quite large. Several hours after the cut your finger is throbbing; you feel as if your entire being is concentrated in that finger and that the whole being hurts. The fibers from the slow pain system make diffuse connections through almost all of our midbrain and limbic system. This is the area that provides quality, emotion and response to sensations.

We can easily distinguish these two perceptions. Fast pain is 1) sharp, 2) easily localized, 3) low in emotional content. Slow pain is 1) dull, 2) difficult to localize, 3) high in emotional content. It is this slow pain sensation which produces the phenomenon I call anguish.

Anguish

Anguish is the "angst" of psychoanalysts, philosophers and theologians. It is an added layer, overlaying the pain, kind of an "epi-pain" phenomenon. When slow pain fibers from the spinal cord enter the brainstem, they excite the reticular system which keeps one alert and can make one very restless. Then they enter the midbrain and make connections with central gray matter and then the thalamus, and ultimately with the limbic system just below the neocortex. You don't have to understand all these fancy words, you can tell that these pain fibers affect nearly the entire brain. When stimulated, they can produce massive changes in neural processes.

This indicates that anguish can occur in animals. When, in fact, one applies a painful stimulus to a rat, one sees behavior indicating that the rat is fearful, anxious, and interested in only escape. This response is mediated by the thalamus and limbic system. This is a circular pathway in which the same impulse can evidently just keep going around and around. You have probably experienced this phenomenon in the emotion of anger which occurs in the same system. You feel like you are thinking in circles; you can't get your mind off your anger, but nothing seems to get resolved; you just get madder and madder. A very similar thing happens in the rat, or the human who feels anguish.

Pain You Don't Want

I think the feeling of anguish is much more intensely painful to a human, however, than it is to a rat. This circular system has two main entrances and exits, you see: the spinal cord and the cerebral cortex. Our cerebral cortex is vastly more powerful than the rat's. With our well developed consciousness and strong will we can send intense input into that circular system when we feel anguish. My first simple definition of anguish is that it is pain that you don't want. Think back to your last really bad head cold, menstrual cramps, migraine headache, or a longstanding interpersonal conflict in your family or community. Your whole being seems to ache. You say to yourself: "I can't take anymore of this." Each of these thoughts feeds back into the limbic system, perpetuating and intensifying our anguish.

Escaping Pain

The anguish phenomenon contains, as you can tell, strong elements of anxiety and frustration which generally increases total body tension. This tension produces, on its own, more slow pain which feeds into the same circuit. All in all, anguish is "more painful," more difficult to bear, than the pain which engendered it. This is one of the reasons that relaxation techniques are so important in pain clinics. One can also decrease anguish reactions and even pain sensitivity in rats by teaching them that the pain stimulus is "inescapable." I think this is one of the reasons that humans sometimes allow themselves to be marginalized. It stops the pain. This is a very primitive neural system and I think we relinquish some of our humanity when we use it, but it does alleviate some of the anguish. It is analgesic to give up. I call this reaction "resignation".

Power Over Pain

Given that we have access to the anguish system not only by slow pain messages from the spinal cord, but also from our powerful cortex, humans are much more able to feel or intensify anguish for mental or emotional reasons. This allows us to feel anguish over the loss of capabilities, the loss of beauty, the loss of hope. If we retain our full humanity - that is, we don't resign ourselves - we behave much less like rats. According to Dr. Hans Selye, the easiest way to give a human peptic ulcers or any other symptom of distress is to put him in an unpleasant situation over which he has no control. To alleviate this added layer of anguish, people in pain need some power, some control over their situation., This allows signals to escape from that circular anguish system and go either up to the cortex or down through the spinal cord into action. It stops the reverberating, intensifying feeling. This escape from anguish is just what we take away from people when we marginalize them.

As an aside, this feeling of control is what makes bearable the pain of exercise, dieting or truly elective surgery. We decided to do it. In contrast, even rather minor pain, if it is intractable or chronic, produces full-blown anguish.

Pain-Killing Systems

Now, when a person is directly in pain-be it physical or emotional-often there is something one can do about it, or at least in regard to it. One can go to the doctor, receive therapy and make decisions. This activity in itself decreases anguish and probably sets one of our intrinsic analgesic systems into action. We now know that there are several natural pain-killing systems which work under different conditions but there is one similarity in all of them: you need to have something going on besides the pain. Novelty, excitement, or productive work will all be effective. They probably are not working in the spouse, parent or child who can only stand and watch. A recent study of the spouses of cancer patients pointed this out. Their emotional pain is uninhibited by any of these analgesic systems. In addition, they may have a much higher level of anguish, characterized by a terrible feeling of powerlessness. In plain words, sometimes the onlooker's pain is the more difficult to bear.

Overwhelming Anguish

This anguish may be most intense at the birth of a child with a severe problem. This is explained very well by John Fletcher in his book, Coping with Genetic Disorders. At the time of the birth, parents are all geared up, both by their biology and their culture, for a moment of joy. Instead, they look at a whole lifetime of anguish in just a few minutes or hours. Their thinking and feeling brains are completely overwhelmed by the anguish phenomenon. Medical decisions often need to be made when they're having trouble thinking. Once some of the shock has worn off, having information to learn and decisions to make to help their child probably does relieve some of their anguish, but even then, the medical personnel are getting to do so much more than the parents that the doctors and nurses get the greatest analgesic effect. In addition, the parents have to function without knowing that their child, if she lives, will develop with herself, not their ideal baby, as her reference point. She won't feel the same anguish of deprivation that they feel now.

A few years ago, a couple of us disabled adults were called to talk with a woman who had given birth that day to a handicapped child. It was amazing to see the difference between the grandmothers who were in deep anguish, and the mother who, with tear-stained face, was busy finding out how she could help her child and what was available to him. I thought at first that the grandmas had the luxury of falling apart and the mother didn't. I realize now that, with a job to do and a way to help, Mother was the fortunate one.

Suffering

Suffering has been defined as "to be for another," It is love. It is compassion, a 'feeling with'. It's the "He ain't heavy; he's my brother" phenomenon. lam beginning to think that some animals suffer, too. Perhaps, much of what makes us human is simply a more intense, conscious, and deliberate experience of many things that our friends, the animals, have done before us.

You will notice that in this section the impersonal pronouns disappear from my grammar. All the "ones" become "you" and "I". I cannot discuss suffering impersonally because it can't be impersonal.

Suffering involves pain too, often severe or long term, and anguish as well, but it is easier to bear than pure anguish is. You are either enduring pain to help, or to be with, someone you love. Sometimes the pain is a direct result of your effort to love. This is the case in parents, social activists and missionaries who often experience pain as they try to help their loved ones. At other times, you have the pain already but you decide to bear it in the faith that the Lord can somehow transform it into help for those who need it.

I think we can call either type of suffering "LIVED PRAYER" or "lived contemplation". In either case, you are putting your body or your life where your mouth is when you verbally pray for someone. You may be feeling anguish, but you give up that sense of power that is so important to relieving anguish. You give over your life to someone else.

Suffering for the Other

We need to distinguish this from both the old idea of sacrificial penance and from the "offer it up for the Poor Souls" syndrome. I have personally found that if a particular person is causing me pain, I can only suffer it for that person. And, if I cannot suffer the hurt feelings in love, I cannot try to bear my sore shoulder in their behalf. I have also found that 1 cannot do it for myself. I can't try to suffer my own way into heaven, I need someone else to do that for me. I am also not usually holy enough, not so completely open to God, to be able to bear suffering for whomever the Lord chooses, or for some hypothetical "Poor Soul". It is much, much easier to suffer for someone you know, or whose situation you know, someone you love in a human kind of way.

I had a friend, Connie-a post-polio person, whose life was transformed by this. Connie could breathe on her own, but could only move the little finger on one hand. She lived in a nursing home and later in a hospital. We suggested that she pray and offer her life for others. Then, every time someone was having trouble we took them to see Connie. She could meet them, find out about their lives, care about them. From her small room, Connie's prayers and her suffering reached across the world. Her life and her pain were no longer meaningless; she had something to do with it.

Transforming

As you can tell, I really believe that when we truly suffer, God transforms our pain and anguish into help for others and also makes it more bearable for us. As a biologist, I think I know part of how He does that. Remember anguish, and how our intense desire to stop the pain usually only make the anguish worse? Well, when you suffer, you give up that desire for power over your own pain. You receive instead the feeling that you are a partner with the Lord, part of the healing power in the lives of those you love. That stops the vicious intensifying cycle of anguish and activates one of the analgesic systems to help inhibit those circular impulses. You still feel pain. You still feel anguish in the very core of your being, but it isn't spilling over, dominating your entire life. Suffering is peaceful. You know the pain may kill you, but it won't destroy you. In a very risky way, you are safe.

Marginalizing

This anguish, I believe, leads us to marginalize others in an attempt to relieve our pain. We would rather not visit our critically ill friends because it hurts so much to see them. We would rather do things for a disabled person than watch them struggle with the task because it hurts to watch, and we often think of our own hurts first. As an example, a plush retirement home once asked a group of disabled persons not to come to Sunday dinner with their friends because it gave people bad dreams to see them.

Now that we have explored pain, anguish and suffering, I would like to put forward the following two-part hypotheses. 1) Anguish leads to marginalize the person who triggers the anguish. 2) Suffering, on the other hand, leads one to include the person for whom one suffers.

"I Can't Take It"

The pain or disability we see in the lives of those around us can trigger either anguish or suffering. We look at the disabilities of others, without benefit of any adjustment or identification processes, and just know that "we couldn't take it." We see the pain of others, from our vantage point of powerlessness, and it is unbearable. So we decide that this really isn't living, or, if it is, it isn't worth doing. And it really is unbearable to us. It is terrible anguish.

Suffering, on the other hand, could never lead to marginalization. Suffering involves not only grief but also hope, for the Lord is helping. When we suffer for another person we are heavily investing our life in theirs. We won't say that their life is worthless because, in suffering, we gain the knowledge that our life isn't worthless. The circles of our lives have intertwined.

De-Marginalizing

From these hypotheses about anguish and suffering, we can see ways to prevent marginalization of people by aiding those around them. We need to tell people in general that there may be mechanisms operative in another person which make his perception of the situation much different from their own. Most persons with disabilities, for instance, are very aware that there is more than one way to do any given task. They know, too, that whatever they can contribute to life is indeed valuable. Many terminal patients see dying as their last great task, to be done well-and they're not going to hurry it. If we can share things like this with people, they won't be quite so apt to marginalize people in order to stop the pain.

Those who are deeply involved need even more assistance. First, stop the anguish. See if there is something for the bystander to do to help so those anguish signals will stop going round and round in his head. Second, lead the friends into suffering. Help them to understand that, in more ways than one, their grief is that sacrificial love which the Lord can utilize to give aid to their loved one. Help them to see that continuing to love) despite the pain, is one of the most precious things they can give the loved one. They will still feel pain and still feel anguish, but they won't feel so helpless or so angry. They won't feel anguish about the anguish. It will be bearable. They won't have to marginalize anyone in order to stop the pain.

Bibliography

• Angevin, J., Cotman, C.; Principles of Neuroanatomy, 1981
• Fletcher, John; Coping with Genetic Disorders, 1982
• Graw, Hyson, Maier, Madden, Barchus; Longterm Stress-induced Analgesia and Activation of the Opiate System; Science 213:1409, 1981
• Kandel, E., Schwartz, V.; Principles of Neural Science, 1981
• Ramsay, L., Rayman, P.; Health and Social Costs of Unemployment: Research and Poilcy Considerations, American Psychologist 37:1116, 1982
• Selye, H.; Stress, The Rotarian, 1978
• Schulz, R.; The Effects of Control and Predictabillty on the Psychological and Physical Well Being of institutionalized Aged, Journal of Personality and Social Psychology 33:563, 1976