SPIRITUALITY TODAYDaniel A. Helminiak:
Summer 1986, Vol. 38, pp. 136-148.
Modern Science on Pain and Suffering: A Christian Perspective
Our experience of pain and suffering finds both contemporary therapies and authentic religious ministry willing and able to assist us to overcome the limitations of mortal existence.
As a result of his interest in spirituality, Fr. Daniel Helminiak of the Oblate School of Theology, San Antonio, Texas, has begun work on a second doctorate in psychology at the University of Texas in Austin. His book, The Same Jesus: A Contemporary Christology has been recently published by Loyola University of Chicago Press.
JESUS' suffering and death is central to Christian understanding of human salvation. So pain and suffering is a natural concern for Christians. But today, no doubt because of the influence of Christianity on Western society, pain and suffering is also a major concern of medical science and psychology. So the Christian who would have an adequate Christian understanding of pain and suffering must also consider what modern science has to say on the subject. This is particularly true of the Roman Catholic tradition, for one hallmark of Catholicism -- despite glaringly notorious incidents in its history -- is its insistence on the basic harmony of faith and reason.(1) There can be no real conflict between valid science and authentic religion.
In this paper I will review the approach of modern science to pain and suffering and relate that approach to Christian concern. I will begin with some general comments about pain and suffering in contemporary medical and psychological literature. Then I will turn to a more detailed presentation of that material under four main headings: the body's own mechanisms for experiencing pain; medical treatment of physical pain; psychological treatment of physical pain; and psychotherapy, the psychological treatment of human anguish or emotional suffering. Finally, I will highlight the relevance of this scientific material to Christian living.
PAIN AND SUFFERING IN GENERAL
The item "pain" occurs frequently in current listings of medical and psychological research.(2) There are literally hundreds of articles published annually on the subject. As might be expected, here pain refers quite simply to physical discomfort. Medical articles deal with pain and its control in general and also with very specific pains in particular, like chest pain, post-operative pain, arthritic pain, headaches, back pain, pain in cancer patients, and so forth. Much of this medical literature deals with chronic pain, that is, pain that lasts for months and years without letup. Much of the psychological literature also treats chronic pain. Helping people who have to live with pain has become a growing specialization among health practitioners. In addition to concern for physical pain, the psychological literature also deals extensively with treatment of human unhappiness, dissatisfaction, anxiety, depression, grief, loneliness -- that is, with all those all too common human experiences that could be generally catalogued as "suffering." indeed, it is the express goal of psychotherapeutic treatment (counseling) to help alleviate such human suffering.
As is already clear, by "pain" I mean that discomfort that is associated with physical sensation. By "suffering" I mean the emotional, mental, social, and even spiritual disease that people experience. Consultation of almost any dictionary will justify such a use of these terms. But note this: most theological dictionaries will carry an entry on both pain and suffering, but medical and psychological dictionaries will list only pain. So the term "suffering" is really more proper to theological circles. Still, what it refers to mental and emotional anguish is a prime concern of the scientific community, and I will continue to use the term freely throughout this paper.
MECHANISMS OF PHYSICAL PAIN
The most fascinating aspect of medical studies on pain is discoveries made within the last fifteen years,(3) Research has revealed much about the actual physical mechanisms of pain experience in the human organism. This same research has also raised numerous questions, for there is more to human pain than physical processes. If one thing is certain, it is that modern science is completely convinced of the complexity of human experience of pain. This is so much the case that one recent author could write, "Pain is probably the least understood and most ineptly treated subject in medicine today."(4) As background for what follows, I now briefly summarize some of this fascinating physiological research.
To begin, let me recall what you may already know. The experience of pain occurs like this. Certain nerves in the body and near its surface are sensitive to hurtful stimuli -- pressure, heat, or both. When these nerves are stimulated, they send a message to the spinal cord. The message is relayed up the spinal cord and to various centers in the brain. Then one feels pain.
Now let me add some detail.(5) Actually, there are different kinds of nerves sensitive to hurtful stimuli. Some respond to sharp, sudden, localized pain. A cut on the finger would be felt through these nerves. Other nerves respond to slow, burning, excruciating pain. The dull but endless pain of a toothache or a bone bruise would be an example here. Now these two different kinds of pain messages follow parallel but separate paths to and along the spinal cord and up into the brain. In addition, there is a third spinal nerve path that also carries pain messages to the brain, the ipsilateral tract, but little is understood about it.
In the brain, pain messages first arrive at the thalamus. This small organ, deep within the brain, is composed of many clusters of nerve cells and is sometimes said to function as the brain's switchboard. The different kinds of pain messages that reach the brain are processed through separate clusters of nerve cells in the thalamus. From these various centers in the thalamus, pain messages are then sent to a number of areas of the cerebral cortex. The cortex is the highest and most developed part of the brain. It is generally associated with typically human capacities like thinking and creativity. What area of the cortex will be involved in pain experience depends on which part of the body will feel painful and on what kind of pain will be felt. When the pain messages are finally processed in the brain and only then, one has the experience of pain.
However, the sending of pain messages up to the brain is only part of the story. The human brain also has systems for sending pain messages back down. Recent research has revealed a number of centers just below the thalamus which, when stimulated, cancel the pain messages coming up into the brain. This is to say, because of the action of these centers, physical injury that occurs in the body may not be experienced as pain. There is injury but no pain.
How is that possible? One theory suggests that these centers in the brain send a message down the spinal cord. There they stimulate other nerve cells that produce certain chemicals that in turn affect the nerves sensitive to hurt. These chemical prevent the pain sensors from sending their message to the spinal cord and so up to the brain.
These neuro-chemicals that cancel pain messages have been only recently discovered. As a group they can be referred to as endorphins.(6) They affect the body the same way as does morphine and are named for that very reason: endogenous + orphines; that is, they are morphine-like chemicals produced within the body itself.
This theory that explains the working of endorphins in the body is only a theory, and it is only one theory. In fact, no one really understands completely how the pain-cancelling systems within the human organism work. And there is more than one such system.
Certainly stress and trauma -- physical and emotional -- are one of the triggers of the pain-control systems in the body. So soldiers in the thick of battle, athletes in the heat of competition, and people overwhelmed in crisis may be unaware of major injuries until the urgency of the moment passes. Strenuous exercise also certainly triggers the release of endorphins in the body. These account for the "high" runners feel and explain the "addiction" some people have to prolonged and regular exercise. Beyond this, there is the real possibility that the pain-control centers in the lower brain are subject to influence from the higher centers in the cortex; that is, they may be subject to deliberate human control.
Medical science clearly admits a subjective dimension in the experience of pain. The important point here is this: physiological research itself indicates an opening to, and some possible explanation for, spiritual healing.
MEDICAL TREATMENT OF PHYSICAL PAIN
From the physiological mechanisms of pain and pain control in the human organism, certain physical treatments for pain follow. The most common, of course, is the use of pain-killing drugs.(7) Morphine, known and used since 3000 B.C.E.; aspirin, used under that name since 1899; and acetaminophen -- better known as Tylenol -- first marketed in the U.S.A. in 1955 are the best known and most widely used analgesics.
Simple physical stimulation is another common therapy for pain -- massage, hot or cold packs, whirlpool treatment, electrical stimulation. It is believed that the nervous system can process only so much information at one time.(8) Stimulation of one part of the body decreases the possibility for transmitting pain signals from another part, This explains the spontaneous inclination to rub an injured and painful part of the body. This may also partially explain the effectiveness of the traditional rubbing with oil -- anointing! -- or laying-on-of-hands even as a religious healing practice.
Acupuncture -- the exotic pain remedy from the East that prescribes the insertion of small needles in appropriate places on the body -- probably also works for the same reason. Studies show that acupuncture therapy is probably as effective as conventional treatments and is free from adverse side-effects often associated with those treatments.(9)
In extreme cases modern science will turn to surgery to relieve chronic pain.(10) In the case of back pain, for example, laminectomy removes parts of the spine that may be irritating the nerves in the spinal cord, and spinal fusion permanently joins vertebrae of the spine to prevent similar irritation. In some cases the nerves that transmit the pain impulses are severed -- sympathectomy and rhizotomy. Unfortunately, these operations do not always relieve all the pain, precisely because there are numerous pathways for pain messages to the brain, as noted above. Finally, as a last desperate measure for the relief of unbearable chronic pain, part of the thalamus itself may be excised -- thalamotomy.
PSYCHOLOGICAL TREATMENT OF PHYSICAL PAIN
In addition to physical treatment of physical pain and precisely because of that mysterious subjective dimension in the experience of pain, modern medicine also prescribes various forms of psychological treatment.(11) One of these has been most successful in the treatment of headaches. It is known that headaches are related to muscle tension and sometimes to body temperature. Using machines that give patients immediate information about subtle changes in the state of their muscles and temperature -- biofeedback -- patients can learn deliberate control over these body functions and so eliminate headaches.
Another treatment focuses on the social dimension of the human being. Obviously, people give attention and sympathy to others who exhibit signs of pain -- moans, grimaces, limps, and the like. For want of attention, people in pain may make such pain-related behaviors a permanent part of their self-image and their relationships with others. Then these behaviors become valuable, so the patients retain them -- and the pain! Behavior therapy helps patients to replace these pain-related behaviors with other behaviors. As a result, this therapy frees the patient from constant social reinforcement of his or her pained condition and so frees the patient to give up that pain.
The point here is not that anyone should treat another's pain as mere fantasy. Awareness of the subjective dimension of pain requires that no one can assess another's pain. Only the person feeling it really knows the pain; and all felt pain, regardless of its source, is real. Rather, the point is this: awareness of the subjective dimension of pain also implies that people have more control over their pain than they may want to admit -- especially if they get a lot of attention because of their pain. This therapy helps free the patient from those social reinforcements of pain and so opens the possibility of living a life not dominated by pain.
Other kinds of psychotherapy are also sometimes useful for treating pain. Emotional discomfort often expresses itself in physical pain -- psychosomatic symptoms -- or may increase already existing physical pain. In general, it is easier to bear with anything when we are at peace with ourselves, have a positive outlook on life, and feel loved by family and friends. So any kind of psychotherapy may affect the experience of pain. However, since the therapies in question are the very ones I will be discussing below, I will not mention them in detail here. Rather, I will make some remarks about specific techniques that may be used in many different kinds of psychotherapy.
One of those techniques is hypnosis. There is abundant evidence that hypnosis can be useful in dealing with pain. However, how exactly hypnosis works and how effective it really is remains one of the great mysteries of psychology.
Another set of techniques involves the use of active imagination. Anyone familiar with imaging techniques now commonly used in meditative prayer forms will recognize the similarity immediately.(12) One technique, imaginative inattention, relieves pain by encouraging the patient to imagine a scene incompatible with pain, for example, lying on the beach. Another technique teaches the patient to imagine the pain sensations as occurring in a more pleasant context. For example, a sharp pain might be associated with intense cold felt while playing in the snow. These techniques are similar to those used successfully by the Simontons in their cancer treatment clinic.(13) Exactly how active imagination achieves its healing effect is not yet understood. It may be that deeply felt impulses -- used in prayer or otherwise -- are one trigger for the body's own pain-control systems.
Other cognitive techniques involve what might be called the power of mind over matter. One technique teaches the patient to relabel pain sensations with more congenial terms: discomfort, tingling, numbness, cold, or warmth. Thinking and speaking in these terms tends to lessen the experienced pain. Or again, through "somatisation" one focuses on painful sensations in a detached way. One might imagine one were writing a biology report about the sensations. This technique is similar to that of Buddhist shamatha meditation, sometimes called insight meditation. (14) Finally, "attention diversion" bids the patient turn attention to something other than the pain, something internal, like mental arithmetic or reciting a poem, or something external. Dentists use this technique when they attempt to distract and entertain patients with puzzle posters on the walls or ceilings of the operating room.
In general, there is to date little scientifically acceptable evidence that proves the effectiveness of these techniques as such. However, studies do show that the more valuable techniques are those that imaginatively transform the pain rather than attempt to deny it.
Behind this whole discussion of the subjective dimension of pain lies another fascinating phenomenon. It explains the difficulty in proving that any of these techniques is actually effective despite the obvious relief they bring to many. That phenomenon is the placebo effect.(15) A placebo is any treatment that in itself has no real healing power but is effective because the patient thinks it will work. Studies show that in pain treatment a placebo will help over one in three people. Morphine itself is only seventy percent effective. Comparing the two, a sugar pill is about fifty-five percent as effective as morphine in controlling pain! The placebo effect does not depend on the gullibility of the patient. Rather, it depends on the patient's expectations, level of anxiety, and other aspects of the doctor-patient relationship. These very factors, the subjective ones, may be involved in the body's production of endorphins.(16)
PSYCHOTHERAPEUTIC TREATMENT OF HUMAN SUFFERING
Up to this point I have been considering physical pain and its treatment. Now I turn to contemporary treatment of human anguish or suffering. In general, this treatment is called psychotherapy or counseling.(17) However, in professional circles the two terms are not strictly synonymous but depend on the credentials of the therapist.
The conspicuous beginning of modern psychotherapy was Sigmund Freud's use of what he called "the talking cure." Freud discovered that allowing people to talk about, and so in some sense relive, past traumatic experiences would often free them from oppressive inner forces that controlled their lives. Freud and his disciples launched the psychoanalytic movement. For various theoretical reasons some -- like Carl Jung -- broke with the Freudian circle and formed their own schools. Others, emphasizing different aspects of human psychology, formed still other schools of psychotherapy. Thus, Harry Stack Sullivan emphasized interpersonal relationships as the most important part of a person's life. Carl Rogers developed a client-centered or non-directive therapy, which relies on unconditional positive regard to help the client overcome blocks to growth. B. F. Skinner and Joseph Wolpe's behavioral therapy changes external behavior in order to modify internal emotional experience.
One application of behavior therapy was discussed above. Humanistic psychology, associated with Abraham Maslow and others like Eric Fromm, Gordon Allport, Rollo May, and Ira Progoff, focuses on development of potential rather than on cure. The list could go on and on to include actualizing therapy, art therapy, assertiveness training, bioenergetics, cognitive therapy, creative aggression therapy, gestalt therapy, implosive therapy, play therapy, psychodrama, reality therapy, rebirthing therapy, transactional analysis, and many others.
Psychotherapy can be conducted on a one-to-one basis or in groups of various size and composition: in regular thirty to sixty to one hundred twenty minute meetings or in marathon sessions of one to three or more days. Its concern can be family and career problems, relationship difficulties, sex, grief, or any other human suffering. It may be crisis intervention, which deals on a short-term basis with an acute situation; supportive therapy, which expects no real improvement but in an on-going way helps the client cope with life; symptom-oriented therapy, whose concern is one specific symptom, like pain, as discussed above; or insight oriented therapy, which expects the client to achieve significant understanding of his or her situation and so make important personality changes.
Psychotherapies use a wide variety of techniques. Some of these were discussed above; others are suggested by the names of the various therapies: drama, play, art. Outside of those schools that insist on rigid orthodoxy, therapists will generally use whatever techniques work. Moreover, studies show that certain qualities in the therapist -- warmth, empathy, patience, openness, and honesty -- determine the effectiveness of the therapy, regardless of what theories or techniques are followed. This is an important subjective factor on the side of the therapist. Personal qualities and not just technical training condition the effectiveness of healing professionals.
Despite this wide range of variations in psychotherapies, all have these factors in common: they depend on a relationship developed between the client and therapist. They provide some rationale or explanation of the client's problems. They supply new information about the client's problems and ways of dealing with them. They offer the client hope, initially because of the professional status of the therapist and later because they build up a "track record" of successes that bolster the client's self-confidence. Finally, they depend on emotional involvement, on the feelings that are central to human experiences. Using ordinary human helping behaviors and elaborating them in a complex system of theory and practice, contemporary psychotherapies address human suffering on many levels and help alleviate it.
IMPLICATIONS FOR CHRISTIAN LIVING
I have been considering modern science's understanding of human pain and suffering and its approaches to treating them. Some comments about the relevance of this material to Christian concerns is now in order.
First, there is a universal attitude in the scientific literature that pain should not be accepted. Pain and suffering are "pains" and should be eliminated whenever possible. The whole of modern 'science works precisely toward that goal. This scientific attitude ".finds a parallel with the religious belief that God does not want us to be miserable. Rather, God made us to enjoy life here and to have life to the full hereafter. According to the account in Genesis, it was not God's plan that human life be filled with pain and suffering. These are the result of human sin. The same must be said in Jesus' case, despite some deeply rooted but pathological misunderstanding of this issue. Jesus' death was the result of human wickedness. To use Augustine's distinction, if God allowed Jesus' death, he certainly did not will it. God did not enjoy the murder of his son, but God was certainly well pleased with Jesus' fidelity even in the face of death. So pain and suffering have no value in themselves. It was Jesus' love and fidelity even at the cost of pain and suffering that was redemptive. Modern science and Christianity agree on this: pain and suffering are not something simply to be accepted. They are not good in themselves.
Second, both modern science and Christianity admit, however, that pain can be useful. Insofar as pain and suffering are symptoms of something that is wrong in us, they alert us and urge us to deal with the issues. On a much more philosophical plane, Christianity also sees pain and suffering as symptoms -- symptoms of the sin in our world. So the pain and suffering in and around us can become occasions for us to turn to deeper realities. They can invite us to repentance, forgiveness, compassion, ministry.
Third, on the question of pain and suffering, the medical community clearly acknowledges a subjective, a specifically human, dimension -- both on the side of the client and on the side of the doctor or therapist. As we have seen, medical research even suggests a possible neurological mechanism through which this subjective dimension in the client operates. Medicine -- it would be the first to agree -- does not have all the answers.
Here is an opening to religious questions. Here is a scientific legitimation for belief in some spiritual healing. What hope for peace and joy in this life could be ours if we were always true to God's ways? Or to phrase the same question otherwise, how much of our pain is self-inflicted? How does this self-punishment relate to some deep sense of being unloved or unworthy, that is, to a lack of faith? Or to being guilt-ridden, resentful, or hateful? How much do these same spiritual flaws dam up the healing power in our health professionals? Undoubtedly, psychology and psychotherapy could address these same issues at some level. Regardless, my point remains; in fact, it is strengthened: these issues are openings to religious questions, and they lie in the heart of modern science.
Finally, there is also a striking contrast between the scientific and the religious attitudes toward pain and suffering. The scientific attitude is just that -- scientific: a methodical, reasoned approach that intends to understand the subject and so achieve human control. The religious attitude, on the other hand, tends to trail off into the big questions. It asks about the meaning of pain and philosophizes about how one can bear pain.
Now, each attitude has its proper place. When all that is humanly possible has been done and pain and suffering still remain, then the religious attitude comes into its own -- but only then. To recall divine providence when no other answer is available is religion's prerogative and contribution. Then such recall is appropriate and welcome. We need religious faith. But to find meaning in pain or suffering and to bear it when medical science could easily enough relieve it is blasphemous. To bear unnecessary suffering is to shun God's gifts because they do not come as obvious miracles. As noted at the beginning of this paper, there can be no real conflict between faith and reason, between valid science and true religion, since God is the ultimate source and goal of both.
Such an understanding is not irreligious. It is not to be accused of merely invoking God to plug the holes in our understanding and control of the world. An adequate Christian understanding of things will include the scientific approach and so see God also in what science explains.(18) Likewise, authentic Christianity avoids an all too easy appeal to "the Holy Spirit" or "the Lord" in these matters. Such appeal suggests that all has been said when "God" has been named. But modern science can say much more. Granted God is in some way behind everything that happens, science can spell out how God does what God does. Science can explain the mechanisms -- created and guided by God, to be sure -- that effect our experience of pain and suffering and alleviate it. In the modern world to ignore such knowledge is also to be irreligious.
There is a further point.(19) In God's good wisdom not only do different approaches to issues provide different but complementary answers -- the scientific and the religious; different approaches also require that we turn to different people for the help we need. For not all are doctors or therapists or pastoral ministers. But all together are Christ's body, though each is a different part of it.(20) The relationships of dependence, gratitude, and respect that bind us to our health professionals are the stuff of Christian love. The very need for such relationships is another of the mechanisms God uses to help us grow in God's own life.
Insofar as modern science offers valid understanding and treatment of pain and suffering, the approach of modern science must also be a part of the approach of a Christian. In this case science is merely spelling out in some detail what Christians profess generally in faith: in varied and marvelous ways God cares for us and attempts to bring us to fuller, richer lives.
- Cf. Gerald McCool, "Education and the Catholic Mind: Past and Present Models," Catholic Mind 79 (Nov., 1981): 27-38.
- E.g., Index Medicus and Psychological Abstracts.
- G. F. Gebhart, "Recent Developments in the Neurochemical Bases of Pain and Analgesia," in Contemporary Research in Pain and Analgesia, 1983, ed. Roger M. Brown et al., (Washington, D.C.: National Institute on Drug Abuse), pp. 19-35.
- "Pain: psychiatric and psychological aspects," in The Encyclopedic Dictionary of Psychology, ed. Rom Harre and Roger Lamb (Cambridge, Massachusetts: The MIT Press, 1983), p. 441.
- Cf. Siegfried Mense, "Basic Neurobiologic Mechanisms of Pain and Analgesia," The American Journal of Medicine 75 (Nov, 14, 1983): 4-14; Gebhart, "Recent Developments."
- Cf. J. R. Cautela and A. J. Kearney, "Endorphins/Enkephalins," in Encyclopedia of Psychology, ed. Raymond J. Corsini (New York: John Wiley & Sons, 1984), Vol. 1, p. 436; Jack R. Cooper, Floyd E. Bloom, and Robert H. Roth, The Biochemical Basis of Neuropharmacology, 3rd ed. (New York: Oxford University Press, 1978), pp. 259-271.
- Cf. Hans Haas, "History of Antipyretic Analgesic Therapy," The American Journal of Medicine 75 (Nov. 14, 1983): 1-3.
- Cf. "Pain: gate control system," Encycl. Dict. of Psych., pp. 440-441.
- Cf. George T. Lewith, "How effective is acupuncture in the management of pain?" Journal of the Royal College of General Practitioners 34 (1984): 275-278.
- Cf. J. C. Rook, "Pain," in Encycl. of Psych., Vol. 2, pp. 476-477.
- Cf. Charles P. O'Brien and Marvin M. Weisbrot, "Behavioral and Psychological Components of Pain Management," in Contemporary Research, pp. 36-45; Shirley Pearce, "A Review of Cognitive-Behavioral Methods for the Treatment of Chronic Pain," Journal of Psychosomatic Research 27 (1983): 431-440.
- E.g., Marlene Halpin, Imagine That! Using Phantasy in Spiritual Direction (Dubuque, Iowa: Wm. C. Brown Co. Publishers, 1982); Linda Sabbath, The Radiant Heart (Denville N.J.: Dimension Books, 1977).
- Cf. O. Carl Simonton, Stephanie Matthews-Simonton, and James L. Creighton, Getting Well Again: A Step-by-Step Guide to Overcoming Cancer for Patients and Their Families (1978; reprint, New York: Bantam Books, 1980).
- Cf. Chogyam Trungpa, Cutting Through Spiritual Materialism (Berkeley: Shambhala, 1973), pp. 154-157; Daniel A. Helminiak, "Meditation-Psychologically and Theologically Considered," Pastoral Psychology 30 (1981): 6-20.
- Cf. F. I. Evans, "Placebo," Encycl. of Psych., Vol. 3, pp. 55-56.
- Cautela and Kearney, "Endorphins."
- Cf. B. Fabrikant, "Psychotherapy," Encycl. of Psych., Vol. 3, pp. 184-186; "Psychotherapy," Encycl. Dict. of Psych., pp. 511-513.
- See Daniel A. Helminiak, "Where Do We Stand as Christians? The Challenge of Western Science and Oriental Religions," Spiritual Life 28 (1982): 195-209.
- I am grateful to Mrs. Myrtle Juelg for this insight.
- Cf. 1 Cor. 12:27.
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