Trillium Book Awards Author Reading 2015

Pain Re-Presented as Possibility: A Conversation with Poet & Physician Shane Neilson

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Pain Re-Presented as Possibility: A Conversation with Poet & Physician Shane Neilson

BT: You’re currently a poet/fiction writer, family physician, and PHD student in English and Cultural Studies at McMaster University. In your dissertation, “Damage, Weapons, and Medicine: Pain Re-Presented as Possibility,” you argue that pain can be transcendent rather than a negative experience. Anyone who has experienced severe or chronic pain would probably be skeptical. I think most would agree that pain changes you as it affects your mood, how you concentrate, your ability to socialize with other people, etc. but it's hard to imagine it as anything other than negative. How exactly can the bearer of pain "transcend?" What might that look like in concrete terms? How can it not default into the negative framework?

SN: It is hard to imagine chronic pain as anything but negative, but this is a trick of the language and culture. I think that the concept of pain needs to be freed from its negative confines not so that pain can be celebrated as a good thing, but that pain can be celebrated for what it is–and that bodies in pain are not recognized as mere bodies in pain, but lives with pain. Pain exists in a context, but it often obliterates context. I want to do work that is able to give the context back to people.
Have you ever met an alcoholic who said he was a “grateful” alcoholic? Have you ever met someone suffering mental illness who takes pride in their identity? Among these groups of people, some unabashedly celebrate survival and the resultant perspective and worldview illness gave them. They claim that they are who they are because of their illnesses and they claim benefits that they would not possess if they were "normal."
I am still thinking through the problem of pain, but I do think it strange that pain as physical sensation and emotional experience can only ever be negative (outside of sadomasochism and religious ecstasy.) I consider pain to be meaningful insofar as the person in pain has pain and that this condition can be used to form affective bonds with other people. Don’t get me wrong, I don’t think that chronic pain is great to have–I don't wish it on anyone–but I do think that life is complex and that someone in pain might have insights into a range of human experiences that I don't have. And that these insights are, in themselves, a positive thing to share with other sufferers. Here I take a very practical view, but I'm still trying to renovate that into a broader, more positive view . . . like that of the aforementioned “grateful” alcoholic or chronic depressive who might be better prepared to face certain kinds of adversity than, say, you or I. Who has different skills than you or I because of their individual experiences.
So when I say "transcend," I mean to go beyond pain as sensation, to refuse to let sensation insist on a primary importance, to encourage a healthful rally before disability becomes the definition of identity. I have nothing against the disabled–I myself suffer from what, at times, would most certainly be construed as a disability to the average Western physician–but I am dismayed by a culture that encourages pain to only be limiting. What about the ancient soldiers who sang on the battlefield about their wounds, for strength? I'm with Hemingway: we are strong in the broken places! And we are badly served by how we talk about pain because our assent to negative language limits us. The pain experience need not exclusively be negative. Poetry can be of great assistance here, and at the moment I'm on the lookout for feminist work that speaks of wounds and wounding. I expect this will further my thinking quite a lot.
But if you need a concrete example, okay. People need examples in order to understand, people need metaphors and analogies. How about a hypothetical factory worker who injures his back, but for whom the injury is partly a good thing because the pain he suffers makes him look for another job . . . let's say night watchman . . . that allows him to do what he always wanted to do, which was . . . read on the job. He's happier as a result, and on this new job he meets a janitor and falls in love with him. So there you go! Pain as !!!!!PAIN OW OW OOoooOOO OWWW!!!!! is always negative because we allow it to be voiced along an ouch-agony spectrum, but pain expressed as narrative is not necessarily negative. Furthermore, a strong narrative actively resists such limitations. Conceiving of things in this way is a step we should take.

BT: You say that pain is a type of narrative. Can you expand on that?
SN: I advance the theory that pain is a narrative because if it isn't, then all we have to describe it is metaphor. And that's a problem. Pain exists in time, is dynamic, and has implications for the sufferer. These implications then have further implications. Pain is an actual force–for example, it drives plot, fictional and real. The person in pain will do some things, won't do others. Why? What things are they limited to do, and what are they privileged to do? How is their experience different than that of others? With such questions I’ve left the province of metaphor and stepped into narrative country. Since I'm a poet who cares about words, I know that "narrative" comes from the verb "to narrate" which has its roots in the Latin gnarus, or "to know." We should get to know pain as being richer than the one-note representation of destructive metaphors. The trick is to get the person in pain to see pain in this way, not as an awful alien or torturer but instead as something that actively, and in some cases constructively, shapes their lives.
BT: How much do you focus on physical pain in your thesis? How about emotional pain? Is there a distinction made between the two?
SN: I focus on both kinds of pain. Being a person with mental illness, I started off a few years ago thinking I wanted to focus only on somatic pain so that I could get away from what I knew. I didn’t get far . . . I ran away from psychological pain only to run into writing On Shaving Off His Face (PQL, 2015), a book of poetry about the iconography of the face in mental illness (and covered by Open Book here
As I thought about the dichotomy more, and especially as I read shelves of Canadian literature, I noticed a curious phenomenon that I am working to verify: that psychological pain often tries to reach for physical metaphors to communicate experience (as Scarry points out, psychological pain tries to find an object) and somatic pain sometimes reaches for psychological metaphors (but is only partly successful and largely has no object.) They can be the spectral flip sides of one another, needing each other for a more comprehensive portrayal of experience. I am not making a clear argument here –it's something I need to think about more, though I should mention David Morris’s seminal work The Culture of Pain. Morris wrote of what he antagonistically referred to as "the myth of two pains" and I think he's right. Why even distinguish between the two since somatic pain has an emotional component? Make too fine a distinction and pretty soon pain wouldn't be what we actually feel as pain anymore. We'd define it into something artificial.
BT: In your dissertation you discuss observations you’ve made as a physician. How has your role as parent or patient transformed your perspective on pain?
SN: I don't suffer chronic pain, so I can't give a good answer to this question. If I had to offer an answer, it would involve psychological pain–and that kind of pain is inherently metaphorical. Perhaps the best answer I can give is: as a man who has, like everyone else, suffered his fair share of–cue an overused word– "trauma," it is the pain that I carry and know that creates in me the capacity to be empathetic to other people. This is a fundamentally Levinasian view and I'll hold it until the day I die. Pain is here because it is here, with us. We feel pain and we can help others who feel it because we know what it is like. In knowing what pain is like, we can choose to help sufferers, which is in a strange way always an opportunity to help ourselves.
Okay . . . I take back my dig against "trauma" since it's the Greek word for "wound." It's like this: you show me yours, I show you mine, and we take part in a narrative in which we have the option to help one another, or to simply be with one another, to witness. It doesn't always go this way, of course. We can always make things worse.
BT: Your explanation of the metaphors we use to describe pain is something I've never noticed before. Where does the use of weaponry and warfare as metaphorical descriptors of pain originate?
SN:This fact was popularized by Elaine Scarry in The Body in Pain (1985), a book first given to me by Margaret Christakos. But Scarry is careful to mention the discoverer of the phenomenon– she doesn't pass it off as her own finding. Scarry spends the first half of her book showing how pain "unmakes the world" through silencing its sufferers. Her analysis of agency metaphors is, quite frankly, virtuoso. To paraphrase her is to do (ironic) violence to her work. But Scarry also does something much less remarked on by academics: she spends the second half of her book using biblical metaphors to show how pain can be expressed in ways other than the negative! Why the first half gets all the play, I can't really understand. I suppose torture is more interesting nowadays than the boring old bible? But the bible has similar scenes in parts. Oh well.

BT: What are some examples of the changes in language usage that you would like to see in the discussion of pain and the treatment of patients in the medical field?
SN: The change in language is something I can't foresee. I'll leave that to the poets! But I can foresee a willingness to change the way we talk about pain, to acknowledge that a change should come. To move the discussion into narrative is exciting and there are an infinite number of narratives.
It is the second part of your question that particularly excites me at the moment because it is a point that is new to me in its practical application. I read books, lots of them, and think about them in terms of pain. But the "end point" of reading those books is not immediately apparent on other people. In my own medical practice, I routinely summarize information so that a patient's information is placed into a narrative. I say "my" version, and it's presented as only a version; the patient adjusts it as they feel necessary, but I adjust back if I think it's necessary. We talk about things, essentially; and in our talking, we discover what's really happened, and what might continue to happen, and what might be changed. Yet this is an individual initiative in two small examining rooms that I haven't tried to measure in any way.
You can imagine my delight when, in the October issue of the Canadian Family Physician, I read a commentary on pain treatment by Dr. Fabian Schwarz, a family doctor practicing in Abbotsford, British Columbia. Fabian advocates for the creation of peer pain consultants, like those personnel used in the mental health and addictions fields. Fabian's trying to bridge a gap between medical management of pain (poor) and patient experience of pain via the intermediary of another person in pain, a person who has contextualized their pain and who possesses a narrative that patients might find themselves in. After attracting some interest from experts in the field, he is starting a pilot study and I'm excited to be part of the narrative medicine element of the initiative. I really do believe that drugs and blocks have their place but the great undiscovered country in pain management is narrative–and that the narrative comes in both written and embodied form.
BT: I think one of the most troubling aspects of chronic pain is not knowing the origin. There's this assumption out there today that we always want a quick fix or cure for whatever problems we have, but something that is often more of a pressing matter for people is finding a cause for your problems. I think this is particularly true for those who suffer from any kind of chronic pain. Strangely enough, it seems it is often the chronic type of pain that is the hardest to diagnose, where patients may go years or even decades without knowing the true source or reason for that pain. When you are given a reason for the pain, you can find a treatment plan that works for you even if a cure is not an option. That gives you a sense of control and empowerment, and allows you to set up a framework around your pain, goals to achieve, things to avoid, etc. But when the cause of that pain is unknown, it can be more debilitating than the pain itself. The idea of narrative as a pain management tool is intriguing, especially because with any narrative there is often a "beginning" or origin so to speak. I guess my question is how do you see "origin of pain" fitting into that narrative for patients who suffer from unknown causes of pain? Can that ultimately be a part of the process, or is that part of the old pathology of pain that needs to be re-structured?
SN: It’s not a mystery that chronic pain is a mystery. For some pains to last, they need to be mysterious! And of all the mysteries of pain, back pain is one of the greatest. Pain is a palimpsest: as we live, what happened long ago becomes enfolded into the present monolithic monochrome. The eternity of being in pain, its timelessness, renders us vulnerable to wishes of origin.
I’m not sure the focus on original injury or cause is necessary unless there is a traumatic component to the injury–either physical or mental–that requires addressing. But in such an instance, the cause is usually obvious. This isn’t the scenario you’re describing in your question. In more cryptic cases, I wonder if looking for cause is worse than a waste of time. I wonder if the search somehow impedes getting better. I’m speaking generally, and of course the right investigations should be done to figure out the cause, but in my view the least important element to the pain narrative of pain is the origin story. I think this holds true for any superhero fan (who cares that Kal-El came from Krypton? Let’s watch him kick some ass!) but also for any sufferer of chronic disease. It holds a certain interest, I suppose, to learn of the exploits of an addict when they were in full flight. It does help us recognize the sufferer as what they are–a sufferer–and perhaps we can identify with them more as we hear the story. But much more interesting, and complex, is to learn of how the recovering addict (to name just one example) stays well. I personally find that much more interesting, and I speak here both as physician and sufferer of a chronic illness.
Thus the search for cause is, for many in pain, excavating an unknowable past whilst succumbing to distraction in the present. What I’m saying right now can degenerate into loaded words like “resiliency” and “functionality,” neither of which I particularly like, but suffice to say that cause/origin needs to be addressed, but once that’s done, it’s time to move on just like narrative moves on. It can be a tragic narrative if that movement doesn’t occur; and I acknowledge that some people can’t move on as I acknowledge that some pains won’t let people move on.
BT: You have a fairly unique perspective in your writing and how you deal with the concept of pain. Not only are you a doctor, but also a scholar and a poet/fiction writer. How does each role or perspective inform the other? Do they ever collide or conflict with each other, or does it merely enhance your understanding of pain and how you write about it?

SH: I think that the scholar/doctor/poet multi-hattedness is a good mix, because:
(a) I want to understand the role pain has played throughout history in terms of health, but also in terms of social policy, religion, economics, etc.
(b) I want to keep honest by never forgetting that people in pain have pain and that it is a “real” thing, not something I “just write about.”
(c) Yet I want to write about pain as a poet. Other than love, I’d say it’s my main subject. The reason is simple (though I still need to work out this idea with Jeffery Donaldson, a professor of poetics at McMaster University): there is a poetics of pain, an aesthetic making into being that both represents experience but also transfers experience into another’s consciousness such that relief, release, or the recognition of mutual wreckage can occur. The mobilization of language for the purpose of expressing pain as poetry requires invention, newness–and I do not think it an exaggeration to say that poets must answer the call of pain and represent it anew, so that the scholars and doctors can study it better. I think we have more than a scholarly and medical deficit: I think we have a deficit of expression, and it’s a vacuum poets were made to fill. So get to work, poets!


Hi Tina, thanks for the comments. I'd be interested to read more on what you have to say, but it looks like there was an issue with the link. A website on where to buy essays pops up instead. Mind trying again?

Well this article is a great food for thoughts. From biological point of view, pain gives us a signal that there is some danger that should be taken care of.
From the point of view of pure philosophy, pain shows us a "difference" so we can understand the value of health and wellfare.
More about it- at nice blog .

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