Tough as it is, pain has value and purpose! It is curious that people have found that the boundary between pain and pleasure is very tenuous and at times it may even disappear. Certain sexual activity can render pain a bitter-sweet stimulus and spanking, or the deeper level of so-called sado-masochism, for many individuals, is a source of much gratification, however unlikely it seems to those who do not share the bent.

On similar lines, it is simple to observe, though rarely remarked and discussed, that the movements and facial appearance of an individual at the moment of orgasm are virtually identical to someone in great pain. Even the sounds are indistinguishable from those emitted in agony (how much more appropriate to burst into song, for instance, though the idea seems passing silly).

As a doctor I have long found this pain-mockery fascinating but without any real insight into why it should be so. We are missing an understanding here which may be vital. It could be indicative of some aspect of body consciousness that has yet to be decoded and may be very helpful to the management of pain and disease.

If the dividing line between pain and pleasure is so slight then it may be possible, in the light of fuller knowledge, to push a suffering patient back over the threshold in the more favorable direction, without losing sight or control of the disease process that has heralded itself.

Blockage

Hippocrates gave us the word “ponos” and from it comes pain. He meant the body’s fight back. Without it there was no disease process but we would quickly die.

The ensuing turmoil may be unpleasant but it is a necessary part of the disease limiting process. We must not lose sight of this important fact, which is constantly being reinvented. The famous surgeon anatomist John Hunter observed almost two centuries ago: “There is a circumstance attending accidental injury which does not belong to disease – namely, that the injury done has in all cases a tendency to produce the disposition and the means of cure”.

The trouble is, if you block symptoms, you block the natural defences too. This can limit the body’s own reckoning with the disease process; it fails to expel the disease properly. Long-term problems then become likely and modern medicine is nothing if not about chronic disease and its management. Have we created our own lingering pathology?

The alternative healers’ view of pain is that it denotes a blocked energy flow. Where natural life force is held back or stopped, then build-ups can occur and sooner or later these announce themselves as pain. A simple example would be a gallstone or kidney stone; these impact in their respective drainage ducts, obstructing all other flow,  and anyone who has experienced the resultant colic will know that there is severe pain indeed, until the blockage is relieved.

It is fashionable, though to me useless, to divide pain into what is supposed to be real pain and what is “in the mind”. The total folly of this view is that all pain is in the mind. Think about this! Pain is just a perception, an interpretation of signals. True there are reflex responses to stimuli that are so fast that the mind could not possibly have time to be involved, at least on the simple neurological model.

But the action (say, withdrawing a hand from a hot surface) is done without any feeling of discomfort whatever. Done quickly enough, there may be no sensation of pain at all, though a fraction of a second longer could have resulted in very unpleasant sensations and the beginning of tissue damage.

The fact is that “pain”, as such, is always centrally organized and perceived. That being so, why bother to distinguish between peripheral pain and that which is felt centrally but without any (apparent) visceral or somatic cause? It is particularly unworthy of doctors to allow the pejorative attitude towards the latter, while supposing the former is the only one in need of help and relief. At the end of the day pain is pain. If the patient has it, he or she is distressed. If it is supposedly created in the mind, then this must be for some purpose and it is the physician’s job, no less than in “real” pain, to find the cause and bring relief from suffering.

What could be wrong with a patient, that he or she wants to fake something as awful as pain to get attention?

Emotional Pain

Well, I wrote these words back in 1995. But there is another aspect to this wisdom, which I’m sharing here. It comes from a forthcoming book.

In the ensuing misery after my first wife left, it occurred to me that exactly the same principle applied to emotional health: that blocked flow would, sooner or later, lead to great pain.

I am thinking especially of a blocked communication flow. If you don’t talk and work things out, sooner or later the pain switches on. When it does, it can be very severe and hurtful. This mirrors exactly what happens when a stone gets stuck in the bile duct. It’s agony!

There may be temporary discomfort, during the process of communicating about difficult matters. Unpleasant words may hurt for a time, though not if you properly observe my Gentlepersons’ Guide To Good Behavior. But by taking the longer term view, keeping communication flowing will ultimately spare you the greater pain.

Let’s take a fictional example, from a well-known and much-loved Jane Austen story: Pride and Prejudice. Mr. D’Arcy is haughty and aloof. Yet he finds himself falling in love with a lady from far below his social status (miss Elizabeth Bennett). The comical and moving story centers around his inability to articulate his desire for Elizabeth , which he keeps bottled up for almost the entire story.

She in turn mistakes his taciturn reserve for pride and arrogance. So she pretty soon learns to despise D’Arcy. The clever weaving of the story creates huge tension for readers or viewers, since we are kept guessing. But finally, after much soul-searching, D’Arcy decides “it will not do” and he storms into the room with Elizabeth and declares his profound love.

Jane Austen still does not allow us to sympathize with him, but portrays him as an insensitive oaf. Elizabeth soundly rejects him with crushing words and D’Arcy exits in great pain and humiliation. They are finally reconciled and it emerges that D’Arcy is the least arrogant person in his circle but he is ruinously reserved, almost shy. The lovers are united and the greatest love story ever told comes to a wonderful and satisfying conclusion.

But I’m not here to fill in the story line; just make the point that if you don’t say it early on, it will sooner or later accumulate force that makes it very unpleasant and painful indeed. You could say that of most marriage break ups: they are horrendously cruel and hurtful but if communication had been kept going, there may never have been a break up.

Better the short-term awkwardness than long-term misery.

Remember that and keep communication flowing, as if it were juice in a channel and blocking it would build up pressure till something bursts. Because—indeed—that’s exactly what will happen!