Pain: The Science of Suffering

  • Patrisck D. Wall
Weidenfeld & Nicolson: 1999. 186pp. £12.99,
Excruciation: Bronzino's sculpture of pain. Credit: CORBIS/BETTMANN

Scientists tend to scorn what they consider ‘popular’. Yet they generally expect the populace to support their work gratefully or, in the case of physicians, to accept their diagnoses and prescriptions credulously. When a venturesome few do write for audiences beyond their cloistered laboratories and clinics, their colleagues' response is likely to be something akin to Samuel Johnson's slur upon a woman's preaching — “It is not done well; but you are surprised to find it done at all.” Still, the truth must be told, whatever the motives for such ventures, even if it may sound curmudgeonly.

The field of pain research has flowered wonderfully in the past 30 years, in both its clinical and scientific facets, and Patrick Wall has been a highly influential figure. As co-founder and enduring co-editor of the journal Pain, and as co-originator of the so-called ‘gate control’ theory of pain (which proposed that nerve cells in the spinal cord could, depending on circumstances, operate like a gate that is either open to or closed against painful input), Wall's achievements are genuine and substantial. As well as speaking to the profession, he has been willing to communicate with a wider public: The Challenge of Pain (Penguin, 1982), for example, which he wrote with his Canadian friend and colleague Ronald Melzack, remains a significant and valuable book. Whatever Wall's intentions, the grandiloquently titled Pain: The Science of Suffering is not that.

Despite its extravagant promise to “explore all we know about the nature and causes of pain”, it is a far simpler and shorter book than that earlier one, and its intended readership is not at all obvious; to a real extent, its contents are merely a rechauffé. It is, to be blunt, an old man's pensées, and is, for all its liberal use of sub-headings, over-discursive, solipsistic and scrappily documented. I am not saying that a ‘popular’ book should be encrusted with footnotes, but it must at least provide some plausible basis for its material. Wall's new work relies too much for my comfort on its author's ‘introspection’, and on dogma and an appeal to the reader's respect for the author's gravitas. The fact that there is a scattering of careless errors (such as his statement that acupuncture “was well known in the West in Elizabethan times, beginning with a textbook ⃛ in 1683”, or the suggestion that the Latin word placebo originated with Chaucer) erodes one's confidence.

Wall's chapter on “The philosophy of pain” is not especially lucid. Many fine minds have, over the centuries, grappled with the plethora of puzzles about pain, and I am certainly not adequate to do them justice: nor, on this evidence, is Wall — his approach being compromised by his dismissal of their efforts as a “confused mess”. He is hostile to mind-body dualists for reasons that are not cogently explained; he is hostile to Catholicism, especially its tradition of valuing suffering which, I suspect, he does not understand; he tells us that he despises something for its triviality, yet trivializes or misrepresents ideas he does not value or appear to comprehend.

He also tells us — in an otherwise interesting chapter on “The placebo response” — that, in one unspecified study, “no personality type was found diagnostic of the placebo responder”, yet only a few lines later he advises, “Avoid pessimists if you are looking for placebo reactors”. He also claims that — apart from a few trivial and serendipitous (but useful) side effects — the pharmaceutical industry has, over the past 50 years, made no advances in pain treatment. Yet in that period, for example, opiates with greater potency but attenuated side effects, and far safer anaesthetic agents, have appeared.

Some of Wall's criticisms of medical education and clinical culture are telling, even if the whole book shows an invalidating Anglo-centricity. He also proposes an interesting (though not wholly convincing) concept of pain as an action-directed experience, and writes, “Pain is then best seen as a needs state, like hunger and thirst, which are terminated by a consummatory act”. Can this be true? At the risk of my sounding Platoesque, and describing pain, not as a consequence of tissue damage but as a quality of the psyche, opposite to pleasure, could much the same not be said of the concatenation of sensory inputs that determine our responses to music or painting? Those sensations, surely, warrant consideration as a special functional category, as Wall insists on exclusively for pain.

So, in the end, we will all do far better to disregard this slight book — which mostly reads as if it had been dictated to a machine — return to The Challenge of Pain and look to Wall's accumulated papers (for all that some colleagues have been sceptical of their content) as a more fitting testament to his achievements.