My Wednesday reflection on service and my recent experience in the ER (from both sides of the curtain) got me thinking about pain.

Simply put my job as a physician can be boiled down to two primary objectives – 1. To treat treat/cure disease, and 2. To alleviate suffering. And, of course, in the application of each of these there is the ever present imperative to “benefit and yet not to harm.” Based on my observations thus far, there are three primary reasons people come to the ER – 1. They come for treatment, 2. They come for reassurance, 3. They come for pain pills.

PAIN PILLS: THE BANE OF AN ER PHYSICIAN’S EXISTENCE

It sucks to feel used, it is no fun to be lied to. It sucks to be in pain, it is no fun to be ignored. And thus the conflict that gets played out hundreds, nay thousands of times in American emergency rooms each day. The classic dilemma of distinguishing between those who are “drug seeking” and those who are in “real pain,” begs any number of questions. Who is to say they are different people? Whose right is it to determine or judge the level of pain another individual is experiencing? Is all pain bad? Does pain always need to be treated? Are narcotics over-used? Are narcotics under-used? Is it a doctor’s job to relieve patients of all pain and at what cost?

These questions and more have led me to a broader reflection on the meaning of pain in our culture. What follows is a collection of scenarios, quotes, and common sayings related to or inspired by pain. I am curious to hear what the topic brings up for you.

• “No pain, no gain.”

• Narcotics: Illegal, Prescribed, Controlled, Addictive, Pain-alleviating, Sleep-inducing, Potentially-lethal, Expected.

• The brand name of prescription narcotics and muscle relaxants are also household names: Vicodin, Percocet, Flexeril.

• Most people I know have been prescribed a narcotic for one reason or another at one point on their life.

• The juxtaposition of a sweating writhing man passing a kidney stone rating his pain at a 6-7/10 and a young woman with a sprained ankle resting comfortably in bed rating it at a 10/10 and demanding narcotics.

• “A lot of people run a race to see who is fastest. I run to see who has the most guts, who can punish himself into an exhausting pace, and then at the end, punish himself even more.” -Prefontaine

• An elderly woman is dying. Her disease causes her severe pain even at rest and makes her feel as though she is suffocating. Morphine could help alleviate both, but she refusing saying, “I don’t want to get addicted.”

• The husband of a young woman with chronic headaches threatens to kill an ER physician for not giving his wife more Dilaudid stating,”You are obligated to treat her pain.”

• “Cutters” – inflicting physical pain on themselves to relieve existential, emotional, psychological distress.

Merely the body’s messenger of injury and imbalance?

Perhaps a villian to be slayed at all costs?

Or is it a virtue to be endured and even relished?

Discuss.

One of the first things I learned in my intro to phil class freshman year of college is that happiness cannot function as a guide for the formation of an ethical theory. After all, if everyone got what they wanted there certainly wouldn’t be enough left for me! At least that’s a crass way of generalizing the supposed dangers of a schematic as fickle and subjective as happiness. However, this critique of happiness has grown tired. Ethics always boils down to happiness, most theories simply sublimate it.

This begs the question. Why are we so afraid of happiness? Of course, at first glance that seems like a ridiculous question. Our entire culture is one big satisfaction orgy. But that doesn’t change the fact that happiness scares the be-jezus out of good capitalists. Satisfaction should not be confused with happiness, especially not the perpetual (dis)satisfaction of misappropriated desire that is the satisfaction of American capitalism. In our culture satisfaction functions as both a fetish and a salve. On the one hand it is that little magic charm that empowers you to go through with the disgusting act that you wouldn’t be able to complete otherwise. On the other, it serves as a recovery from the dissonance of a fetish driven lifestyle.

Capitalism (as a sociological phenomenon) is founded on the faux axiom that there is a fundamental lack in human being that cannot be solved through living, only through accessorizing. That’s why we trade our time for capital. That’s why we trade our capital for products. That’s why products are always recycled for new products. We have become convinced that our existential lack is not only innate, but that it can only be addressed through prosthetic.

I can’t help but wonder if we’ve got the story wrong. What if we’re not mis-shapen? What if our culture is? How does that change the way we address our dissatisfaction?

To put it into a metaphor: are we happier if we live in a human shaped culture as opposed to a culture fashioned around capital? Let’s take it a step further and put it into a literal metaphor: are we happier creatures if we’re living in a human shaped house? I’ll be coming back to this question in future posts because it deserves a bit more unpacking.

After years of working through some of these questions I’ve come to some unpopular conclusions. First, it’s worth talking about what a human being is. I know that some of you will want to say, “But there is no the-human-being.” And you’re right, but that doesn’t mean that there is no the-human-being.

Second, it’s worth taking what we discover about the shape of a human being, chucking parts of our culture that don’t fit the model, and building a culture around what we are. Our current iteration of culture is founded on our supposed lack, hence the accessorizing.

Finally, if we’re honest with ourselves, something as seemingly inconstant as happiness can function as a guide. If we follow it, it can trace the lines of dissonance between the-human-being and the misshapen culture we’ve constructed for ourselves.

To put it ever so simply, we follow our bliss to a new blueprint. So, that leaves several questions that I’ll put to you.

1. what does following look like? how do you do it?

2. what sorts of dissonance do you uncover when you try to live a human shaped life?

3. what edges of the blueprints have you stumbled across?

The Today Show describes her as “47, unemployed, lives alone with her cat and has never had a date or been kissed.”  Her appearance lines up with this stereotypical description.  So, when she walked out on stage the audience snickered and cringed, and apparently had zero expectations.

When she started singing and people realized she actually had a voice, everyone went nuts.  The judges are described as “gaping in disbelief.” The audience went crazy. The internet has been abuzz with talk of the performance.  She has received more than 20 million clicks on YouTube.

I’m intrigued by people’s reaction to her.  It all seems a tad weird to me.  Don’t get me wrong—she really does have an amazing voice.  It’s nice that people are taking notice of her talent.   She should certainly be recognized for her abilities.  But why are people so touched and surprised? Why so shocked? Because someone who doesn’t look like a model actually has talent?

Doesn’t it seem a little insulting? What does this say about our society?  About the music world? I might be wrong about this, but I imagine if she were younger and better looking the internet wouldn’t be buzzing quite so much.

On the other hand, I’m intrigued by the extent of many people’s reaction.  Why do so many people say they actually cried while watching the clip? Have our expectations of the art/entertainment world become cynical, even resigned? Does the recognition of Boyle’s talent provide some momentary relief from the typical, superficial requirements of our culture?

In any case, I hope Boyle will not just serve to give us a touching underdog story, but as a reminder—however brief—that music is an art form, and that artists come in many shapes.

The next thought that struck me was, “holy shit, I wonder if we’re in our own version of the dark ages?” After all, if we were would we even know it? As my mind was racing through the implications of the question, I tried to calm down and see if there was some sort of quasi-object measure of the darkness of a dark age. Unfortunately that didn’t calm me down for very long.

It didn’t calm me down because the measure of darkness that I decided to use as a hermeneutic was forgetfulness. That put me uncomfortably over an ideological picket fence with one picket putting me in a very vulnerable situation. In other words, the implications of forgetting as a measure for the darkness of a dark age seem directly correllated to the optimism of positivists like Kurzweil. Consider stonyhill’s recent post on our own blog. He and I have conversed quite a bit about what it might mean to be able to write down everything–one possibility is that if we can write down everything we can also forget everything.

So, I wonder. Does specialization mean setting up for a dark age? Before we get deeper into that, let me break down the correllation between forgetting and dark ages. Why is forgetting a workable measure? If we look back at our most recent dark age (roughly 1000 years from the 5th to the 15th centuries), we discover a milenium of forgetting. Medicine, agriculture, architecture, philosophy, language, mathematics, science, physiology, astronomy, all forgotten. More than 2000 years ago philosophers in Alexandria understood the circulatory system, the steam engine, argued for a heliocentric solar system, developed the geometry text that was used for the next 1000 years. Most of that knowledge was lost, forgotten, only to be re-discovered in the 18th, 19th, and 20th centuries. As Jackson’s intro to The Fellowship of the Ring says: “Much that should not have been forgotten was lost.”

So, we come to it. What do we know? Of the things in your day to day life, the things that you have to have to survive, how many of them do you understand? I thought about it the other day. I can’t fix my car, my computer, my cell phone. Can’t grow enough food for my family. I don’t know how to make clothes, hunt, couldn’t make tools, or repair a powerstation, or water plant. Don’t know any basic herbs or healing. The vast majority, the vast, vast, vast, majority of what it takes to sustain my day to day life has been written down and forgotten, at least by me.

I’ll ask again. Is this a new dark age? Dark age 2.0? Are we on the front end of an age of momumental forgetfulness?