The Gift of Pain: Why we hurt and what we can do about it

by Philip Yancey and Dr. Paul Brand

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Grand Rapids, MI: Zondervan/HarperCollins 1993, 1997.  340 pp   3 ½ pp Bibliography  US$12.99

This is the heartwarming story of Dr. Paul Brand, son of English missionaries who served in India as an expert in hand surgery (and, by frequent necessity, in general surgery) and in leprosy. Philip Yancey is editor-at-large for Christianity Today.

Brand is one of those rare, deeply compassionate surgeons who has a wonderful gift for observing the human condition and for developing ways to offer his presence as an essential part of his healing ministry. (See also the editorial of Martina Steiger, ThD on presence in this issue of IJHC.)

Brand trained during WWII in London, which served as a helpful preparation for his work in Velore, India – as in both situations doctors often had to do what was required in the situation for the immediate, urgent benefit of the injured and sick – frequently improvising due to limited human and material resources.

Brand was attracted to surgery not for the glory of surgical performances and achievements (although he certainly achieved both), but to improve the lives of the people he helped. He became fascinated with the fact that lepers had deterioration of their limbs to a great extent because of loss of pain sensations. This left them vulnerable to injuries and infections of which they were often totally unaware because they could not feel the warnings pain ordinarily provides – to be gentle and to seek medical or surgical care for the damaged tissues.

Brand developed innovative surgical procedures, but always had to give special attention to the unusual vulnerabilities of the lepers under his care. These required compassionate listening, along with awareness of the psychological and social needs of the lepers, which could easily undermine and counteract the best of surgical methods.

Starting with the awareness of how the lack of pain was a serious, sometimes even fatal liability to the lepers, Brand develops his thesis on how pain contributes to our lives in positive ways.

Here are but a few of the many golden nuggets of medical, surgical and human wisdom Brand shares:

Brand clearly clarifies mechanisms of pain perception that include the peripheral signal set up by nerve stimulations of the body; the nerve impulses that carry the messages; and the brain that interprets the meaning of the signals and messages.

I learned a fundamental distinction: a person who never feels pain is task-oriented, whereas a person who has an intact pain system is self-oriented. The painless person may know by a signal that a certain action is harmful, but if he really wants to, he does it anyway. The pain-sensitive person, no matter how much he wants to do something, will stop for pain, because deep in his psyche he knows that preserving his own self is more significant than anything he might want to do. (p. 195)

The implications of that observation are much more far-reaching than in just addressing the pains of people considering surgical interventions. The same processes apply with pressures on men in Western society to be reasonable, on top of masculine genetic preferences for left-brain, linear thinking and socially acquired preferences for disconnecting from their emotions. As men conform to encouragements to ignore and push through their pains, they are more likely to act in ways that can be harmful. People sensitive to pain are not only aware of preserving their own selves, they are also aware of the importance of preserving the integrity of others.

I have treated patients with acute arthritis who have the same degree of degeneration but respond in opposite ways to the pain it produces. One woman stays in bed all day, clutching the affected hand in genuine agony, and will not even attempt to pick up a pencil. The other says to me, "Yes, my hand hurts. But I'd go crazy just lying around. I've got to work as best I can. After a while, I forget about the pain." Behind these two responses lies a great difference in personality, belief system, confidence, and expectations about health. The "pain-prone" person sees herself as a victim, unfairly cursed. The disorder defines her identity. The second sees herself as a regular human being somewhat slowed down by pain. I have had some arthritis patients who strike me as genuinely heroic about pain. In the morning they slowly force their stiff hands open; it hurts, yes, but the fact that they feel in charge gives them a measure of control that keeps pain from dominating. (p. 280)

Dr. Hans Selye was the true pioneer in discovering the impact of emotions on health…

As Selye summarized his research toward the end of his life, he named vengeance and bitterness as the emotional responses most likely to produce high stress levels in human beings. Conversely, he concluded, gratitude is the single response most nourishing to health. I find myself agreeing with Selye, in part because a grateful appreciation for pain's many benefits has so transformed my own outlook.

People who view pain as the enemy, I have noted, instinctively respond with vengeance or bitterness – Why me? I don't deserve this! It's not fair! – which has the vicious circle effect of making their pain even worse… (p. 222)

I also give Brand top marks for his wonderful ways of encouraging people to employ all of their capacities to bring about healing in their lives. These also include social supports – which are much more commonly present in India.

Where this book is a bit dated is in its stopping short of understanding that physical pain is often a message about the disharmonies in a person's life. When these pains are addressed, the physical pains often clear. (This is well illustrated in the article in this issue of IJHC by Patsy Anthony-Green on clearing the pain of severe cartilage degeneration in her knee by using Emotional Freedom Techniques; and also illustrated in WHEE: Whole Health – Easily and Effectively, www.paintap.com.) An index would also have been helpful.

The above criticisms are minor, however, relative to the wonderful, heart-felt sharings about Paul Brand's work.

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