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CHAPTER XV
PAIN

Pain is one of the very hard things of life which most people find it extremely difficult to bear with equanimity. I suppose that the majority of human beings, especially when they are young, do not feel nearly so much dread of death as they do of the possibility of years of discomfort preceding it or even a short period of very acute pain when nature is preparing for dissolution. Older folks learn to bear physical pain better and come to appreciate how much harder to stand is mental anguish. Modern life, with its cultivation of comforts and conveniences and the elimination of discomforts of all kinds, has greatly fostered the dread of pain. We hear much of the progress of humanity founded on the increase of comfort, but that way lies degeneracy and failure to take life seriously. Human character develops under the stress of pain and even the body acquires self-control through it and is trained under the discipline of pain not to react so disturbingly as is the case when there has been no experience with it or but very little.

We find it almost impossible to understand, now that we have cultivated the comforts of life so sedulously, how men and women stood the discomforts to which they were subjected in the ordinary run of life practically every day two generations ago. A great many of them slept in little stuffy attics with scarcely any chance for the free movement of air on the hot days of summer, often immediately underneath a roof which had been exposed to the direct rays of the sun all day long. In the winter not infrequently they broke the ice in their pitchers to secure water for washing. Their heating arrangements were so imperfect that in the colder months at least there was very little possibility of comfort. A grate fire makes a very charming ornamental addition to a room which is heated by steam or some other modern heating arrangement, but when it is the only means of heating it is not very efficacious except in milder weather. On very cold days an open fire will heat one side of the individual, but not the whole person, and at best the feet are likely to be cold because the open fire must be fed with an abundance of air and the draft runs along the floor in order to get to it. The story is told of an English public school in the old days where the head master met one of the smaller boys crying because of the cold; on being told what was the matter, the head master simply remarked that "this was no young ladies' seminary, and young gentlemen are expected to stand things without tears." Twenty years later in India, during the Mutiny, just before that boy who had cried from the cold led a forlorn hope of a charge with the idea of saving the lives of women and children, he remarked to his commanding officer who was himself also from that same public school, "This is what old… "—naming the head master—"would have said is no young ladies' seminary." And then he went out without more ado to accept death in a great cause.

It is extremely difficult for us to understand how the people of the older time, young and old, endured all these trials and hardships, though it is not difficult to comprehend that if one were exercised daily in standing things of this kind it would be much easier to bear pain and even serious discomfort than it is at the present time, when many people can bear only the touch of silk on the skin and the sybarite's complaint of his utter inability to sleep because there was a crushed rose leaf underneath him has become almost a literal reality. More and more we are eliminating discomforts from life and making things as comfortable and easy as possible. From the carefully tempered water of the morning bath to the warm foot bath just before sleep, in a bedroom where the temperature makes it possible to undress for bed without a shiver, all is arranged for the avoidance of the slightest discomfort.

Pain has become a veritable nightmare to most people as a consequence of the lack of the necessity to stand things in life, and it is therefore all the more interesting to see what an effect religion can have in enabling people to stand pain. In my volume "Health through Will Power" I have told the story of the second last General of the Jesuits and the very serious and intensely painful operation which he insisted on standing without an anaesthetic. The story is worth repeating here as showing what a habit of prayer and practice of self-control can do for a man in the face of some of the severest pain a human being is asked to stand. Generals of the Jesuits have usually found their way into literature for very different reasons from this.

He had developed a sarcoma of his upper arm and was advised to submit to an amputation at the shoulder joint. As he was well on in the sixties the operation presented an extremely serious problem. The surgeons suggested that he should be ready for the anaesthetic at a given hour the next morning and then they would proceed to operate. He replied that he would be ready for the operation at the time appointed, but that he would not take an anaesthetic. They argued with him that it would be quite impossible for him to stand unanaesthetized the elaborate cutting and dissection necessary to complete an operation of this kind in a most important part of the body, where large nerves and arteries would have to be cut through and where the slightest disturbance on the part of the patient might easily lead to serious or even fatal results. Above all, he could not hope to stand the exaggerated pain that would surely be produced in the tissues rendered more sensitive than normal by the increased circulation to the part, due to the growth of the tumor.

He insisted, however, that he would not take an anaesthetic, for surely here seemed a chance to welcome suffering voluntarily as his Lord and Master had done. I believe that the head surgeon said at first that he would not operate. He felt sure that the operation would have to be interrupted after it had been begun, because the patient would not be able to stand the pain, and there would then be the danger from bleeding as well as from infection which might occur as the result of the delay. The General of the Jesuits, however, was so calm and firm that at last it was determined to permit him at least to try to stand it.

The event was most interesting. The patient not only underwent the operation without a murmur, but absolutely without wincing. The surgeon who performed the operation said afterwards, "It was like cutting wax and not human flesh, so far as any reaction was concerned, though of course it bled very freely."

Professor William James has noted this same power with regard to that most painful of all diseases in which pain seems so much harder to stand because it is hopeless, and there is no possibility that the endurance of it can lead eventually to any improvement. The patient must just stand being racked to pieces until the end comes. No wonder then that the professor of psychology should note with commendation the effect of religion in bringing about a sense of well-being in spite of the constantly progressive physical condition which was so painfully eating life away. He said:

"The most genuinely saintly person I have ever known is a friend of mine now suffering from cancer of the breast—I hope that she may pardon my citing her here as an example of what ideas can do. Her ideas have kept her a practically well woman for months after she should have given up and gone to bed. They have annulled all pain and weakness and given her a cheerful active life, unusually beneficent to others to whom she has afforded help. Her doctors, acquiescing in results they could not understand, have had the good sense to let her go her own way."

Many physicians, I am sure, have had the opportunity to witness instances very like that which is thus recorded with whole-hearted sympathy by Professor James. I count it as one of the precious privileges of life to have known rather well a distinguished professor of anatomy at Professor James' own university. He suffered from incurable cancer and two years before the end knew that nothing could be done for him and that it was just a question of time and pain and the most poignant discomfort until the end would come. He continued his lessons at the university; he finished up a book that he had long wished to write and had begun several times; he maintained his simple, social relations with friends in such a gracious spirit that none of them suspected his condition and continued until the very end bravely to go on with his work quite as if there were nothing the matter.

I shall never forget how shocked I was when I once presumed to invite an addition to his labors by asking him to make a public address, and he told me, as a brother physician, just how much he had to be in the trained nurse's hands every day so as to keep himself from being offensive to others. I had met him at lunch in the bosom of his family and spent several pleasant hours with him afterward without ever a thought of the possibility of the hideous malignant neoplasm which was constantly at work making a wreck of his tissues and which no one knew better than he would never be appeased with less than his death.

He himself would have said that whatever there was of courage in his conduct was due to the strength that came to him from prayer. It was his consolation and the sources of the energy which enabled him to stand not only the pain he had to suffer but to suppress any manifestations with regard to it and keep on with his work.

There is an impression in many minds that as time goes on and medicine and surgery advance and science scores further triumphs, pain and ill health generally will decrease, and there will not be nearly so much necessity for standing pain as there is even at the present time. Besides, it is thought that the discovery of new modes of stilling pain will still further eliminate the necessity for patience. As a matter of fact, all our advance in hygiene and sanitation and scientific medicine has served rather to increase than lessen the amount of pain. People now live longer than they used to. They live on to die of the degenerative diseases which are slow running and often involve a great deal of pain over a prolonged period. One reason, probably the most important one, for the great increase of the number of deaths from cancer in recent years is the fact that ever so many more people now live on to the cancer age than before. Every year beyond forty which a human being lives increases the liability of death from cancer in that individual. There are some enthusiasts in the field of medicine who are inclined to think that we may discover the cause of cancer and eliminate the disease, but after a generation of special effort in that direction with absolutely no hopeful outlook, this is at least a dubious prospect. Indeed, there are many good authorities on the subject, who are inclined to feel that cancer more often represents an embryologic or developmental defect than almost anything else and that in so far as it does we can scarcely hope ever to eliminate it.

While the death rate from other acute diseases has been decreasing in recent years and especially from the infectious diseases, the mortality from affections of the kidneys, heart and brain has been increasing. Almost needless to say, these affections are practically always chronic, involve definite discomfort when not positively acute suffering, and not infrequently produce bodily states in which people must bear patiently a great deal of discomfort, sometimes for years. When people live beyond middle life they become more and more liable to be affected by these diseases, so that instead of needing less consolation for pain, our generation and the immediately succeeding generations at least are going to need more. It is particularly the people who are stricken with chronic disease who need the consolation afforded by religion, above all when they know that their affection is essentially incurable and that the only absolute relief they can have will come from death.

It is with this as with regard to hospitals and charity. The greater the advance in medicine and the longer people are kept in life, the more need there will be for hospital care and consequently for the exercise of charity in the best sense of that word and also for patience in pain and suffering. In these matters, as with regard to knowledge, science, instead of lessening the need of religion and its influence, is multiplying it. There is not the slightest reason for thinking that a man will ever make here on earth a heaven in which he may be perfectly happy, and even those enthusiastic advocates of modern progress who are inclined to think of the possibility of this set the date of it so far forward in the future, especially since the disillusionizing process of the Great War, that even the fulfillment of their prophecy is not likely to do very much good for our generation or for many subsequent generations. We are going to need the consolations afforded by religion even more than our forefathers did in the past, now that physicians are able to prolong life and yet cannot entirely do away with suffering.

Above all it must not be forgotten that the cult of comfort and convenience and what may well be called the habit of luxury in the modern time has greatly increased sensitiveness to pain. There are two elements that enter into suffering, as we have said in the chapter on that subject. The one is the irritation of a sensitive nerve and the other is the reaction to it in the mind of the sufferer. If, for any reason, the nerve has been rendered insensitive, or the mind put in a condition where it cannot receive the irritation, the subject will not feel the pain. If anything has happened to increase the irritability of a nerve, as happens, for instance, when continued irritation has brought more blood to the part than usual and the affected area is hyperemic and swollen, the pain will be greater because the nerve is more sensitive. If anything happens to make the mind more receptive of pain, and especially if the pain message that comes up along a nerve is diffused over a large part of the brain because there is a concentration of attention on it, then too the pain will be ever so much worse. We are, in various ways, adding to this subjective element of pain and therefore increasing it. We are going to need then all the possible consolation that can be afforded by religious motives.

In an article written for the International Clinics,¹¹ on "Neurotic Discomfort and the Law of Avalanche", I called attention to how much even comparatively mild pains can be increased by concentration of attention.

The law of avalanche is a term employed by Ramón y Cajal to indicate the mode by which very simple sensations at the periphery of the body may be multiplied into an avalanche of sensations within the brain. In a lecture of his for International Clinics¹² Professor Ramon y Cajal said: "Impressions are made upon single cells at the periphery. As the result of the disturbance of the single cell, an ever-increasing number of cells are affected as the nervous impulse travels toward the nerve-center. Finally the nervous impulses reach the brain and are spread over a considerable group of pyramidal cells in the cortex."

In his paragraphs on attention he says that if conscious attention is paid to the sensation a great many other cells throughout the brain become affected by it. It may be that every cell which subtends consciousness will at a given moment of intense attention be tingling from a single sensation. If it is unpleasant, the unpleasantness is multiplied to a very serious degree. The "law of avalanche" has a very large place in disturbing the lives of those people who have much time on their hands to think about themselves and who are always solicitous lest some serious condition should be developing.

Our self-conscious generation, as religious impressions have been diminished in recent years, is making its pains ever so much more difficult to bear than they were before. Paying attention to slight discomfort will quite literally turn it into a veritable torment. Prayer of itself, by distracting the attention, will act in an actual physical manner to reduce the pain, and the habit of prayer could accomplish very much in that direction. The feeling that somehow the pain that is being borne is not merely a useless torment but has a dual beneficial effect in strengthening character and storing up merit for the hereafter, as the religious minded believe, will do a very great deal to make the pain more bearable. As we are not going to have less pain for humanity, and suffering and death are to be always with us, not even the most roseate dreams of medical scientists contemplating their elimination, it is easy to understand how valuable religious motives will continue to be. Meantime physicians have abundance of experience of how much religion can do to make life, even under the most trying circumstances, not only useful for self and others, but even satisfying for those who would otherwise find it an almost intolerable burden.

Probably the most fruitful source of consolation to be found in life is contained in the profound conviction that the Lord and Master said to those who would come after Him that if they would be His disciples they must take up their cross and follow Him. One of the very great books of world literature is "The Imitation of Christ", the keynote of which is contained in its title.

This little book, which has chapters bearing such titles as "That a Man Must not be over Eager about his Affairs" and "That a Man has Nothing Good of Himself" and which suggests "That True Comfort must be Sought in God Alone" and "That All care Should be Cast upon God" and "That Worldly Honor must be Held in Contempt" and "That All Things, however Grievous, are to be Borne for the Sake of Eternal Life" and "That a Man ought to Consider Himself more Worthy of Chastisement than of Consolation", has been the favorite reading of more of the men and women whose opinions are worth while in the world's history than probably any other, with the exception of the Bible itself. It has been placed next to Homer and Dante and Shakespeare among the books which scholars would preserve if, by a cataclysm, all the other books in the world were to be destroyed. When, some years ago, there was a spirited discussion in the English newspapers and magazines as to the ten books which should be selected if one were to be on a desert island for the rest of life with only these ten books for company, the "Imitation of Christ" almost invariably found its way into the list and usually among the first five.

If the little book which emphasizes the pain and suffering of life has come to be looked upon as one of the greatest books of the world, by the very fact of its profound treatment of this subject in lofty poetry, then it is easy to understand the place that pain bears in life. It is at the very heart of it. Nothing so reveals its meaning and makes it so bearable as religion. Just as it is true with regard to suffering, as stated in the chapter on that subject, that the five poets who at long-separated intervals in the world's history dared to take the mystery of suffering in the world for the subject of their poems, made by that very fact the greatest dramatic poetry that has ever been made, so this humble member of the Brethren of the Common Life, Thomas à Kempis, working just as the Renaissance was beginning, and writing the spiritual conferences for "those humble-minded patient teachers and thinkers" as Hamilton Mabie said, "whose devotion and fire of soul for a century and a half made the choice treasures of Italian palaces and convents and universities a common possession along the low-lying shores of the Netherlands", composed what his contemporaries called "ecclesiastical music", and what all subsequent generations have agreed in thinking the most wonderful expression of the significance of life in terms of Christianity that has ever been written.