PAIN AND THE WILL
"That the will is infinite and the execution confined."
_Troilus and Cressida_.
The symptom of disease that humanity dreads the most is pain.
Fortunately, it is also the symptom which is most under the control of
the will, and which can be greatly relieved by being bravely faced
and, to as great an extent as possible, ignored. It requires courage
and usually persistent training to succeed in the relief of severe
pain in this way, but men have done it, and women too, and men and
women _can_ do it, if they really want to, though unfortunately all of
the trend of modern life has been in the opposite direction, of
avoiding pain at whatever cost instead of bravely facing it. The
American Indian, trained from his youth to stand severe pain, scoffed
at even the almost ingeniously diabolical tortures of his enemy
captors. After they had pushed slivers beneath his nails or {113}
slowly crushed the end of a finger, or put salt in long, superficial
wounds that had bared a whole series of sensitive cutaneous nerves, he
has been known to laugh at them, and ask them proudly, without giving
a sign of the pain that he was enduring, whether that was all that
they could do. It was just a question of the human will overcoming
even the worst sensations that the body could send up to the brain and
deliberately refusing to permit any reactions that would reveal the
reflex torment that was actually taking place.
The war has done much to bring back the recognition of that
diminution--to a great extent at least--or even almost entire
suppression of pain which may occur, indeed almost constantly does
occur, as a consequence of a man facing it bravely. We have been
accustomed to think of the early martyrs as probably divinely helped
in their power to withstand pain. Whatever of celestial aid they had,
we know that martyrs for all sorts of causes, some of them certainly
not divine, have exhibited some degree of this same steadfastness.
Their behavior makes it reasonably clear that as the result of making
up their minds to stand the pain involved, they have actually suffered
so little that it was not {114} difficult to suppress external
manifestations of their sufferings. It is not merely a suppression of
the reflexes that has occurred but a minimizing to a very striking
degree of the actual sensations felt. We have many stories of the
older time before the modern use of anaesthetics, which tell how
bravely men endured pain and at the same time retained their power to
do things. Indeed, some of them accomplished purposes in the midst of
what would seem like supreme agony which made it very clear that pain
alone has nothing like the prostrating effect that it is often
supposed to have.
For we have well authenticated tales of physicians performing
amputations on themselves at times when no other assistance was
available, and accomplishing the task so well that they recovered
without complications. A blacksmith in the distant West, whose leg had
been crushed by the fall of a huge beam, actually had himself carried
into his shop and amputated his own limb above the knee, searing the
blood vessels with hot irons as he proceeded. Such a manifestation of
will power is, of course, exceptional to a degree, and yet it
illustrates what men can do in the face of conditions that are usually
supposed {115} to be overwhelming. Many a man in lumber camps or in
distant island fisheries or on board fishing vessels, far beyond the
hope of reaching a physician in time for him to be of service, has
done things of this kind. We can be quite sure that the will to
accomplish for himself what seemed necessary to save his life lessened
his pain, made it ever so much more bearable and generally proved the
power of the human will over even these physical manifestations in the
body that are commonly supposed to be quite beyond any interference
from the psychical part of nature. The spirit can still dominate the
flesh, even in matters of pain, and dictate how much it shall be
affected. It is a hard lesson to learn, but it is one that can be
learned by proper persistence.
In the early part of the war particularly many a young man had to face
even serious operations without an anaesthetic. The awful carnage of
the first six weeks of the war had not been anticipated and therefore
there were not sufficient stores of anaesthetics available to permit
of their use in every case. Besides, many operations had to be
performed so close to the front and under such circumstances that
there could not be anaesthetics for all of them; and it was a
never-ending source of {116} surprise to those who witnessed the
details to see how bravely and uncomplainingly the young men took
their enforced suffering. Many a one, when his turn came to be
operated on, quietly asked for a cigarette and then bore unflinchingly
painful manipulations that the surgeon was extremely sorry to have to
inflict. Over and over again, when there was question of the regular
succession of patients, young soldiers in severe pain suggested that
some one else who seemed in worse condition than they, or who perhaps
was not quite so well able to stand pain and control himself, should
be attended to before they were. There is no doubt at all that this
very power of self-control lessened their pain and made it ever so
much easier to bear and less of a torment than it would have been
otherwise.
Any great diversion of mind that turns the attention completely to
something else will lessen even severe pain so much as to make it
quite negligible for the moment. Headaches disappear promptly when
there is an alarm of fire, and toothaches have been known to vanish,
for the time at least, as the result of a burglar scare. Much less
than this is needed, however, and there are many familiar examples
{117} which illustrate the fact that the turning of the attention to
something else will greatly diminish or even abolish pain.
The well known story of the French surgeon about to set a dislocation
is a typical demonstration. His patient was a woman of the nobility,
her dislocation was of the shoulder and it was necessary for him to
inflict very severe pain in order to replace it. Besides, as the
result of the reflex of that pain, he was certain to meet with great
resistance from spasm in the surrounding muscles. It was before the
days of anaesthetics, which relieve all of these inconveniences, and
above all, relax the muscles. The surgeon got ready to do the ultimate
manipulation that would replace the joint in its proper relation, and
necessarily inflicted no little pain in his preparations. The lady
complained very much, so he turned on her angrily, told her that she
must stand it, slapped her in the face, and before she had recovered
from the shock, the dislocation had been restored to the normal
condition. It was rather heroic treatment, and it is to be hoped that
she understood it, but it is easy to understand how much the procedure
lessened her physical pain.
When the mind is very much preoccupied {118} and the will intent on
accomplishing some immediate purpose, even severe pain will not be
felt at all. Instances of this are not rare, and men who are advancing
in a charge on a battlefield will often be wounded rather severely,
and yet continue to advance without knowing anything about their
wounds until a friend calls attention to their bleeding, or they
themselves notice it; or perhaps even loss of blood may make them
faint. The late President Roosevelt furnished a magnificent
illustration of this principle when he was wounded some years ago in
the midst of a political campaign. A crank shot at him, in one of the
Western cities, and though the bullet penetrated four inches of muscle
on his chest wall, and then flattened itself against a rib, he did not
know that he was wounded. The flattening of the bullet must have
represented at least as much force as would be exerted by a heavy blow
on the chest, and yet the Colonel never felt it. His friends
congratulated him on his escape from injury until it was noted that
blood was oozing through a hole that had been made in his coat. The
intense will activity of the President simply kept him from noticing
either the shock or the pain.
{119}
Not long before the war a striking example was given of how a man may
stand suffering in spite of long years of the refining influences of a
sedentary scholarly life, most of it spent indoors. The second last
General of the Jesuits developed a sarcoma on his upper arm and was
advised to submit to an amputation of the arm at the shoulder joint.
He was a man well on in the sixties and 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 suggested, but that he would not take an
anaesthetic. They argued with him that it would be quite impossible
for him to stand unanaesthetized the extensive cutting and dissection
necessary to complete an operation of this kind in an extremely
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 it in tissues that had been rendered
more sensitive than before by the enlarged circulation to the part,
due to {120} the growth of the tumor, and the consequent hyperaemic
condition of most of the tissues through which the cutting would have
to be done and which were thus hypersensitized.
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. The General
of the Jesuits, however, was so calm and firm that at last it was
determined to permit him to try at least to stand it, though most of
the surgeons were sure that he would probably have to give up and
allow himself to be anaesthetized before they were through.
The event then 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."
{121}
The story carries its lesson of the power of a brave man to face even
such awful pain as this and probably actually overcome it to such an
extent that he scarcely felt it, simply because he willed that he
would do so and occupied himself with other thoughts during the
process.
Such an example as that of this General of the Jesuits will seem to
most people a reversion to that mystical attitude of mind of the
medieval period, when somehow or other people were able to stand ever
so much more pain than any one in our time could possibly think of
enduring. We hear of saints of the Middle Ages who inflicted what now
seem hideous self-tortures on themselves and not only bore them
bravely but went about life smiling and doing good to others while
they were under the influence of them. It would seem quite impossible,
however, for people of the modern time to get into any such state of
mind. Our discoveries for the prevention of pain have made it
unnecessary to stand much suffering, and as a result mankind would
seem to have lost some if not most of the faculty of standing pain. So
little of truth is there in any such thought that any number of the
young men of the present generation between {122} twenty and thirty,
that is, during the very years when mankind most resents pain and
therefore reacts most to it, and by the same token feels it the most,
have shown during this war that they possessed all the old-fashioned
faculty of standing pain without a whimper and thinking of others
while they did it.
Lack of advertence always lessens pain and may even nullify it until
it becomes exceedingly severe. In his little volume, "A Journey around
My Room", Xavier de Maistre dwells particularly on the fact that his
body, when his spirit was wandering, would occasionally pick up the
fire tongs and burn itself before his _alter ego_ could rescue it.
Concentration of attention on some subject that attracts may
neutralize pain and make it utterly unnoticed until physical
consequences develop. Undoubtedly dwelling on pain, anticipating it,
noting the first sensations that occur, multiplies the painful
feeling. The physical reasons for this are to be found in the
increased blood supply consequent upon conscious attention to any
part, which sensitizes the nerves of the area and the added number of
nerve fibers that are at once put into association with the area by
the act of concentration of the attention. These serve to render
sensation {123} much more acute than it would otherwise be. It might
seem impossible to control the attention, but this has been done over
and over again, even in the midst of severe pain, until there is no
doubt that it is quite possible. As for the increase of pain by
deliberate attention, that is so familiar an experience that
practically every one has had it at some time.
The reason for it has become very clear as the result of our
generation's investigations into the constitution of the nervous
system. The central nervous system, instead of being a _continuum_, or
series of nerve elements which are directly connected with each other,
consists of a very large number of separate individual cells which
only make contacts with each other, the nerve impulses flowing over
across the contact. The demonstration of these we owe originally to
Ramon y Cajal, the distinguished Spanish brain anatomist, to whom was
awarded some years ago the Nobel Prize as well as the Prize of the
City of Paris for his researches.
In connection with his surprising discoveries as to the neurons which
make up the brain, he suggested the Law of Avalanche, which would
serve to explain the supersensitiveness of parts to which concentrated
attention is paid. {124} According to this law, pain felt in any small
area of the body may be multiplied very greatly if the sensation from
it is distributed over a considerable part of the brain, as happens
when attention is centered upon it. A pain message that comes from a
localized area of the body disturbs under normal conditions at most a
few thousand cells in the brain, because the area is directly
represented only by these cells. They are connected however by
dendrites and cell branches of various kinds with a great many other
cells in different parts of the brain. A pain message that comes up
will ordinarily produce only disturbance of the directly connected
cells, but it may be transmitted and diffused over a great many of the
cells of the cortex of the brain if the attention is focused strongly
on it. The area at first affected, but a few thousand cells, may
spread to many millions or perhaps even some hundreds of millions of
them, if the centering of attention causes them to be "connected up",
as the electricians say, with the originally affected small group of
cells.
It is just what happens in high mountains when a few stones loosened
somewhere near the top by the wind or by melting processes begin their
course down the mountain side. {125} On the way they disturb ever more
and more of the loose pieces of ice and the shifting snows as well as
the rocks near them, until, gathering force, what was at the beginning
only a minor movement of small particles becomes a dreaded avalanche,
capable not only of sweeping away men in its path but even of
obliterating houses and sometimes of changing the whole face of a
mountain area. Hence the expression suggested by Ramon y Cajal of the
Law of Avalanche for this wide diffusion of sensation, which spreads
from a few thousand to millions or billions of cells, and from a
rather bearable pain becomes intolerable torture, as a consequence of
the brain's complete occupation with it.
Now it is possible for most people, indeed for all who have not some
organic morbid condition, to control this spread of pain beyond its
original connections, provided only they will to do so, refuse to be
ruled by their dreads and proceed to divert attention from the painful
condition to other subjects. Here is why the man who bravely faces
pain actually lessens the amount that he has to bear. There is no pain
in the part affected. That we know, because any interruption of the
nerve tract leading from the affected part to the brain {126}
eliminates the pain. In the same way, the obtunding of the nerve cells
in the cortex by anaesthetics or of the conducting nerve apparatus on
the way to the brain by local anaesthesia, will have a like effect.
Anything then that will interfere with the further conduction of the
pain sensation and the cortical cells directly affected will lessen
the sense of pain, and this is what happens when a man settles himself
firmly to the thought that he will not allow himself to be affected
beyond what is the actual reaction of the nerve tissues to the part.
As a matter of fact, the anticipation of pain due to the dread of it
predisposes the part to be much more sensitive than it was before. We
can all of us readily make experiments which show this very clearly.
Ordinarily we have a stream of sensations flowing up from the surface
of the body to the brain, consequent upon the fact that the skin
surface is touched by garments over most of the body, and that our
nerves of touch respond to their usually rather rough surface. We have
learned to pay no attention to these because we have grown accustomed
to them, though any one who thinks that they are negligible should
witness the writhings of a poor Indian under the stress {127} of being
civilized when he is required to wear a starched shirt for the first
time. Ordinarily Indians have learned to suppress their feelings, but
the shirt with its myriad points of contact, all of them starchily
scraping, usually proves too much for his equanimity, and he wiggles
and twists to such an extent as shows very clearly that he is
extremely uncomfortable. Most people have something of the same
feeling the first day that they change into woolen underclothes after
they have been wearing cotton for months, and the sensation is by no
means easy to bear with equanimity.
Ordinarily from custom and habit in the suppression of feelings we
notice none of these contact sensations with their almost inevitable
itchy and ticklish feelings, though they are constantly there, but we
can reveal them to ourselves by thinking definitely about any part of
the body. Such concentration of attention at once brings that part of
the body above the threshold of consciousness, and we have distinct
feelings there that we did not notice before. If for instance we think
about the big toe on the left foot, immediately our attention is
turned to it and we note sensations in it that were quite unnoticed
before. We can feel the stocking touching any part of it {128} that we
think of. Not only that, but if we concentrate attention on a part
most uncomfortable sensations develop. If anything calls our attention
even to the middle of our backs, we find at once that there is a
distinct sensation there, and this may become so insistent as to
demand relief.
It is well understood now what happens in these cases. As we have
said, the attention given to a part leads to a widening of the minute
blood vessels located there so that the nerve endings to the part are
supplied with more blood and therefore become more sensitive. We know
from experience in cold windy weather that when the cheek is
hyperaemic the drawing of a leaf or even of a piece of paper across it
may produce a very acute painful sensation. Hyperaemia always makes
parts of the body much more sensitive than before. Attention has just
this effect over all the surface of the body, as we can demonstrate to
ourselves. We can actually, though only gradually, make our feet warm
by thinking about them, because the active attention to them sends
more blood to them. The dread of pain then, by concentrating attention
on the part beforehand, actually increases the pain that has to be
suffered and makes the subject {129} ever so much more sensitive.
Sensitiveness is of course dependent on other factors, as for instance
lack of outdoor air and of oxygenization, which actually seems to
hypersensitize people so that even very slight pain becomes extremely
difficult to bear, but the question of attention, which is after all
almost entirely a voluntary matter, has more to do with making pain
harder to bear than anything else.
In the preanaesthetic days, men have been known to sit and watch
calmly an amputation of one of their limbs without wincing and
apparently without undergoing very much pain. Many are the incidents
in history of a favorite general who showed his men how to bear pain
by calmly smoking a cigar while a surgeon amputated an arm or a leg or
performed some other rather important surgery. Pain is after all like
the sense of danger and may be suppressed practically to as great a
degree. Once during the present war, when long columns of soldiers
going to the front had to pass by the open market place of a town that
was being shelled by the Germans, there was danger of the troops
losing something of their morale at this point and of confusion
ensuing. It would have been disturbing both to discipline and the
{130} ordered movement of the troops to divert them by narrower
streets, and the shells, though dangerous, were not falling frequently
and not working serious havoc. Every one knew, however, that the
German gunners had the range, and a shell might land square in the
market place at any time; thus there was a feeling of uneasiness and a
tendency to nervous lack of self-control, with the inevitable
confusion of movement afterwards. One of the French generals ordered
an armchair to be brought out of one of the houses near by, took a
position in the center of the square, with a little wand in his hand,
and calmly joked with the soldiers as they went by about the
temperature of the day mentioning occasionally something about a shell
that happened to strike not far away. According to the story he was an
immense man weighing nearly three hundred pounds, and so provided a
very good-sized target for shells, but he was never touched and,
almost needless to say, the line of soldiers never wavered while their
general sat there joking at the danger.
It is sometimes thought that men in the older, less refined times
could stand pain and suffering generally much better than our
generation which is supposed to have {131} degenerated in that
respect. We have found, however, during the war that the soldiers who
could stand supreme suffering the best were very often those who came
from better-to-do families, who had been subjected to the most highly
refining influences of civilization, but also to that discipline of
the repression of the emotions which is recognized as an important
phase of civilization. Strange as it may seem, the city boys stood the
hardships and the trials of trench life better than the country boys
and not only withstood the physical trials but were calmer under fire
and ever so much less complaining under injury. After all it is what
might be expected, once serious thought is given to the subject, and
yet somehow it comes as a surprise, as if the country boy ought to be
less sensitive,--as indeed he probably is; but he lacks that training
in self-control which enables the city boy to stand suffering.
All our feeling that human nature has degenerated in physical
constitution has been completely contradicted by the reaction of our
young soldiers to camp and trench life. They have gone back to the
lack of comforts and conveniences of the pioneer days and have had to
submit to the outdoor life and the {132} hardships that their pioneer
grandfathers went through and have not failed under them. The boys
have come out of it all demonstrating not only that their courage was
capable of supporting them, but with their physical being bettered by
the conditions and their power to stand suffering revealed in a way
that would scarcely have been believed possible beforehand.
{133}