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No Pain, No Gain

We run from it. We fight it. We beat it back with all we've got. But one expert says we should welcome pain into our lives as a beloved enemy to fully experience pleasure.


The world of suffering has taken some pretty strange turns.

In Washington, President Clinton claims to feel our pain.

In parts of Micronesia and the Amazon Valley, pregnant women break from work for just three hours to give birth--while their husbands lie in bed during and after the delivery, writhing in agony.

And from Seattle, a renowned surgeon who grew up in India reading books by "insect light" (a jar of fireflies) now tours the country as a self-described "lobbyist for pain." Dr. Paul Brand makes the intriguing argument that American society's pursuit of pleasure and attempts to eradicate discomfort actually produce the opposite.

"A double irony is at work," he says: In conquering pain and suffering to a degree unmatched in history, we've inadvertently become less able to cope with it. And by endlessly seeking pleasure, we've bred ever-rising expectations that keep contentment "tantalizingly out of reach."

Brand bolsters this thesis with sometimes bizarre medical cases and anecdotes from a career that spans three continents and half a century. He tosses in quotes from the Bible and a 5th century saint. And he has support from the likes of former surgeon general C. Everett Koop.

He also proposes a paradoxical prescription for the problem--one that might not be welcome in a land where headache-pill ads blanket the airwaves and politicians who urge sacrifice plummet in the polls.

He suggests treating pain as a "beloved enemy."


Brand opens his case--in "The Gift Nobody Wants" (HarperCollins, 1993)--with the story of Tanya, a 4-year-old girl afflicted with a rare disorder known as "congenital indifference to pain." Her left ankle hangs loose from its socket and her hands are riddled with sores, but as he pokes and prods the wounds, she remains "eerily unafraid."

Tanya, he discovers, is unable to feel pain. And unless she can be made to understand the problem and learn to protect herself, things will get worse.

Seven years later, she ends up in an institution with constantly dislocated elbows, fingers worn to stubs and both legs amputated.

She becomes, he says, "an extreme example--a human metaphor . . . of life without pain."

To further illustrate the potential benefits of physical and psychological hardship, Brand points to lessons from foreign cultures.

In World War II London, for instance, where he served his medical internship, German bombers pounded the city mercilessly. "Yet I have never lived among people so buoyant," he reports, adding that a recent poll found "60% of Londoners who lived through the Blitz remember it as the happiest period of their lives."

In India, too, "a land of poverty and omnipresent suffering," pain was "borne with dignity and calm acceptance." It was also there that Brand revolutionized the treatment of leprosy by discovering that its victims lost their fingers and toes not because the disease ate their flesh but because it deadened their ability to sense pain and left them, like Tanya, oblivious to injury.

Brand stayed in India nearly two decades, working as a missionary physician. Then he came to the United States, where "pain" is a four-letter word and pain relief is a $63-billion-a-year industry. Here, patients lived "at a greater comfort level than any I had previously treated, but they seemed far less equipped to handle suffering and far more traumatized by it," he says.

In the U.S., Brand also embarked on one of his oddest projects: a five-year, federally funded effort to invent an artificial pain device. The idea was to install electronic sensors inside special gloves and socks to warn people with leprosy or diabetes (which damages nerves in similar fashion) of excessive stress to their hands and feet.

But the scientists involved finally gave up. The $2,000 socks wore out after one or two weeks and the most elaborate glove--a $10,000 tangle of wires and fiber--didn't come close to duplicating the "thousand pain detectors in [a human] fingertip, each calibrated to a threshold specific to that fingertip," Brand says.

"How could we get a mechanical sensor to distinguish between the acceptable pressure of, say, gripping a fork and the unacceptable pressure of gripping a piece of broken glass?"


Today, at age 81, Brand is semiretired, working on his fourth book and lecturing frequently.

The secret to mastering suffering, he tells people, lies in the brain: "What takes place in a person's mind is the most important aspect of pain."

Medical literature is loaded with stories of pain-defying athletes and soldiers. "There is no simple direct relationship between [a] wound per se and the pain experienced," one researcher concluded.

Brand and co-author Philip Yancey cite a number of fascinating cases, including the birth-pang-experiencing husbands of Micronesia and the curious saga of Pavlov's other dog.

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