Tag Archives: metaphor

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Imagination bodies forth the forms of things unknown

The poet’s eye, in fine frenzy rolling,
Doth glance from heaven to earth, from earth to heaven;
And as imagination bodies forth
The forms of things unknown, the poet’s pen
Turns them to shapes and gives to airy nothing
A local habitation and a name.
Such tricks hath strong imagination.                                                                                                                   Theseus, in Shakespeare’s A Midsummer Night’s Dream

Shakespeare had a keen appreciation of the value of imagination, as that quote from A Midsummer Night’s Dream suggests. But what is imagination? Is it a luxury -a chance evolutionary exaptation of some otherwise less essential neural circuit- or a purpose-made system to analyse novel features in the environment? A mechanism for evaluating counterfactuals -the what-ifs?

A quirkier question, perhaps, would be to ask if it might predate language itself -be the framework, the scaffolding upon which words and thoughts are draped. Or is that merely another chicken versus egg conundrum drummed up by an overactive imagination?

I suppose what I’m really asking is why it exists at all. Does poetry or its ilk serve an evolutionary purpose? Do dreams? Does one’s Muse…? All interesting questions for sure, but perhaps the wrong ones with which to begin the quest to understand.

I doubt that there is a specific gene for imagination; it seems to me it may be far more global than could be encompassed by one set of genetic instructions. In what we would consider proto-humans it may have involved more primitive components: such non-linguistic features as emotion -fear, elation, confusion- but also encompassed bodily responses to external stimuli: a moving tickle in that interregnum between sleep and wakefulness might have been interpreted as spider and generated a muscular reaction whether or not there was an actual creature crawling on the skin.

Imagination, in other words, may not be an all-or-nothing feature unique to Homo sapiens. It may be a series of  adaptations to the exigencies of life that eventuated in what we would currently recognize as our human creativity.

I have to say, it’s interesting what you can find if you keep your mind, as well as your eyes, open. I wasn’t actively searching for an essay on imagination -although perhaps on some level, I was… At any rate, on whatever level, I happened upon an essay by Stephen T Asma, a professor of philosophy at Columbia College in Chicago and his approach fascinated me. https://aeon.co/essays/imagination-is-such-an-ancient-ability-it-might-precede-language

‘Imagination is intrinsic to our inner lives. You could even say that it makes up a ‘second universe’ inside our heads. We invent animals and events that don’t exist, we rerun history with alternative outcomes, we envision social and moral utopias, we revel in fantasy art, and we meditate both on what we could have been and on what we might become… We should think of the imagination as an archaeologist might think about a rich dig site, with layers of capacities, overlaid with one another. It emerges slowly over vast stretches of time, a punctuated equilibrium process that builds upon our shared animal inheritance.’

Interestingly, many archaeologists seem to conflate the emergence of imagination with the appearance of artistic endeavours –‘premised on the relatively late appearance of cave art in the Upper Paleolithic period (c38,000 years ago)… [and] that imagination evolves late, after language, and the cave paintings are a sign of modern minds at work.’

Asma, sees the sequence rather differently, however: ‘Thinking and communicating are vastly improved by language, it is true. But ‘thinking with imagery’ and even ‘thinking with the body’ must have preceded language by hundreds of thousands of years. It is part of our mammalian inheritance to read, store and retrieve emotionally coded representations of the world, and we do this via conditioned associations, not propositional coding.’

Further, Asma supposes that ‘Animals appear to use images (visual, auditory, olfactory memories) to navigate novel territories and problems. For early humans, a kind of cognitive gap opened up between stimulus and response – a gap that created the possibility of having multiple responses to a perception, rather than one immediate response. This gap was crucial for the imagination: it created an inner space in our minds. The next step was that early human brains began to generate information, rather than merely record and process it – we began to create representations of things that never were but might be.’ I love his idea of a ‘cognitive gap’. It imagines (sorry) a cognitive area where something novel could be developed and improved over time.

I’m not sure that I totally understand all of the evidence he cites to bolster his contention, though- for example, the view of philosopher Mark Johnson at the University of Oregon that there are ‘deep embodied metaphorical structures within language itself, and meaning is rooted in the body (not the head).’ Although, ‘Rather than being based in words, meaning stems from the actions associated with a perception or image. Even when seemingly neutral lexical terms are processed by our brains, we find a deeper simulation system of images.’ But at any rate, Asma summarizes his own thoughts more concisely, I think: ‘The imagination, then, is a layer of mind above purely behaviourist stimulus-and-response, but below linguistic metaphors and propositional meaning.’

In other words, you don’t need to have language for imagination. But the discipline of biosemantics tries to envisage how it might have developed in other animals. ‘[Primates] have a kind of task grammar for doing complex series of actions, such as processing inedible plants into edible food. Gorillas, for example, eat stinging nettles only after an elaborate harvesting and leave-folding [sic] sequence, otherwise their mouths will be lacerated by the many barbs. This is a level of problem-solving that seeks smarter moves (and ‘banks’ successes and failures) between the body and the environment. This kind of motor sequencing might be the first level of improvisational and imaginative grammar. Images and behaviour sequences could be rearranged in the mind via the task grammar, long before language emerged. Only much later did we start thinking with linguistic symbols. While increasingly abstract symbols – such as words – intensified the decoupling of representations and simulations from immediate experience, they created and carried meaning by triggering ancient embodied systems (such as emotions) in the storytellers and story audiences.’ So, as a result, ‘The imaginative musician, dancer, athlete or engineer is drawing directly on the prelinguistic reservoir of meaning.’

Imagination has been lauded as a generator of progress, and derided as idle speculation throughout our tumultuous history, but there’s no denying its power: ‘The imagination – whether pictorial or later linguistic – is especially good at emotional communication, and this might have evolved because emotional information drives action and shapes adaptive behaviour. We have to remember that the imagination itself started as an adaptation in a hostile world, among social primates, so perhaps it is not surprising that a good storyteller, painter or singer can manipulate my internal second universe by triggering counterfactual images and events in my mind that carry an intense emotional charge.’

Without imagination, we cannot hope to appreciate the Shakespeare who also wrote, in his play Richard III:

Princes have but their titles for their glories,                                                                                                      An outward honor for an inward toil,                                                                                                                And, for unfelt imaginations,                                                                                                                                They often feel a world of restless cares.

Personally, I cannot even imagine a world where imagination doesn’t play such a crucial role… Or can I…?

 

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Lying down in green pastures

I suppose I should admit something from the start: I’m not particularly religious, and I certainly do not have anything but the most superficial knowledge of Biblical writing. Still, I have come to appreciate the glory of metaphor and how it is able to transmute otherwise ineffable concepts into words. Feelings. Poetry, of course, aspires to that, but so do many of the texts in the Bible -especially the in ‘Old Testament’, apparently.

And yet, except for a very few of the more memorable lines I was taught in Sunday school as a child -parts of Psalm 23 spring to mind- I can’t say I was ever able to differentiate the poetry from the -what?- commands: the instructive reverence with which I was intended to regard the message. But, it seems to me that by its very nature, poetry, through metaphor, simile, and even word play would be particularly helpful for some of the ideas the Bible is trying to describe -things like lamentations, or hymns of praise where it would make sense to draw on the emotive powers of poetry to make a point.

In my adult years, on those rare occasions when the subject of biblical poetry has arisen, I have usually attributed my wonted tone-deafness to translational problems. Cross cultural, not to mention cross-temporal issues mean that some figures of speech, or clever puns in the original language do not have much chance of making the same impact on us as they would have on the recipients when and where they were originally composed.

Even nowadays, the European poems of Schiller (German), or Baudelaire (French), for example, are difficult to translate into English and preserve their same emotional intensity -and they were written as recently as the 18th and 19th centuries, respectively. Imagine the difficulty of attempting to render the writings of people living more than 2000 years ago into meaningful word-pictures that would resonate in today’s modern world. And, given the sacred nature of the Bible, any attempt to change the wording, or render the sentences into something like their original poetry, risks immediate condemnation.

The very idea that someone was willing to take the risk intrigued me. It would require impeccable credentials in ancient Hebrew with an equivalent temporal knowledge of the customs and literary devices used so long ago -and an ability to maintain the intended meaning without trivializing the message.

Of course, I have no way of knowing how well any translational skills succeeded in walking that  obviously difficult path, but some of the word-play involved in the effort was explained in an article in Aeon by Robert Alter, a professor of Hebrew and comparative literature at the University of California at Berkeley: https://aeon.co/ideas/how-translation-obscured-the-music-and-wordplay-of-the-bible

‘An essential fact about the Hebrew Bible is that most of its narrative prose as well as its poetry manifests a high order of sophisticated literary fashioning. This means that any translation that does not attempt to convey at least something of the stylistic brilliance of the original is a betrayal of it, and such has been the case of all the English versions done by committee in the modern period.’ True, the Hebrew Bible is basically a religious text, and yet, ‘If a translation fails to get much of its music across, it also blurs or even misrepresents the depth and complexity of the monotheistic vision of God, history, the realm of morality, and humankind.’

So how, after millennia, can one ever hope to express this language from the depths of time into relevant, let alone evocative English phrases? The accuracy of the message is one thing, of course, but conveying it in anything like the clever style of the original so the reader can still appreciate the poetry is another. ‘One small but telltale manifestation of the artistry practised by the biblical writers is their fondness for meaningful word play and sound play.’ However, ‘translation… entails a long series of compromises because full equivalence is rarely an option.’

For example, ‘The prophet Isaiah, like any great poet, commands a variety of formal tools – powerful rhythms, striking imagery, pointed literary allusions (in his case, to earlier biblical texts). Isaiah is particularly fond of sound play that verges on punning. In order to convey with force the perversion of values in the kingdom of Judah, he often juxtaposes two words that sound rather alike but are opposite in meaning… The Hebrew writers repeatedly revelled in the expressive possibilities of their medium, working inventively and sometimes surprisingly in their stories and poems with rhythm, significant repetition, narrative point of view, imagery, shifts in diction, the bending of language in dialogue to represent actual speech or the nature and location of the speaker.’

The article offers a few examples of Alter’s clever compromises to restore the music of the text, but I suspect it is intended more as a kind of a proof-of-concept than as a detailed slog through each Biblical book and chapter; it was both tantalizing and yet mercifully short. Still, it was enough to alert me to the things I never appreciated in my Protestant Sunday school. In fact, I don’t recall them ever mentioning anything about Biblical writing styles -it was the message they were trying desperately to inculcate in our young minds, I suppose.

But lest readers of my humble feuilleton suspect that in these penultimate years I am finally succumbing to Pascal’s wager and conceding that even though the existence of God may be unlikely -and at any rate unprovable-  and that the potential benefits of belief far outweigh shuffling off unshriven, let me assure them that any quest for hidden beauty need not involve ulterior motives. In the words of the poet Kahlil Gibran, Beauty is life when life unveils her holy face.

Sometimes it’s enough to know what one’s education may have missed without having to read the whole of Tolstoy’s War and Peace. No, Alter stirred my interest enough to allow me to finish his essay, but, sadly, not enough to make me want to retrain as a biblical scholar. I’m happy the Bible is poetic, but not, well, overjoyed, or anything…

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What is the Merit of Originality?

‘I am not young enough to know everything,’ as Oscar Wilde once said, and maybe the rest of us aren’t either. It is often an unquestioned assumption that New trumps Old, that innovation usually leads to improvement, and that by standing on the shoulders of giants, the view is necessarily better. Clearer.

But there is wisdom in both the long as well as the panoramic views. Neither changing  your shoes nor altering your hat, really improves the safety of a voyage -nor does it address the original goal of a safe arrival of everybody on board. Appearing modern, seeming prepared, only helps if it helps –a leak is still a leak, especially if there are only lifeboats for a few…

Let me explain. I happened upon an article in the journal Nature that chronicled the introduction of a new, and highly accurate method of diagnosing TB through genetic analysis.  https://www.nature.com/news/improved-diagnostics-fail-to-halt-the-rise-of-tuberculosis-1.23000?WT ‘The World Health Organization (WHO), promptly endorsed the test, called GeneXpert, and promoted its roll-out around the globe to replace a microscope-based test that missed half of all cases.’ It sounded like a perfect technological fix for a disease that has so far avoided effective control. ‘Some 10.4 million people were infected with TB last year, according to a WHO report published on 30 October [2016?]. More than half of the cases occurred in China, India, Indonesia, Pakistan and the Philippines. The infection, which causes coughing, weight loss and chest pain, often goes undiagnosed for months or years, spurring transmission.’

Unfortunately, ‘[…] the high hopes have since crashed as rates of tuberculosis rates have not fallen dramatically, and nations are now looking to address the problems that cause so many TB cases to be missed and the difficulties in treating those who are diagnosed. […] The tale is a familiar one in global health care: a solution that seems extraordinarily promising in the lab or clinical trials falters when deployed in the struggling health-care systems of developing and middle-income countries. “What GeneXpert has taught us in TB is that inserting one new tool into a system that isn’t working overall is not going to by itself be a game changer. We need more investment in health systems,” says Erica Lessem, deputy executive director at the Treatment Action Group, an activist organization in New York City.’

But I mean, just think about it for a minute. ‘The machines cost $17,000 each and require constant electricity and air-conditioning — infrastructure that is not widely available in the TB clinics of countries with a high incidence of the disease, requiring the machines to be placed in central facilities.’ Sure, various groups agreed to subsidize the tests in 2012, but: ‘each cost $16.86 (the price fell to $9.98), compared with a few dollars for a microscope TB test.’ So which test would you choose if you were a government strapped for cash to provide for healthcare for a broad spectrum of other equally pressing needs?

‘Even countries that fully embraced GeneXpert are not seeing the returns they had hoped for. After a countrywide roll-out begun in 2011, the test is available for all suspected TB cases in South Africa. But a randomized clinical trial conducted in 2015 during the roll-out found that people diagnosed using GeneXpert were just as likely to die from TB as those diagnosed at labs still using the microscope test.’ That seems counterintuitive to say the least.

So what might be happening? ‘Churchyard [a physician specializing in TB at the Aurum Institute in Johannesburg, South Africa] suspects that doctors have been giving people with TB-like symptoms drugs, even if their microscope test was negative or missing, and that this helps to explain why his team found no benefit from implementing the GeneXpert test. Others have speculated that, by being involved in a clinical trial, patients in both arms of the trial received better care than they would otherwise have done, obfuscating any differences between the groups.’

‘Even with accurate tests, cases are still being missed. Results from the GeneXpert tests take just as long to deliver as microscope tests, and many people never return to the clinic to get their results and drugs; those who begin antibiotics often do not complete the regimen.’ Clearly, technology alone, without an adequate infrastructure to support it –without a properly funded and administered health care system- is not sufficient.

And it’s simply not enough to have even a well-funded health system that benefits just those who can afford it, leaving the rest of the population to fend for itself, and only seeking help when they can no longer cope –often when it is too late. Health care is a right, not a privilege –no matter what those in power would have us believe.

I’m certainly not arguing that improving technology is not part of the solution, but sometimes I wonder if it is merely putting new clothes on a beggar. Handing out flowers in a slum.

Let’s face it, real Health Care is more than a sign on a door, more than a few people in white coats. It is a kind of national empathy. A recognition that even the poorest among us, have something valuable to contribute; that even those who have strayed from society’s chosen path, are who any of us might be, but in different clothes.

The myth of Baucis and Philemon tugs at my memory: They were an old married couple living in a small village in Anatolia (part of Asian Turkey nowadays) who, unlike everyone else in the town, welcomed two peasants at their door who were seeking refuge for the night. The couple, of course, were unaware that they were actually welcoming two gods, Zeus and Hermes, disguised as humans. A common enough trope, perhaps, but an instructive one, I think -one that transcends virtually all cultures, and borders: the idea of helping others without any expectation of reward. It is not an exchange -a transaction- so much as an action. Agape, in fact.

Health care is like that. Or should be… It’s not about the glittering display in the shop window –there to impress the passersby- it’s about the people in the shop.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Trippingly on the Tongue

I’ve always liked the poetry of metaphor with its imagery revealing nuances hiding shyly in the background. Words alone sometimes convey their meanings too narrowly, whereas metaphors allow imagination to roam more freely, only loosely tethered to definitions. After all, depending on the context of its use, meaning is often reliant on Weltanschauung. Such is communication; language is only the messenger.

Usually one can imprison meaning, of course -confine it in a cramped little box from which, should it ever escape, it would cease to be useful. Indeed, it would be a Pandora’s box from which it escaped. And yet, even there, what remained inside after all the mischief and malevolence had escaped, was Hope. Maybe that’s what metaphors are: unexpected colours leaking from behind the bars… Liberations.

Of course, metaphor is value-laden as well as culture-dependent. One society’s metaphors do not always translate into that of another -hence the difficulty of truly understanding and appreciating the poetry of another nation, especially if it must be converted into a different language. It made me wonder whether there may be similar disparities with gendered interpretations of metaphor.

There was an interesting article in BBC Future a while ago that caught my eye: http://www.bbc.com/future/story/20170718-the-metaphors-that-shape-womens-lives It made me realize that there are many ways the genders differ. Of course, it may be that when we hear an unusual expression for the first time, we (either sex) cling too firmly to denotative -definitional- aspects of the words for interpretational safety, when the more imaginative and unexpected connotative sense is what was intended all along. And it’s in the connotation -the metaphoric significance- where we differ…

For example, what is a ‘glass ceiling’? ‘Originally popularised by Gay Bryant at the height of the feminist movement in the 1980s, it’s a widely used term today that describes an invisible barrier that keeps women from occupying executive positions. The metaphor suggests that women should aspire to ‘break through’ the ceiling – but the problem is that it describes only the women reaching up, rather than, say, the men that are peering down from the top. This arguably places unfair responsibility on women to smash the ceiling, rather than focusing on the role of men in creating and maintaining it.’

There are other metaphors in use of course, often involving glass -presumably to convey the idea of invisible barriers to movement for women. So, the ‘glass cliff’ which depicts the idea of  ‘how senior women are often hired for risky and precarious roles at times of crises’ and therefore making them look bad if they fail to succeed. Or, the non-glass example of the ‘sticky floor’, which describes how women often feel stuck in low-wage jobs where career ascension is unlikely.’ 

But, handy as they are in explaining often complex topics, metaphors -in these contexts anyway- tend to oversimplify the problems ‘offering only a specific angle or viewpoint that isn’t the full picture.’ They confine us to viewing the world through a narrow aperture -a spotlight that illuminates only one small part of the stage. ‘“Women are the effect to be explained,” says Michelle Ryan, a psychology professor at the University of Exeter. “We never talk about men being overconfident, we always talk about women being underconfident. And we never talk about men having privilege or finding it easy; we always talk about women finding it difficult.” Ryan believes that the metaphors we’re using to describe women at work reflect the world’s androcentricism [sic] – our insistence that, even in 2017, we consider the male experience as “the norm”’

The issue is not entirely one-gendered, though. There is the concept of the ‘glass escalator’, a term occasionally applied to men in female-dominated industries that ascend to upper ranks more quickly than women. And yet, as Caren Goldberg of Bowie State University in Maryland points out, metaphors are employed when there is an “exception” to the rule or gender stereotype.’ So in the example she cites, it was applied to a male nurse (in a predominantly female dominated profession at the time) and implied that he probably chose nursing because he wasn’t able to get in to medical school.

‘The obvious upside of any these metaphors, however, is that they highlight social phenomena that might otherwise remain invisible and therefore impossible to resolve. But in order to address the circumstances that lead to women being held back, and men rising seamlessly, it shouldn’t be forgotten that metaphors simplify complexity.’

In an admittedly convoluted way, it reminds me of a woman I met the other day at a bus stop. I suppose I only met her by default, really -nobody would stand beside her because she was exhibiting a rather odd behaviour -probably Tourette’s syndrome, I’d thought at the time. She would be standing quietly at the curb, and then suddenly bend forward and seem to be vigorously cleaning and polishing something above her. This would last for a few seconds, often becoming more and more frantic, and then subside, leaving her once again peaceful, although by the look on her face, perhaps not content.

She was in her thirties, I would guess, and dressed quite respectably in a blue pant-suit, with a spotless white blouse and short stubby earrings that would be unlikely to achieve any unwanted momentum during her seemingly randomly timed tics. Her auburn hair was sensibly short and her makeup intact as far as I could tell. Apart from her odd movements, she seemed like a typical business woman on her way home from work.

And, when she moved beside me in the now-disrupted line up, she smiled apologetically. “I’m sorry, sir,” she said -hurriedly, I thought, in order to explain herself before she was once again overcome by the movement. “It’s just my latest tic…”

At that point and without any obvious warning, she launched into another bout of scrubbing something invisible over her head. I tried to pretend I didn’t notice, but she wasn’t fooled.

“I think stuff at work must have kicked this one off,” she said and then blushed.

“What do you mean?” I asked, genuinely interested.

She stared at me for a moment, perhaps wondering if it was something appropriate to confess to a stranger at a bus stop. Then her smile returned briefly before the tic arrived again.

“They’re all used to me at work,” she explained when she was able to. “But the boss isn’t.” She risked a sigh to indicate her frustration. “I mostly just repeat words to myself so they’re not as disruptive. But occasionally a movement takes over, and that’s what he doesn’t understand… Or like. I think he wonders if I’m actually mentally handicapped, or something.

“Anyway, even though I’ve been working there as an accountant for almost ten years, he’s never promoted me. I’m well regarded by my colleagues, and they’re almost all men…but…”

I could see a sudden change in her face as she leaned over the curb and the tic began again.

“But my friend Amrita thinks it’s just the glass ceiling that’s holding me back,” she said, once again in temporary control. “And yet, I’m not certain that reassures me…”

Her bus pulled up suddenly, and she stepped onto it like any other passenger, and was gone. I saw her smile at me through the window when she found a seat though, and I nodded in a friendly recognition of what she’d shared with me. But, like her, I’m not sure her friend was right -ceilings are not the only battles.

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The Myth of Medicine

The concept of the myth has always intrigued me. Not, as it is historically characterized – the fabulous stories of gods and heroes- or the more populist idea of an untruth or counterfactual, but rather as a metaphor. Myth as a way of explaining something that is difficult to put into words, that defies rational explanation: the meaning behind the meaning. Like those Russian nesting dolls, they are multilayered, with understanding hiding within significance which is in turn hiding under context hiding behind appearance… A myth is the meaning of a flower. It is a poem.

And yet it need not be so abstract, so elusive. All of us have myths: they are our stories –who we are, or at least how we have come to understand ourselves. As the famous Swiss psychiatrist Carl Jung said in his autobiography: Thus it is that I have now undertaken, in my eighty-third year, to tell my personal myth. I suppose the challenge, however, is to disentangle the reality from the fantasy… Or does it really matter? And are they both merely different colours of the same myth? Joseph Campbell, the author of many books about mythology, said: “…the only way you can describe a human being truly, is by describing his imperfections. The perfect human being is uninteresing… Aren’t children lovable because they’re falling down all the time and have little bodies with heads too big?”

We are, for all intents, our mistakes. Our foibles. Our myths. And that which we appear to be, we are not –or at least that may not be how we see ourselves. So, for the doctor, which is the more important –because to treat the person, we have to find them first?

I am reminded of a patient I saw  long ago when I was a freshly washed gynaecologist just setting up my practice in an era of militant feminism. Ms Debrashen –that was her title, she insisted, just like mine was ‘doctor’- was a frail-looking eighty year old but dressed in jeans and a sweat shirt that had I’m Talking to You written in Gothic script on the front. I suppose I should have been intimidated, but her smile was so disarming, I couldn’t help but return it as I greeted her in the waiting room. She extended a bony hand to shake before I could even free my own from her chart, and would have led me  down the hallway to my office if I hadn’t stepped in front of her to make sure she went through the correct door.

“So what can I do for you Mrs. Debrashen?” I said, still smiling, as she plonked herself down on a chair beside my desk.

“Ms Debrashen,” she corrected me, but not unkindly. “I want you to do a pap smear. I haven’t had one in years, and my family doctor refuses to do one on me.” As she said this, she replaced her smile with a flinty stare that brooked no nonsense. I will be obeyed, it said for a moment, and then relaxed into a more Canadian, please. “I don’t know what got into him; I’ve gone to him for years, but he just climbed up onto his doctor horse and said I was too old.” She sighed theatrically and shrugged angrily. “Too old? Too old to be screened for cancer..?” She shook her head in disbelief. “Does he think I’ve lived long enough already?”

I took a carefully disguised deep breath and let it out slowly. Quietly. I decided to start with a thorough history in case there were some extenuating circumstances. Most cancer agencies throughout the world, and certainly the one in my own province here in British Columbia, have said that there is no indication for continuing to do pap smear screening after the age of sixty-nine. Only if there were recent abnormalities in the pap or as a followup to recent treatment for abnormal cells would it be justified. And of course, then it wouldn’t be screening, per se, but followup.

I took what I felt was a complete history and then, as a tactical decision, asked about her pap smear history at the very end. But no, all of her past pap smears were normal, she insisted.

She sat back in her chair, folded her arms across her chest and stared at me with a rather smug but expectant expression on her barely-wrinkled face.

“The Cancer Agency in British Columbia usually recommends not doing any more pap smears after you turn seventy,” I said, rounding it off for simplicity.

A curiously satisfied smile captured her face –as if she were laying a trap for me, but had to be careful not to give it away. “And why is that, doctor?”

“Well…” I started, not totally comfortable explaining to a woman of her age about the increasing belief in those early years of virology, that the abnormalities of the cells of the cervix registered by the pap smears were in fact the result of some sexually transmitted agent.

Her smile turned into a chuckle when she noticed my obvious embarrassment. “We are not always as we appear,” she said, the merriment evident on her face. “We write our own myths, then wear them, you know… Doctors no less than their patients.” I suppose I must have looked puzzled, because she sat back in her chair as if she were settling in to tell me a story. “Both you and I are Matryoshka dolls, and we only unveil the deeper ones when and if it serves our purposes.” She softened the severity of her latest array of smiles. “You are only looking at one of the dolls –the one you expect to see.”

I smiled the tolerant doctor-patient smile, and started to say something, but she waived it away with a flick of her hand.

“You didn’t ask me much about my sexual history, did you?” I think I blushed and she immediately seized upon it. “Too embarrassing, right? And yet had I been twenty or so, you would have jumped on it immediately when I told you I wanted a pap smear.” I didn’t have to answer –she had me. “But despite my age, and my failing eyesight, I can still read…” She pretended to look out of the window behind my desk to ease my discomfort, but I could tell she was actually watching me out of the corner of her eyes. “The current thinking is that abnormal pap smears are the result of sexual transmission, I understand. Like a disease.” She risked at direct glance at my face and when she could see the astonishment on it, she left her eyes resting there. “So, how would you get a new sexual disease, I wonder?” She let her words dangle for a moment to tease me. “I suspect there are only two mechanisms –either my partner is dallying in another realm, or I myself have strayed into a new kingdom.”

I tried to keep my mouth from falling open -I loved her words.

“But suppose I knew all this, but was unwilling, or afraid to share that aspect of my story with you because it didn’t conform to what I have always wanted to believe about who I am? And what you wanted to believe…” She stared at me for a while with innocent cow-eyes. “Or, on your side of the curtain, suppose you didn’t want to risk offending me because it would be like talking back to your grandmother. Belittling her. Disrespecting her…” She straightened herself in the chair as if she were about to get up. “So you see we are both trapped in our stories.” A huge smile spread from ear to ear as she rose to her feet. “But we’re only trapped as long as we don’t recognize them as surfaces. Clothes…”

She pointed at the examining room. “Let’s do the pap smear, now. I’m going to be late for my friends,” she said, and then started for the door, as I still sat immobilized in my chair.

“I was a Social Anthropologist in my previous life,” she said, looking back over her shoulder and winking. “Just thought you’d like to meet one of my deeper dolls…”

 *

I’ve never forgotten Ms Debrashen over the years. She taught me to question assumptions. Interrogate them. But it made me wonder just how much I can know about anybody. Some of those deeper layers are inaccessable even to the person from whom I’m trying to obtain a history. So overlayered with hope and retrospectively altered memories, some are forever hidden in the myths they have become. Perhaps for clearly displayed symptoms and signs, my medicine can work. I can treat a prolapsed uterus, or an elevated blood pressure, but in a way, that is almost like mending a sweater, or washing a shirt. It is hard to see the skin they hide beneath. And I am at a disadvantage peering through the murky water in which they stand to find something they’ve dropped or hidden. …

She made me appreciate the words of Hamlet when he repudiates his mother for insinuating he is pretending grief merely to get attention:

Seems, madam? nay, it is, I know not “seems.” ‘Tis not alone my inky cloak, good mother, Nor customary suits of solemn black, Nor windy suspiration of forc’d breath, No, nor the fruitful river in the eye, Nor the dejected havior of the visage, Together with all forms, moods, shapes of grief, That can denote me truly. These indeed seem, For they are actions that a man might play; But I have that within which passes show, These but the trappings and the suits of woe.

by

The Mystery of Pain

Obstetricians and midwives are, at times, unavoidable witnesses to pain; they wade through it, explain it, try to alleviate it, but never experience it because the physical sensation of pain cannot be transferred to anyone else. It is the one constant attendant in the labour room, the uninvited guest that, welcome or not, arrives early and departs late. It is the ghost in the room, invisible to all but the patient. Unsharable. Unprovable. Indescribable except by metaphor, analogy – it is like something: a drill, a knife, a pressure… We all realize it is there -but there, not here. We do not share in the pain; we have to believe it exists because we are told it does. It is not an objective thing, pain; it is entirely subjective –an owned phenomenon.

In a way, pain has no voice. As Virginia Woolf put it [and here I will use Elaine Scarry’s paraphrase and elsewhere, quotations from her extremely helpful book The Body in Pain]: “Physical pain does not simply resist language but actively destroys it, bringing about an immediate reversion to a state anterior to language, to the sounds and cries a human being makes before language is learned.”

It is a cruel proof of the Theory of Mind: although I realize that you may have different thoughts and feelings from what is in my head, I can only guess what they are; I can never know what they are. Scarry again: “For the person whose pain it is, it is effortlessly grasped (that is, even with the most heroic effort it cannot not be grasped); while for the person outside the sufferer’s body, what is “effortless” is not grasping it (it is easy to remain wholly unaware of its existence; even with effort, one may remain in doubt about its existence …).” And indeed, “… if with the best effort of sustained attention one successfully apprehends it, the aversiveness of the ‘it’ one apprehends will only be a shadowy fraction of the actual ‘it’”.

We can only know something of what the other person is feeling if they can verbalize a suitable metaphor that we all can understand. And given the difficulty of descriptions in the setting of ongoing pain, these can be hard to find, let alone verbalize. Pain Clinics will often use aids such as the McGill Pain Questionnaire that suggest words that do other than merely measure intensity: moderate, severe, or number on a scale of ten, for example. So their vocabulary offers a choice of qualitative descriptions as well as quantitative.

But for most of us following a woman in labour, such questionnaires are unhelpful -and except for the vocabulary, almost useless, in fact. We are still left standing on the outside, trying to sense the existence of something we do not apprehend. It is not like Nietzsche calling his pain ‘Dog’ and saying “it is just as faithful, just as obtrusive and shameless, just as entertaining, just as clever as any other dog –and I can scold it and vent my bad mood on it …” For us, the attendants, this is sophistry.

Pain –the verbal reaction to pain, at any rate- seems to have different ways of expression in different languages, different cultures, even different geographical regions. As Scarry notes: “… a particular constellation of sounds or words that make it possible to register alterations in the felt-experience of pain in one language may have no equivalent in a second language.” And yet it is really all about the same thing, and serves to “… confirm the universal sameness of the central problem, a problem that originates much less in the inflexibility of any one language or in the shyness of any one culture than in the utter rigidity of pain itself: its resistance to language is not simply one of its incidental or accidental attributes but is essential to what it is.”

Empathy, which is as close as an outsider can get to the pain experienced, will have to suffice. Or -far better phrased- Shakespeare’s opinion:

A wretched soul, bruised with adversity,

We bid be quiet when we hear it cry;

But were we burdened with like weight of pain,

As much or more we should ourselves complain.

I suppose it is the ‘why’ of some types of pain that is so puzzling. The etymological root of the word itself is poena: punishment. In the end, is that really what it is: nothing more than an  arbitrary abuse meted out by a blind and indifferent Nature?  We may understand the physiology of pain, the biochemical irritants that cause it, the nerve fibers that fire in response; we may even postulate the evolutionary protective purposes it sometimes purports to serve, and yet… And yet we are still left wondering about more than the physical nature of pain. As Scarry says: “… when one speaks about ‘one’s own physical pain’ and about ‘another person’s physical pain,’ one might almost appear to be speaking about two wholly distinct orders of events… Thus pain comes unsharably into our midst as at once that which cannot be denied and that which cannot be confirmed.”

It is a relief to find that I am not the only one who finds these disparate aspects of pain to be numinous -and the ‘why’ of pain as elusive to others as it is to myself. If the only way to describe one’s own pain, as I have already mentioned, is through metaphor, perhaps the only way to understand pain, then, is also through metaphor. Story. Literature.

Nietzsche once again: “Only great pain, the long, slow pain that takes its time… compels us to descend to our ultimate depths… I doubt that such pain makes us “better”; but I know it makes us more profound… In the end, lest what is most important remain unsaid: from such abysses, from such severe sickness, one returns newborn, having shed one’s skin… with merrier senses, with a second dangerous innocence in joy, more childlike and yet a hundred times subtler than one has ever been before.”

I do not understand Pain, but I do not discount it. I will merely rest my discomfort on another of Shakespeare’s observations: that maybe “Pain pays the income of each precious thing.” It’s a start anyway…