Acknowledging the Mind’s Eye

Sometimes, in the midst of a problem –in the midst of an era- the resolution derives not so much from the answer as from the acknowledgement that there is an issue to begin with. I find it interesting that Nature has given us an ability to adapt more efficiently -to ignore, I suppose- that which arises gradually than that which falls upon us as an event –interesting, because that allows us to discount something until it results in complications. Difficulties. It is the Janus view of evolution, I suppose.

An article in the BBC news alerted me to one novel approach to encourage acknowledgment of an issue that has plagued some societies for what seems to be millennia: sex selection –or perhaps, more honestly,  destruction:

It got me thinking… We tend to cherish and preserve what we value; we neglect, or abandon that which we don’t. Denigrate it, even. Perhaps an occasional nudge in the ribs may cause us to look around and see where we have wandered –realize that there is really no need to stand so close to the edge.

But it does give one pause for thought –how do some of these things become imbedded in a culture? Surely they don’t start out as intentionally malevolent. Or is that being revisionist and unduly naïve? I’d like to think that some of the customs, however egregious we find them now, were products of a different time when other priorities required precedence. Confusing times, perhaps, when we barely knew who we were in our overarching need to identify and fend off them. Troubling times beneath the roiling waters in which we are just beginning to be able, however slowly, to surface for air.

And the problem, as always for those of us less afflicted, is acknowledgement –recognition that there is more to do. There is always more to do…

Despite being a gynaecologist for more years than I can remember, I suppose I have always lived in a man’s world. It’s hard not to wear the clothes you were assigned. And yet, every so often, that usually-locked door is knocked ajar briefly, and the light from within is blinding. Unintentionally heuristic.

I was sitting in a busy coffee shop recently and managed to find a tiny unoccupied table against a windowless and shadowed wall in the corner. Perhaps it camouflaged me -made my presence less noticeable, my gender less obtrusive- but as I sat there staring silently at the busy room, fragments of conversation from the next table floated past like dust motes in the feeble light. Two women were catching up on their lives. I didn’t mean to listen, but sometimes words are beacons: currents, vacuuming up the air between –meant to be heard, meant to inform. It’s hard to ignore words when you sit in shadows.

“And so how is Janice doing now?” a grey-haired woman in pigtails wearing black track pants and a yellow sweat shirt asked between gulps of coffee and grabs for the oversized chocolate cookies she had balanced precariously on her plate. She clearly had little need of more calories, but the presence of her more sizeable friend likely justified the debauch in her mind. It works for all of us, I think.

Her friend just shrugged amicably. “You know what it’s like, Dory,” she said, and launched into her bagel as if she were packing a box. “Kids are kids…”

Dory munched softly on a cookie and considered the issue. “She’s hardly a kid, now, Alice. She’s, what, seventeen?”

Alice nodded her head equally thoughtfully and her long dark hair slid back and forth over her shoulders like a wash cloth. Although considerable larger than her friend, she carried her weight gracefully, and with the gravitas that suggested a person of authority. Dressed in what seemed in the dim light to be an expensive white silk blouse I could make out little ruffs on each wrist. I don’t normally notice such things, but with each movement of her arms, they risked coating themselves with cream cheese from an impertinent bagel, now lying in fragments in front of her. “Eighteen…” She took a delicate sip from her coffee and sat back on her chair as if the subject required a little more thought.

“Still, she should know where she’s headed by now…” Dory left the question of direction open, but her eyes betrayed her opinion. “I mean, who she is…” she added, italics begging for attention.

Alice sighed and leaned forward again to pack another item into her waiting mouth. “I think she’s always known.”

“And how about you?”

Alice smiled and nodded. “Some things a mother just knows, Dory.”

Dory was obviously trying to understand, but her confusion was apparent, even to accidental eyes watching from the shade. She shook her head, disapproval hovering over her like a cloud. “Did you ever to speak to her about it, Alice?”

Alice’s eyebrows both rose at the same time. “Whatever for, Dory?” she said, genuinely puzzled at the remark.

It caused Dory to sigh rather more loudly than necessary. “Well, I would have thought…”

Alice refurbished the smile she’d sacrificed to the bagel and leaned an elbow on the table. “Thought what?”

Dory straightened her back like a boxer ready to receive a blow. “Well… that…”

“That my daughter would think the same way as her mother? She learned the Theory of Mind when she was five, Dory.” Her friend visibly winced at that. “The world is different for each of us, Dor,” she said, reaching out and grasping Dory’s hand. “And the question should not be why, but rather, how can I best negotiate it…?”

Dory tried to smile, but even from the shadows I could see her lips twitching with the effort. “Do you think if…” But she was clearly too embarrassed to finish her thought –and anyway, I could see Alice shaking her head and squeezing her hand affectionately.

“Somethings just are, Dory. And my main duty as a mother is to help her to accept them.” She let go of Dory’s hand and picked up her coffee for a sip. “And to help others to accept her…”

“But…” There was a hint of helplessness in that one word.

“But what’s not to love, eh?” she said, glancing towards the door and standing up to wave at a smiling teenager gliding towards them like a boat about to dock. And then Janice waved back, just like anybody else…

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…