No Pain, No Gain

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.”

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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?”

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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.

In the latter, a Russian scientist alters a dog’s perception of pain by rewarding it with food after zapping one of its paws with electrical shocks. Within a few weeks, “instead of whining and struggling to get away from the shocks, the dog responded by wagging its tail excitedly [and] salivating,” Brand and Yancey write. “Somehow, the dog’s brain had learned to reinterpret the . . . pain.”

Humans, too, can adjust to life’s inevitable slings and arrows, Brand says. And he outlines the steps:

More physical activity (to build endurance); prayer or meditation (which calms the body and reduces pain); gratitude (an antidote to the pain-intensifying effects of anger and resentment); and a network of friends and family. “The best single thing I can do to prepare for pain is surround myself with a loving community who will stand by me when tragedy strikes,” Brand notes.

He also says Americans need to embrace pain as a friend: “We silence pain when we should be straining our ears to hear it; we eat too fast and too much and take a seltzer; we work too long and too hard and take a tranquilizer. . . .

“In the 1980s, I started making a list of all the behavior-related problems [discussed at a meeting of U.S. health officials]: heart disease and hypertension exacerbated by stress . . . cancers associated with a toxic environment, AIDS, sexually transmitted diseases, emphysema caused by cigarette smoking. . . .

“A comparable gathering of experts in India . . . would have dealt instead with malaria, polio, dysentery, tuberculosis, typhoid and leprosy. After valiantly conquering most of those infectious diseases, the United States has now substituted new health problems for old.”

Reaction to Brand’s theories is hard to gauge. Although ex-surgeon general Koop penned the book’s foreword--and the volume received a kind review in the Journal of the American Medical Assn.--none of the half a dozen pain experts contacted by The Times had heard of it.

The book also drew scant media attention, which might support Brand’s contention about fear of the topic. And which might explain why the current U.S. edition of the book is missing a few letters from its original title, “Pain: The Gift Nobody Wants.”

The offending parties: P-a-i-n.

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Another part of America’s struggle with suffering, he asserts, is its misunderstanding of pleasure:

“Pain and pleasure come to us not as opposites but as twins, strangely joined . . . a massage after a long day in the garden . . . a log fire after a hike in a snowstorm. . . . Nearly all my memories of acute happiness involve some element of pain or struggle.”

Quoting St. Augustine, he adds: “Everywhere a greater joy is preceded by a greater suffering.”

Indeed, “The Gift Nobody Wants” notes that people who “voluntarily take on suffering as an act of service,” such as Mother Teresa and Albert Schweitzer, “achieve a level of contentment virtually unknown to the rest of the world.”

True joy, Brand suggests, “is an inner state. . . . The more we let our level of contentment be determined by outside factors--a new car, fashionable clothes, a prestigious career--the more we relinquish control over our own happiness.”

Thus, “children rush around on Christmas Day from one electronic toy to another, bored with them all in a few hours,” he says.

Simplicity and discipline are the keys to happiness, Brand suggests in a telephone interview from his Puget Sound home.

“Perhaps because I have had to repair so many physical problems caused by overindulgence, I take a long-term view of pleasure. [For example], gluttony may give short-term pleasure, [but] it sows the seed for future disease and pain. Hard work and exercise, which may seem like pain in the short term, paradoxically lead to pleasure in the longer term.”

Brand contends America’s shortsighted view extends to politics, where “accumulating a massive debt that our children and grandchildren will have to pay off [and being] irresponsible toward the environment” are the order of the day.

“I am a doctor, not a theologian,” he adds, “but after living in several cultures I am ready to diagnose promiscuity as the disease of our modern age. To me, the word covers far more than a sexual connotation; it implies a kind of irresponsibility . . . a spirit of ‘Have fun today; tomorrow will take care of itself.’ We approach politics that way.”

Yancey also detects risks in America’s collective and individual flight from hardship: “The more success a culture has, the more difficult it is for individuals to make sacrifices for the good of the whole. . . . It creates a soft society, ill-equipped to handle the adversity that will inevitably come.

“Previous generations, because life was rougher, didn’t place so much emphasis on pleasure. Even air-conditioning in cars is fairly recent. It’s very easy for a culture to assume pleasure is a right . . . and that sets you up.”

Overemphasizing pleasure, he adds, also weakens the discipline needed for achievements in science and the arts.

Or as author Graham Greene put it in a quote cited by Brand and Yancey:

“In Italy for 30 years under the Borgias, they had warfare, terror, murder, bloodshed--but they produced Michelangelo, Leonardo da Vinci and the Renaissance. In Switzerland, they have brotherly love, 500 years of democracy and peace, and what did that produce?

“The cuckoo clock.”