Tuesday, October 31, 2006

Voluntary pain

Rev. Jason Cusick writes about how the social meaning of pain has changed over the past 150 years or so and how different people apply different values to the experience of pain. The article is entitled Spirituality and Voluntary Pain and appears on the website of the American Pain Society.

Rev. Cusick reviews the debate that occured over the introduction of pain relief in labor:
As recently as the 19th century, James Young Simpson, the founder of obstetric anesthesia, unknowingly fell into religious territory as people of faith debated whether pain relief was a sign of God's grace or modern man's attempt to avoid the natural consequences of original sin ... Those interested in character development argued pain was a door to spiritual and moral growth...

In the end, mainstream religious thought overwhelmingly promoted pain relief with strong theological and religious support. Anesthesia and other approaches to pain management have flourished, especially in Western medicine, but the seeds of doubt, questioning of scientific promises, and deep religious convictions still remain strong, especially among more conservative people of faith. In fact, some have even questioned whether the advent of pain management has given a new, even extreme spiritual meaning to pain - that it is "evil and must be eliminated".
Despite the general consensus among the American public that pain is bad and should be eased whenever possible, there are those who find spiritual meaning in pain. Rev. Cusick discusses five spiritual meanings of pain: pain as punishment, pain as an opportunity for transcendence, pain as test or competition, pain as atonement, and pain as gaining or retaining control. He suggests that the decision to forgo pain medication in labor owes much to the social meanings of pain as transcendence and pain as a test or competition.

Pain as transcendence:
The best example of the use of pain in modern health care is in our labor and delivery rooms. A new mother writes, "I am no masochist; I have been known to cry over cuts, menstrual cramps, and even spilt milk. Childbirth is pain like none of those, nor is it like any other pain I have had...I had no need or desire to end or diminish the sensations of birth. It was exhilaration to be part of a primal experience. I was caught up in the desire to know each moment; to discover the unique progression of events leading to the entrance of a new being - or is it 'exit'? Not only me, but no one else can have that time again. It was an opportunity".
On pain as a test or competition:
Marie, a 28-year-old Vietnamese-American woman, chose natural childbirth to give birth to her son. While intending to give birth "as God intended" (meaning without medical intervention) and later viewing the experience as an opportunity for transcendence, her primary motivation for voluntarily enduring the pain of labor was more to test her own limits and prove to herself and to others that she was not a weak-willed person. "I want to see what I can handle," she said, speaking of the modern world's overemphasis on personal comfort and convenience. For those who choose it, voluntarily enduring pain becomes an opportunity to discover one's own limits and potential and connect with one's self on the most intimate level.
I found the article to be enlightening on several levels. First, it views pain through an entirely different prism: the role of pain in spirituality. Interestingly, there is no suggestion that the people who voluntarily choose to accept pain don't feel much pain. Indeed, it is made clear that the pain of women who choose unmedicated childbirth is exactly the same as those who choose medication. What is different is the response to that pain, because the response is mediated by the meaning that the woman assigns to her pain.

The meanings of the pain are socially contructed based on the individual's background, philosophy and religious training. Some women experience the pain of labor as an opportunity, and some women (as I have argued all along) view the pain of labor as a test of themselves or a competition with other women. For those who view the pain of labor in this way, the reason why they are so obsessed with other women's choices is obvious. It provides a ready made opportunity to feel superior to women who chose pain medication in labor.

What is important for natural childbirth and homebirth advocates to understand is that their views of pain are simply personal views. Most people do not share these views and there is no reason why they should since the meaning of pain for an individual is shaped by that individual's personal choices.

It seems to me, that some women are not able to accept that the decision to use pain medication in labor is simply a personal preference. Perhaps the fact that most women do not view the voluntary acceptance of pain as an achievement plays a role in this. If a natural childbirth advocate believes that she has achieved something in forgoing pain medication, she may expect validation of that "achievement". Obviously, there is going to be no validation in accepting that different people view pain differently. Hence the extraordinary effort to convince themselves and others that the willingness to forgo pain medication is "healthier" or "better for the baby". It's not, it's simply a personal preference, based on an individual's interpretation of the meaning of pain as shaped by her personal experiences, philosophy and religious training.


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