Monthly Archives: March 2015

The MWS Podcast 56: Julian Baggini on the Virtues of the Table.

The philosopher Julian Baggini talks about his latest book ‘The Virtues of the Table‘, how our relationship with food and drink is a great way to explore what it means to be human and how to try to live conscientiously.

MWS Podcast 56: Julian Baggini as audio only:
Download audio: MWS_Podcast_56_Julian_Baggini

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Pain (2)

Although this page will pick up the threads from Pain (1), I want to mention two comments received already, because they’re relevant to where we go from here.  One was about working with the ideas and assumptions that may be associated with pain, and I shall propose some that I’ve used myself, or supported others in using, and report what happened as a result.  Another interesting comment asked if physical pain and mental pain are different, and in what way.   Both writers seem to acknowledge a physical and a mental component to pain, and to suggest that these two may interact at the level of causation, on the experience of pain, and perhaps figure in its relief.

Although it might be stretching a point to assert that anger, fear or anxiety cause pain, these emotions could well modify our experience of it, lessening it in some cases (as when a badly wounded soldier fights for his life in unarmed combat against an enemy) , or increasing it (as can  happen when the cause of the pain is not obvious to the patient, who fears it may be a sign of impending death).

These and other psychological modifiers I shall explore, albeit not in great detail, and not necessarily as a specialist practitioner in evidence-based pain management techniques.  I therefore welcome other contributors who can challenge, supplement or break new ground in this investigative effort.


In 1970 I emigrated to sub-Saharan Africa (Zambia) on a three year contract in the medical department of a huge American copper-mining consortium.  My job was primarily as a qualified nurse-teacher, but I also had substantial personal hospital nursing experience, including tropical and some emergency medicine and surgery,  gained in UK before setting out for the sub-tropics.  I had never set foot outside the British Isles, however.  I had no knowledge about other countries or cultures, and had earned an examination grade D for “Disgraceful” (Mr “Sniffer” Ellis, my geography teacher) in Geography.

The work involved a lot of hands-on clinical work as well as teaching and I felt reasonably at home in the modern hospital where I was based. This was on the edge of a huge mine “township” where mine employees and their families lived.  Almost all the patients were indigenous African workers and their immediate families.  Most of the nurses were African, though all the doctors were white as were the senior sisters and matrons.

A few months after I started there was a catastrophic underground collapse and flooding in a major section of the mine workings, which were several hundred metres below ground, and full of workers and heavy plant (machinery, earth movers, and giant transporters). About 400 workers were trapped by falling rock along a 1 km long lateral traverse twice as wide and high as a London Underground tunnel.

I was woken in the early hours and summoned to work to help with the recovery and treatment of injured and dead miners.  Within twelve hours, scores of bodies had been raised to the surface, and the hospital was full of crushed and mangled survivors.  The rescue teams were brave, well-trained, and as determined to save the lives of their comrades as miners anywhere in the world.  But the situation was generally ‘organised chaos’.

As I worked with others on the badly injured patients, some devastatingly so,  I was struck by how undemanding the patients seemed to be and,  in the case of patients who weren’t unconscious or anaesthetised,  by their not showing signs of serious physical distress or pain. The same seemed true of the African staff, whose approach to care was not that of the “soothing hand on fevered brow” kind, but brisk, matter-of-fact, and cheerful, whilst observing the simple protocols of African social behaviour.  The concept of ‘sick role’ which is very prevalent in British hospitals even to this day, seemed to be absent.

Professor Michael Gelfand, “one of Africa’s most distinguished medical practitioners”*, founding professor of African medicine at the University of Rhodesia (now Zimbabwe), and author of ‘The Sick African’ (1957) has posited that Africans have ‘a high pain threshold’, meaning that they have a lower susceptibility to pain than white races, the implication being that bantu (negro) races have a coarser and less refined physical and neurological endowment than that of the superior European race, thus lower sensitivity to pain.

This was the received wisdom (amongst white practitioners) at the African hospital where I worked.  I did not believe it then, and Professor Gelfand has himself recanted his opinions (he is now deceased), in the light of his own ethnographic and cultural researches. In my own experience, pain has a different meaning to the African patient than it does to most of us northern Europeans.  Although it may be inconvenient and uncomfortable,  it is generally much less disabling and has fewer emotional correlates (such as fear or anxiety), than it does for non-indigenous people brought up in a different culture.

After the mine accident, men who had endured serious crush injuries or fractures necessitating whole-limb amputations, or major burns, were able to get up from their beds within hours of admission or major surgery without prompting or assistance, to clean their teeth, take themselves to the shower rooms to wash, and to use the toilets unaided.  The level of resilience, self-care and independence was astounding to me.  Little analgesia was required or requested.  This impression I inferred about the meaning and significance of pain for indigenous African people survived my whole experience in Zambia over many years of work there.

However small my justification for a firm conclusion on the matter, I am inclined to think that culture and upbringing is likely to be a key determinant in the human response to pain, alongside psychology.  I confess to not knowing how to proceed with this idea beyond the point stated here.

* Unattributed source,

The MWS Podcast 55: Pete Mallard on the Barn Retreat

Pete Mallard is the manager of the Barn Retreat near Totnes in Devon. He talks about the Barn, what it does, the ethos behind it, the value of going on retreat and how all this might relate to the Middle Way.

MWS Podcast 55: Pete Mallard as audio only:
Download audio: MWS_Podcast_55_Pete_Mallard

Click here to view other podcasts

Pain (1)

Pain is an almost universal human experience, and one which almost all of us want to avoid.  It’s said (and many might agree) that whereas we can tolerate the thought that we shall die, the thought that our deaths may be excruciatingly painful is hard to contemplate, and for some of us that fear justifies euthanasia, or legally assisted suicide, even when doctors reassure us that pain relief is available at the end of life, and is generally effective in controlling it.

Pain probably doesn’t need definition, it even defies definition.  But pain can be usefully described in terms of its characteristics.  Doctors use the terms crushing, lancinating, throbbing, colicky, gnawing, boring, burning and twisting because these are regularly used by patients to describe their experience  of pain, and are subjectively recognisable, as well as being characteristic of certain medical conditions to the extent that they can sometimes justify diagnosis of medical conditions without much further examination or tests.

Pain is also subjectively measurable, and a simple scale of pain intensity has been used for years: it runs from 0 to 10, with ten being the most intense, excruciating or unbearable pain, and one the least.  Practitioners are taught to accept the patient’s own assessment of intensity.  The days when nurses could say, “She’s exaggerating her pain to get attention, or to get pain-relief” are generally over: “Pain is what the patient says it is” is the accepted dictum.

Besides the administration of analgesic (pain-relieving) medicines, much attention is presently given to ways that people can manage pain without analgesia, to complement analgesia where its use isn’t completely effective, or where its use is not well tolerated by patients because of the unpleasant effects or side-effects it may produce.  Not a few patients decline the offer of analgesia on principle (because they shun chemicals in favour of more ‘natural’ remedies); or because (like some Buddhists), analgesia is deemed likely to cloud consciousness in breach of the religious precepts they observe as an aspect of practice.

Although there are several ways of managing pain that don’t involve medication, the one I shall concentrate on here, because it may relate usefully to the Middle Way, is concerned with the idea of pain, or the ideas and assumptions that surround the experience of pain, and may influence our subjective experience of it.

One very prevalent idea about pain is that it is a kind of suffering.  It is almost always described as disagreeable, often extremely so, although for some otherwise ‘normal’ people it’s a sought-after item on the menu of aphrodisiacs that heighten sexual pleasure .  However, it also disables, or is prone to disable, the “sufferer”.  I attach quotes because this is a hugely typical way of describing an individual who is experiencing pain.  Pain can seriously and adversely affect the “sufferer’s” capability and capacity to discharge normal functions, including automatic ones like breathing, swallowing or eliminating.  Pain may make life very difficult.

Pain can also cause mental distress, and often does so.  The experience of pain may be accompanied by thoughts that preoccupy or dominate consciousness:  “What’s wrong with me?”, “What’s causing it?” “When will it stop?”, “What can I do to get rid of it?”, “Is it getting worse?”, “Why isn’t it going away?”,What have I done to deserve it?”,  “Can someone help me?” Pain may be attended by anxiety, fear, and sometimes by guilt or anger.  Pain which comes and goes (intermittent pain) may give rise to crippling apprehension and vigilance for signs that pain is returning, both of which can interfere with the activities of living.

Another possible accompaniment to pain is the idea that pain is a punishment, deserved or undeserved, and that to experience pain is to be a “victim” of some kind of retribution.  The idea that “it’s my own fault” may pop into a “victim’s” mind without warning, and take firm root in consciousness.  Some patients find that to accept responsibility for one’s pain is a way of reconciling oneself to the experience, and even of mitigating it to an extent.  This capacity we may enjoy to change the subjective experience of pain is something I shall return to in the posts that will follow.

Readers’ comments will be very welcome, especially comments in which a personal experience of pain is addressed, or ideas about managing or coping with pain.  Readers will know how to stay within their ‘comfort zone’ in doing so, bearing in mind that these threads are accessible to the general public.