Thr Problem of Pain - Unedited Appendix

In the All About Jack podcast there is an interview about disability which includes the original appendix by Robert Havard, CS Lewis's and JRR Tolkien's personal physician and a member of the Inklings. In all current editions the appendix to The Problem of Pain, written in 1940, reflects Lewis's editing of Havard's essay. The original has recently been unearthed and received more attention. Of particular note is that just prior to the book coming out Mrs. Moore's brother visited at The Kilns while deteriorating mentally.  Lewis sat up with him often as he became more psychotic, until he eventually had to be confined. Those who have read Perelandra may recall Weston's speech at the end, as the demonic spirit is gradually taking him over, "My God, Ransom, it's awful. You don't understand. Right down under layers and layers. Buried alive. You try to connect things and can't.They take your head off...and you can't even look back on what life was like in the rind,because you know it never did mean anything even from the beginning...Oh Ransom, Ransom! We shall be killed! Killed and pulled back under the rind..." The man had dabbled in the occult all his days, and Lewis thought this deeply connected to his growing insanity.  It had a profound effect on him (something similar is described near the end of That Hideous Strength), so when he edited Havard's appendix he cut out a great deal about mental pain. I have read Lewis's description of the man losing his mind before him, and it sounded quite biological rather than spiritual to me.  But then, it would, having witnessed such things for decades.

I wish Lewis had left it alone and let Dr. Havard's experience speak for itself. I don't find Robert's description entirely without fault either. I recognise cases similar to the ones he describes, but I am aware of many which do not look like it at all. The are the observations of a man who has seen more than most people have and thought hard about it.  But there is much more than could be said. I will not comment further. These are the thoughts of a very decent man trained in medical observation about a century ago, who was about to be a doctor in the British Navy during WWII. He would be about the height of what men might expect to see under all manner of suffering at the time. I think they are interesting in themselves, and in understanding what pain does to the human personality.

Pain is a common and definite event which can easily be recognised. Although the sufferer may attempt to conceal, distort, or even exploit his pain, its real extent can be estimated with fair accuracy. But the observation of character or behaviour is less easy, less complete, and less exact, especially in the transient, if intimate, relation of doctor and patient. So an attempt to estimate the effect of pain upon general behavior must. it seems, be subject to large inaccuracies. In spite of this difficulty certain impressions gradually take form in the course of medical practice which are confirmed as experience grows. In the next few pages, an attempt is made to describe certain conclusions selected from a multitudinous and unmanageable mass of detail. A short attack of severe physical pain is overwhelming while it lasts. The sufferer is not usually loud in his complaints. 

There is intense and obvious distress.  there are the physical sign of pain, pallor, sweating, nausea, even vomiting, and a characteristic facial expression which cannot be concealed and seldom be imitated. The sufferer is not usually loud in his complaints. He will beg for relief but does not waste his breath on elaborating his troubles. His whole energy is devoted to fighting the enemy within him. It is unusual for him to lose self control and to become wild and irrational. It is rare for the severest physical pain to become in this sense unbearable. When short, severe, physical pain passes it leaves no obvious alteration in behaviour.  It may have been met with courage and recognition or with rebellion and despair.

In either case, the patients seems to be little altered by it when it is passed.  Long continued pain has more noticeable effects. It is exhausting and is a greater trial of patience. Yet it is often accepted with little or no complaint and great strength and resignation are developed. Pride is humbled or, at times, results in a determination to conceal suffering. Women with rheumatoid arthritis show a cheerfulness which is so characteristic that it can be compared to the spes phthisica of the consumptive: But these examples of behavior due more to a slight intoxication of the patient by the infection than to an increased strength of character. They are a sign of weakness, of diminished will to activity. They are not necessarily examples of an indomitable will surmounting the weakness of a diseased body. 

Some victims of chronic pain deteriorate. They become querulous and exploit their privileged position’ as invalids to practise domestic tyranny. But the wonder is that the failures are so few and the heroes so many; there is a challenge in physical pain which most can recognise and answer. 

On the other hand, a long illness, even without pain attached to it, exhausts the mind as well as the body. It produces weakness and fatigue. There is no vigor left to fight with. The invalid gives up the struggle and drifts helplessly and plaintively into a self-pitying despair. He will be found quietly weeping, yet when questioned is unable to explain why. Even so, some, in a similar physical state, will preserve their serenity and selflessness to the end. The spirit shines more clearly through the weakness of the body. To see it is a rare but moving experience. 

Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “my tooth is aching” than to say “my heart is broken”. Yet if the cause is accepted and faced, the conflict will strengthen and purify the character and in time the pain will usually pass. Sometimes, however, it persists and the effect is devastating; if the cause is not faced or not recognised, it produces the dreary state of the chronic neurotic who is bane to himself and to all with whom he comes in contact. Some, however, by pure heroism overcome even chronic mental pain. They often produce brilliant work and strengthen, harden, and sharpen their characters till they become like tempered steel. 

In actual insanity the picture is darker. The first sign of approaching insanity is often deterioration of character. In full developed insanity the character is completely hidden by the disease,which takes possession of the character so completely that the phrase "possessed of a devil" is graphically descriptive. In the whole realm of medicine there is nothing so terrible to contemplate as a man with chronic melancholia. To speak with him has all the effect of witnessing a high tragedy transferred from the stage to life. But most of the insane are not unhappy or, indeed, conscious of their condition. In either case, if they re- cover, they are surprisingly little changed. Often they remember nothing of their illness. It is impossible to form a a conception of what insanity means to the sufferers themselves. But to look after the instance is valuable discipline. It teaches gentleness and self-control. It induces a deep humility when it is recognised that reason itself is a gift which can be lost. The biological purpose of pain is to draw attention to something harmful so that it may be avoided. 

Frequently, as in physical or mental disease, human pain fails to achieve its biological purpose. It then becomes a grave disorder. But the adversity of pain provides an opportunity for the development of heroism; the opportunity is seized with surprising frequency.  Any view of life in which heroism ranks higher than comfort must see that the disorder of pain when faced is less harmful when the result is good.