The Killing of Pain


When cosmopolitan medical civilization colonizes any traditional culture, it transforms the experience of pain. The same nervous stimulation that I shall call “pain sensation” will result in a distinct experience, depending not only on personality but also on culture. This experience, as distinct from the painful sensation, implies a uniquely human performance called suffering. Medical civilization, however, tends to turn pain into a technical matter and thereby deprives suffering of its inherent personal meaning. People unlearn the acceptance of suffering as an inevitable part of their conscious coping with reality and learn to interpret every ache as an indicator of their need for padding or pampering. Traditional cultures confront pain, impairment, and death by interpreting them as challenges soliciting a response from the individual under stress; medical civilization turns them into demands made by individuals on the economy, into problems that can be managed or produced out of existence. Cultures are systems of meanings, cosmopolitan civilization a system of techniques. Culture makes pain tolerable by integrating it into a meaningful setting; cosmopolitan civilization detaches pain from any subjective or intersubjective context in order to annihilate it. Culture makes pain tolerable by interpreting its necessity; only pain perceived as curable is intolerable.


A myriad virtues express the different aspects of fortitude that traditionally enabled people to recognize painful sensations as a challenge and to shape their own experience accordingly. Patience, forbearance, courage, resignation, self-control, perseverance, and meekness each express a different coloring of the responses with which pain sensations were accepted, transformed into the experience of suffering, and endured. Duty, love, fascination, routines, prayer, and compassion were some of the means that enabled pain to be borne with dignity. Traditional cultures made everyone responsible for his own performance under the impact of bodily harm or grief. Pain was recognized as an inevitable part of the subjective reality of one’s own body in which everyone constantly finds himself, and which is constantly being shaped by his conscious reactions to it. People knew that they had to heal on their own, to deal on their own with their migraine, their lameness, or their grief.


The pain inflicted on individuals had a limiting effect on the abuses of man by man. Exploiting minorities sold liquor or preached religion to dull their victims, and slaves took to the blues or to coca-chewing. But beyond a critical point of exploitation, traditional economies which were built on the resources of the human body had to break down. Any society in which the intensity of discomforts and pains inflicted rendered them culturally “insufferable” could not but come to an end.


Now an increasing portion of all pain is man-made, a side-effect of strategies for industrial expansion. Pain has ceased to be conceived as a “natural” or “metaphysical” evil. It is a social curse, and to stop the “masses” from cursing society when they are pain-stricken, the industrial system delivers them medical pain-killers. Pain thus turns into a demand for more drugs, hospitals, medical services, and other outputs of corporate, impersonal care and into political support for further corporate growth no matter what its human, social, or economic cost. Pain has become a political issue which gives rise to a snowballing demand on the part of anesthesia consumers for artificially induced insensibility, unawareness, and even unconsciousness.



– Ivan Illich. (1976) Medical Nemesis – The Expropriation of Health. Pantheon Books.








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