Chronic pain, even if the pain is “not that bad,” ends up taking a significant toll. Why? The physiological answer is that the brain’s processing power is preoccupied with interpreting incoming pain signals and other signals as pain, leaving it with less time, energy, and space to interpret signals that are not associated with pain. This leads to issues such as brain fog and depression.
However, what I want to work through is how we conceptualize chronic pain. Elaine Scarry was the first to write extensively on physical pain, and for her “physical pain has no voice” (1985, 3) because it is an experience within the body. Because of this, pain only becomes visible through language (Scarry 2985, 27). Pain is one of the sensations that makes us aware of physical boundaries, the other being pleasure, and when there is no source for the pain we construct metaphors that demonstrate the breaking of barriers, such as “I feel like I have been stabbed by a knife” (Ahmed 2004, 27). Ahmed notes that:
It is this perceived intrusion of something other within the body that creates the desire to re-establish the border, to push out the pain, or the (imagined, material) object we feel is the ‘cause’ of the pain. Pain involves the violation or transgression of the border between inside and outside, and it is through this transgression that I feel the border in the first place. (26)
Pain “unmak[es] the body” (Brown and Tucker 2010, 28) so to articulate pain, the body is reduced to an inside, an outside, and a border between the two. Pain is conceptualized as an intrusion of boundaries, primarily physical boundaries. This is reflected in how we treat pain: aside from consuming painkillers, we talk about resting until an injury—the site of a broken physical boundary—until it’s healed.
What about chronic pain? The dimension of time changes the function of pain. If pain makes us aware of the body, then what does a perpetual awareness of the body do?
Consider this typical model of how chronic pain develops:
A child experiences enough trauma, neglect, and abuse that their adrenal response system during crucial developmental stages becomes over-active. This jumpy adrenal response system is in play when this child becomes an adult, and during that time of growth they accrue numerous injuries that stem from the hypermobility of their joints. (If you’re wondering why I’ve included the bit about hypermobility, something like three out of four people living with chronic pain are hypermobile.) Each injury trains an already trigger-happy adrenal response system to be even more alert, and each injury conditions the body’s pain response system. This combination means that the body interprets normally benign signals as threats and pain, and rushes of adrenaline that most people would find exciting and fun are translated into pain. This then feeds back to the nerve cells, whose morphology change to become more fibrous and sensitive to pain. On and on the cycle goes.
In this model, the physical boundaries of the body are disturbed from time to time, but this alone does not account for chronic pain. The other component is the fact that the processes through which the body develops and emerges have changed. The processes themselves create, or perhaps are, boundaries of the body. We tend to think of pain as a discrete sensation, but chronic pain is not that. Chronic pain is a manifestation of disturbed processes. It is therefore not only a perpetual awareness of the body, but a perpetual awareness of how normal processes of change have gone awry. Chronic pain is a reflection of broken metaphysical boundaries.
While discrete pain unmakes the body, chronic pain unravels a person’s sense of self. We like to think of leaving the past in the past, letting bygones be bygones, but chronic pain does not allow for that. People who live with chronic pain are often fixated on the past—because we feel, on many levels, how the events of the past are not discrete, have impacted our present selves, and shaped our futures.