Abstract

Because pain is a ubiquitous feature of the human experience, it is one of the few universals of
human existence. This article presents an anthropology of pain.
Anthropology is briefly defined as the cross-cultural and comparative study of human behavior.
Culture—the hallmark of anthropology—is a concept defined as a set of societal rules and
standards developed over time and shared by the members of a particular society. When cultural
rules and standards are acted upon by the members of a society, their behavior falls within the
range of that which is considered proper and acceptable within that society. Culture is an
evolutionary process that changes over time—or, if you will, “with the times.” What works and
is fashionable is also perpetuated, and what does not work tends either to disappear altogether or
is considered aberrant behavior. Thus, culture is the essence of a society. An early hypothesis
suggested that the use of the concept of culture of a given society to explain the behavior of that
society required recognition of its cultural concepts as a reference for measuring and interpreting
real things and events of a given society (1). To anthropologists, then, the culture of any society
and the cultural concepts developed and learned, over time, by its members constitute the sources
of all the appropriate behavior of the people in that society.
The way of perceiving, expressing, and controlling pain is one of these learned behaviors that,
when manifested, is culture-specific (2). Moreover, cross-cultural data gathered by
anthropologists during their fieldwork—the anthropological term for research—show that, while
few universals exist between and among discrete societies, from the small, undeveloped,
primitive ones to the large, developed, industrialized ones, pain is one of these universals. Thus,
while the stimulation of pain fibers to tell the brain that something is wrong is the same among
all human beings, the perceptions and control of pain vary from society to society.
The word pain is derived from the Latin word poena, meaning a fine or a penalty. According
to Taber's Cyclopedic Medical Dictionary (1983), pain is “a sensation in which a person
experiences discomfort, distress, or suffering due to provocation of sensory nerves.” Taber's
further defines pain as “one of the cardinal symptoms of inflammation which may vary in
intensity from mild discomfort to intolerable agony and, in most cases, pain stimuli are harmful
to the body, tend to bring about reactions by which the body protects itself, and with adaptation
to pain stimuli not readily occurring.”
That pain, but not necessarily its diagnosis and treatment, is a part of the human condition has
been established by the research of many scholarly biological, physical, and social scientists. The
existence, etiology, and intensity of pain have been recorded by anthropologists in the Old and
New Worlds. These analyses include results of archaeological and physical anthropological
excavations of prehistoric and historic sites. Prehistoric sites have unearthed ethnographic
(social) artifacts such as cave paintings, sculptures, tools, hearths and fires, medical instruments
and potions, and human funery. Historic explorations have revealed literature, paintings, human
funery, housing remains, medical containers, fabrics (some colored with natural dyes derived
from plants in the environment), and other artifacts. Because examples of teeth and bones
(especially the jawbone—the hardest bone in the human body) have survived over time, the use
of modern dating technology (such as carbon dating) has revealed much data about early
humans, including disease processes.
Investigators of the culture of pain have also extrapolated the incidence of pain across the span of
racial groups and ethnic groups, social classes, and ages in New World society. Findings reveal
that its cultural elaboration involves greatly diverse categories, idioms, and experiences. By
means of illustration, since 1000 BC, the Paracas of the Southern Coast of Peru have practiced
trepanation (David Wilson, PhD, personal communication, 2001). The medical purpose of
trepanation is to perforate the skull to relieve internal pressure. Its purpose among Peruvian
Indians, however, is to release the evil spirits that have inhabited the skull of a possessed person.
As such, it is considered skull deformation. Lesions are treated with poultices of cocoa leaves
and covered later by copper plates. Survival is attributed to the regenerative potential of the
skull.
Acute pain, lasting for minutes or hours, is reported at some time by virtually all adults and by
most juveniles everywhere and is indicated by the cries and facial expressions of infants and
toddlers (3). Chronic pain, which lasts for months, years, or a lifetime, is neither a ubiquitous nor
a universal occurrence (2). It is not infrequent within most world populations, however (2).
Attention to pain and a focus on pain are parts of the literate medical traditions of countries such
as China, Japan, India, and Islamic cultures (4–7). For example, Oknuki-Tierney (8) reports that
pain among the Sakhalin Ainu of Japan is described culturally as “bear headaches” that sound
like the heavy steps of bears; “deer headaches” that feel like the much lighter sounds of running
deer; and “woodpecker headaches” that feel like a woodpecker pounding into the trunk of a tree.
These headache pains are not intended to be on a sliding scale. Each one is of the same painful
intensity.
Pain is, of course, a pervasive condition of large melting-pot societies, such as the USA. In the
USA, pain is among the biggest causes of disablement and, hence, is responsible for a substantial
apportionment of disability payments (2). The cultural gap between the modern US medical
system and the large number of ethnic minorities it serves, although sometimes subtle, is not an
infrequent problem. The cross-culturally derived academic and medical literature is rife with
descriptions of ethnographers, physicians, and public health experts concerning reports of acute
and chronic pain complaints of patients from a variety of societies. Thus, the so-called cultural
clash, which is not limited to the medical system of the USA, often is set in motion.
Payer (9) and Galanti (10) pose examples of cultural clash and resulting conundrums when they
ask the following: What happens when an Iranian doctor and a Filipino nurse treat a Mexican
patient? What takes place when a Navajo patient calls a medicine man to the hospital? What is
the result when an Anglo nurse and a Japanese doctor have difficulty understanding one another?
Why do Asian patients rarely ask for pain medication while patients from regions on the
Mediterranean coast prefer pain medication for the slightest discomfort? Why do Middle Eastern
men not easily allow a male doctor to examine their mothers, sisters, wives, and daughters? Most
Western medical personnel do not understand that coin rubbing is a form of medical treatment
and not child abuse. Between and among different factions, the result may be confusion, conflict,
and misunderstanding.
While individual scholars conduct studies and issue reports on the phenomena of pain and its
control, it is simply impossible for clinicians to understand all of these differences and societal
belief systems. What is possible for clinicians and is important and comforting to patients is to
ask them about their belief systems. This strategy lets these patients from the various medical
belief systems know that, while they are in fact in a modern health care facility and will receive
modern medical treatment, their differences—if any—are accepted. A melding of the minds of
medical personnel and patients results. By this means, much of the confusion resulting from the
“cultural clash” of different belief systems can be avoided.
Albeit idiosyncratic behavior is the unique action of an individual, is not frequently repeated, and
often is unpredictable (11), a person is rarely isolated from others. Thus, individual behavior
mirrors, at least in part, the behavior of the group to which a person belongs. But, clearly, not all
human behavior is idiosyncratic—that is, parted from societal norms (1). Therefore, albeit one's
behavior can be individual, it is most often shared with a significant number of other members of
one's cultural (or subcultural) group.
In the modern world, neuroscientists regard pain as a salient feature of the nervous system. In
traditional societies, pain is generally perceived to be the result of a societal transgression. On
the one hand, Melzack (12, 13), and in conjunction with Torgerson (14), draws on the condition
of phantom limb pain to reinforce his theory of the “neurosignatures” that emerge from the
brain-self's “neuromatrix.” For these theorists, the neuromatrix comprises central nervous system
constraints on experiences that occur even independent of peripheral sensory signals.
On the other hand, Haviland (15) discusses pain perceptions of people of the traditional world of
Africa, such as the Nuer and the Dinka. Among these and other pastoral, Nilotic (region of the
Nile River) tribal people of the Sudan, which borders on Ethiopia and from Kartoum southeast
into Kenya and Tanganyika, pain is believed to result from societal transgressions. Moreover, I
suggest that, because these Nilotic people are among the African immigrants to the USA and are
often taxi drivers in major US cities, one may meet them, complete with their traditional medical
beliefs, here in the clinical setting as well as in their taxicabs. Their medical beliefs can be
perplexing, but most of them are aware that, in the USA, they will meet practitioners of modern
medicine in modern facilities. Simply understand' ing that differences prevail is the key.
Pain is observed in small, cohesive, traditional societies. For example, in West African countries,
such as Benin, during labor and midwifery delivery, the expectant and soon-to-be new mother
expresses her pain by a barely audible “whee” (16). According to Sargent (16), the process of
labor and delivery in Benin is strictly a “woman thing.” Men are neither present at nor have a
responsibility in this event. It can be inferred that the cultural behavior during this “woman
thing” results from the laboring mothers' lack of need of extra attention from male members of
the society.
Further, according to Chagnon (17), among the Yanomamo Indians, an Amazonian tribe living
on the Orinoco River in Venezuela, the tribal members are referred to as the “fierce people”
because their daily entertainment is composed of ax and/or club fights. The fights are put on by
the young men of the tribe. The Yanomamo boys attend sessions of painting and piercing the
skin of their elders, which is undertaken in preparation for the fights, in order to learn this craft
for their future roles as “fierce” people. The young women (whose manners are aberrant and
unacceptable in both Western and most other non-Western societies) paint the skin of the men
with war decorations and also act as “cheerleaders” for these fights (17). These warriors show,
with pride, the bald, scarred crowns of their heads—honor badges earned from their courage
during these fights. While death by blows of the clubs and axes does occur among the men,
missionaries have given these fierce people shotguns. Chagnon (17) reports that, as a result of
these guns, survival of these people is threatened, because tribesmen clearly articulate that if
Yanomamo Indians receive guns, they will kill each other.
The Dugum Dani of Highland, New Guinea, is a culture of peaceful but intrawarring people
(18, 19). It is a patriarchal society with spear fights as the center of entertainment. In this culture,
the men play “war games” by positioning themselves side-by-side in 2 parallel lines of some 25
men, facing each other, with a distance of some 30 yards between the lines. Each man holds a
long spear which, upon signal, is thrown at the man across from him. This is a nightly
entertainment. During the day, the men weave and hunt for food in the natural environment.
When they are small children, women of this tribe undergo primitive surgical removal of all
distal joints of the interphalanges in order to “protect” them from being evil. They tend babies,
wash clothes, build and tend campfires, and prepare food. The results of all of these traditions
would certainly cause pain in most societies. For the Dugum Dani, however, these are natural
occurrences and, therefore, pain is essentially controlled by attitude.
The body in pain takes authority over and against itself, becoming a “decayed mass of tissue”
that is separated from itself (2). Then the self becomes defective and loses integration. People
who are not victims of this terrible condition assume that the world is inhabited by people whose
lives are not infiltrated by intractable physical pain. This assumption, according to Good,
Brodwin, Good, and Kleinman (2), is inconceivable for the many people who suffer chronic
pain. Their pain, which becomes unbearable, is the center of the whole world for each of them.
Pain is subjective, resisting the usual medical testing; no meters or chemical assays can measure
it. It is often elusive in terms of its sites. It does not respond to searches for its locations with
imaging techniques. In preparing this paper, this author became aware—in a dramatic fashion—
that the offer of control of pain is the only therapy that purports to give victims of pernicious
pain both a piece of and a peace with the lives that most of us take for granted.
Several decades ago, a weekly television show entitled The Naked City presented with the
opening lines, “There are a million stories in the naked city. This is one of them.” This was
followed, as I recall, by a very good televised play about some dramatic happening in the setting
of New York City—a city of people who, in this 21st century, have undergone a dramatic and
inconceivable degree of pain that has impacted much of the world's population and has destroyed
some of the world's notable artifacts. In paraphrasing the now prophetic words of that earlier
television drama, there are countless people everywhere with chronic pain. This paper presents
but a few of the many cases of this debilitating and disabling disease.
In summary, cross-cultural investigations of aspects of pain show that, while it a ubiquitous
condition of human beings, the definitions, descriptions, and perceptions of pain and pain control
are culturally specific. But the absolute bottom line is that pain and pain control are inner and
subjective experiences of the person who is in pain.
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References
1. Schwartz BH, Ewald RH. Culture and Society. New York: The Ronald Press Co.;
1968. [Google Scholar]
2. Good MJD, Brodwin PE, Good BJ, Kleinman A, editors. Pain as a Human Experience: An
Anthropological Perspective. Berkeley: University of California Press; 1992. [Google Scholar]
3. Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral,
and Public Policy Perspectives. Washington, DC: National Academy Press; 1987. [Google
Scholar]
4. Brihaye J, Loew F, Pia H. Pain: A Medical and Anthropological Challenge. New York:
Springer-Verlag; 1987. [Google Scholar]
5. Kleinman A. Social Origins of Distress and Disease. New Haven: Yale University Press;
1986. [Google Scholar]
6. Kleinman A. The Illness Narratives: Suffering, Healing, and the Human Condition. New
York: Basic Books; 1988. [Google Scholar]
7. Kleinman A. Rethinking Psychiatry: From Cultural Category to Personal Experience. New
York: Free Press; 1988. [Google Scholar]
8. Oknuki-Tierney E. Illness and Healing Among Sakhalin Ainu. Vol. 49. Cambridge:
Cambridge University Press; 1981. [Google Scholar]
9. Payer L. Medicine and Culture: Varieties of Treatment in the United States, England, West
Germany, and France. New York: Henry Holt and Co.; 1988. [Google Scholar]
10. Galanti GA. Caring for Patients from Different Cultures: Case Studies from American
Hospitals. Philadelphia: University of Pennsylvania Press; 1992. [Google Scholar]
11. White L. The Evolution of Culture. New York: McGraw-Hill; 1959. [Google Scholar]
12. Melzack R. The Puzzle of Pain. New York: Basic Books; 1973. [Google Scholar]
13. Melzack R. Phantom limbs, the self and the brain. Canadian Psychology. 1989;30:1–
16. [Google Scholar]
14. Melzack R, Torgerson WS. On the language of pain. Anesthesiology. 1971;34:50–
59. [PubMed] [Google Scholar]
15. Haviland WA. Cultural Anthropology. 5th ed. New York: Holt, Rinehart and Winston;
1987. [Google Scholar]
16. Sargent C. The Cultural Context of Therapeutic Choice: Obstetrical Care Decisions Among
the Bariba of Benin. Boston: D. Reidel Publishing Co.; 1982. [Google Scholar]
17. Chagnon NA. Yanomamo: The Fierce People. 2nd ed. New York: Holt, Rinehart and
Winston; 1977. [Google Scholar]
18. Heider CG. Dugum Dani: A Papuan Culture in the Highlands of New Guinea. Chicago:
Aldine Publishing Co.; 1970. [Google Scholar]
19. Heider CG. Dead Birds: The Dugum Dani of Highland New Guinea [motion picture] Fort
Worth: Holt, Rinehart and Winston; 1991. [Google Scholar]

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