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33.1.Scullin

Hippocratic authors almost always approach pain as an objective phenomenon as real as–and often synonymous with–not only the symptoms of disease, but even disease itself. Throughout their treatises pain is regarded as scientific fact,as material as sediment in urine and as visible as blood from a wound. This paper focuses, however, on the seeming exceptions to this rule–those few places where pain seems to be deemed a subjective experience–as a way of giving shape to the Hippocratic notion of “objective pain.”

This paper thus functions as a telescopic introduction to the larger notion of the objectivity of pain in the Hippocratic Corpus–a feature of pain that modern scholarship has assumed (e.g. Rey,Horden, King, Marzullo, Villard), but rarely discussed. With the negative space around this issue highlighted, then, its form gains definition.

Of these outliers, the most striking (for its absurdity, if nothing else) is the following description from Epidemiae 6of a tricky treatment: “If a patient has pain in the ear,twirl wool around your finger and pour warm fat on it, then put the wool in the palm of your hand and move it underneath the ear so that the patient thinks something is coming out of it. Then throw the wool upon the fire: a deceit,” (Ἢν οá½–ς á¼€λγέῃ, εá¼°ρίονπερὶ τὸν δάκτυλον ἐλίξας, ἐγχέειν ἄλειφα θερμὸν, á¼”πειτα ἐπιθεὶς á¼”σωἐν τá¿· θέναρι τὸ εá¼°ρίον ὑπὸ τὸ οá½–ς ἐπιθεá¿–ναι, ὡς δοκέῃ τί οá¼± ἐξιέναι, á¼”πειτα ἐπὶ πῦρ ἐπιβάλλειν· á¼€πάτη, Hippocrates Epidemiae 6.5.7. See Manetti and Roselli 1982 on the authenticity of this passage). While this passage has been adduced in reference to the theme of deceit in the Hippocratic Corpus (King 1998), or included under the heading of “courtesies owed by the physician to the patient” (Jouanna 1999, 133-134), it has not figured in discussions about Hippocratic notions of pain. This omission is glaring, as this “trick” in particular points to a belief in what might today be called “psychosomatic” pain.

However, “psychosomatic”is not quite the right term to describe these types of pain. After all, throughout Hippocratic medical theory the humors within the body are shown to be in symbiosis with–or even the same as–the stuff of the soul. Rather, what is revealed in all of these exceptions is a distrust in the perception–not the phenomenon–ofpain. A patient's perception of pain in the ear is a mirage that can be dissolved by a flashy pyrotechnic display; a woman's ability to properly recognize her own pain is called into question (e.g. Epidemiae 7.1.11.24),rather than the existence of the pain itself. Similarly, a doctor's ability to recognize and categorize a patient's pain (e.g.Prognosticon 3.14-16) is privileged over the patient's own knowledge of his body–not because the patient's perception of pain is less reliable, but because the physician's ability to recognize pain is more impressive. Finally, the remarkable notion of a pain that exists even though the patient doesn't feel or perceive it(e.g.epileptic patients are described as “pain-free in the face of pains,” á¼€νάλγητοί τε πρὸς τοὺς πÏŒνους, De Flatibus14.31-33) is adduced as a counter-example to these outliers in an effort to underscore the extensiveness of the objectivity of pain in Hippocratic thought.

In Hippocratic medicine, as in medicine today, the reality of the subjectivity of pain is perpetually at odds with the usefulness of pain as a diagnostic and prognostic tool (on the subjectivity of pain, see, e.g. Melzack and Wall 1988). Pain is subjective; medicine purports to be an objective science–or, better put, a science that deals with objective facts. Any medical approach that seeks to objectify pain will necessarily grapple with pain's inherent subjectivity. In fact, while these examples of subjective pain may stand out as glaring inconsistencies, it is only because they are rare–a rarity that I suggest is their most remarkable feature.

Bibliography

  • Horden, P., “Pain in Hippocratic medicine,” in: J. Hinnels and R. Porter, eds., Religion, health and suffering. London, 1999.
  • Jouanna, J., Hippocrates. Tr. M.B. DeBevoise. Baltimore, 1999.
  • King, H., Hippocrates'woman: reading the female body in ancient greece.London, 1998.
  • --------- “Chronic pain and the creation of narrative,” in: J. Porter, ed., Constructions of the classicalbody. Ann Arbor, 1999: 269-286.
  • Manetti, D. and A. Roselli, Ippocrate:Epidemie, libro sesto. Florence, 1982.
  • Marzullo, B., “Il 'dolore' in Ippocrate,” Quaderni urbinati di cultura classica 92 (1999), 123-128.
  • Melzack, R. and P. D. Wall, The challenge of pain. London, 1988.
  • Rey, R., History of Pain.Paris, 1993.
  • Villard, L., “Vocabulaire et représentation de la douleur dans la Collection Hippocratique,” in: F. Prost and J. Wilgaux, eds., Penseret représenter le corps dans l'Antiquité: actes du colloque international de Rennes, 1-4 septembre 2004. Rennes, 2006, 61-78.

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