as if ... visualizing pain

Deborah Padfield and Brian Hurwitz

All enquiries regarding the use of this material should be directed to Ms Deborah Padfield, 36 Chelsea Gardens, Chelsea Bridge Road, London SW1W 8RG. E-mail: dpadfield{at}tiscali.co.uk.

Pain has probably driven more people into the hands of doctors than any other symptom in human history.1 Recipes to dull its effects survive from the Roman period,2 and modern-day surveys reveal how prevalent pain remains. In the general population, 15–20% suffer from chronic pain, its prevalence showing a strong age, but little social class gradient.3,4 In very many medical contexts pain is under-treated.5–7

Depiction of physical and mental pain in Western art reflects its pervasiveness and association with moral retribution. Over more than two millennia, pictorial and sculptural depictions of screams, sighs, and tears have surmounted bodily contortions of all sorts: bending, writhing, twisting, and bleeding, often in the context of flagellation, flaying, attack, injury, damnation, and crucifixion.8 Pain as a state of ‘as if’—as if punishment, compression, burning, stabbing, bruising, and tearing—has been a dominant theme in its visualization. Yet few images of pain have been produced by sufferers themselves or have focused on the actual sensations experienced.9,10 These images begin to correct this deficit.11

These photographs are part of a collection resulting from a collaboration between artist, Deborah Padfield, Consultant Pain Specialist Dr Charles Pither, and patients undergoing residential treatment at the St Thomas’ Hospital INPUT Pain Clinic in London. Patients were offered the opportunity to explore and co-record their experiences of pain with a professional artist and to use a selection of the images produced in subsequent medical consultations.


‘I can’t feel the flesh properly, it is as if it were not alive, as if it had been turned off in some way.’

‘It is very deep, not just the surface. It is as if it had turned to cloth ... it is more a difference in feeling—the wrong feeling. It is about a loss, a lack.’

Through this process people in pain were encouraged to project the private sensations and experiences of pain—its associations, intensities, qualities, and significance—outwards on to the publicly accessible surfaces of canvasses and photographic plates, rather than inwards towards anger, despair, and isolation.12 Their images demonstrate the need of sufferers to feel understood by others, particularly by those treating them. They assert the desire to communicate and to gain control over the process of individual pain.13

In gaining help and understanding, visualization can complement words, counting, and measurement. Visual images may also provide a more easily shared reference point from which to begin dialogue.


‘I have always found it hard to explain my pain to doctors. You have to explain it to them so that they can understand it, and it doesn’t matter how often you try to explain it to them, they still don’t understand. This is a wonderful idea.’

‘I had people not believing me and so I became very depressed and self-harmed.’

‘I see a huge rubbish tip that has mounds of rubbish on it. It feels as if there comes a point in my pain where things are under control and suddenly someone dumps a whole load of rubbish on it. It can be other people’s rubbish ... it can be a change of medication.’




‘It is not just my body that is overwhelmed, it is my consciousness. It is as if my brain is actually being swamped, and that is the part that I resent—that I totally lose control.’

‘When you have pain you are stuck in a dark cocoon and you suffer in your own darkness. Pain = Evil; Evil = Darkness; Darkness = Pain.’

‘There is another me, all around, rather like an aura. That is the pain and is what I am continually fighting to get out of ... I think possibly I am battling with my own mind.’


    Acknowledgments
 
Photographs by Deborah Padfield with Nell Keddie, Helen Lowe, John Pates, Robert Ziman-Bright, and Rachel Brooks. Copyright: for images—Deborah Padfield; for text—Brian Hurwitz. The full collection of images and testaments with additional texts by Professor Brian Hurwitz, Dr Charles Pither, and Deborah Padfield is available as Perceptions of Pain. Stockport, UK: Dewi Lewis Publishing, 2003. ISBN: 1-904587-02-X.

With thanks to: Dr Charles Pither, the staff and patients at INPUT Pain Managment Unit, St Thomas’ Hospital, Sciart for supporting the original research; Guy’s and St Thomas’ Charitable Foundation for supporting the exhibitions; and Novartis Pharma AG for supporting the publication.


    References
 Top
 References
 
1 Hurwitz B. Looking at pain. In: Padfield D. Perceptions of Pain. Stockport, UK: Dewi Lewis Publishing, 2003, pp. 7–13.

2 Carter AJ. Dwale: an anaesthetric from old England. BMJ 1999; 319:1623–26.[Free Full Text]

3 Blyth FM, March LM, Brnabic AJM, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain 2001;89: 127–34.[CrossRef][ISI][Medline]

4 Macfarlane GJ, McBeth J, Silman A. Widespread body pain and mortality: prospective population based study. BMJ 2001;323: 662.[Abstract/Free Full Text]

5 Larue F, Fontaine A, Colleau SM. Underestimation and undertreatment of pain in HIV disease: multicentre study. BMJ 1997;314:23–28.[Abstract/Free Full Text]

6 Mayor S. Survey of patients shows that cancer pain still undertreated. BMJ 2000;321:1309.[Free Full Text]

7 Charatan F. Doctor disciplined for ‘grossly undertreating’ pain. BMJ 1999;319:728.[Free Full Text]

8 Spivey N. Enduring Creation. London: Thames and Hudson, 2001.

9 Sacks O. Migraine: Evolution of a Common Disorder. London: Pan Books, 1981.

10 Spence J. Putting Myself in the Picture. London: Camden Press 1986. See also: The Picture of Health. Alternative Approaches to Breast Cancer (Exhibition) and Phototherapy. hosted.aware.easynet.co.uk/jospence/ (accessed 2002).

11 Padfield D. Perceptions of Pain. Stockport, UK: Dewi Lewis Publishing, 2003.

12 Berger J. Ways of Seeing. London: BBC and Penguin Books Ltd, 1972.

13 Scarry E. The Body in Pain. Oxford: Oxford University Press, 1985.





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