I didn’t really think about it until I saw them wheel one of the bodies out ahead of me, that that was going to be me, laying in the same position, not dead, but dead to the world. The procedure was described to me as something relatively simple, an endoscopy, from the Greek tendon meaning “inside” and skopein, meaning “to look”, a procedure during which the gastroenterologist would push a long flexible tube with a tiny camera mounted on it down my digestive tube and into my stomach to attempt to discover the root causes of my persistent heartburn, and see if there was any sign of the cell damage that can be a precursor to cancer. I was told that the procedure would involve an anesthetic, and it wasn’t until the day before that I felt some sense of giddiness and excitement at the thought that I was going to be knocked out, if only for a brief time. I have never had any kind of surgery, except for a few stitches here and there when out of clumsiness or distractedness I’ve cut myself. I do however have an interest in altered experiences and what can happen to the body and consciousness with the introduction of a foreign substance.
While numbing substances have been used in primitive surgical procedures since time immemorial effective anesthetics are a product of modernity and Western medicine. The Inca were highly skilled at a procedure called trepanation, used to treat disorders ranging from epilepsy to scalp diseases, which involved drilling a hole in the skull with silver chisels and obsidian knives. During the procedure the patient would chew on coca leaves to numb the pain, as would the Incan surgeon, spitting into the wound as the operation proceeded to numb the surrounding area. The Chinese used the plant henbane, which contains scopolamine, later isolated and extracted and found to have an amnesia-producing effect, partly blocking the memory of the pain of surgery.[1] Ether - called “oil of sweet vitriol” by the 16th Century botanist who found that the distillation of sulfuric acid and ethanol produced a substance whose vapors caused a dizziness and light-headedness - wasn’t used as a full body anesthetic until the middle of the 19th Century, when it revolutionized the potential of surgery and the medical exploration and treatment of the living body.
Surgery was a brutal affair before the discovery of an effective means of blocking pain during the course of an operation. A famous account by Fanny Burney, also known by her married name as Madame d’Arblay, captures a shadow of what she felt when she had a mastectomy in 1811 without anesthesia: “Yet - when the dreadful steel was plunged into the breast - cutting through veins - arteries - flesh - nerves - I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision - & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound - but when again I felt the instrument - describing a curve - cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator, who was forced to change from the right to the left - then, indeed, I thought I must have expired.”[2] The nervous system is a most exquisite and delicate structure that through a delicate and complicated filament transmits and receives signals through the entire body, but is for the most part not seen or observed, and secondary to the gross structures of the body: the visible parts like the skin, the eyes and the face, the hard parts like the skeletal structure and the skull, as well as the soft parts that are hidden behind the veil of the dermis, the stomach that growls, the heart that beats, its faint pulse felt in the surge of the veins. While not visible to the naked eye the system of long cells suffusing the tissue of the body is so ubiquitous that if somehow all the other structures of the body could be removed, “there would still remain in place a gauzy fabric of innumerable spidery cells and finespun fibers that would preserve completely in ghostlike form the original outlines of the body.”[3] It is a testament to the biological tenacity of living beings that an experience like that described by Ms. Burney would not simply overwhelm the organism, causing the heart to not just skip a beat but simply stop, giving the body some peace by finally ending its suffering. The capacity to endure pain is intrinsic to organisms, and one that human beings are fond of exploiting to social and political ends.
The UN Convention Against Torture (CAT) was first adopted only in 1975, when torture was defined as “…any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity.”[4] In my research for this piece I was surprised to learn that it was so late that the CAT was first adopted, but upon reflecting on the long and torturous history of the wars of decolonization that preceded the adoption of the CAT, I presume that the Western and Northern nations that most strongly affect the programme of the United Nations figured that they had dispensed of the need for the primary tool of the torturer - the deliberate infliction of pain as a method of political control - and so felt ready to make a soft agreement enjoining them from its official use.
In her magisterial study “The Body in Pain” Elaine Scarry analyses the intrinsic language inherent in the relationship between the torturer and tortured, wherein the victim is, through a series of questions, gestures, and violent acts reduced to nothing other than a thing that experiences pain. The author reflects on the totalizing nature of pain, the way that extreme physical pain obliterates the world and language, blurring the distinction between inside and outside, public and private.[5] She is amazed at the body’s capacity for pain, showing that the sensation of pain commands a “…mastery of the body….suggested by the failure of many surgical attempts to remove pain pathways because the body quickly, effortlessly, and endlessly generates new pathways.”[6]
In signing the UN Convention Against Torture, the United States committed itself to forgoing the infliction of intense pain in the course of any form of official interrogations, and in the Geneva Conventions, signed in 1949, the United States committed itself to certain basic treatment of prisoners of war, civilians, and casualties of international conflict. The Army Field Manuals published after 1949 lay out methods of interrogation that explicitly avoid and deter the use of force and the infliction of pain in the course of interrogations, specifically enjoining interrogators from engaging in actions where they believe that the detained person’s rights under international law may be violated.[7] After September 11th, and the launching of the War on Terror, the official restraints on torture were jettisoned, partly through legal maneuvers such as labeling people captured as “enemy combatants” rather than soldiers, excluding them from the Prisoner of War (POW) provisions of the Geneva Conventions.
In 2006 the Center for Constitutional Rights published a report on the detention center at Guantanamo Bay, Cuba, where accounts of numerous detainees tell of the systematic use of torture, not simply the much debated techniques of waterboarding, extreme humiliation and other degrading treatments that inspire panic and the fear of death in the subject, but also the simple infliction of pain that has been the basic tool of torturers since the dawn of organized human communities. Mustafa Ait Adir has his body thrown against the steel bed in his cell, his head is smashed against it repeatedly, a chain around Mr. Al Dasir’s stomach is pulled so tightly it makes him vomit, Omar Deghayes is beaten in the abdomen until his stomach ruptures, he is refused medical care.
As I write this I want to think about my own body and my own experiences of pain, all of them minor nervous system events compared to the great pains of survivors of torture and abuse, terrible accidents, great fires, and consuming disease. I will imagine it possible to offer up my own minor pains as pale shadows of great suffering, like a vaccine to inoculate all the sufferers of severe pain the world over. I invite the reader to imagine their own body as I write, hoping that you are not now experiencing any significant physical pain, but asking you to gently recall all the offenses against your bodily integrity that have occurred, stimulating the neural pathways in your body to indicate pain. I see myself stretched out, floating on a cloud against a sky-blue background, and try to conjure my dim recollection of childhood scrapes. I remember running and falling, scraping the palms of my hands against a gravelly surface, the shock of the abrasions on my rough palms. I recall running into a post as a kid playing tag, not looking ahead of me, but behind at my pursuer, whacking into the metal structure of the swing-set; I remember the pain in my head, the tenderness of my soft skull. I remember the first time I was hit by the police at a demonstration, fifteen years old and trying to un-arrest someone, getting hit in the head by a rubber truncheon and seeing stars, blacking out for a moment as I ran away. I remember cutting my fingers cooking, somehow I’ve done it more than once, the quick and sharp sensation as the knife slices through the skin into the meat of the finger, the stitches; I have slight scars and somehow must have severed the nerves as my fingers are still numb and tingly years later. I am fortunate to never have suffered from migraines, as I recall with a dim wince the few times that I have suffered a headache, from dehydration or hangover, the terrible throb and pounding inside the skull. I have always found internal pains to be more disturbing than external, I can handle the violations of skin fairly well, but wince at recalling the internal pain of heartburn, as the stomach acids leak into my esophagus and the nerve endings are stimulated by the shock of the cells. Then there are the emotional pains; while I am privileged by gender and social position to have avoided the violation of rape or the witnessing of war or other great violence, I know the shadow pains and struggles of emotional malaise.
The study of trauma began with the study of hysteria; in the early 20th Century the French neurologist Charcot studied the condition of female “hysterics” in the sprawling asylum of Salpetriere on the outskirts of Paris. Charcot mounted weekly salons where he discussed his ideas about hysteria and presented his patients, who fulminated and writhed upon the stage. By submitting to rational inquiry the conditions of women previously regarded as subjects of demonic possession Charcot demystified the condition of hysteria by closely observing his patients to identify common symptoms and patterns of expression. His salons attracted the intelligentsia of Paris as well as the scrutiny of visiting physicians and practicants of the embryonic discipline of psychiatry, including Sigmund Freud, who traveled from Vienna to observe Charcot’s treatment of female hysterics. Freud took up the study of hysterics, using the “talking cure” promoted by his collaborator Joseph Breuer, until he came to the conclusion, laid out in “The Aetiology of Hysteria” that the origin of the set of symptoms labeled as hysteria in the late 19th Century almost invariably arose from the trauma of childhood sexual abuse.[8] This finding, that there was rampant childhood sexual abuse in the upper-class households where his hysteric subjects came from, was too much for bourgeois society at the time to absorb, and Freud ended up repudiating his theory in order to maintain some professional respectability.
Trauma and pain are intimately related, although traumatic events do not necessarily have to involve physical pain, as they can also be triggered by experiences that induce a biological response wherein the organism reacts to a stimulus perceived as threatening imminent death. Events that can trigger survival related responses at the level of the nervous system can include sexual assault, witnessing murder, violence or dismemberment, and captivity; soldiers who at times are the perpetrators of torture, violence and murder can also suffer the long-term effects of trauma. Waterboarding, dating to the Spanish Inquisition and frequently practiced by the Cambodian regime of Pol Pol, is the practice of covering a prisoners mouth with a cloth and pouring water on their face, mimicking the sensation of drowning and provoking the fear of imminent death. The technique was used by the US Government on “high-value” detainees in the course of interrogations after September 11th . The infamous Bybee Memo, issued by the office Attorney General Alberto Gonzalez in 2004 to provide legal cover for existent CIA practices and later repudiated by the Bush Administration in 2006, sought to narrow the legal definition of torture as “equivalent in intensity to the pain accompanying serious physical injury, such as organ failure, impairment of bodily function, or even death.”[9] This definition fails to capture the true nature of trauma, which is an affliction of a nervous system that has been stimulated into a defense response provoked by a perceived threat of annihilation.
Some scholars studying trauma perceive trauma responses as governed by a complex relationship between the layers of the nervous system, the parasympathetic, which governs social interaction and the higher orders of the cognitive mind, and the sympathetic, which governs gross body response and basic instincts. The polyvagal theory of trauma locates trauma response in the autonomic nervous system, proposing a cascade of responses to trauma where first the part of the nervous system that governs social engagement is overwhelmed, then the part that governs the fight/flight response, and finally, in cases of severe and persistent trauma, the freezing response provoked in organisms that are about to be consumed by a predator is stimulated, the body goes slack and slumps into an immobile state.[10]
Opossums are the only North American marsupials, able to carry up to 13 young in their ventral pouches, ambling along slowly in the dark they try to avoid trouble. When attacked they have the habit of “playing possum”, their bodies going into a state of hypo-arousal mimicking death, their breathing slows, their bodies stiffen, they even secrete an oil from an anal gland that makes them smell like death. A few hours later, after a period of shock and immobility, an opossum that has been rejected as a midnight snack due to its performance as unpalatable carrion can get up, shake off its state of immobility and move on in its evening ramble. While extreme, this is not unlike the immobility response that happens in other animals, including human beings, faced with the threat of imminent death. The body retreats into a trance state, near but not quite dead, ready to be subjected to the final insult of annihilation, or, if lucky, prepared to wake up from its ruse when the danger has passed and run off at the earliest opportunity. Several theories locate the biological source of traumatic responses in the freezing response that is natural to all orders of animal. However, for animals the persistent symptoms of trauma are unusual, from invertebrate jellyfish, pulsing through the ocean currents, to the higher animals like bears or chimpanzees. Rare instances of animals exhibiting the symptoms of trauma are generally associated with domestication, captivity or prolonged stress induced in laboratory experiments.[11] Peter Levine’s theory of trauma suggests that traumatic response is the result of the functioning of the neo-cortex, the part of the human brain that governs our advanced intellects and the capacity for negotiating the complex social structures that make us the dominant species on the planet. As a first step towards recovery from trauma Levine rejects some of the tenets of traditional approaches to trauma, recommending avoiding the details of the traumatic event, rather his approach focuses on the recuperation of the body and the enhancement of the felt-sense, the elemental awareness of the individual organism that is the foundation of human experience.
It seems a simple thing, basic body awareness, but I think that human beings tend to tune out our environments and our own bodies. We all know the moment when we notice that our shoulders are impossibly tensed and wonder for how many minutes or days that we have been walking in a cramped posture, the tension in our backs or bellies a physical expression of a mental cramp, a literal and figurative narrowing of our vision. Cultural anthropologists engaged in the study of indigenous peoples who maintain pre-urban, nomadic, or hunter-gatherer lifeways notice a tendency towards the perception of a reciprocal relationship between individuals and their environment, and a deep understanding of the felt-sense described by Levine, extending a continuous field of perception from the interior of the body out to the encompass the whole of the physical environment.[12] For indigenous peoples the necessities of maintaining their precarious existence require an intimate relation with the world and with their own bodies.
When I went into the operating room for my procedure I was surprised that they had me keep all my clothes on, even my shoes; I had to remove my coat and put a surgical gown on over my clothes, which struck me as an unnecessary formality. I lay on my side and watched as the anesthesiologist slid the needle into the vein on the inside of my elbow. I have great veins for injection and no fear of needles so I watched the needle as it punctured the vein. A large syringe filled with a milky fluid was attached to the tube connected to the needle. The doctor had previously told me that she would be using propofol as an anesthetic; she said it with a bit of wink, “like Michael Jackson.” I remembered reading about the trial of the doctor who had supplied Jackson with propofol, injecting it so he could finally sleep and find some respite from the existence of an eccentric and international superstar, specifically recalling that Jackson had called it “milk” when he begged his doctor for it, like a toddler reaching for a reliable comfort before drifting off to sleep. The doctor asked me to lie on my side for the procedure, the anesthesiologist pressed down the plunger on the syringe. I remember the taste of it in my mouth, as the chemical coursed through my bloodstream, and then nothing, a darkness and the afterimage of a dream.
[1] A Short History of Medicine, F. Gonzalez-Crussi, Modern Library, 2008
[2] http://www.mytimemachine.co.uk/operation.htm, Source: Selected letters and Journals, edited by Joyce Hemlow, (Oxford University Press, 1986)
[3] Biology of the Vertebrates, Herbert E. Walter, Macmillan Company, 1940, p.661
[4] UN Convention Against Torture And Other Cruel, Inhuman or Degrading Treatment or Punishment, http://www.hrweb.org/legal/cat.html
[5] The Body in Pain: The Making and Unmaking of the World, Elaine Scarry, Oxford University Press, 1985
[6] The Body in Pain: The Making and Unmaking of the World, Elaine Scarry, Oxford University Press, 1985, p.55
[7] Report on Torture and Cruel, Inhuman and Degrading Treatment of Prisoners at Guantanamo Bay, Cuba, Center for Constitutional Rights, July 2006
[8] Trauma and Recovery, Judith Herman, Basic Books, 1997
[9] Memorandum for Alberto R. Gonzalez, Counsel to the President, Jay S. Bybee, Assistant Attorney General, US Department of Justice, August 1st, 2002, downloaded from: http://news.bbc.co.uk/nol/shared/bsp/hi/pdfs/23_06_04_aug02bybee.pdf
[10] Trauma and the Body, Ogden, Minton, Pain, V.W. Norton, 2006
[11] Waking the Tiger: Healing Trauma, Peter Levine, North Atlantic Books, 1997
[12] Spell of the Sensuous, David Abrams, Vintage Books, 1997
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