There have been hundreds of books published in the last decades on pain and its management, but none that combine memoir, scholarly research and journalistic reportage in the way Ms. Thernstrom, the author of two previous books, does. A stellar example of literary nonfiction (parts of which first appeared in The New York Times Magazine), the book recounts the author's own years with chronic pain and the preconceptions she brought to it (including the idea of pain as the price for romantic love); summarizes its social, cultural and medical history; and gives us a reporter's view of state-of-the-art treatment.
The book has a patchwork quilt structure: more than one hundred small captioned patches (or dispatches), organized into five parts and threaded with personal narrative. This invites differently motivated readers to skip or skim. You can chuckle over the aperçus of poets and philosophers like Aristotle, Coleridge, Dickinson, Sontag, and Foucault in the section entitled "Pain as Metaphor." You can become absorbed, as I was, in the fascinating struggle over the use of anesthesia (and, later, opiates) in "Pain as History," or play voyeur during absorbing clinical vignettes of "Pain as Disease."
Ms. Thernstrom begins with the transformation of the centuries-old mystical disease of consumption, which, in 1882, was finally revealed to be caused by a bacterium. As a result, consumption became tuberculosis — not a curse, not a character weakness, but a disease. Chronic pain, Ms. Thernstrom writes, is currently in the same state of transformation, and because she suffers from an arthritic condition that ranges from irritating to incapacitating, she is bent upon learning the state of the medical art.
She dates the onset of her chronic pain to the day she falls in love with a young academic, the least compellingly drawn of the large cast of characters we meet. They go swimming, and that night she feels an unpleasant burning sensation spread from her neck to her right shoulder, down her right arm to her hand. At first she sees it as "a pointless ache in my neck and shoulders, which I dimly attributed to a structural weakness in my body"; once she realizes that it is chronic, she compares it to "a sour domestic partner — intimate and ugly; a threatening, dirtying, distracting presence, yet one who refused to move out."
A magazine assignment steers her to what became a kind of narrative therapy, a meditation on pain as seen by art, literature, philosophy, religion and science.
Except for a reference to her favorite grandmother, a Christian Scientist, Ms. Thernstrom tells us little of her family's attitudes toward pain. We do, however, reap the rewards of her lifelong prodigious reading, as she investigates the cultural connotations of pain, from the etymology of the word in various languages to its interpretations.
Throughout her narrative physicians are both villains and heroes. Ms. Thernstrom gives us glimpses of the mid-19th-century men (Dr. Henry Bigelow: "Our craft has, once and for all, been robbed of its terrors") who discovered or recognized the efficacy of ether and chloroform, and the surgeons who, at first, opposed their use (Alfred Velpeau: "To escape pain in surgical operation is a chimera").
There are mini-profiles of 21st-century doctors on the frontiers of neurobiology; placebo researchers; and pain specialists who allowed her to sit in on their sessions with patients and interview them afterward. And there are many patients, often eloquent chronic pain sufferers, whose stories complement and contextualize her own.
Although some of them discuss massage and acupuncture, Ms. Thernstrom gives these treatments short shrift and evinces little interest in how Eastern medicine addresses pain. Nor does she provide a judicious evaluation of psychotherapy; she refers to an early "psychoanalysis session, " and doesn't return to the subject. Physical therapy reminds her of dating: "small, futile-feeling gestures that require faith to believe they will eventually lead you somewhere."
But memoir is a subjective form that chooses its own territory and doesn't claim to cover all the bases. What counts is the narrator's voice, interests and sensibility. Melanie Thernstrom is such an engaging and intelligent writer that I remained intrigued with her investigation even as I disagreed with some of her reportorial choices. I cheered as she disentangled romantic from physical pain and found a caring partner. I was dismayed to discover that she found no remedy and that, for the time being, she and millions of others will continue to suffer from chronic pain.