Nonfiction review: 'The Pain Chronicles' by Melanie Thernstrom

pain.JPGView full sizeThe Pain Chronicles by Melanie Thernstrom
In "The Pain Chronicles," Melanie Thernstrom tells the story of a former train conductor who lost both legs and an arm in an accident caused by his multiple sclerosis. One day, his doctor finds him propped up in his hospital bed holding "Kitchen Table Wisdom," a book of medical stories, with his one remaining limb. "Hey Doc," he says, "Some of these people ... the way they cope -- it's incredible."

Why do some people stay resilient in the face of intractable pain while others despair? What is pain, Thernstrom asks, "sensation, emotion, or idea?" How does the body's alarm system turn into a "state of being unlike any other, a magic mountain as far removed from the familiar world as a dreamscape"?

"The Pain Chronicles" follows Thernstrom's personal and intellectual journey through these vexing questions. Her lengthy subtitle -- "Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering" -- is apt. She covers vast swaths of history, culture, religion and science in short, accessible and beautifully sequenced chapters. If you're one of the 70 million Americans who suffers from chronic pain or has witnessed others' suffering, this book offers an illuminating journey toward new vision and possible relief.

Thernstrom begins with links between pain, myth and religion in the "pre-modern world." Banishment from Eden brought consciousness and pain together; witches thrust arms into boiling oil to determine guilt or innocence; the Babylonians drilled holes in the skulls of migraine sufferers to release demons. The 19th-century discovery of disease pathogens transformed the paradigm. Biology liberated us from metaphor, the tuberculosis patient from the imprisoning romance of consumption. But there was a price: Science may explain the genesis but not necessarily the experience of pain.

Thernstrom describes contemporary views as a postmodern mix of biology and metaphor. In one of the book's most compelling examples, Thernstrom attends the Thaipusam festival in which Hindu pilgrims dance with weighted fishhooks hung on their pectoral muscles, free of pain. Neuroscientists explain their religious ecstasy as "stress-induced descending analgesia." Placebos similarly reveal the workings of both brain and mind. The shaman's chants and the sugar pill activate the brain in "neurologically indistinguishable" ways.

Thernstrom, who lives part of the year in Portland, has written with equal grace about difficult subjects in two previous books, "The Dead Girl" and "Halfway Heaven: Diary of a Harvard Murder." "The Pain Chronicles" began as an assignment on chronic pain for The New York Times Magazine, where Thernstrom is a contributing writer. She visited clinics all over the country, interviewing hundreds of patients and doctors. Throughout, she sought relief from her own mysterious ailment. Thernstrom's personal pain diary drives the narrative, a taut thread intertwined with her search for a meaningful relationship. The reader follows, fully engaged. We want to ask, as she does, "Why me? Why must I suffer?" The question is not self-pity but existential query.

We watch Thernstrom move toward greater happiness, deepened empathy with others and stronger pain management. The final pages of the book find her undergoing an advanced form of MRI. In real time, she watches the nerve cells in her brain fire and try to control pain. This astonishing use of "the magic of science to see the science of magic" may propel us toward managing, if not conquering, chronic pain. Yet for all the scientific illumination the book offers, the reader is left to ponder unanswered questions. Watching a brain scan does not reveal consciousness or the Hindu pilgrim's ecstasy. Perhaps the ultimate questions are only accessible through metaphor and story, the primary tools Thernstrom returns to in her final chapter.

-- Joanne B. Mulcahy

Reading: Thernstrom discusses "The Pain Chronicles" at 7:30 p.m. Tuesday at Powell's City of Books, 1005 W. Burnside St.

Melanie Thernstrom 
Farrar, Straus and Giroux
$27, 384 pages