On June 15, 2020, just three weeks after the murder of George Floyd and the massive global protests that followed, the New Yorker published a commemorative poem by Terrance Hayes. “You can be a bother,” the poem begins, both accusing the reader and seemingly voicing accusations against Floyd, “who dyes / his hair Dennis Rodman blue / in the face of the man kneeling in blue / in the face of the music of his wrist- / watch.” The words tumble out: between the “unarmed brother ground down” and “the wall street people,” between the “bullet . . . that kills” and those “bored to death”—both “means of killing / time.” Pitting the flow of enjambments and their unexpected syntax against the line breaks’ implied grammar, each line or couplet insists on at least two if not three different readings, refusing to settle meaning, subject, or scale, as the poem careens toward the final lines:

of the truck transporting Emmett
till the break of day Emmett till
the river runs dry your face
the music of the spheres
Emmet till the end of time

Even as Hayes’s poem cries out against the individual pain Floyd suffered and joins the chorus of grieving voices that his death called forth, the lines steadfastly refuse to resort to the language of pain or to represent its event. Rather, “George Floyd” illustrates Hayes’s wariness of representing Floyd’s pain, ubiquitous as it already was that June, as well as the difficulty of doing so. Instead, Hayes synecdochally suggests this pain and obliquely connects us to it through the wristwatch, “brother ground down,” “blue / in the face.” Yet these components of the event of Floyd’s torture are, the poem underscores, anything but singular, interchangeable as they fatally are with other familiar images of the violence exercised against Black bodies. Powerfully, the poem’s most direct representation of Floyd’s pain surfaces in the culminating repetition of “Emmett till,” which at once conjures the indelible image of Emmett Till’s body in the reader’s mind with its testament to the pains of brutality suffered and, in the lower case “till,” past, present, and future pain—in fact, “till the end of time.” And, once more, Hayes does so without describing pain at all, indexing it instead through the strategic positionings of the name/phrase “Emmett till” echoing across the poem’s closing lines—that is, through versification, syntax, and grammar.1

We begin with this gut-wrenching elegy because it articulates the urgency of (re)evaluating pain after 2020, in a world remade by the murder of George Floyd and the COVID-19 pandemic. Both drew new attention to the structural dimensions of individual pain. In the case of COVID-19, pain was rendered insistently, and paradoxically, individual—a global catastrophe presented time and again as personally painful, thus eliding discussions of structural changes. With legal and ethical regulations limiting the circulation of images of bodies in pain, only those with intimate knowledge of the COVID wards had direct access to the cumulative pain the pandemic exacted.2 Conversely, images of George Floyd’s body in pain were everywhere, but his pain—unlike that of so many murdered Black men and women before him—was adamantly connected by Black Lives Matter (BLM) protestors to its structural causes, making systemic racism, structural racism, and white supremacy household phrases.3 Though by no means unprecedented or unacknowledged—especially by Black scholars and the Black community—the pain wrought by police violence had been too long rendered individual, BLM protestors argued, and thus too often silenced. Hayes’s poem speaks directly to the inextricability of the manifold scales of pain that came into view so forcefully in 2020, precisely by refusing the individual and the structural as either/ors of pain’s articulation, just as his unpunctuated twenty-nine-line poem resists the idea of pain’s boundedness. Like Hayes, we are interested in the entanglements of pain across scales—ontological, epistemological, phenomenological, linguistic, aesthetic, social, cultural, political, and historical.

At the same time, both Floyd’s murder and the COVID pandemic moved two other underappreciated aspects of pain to the fore: pain’s multiplicity—that the word pain describes not one but a group of distinct states—and the limitations of biomedical accounts. Police violence and COVID-19 were cast as “twin pandemics,” in the phrasing of the day, but the pains resulting from structural racism—the eight-minute asphyxiation from a knee, the slow violence endured by epidemiologically vulnerable populations—were distinct, thus highlighting the damaging collision as well as the fundamental differences between epidemic contagion and endemic, or chronic, racism in the United States—what W. J. T. Mitchell (2021: 377–78) calls the “dis-analogy between the virus and racism,” that is, the imbrication and compounding of nonidentical pains.4 Furthermore, the BLM protests urged the nation to ask whether white Americans could truly understand Black pain. While the virus-wrought pains of the pandemic might seem more easily captured by biomedicine, biomedical explanation was precisely what was most difficult in the early months of the pandemic. Doctors struggled to know the virus, how it wrought its damage, or what might alleviate the pain of those dying horrible deaths. Caught flat-footed, the US biomedical establishment took extraordinary steps to reimagine its ways of knowing: healthcare workers tried therapies before they were formally tested; researchers greenlit vaccines early for human testing; and scientific knowledge was organized around studies published digitally while they awaited peer review.5

Not two months after Floyd’s murder and four months into the COVID-19 pandemic, the global healthcare community adopted a new definition of pain, in a fortuitous, though retrospectively fitting, response to the increasingly widely felt inadequacies of previous ways of understanding pain.6 On July 16, 2020, a task force created by the International Association for the Study of Pain (IASP) redefined pain for the first time since 1979. This new definition included a number of changes, but among them was an untethering of pain from “actual or potential tissue damage” toward “sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage” (Raja et. al. 2020: 1976, emphasis added). Such a definition recognizes pain’s multiplicity, freeing it from the requirement to be grounded in an identifiable biological cause. Additionally, the IASP’s findings and the community response to the proposed shifts made manifest, as COVID and the BLM protests did too, the necessity of understanding pain across scales and of imagining new ways of knowing to apprehend the full complexity of its “biopsychosocial” dimensions (Raja et. al. 2020: 1979). Finally, the IASP’s new definition, we note, explicitly draws on a humanistic understanding of pain and emerged in consultation with humanities scholars to account for the “philosophical and linguistic underpinnings” of the definition of pain—an insight to which we will return (Raja et. al. 2020: 1979).

This constellation of concomitant events prompts us to recognize what may well be a paradigm shift in the broader cultural understanding of pain after 2020. And, since criticism can only ever be written in its own moment, we must now ask: how are we to understand pain in light of that shift and what roles might literature and literary criticism play? By calling what we observe a paradigm shift, we do not mean that such insights were unavailable or unarticulated before 2020. Most notably, activists, thinkers, and scholars from minoritized communities had indeed long worked to alert us to the multiscalar, entangled dimensions of pain illustrated, for example, in Hayes’s poem. Nevertheless, the broader cultural understanding of pain has fundamentally shifted since 2020 in ways that bear reckoning. There are three elements of this shift. The first underscores pain’s multiplicity. COVID, BLM, and the biomedical redefinition of pain all insist that pain is not one thing but multiple, irreducible to a single core quality; even the act of definition reveals the singularity of pain’s nature and experience to be primarily a linguistic convention, however difficult the pluralities may be to disentangle. The second aspect of this paradigm shift is the recognition of the simultaneity and connectedness of the different dimensions of pain. That is, the at-once-ness of the individual and the structural, the psychological and the political, the biological and the historical. It is from this second observation that we can begin to grasp the third dimension of the shift: a broader insistence on the necessity of nonempirical ways of knowing pain that can articulate the intertwined dimensions of pain across different scales, as well as its plural nature. The humanities—and particularly literary studies—are well-suited to illuminate these nonempirical ways of knowing pain, as the essays in this special issue bear out. Through its careful attention to questions of representation and resemblance and through its ability to describe both pain’s multiplicity and its irreducibility across scales, literature provides crucial forms through which to depict pain; in turn, literary analysis, with its keen ability to read those forms and capture those aspects of pain, provides essential methods for understanding pain’s newly salient complexities.

The Nature and Scale of Pain

In her 2005 creative nonfiction essay “The Pain Scale,” Eula Biss unpacks how chronic pain disrupts the clinical idea of a simple quantification of pain. Taking her title from the clinical pain scale—an enumeration from 0 to 10 intensities of pain or 0 to 6 faces of emotional response offered to children—she nevertheless challenges the efficacy of scales, numerical or otherwise, to account for her pain by foregrounding ironically the formal promise of a straightforward calculus that her chronic condition and her careful prose consistently muddle. Through the lens of chronic pain, Biss reveals the problem of pain to be fundamentally irreducible, mushrooming rather than distilling through efforts to define it. Attempting to understand what “3” means, for example, Biss endeavors to set limits on her inquiry: “‘You are not meant to be rating world suffering,’ my friend in Honduras advises. ‘This scale applies only to you and your experience.’ This thought unburdens me of factoring the continent of Africa into my calculations,” she decides, even as her turn to advice from Central America provocatively undoes the very boundedness of her formulation (Biss 2005: 28).

Biss thus anticipates what some healthcare practitioners have very recently identified as central to the IASP’s redefinition. Working to translate the 2020 definition of pain into practice, Kathleen A. Sluka and Steven Z. George highlight the multiscalar nature of pain as key to clinical application in the practice of their own fields of physical therapy and rehabilitation science to improve patient care. As they write, the new insistence that pain is “always a personal experience . . . influenced . . . by biological, psychological, and social factors” fundamentally changes biomedical understandings of the nature of pain (Sluka and George 2021: 2). “The ‘always’ is a key part of this note,” they reflect, “as it indicates that these influences are an embedded, integrated part of the pain experience. In other words pain cannot be separated into biological, psychological, OR social components, but rather pain always encompasses biological, psychological, AND social components” (2, original emphasis).

As Biss’s essay suggests, writers and cultural critics have long been at work on such problems. In her foundational book The Body in Pain (1985), Elaine Scarry explains how pain is at once represented as universal (and thus aspirationally legible through a common scale) yet often experienced as isolating and individual. Since then, we have learned from historians how pain is historically contingent and “always reshaped by a particular time, place, culture” (Morris 1991: 6; see also Halttunen 1995; Wailoo 2014, 2016); from anthropologists how the very concept of pain as a distinct, individual experience is culturally specific and can be limiting and flawed (see Livingston 2012; Asad 2003); and from disability studies scholars how pain is “leaky” and porous (Patsavas 2014).7

In fact, it is writers and scholars whose keen observations and analysis lead our developing understanding of pain where biomedicine has only later followed. Here we must particularly underscore the work of Black writers, critics, and activists who, like Hayes, have relentlessly implored us to understand the multiscalar entanglements of pain as a way to grasp its multiplicity and to begin reckoning with the distinctiveness of its experience, especially for different communities. Debra Walker King (2008: 6), for example, draws our attention to the distinctiveness of what she calls blackpain, or the “overwhelming presence of black bodies in pain” in US history and culture beginning in the nineteenth century, which has gone hand-in-hand with the centuries-long cultural and biomedical denial of individual Black Americans’ pain.8 This demonstrates, as Saidiya V. Hartman (1997: 51) succinctly puts it, that “pain must be recognized in its historicity and as the articulation of [social conditions].”9

How, then, might we heed Hartman’s call anew in the wake of 2020? One answer might be to extend the current understanding of individual pain as irreducibly biological, psychological, and social further to consider the structural dimensions of pain, and particularly the way this entangled structural dimension underwrites the range of different kinds of pain across lines of race, class, gender, sexuality, and ability, as well as biology.10 Jasbir K. Puar’s (2017: xiii) distinction between disability and debility offers a useful heuristic: debility “foregrounds the slow wearing down of populations instead of the event of becoming disabled. While the latter concept creates and hinges on a narrative of before and after for individuals who will eventually be identified as disabled, the former comprehends those bodies that are sustained in a perpetual state of debilitation precisely through foreclosing the social, cultural, and political translation to disability.” Might not one of the lessons of George Floyd’s murder then be, pace Hayes, that pain can itself be a category of political privilege? In this post-2020 world, we invite readers to ask whether certain kinds of pain and the benefits that attend pain (treatment, work relief, political action) are, in certain times and places, not simply unheard or unheeded but structurally unavailable to particular populations.11 The US opioid epidemic, to give but one example, has been cast as an overwhelmingly white phenomenon in no small part because Black patients are less likely to receive prescription painkillers than white patients for the same conditions (e.g., Meghani, Byun, and Gallagher 2012; Morden et al. 2021).12

One way to understand the distinct experiences—perhaps even ontologies—of pain across race might be through Jennifer C. James’s description of the Black experience of COVID-19. White responses to national trauma usually figure a “before” and an “after,” James observes, but for the Black community, the pain wrought by the COVID pandemic surfaced instead “a familiar question: ‘How does it feel to wake up each morning to the fact that your people are dying?’ . . . the deaths are still occurring at a disturbing pace. Those deaths have happened before” (James 2020: 691). What James teaches us is that the instances of pain caused by and associated with the COVID pandemic were not experienced as “novel” or “unprecedented,” as we so often heard, for the Black community; rather, this pain was experienced as “familiar”—a grim continuity. If “each lost life comes like punctuation at the end of a death sentence, a Black life again sentenced to death . . . the sentence is a never-ending one . . . happening now, as a result of the ongoing, slow violence of environmental racism, impoverishment, mass incarceration, unequal access to health care and other, innumerable structural inequalities, which have only made the virus’s terrible work easier and more lethal” (691). James’s sobering account of Black pain during the COVID pandemic both resonates with Christina Sharpe’s (2016: 10) description of the specific Black pain experienced in “always living in the push toward our death” and also uncannily echoes the grammar of Hayes’s poetic meditation on Floyd’s murder, thus bringing to the fore particular structural, temporal, and aesthetic contours of Black pain. At the same time, the crisis of spectacular, collective suffering that began in 2020 prompted (particularly white) Americans to rethink pain, like so many other things, thereby opening a space to hear what Black writers and critics had so long been saying. As we write four years later, however, it remains unclear whether that recognition will lead to a renewed understanding grounded in the recognition of pain’s incommensurability or to the further suppression of Black voices and experience.

The structural pain of Black life, writers like James, Sharpe, and Hayes teach us, is not the punctuated pain American culture has, since the nineteenth century, deemed “unacceptable” (Halttunen 1995). Rather, it is recognizable through its recursive temporality and through its continuities. Immigrant communities taught this lesson, too, in 2020 as the pains of infection and long-term impairment from COVID—likewise exacerbated by, in James’s terms, environmental racism, impoverishment, unequal access to health care and other structural inequities—were considered acceptable sacrifices for so-called essential workers in industrial farms and meat packing plants so that white Americans could continue eating hamburgers at home. This experience, like that of Black Americans, is a kind of pain but particularly a pain denied.

We do not advocate using a different word, which risks inadvertently repeating the denial of pain to the very communities who most urgently need to have their pain recognized, but we return again to the increasingly central insight that pain does not describe one thing and that the things pain describes need not share a common attribute. What seems more broadly clear after 2020 is not only that pain is at once biological, psychological, social, cultural, historical, and political, but also that forms of pain in some communities may simply not have corollaries in others, just as the pains of childbirth, arthritis, and cancer are distinct. As David B. Morris and Peter R. Wilson (2003: 90) neatly summarize in an article cited by the IASP task force: “Pain (an abstract concept) exists only in concrete, multiple, and very distinctive pains.” We would add that those distinctions are the products of the multiple, simultaneous dimensions and scales through which pain is constructed and that literary and cultural analysis can provide valuable resources for knowing pain in light of our shifted cultural understanding.

Humanistic and Literary Insights

The IASP’s new definition recognizes pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (quoted in Raja et al. 2020: 1976). The clause that defined pain in terms of resemblance was added in January 2020 to account for the social and psychological dimensions of pain and its multiple forms of expression, as well as the prevalence of pain that could not be located through technologies of physical examination (Raja et al. 2020).13 While some felt this revision did not go far enough, the expanded definition better reflects various experiences of chronic pain that cannot be linked to “actual or potential tissue damage” and also steers clear of insisting that pain must be witnessed or voiced to be acknowledged (Raja et al. 2020: 1981).

The revised definition opens the door to the kinds of knowing the humanities can offer health and healthcare.14 The finalized new definition not only includes notes about the “biological, psychological, and social” dimensions of pain and the relationship between “life experience” and understanding of pain, but it also considers the role of “verbal description” in the expression of pain and the significance of its etymology. The task force added etymology explicitly “to raise awareness among readers of its transactional, punitive meaning in contrast to other archaic words that emphasized the location of pain or its negative effect on mood” (Raja et. al. 2020: 1979). The inclusion of etymology also centers a philological consideration of pain, gesturing toward its multiple meanings and how those meanings have shifted, refracted, contradicted one another, and developed separately. After all, the IASP issued its new definition alongside the old one, adding that the word pain came from the “Middle English, from Anglo-French peine (pain, suffering), from the Latin poena (penalty, punishment), in turn from Greek poinē (payment, penalty, recompense)” (Raja et. al. 2020: 1977). Raymond Williams himself might be proud. Together, these features of the new definition demonstrate, if unwittingly, the centrality of humanities epistemologies to capturing the nature of pain.

In their new definition the IASP shifted focus away from the description of pain toward resemblance, a shift we argue makes humanistic modes of analysis even more crucial to understanding pain. The new definition revised the phrase “described in terms of [actual or potential tissue damage]” to conditions “resembling that associated with[] actual or potential tissue damage,” retaining the importance of verbal description but moving it to the notes section to be more inclusive of nonverbal humans and animals (Raja et al. 2020: 1977, 1979). At first blush, our assertion that this change makes humanistic analysis more crucial may seem counterintuitive, since description emphasizes the importance of language in identifying pain. Nevertheless, we argue that resemblance actually opens more space for humanistic and literary insights.15 After all, as Jorge Luis Borges taught us long ago in “On Rigor in Science” (“Del Rigor en la Ciencia”) (1946), no representation can replicate anything exactly, short of the thing itself. Thus, representation—or, in this case, description—always already was resemblance, perhaps now more honestly and capaciously so. Resemblance, in other words, at once captures the nature of description more faithfully (as any description can only bear a resemblance to the thing itself, thus evincing their essential “dis-analogy,” to take up Mitchell’s term) and leaves room for the multiplicity of pain that need not prove its authenticity initially or eventually in damaged flesh. The fact that pain now need only “resembl[e] that associated with[] actual or potential tissue damage” means we are no longer always waiting for that biologically verifiable or technologically produced confirmation. Resemblance validates pain even if that pain is never corroborated thus or lacks the promise of such corroboration. In doing so this new definition moves pain beyond the purview of empiricism; in fact, it insists that some pain is centrally not empirically verifiable or, at the very least, that empirical verification is, by itself, incomplete.16

It is these subjective aspects of pain, identified through resemblance to damaged flesh, that mark yet another space for the kind of interpretive work that is the domain of literary expertise. These include the skill to unpack the work of narrative, rhetoric, and language, the practice of close reading, and the ability to connect text to context, among other analytical proficiencies. Scholars and writers of fiction know well, for example, that fiction makes its claims to truth precisely through resemblance rather than mimesis. Or, to view the question grammatically, we might turn to Elaine Scarry (1985: 15), who noted long ago that the articulation of pain relies not on clear description but on similes, the grammar of resemblance: “because the existing vocabulary for pain contains only a small handful of adjectives, one passes through direct descriptions very quickly and . . . almost immediately encounters an ‘as if’ structure.” This grammar of resemblance, Scarry (1985: 5, 16) contends, catapults pain from a “state of consciousness [that] has no referential content” toward “external social circumstances.”17 Or perhaps we can view the grammatical question more broadly, recognizing that, while some dimensions of pain require, to borrow Carrie Hyde’s formulation, “the descriptive neutrality of the indicative” to which biomedical writing (and its idea of description) aspires, others require the subjunctive mood, which marks the uncertain or the possible (the as if, the resemblance), which fiction and other literary forms harness so effectively.18 Literary insights—grounded in sustained attention to the shape, function, grammar, and historical and theoretical work of written forms—are so essential here because, as Catherine Belling (2023: 153) explains, pain is a “question of epistemology and discourse” and because pain is not “an unambiguously indexical sign,” making it “always a translational challenge.” Or, as anthropologist Veena Das puts it, pain is “the beginning of a language game” insofar as “it makes a claim asking for acknowledgement, which may be given or denied” but on which the “future” of both parties “is at stake” (Das 2007: 40, 90).19

This call for the critical role of literary knowledge in understanding pain is not to side against doctors and the allied healthcare professions or their expertise. We agree with Morris and Wilson (2003: 87) that definitions like the ones drafted by the IASP are necessary, and that, while inevitably “imperfect or provisional,” they nonetheless “perform work that cannot be accomplished by less precise instruments.”20 Rather, we seek spaces where writers and humanities scholars can collaborate with healthcare professionals to deepen our understanding of pain, especially because we are coming to realize that so much of pain resists empirical knowing.

Finally, it is possible that the introduction of the word resembling was itself inspired by humanistic approaches to pain. In their discussion of the process of arriving at the new definition, the IASP’s task force draws on Morris and Wilson’s article on the cultural and biomedical aspects of pain. In that 2003 essay, Morris and Wilson describe the emergent biomedical understanding of pain as “refer[ring] to innumerable different experiences linked together not by a common essence (or immutable shared core) but by what philosopher Ludwig Wittgenstein calls ‘family resemblances,’” or concepts that are related but need not share a common attribute (Morris and Wilson 2003: 90, emphasis added).21 Whether or not the IASP intentionally borrowed the language of resemblance from Wittgenstein, whose work is a touchstone in pain studies, their discussion makes clear that defining pain is an act with linguistic, ethical, and political dimensions for which they required humanistic expertise.22 In fact, the contributions of the IASP’s philosopher consultants, the new definition’s etymological concerns, and the shift to include both material conditions and resemblance attest simultaneously to the ontological multiplicity of pain and to the increasing importance of the kinds of hermeneutic and epistemological contributions the humanities—particularly fields like literary and cultural studies—can bring to conversations about pain.

As we have already suggested, our issue takes its urgency from shifting ideas of pain in the present moment. Even as the IASP’s new definition of pain invites humanities expertise, for example, many still criticize it for its failure to account for the structural dimensions of pain. It is this ability to capture the connections across scales that we see as a particular strength of literary writing about pain and literary analysis. As writing like Hayes’s and Biss’s—as well as many of the works discussed in this issue—demonstrate, pain bleeds across and exceeds ontological categories, the boundedness of individual bodies, the confines of geographical space, and the expected rhythms of personal and historical time.

The Essays

The essays in this special issue build on a body of scholarship that identifies the insights of literary knowledge for the study of pain. Most such discussions wrestle with Scarry’s (1985: 35, 19) foundational and oft-repeated formulation that pain is “language-destroying,” although fewer attend to her essential corollary, taken up by many of the essays in this issue, that, as a result, describing pain and attending carefully to descriptions of pain are thus politically and ethically essential. In the forty years since the publication of The Body in Pain, scholars have challenged and complicated the idea of pain as “language-destroying,” drawing particular attention to what literary insight offers. Ann Jurecic (2012: 43), for example, contends that pain is “everywhere in literature,” and thus, while Scarry may be right that extreme pain destroys language, literature provides a rich cache of attempts to make pain in its myriad forms legible through language. Susannah B. Mintz (2013: 9) claims that “form underwrites” our understanding of pain such that literature has a unique capacity to reframe our understanding and experience of pain. Rachel Ablow (2017) argues that literary texts can help reframe the problem of pain at the intersection of the personal and the social. Michael D. Snediker (2021: 212) invites us to understand pain through a readerly confrontation with the aesthetic force of the figurations of literature, that is, with their contingency, their capacity literally to touch us and to make us feel our pain “as if it were [our] own.” Cynthia J. Davis (2021) attends to literary realism’s reckonings with the functions of pain at a time, the turn of the twentieth century, when the pursuit of painlessness was a cultural ideal. And Thomas Constantinesco (2022: 3) calls us to see the way pain “fuels the work of literature” with particular attention to the historical contingency of pain’s forms and modes of articulation. The essays that follow begin where that scholarship leaves off, importantly demonstrating what pain scholarship after 2020 might look like.

In “Taxonomy of an Enslaved Heart,” Shari Goldberg takes up the problem of Black pain—its distinctiveness as well as its multiscalar nature—through the seemingly hackneyed trope of the aching heart. Centering on Harriet Jacobs’s Incidents in the Life of a Slave Girl (1861), while tracking hurting hearts across the writings of Mary Prince, Sojourner Truth, and James Baldwin, Goldberg demonstrates that the figuration of heartache articulates a “multidimensional pain” (at once “physical, mental, [and] interpersonal”) specific to minoritized bodies that is otherwise illegible from the empiricist standpoint of white Western medical science, and thus frequently dismissed as illegitimate. Although a reservoir of conventionally sentimental metaphors, broken hearts are also “medical facts,” Goldberg contends, and the pain that their imagery registers invites us to read metaphor and facts, figuration and literalization, together and to “hold[] them in tension,” at the risk of contradiction. A literal account of heart trouble, she argues, indeed threatens to undo not only the conventionality of sentimentalism but also its “biopolitical implications,” which, by reducing heartache to metaphor and testimonies of pain to fakery, often facilitate the denial of care for racialized and gendered patients. This does not mean, however, that the metaphorical and the literal could ever be disentangled. Rather, the stories of the heart Goldberg traces reveal how “the reader only receives the most complete account of the illness [and the pain] through metaphoric thinking,” whereby literary writing produces its own “taxonomy” of the heart in pain. In this view, the story of the heart evades the “true/false binary” on which epistemologies of pain customarily rely, so that “the formulation couched in fiction . . . changes the terms of what qualifies as . . . pain,” thus calling for the invention of new protocols for the conditions that the fictional-historical archive records and helps us to identify.

Also taking the 1860s as her starting point, Jess Libow traces the history of the representation of facial expressions of pain as a therapeutic tool during the Civil War and stretching into the present. In “‘A Face of Anguish’: Pain and Portraiture in the Civil War Hospital,” Libow reads Louisa May Alcott’s Hospital Sketches (1863) together with Walt Whitman’s war poetry and prose, as both writers take up the challenge of converting the inner and often intangible experience of pain into a legible phenomenon, against the backdrop of an increasing interest in visual representations of human emotions fostered by the development of photography. While Alcott and Whitman surely document the pain occasioned by the war through memorable portraits of agonizing soldiers, they also go beyond this archival function, as their “ekphrastic writings” seek to “instruct readers by teaching them how to interpret the visual records of pain.” Establishing the centrality of facial expressions to both medical and lay understandings of pain at the time of the Civil War, Libow then demonstrates how Alcott and Whitman built on the dual register of the sketch, at once painterly and writerly, to elaborate visual literacy as a set of diagnostic skills in the clinic, and how they strove to “extend this educational orientation to expression to their readers as well,” whom they train in providing affective care. By honing their and their readers’ powers of observation, Libow concludes, Alcott and Whitman each offer a different model whereby humanistic scholarship, and methods of visual reading and textual analysis in particular, might contribute to the training of healthcare professionals, prompting them to reckon with themselves and their own biases and assumptions as they attempt to know and alleviate the pain of others.

In “‘Alive in Every Fibre’: Chopin and Wharton on Pain, Pleasure, and Private Feeling,” Cynthia J. Davis then brings us to the turn of the twentieth century, as she maps out the distinctions of race, class, and gender that pertain to the differences “between externally expressive responses to pain and pleasure and those that are quietly internalized.” In Kate Chopin’s and Edith Wharton’s fiction, public displays of emotional turmoil, whether painful or pleasurable, are aligned “with people marginalized by ascriptive identities of race and class,” which legitimizes the denigration of this demonstrativeness and elevates in turn the invisible yet vibrant affective interiorities of white elite subjects. The privatization of emotion and its valorization trouble the organizing polarities of the “hedonic continuum” to suggest that, even as the pursuit of pleasure and the eradication of pain became cultural imperatives from the end of the nineteenth century, pain continued to be sought after, operating as an instrument of social categorization and hierarchization “not only between but also among groups.” Davis goes on to show that Chopin and Wharton offer divergent versions of the internalized affects they valorize. In Chopin’s The Awakening (1899), Edna Pontellier embodies “an internally conflicted self . . . subjected to ungovernable moods” and pleasurably surrendering agency, whereas in Wharton’s The Reef (1912), Anna Leath foregrounds “a self-governing subject in command of her inner forces.” Whether unruly or contained, however, affective intensities are all the more distinctive as they remain muted and illegible to the other characters, while being made accessible to the readers. The genre of the realist novel, with its emphasis on singularities and emotional depths, is particularly suited, Davis contends, for articulating and circulating this privatized model of affective distinction, where an “internalized . . . form of aliveness” to pain and pleasure is deemed preferable to “other manifestations of animacy”—a sorting mechanism that continues to exert its hold today.

While Libow and Davis essentially focus on accounts of white pain, Cera Smith returns us to the other side of the chasm of race through a close reading of the hospital chapter in Ralph Ellison’s Invisible Man (1952), in which the protagonist-cum-narrator experiences excruciating torture masquerading as therapy at the hands of a white biomedical institution. In “Shocking Therapy: Narrating Racism’s Psychobiological Injuries in Ralph Ellison’s Factory Hospital,” Smith details Ellison’s involvement with the Black hospital movement and the Lafargue Mental Hygiene Clinic, as well as his interest in neurobiology and psychiatry, showing how these form an essential backdrop to the novel’s “factory hospital chapter” and underwrite its narrative structure and its epistemological and political claims. Centering the analysis on a single chapter, Smith unpacks the contradictory effects of pain on Black selfhood. On the one hand, the narrator’s retrospective account demonstrates how medical technology—here, electroshock therapy—both conceals and enacts antiblack violence, exploitation, and oppression by disrupting cognitive pathways and attempting to sever the mind from the body, thus returning Black selfhood to a condition of mere embodiment for the infliction of pain. On the other hand, the chapter simultaneously functions as a patient narrative of the kind that Ellison would have encountered in the Lafargue Clinic. Writing itself then becomes “a countertechnology” to the doctors’ “racializing machine,” as well as “a therapeutic method,” whereby the narrator arguably succeeds in beginning to re-member himself, body and mind, through the operations of remembrance. Doing so, Ellison foregrounds the violence of structural racism, while affording his narrator and his readers means to imagine Black survival in the wake of chronic and debilitating pain.

Extending Smith’s thinking about the intersections among embodied pain, structural harm, and the potentialities of narrative, Alex O’Connell turns, in “National Wounds and Gendered Harm: Reframing Abortion Pain in The Worst of Times,” to personal testimonies of abortion pain to ask how literary analysis might help illuminate the ways in which “life writing about painful experiences connects people beyond the boundaries of idealization, voyeurism, or sentimentality, instead working as a powerful tool to critique and reimagine social hierarchies.” The 2022 overturning of Roe v. Wade disrupted the narrative of progress that seemed to many to underwrite the history of reproductive rights in the United States. Turning to “nonfiction accounts of illegal abortion” in the mid-twentieth century thus becomes a way to reflect on our troubled present, while revisiting “a tense midway point” in the history of abortion. First surveying anti- and proabortion rhetoric in the post–World War II period, O’Connell shows how “the health, progress, and fate of the nation-state were repeatedly tied to the legal status of abortion,” demonstrating that “narrating one’s personal experience” was inevitably “entangled within both a nationalist and feminist overdetermination” of abortion pain, which threatened to erase what we have called in this introduction the multiscalar and structural dimensions of this pain. The narratives gathered in The Worst of Times (1993), O’Connell claims, mount a cumulative challenge to such flattening overdeterminations, cohering “into . . . relational clusters of experience, which underscore how pain is both shared and distinct.” The essay then explores three of these clusters by centering in turn on accounts of “singular, overwhelming pain,” of multiple abortions, and of abortions performed rather than experienced. Echoing each other in multiple ways, these narratives eschew the sensationalism of sentimentality, while allowing for the circulation of experiences of pain that the sentimentalization of pain promised yet so often blocked.

The final essay in this issue, by Catherine Belling, confronts head-on the problem of sensational pain avoided by the narratives taken up in O’Connell’s essay, while engaging Scarry’s notion of incommunicable pain and contesting some of its foundational assumptions. In “Ouch: Pain Heard and Referred,” Belling examines, or rather listens to, the sound of pain across literature and film, connecting the referrals of pain from page to screen to the biological and semiotic dynamics of referral whereby “nerve excitation can be felt by a subject as pain . . . along filaments both anatomical and linguistic.” These filaments, Belling shows, extend to the reader or viewer of sensational texts or films, so that pain, however aversive, ceases to be a solipsistic experience and becomes communal. This extension is made possible through the linguistic and aural representation of the sound of excruciating physical pain. Taking us from horror story to thriller to adventure-survival story—from The Ruins (2006) by Scott Smith to Marathon Man (1974) by William Goldman to Between a Rock and a Hard Place (2004) by Aron Ralston and their respective adaptations into film (2008, 1976, 2010)—Belling demonstrates the centrality of witnessing to the transformation of pain “from referent to sign,” even as she emphasizes hearing rather than viewing as key to the practice of witnessing she elaborates. Doing so, she invites us to reconsider “the cry or scream or groan” of pain, not as evidence of pain’s destruction of language but, pace Scarry, as pain’s “protolanguage,” for which we might do well to develop “an acoustic poetics,” which the very title of her essay—“Pain Heard and Referred”—so elegantly enacts.

Together these essays begin to reflect elements of the paradigm shift we trace earlier in this introductory essay. They insist on accounting for pain’s multiscalar entanglements, on the simultaneity and interconnectedness of the different dimensions of pain, and on the importance of tools for knowing pain that are less tethered to empirical epistemologies—especially as evinced through the insights of close reading. Additionally, these essays foreground the inextricable imbrication of pain with the structural violences of race, sex, gender, and disability and underscore the multisensory dimensions of pain, which we come to know through internal feeling, through sight, and through sound. Reaching from the nineteenth century to the twenty-first, they provide a rich account of what literature and literary criticism can contribute to pain studies today.

The editors of this issue are indebted to Erica Fretwell, Shari Goldberg, Carolyn Roberts, Jonathan Schroeder, and Kristen Treen for their participation in a series of seminars on pain and American literature at Oxford University where this project began to take shape in 2021 with funding from a Marie Skłodowska-Curie European grant. We would also like to thank Juliette Utard for suggesting Hayes’s poem and Chris Parsons and the “Politics of the Prescription Pad” group at Brown University for providing feedback on a draft. Most of all, we would like to thank our contributors for their continued commitment to the project of this special issue and for their rigorous efforts to think pain with literature in the wake of its reappraisal in a post-2020 world.

Notes

1

In this Hayes’s poem echoes a longer history of poetic representations of pain through indirection or refusal. For example, Ann Jurecic identifies, in Emily Dickinson’s “Pain—has an Element of Blank –” (F670), an effort to suggest “pain’s inexpressibility by omission; [Dickinson] does not even attempt to describe the feeling of being in pain. Instead, she defines pain as a force that reduces people to passive objects . . . Unnamed, pain is still recognizable” (Jurecic 2012: 45).

2

While the media showed some images that alluded to this, like the mass graves in Italy and field hospitals in New York City’s Central Park, media and HIPAA laws generally prevented images of sick Americans, in contrast for example to some of the more graphic images that circulated in other nations.

3

Priscilla Wald and I (Altschuler) wrote about this in our essay “COVID-19 and the Language of Racism” (2021).

4

For a critique of the “virus of racism metaphor” that implicitly extends Mitchell’s argument, see Wald 2022: 292–93.

5

For more on the failures of medical knowing during the early pandemic, see my (Altschuler’s) “Learning from Crisis: Narrative and the History of Medicine” (2020). See Charles E. Rosenberg’s The Cholera Years (1962) for the definitive study of how pandemics challenge and remake medical knowledge.

6

In all cases, of course, the changes included in the new definition, which we detail below and in the last section of this introduction, had both short- and long-term causes.

7

The list here is meant to be suggestive rather than comprehensive: one finds these discussions across disciplines. As Julie Livingston (2012: 120) writes of her work in a cancer clinic in Botswana, “In my conversations with Tswana healers, I found that it was nearly impossible to talk about pain as pain, to imbue it with ontological import, to construct it as an object. Pain, it seemed, could not be separated out; it collapsed back into its underlying pathology, which in Tswana medicine is necessarily a social pathology.” Livingston characterizes this as the “total situatedness of pain” in this African context (120). Likewise in describing her “queercrip understanding of pain,” Alyson Patsavas (2014: 213) writes of “pain as a fluid, relational, and—to borrow Margrit Shildrick’s understanding of leaky bodies—leaky experience that flows through, across, and between always-already connected bodies.”

8

One place where we depart from King is in her use of Scarry. King (2008: 19) writes that “Elaine Scarry reminds us [that] pain is the unsayable.” We follow Saidiya V. Hartman (1997: 51) in insisting that Black pain is not inexpressible, but its reception has been constrained by the historical construction of Black bodies as “insensate and content.” As Hartman (1997: 51) instructs, if Black “pain has been largely unspoken and unrecognized, it is due to the sheer denial of black sentience rather than the inexpressibility of pain. The purported immunity of blacks to pain is,” she continues, “absolutely essential to the spectacle of contented subjection or, at the very least, to discrediting the claims of pain.”

9

As Talal Asad (2003: 85) writes, “Sufferers are also social persons (animals) and their suffering is partly constituted by the way they inhabit, or are constrained to inhabit, their relationship to others.”

10

While we understand that structural factors are social, we distinguish between the two here because social has so often referred to interpersonal (even cultural) dimensions of pain rather than, say, institutional structures that shape pain beyond the interactions among people. We adopt this idea of the structural dimensions of health and healthcare from Jonathan M. Metzl and Helena Hansen (2014: 128), who describe structure in biomedicine as everything from material structures to “oft-invisible diagnostic and bureaucratic frameworks that surround biomedical interactions, and that potentially shape the contents within,” and encompassing “assumptions embedded in language and attitude that serve as rhetorical social conduits for some groups of persons, and as barriers to others.”

11

Pain is, after all, staunchly political, as Keith Wailoo (2016: 254) has persuasively shown, “because it is a microcosm of deeper social questions that often swirl around disease recognition and care—questions about compassion for suffering, citizenship, belonging, and social welfare.” Our thinking about the importance to articulate the biological, the psychological, the social, and the political dimensions of pain is also informed by Kyla Schuller’s (2018) concept of “impressibility,” which operates at the nexus of these dimensions and includes a susceptibility to pain—or purported lack thereof—whose ambiguous privilege is unequally distributed across different populations. Finally, we are also, of course, indebted to the forty-year-old idea of the “biopsychosocial” model of pain in biomedicine.

12

While in this instance the recognition of pain and its consequent medicalization have had negative, rather than alleviating, effects on the white population, they are not nearly the negative effects experienced by Black Americans who struggle with dependency, as the criminalization of the crack-cocaine “epidemic” abundantly demonstrates. The problem of honoring and making space for Black pain in medical settings continues into the present: a 2016 study revealed that half of white medical students and residents still believed that Black patients were biologically less susceptible to pain (Hoffman et. al 2016: 4296).

13

As Morris and Wilson (2003: 88) write, the principal objections to the original (1979) definition of pain were that “it is Cartesian and it neglects the ethical dimensions of pain,” particularly “that the definition fails to highlight pain among disempowered and neglected minorities, such as women, blacks (sic), children, and the elderly.”

14

The 1979 definition was more straightforwardly biological. As Biss wrote in 2005, “The medical definition of pain specifies ‘actual or potential tissue damage.’ Pain that does not signal tissue damage is not, technically, pain” (Biss 2005: 30). Ann Jurecic (2018) offers Biss’s essay as an example of the way literature can translate the experience of physical pain beyond the inadequacies of the pain scale.

15

Our discussion here diverges from the one offered by Catherine Belling in her entry on pain in Keywords for Health Humanities. Belling finds the new IASP definition wanting, criticizing in particular the deletion of the phrase “described in terms of such damage.” For Belling (2023: 152), “this change eliminates the activity of description . . . But without representation, the definition is circular: we associate pain with tissue damage, and pain both is and resembles experience associated with tissue damage. The passive voice shuts down communicability further.” We take her point, although the shift away from description in the new definition was intended to extend the experience of pain to those who cannot verbalize it yet might be able to communicate it otherwise. We also take seriously Biss’s (2005: 30) withering critique, cited above, that according the 1979 definition “pain that does not signal tissue damage is not, technically, pain,” a problem the move toward resemblance resolves. Furthermore, description, of course, remains a mainstay of the practice of understanding pain and still appears in the notes of the new definition as “one of several behaviors to express pain” (Raja et. al. 2020: 1977). We should note that Belling cites the definition as proposed in 2017 rather than as ratified in 2020, and our differences may emerge from changes that occurred later.

16

This is also reinforced, if a bit unsatisfyingly, by the notes, which assert that pain is “always . . . personal” and that “a person’s report of an experience of pain should be respected” (Raja et. al. 2020: 1976).

17

Of course the IASP and Catherine Belling in her essay for this issue debate the lack of referential content.

18

Here we are inspired by Hyde’s (2018: 16–17) discussion of the subjunctive, the indicative, and the particular power of literary form in Civic Longing, especially.

19

Das (1996: 88) continues contra Scarry, “denial of the other’s pain is not about the failings of the intellect but about failings of the spirit. In the register of the imaginary, the pain of the other not only asks for a home in language but also seeks a home in the body.” It is for this reason, Rachel Ablow (2019: 2) argues, that “representation” provides the essential means of access to pain, which is “always already enmeshed in social life.”

20

Also quoted by Raja et. al. 2020: 1976.

21

This does not simply mean that the social, cultural, and psychological dimensions of pain and its “variations in quality, length, and intensity of sensation” make different pains distinct, although that is certainly true, but that even the mechanisms of different kinds of biomedical pain are distinct (Morris and Wilson 2003: 90).

22

See, for example, Das’s Life and Words (2007) and Ablow’s Victorian Pain (2017).

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