Pain: The Fifth Vital Sign By Marni Jackson Random House,

Marni Jackson’s obsession with pain was sparked by a minor mishap. While biking through the mountains in Banff, Alberta, she was stung by a bee in the back of her throat. As she languished in bed nursing her puffy, aching mouth, Jackson – an award-winning journalist and the author of an acclaimed book on motherhood – began to wonder about the nature of pain in all its manifestations. Her book, Pain: The Fifth Vital Sign, is a record of her in-depth exploration.

“Basically, it’s the written version of my expedition into learning about pain and all its aspects – it’s a guided tour, essentially, of what I feel is missing in our understanding of pain,” says Jackson.

Jackson’s book doesn’t talk about pain the way we’re used to. When we bring it up at all, we approach it either in purely medical terms, or we communicate metaphorically, in myths, songs and stories. Jackson’s book incorporates both these approaches and strings them together bravely, staying faithful to her conviction that the questions are far more important than the answers.

“The book has an episodic structure that readers may not be used to,” she says. “But most importantly, the book does not offer any kind of miracle cure, or epiphany on my part that solves the puzzles of pain, because I didn’t find one. And in fact, I was never looking for one in the first place.” The result? A net of 33 loosely-woven chapters flung far across the human experience of pain. We meet Bob Flanagan, a sado-masochist dying of cystic fibrosis; a young Toronto street punk suffering from a heroin addiction; the famous nurse Florence Nightingale, who helped invent our present-day medical administration of pain medication; a woman terminally ill with cancer who eschews our medicare system for a rudimentary clinic in Mexico; and Jackson’s own, aged parents. We explore hangovers, opiates, barbiturates, cancer, migraines, genetics, acupuncture and various alternative pain-treatment techniques. Jackson’s personal anecdotes and shrewd musings cleave uncomfortably to her strident interviews with some of the foremost researchers on pain in the fields of biology, psychology, and neurology.

“If there’s one thing I discovered from looking into the medical profession, and the way it relates to pain, is that bedside manner – human relations – makes more difference, by far, than anything else,” says Jackson.

For example, one researcher Jackson discusses found that many different treatments for pain were equally effective. “It really didn’t matter so much what exact technique was used. Rather, the most important thing is that patients in pain really want to be cared for, more than anything else. Their pain has a story, and they want to tell their story more than anything, and have someone listen to their story.” Jackson is hardly anti-doctor, but she vigorously deconstructs the logic of the one-pill-fits-all fixums we’ve all been subjected to when we visit the emergency room.

“Don’t get me wrong,” she says. “The scientific [realm] is full of wonderful, creative minds doing phenomenal work. But there is something missing from the core of their approach, a division which makes them unable to treat the whole person effectively. The medical profession is very wary of this approach to treating pain as a story to be heard, as a narrative that is ongoing, rather than simply symptoms to be controlled or cured. Why take the human voice out of the most human of experiences?” Jackson asks.

“Pain defines who we are, after all. This resistance to a holistic approach to treatment makes me as a [writer and researcher] deeply unsure about science, or at least about the way it is used to understand us right now.

“These ambivalent feelings go back to my upbringing, probably – I was raised very strongly in the [scientific method], and I find it quite cold. An artistic approach, a more narrative way of describing pain, is much warmer and more appealing to me.” Jackson’s approach is refreshing for the simple reason that she can’t make up her mind. She doesn’t dismiss the “doctor cure” completely, nor does she subscribe to the theory that pain is all a matter of attitude. She does, however, refuse the usual divisions between emotional and physical pain, asserting that all pain is ultimately in the mind, no matter where it originates.

“In a way, my exploration of all these myriad aspects of pain is an attempt to re-integrate the split between mind and body, and to close separation between artistic and scientific understanding of pain,” she says.

In the future, it’s likely that the idea of standardized treatments for pain will seem as quaint to us as the process of leeching a feverish patient to clean his blood. New developments in our understanding of human genetics and DNA, such as the mapping of the human genome, will soon allow our doctors to custom-tailor our pain treatments to our own specific hereditary mapping.

“The idea of administering the same medication to, say, a large adult male and a petite woman is really quite primitive,” says Jackson. “Soon, the simple, straightforward aspirin pill will be rendered obsolete. Human beings in pain will instead be able to access much more effective treatments, based on a wider, more holistic understanding of the nature of pain itself.” Jackson hopes, also, that our relationship as humans to our pain will be more complex than a simple “it-hurts, make-it-go-away” scenario.

Our pain exists for many reasons and in many forms, not all of which are simply caused or simply cured. We may put ourselves in jeopardy – spiritually as well as physically – if we approach our pain as a problem to be solved or a switch to be flicked at will rather than as an urgent voice from deep within ourselves, a voice that craves a sympathetic ear.

As the last line of Jackson’s book proclaims, our bodies are not our enemies. Rather, they are our closest lifelong friends, and pain is the language of their deepest intimacy.