Pain is a fundamental part of the human experience – from the short, sharp shock of stubbing a toe to the sometimes life-changing agony of chronic pain, it is something that links humans throughout the ages. It is fascinating to chart the study of unexplained pain, and it can be helpful in thinking about our attitude to pain today. The importance of considering a person’s state of mind as well as the physical site of pain has been recognised for many years.
References to pain can be found dating as far back as 2250 BC on Babylonian clay tablets, and it’s likely that pain was at that time blamed on evil spirits. Several thousands of years later in Ancient Greece, philosophers and early doctors were still learning. Though their knowledge of anatomy and disease was primitive, some were beginning to understand the mind-body link much better than many do today.
Fragment of inscribed clay tablet believed to be from Babylon.
In 400BC Greek Hippocrates observed that strong emotion or excitement could cause physical symptoms such as sweat or an unusually fast heartbeat. In his view, treating the mind was as important as treating the body, and it was necessary to view an invalid as a whole, body and mind, in order to heal them.
Like Hippocrates, Herophilus (c.335-280 BC) considered the brain the site of pain perception, and his work was rediscovered by a Roman philosopher named Galen around 400 years later. Galen made the link between emotional trauma and physical symptoms, and wrote in c.150 AD that a patient was “afflicted not by a bodily disease, but rather some emotional trouble grieved her.”
A millennium and a half later, the Frenchman René Descartes concluded the mind influenced the body in the same way as levers influence the workings of machinery, and is reported to have told Princess Elizabeth in the early 1640s that bad thoughts could cause bad dreams and bodily disorders.
French neurologist Jean Charcot (1825-1893) gave a lecture in 1888 arguing that psychology plays a role in the area of nervous diseases. His student, Sigmund Freud, took the influences of Charcot and contemporaries Pierre Janet and Josef Breuer, and surmised that trauma could lead to repression of feelings and memories. With no other outlet, these thoughts ‘converted’ into a physical complaint – ‘conversion disorder’ is a term still used today.
Sir William Osler (1849-1919), often referred to as the father of modern medicine, regarded emotional factors as important in physical illness. He wrote “the good physician treats the disease; the great physician treats the patient who has the disease”.
Francis Peabody (1881-1927), a well-respected American doctor who spent much of his life training and then teaching at the University of Boston, wrote at length about the importance of a personal relationship between the doctor and patient. He famously said that: “the secret of the care of the patient, is in caring for the patient”.
This is an edited and condensed version of the history chapter I co-wrote with David Clarke for the book Psychophysiologic Disorders: Trauma Informed, Interprofessional Diagnosis and Treatment, published in November. It was fascinating to research, and we both wished we had more space to delve deeper into the history! The textbook is available to purchase here.