Pain is not a concept with a single, universally accepted meaning. Instead, those who suffer refer their physical discomfort to external systems of value: to suffer is manly, is the result of sin, is a sign of civilization and its attendant sensitivity, is just the product of neurology. People read the experience in profoundly different ways, and make sense of what they feel in a multitude of fashions.

In his textbook Psychology, written in 1892, the American psychologist and philosopher William James began his section on pain with an unequivocal statement: "The physiology of pain is still an enigma" (1), and for the late Victorians this was certainly the case. The ability to treat pain – with local and general anaesthetics, by means of surgery, or with drugs such as morphine – had, by the end of the nineteenth century, far outstripped the ability of physiologists to understand why such medical interventions worked, or the nature of the nervous system on which they acted.

While medical understanding remained imperfect, physiologists worked towards connecting the pain of the body with the body itself. In so doing, they undercut the much older Christian belief that pain was in the hands of God: that a beneficent God inflicted pain both for the pragmatic reason that it short-circuited serious bodily harm by prompting individuals to recoil from the source of pain, as the burnt hand is taken away from the fire, and because it kept potentially errant humans on the straight and narrow.

The value of pain
Christianity and medicine provided the two dominant, though conflicting, discourses for understanding pain in nineteenth-century Britain, though over the course of the century the pre-eminence of the first largely gave way to the second. Harriet Martineau, English economist and novelist, writing in response to her own serious, long-term illness in 1844, was earnest in her "supposition – indispensable and… almost universal – that pain is the chastisement of a Father; or, at least, that it is, in some way or other, ordained for, or instrumental to good." (2)

But this was a position that was not to last across Queen Victoria's reign. As belief in the literal truth of the Bible and the reality of a physical hell dwindled, so too the belief in the necessity of pain began to be eroded. By the 1870s, what came to be known as the 'problem' of pain, the question of how physical suffering could be reconciled to the idea of a loving God, was widely recognized as a stumbling block to belief in Christianity in its own right. As Charles Voysey, a priest who was later to be found guilty of heresy over his errant views, was to argue:

I am literally besieged with letters pressing me for an answer to the questions, Why should there be so much apparently needless suffering in the world? How can we, in the presence of these painful facts, believe in the existence and sovereign control of a good God? On every hand such and kindred discussions are raised. One hardly ever touches the subject of Religion without the conversation drifting rapidly to this central and vital enquiry. (3)

The religious meanings of bodily pain largely took shape in relation to other doctrinal argument, as the pains of crucifixion or of hell were held up for examination, and as different denominations within the Victorian church became less confident that hell was a place of physical rather than mental suffering. Such works as the Reverend J Furniss's The Sight of Hell – a book deliberately aimed at the young – described in detail the fate of those destined to spend eternity in hell:

The sinner lies chained down on a bed of red-hot blazing fire! … All the body is salted with fire. The fire burns through every bone and every muscle. Every nerve is trembling and quivering with the sharp fire. The fire rages inside the skull, it shoots out through the eyes, it drops out through the ears, it roars in the throat as it roars up a chimney. (4)

This is precisely the sort of description that Voysey was reacting against, and it is wrong to assume that the decline of belief in orthodox Christianity in the second half of the nineteenth century stemmed only from the rise of evolutionary thought after the publication of Darwin's On the Origin of Species in 1859. A great number of people, George Eliot among them, lost their faith because of a deep distaste for the way physical pain was used to instil fear among the laity. As the critic W R Greg was to put it in 1872, making his own opposition to inflicted pain clear, sinners in hell did not need physical punishment after death: "No other punishment whether retributive or purgatorial will be needed. Naked truth, unfilmed eyes will do all that the most righteous vengeance could desire." (5)

Deliberately inflicted pain began to look like a very blunt instrument in God's armoury, and as the retributive purpose of physical pain was stripped away from eternal damnation, so the theological value attributed to pain – of all kinds – was called into question.

Science responds
Despite the damage done to their own careers, the outspokenness of Voysey, F D Maurice – who taught theology at King's College, London, and was tried for heresy in the middle of the nineteenth century because he refused to teach his undergraduates the doctrine of eternal damnation – and others was instrumental in effecting a huge shift in public thinking. Opinions that were dangerous and heretical in the 1840s had become mainstream by the 1880s, as the general public in large part refused to accept that God willingly, and indeed wantonly, inflicted pain on His creation.

In a process epitomized in a vehement exchange of letters that appeared in the correspondence pages of the prestigious medical journal the Lancet in August and September 1887, Christian justifications of pain were challenged by the new wave of evolutionary and medical thinkers. In this altercation, H Cameron Gillies, using the pages of the medical journal to air a series of articles called 'The Life-saving Value of Pain and Disease', left himself open to the ridicule of his fellow doctors.

Gillies offers the utility of pain as its God-given purpose, couching his arguments in specifically religious terms, as he recites the arguments that had been standard in the defence of pain: that it is, for example, of use as a warning to stop drinking port once the first twinges of gout suggest worse things to come. He makes the somewhat surprising claim that, "I do not concern myself with definitions of pain. It is not the Whence nor the How of pain that is of practical interest, but the Wherefore – its meaning, intention, and purpose", suggesting that its much-vaunted utility is a question of being able to read and interpret the sensation of pain in the light of Christian revelation.

Alongside this, he made the further claim, hotly disputed in a series of letters over the next two months, that, "Pain never comes where it can serve no good purpose". It was this claim, in particular, that was challenged by a number of medical practitioners, picking up particularly on cases of intractable diseases, for which pain appears too late to be of any diagnostic value, but made dying an agonizing experience. As W J Collins wrote in vehement disagreement:

Pain, [Gillies] says, in such cases would 'serve no good purpose; there is no pain'. Is this the grim comfort he would bring to a suffering woman tortured slowly to death by a sloughing scirrhus of the breast, or to a man, made almost inhuman and killed by inches by the slow yet sure ravages of a rodent ulcer? (6)

Collins upholds the suffering of the patient here, and in so doing points to a failure in medical procedure: doctors believing in such Christian rationalizations of pain and its meaning can only fail to recognize suffering in the patients who come to them. While Collins is angry at this ability to wish away pain that runs counter to notions of God's beneficence, his argument runs deeper. Such blindness to the suffering of patients also reflects a blindness to current scientific and evolutionary thought:

"It is too late in the day to attempt to prop up a theory of the invariable and direct beneficence of pain, shutting the eyes to facts to save a teleological theory which experience and reason have alike discredited." (7)

For him, and for many others, pain was the by-product of evolution; it was the necessary corollary of the sensitivity required for progress, and had no connection at all to the designs of a Christian God.

So, if Christian explanations began to fail, medical explanations for pain, based on the body and its neurological organization, both created and went some way towards filling the resulting conceptual gap. Advances in medical knowledge breached Christian certitude as they undermined the naturalness of pain and put in its place a bodily function that could be removed, or at least alleviated, by chemical or surgical interference – the nineteenth century was, after all, the century that introduced chloroform and other general anaesthetics into surgery.

Christianity was forced by its nature to accept pain not as a function of the body in distress, but rather as an aspect of God's interaction with humankind. The rising medical profession of the nineteenth century sought ways of addressing the problem of pain in a very different arena. Instead of seeing pain as a divinely ordained 'mystery', medical practitioners began to look for its method of functioning and to conclude that, in many cases, painfulness far outstripped any putative beneficent value.

From asking, in Christian terms, what value pain could have to a particular suffering individual, the medical profession began to ask some fundamental questions. What is pain? What is its specific link, neurological or otherwise, to the body? To understand its function and to cure, rather than to justify, became the aim of the medical profession as the nineteenth century drew to a close.

At the beginning of the twenty-first century in Britain we have inherited this crossover in belief systems, perhaps at some cost to ourselves. If bodily pain is simply something to be alleviated at all costs, then those beliefs that had made it possible to bear it and to suffer with Christian fortitude have largely made their exit, and the sufferer is left with the pain itself, and a bottle of pills, rather than an internal system of understanding, to assuage it.

Lucy Bending is a Lecturer in the School of English and American Literature at the University of Reading. She is the author of a book on nineteenth-century representations on pain (Clarendon Press). A longer version of this essay can be found on the CD-ROM accompanying the 'Pain' exhibition, available from the Wellcome Trust.

References
(1) James W (1892) Psychology. London: Macmillan.

(2) Martineau H (1844) Life in the Sick-Room. London: Edward Moxon.

(3) Voysey C (1878) The Mystery of Pain, Death and Sin, and Discourses in Refutation of Atheism. London and Edinburgh: Williams and Norgate.

(4) Furniss Reverend J (1870) The Sight of Hell. Reprinted with exegesis, in T R, Hell and its Torments, London: Geo. John Stevenson.

(5) Greg W R (1872) Enigmas of Life. London: Trübner.

(6) Collins W J (1887) Pain and its Interpretation. Lancet. 20 August: 391.

(7) Collins W J (1887) Pain and its Interpretation. Lancet, 20 August: 391.