Pain & history (08.02.2019)
I’d been trying to remember, for more than 2 years now, in which book I’d read a particularly disturbing comment concerning pain. Almost all I could recall is that I’d read the line more than 10 years ago, in a book.
And that, although the work wasn’t specific to my field – biomedical ethics (or bioethics) – it provided a perspective on its historical development.
Given that I’ve been known to read a book a day, there was a strong possibility that I simply wouldn’t be able to recall which one it had been. So I was somewhat surprised when it finally came back to me today.
The line is from a book I read back in 2004, and – unsurprisingly to anyone who knows me well! – it’s been sitting in my bookshelves all this time. The book is: Hitler’s Scientists: Science, War, and the Devil’s Pact.(1)
This work provides a history of science in the years leading up to – and during – the Nazi regime; including chemistry, math, medicine, and physics. The opening quote, from Rabelais, sets the tone:
“Science without conscience is the ruin of the soul.”(1)
The comment I’d been trying to pin down is somewhat hidden, in a chapter describing the history of eugenics and ‘racial hygiene’. The entire chapter was disquieting to reread this evening, given our current socio-political climate of apparently increasing discrimination, populism, and anti-Semitism.
This one quotation had been in my thoughts again, as I spoke with a group of bright and engaging second-year medical students on Tuesday. That discussion was part of the teaching activities of the university-hospital pain management unit (PMU) at which I’m a patient.
It was an opportunity for medical students at McGill University to meet with a patient, and to then be debriefed by the PMU’s Medical Director. You can read more about my talk with these medical students here.
My plan for this talk had been to describe my chronic pain disease, from a patient perspective. I’d also hoped to have time to highlight the importance of multidisciplinary PMUs like this one – for patients.
Several of the students asked me about the 3-month period during which I’d struggled to obtain a diagnosis; those queries somewhat derailed my plan. They wanted to hear about how the clinical signs and symptoms of my disease had been dismissed, and disregarded, by a specialist physician.
Recounting that stage of my patient journey is never pleasant, but I’m hopeful that it gave these students a sense of how important it will be for each of them to listen to their own future patients.
Discussing it also helped me recall the source of the quotation which had been eluding me for months. It is perhaps telling that recalling how I’d felt when that one specialist clinician failed to listen, to diagnose my disease – failed me as a patient – is what triggered my memory of this section of the book.
Telling, because its author was describing a Nazi medical doctor; Erwin Liek. “A key figure in Nazi medicine”(2), he is “widely reviled today as the “father of Nazi medicine”(3). Not an association that I’d ever have expected my memory to make with a physician who’d treated me.
“In his thirty-year professional career he produced writings on a broad range of topics—including a stirring attack on overzealous human experimentation—but he was best known for his critique of the “spiritual crisis” of modern medicine, medicine enervated by specialization, bureaucratization, and scientization, warped by greed and myopia but also by its failure to appreciate the natural capacity of the body to heal itself.”(3)
With “strong ties to homeopathy and the natural foods movement, he helped to usher in a broader and more holistic medicine of the sort embraced by many Nazi leaders—medical men like Kurt Klare, Karl Kötschau, Walter Schultze, and Ernst Günther Schenck, but also high-placed politicos like Heinrich Himmler, Julius Streicher, Rudolf Hess, and even Hitler himself.”(3)
Despite being a medical doctor, he strongly believed in homeopathy (generally called the ‘science of nothing’ by many of the physicians & bioethicists I know!), along with many other questionable theories.
Some of these beliefs may have eventually – and immmorally – led him to espouse eugenics, and murder, as being acceptable practices. Despite being a physician:
“Liek believed that illness was due to lack of moral fibre, a conviction that in time would add impetus to the influences within professional medicine that justified the elimination of the sick.”(1)
The specific quotation that I’d been trying to pin down, for months, is that Erwin Liek:
“argued that pain was a benign secretion of a disorder and an essential part of the healing mechanism: to suppress it impeded recovery. Endurance of pain was, moreover, a prime virtue“.(1)
This dual concept, of pain being something ‘to be endured’ and of the endurance of pain as being a ‘virtue’, is what kept coming to my mind as I was speaking with the medical students earlier this week.
I can’t help but wonder whether that one dismissive & disrespectful specialist harboured sentiments similar to those of Erwin Liek. Why else would he have completely failed to acknowledge – let alone to act on – my obvious clinical signs and symptoms?
It’s a question that I’ve been asking myself for well over 2 years now, and I still have no answers.
(1) John Cornwell. Hitler’s Scientists: Science, War, and the Devil’s Pact. Chapter 5; The “Science” of Racial Hygiene, page 81. Paperback: Penguin Books. 28 Sep 2004. ISBN 9780142004807
(2) George Davey Smith. “Lifestyle, health, and health promotion in Nazi Germany”. BMJ. 18 Dec 2004; 329(7480): 1424–1425. doi: 10.1136/bmj.329.7480.1424. On-line. Accessed 08 Feb 2019. Web: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535959/#!po=46.4286
(3) Robert N. Proctor. The Nazi War on Cancer. Chapter 1; Hueper’s Secret. Paperback: Princeton University Press. 2000. 392 pages. ISBN: 9780691070513. Information: https://press.princeton.edu/titles/6573.html