24. The Suicide Disease

Rene Leriche, pain surgeon and author of the landmark textbook Surgery of pain (1940), describes a patient with trigeminal neuralgia:

He has been forced to abandon all his outside activities, his social life, and his professional life. His whole existence is dominated by his pain: it means everything to him, and he is never allowed to forget it. He avoids anything that may cause it to return. He no longer washes, nor shaves. He is afraid to brush his teeth. He hardly even eats any more. He scarcely speaks, except with closed lips. Frequently he remains in semi-darkness, his head wrapped up in innumerable silk handkerchiefs — unkempt and hopeless. (p. 31)

Of all the cumulative pain I harbor in 2006, it's trigeminal neuralgia that drives me to the clinic. Like the patients Leriche describes, I stop going to class, work, and social events; I lie very still with my eyes closed, as though pain can't see me if I can't see it and if I don't move; I get up only to excrete. It used to be known as the Suicide Disease. I thought long and hard, but based on past experience I decided it would hurt too much to try.

That said, the name suicide disease is stigmatizing and fear-mongering, as trigeminal neuralgia sufferers are no more likely to take their life than anyone else. The sheer sensationalism of such a nickname invites accusations of hypochondria or attention-seeking exaggeration, distracting from a focus on the disease, its treatment, and the patient's needs.

The term might have been justified in Leriche's time, but today, it shouldn't have been the first result that popped up when I Googled trigeminal neuralgia, and in retrospect I have to wonder if it prompted the vague suicidal ideation I had.

Despite the nickname he attributes to the condition, Leriche gently admonishes physicians to be empathetic listeners, to forgive patients their imprecise, nondidactic descriptions of pain, to attend to their signals as witnesses — all of which is needed in Western biomedicine today — but stumbles on the matter of gestural communication. Like many of his contemporaries, he emphasizes posture, gesture, facial expression, reliable signals of acute pain that are less apparent or invisible in chronic pain sufferers, for whom the pain experience is so unrelenting that the pain becomes boring (Dolphin-Krute, 2015).

Still, at the end of the day, "the basis of postmodern medical thinking about pain is a distinction between acute and chronic" (Morris, 2000, p. 108) Acute pain is transient, treatable. It should thus be easy to endure. It should also reveal itself with a flinch, a scream, when aggravated, lay itself bare as a sensuous image, susceptible to repair (Rhodes et al., 1999). As though enduring pain of greater temporality and intensity is impossible and impossible to keep hidden. But pain is both a biochemical response and a discursively constructed social phenomenon intricately bound up with power. We can't overlook how, in Tremain's (2005) words, "any discursive act is embedded, located, and interested; that is, if one speaks, signs, or writes, one always speaks, signs, or writes from somewhere, some social position, and does so with some set of political, social, and ethical values and beliefs" (p. 13). ↩