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Guillermo Sánchez, for sharing the priceless contributions of their creative talents with me; to Juan Fernando Sánchez, for his tireless and competent editorial assistance, and again, to Marta Prats, for her valuable literary advice and unconditional support.

I write this book out of solidarity with those who suffer, out of a sense of duty, I would almost say “in self-defense,”4motivated by my own rejection and powerlessness in the face of our common experience. This book seeks to answer the following questions:

      To what extent is it possible to avoid pain? What can we do to understand pain or learn to control it? How do we transcend pain in order to put this minion of death to the service of life?

      As Leon Gieco sang:

      “I only ask God

      That I not be indifferent to suffering,

      That skeletal death does not find me

      Empty and alone, without having done enough.”

      The Author

      1 . «The most basic human experience is pain: “Human reality by nature is doomed to suffering” (Jean-Paul Sartre, Being and Nothingness, London: Routledge, 2003 (1958). “Let us imagine a number of men in chains, and all condemned to death, where some are killed each day in the sight of the others, and those who remain see their own fate in that of their fellows, and wait their turn, looking at each other sorrowfully and without hope. It is an image of the condition of men” (Blaise Pascal, Pensées [Thoughts], § 199). Cf. Eugene C. Kennedy The Pain of Being Human. New York: The Crossroad Publishing Company, 1997.

      2 . See Paul Heubach, The Problem of Human Suffering, Hagerstown (Maryland, USA): Review and Herald, 1991, p. 4.

      3 . Juan Ponce de León (c. 1460-1521), conquistador from Spain, was the first governor of Puerto Rico and the discoverer of Florida (USA). According to legend, he sought the Fountain of Youth in his travels.

      4 . See Ronald Dunn, Quand le ciel est silencieux [When Heaven is Silent], Marne-la-Vallée (France): Farel, 2003, p. 23

      Note on Bible versions used: While writing this book, the author simultaneously used three different versions of Scripture: the New International Version, the NASB, and the Message. As the content of the biblical texts cited above is essentially the same, the reader is invited to consult his or her preferred version, even if it is different from the versions mentioned above. The author turns to other versions only on rare occasions (as outlined) or to his personal translation.

      Part I

      Awareness

      “He who increases knowledge increases sorrow.”

      Ecclesiastes 1:18

      1

      What We Mean

      by Pain

      “Happiness is a fundamentally

      negative feeling: the absence of pain.”

      Gregorio Marañón

      It’s midnight. Our first child, a premature baby boy only two months old, who we had just brought home from the hospital, wakes us crying. His diaper is dry. He doesn’t want the bottle. He doesn’t have a fever. His mother takes him in her arms, coos to him, trying to calm him, but he keeps on crying. He can’t say what’s wrong, and we, his first-time parents, don’t know how to interpret his cries. Indigestion? An ear infection? Just plain fear? Undressing him completely one more time, trying to find the reason for his crying, we notice a bulge that turns out to be an inguinal hernia. Not even the pediatrician could tell us if the hernia was the cause or the consequence of his crying.

      Quite some time later, I awoke with a strange pain in my upper jaw up near my wisdom tooth or behind it. The pain, vague at first, became increasingly widespread and intense. I could not get a dentist appointment for several hours and my teeth had never hurt this way before. By the end of the day I no longer knew if I had a terrible toothache, headache, earache, or everything all at once.

      Many years later, my wife, a happy and cheerful woman who spends her days singing, began to feel ill without being able to say exactly what was the matter.

      “I don’t know what’s wrong. I don’t feel good, and I can’t say why. Could it be menopause? I don’t feel like doing anything. I feel exhausted, weak. Everything bothers me. I’m sad. Every little thing makes me want to cry. I just want to sleep, to get away from everyone and from myself.”

      My wife couldn’t seem to put a name to her growing depression.

      These three simple, personal experiences, among thousands of others that we could mention, serve as an example to illustrate how difficult it is to describe pain.

      What is pain?

      Although we all feel its sting in some way during our lives, it is not easy for us to define suffering. The experience of pain is very broad and extremely complex to convey because it affects our lives differently, experienced by each individual in a personal and unique way. Pain is, in reality, a mystery.

The term “suffering” has, in many languages, a double meaning that includes both the feeling of unhappiness or displeasure and the feeling of sorrow or grief. If in pleasure we enjoy the sensations of the body, in pain they become a disagreeable nuisance. In joy, we feel exultant; in pain, we know we are powerless. Facing pleasure, our whole being reaches eagerly for new experiences; facing pain, the body recoils as if to protect itself from an intruder. Health takes for granted “the silence of the organs”; physical pain is felt, to the contrary, like “a cry of the body.”1

      If health is a state that permits us to live an independent, happy and full life, as much in the biological sense as in the psychological and social senses, pain upsets this state in all its dimensions.

A lot of ink has been put to paper to try to define the elusive contours of human suffering, without convincing results. The philosopher Spinoza defined pain in the 17th century as “a fundamental affect, contrary to pleasure.” The International Association for the Study of Pain defined it in our times as “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage.”2 But we no longer limit the definition of pain to the effects of an injury. This classical definition has been revised many times, with results not yet satisfactory for everyone.3

      Pain and suffering

There are those who distinguish pain and suffering as two different realities. They argue that pain is organic, while suffering would be more psychological in nature. According to this thesis, what hurts is the body. Rather, suffering affects the spirit, our ability to think. In that sense pain floods the being, suffering faces it. The concrete nature of pain makes experiencing it doable and facilitates therapeutic action. Suffering, however, is expressed in a dark form and its innermost center remains in darkness, including for those who suffer from it.4

      Science has the means to fight organic-physiological pain, but suffering is a more complex reality that can, although not necessarily, include the presence of pain, and whose therapy requires other treatments. So, a paraplegic has no reason to feel pain, but the patient can suffer from it beyond what is imaginable.

Cicely Saunders, founder of the Hospice movement,5 coined the term “total pain,” which includes, in addition to physical discomfort, emotional, mental, social, and spiritual suffering, because all these aspects are interrelated. Suffering is linked to the circumstances that affect us in our whole being and in that sense it becomes more all-encompassing that the pain itself. But the popular use of the terms pain and suffering make them almost interchangeable.6 They are concepts that often are intertwined and get mixed up. Here we will refer to them interchangeably.

Physiologists

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