The Practice

Pain Management:

Wesley Pain and Spine Centre

Wesley Hospital, Chasely Street, Auchenflower Qld 4066

Appointments: 07 3232 6190

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Level 2, Suite 30, Silverton, 101 Wickham Terrace, Brisbane Qld 4000

Telephone: 07 3831 5681

Fax: 07 3831 5682


Dr Leigh Atkinson AO

Pain & Western Art

A paper presented at the Conference Dinner of the Faculty of Pain Medicine Meeting
13th October, 2007


I would like to take you on a short journey through the paintings and sculptures found in the art galleries and the churches of western Europe. There will be a special focus on those artworks showing concepts of pain and suffering. Many of you will have travelled to Islamic mosques, Buddhist shrines and Hindu temples and been a little surprised that there were no images at all of people with pain and suffering, certainly nothing like we might see in Europe.

In our scientific meetings over the past two days great efforts have been made to explain our understanding of pain and suffering. Still, as Elaine Scarry has noted, "It is essential to what it is that pain has a resistance to language." The Latin languages of Europe explain the origins of pain as meaning "compassion" while the non-Latin languages tend to use words that are more suggestive of feelings. Compassion means that we can feel joy, anxiety, happiness and pain. It means that we develop an art of emotional telepathy.

The Laocoon Group

This great sculpture is probably the most famous in antiquity. Its provenence goes back at least to the 2nd Century BC. The concept may have originated from the marble figures in the Pergamon Altar. The sculpture was found in 1506 in Rome. It takes us back to the Trojan war.

The Laocoon was a Trojan priest who warned against Greeks bearing gifts. He died before the Trojan Horse was allowed in for the subsequent destruction of Troy. But here in this sculpture the central figure writhes in pain and despair; the body twists in agony; the head is extended upwards; the brow is furrowed; the eyes are gritted, and a loud scream seems to come from the carving.

This was one of the great artworks of antiquity. It suggests that pain is ennobling.



Christ on the Cross

But the legacy of pain and suffering in Western art goes back to the Crucifixion.

Thousands of artworks centred on the Crucifix have been and this in recent years was done by the Australian artist, Brett Whitely. It shows the tortured figure. The hands are exaggerated. The arms outstretched. The body is distorted; but there is no doubt about this image of pain.

Two thousand years have not shifted the focus.



This Pieta is one of the great artworks by Michelangelo. It now sits in the Vatican.

It provides these sweeping symmetrical lines. The body of Christ is not anatomically correct, but the exaggeration adds to the concept.

The suffering is there in the mother's eyes tilted down looking at the body of her son, maybe recalling the years when he was a baby.

Pathos, empathy, compassion flow from this masterpiece.

The Lamentation of Christ

Guido Mazzoni, in 1505, working in Tuscany, presented this group of people in terracotta centred around the body of Christ.

Each face is a picture of pain and sadness as they bear the burden of the loss of Christ. It is said that Mazzoni used death masks to get this reality.


The 3rd of May - Goya

But it was probably the great Spanish painters, Goya, El Greco and Rubina, amongst others, who could really present the ferocity of blankness of the tortured suffering body.

In the painting called "The 3rd of May" we see a central figure almost transfigured in its whiteness, with hands outstretched, even hands stigmatised, and certainly hands and arms appearing to be a cross-like figure. It is said that the figures around this partisan were very similar to those at the foot of the cross.

This painting by Goya had great political messages. It was there to support the partisans in their fight against Napoleon's troops. It carried great messages of rebellion and fight and resistance to Napoleon's marching troops.


The Death of Marat

Jacques David, the French painter, also used the figure of Christ in this painting called "The Death of Marat".

Jean-Paul Marat was one of the leaders of the French Revolution, and 1793 was a particularly bloody year. Marat himself was a man tortured by the pain of a severe skin condition so that he spent hours each day in a bath trying to get relief.

Here we see him with the turban around his head, the turban soaked in vinegar again to relieve his head and neck pain. But while he was in his daily bath, he was murdered by a woman, Charlotte Corday.

Jacques David, the painter, recalls this interestingly. Picasso recalled it again in one of his famous paintings.

But Jacques David, a great sympathiser with the French Revolution, and one who was anti-religious, presents here a figure almost like Christ in the Pieta - slumped and at peace but calling for compassion.


The Martyrdom of St. Sebastian

Between the 11th and 17th centuries, there were countless paintings of the Martyrdom of St. Sebastian.

Sebastian was a Roman centurion; he was sentenced to death by the Emperor Diocletian. However, surprisingly, he did not die from the arrows, and he was rescued by his friend, Irene. This gives us the origin of the multiple paintings, as he became the Saint of Plagues because of all the disfigurement. During these centuries there were many plagues, and the people needed someone to pray to - hence Sebastian.

But there was another reason for St. Sebastian, as so many of the aspiring artists saw a great opportunity to study the male nude figure. Many of these figures were quite erotic and suggestive. So much so that one had to be withdrawn from the altar, as females in the church were tempted to too many erotic thoughts.

So often the figure of St. Sebastian during these years did not seem to represent a figure in pain. Was he so carried away by his spiritual uplifting that pain was of no great significance, or were the painters unable to really project the real concept of pain and suffering in a human?


The Scream

Edward Munch was one of the most emotional painters that I have ever seen.

Over the 82 years of his life his countless paintings cried out from the canvas presenting the unspoken language of pain and suffering.

"The Scream" is probably the most famous example of expressionism. Here nature is in revolt; the clouds are blood-red; the painting seems to vibrate. The noise of nature is too much for the figure who clamps his hands over is ears in distress.

Munch himself said that this had to be the work of a madman.

During the years he painted this, he was on inappropriate amounts of drugs such as opiates, alcohol and digitalis.


The Eton Man

The sculpture, The Eton Man, by McKennal in 1921, was a wonderfully suggestive sculpture. Here we see a sculpture of a young man moving forward with sensitively outstretched hands. He is making an unconditional sacrifice of himself.


The story was that streets and whole classes of young men were killed, eliminated in the First World War. To commemorate the class losses, the Eton College asked Bertram Mackennal to make one of his many monuments.


Mackennal, who had some contact with Rodin, was introducing more realistic psychological messages in his sculptures in the early 20th Century. This one is one of his more subtle ones.


It is most alive and empathetic to all those young men who offered their lives for their country.


Interestingly, it was rejected by the Eton Masters.



Probably the most outstanding painting of the 20th century was Picasso's "Guernica". This huge painting, 8 metres long and 3.5 metres high, was monochromatic - all  in grey. It sits in the Queen Sophia Museum in Madrid.

It recalls a day, the 26th April 1937 at 4.15 p.m., when Hitler's Condor aeroplanes struck the small Basque town of Guernica, and over the following three hours wiped it and the population out. It was one great massacre that might have been quickly forgotten but for the political message from Picasso. Time and time he refashioned this structure. He presents the horror of war in a way that few others have ever reached.


On the right you see a woman falling from a window, her body in flames, her arms outstretched. Below her another woman struggles through the city, dragging her broken leg. In the centre is a soldier, his arms outstretched holding a sword that turns to a flower. The whole painting is open to the ceiling, to the bombs that are falling, falling on the central figure of a horse, tortured and rearing in terrible pain. To the left another woman, a tragic figure, holds her dead child.

Guernica appeared with this political message in a Paris international exhibition, and its message rang out for the world.

The image of pain and suffering seems to be particularly highlighted in western art. While the Russian icons often show the death of Christ, they are really celebrating the Resurrection in contrast to the sufferings focussed on by the Christian West. It reminds us that the legacy of the Crucifixion was a philosophy that to gain a higher place in Heaven one needed to indulge in pain, penance and preparation for the next world. Great orders such as the Carmelites, the Capuchins and the Benedictines all focussed on this message of sacrifice and penance in preparation for better times. The church encouraged these images to remind their believers that pain and suffering were acceptable and were necessary if one hoped for better times. To those a little more affluent, indulgences were sold. This legacy of pain and suffering at times led to masochism and self-harm and self-abuse, which at times we see in the Munchausen patient.

The pain physician must develop high levels of compassion if we are to develop the emotional telepathy that we need to understand our patients particularly as 60% of communication between people is non-verbal.




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