For Pain: Medical or Shamanic Help?

Pain is part of life; it is a companion that cannot be shaken off between the cradle and the grave. A person does not even have to be born to feel pain; it is medically proven that the embryo in the womb – from the 23rd week of pregnancy – can feel pain.

From a certain age, one learns that pain is important, it can be a life-saving warning signal. Or it acts as behavioural teachers: young children are capable of highly sophisticated strategies for avoiding pain. This can get on the nerves of those around them.

Change the Point of View

A different perspective can change things. Gregory of Nazianzus (c. 330-390), for example, wrote a kind of hymn in praise of pain: “For at times pain is more useful to man than health, tension more useful than relaxation, rebuke more beneficial than forbearance. So let us not become overconfident in good days, and in misfortune let us not despair and collapse”. Well, he was a saint and a teacher of the church.

Apart from the moral, there is nevertheless truth in this thesis – so much that modern science takes this approach quite seriously. The concept of painfulness goes back to the German ethno medicine expert Norbert Kohnen. This means that people perceive pain not only physically, but also emotionally. Pain is therefore not only experienced emotionally, but our psyche “evaluates” it, as it were. Thus, pain stands in the context of the social environment, the respective culture.

“An Indian knows no pain” – meaning: there are strong cultural differences in the perception of pain. A well-known study shows that Spaniards, for example, experience pain more often and more emotionally than Americans and Poles. Consequently, Spaniards believe that acting out pain emotionally is the best way to deal with it, while Poles take the opposite view: pain must be controlled. Personal attitude and the degree of attention to pain seem to influence the perception of the severity of pain. Europeans complain little about postoperative pain, while Latinos and African Americans complain a lot; they also use more remedial techniques against it – such as praying. Asians, Native Americans and other Folks are considered less sensitive to pain. On the contrary, enduring pain is often considered honourable and enhances the reputation of young men.

What is pain anyway?

Medicine sees it as a physical sensation: “Pain is an unpleasant sensory or emotional experience that is accompanied by actual or threatened tissue damage or is described by affected persons as if such tissue damage were the cause” (definition of the International Association for the Study of Pain). This has since been significantly expanded – precisely because of the emotional component and the fact that there can be pain without tissue damage, for example, neuropathic due to diabetic neuropathy. The nerve endings (“nociceptors”) register pressure, burst, bruise, heat, cold, and transmit the stimuli to the brain; the brain, in turn, triggers actions to eliminate the cause of pain if possible, such as defensive or escape reactions. In the long term, the experience of pain leads to changes in the nervous system; the memory is stored, this is referred to as “pain memory”. For example, sensory stimuli such as sounds or smells that were associated with pain experiences can trigger renewed pain sensations.

What can be done about pain? Both endogenous substances such as endorphins and externally supplied substances such as morphine are capable of altering pain perception and reducing pain. In addition to medicinal pain therapy, there is also nerve stimulation (acupuncture) as well as physiotherapy and psychotherapy.

The Spirit World plays its part

If one considers the emotion factor, then it is obvious that one can also try to take away the painfulness of pain. This also happens in our country, but with special emphasis in native cultures. For in these, pain has an additional meaning – it destroys, just like illness, the social and family balance. A purely scientific treatment of illness is not enough, because the disturbance of the spiritual world, that of spirits, gods and ancestors, is not eliminated by it. This is the point where the shaman steps in. Indigenous people around the world believe that illness and pain are caused by mysterious demonic forces or by the deceased. However, these same forces are also seen as saviours from physical and psychological problems. In addition, the disregard of divine laws or the breaking of a taboo can also be reasons for the emergence of diseases and pain. Prayer and sacrifices are used to try to deal with the problem.

In a comparative questionnaire study conducted by the University in Salzburg, the perception of pain in Ladakh and in Austria was investigated. Ladakhis usually first seek a shaman or an Amchi (Tibetan Buddhist) healer for pain, for the simple reason that doctors are hardly available. In Austria (the research was conducted on patients at the Interdisciplinary Pain Outpatient Clinic at the Klagenfurt Regional Hospital), the physician is the primary contact. The result of the study in the original quote:

“Both the shamans and the western doctors have mastered their treatment methods and are able to help their patients. Shamanism as well as conventional medicine lead to the desired goal, but a comparability is very difficult because of the different approaches. The shamans have a perfect command of taking away the painfulness of their illnesses from their patients, while the western orthodox doctors quickly treat the painfulness with the help of medicines. It is reasonable to assume that a large part of the healing success can be attributed to the activation of the patients’ self-healing powers. However, it is important for every patient to come to terms with his or her pain or illness. However, since this is often neglected in Western conventional medicine, a combination of complementary methods, such as shamanism, with conventional medicine in pain therapy seems to be a good solution.”

The place where the soul sits – the heart

Some details from the comprehensive interviews:

Site of the pain:
One hypothesis of the study was that Austrians should have increased heart problems due to civilization diseases and atherosclerosis in old age. However, it was found to be noteworthy that heard pain was more prevalent among Ladakhis. Possible explanation: They regard certain pains as “sitting in their heart”, i.e. they regard the heart as the seat of the soul. Pain experienced in this way could be caused by psychological problems or, in the case of their culture, by imprecations, by curses. Ladakhis generally perceive their pain as stronger that Austrians; the result is statistically significant (32 Ladakhis and 42 Austrians were interviewed). Presch: “Tissue damage is neither necessary nor a condition for feeling pain … physical illness cannot be considered in isolation from its psychosocial consequences”.

Women/Men:
Women from Ladakh feel their pain more strongly than men; so do women in Austria (patients had to rate pain intensity in the questionnaire). Possible cause: women can differentiate better and react faster and more intensely.

Age:
In Ladakh, older people experience pain more strongly that young people; however, there was no meaningful result on this in Austria.

Duration:
In Ladakh, people with pain go to the shaman more quickly than Austrians go to the doctor; in Ladakh, it is women who want help quickly – usually within three days. In Austria, people often wait three months before seeing a doctor about their pain.

Music:
Among Ladakhis (as in other cultures such as the Orient), music plays a major role in overcoming pain, whereas in Austria it hardly ever does.

Medication:
Have about the same importance in both cultures. In Ladakh, admittedly, this is understood to be the herbal medicines in spherical form, which are usually administered by the Amchis; in Austria, it is tablets, pills and drops.

Treatment:
Treatment by the Ladakhi shamans (mostly women) usually consisted of extraction, the calling out of intruders seen as triggers of illness and pain. It was noticeable that the shamans usually did not ask where the place of the pain was, but found it on their own. The shamans sucked with their mouth or through a metal tube and spat out the intruders in the form of liquid (water, black mucus), but also as small objects in the form of bones or nails. Sometimes they showed the sick person the object in their hand before disposing of it. Tools of extraction were common: phurpas (ritual daggers), knives, vajra sceptres, cloths, etc.

Further Treatment:
Just as Austrian physicians referred patients to specialists, Ladakhi shamans often recommended consultation with an Amchi or, in rare cases, a Western physician. The shamans have no fear of relapse; the belief prevails that in one session everything necessary has been done to take away the pain and cure illness. The client, however, is free to return at any time.

Mag.a Michaela Presch, Department of Organism Biology, University of Salzburg, Michaela.Presch@sbg.ac.at

The study was supported by the Office for International Relations of the University of Salzburg.