The Persistence of Pain

Have you ever received the arrival of a migraine with gladness or, at least, relief?

Fifteen winters ago, in the days and weeks leading up to my father’s funeral, I assumed I would be met by a migraine on the appointed day. I did not dread such a development but accepted its inevitability and even its rightness. I felt it was proper that my inner anguish should, in some way, reveal itself as a physical malady.

To my astonishment, I tolerated the service on a bleak, unsparingly cold January day at Dayton National Cemetery. My father was buried there because he had, in the 1960s, been an officer in the Air Force. He loved the military but he was sufficiently independent-minded—and opposed to intervention in foreign lands—to have counted Stanley Kubrick’s Dr. Strangelove, or: How I Learned to Stop Worrying and Love the Bomb among his favorite movies even back then. I listened to a cemetery chaplain read some words from Scripture and watched the honor guard present the flag to my mother without ever reaching for my forehead in distress. I felt OK, which felt wrong. 

I remember little of the evening—what we did, what we said—but I do know that I got through it without a headache.

In truth, the migraines I had suffered intermittently since grade school were more often occasioned by something I ate or a change in the weather than by feelings of stress or grief—the last of which I had never really experienced until my father’s death. I questioned the validity of my self-diagnosis, which was based, by and large, on reading accounts of migraine sufferers, including the writer Joan Didion, who memorably evoked the agonizing specifics of the condition in her classic essay, “In Bed.” In my immature literary aspirations, I probably thought that experiencing bad headaches was a kind of occupational hazard of being a famous writer.

Yet with my father’s death came a fresh urgency to be counted among the world’s migraineurs. Frustrated, I began to explain away my migraine-less day in Dayton; perhaps the shock of my father’s death was so immense that it took would take time—multiple awful days—for the headache to grow in strength and ferociousness. It would have been too easy, I reckoned, for a migraine to have come and gone on the day of the burial; what about all the strange and sorrowful days that followed? 

On an evening several weeks after my father’s funeral, the migraine I had expected and secretly sought came upon me. I could not account for it except as an expression of a gradual massing of melancholy. Because I had been prepared for it—waiting for it—I reacted with something like stoicism to the dull pain that eventually progressed to throbbing torment. I decamped to my room, which was already dark because the winter’s light had faded hours earlier. The pain was alleviated neither by the darkness nor by Tylenol—which, I recalled with sudden clarity, my father was forever cautioning me about taking—but that seemed fitting, too. All these years later, I remember my sense that the arrival of this terrible headache reflected a certain order in the universe. My father was gone; it was right that I felt unwell—as unwell as I could ever remember feeling.

In his great 1975 book Limits to Medicine—Medical Nemesis: The Expropriation of Health, the Roman Catholic priest and writer Ivan Illich (1926–2002) contrasted the past instinct for tolerating and comprehending pain with the contemporary obsession with ameliorating and anaesthetizing pain. “The medicalization of pain,” Illich wrote, has resulted in a state of affairs that makes “incomprehensible or shocking the idea that skill in the art of suffering might be the most effective and universally acceptable way of dealing with pain.” 

What does “skill in the art of suffering” look like? “Duty, love, fascination, routines, prayer, and compassion were some of the means that enabled pain to be borne with dignity,” Illich wrote. Instead of turning to the modern healthcare system that, he argued, needlessly intervened even in the lives of healthy people every step of their life’s journey, Illich commended a kind of personal reckoning with one’s suffering. “People knew that they had to heal on their own, to deal on their own with their migraine, their lameness, or their grief,” he wrote. 

Their migraine, their grief—Illich could have been writing about me. 

I would never have expressed it this way at the time, but in my seemingly curious welcoming of a headache commensurate to my sadness at the loss of my father, I was regarding pain as something to be robustly understood and endured rather than anxiously avoided or stifled. Far more than even in Illich’s day, most Americans (and the doctors and pharmacists who mind them) seek to evade suffering no matter the resulting costs—a phenomenon expressed most vividly in the false refuge sought in vaccines and masks during the response to the Covid-19 pandemic, which first disrupted civilization as we knew it five years ago this week. 

I think Illich was right about the overmedicalization of society, and that I was right to understand my migraine as a manifestation of profound woe. Because pain can never be defeated, we can either flee it or make sense of it.