A 'NORMAL' PAIN RESPONSE: CULTURAL STEREOTYPES
A popular sport is to mock women or men, the old or the young, mothers-in-law and so on. Close to these as favoured targets for mockery are ethnic groups. If it is your group, you admire it and mock the others. The whole world is populated by peoples assigned a place on a spectrum from extreme stoicism to utter wimpishness. Icelanders mock Danes, Swedes mock Norwegians, and I bet the Cook Islanders think the Sandwich Islanders a pretty cowardly lot and vice versa. Pain tolerance is a standard popularly assigned to ethnic groups.
There have been many studies attempting to provide support for these beliefs. My favourite was a study in Ontario that set out to compare Canadian-born citizens of European origin and of Chinese origin. They could find no difference between the two groups and decided they had studied the wrong Chinese people. They then recruited recent Chinese immigrants who had been born in China. These showed themselves to be much more sensitive to painful stimuli than the Canadian-born Chinese. The reasonable explanation is that Canadians are blas? about men in white coats sticking electrodes on them, while the recent immigrants were reasonably anxious and ill at ease.
While ethnic differences of personal sensitivity are in doubt, there is no doubt that public display is bound by culture. This has great practical consequences. For example, in the 1930s, Grantley Dick-Read was a colonial doctor in the Tulkarm region of northern Kenya. He wrote of witnessing childbirth in local women who were quiet, calm, dignified and conversing with their tribal neighbours. He was inspired by this and wrote the book Childbirth Without Fear, which was to have a revolutionary effect on antenatal training classes and the education of mothers-to-be in the West. For him, the Kenyans showed that pain did not occur in the absence of fear, anxiety, tension and ignorance. He set about showing that a mother who was transported by herself and others into a 'natural' setting benefited greatly.
So far so good. But fifty years later, a female anthropologist who could speak Tulkarm witnessed a similar scene to that which had so changed Dick-Read and the nature of antenatal training. She asked the woman after the delivery whether it had hurt. The woman answered that the pain had been great. She was then asked why she had not said so, and was told: 'That is not the custom of my people'. There really should be no surprise at this answer. The women in labour rooms in Oslo do not shout out, not because they are not in pain, but because it is not the custom of their people. At the other end of Europe, in Naples, women in labour do shout very loudly, not because they are in more pain than the Norwegians, but because those around them would be worried if they did not shout.
Needless to say, people are consciously aware of the stereotype of their group and may act accordingly when in doubt. The Irish may put on an Irish act, begorrah. The English may put on their stiff upper lip, don't you know. I was sent to find an English soldier who had been admitted in the middle of the night to the emergency ward of a French hospital in Lyons with a broken leg after being run over by a truck. I had no difficulty in locating him because he was shouting, crying and cursing in English, surrounded by French-speaking staff who were attempting to calm him. I walked up to him and said 'What's up, mate?'. The effect was as though I had given him an anaesthetic. He switched in an instant to the cockney 'It's nuffink, doc. I'll be alright'. With three words, I had transported him from the isolation of an alien culture to the familiar.
In 1969, Mark Zborowski wrote People in Pain, comparing pain reactions in American residents who were Old Americans (white Anglo-Saxon protestants, or 'WASPs') with those of Irish, Jewish or Italian origin. He claims that the intensity of their reactions varies in that order. It now reads as the opposite of politically correct and is the stuff of novelists, giving a characteristic label to people of differing ethnic groups, although Zborowski's book is written in 'psycho-sociology speak'.
At about the same time, the psychologist Robert Sternbach and colleagues carried out a more controlled study on volunteer women from the same four groups. They found somewhat similar group differences but went further. When challenged in a pain tolerance test to accept a larger stimulus, some Jews would permit a considerable escalation of the acceptable stimulus, whereas most of the women of Italian origin refused to budge. More importantly, they noticed that some of the women were adopting quite different tactics. The old Americans tended to 'roll with the punches', while the others made themselves rigid in anticipation of each stimulus.
This variation of tactics in response to an identical stimulus can be seen dramatically in a line of young soldiers who are to receive a vaccination shot. Some sweat and tremble. Some appear calm. Some distract themselves by chattering with their mates. Some look at the needle, while others look away. Some faint. We witness here the diversity that characterizes the individual at that moment. This expression of personality influenced by culture and experience is not unique to humans. The phrase 'led like a lamb to the slaughter' implies an innocent uniformed ignorance and passivity for impending horror. However, the fact is that sheep standing in the pen outside the slaughterhouse differ from sheep in a field. They are quiet and they do not eat or drink the available food and water. Most do not react to being touched. Some explore and probe.
Some, 'sheep-like', trot along behind the first into the slaughterhouse while others hang back and panic and have to be wrestled inside.
Cultural stereotypes have a limited validity and show that humans and animals have a wide variety of options and tactics that are particularly apparent in painful situations. In an intensive study of cross-rearing, it has been shown that a terrier who has been suckled by a spaniel mother yelps and rolls over when bitten by any normally reared terrier. Yet the same dog dominates his adopted spaniel brothers and sisters. The stereotype is a myth of generalization and is not even stable. The antisemitic labelling of the Jew as 'coward' can hardly survive the performance of the Israeli army.
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Pain Relief