The McGill Pain Index (and Its Metaphors)

by Jason Tougaw

If you’re in a lot of pain, you’re likely to visit a doctor who will ask you to complete a questionnaire based on the McGill Pain Index, which gets its name from the venerable Canadian University where it was developed. Pain is subjective, and the index is designed to generate something like objective statistics about our collective experience of physical pain.

I can’t help thinking the project is hopeless. How can people know how to rate pain on a scale of 1 to 10? In relation to what? The history of our own pain? The pain of others? The most severe pain I ever experienced was when I was in middle school. I’d sprayed my hair lavender to go to school as a punk rocker on Halloween. I guess I sprayed too many fumes up my nose and ended up in the nurse’s office barfing with a migraine (the only one I’ve experienced). I guess I’d rate that pain a 9. It probably saved me from getting my ass kicked that day, which saved me from physical pain that probably would have rated only a 5 or 6. (And plenty of unrateable humiliation.)

But the McGill Pain Index doesn’t just rate pain. It categorizes it. Pain can flicker, jump, drill, stab, cut, rasp, burn, or shoot.

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Nearly every category of pain on the index is a metaphor. Pain is a knife, it’s a hammer, a fire, a drill, a gun, a piece of sandpaper. Virginia Woolf complained that “English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver or the headache. . . . The merest schoolgirl when she falls in love has Shakespeare or Keats to speak her mind, but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.” The McGill Pain Index was launched in 1971, 30 years after Woolf’s death. I wonder if she would have appreciated it.

In her book, The Body in Pain, Elaine Scarry remarks that “Whatever pain achieves, it achieves in part through its unsharability, and it ensures this unsharability through its resistance to language.” We can’t share pain. It reminds us that we’re alone with our pesky subjective experiences. Based on this, Scarry observes that another person’s pain is always doubtful. We can’t share it, so we can’t believe it, not viscerally. Our own pain, she writes, is “a certainty.” We know it. It dominates us.

But we can share pain, through metaphors. This makes me wonder: Has the McGill Index unwittingly turned the clinical experience of diagnosing pain into an aesthetic exercise?

In the words of Emily Dickinson,

Pain has an element of blank;
It cannot recollect
When it began, or if there was
A time when it was not.

It has no future but itself,
Its infinite realms contain
Its past, enlightened to perceive
New periods of pain.

Pain is an obliterating certainty. It dominates consciousness. It suspends time. It sees itself everywhere. But when we atomize it, with the McGill metaphors, we fill in the blanks and interrupt the infinity. That’s what aesthetic experience does: It hijacks consciousness with experience created through engagement with an artist’s tools for simulating experience in paint or words or video.

I don’t remember if the school nurse talked the fake punk rocker in her office that day through the McGill questionnaire, but from memory I’d call that pain icy. The projectile vomit, on the other hand, was rasping.

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