The Song of Our Scars: The Untold Story of Pain by Haider Warraich

Almost everything we know about pain and how to treat it is wrong, Haider Warraich says in his insightful book The Song of Our Scars: The Untold Story of Pain, published earlier this year by Basic Books. The physician and assistant professor at Harvard Medical School claims that there are dire misunderstandings between patients who feel pain, the clinicians who address it, and the researchers who study it. Worst of all, he says, pain has transformed from a symptom into a disease.

Haider Warraich is a physician, author and researcher at the VA Boston Healthcare System, Brigham and Women’s Hospital and Harvard Medical School. He has published more than 140 research papers including in the NEJM, JAMA and BMJ. He frequently writes for the New York Times and Washington Post, and is the author of the books Modern Death, State of the Heart and the just published The Song of Our Scars – The Untold Story of Pain (Basic Books).@haiderwarraich

One in five American adults—an estimated sixty-six million in total—experience chronic pain, resulting in billions of dollars in direct medical costs and lost productivity. Lower back pain is the leading cause of disability in the United States, followed by migraine headaches, neck pain and conditions like osteo and rheumatoid arthritis. And Americans are most likely to use opioids to help alleviate their pain. Yet, as Warraich points out, opioids provide little to no benefit for chronic non-cancer pain, and can even make it worse.

Pain’s storied complexity is multifaceted and multilayered. Its treatment, in Warraich’s view, requires empathic holistic care that considers how pain is racialized, gendered and personal. Pain is subjective. You can have pain without suffering. There is no single dedicated pain center in the brain. The pain of Black people remains both under-recognized and under-treated. Women are more likely to feel pain, but their pain is also more likely to be dismissed. Simply assessing pain on a numeric scale doubles the risk of opioid overdoses in hospital. And exercise is a vital part of any multidisciplinary approach to managing chronic pain.

Warraich himself has chronic back pain due to a sports injury that happened many years ago when he was a medical student in Pakistan—around the time when he felt confirmed in his vocation to be a doctor. Just when he felt like he had fallen in love with medicine, he broke his back.

Now an insightful, wounded healer, Warraich draws from his own experience of how disruptive chronic pain can be—how it “disrupts the way a person moves through their life, the narrative they define themselves by, the arc of their stories.”

The Song of Our Scars is filled with research findings, clinical vignettes, historical details and sociopolitical commentary. Yet the story Warraich tells is so broad and at times surprisingly sequenced—jumping from the mythological Greek world, to the history of opium, to the American Civil War—that it can sound like listening to the radio while scanning the channels, catching snippets of newscasts in search of a good song. We as readers want to hear more of Warraich’s own personal self-reflections, which would help focus his narrative by giving voice to his song, and deepen its impact on readers, his listeners.

Perhaps most helpful is Warraich’s concern for the origins of the opioid addiction crisis in America. The story of the opioid crisis continues to unfold in the United States, and recently came into the headlines in the documentary “All the Beauty and the Bloodshed,”directed by award-winning director Laura Poitras about artist Nan Goldin’s life and chronicles her addiction and activism that led to major museums such as the National Portrait Gallery in Washington, DC, the Guggenheim, the Tate and others to stop taking donations from the Sackler family and removing the Sackler name from the walls of their institutions. The documentary won the prestigious Golden Lion at the Venice Film Festival in September.

In The Song of Our Scars, Warraich highlights how Cicely Saunders’s revolutionary approach to pain management in hospice care was “hijacked” into a business strategy by the pharmaceutical industry, whose goal, he says, “was to take Saunders’s approach toward total pain experienced by people at the end of life and apply it to people in every phase of life, treating routine medical conditions as if they were terminal illnesses.” Saunders, who started her clinical practice as a nurse and became a doctor, is credited with founding the first modern hospice and establishing the discipline and the culture of palliative care in the late 1950s.

In terms of narrative care, Warraich brings to mind, but does not reference, other prominent physicians and scholars who describe and advocate also for such empathic patient-centered care, including Rita Charon, Victoria Sweet, Arthur Frank and William Randall.

What are the songs of our scars? What type, form and shape do they take? There are love songs, ballads, laments and anthems, to name an obvious few. How do they help us? Do they capture our hearts and move our spirits? Warraich hopes so. As patients tell us their tales of pain, he knows how important it is to listen to them. And he wants healthcare providers to learn how to listen more fully, deeply and more compassionately in clinical practice. Empathy is what makes a good doctor, he says—empathy and kindness.

“As we look to the future and take stock of all that we know about chronic pain,” he says, “we find that the most promising treatment approaches don’t involve any chemical inebriation or procedural manipulation. They involve one human being talking to another, helping them realize that the path to relief was within them all along.”—Robert Mundle

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Robert Mundle is a graduate of Yale Divinity School and a palliative care chaplain in Kingston, Ontario. He is the author of How to Be an Even Better Listener: A Practical Guide for Hospice and Palliative Care Volunteers (JKP 2018).

A Lab of One's Own: One Woman's Journey Through Sexism in Science by Rita Colwell, former director of the National Science Foundation

By cleverly playing with the title of Virginia Woolf’s pivotal feminist essay, “A Room of One’s Own,” Rita Colwell informs us what this book will be about on its very covers. Colwell is a pioneering microbiologist and the first woman to lead the National Science Foundation. She is a Distinguished University Professor at both the University of Maryland and Johns Hopkins University’s Bloomberg School of Public Health. A professional rather than a personal memoir (although for a passionate scientist like Colwell, the two are one and the same), A Lab of One’s Own chronicles and humanizes the female experience in the scientific community over the last half a century.

There is much to admire in this account, co-authored by science writer Sharon Bertsch McGrayne. Riveting chapters describe Colwell’s groundbreaking fieldwork on cholera in Bangladesh, while the exciting role she played in the CIA’s efforts to find the person behind the Anthrax letter attacks in 2001 makes for a thrilling read. Still, it is Colwell’s well-documented female experience of the pursuit of science that elevates the book into a uniquely excellent read.

I was well aware of the fact that what we today easily identify as sexism was “simply the way things were” some fifty years ago, but I must confess I was truly shaken by reading about how far and deep this sexism went. I was distraught to find, in the very first chapter, a young, driven student being told by the late Austrian-born microbiologist and professor Henry Koffler: “We don’t waste fellowships on women.” I’m not certain what I expected, but I did not expect to read a story in which another scientist Robert Steiner simply didn’t allow Colwell to finish her talk at a symposium.

Nor did I expect to read how colleague Einar Leifson yelled at Colwell over post-conference dinner, asking loudly in front of the entire room whether her husband knew where she was and why she wasn’t at home and pregnant. I most certainly did not expect to read that Francis Crick, one of the men who claimed the Nobel Prize for the discovery of the molecular structure of DNA—with no acknowledgement that a photograph taken in chemist Rosalind Franklin’s lab was instrumental in the discovery—casually grabbed molecular biologist Nancy Hopkins’ breasts when they first met. Then there was the shock of reading that Hopkins, after having been a tenured professor, wasn’t allowed to teach a genetics class based on her own discoveries, but instead was asked to teach the material to her male colleagues who would lecture instead. The reason for the switch? She was told male students wouldn’t believe any science explained to them by a woman.

Two aspects of this memoir are striking.

First, Rita Colwell has no fear when it comes to name dropping. No matter who they are, how well-respected, how highly ranked, alive or dead, the men who were part of the agenda to keep women out of science are identified and quoted. Some, like Koffler, for instance, even had the opportunity to deny or at least apologize for their actions. (Koffler, who went on to be University of Massachusetts Amherst Chancellor, refused.)

Secondly, the memoir lacks bitterness. Colwell tells the story of her passage through the system, warts and all. But her tone is not vindictive. If anything, she uses every opportunity to focus on people, both men and women, who played key roles both in helping her personally, and in changing the world of academic science into a more fair and inclusive one. She never dwells on her achievements or toots her own horn: Instead, she dedicates pages and pages to other women who have themselves overcome many obstacles and, despite men, managed to make incredible contributions.

Rita Colwell

What’s fascinating about A Lab of One’s Own are the inside stories of how monumental events unfolded. She explains how the Women’s Equity Action League (WEAL) managed to file a class action suit against the University of Maryland as well as 250 other American colleges for sex discrimination, leading to the Educational Amendments Act of 1972. Focusing on the factual, strengthened by her personal observations, Colwell gives detailed accounts of landmark moments in gender equality, including the passing of Title IX, the phenomenon of the “revolving door” and the “Birgeneau Bump.”

Although the fight against sex discrimination and the gender pay gap is not over, the memoir ends with positivity. The book is at times quite a dense text, packed with names, titles, years. Colwell documented the careers of dozens of female scientists alongside her own, giving each one as much space on the page as she gave herself. As a true feminist, Colwell uses the gravity of her platform to give others a voice. A Lab of One’s Own is essential reading for all genders; however, women in the sciences will find the history especially eye-opening. —Alekszandra Rokvity

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Alekszandra Rokvity is a Serbian-born writer and PhD candidate working on her doctorate between the Karl Franzens University of Graz in Austria and the University of Alberta in Canada. She specializes in cultural studies and medical humanities. Her academic interest lies in the experiences of women with endometriosis within the healthcare system. Her doctoral dissertation is a case study of endometriosis that explores the connection between gender bias in the medical community and the social discourse surrounding menstruation.

Ms Rokvity has previously taught in Austria, Canada, Vietnam and is currently teaching in Belgrade, Serbia. An avid activist for women's rights, she cooperates with various NGOs such as the London Drawing Group (UK) and Vulvani (Germany).

The Psychiatric Biography: A Review of "Staring Night: Queen Victoria's Late-Life Depression" by Robert Abrams

Interest in the royals may well be at an all-time high, with the popularity of the Netflix series “The Crown” and attention to the two-hour CBS interview by Oprah Winfrey of Prince Harry and his wife Meghan Markle, who caught the Palace off-guard last fall when they announced they were stepping back from their royal duties. Yet a few months later, news about another royal appeared in the form of Staring Night, an insightful new biography by psychiatrist Robert Abrams, who chronicles Queen Victoria’s final five months of life. In it, Dr. Abrams writes a biography that not only draws on historical documents but understands these through the lens of contemporary psychiatry, medicine and psychoanalysis. Staring Night: Queen Victoria’s Late-Life Depression deserves as much attention as today’s current entertaining but less insightful royal coverage.

Robert C. Abrams, MD, a graduate of UC Berkeley and the Icahn School of Medicine, practices psychiatry at Weill Cornell Medicine, where he has received awards for clinical teaching as Professor of Psychiatry in Medicine. Dr Abrams' research has been focused on old-age psychiatry, including personality disorders, depression, suicidality, and the humanities. Staring Night stems from his lifelong interest in 19th and 20th-century English history and from a series of published papers on the last years of Queen Victoria's reign.

Initially, when approaching it, I wondered if another biography of Queen Victoria was needed—there are no less than fifty. A quick scan of these accountings shows that her late-life decline was either ascribed to a relapse of her protracted mourning for Prince Albert, or just the decline of old age. Abrams, a geriatric psychiatrist with a deep knowledge of British history, lays out the case for a severe late-life depression.

This fact alone is of interest, but several factors makes this book unusually compelling: a closely observed end-of-life decline; the presentation of this decline in its historical context; and finally, a biography written with the utmost attention to language—sentence after perfectly balanced sentence flows.

The main material source is the Queen’s journals, which she assiduously wrote through her life. “The Queen’s accounts of her last five months of life present an often-moving ‘Book of Pain,’ in which her physical decline and person losses are described, elaborated, and lamented,” states Abrams. These last journals begin 17 August, 1900, ending on 13 January, 1901, nine days before her death. We learn of the day-in and day-out last concerns of the Queen. She struggles to maintain her official functioning, yet a lady-in-waiting returns to service after a two-month absence and notes, “The Queen is growing very old and feeble, and each time I see the change, even since August.”

The family made major edits to her writing. Abrams notes, “Whatever may have been lost the overall style and authenticity of the Queen’s writing are likely to have been preserved . . . and appear to have survived the conflagration of the original volumes.” He later writes, “Within the pages of her Journal she felt a freedom to express her genuine self . . . and in so doing she was able to find an authentic literary voice.”

The Queen’s decline is not without some rallies. She rises to official duties: “At that Council meeting, the Queen masterfully oversees the elaborate protocol involving the exchange of seals required by changes in the Cabinet.” Abrams notes this is not unusual for the course of a vascular depression, and moves between resurrecting the Queen’s history, as an historian, and understanding it as a contemporary geriatric psychiatrist. And in this, among many insights, Staring Night makes the case for the medical and/or psychiatric biography. While this genre of biography might maintain too narrow a focus, Abrams’s biography is justified on every page. He writes as if we were in attendance and witnessing the progressive demise. These five months are a window into a universal condition (late-life depression) and its “Victorian” presentation.

Abrams selects details that bring to life the court. Lady-in-Waiting Marie Mallet, a confidant of the Queen, brings her young son for a visit:

Victor danced by my side shouting, “Go to Queen, Go to Queen.” Once in the Queen’s sitting room he focused immediately on a portrait of the Prince Consort’s favorite greyhound, “Bootiful dog.” When he was presented with a small gift, he replied: “Thank-oo kind Queen.”

The documentary source for the last nine days become the notes of Sir James Reid, her physician. This material is more clinical and provides a transition to the final chapters, which include more contemporary science on late-life depression. Abrams notes, “Sir James Reid understood that Queen Victoria was depressed, but he did not fully appreciate the contribution of depression to her decline.” We are left with a glimpse into the doctor-patient relationship and the importance of positive transference and hope. Although the biography focuses on just five months, we close the final chapter as if we’ve lived through the saga ourselves.

I left this book saddened. The end of a life is difficult. That life has to end is difficult and must be confronted again and again. In hindsight we are often tempted to think—had a loved one died in a different medical era . . . This biography accomplishes something similar to Atul Gawande’s Being Mortal and Paul Kalalithi’s When Breath Becomes Air—all three express a profound experience of the end of life, a more deeply felt appreciation of life, and a sense of humility about medicine’s capacity, whether in the Victoria era or in our contemporary days.—Owen Lewis

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Owen Lewis

Owen Lewis is the author of three collections of poetry, Field Light (Distinguished Favorite, 2020 NYC Big Book Award), Marriage Map and Sometimes Full of Daylight, and two chapbooks. best man was the recipient of the 2016 Jean Pedrick Chapbook Prize of the New England Poetry Club. His poetry has appeared in Nimrod, Poetry Wales, The Mississippi Review, Southward, The Four Way Review and Stay Thirsty Poets. He is a professor of psychiatry at Columbia University, where he teaches Narrative Medicine in the Department of Medical Humanities and Ethics.