Advanced Pain Studies

I read Lisa Olstein’s Pain Studies straight through a headache day. Her account of chronic migraine is unexpectedly bright and punchy. It forgoes ponderous phenomenology; it forgoes arguing for her suffering; it nearly forgoes long sentences. Olstein doesn’t fight the weight of Elaine Scarry’s legendary thesis that pain is inarticulate. She drops the heavy mantles of pain writing and dips, like a swimmer, into the ways that pain infiltrates and orients a bodymind, into the ways that it arranges a life. 

Her dips are bracing. They also surprised me with the details they revealed. Several details that appeared to be personal disclosures were exactly familiar, part of my chronic migraine condition too. Her point, for instance, that when it comes to onset, it’s always goldfish-memory: “despite all the information at your disposal, you’re not going to see this coming. (I never do.)” (13). I don’t either: it never seems right that feeling fine should be followed by anything else. 

Then there’s the sense that “migraine turned all colors all-body: the eyes absorb them as if drinking through a double straw, the nerves register vibrate or lull, vessels smooth or bristle, a concert of sensation loops from eye to stomach to back of skull, something deep in the arms starts to whir” (24). My arms are often whirring. And the sense that “isn’t suicidal ideation” in which I imagine of stepping out from a second-story window, which Olstein links to the vertiginous feeling she and I both get on Texas highways: “something is off in the color of the asphalt, in the angle of the sun, but mostly it’s the towering overpasses, over which you see only blue” (90-91). 

These sensations Olstein articulates had always seemed to me idiosyncratic: not ineffable but not worth communicating. Yet here they are, potentially coincidental to Olstein and myself, potentially additions to a long list of migraine effects aside from pain: enduring surprise, absorption of color, whirring arms, fantasy of air, and height, intimidation by Texas highways.

Despite its title, what the book cracks open about migraine are its other, non-pain dimensions. The openings reveal, beyond the study of pain’s advance, advanced study of how pain can evolve. If you do not have a migraine, or if you have what Olstein calls “‘normal-person’ migraine” (21) — occasional, episodic migraine — the condition may very well be defined by the pain. In that case, having seen on t.v. the wincing woman and the darkened room, or have experienced for yourself the nausea and the sensation of sharp metal lodged behind your eye, you may be wondering how I could have spent a migrainous day reading a book. I am familiar with the nausea, the sharp metal, etc. But three years into chronic migraine, I am on enough medication that severe pain is often kept at bay. Still, some days are bed days and some days are not. Some days I can look at a screen and some days I cannot. What is migraine when it is not pain? 

There is a long-standing clinical answer: a neurological disturbance. Nosologically, migraine is not a pain condition but a neurovascular one; when in the nineteenth-century migraine was called a nervous disorder, the nervous system, not an unsettled woman, was invoked. The spinning zigzags of migraine’s visual aura are the most well-known manifestation of its neurological disturbance. Yet the scope of what such a category might include is broad: recall my odd sensations that turned out not to be so odd. 

Threaded through Pain Studies is the suggestion that migraine consists of a state of perception not only heightened, as in the vibrancy of colors but alternative. “Migraine is a space you enter and are enveloped by and it is a different version of the world in there,” Olstein writes, “and all the familiar and all the strange, the invented and the reflected and the revealed take up their parts and, like music, unfold in time, but a form of time contained by the architecture of certain stabilities so you can not quite rewind or repeat but continue playing or step back into the playing, which is always playing until you step back out of it and in some ways it stops and in other ways, it keeps going” (142-143). Migraine as postmodern fairytale: a location and a temporality partially continuous with the non-migrainous realm but partially spilled out into it, encompassing apparent normalcy. In some ways, migraine-perception stops and in other ways, it keeps going. This means that when migraine is not pain, it is not relieved. It becomes the background orchestra of your life. Or perhaps: the orchestration of your life.

‘On a distinct form of transient hemiopsia’, by Hubert Airy, 1870.

To think about migraine as orchestra or orchestration is neither to lament nor to celebrate its presence. I pursue the consequences of what Olstein calls the stopping and the going, their unruliness. If migraine changes how I perceive or the way I encounter space, and it is not clear that I give up those changes when an acute episode ends, then migraine is not an addition to my ordinary way of functioning. It is embedded in how I function. 

Then I do not experience the effects of migraine: I am already those effects. (My arms are often whirring.) Or: we conceive of migraine as a medical condition, defined by certain symptoms, defined by pain. Migraine is also a condition about conditions. The symptoms, the pain, are not discrete discomforts that appear and demand treatment. They are ways of experiencing the world that shift one’s axis, one’s orientation. The symptoms and the pain and the shift may even all be indistinguishable, or identical. My neurologist, who is also a researcher, once told me that while chocolate is infamous as a headache trigger, the feeling of craving may in fact be an expression of the headache. 

Craving as headache; headache as craving; ache as something that is not ache at all, that has no pain. But that arrives and orients the bodymind. I think, too, of my drawers of neutral sweaters and neutral t-shirts, barely a pattern never stripes: most days, even non-headache days, most colors feel too bright. My habits start to seem like migraine’s habits, its needs, its oddities, its rhythms.

Migraine is a way of life, which does not mean only that it demands days in bed and ice packs in the freezer and getting to know a good neurologist. That migraine is a way of life also means that it is a way of being. It runs through the way that I desire and feel and think. 

Toward the end of Pain Studies, Olstein sketches a scene: “5:00 A.M., blindered, desperate for the meds to kick in, I blink at a blinking screen” (176). Because she has already made the case for migraine’s perception-altering qualities, the detail may be quick, but it is a tricky one if the reader is alert.: iIs the blinking a cursor? a monitor malfunction? or pixelated light that, because of her condition, does not appear steady? I vote (c). But more important than the ambiguity is the fact that Olstein is writing anyhow before the meds kick in.  She is writing through the blinking, because the migraine is chronic, and you can’t pause your studies forever. It is another detail familiar to me. I write through and I write with the blinking. The sentences don’t form any other way.

Shari Goldberg avoids zoom meetings. She writes about managing illness in nineteenth-century U.S. literature.