349

Br. J. med. Psychol. (1976).49, 349-371 Printed in Great Britain

Language and cultural influences in the description of pain BY HORACIO FABREGA, JR

AND

STEPHEN TYMA*

The general aim of this paper is to provide a way of conceptualizinghow the language and culture of an individual can affect the experiences which he has during disease. Insofar as such experiences underlie the behaviors of the person who is ill they are basic to the scientific understanding of how persons cope with disease. In a theory of disease, generic attributes of these experiences, and of the behaviors which accompany them, will have to be codified and explained. As a step towards the accomplishment of this long-range aim, we concentrate on a single but cardinal element of disease, namely pain. Any number of other private ‘signals’ of disease, each of which implicates mind-body relations,could have been used; for example, nausea or malaise. We have chosen pain because much is known about this phenomenon. Heretofore, an essentially psychophysiological approach has been adopted towards pain. Our efforts are intended to complement the work of others (Fabrega, 1975). Viewed in this light, the aim of the paper is to analyze in a broad manner the influences which language and culture can have on the study of the signals of disease. Such problems are of importance to the field of psychosomatic medicine. Ideas from anthropology and especially linguistics will be used in this effort. There is a large body of literature on the general question of how psychological variables affect the expression of pain and physiological responses to noxious (i.e. ‘painful’) stimulations (Sternbach & Tursky, 1%5; Buss & Portnov, 1%7; Tursky & Sternbach, 1%7; Sternbach, 1968; Sadler et al. 1%9; Tursky, 1974). However, there is a surprising lack of attention devoted to the role of culture and language (Wolff & Langley, 1968; Zborowski, 1%9). In view of the long-standingacademic interest in the relation between language and psychological experience, generally, this is surprising (Fabrega, 1974). ORIENTING APPROACH TO THE PHENOMENA OF PAIN

In order to give focus to the discussion, we shall adopt a definition of pain which is modified from the one provided by Engel (1970): pain is an unpleasant perception which the individual explicitly refers to his body and which can represent a form of suffering. In this definition, the purely sensorydiscriminative properties of pain are minimized in favor of the affectivemotivational properties. However, no mention is made of qualitative aspects nor of behavioral consequences. The absence of determinate physiological correlates is to be noted.t * Department of Psychiatry, Michigan State University, East Fee Hall, East Lansing, Michigan 48824. t This is a preliminary and working definition of pain. The definition is broad since an attempt is made to embrace cultural differences. In defining pain in this general and abstract fashion one excludes physiological and chemical features which biomedical science has uncovered as explanations of (our) pain. Requiring physiological or neurological factors in a definition of pain would constitute a form of reductionism which is antithetical to our aim of clarifying cultural and linguistic factors. In the definition, emphasis is given to perception, unpleasantness, and the individual’s judgement that his body or physical apparatus is the site and proximal source of the ‘pain ’. In our culture, the explicit link with the apparatus distinguishes pain from other unpleasant ‘perceptions ’, for example sadness, guilt or nausea. Nausea, furthermore, has an explicit link with alimentary, gustatory and gastrointestinal functions. This linkage may be a universal feature of nausea, in which case an independence between nausea and pain could be posited. If it is not, and if in addition people judge what one might term ‘nausea’ as an unpleasant perception and link it explicitly to the body, then this would have to be included as a component or form of their ‘pain ’. Cross-cultural linguistic studies are needed which will carefully document perceptual, behavioral, and cognitive features of ‘pain’ and of other signals of disease.

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Several additional aspects of pain need to be distinguished. There is obviously a neurological component to pain which includes nerve endings in the body surface and viscera, peripheral nerves, pathways in the spinal cord and brain stem, neural connections with the substance of the brain stem and diencephalon, and eventual connections in the neocortex. The perceptual experience of pain is viewed as identical to a state of the brain; more generally, as the accompaniment or representation of a state of the nervous system as a whole (Globus, 1973; Feigl, 1967). Physical stimuli of various types which impinge on the body surface or which arise from within the internal organs are believed to activate the neurological substructure subserving the pain experience. Such physical stimuli will be termed here the bodily sources of pain. The mental, neurological, and bodily components of pain together account for actual instances of pain. It hardly seems worthwhile to emphasize that pain as such cannot be directly observed; only persons claiming that and/or behaving as though they are in pain. Clearly, what people say when they claim pain, and how they behave while claimingthis pain, will vary substantiallyacross human groupings. Together, these two observable and hence ‘external ’ accompanimentsof a presumed internal state of pain will be termed pain behavior. Pain behaviors, then, embrace changes in facial expressions, demeanor, and activity. They also include verbalizations which describe and qualify the pain experience in a determinate way. The latter constitutes the linguistic dimension of pain, i.e. the structure and content of verbal descriptions of pain. Such descriptions realize the language system of a people. It is this latter aspect of pain, examined in the English language, which will be explored presently. Pain also has an abstract conceptualdimension. This is to say that people talk about pain and derive theories to explain it. In this sense, pain is similar to any other abstract cultural category which has no visible or material form; for example, disease, loyalty, fear, and/or evilness. One anticipates that what people say about pain and how they explain it will be highly variable and will depend on a host of cultural and social factors. In this light, it may be worthwhile to distinguish among categories of pain considered in this abstract conceptual sense. Three types of categories of pain may be distinguished: First, pain which is linked to a state of malaise or dis-ease. The qualification or explanation given to the disease is likely to be similar to that given to this category of pain, and vice versa. Secondly, one may distinguish pain not linked to a state of disease, but which nonetheless has no readily visible source or basis. These two types of pain, considered as cultural categories, are likely to differ significantly in import across human groups insofar as they are not linked to easily observed sources. On the other hand, it is possible that those types of pain which are linked to and explained as resulting from traumatic and visible changes or events which impinge on the body (e.g. lacerations, burns, fractures, etc.) may share some conceptual features across people of different cultures and languages. For one thing, the often sudden, unexpected and disorganizing quality of such events and the fact that they are associated with visible changes in the image and/or integrity of the body may stamp the whole complex in determinable ways. It is even possible that the similarity in the circumstances surrounding these events may affect the actual pain experiences, rendering these more homogeneous. The sum of these issues is that the resulting concept of pain may take on a degree of uniformity. It should be remembered that many such ‘visible’ bodily changes when expected or planned for may not be dealt with conceptually as pain at all ( e g childbirth experiences, mutilations delivered during initiation rites, etc.). Certainly it is the case that the cultural and social setting in which trauma and bodily deformations occur have much to do with whether they are judged as painful at all, as indicated by the classic observations of Beecher (1959). In short, the actual modifiabilityof such kinds of pain experiences may constitute an additional factor which contributes to making this third conceptual category of pain more uniform in its meanings across various people. Aspects of pain are illustrated in Fig. 1.

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Fig. 1. Aspects of pain Mental dimension

1 I

Neurological dimension Bodily dimension Behavioural dimension Non-verbal Linguistic J ConceDtual dimension Pain- with disease Pain secondary to trauma Other pains

Internal condition of pain External accompaniments of a pain condition

Theoretical attributes of pain conditions

ORIENTING CONCEPTS AND DEFINITIONS

In order to facilitate the analyses which are pursued in this paper it appears worthwhile to examine the following concepts. Culture This will refer to ‘ . . .that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society’ (Tyior, 1958). Distinctive features of a people’s entire life style are thus included in this definition. To many, culture is a purely psychological construct embracing such things as values, assumptions, orientations, modes of emotional expression, means-ends patternings, rules for behavior, etc. This latter emphasis makes ‘culture ’ the mould which shapes psychological experience and social behavior. In a strict sense, it is best to emphasize that a researcher observes behavior (including verbal and written behavior), artifacts, and other physical features of a people’s mode of life and that from these. he abstracts ‘culture’.

Human language It seems useful to rely on a distinction provided by Lyons (1972). On the one hand, the expression language behavior will refer to actual context-dependent vocal (e.g. involvingwords) signals by means of which people communicate and inform; this includes the actual utterances, speech acts, and associated communicationsof an individual. On the other hand, the expression language system will refer to the system of rules and regularities which underlies language behavior. Implied here, then, is the ideal pattern and structure which in a linguist’s model of a people’s language behavior accounts for that behavior, i.e. explains it, gives a systemic account of it, etc. Language families The language systems of man are as varied as his cultures; the evolution of language also bears a relation to the evolution of culture. Historical linguistics is concerned precisely with the reconstruction of proto-language forms based on series of predictable changes involving sound, grammar, and meaning. Any number of significantly different language families have been hypothesized (Greenberg, 1968; Langacker, 1968). Through investigations such as these, the paradox of similarity in the presence of difference between any two languages is resolved. Even a casual observation discloses that there are often radical differences between languages in spite of grammatical or vocabulary similarities. In the same vein, the question of whether or not an expression from one language can be translated into another language is moot; the controversy centers now on the degree of economy of expression used in the second language when compared with the first. Just as one culture group may divide, a language may split and yield different languages after a period of time. Thus, if cultures C’and C”were once together as proto-culture C, it follows that their correspondinglanguages L ’ and L”are probably daughters of proto-language

352 HORACIO FABREGA, JR A N D S T E P H E N T Y M A L. It is most important that whenever language influences on pain are sought, comparison of representative languages from diferent families be made. Such comparisons are most likely to implicate fundamentalaspects of language, whether these involve cognition-perception or merely expression. Grammar A grammar of a language is a system which describes the pattern and/or configurationof language units (be these words, phrases, clauses, etc.) by stating which configurations are acceptable or not in the language community (Chomsky, 1965). The emphasis here is on description, as opposed to prescription: grammars state what is acceptable and when; they do not state what should or should not be acceptable. The term ‘syntax’ is used to refer to those aspects of grammar which address the question of how segmental units or words are arranged or combined in a language system. An important additional aspect of grammar is the description of acceptable configurationsof sound segments. The native speaker of English intuitively recognizes that ‘9plit’ (pronounced shplit) is not indigenous to his language while ‘spit’ or ‘split’ are. The use of ‘9’ is limited to specific clusters of consonants. This aspect of grammar is known as phonology. In a sense, the prohibition of pairing of ‘sh’ with ‘pl’ may be seen as co-occurrence restriction in the phonology of English. Semantics This refers to that aspect of grammar which is concerned with the configura!ion of units of meaning (Fodor, 1974). Such units have been called sememes by some linguists. It is in this realm that culture and language seem most intimately interwoven. Features of a language which have semantic import and which are more salient in language X are said to be compensatorily salient in the cultural environment of X. It needs to be recalled that languages necessarily ‘force’ speakers to classify phenomena in a specific way. Such classifications apply to stimuli and objects as well as to more complex processes and events, all of which need to be rendered in a form dictated by the language. This means that semantic units or sememes are expressed in the categories which underlie the classification necessarily entailed by languages, and in syntactic characteristics of units of expression. This makes the notion of plurality (as an example), a sememe, and it is realized as ‘-s’. The analyses of metaphor (likening one thing implicitly to another), simile (description by explicit comparison) and idiom (preferred modes of expression in a language) all fall within the realm of semantics, and such phenomena may actually reflect the realization of additional sememes. It is in fact a postulate of linguistic theory that the semantic value of an idiom, a metaphor, or a simile is only rarely equal to the sum of the respective values associated with its constituents. Semantic features are realized in other more subtle ways. This can be illustrated by examining the pair of sentences ‘Pain raced through my body’ and ‘Pain called up and spoke with me’. The former sentence, because it is acceptable, clearly marks pain semantically as being either animate or an entity that possesses animate-like characteristics. On the other hand, the latter sentence is not acceptable because the verbs ‘call up’ and ‘speak ’ require human subjects; this, by implication, has the effect of marking pain semantically as ‘non-human’. Constraints such as this, which prevent the simultaneous association by either meaning of juxtaposition, constitute co-occurrence restriction in the grammar of English. These examples illustrate the subtle ways in which aspects of meaning are woven into utterances, and from the standpoint of linguistics, the semantic constraints placed on expression. Semantic change. The very purpose of language is the communication of meaning and how this communication changes across time is informative from a cultural standpoint. Although the language changes, it may be the case that phenomena referred to by means of language remain relatively fixed. Intuitively, one assumes that the capacity to experience pain is a constant in human groups and, moreover, that the phenomenon of pain is (and always has been) universally

Influences in the description of pain

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disvalued. Pain has no doubt always had a powerful (i.e. compelling) influence on behavior. Human languages, then, will invariably represent paih in a determinate fashion. The question one asks here is how this linguistic representation (i.e. the way of describing and referring to pain) may have changed across recorded history. It is obvious that to study this, earlier versions of a language are required. This of necessity means that one must work with written forms of language and rely on existing documents. There are two general facets of linguistic change: one phonological and the other semantic. Linguistic forms or words realized as sounds can change, and so can the semantic units implicated (i.e. phenomena referred to or named by the form). Semantic and phonological change are often interdependent,but a discussion of semantic change is more pertinent here (Anttila, 1972). @ The fluid relations that exist between sounds and meaning are made clear by historical analyses. For example, Classical Latin had the forms ‘homo’, ‘vir’ and ‘femina’which referred to the sememes /mankind/, /male/ and /female/ respectively. French (and English) which have been importantlyinfluenced by Classical Latin, have retained these three sememes (i.e. mankind, man, woman); but, ‘homme’ (‘man’), which is still used to refer to the sememe /mankind/, is also used to refer to the sememe /male/. This condition is itself changing in modern English under significant pressure from women’s rights advocates. French (and English) have retained the linguistic form ‘femme’(‘woman ’ or ‘female’)whichstill refers only to the sememe/femalehomo sapiensl. In short, these three semantic units or meanings have been preserved, but the linguistic forms and sounds which are now used to realize them have changed somewhat. It is important to emphasize that the semantic units which are implicated by a linguistic form change only infrequently,but that the linguisticform itself (i.e. the correspondencebetween sound and meaning) changes quite frequently. The principal ways in which this change is brought about are by either extending the meaning of a form or word (sound) to additional realms which are perceived as being somehow similar to the original, or by restricting the meaning of a form by excluding or obsolescing some of the original meanings. Extension and restriction not only encompass a shift in a semantic category (e.g. a new entity is named by a linguistic form), but also a shifting to a new grammatical class which reflects an enrichment of the influence of the original linguistic form, for example, nominalization (verb to noun extension)and predicativization (noun to verb extension). We shall see that this is particularly the case with precursors of our form ‘pain ’ which originally (in Classical Latin) meant a penalty (i.e. noun class) but with time came to refer to the act of making a penalty (i.e. a verb class). Extension and restriction are closely related to linguistic processes such as metaphorization and idiomaticity Viable metaphor is considered by many linguists to be dynamic (i.e. current) semantic change. There is also a marked tendency for phonetically and semantically similar terms to merge phonologicdy with either a corresponding merger in the semantic references or a loss of one semantic referent (see discussion on ‘pain’ below). Finally, a word can be borrowed from another language. Usually, the borrowed word refers semiologically(conceptually)to a concept not present in the borrowing language, although this criterion is far from absolute. The borrowed term then becomes input for the restriction, extension and merger processes.

.

SEMANTIC ASPECTS OF THE DESCRIPTION OF PAIN

The essence of language as a system of communication is that it is symbolic;it consistsof a system of symbols. There is thus an arbitrary but conventional linking of certain symbols (e.g. words, phrases, sound configurations, etc.) with certain referents. In the present instance, the meanings of the symbols (i.e. pain words, pain phrases, etc.) involve a pain experience. One may in this regard ask how these symbols are to be viewed semantically: how or on what basis is pain, a perceptual experience, given meaning and significance by means of language? In discussing

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H O R A C I O F A B R E G A , JR A N D S T E P H E N T Y M A

semantic aspects of pain descriptions we will give attention to two types of related issues, lexical and metaphorical. Lexical issues Here we discuss the meanings of various terms or words which can be used to describe pain in the English language. Comparisons of idealized utterances of pain description in English have led us to formulate three classes of terms that are employed in these utterances. Such a formulation is made here purely for heuristic purposes and bears no relation to that offered by others in discussing related matters (Melzack & Torgerson, 1971). It will be shown that our mode of classification is supported by the historical analysis of the lexicon of pain-related phenomena. Contemporary English has a limited n u d e r of words which serve as a base for the description of the perceptual experience which we have defined as pain; this basic set is referred to henceforth as primary pain terms. Secondary pain terms are those words which denote physical change of state or damage and are employed as qualifying metaphors in pain description (as in ‘I have a crushing pain’). The final, tertiary class consists of terms of qualification that are used to register degree of intensity, fullness, duration, and so on (‘I have an intense pain in my leg’). Primary pain terms The four accompanying charts present a summary of morphological, phonological, syntactic and semantic characteristics of the four primary pain terms of English. The columns indicate change through time; in some cases the change is purely phonological (i.e. the meaning stayed the same but the pronunciation changed), while in others it is essentially semantic (while the pronunciation may not be different from the preceding time period, the meaning has changed). Phonological and semantic change need not have a point-for-point correspondence, and consequently one or the other will be carried through some horizontal gradations (see Figs. 2-5). The first row of the charts is the base form, given in more or less standard International Phonetic Alphabet transcription, with the exception of the most recent forms, which are rendered in standard English orthography. The base form is so named because it is assumed to be the root or stem that is available for regular English morphological expansion (e.g. pain can be expanded through use of the suffixes ‘-ful’, ‘-ing’ or ‘-ly ' or the prefixes ‘un-’, etc.). In the case of ‘sore’, the four original base forms are actually relatable by a series of regular phonological changes (in a very rudimentary sense, sound changes within the word, as If1 to Ivl in life-lives or lil, lael, or la1 in sing-sang-sung), but in the chart, the forms rather than the relational rules are rendered for heuristic purposes. The next row presents the grammatical categories (commonly known as parts of speech). The concepts ‘noun’, ‘verb’, ‘adjective’ and ‘adverb’ are common enough, but the notion of transitivity merits elaboration: a transitive predication must contain a subject (or actor or experience), a verb, and an object as goal, as in ‘John’s stomach pains him’, wherein the action or experience ‘paining’ is expressed as originating with ‘stomach’ and terminating with ‘John’. Hence ‘stomach ’ is the actor or agent and ‘John ’ the recipient or goal of the action. An intransitive predication is one which cannot include an object as goal (e.g. John’s leg is aching). Date of use is an approximation of the time at which the form as cited can be documented as having been used. Dates of use cannot be established for some of the earliest forms, and much debate in linguistics has centered on whether or not the proto-forms (designated with*) ever existed at all. The most definitive statement that can be made about these proto-forms is that they closely resemble forms of some ancestor language. The concurrent meaning row lists the definition for each correspondingly indexed base form as it is assumed to have been when the form was in use. The principal sememic import is a condensation of the most salient semantic information (‘features’) for each set of base forms. By comparing adjacent entries in this row, it is possible to see how the meaning has changed through time. If two adjacent entries are identical or nearly so, the sound change at that stage is most significant between those columns.

Influences in the description of pain

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Geographic setting gives the area in Europe in which the form was used, and the language family whence the term originatedand was used is indicated in the proto-languagegroup.The information in these charts is a condensation of data obtained from The Oxford Dictionary of the English Language, 1933 edition, and from Dr Samuel Johnson’s Dictionary of the English Language (1755).

‘Pain’. The word ‘pain ’ is the principal vehicle of description. In being applied to the general nature of the perceptual experience, ‘pain’ serves as a covering term. Of the four primary pain terms, ‘pain’ is the only term that is not purely Germanic in origin, as it is derived from the Greek ~ o i w f (poine, i a tax) and the Latin ‘poena’ (punishment,penalty, fine, tax) (see painchart). From its inception, then, the base form of our ‘pain’ had an association with wrongdoing, penalization, victimization and indeed the matter of justice and reckoning. It is not clear whether the rise of Christianity was a factor which influenced the shift of the sememe /penalty-punishment/ onto the domain of personal discomfort, i.e. onto pain as a human condition. It must be emphasized that, in Classical Latin, punishment or penalty had both mental and bodily (i.e. physical) implications since legal offenses could entail monetary assessments (i.e. which occasion ‘mental pain ’) and/or corporeal ones (e.g. physical torture). In this sense, it could be said that from a very early appearance in the language, even prior to its shift onto the actual domain of pain, the base form took into account phenomena that implicated mind-body concerns. The concepts of punishment or taxation in connection with pain are still extant, as in (1) I don’t know why she feels she must punish (or, pain) me in this way. (2) In his condition, any extended activity is highly taxing (painful). Grammatically, ‘poena’ is a noun in Classical Latin, and originally had no verb counterpart (until the Medieval period), hence one would say ‘I give (do, make) a penalty (a “pain ”) to him’. It was possible to use ‘poena’ to describe a pain experience, but its use at the time apparently was considered a metaphorical extension (see ‘Semantic change’, above) of the base meaning. In medieval Latin, ‘poena’ was predicativized to ‘poenare’. In finding its way into English, ‘poena’ or ‘poenare’ took two paths, coming first into Old English through the Germanic verb ‘ *pinon’ (to inflict suffering).The second path was through French (n. peyne, v. pener) as aresult of the Norman conquest of England in 1066. The two Old English forms (as pinian, peyne) were retained for a while with a fine distinction in meaning, one relating to general suffering and the other to punishment for crime. After a number of very gradual sound shifts, both forms came to be so phonologically similar that they merged as ‘pain ’ around 1500. The word ‘pine ’ (derived from ‘pinian’) has been retained as a verb in England and in the Southern and Appalachian United States (where its use is considered non-standard). The word ‘pine’, interestingly, can be seen as bridging the mind-body division (‘He pines for her’): ‘Ache’. As with ‘hurt’ and ‘sore’, ‘ache’ appears to be totally Germanic in origin; it is indigenous to Northern Europe and Scandinavia. The reconstructed verb form ‘acan’ (to feel pain) apparently meant both ‘perceiving pain ’ and ‘experiencing need ’ or ‘feeling deprived’. There is evidence that the forerunner of our ‘ache’implicated intense degrees of pain, something which no longer remains. The important point is that ‘ache’ had an early association with personal discomforts and, moreover, discomforts which bore a loose tie to the idea of nonwholeness, separation, as well as wrongdoing and penalty (as in being deprived, dispossessed, removed from office, etc.) as well as the case for ‘poena’. In Middle English, the verb ‘aken’ could be nominalizedas ‘ache ’ by a regular rule (the same rules related ‘bake’ to ‘batch ’, ‘make’ to ‘match’, ‘stick’ to ‘stitch’, etc., each of the latter representing the nominal counterpart of the former). Around 1250, ‘aken’ came to refer to older, prolonging, or persisting pain. The distinction in noun-verb pronunciation (ache vs. aken) was lost c. 1700: the pronunciationbecame leykl (‘ache’), while only the noun spelling was retained. ‘Hurt’. ‘Hurt’is either Frankish @re-RomanFrench, a Germanic language) or Germanic in

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HORACIO FABREGA, J R A N D STEPHEN TYMA

I

I

*pinon verb (transitive) similar to pr-ing

I

I ,-

Pain

I

Torment. cause to suffer

I

Fig. 2 (*) denotes reconstructed or 'proto-' form. These are hypothetical forms. It cannot be firmly established if a form identical to this existed at the stated time, but it is considered highly probable that it did.

Influences in the description of pain

I

pinIan (pinina)

I

verb (transitive)

I

I

I

pine noun

I

verb (intransitive)

II

(a) verb (transitive) ( b ) verb (intransitive)

I I

pine

I

verb (intransitive)

I

IAD

850 1150 A.D. 1200 to inflict suffering suffering inflicted (he was ininet ermiliche tb de e. by wa; of punishment to undergo suffering (He a bin pyned: (he was pained almost (depine of helle: He was suffering) to death) the pains of hell) Physical or emotional A.D.

paine

357

I

I

(b) to suffer (a)inflicting mental or physical torment to be deprived, in a

to be tormented, to

(b) !oLnjcl:go mental or physical

IEngland Germanic

Germanic

state of wanting

I England Germanic

I . pain 2. pain noun A.D. 600

(a)fine. punishment (he was given a fine of $25) (b)discomfiture (he was in-) a) punish for wrongdoin (b) Site of. France

Romance

verb (transitive)

noun

A:D. 600

A.D.

(a) to penalize

(The Judge-$'')

(b) to cause to suffer

1300

(a) suffering for crime or offense

( w e enemyus) (b) discomfort "physical" or **neutral'*suffering ( a ) to fine, to punish ' a ) corporal punishment ib) irritation, discomfort (b) to injure, to hurt France

England

Romance

Germanic

I . noun 2. verb (transitive)

I

Fig. 3. Ache

Around 1600. the rule mentioned above had been modified to 'k-sh' in nominalization. In a very strange series of 'events' around 1700, the pronunciation of 'ake' and 'ashe' were conflated to 'ake', but the spelling of the nominalized fonh was retained, while the spelling of 'ake' has since been lost.

t'ace' is a noun derived from the verb 'aken' by a regular phonological rule of Old English. The rule is 'k+ts' (i.e. 'k' in the verb becomes 'ts' in the noun)

Germanic

Germanic

Germanic (Old English)

Germanic

Proto-language group

England

Northern Europe

Geographic setting

England

to sense pain

England

2. an older, persistent pain

persistent pain

2. a prolonged pain

1. to experience

I . to experience prolonged pain ( I preye God dat oure hedes nevere ake) prolonged pain

A.D.

A . D . 1250

1600

I . verb (intr.) 2. noun

I . verb (intransitive) 2. noun

I . ake 2. ache$

I . oc 2. ake

persistent pain

I ache I have an ache

2. a pain

the experience of deprivation;to sense pain

( I ache)

I . to be in pain

A D

I . verb (intr.) 2. noun

2. ace

I . akent

Principal sememic import

Concurrent meaning

to feel pain. to be deprived

verb (intrans.)

Grammatical category

Date of use

acan

Base form

Ache

Germanic

England

~~

persistent pain

2. a prolonged pain

I . to experience prolonged pain

A.D. 1700

2. noun

1. verb (intr.)

ache

3:

00

ul

W

England

England

pain

-

Fig. 4. Hurt

t The sense of ‘hurt’ as a noun is still extant in English, but its use is considered an archaism or non-natural.

t The notion of ‘hurt’ as pai a verb ‘hurten’ (to ram, tc

Protelanguage group Germanic (Old English)

England

France

Romance

cause or experience

injuring or destroying by striking

pushing or ramming

Principal sememic import

striking motion 2. to push, to injure

a butting (They W e the door a _ ) 2. to push, to butt, to ram (Theythe door (in))

-

1. an injury, a mark from a blow (the club left a-) 2. (a) to cause to suffer (I him) (b) to suffer (I from it)

1. a push or shove, a

1. a push or a shove,

1300

Concurrent meaning

A.D.

A.D.

1100

I. noun 2. (a) verb (transitive) (b) verb (intr.)

1. hurte 2. hurte(n)

Date of use A.D.

I . noun 2. verb (transitive)

I. noun 2. verb (transitive)

Grammatical category

600

1. hytre 2. hirtenn

I. hurte 2. hurter

Base form

Hurt

I

1500

cause or experience pain

(a) to injure (He hurt me) (b) to suffer, to sense pain (My leg hurts)

A.D.

(6) verb (intr.)

(a) verb (transitive)

hurt(e)

W

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H Q R A C I O F A B R E G A , JR A N D S T E P H E N T Y M A

-

i

5;H

p ;* p

N n *

Influences in the description of pain

36 1 origin, but it is most likely Frankish’. The original forms were ‘hurte ’ (a noun) and ‘hurter’ (a verb) meaning a physical blow and to ram or butt respectively. Neither of these earliest meanings at the time implicated the notion of injury, much less of pain or suffering. Hence, in the framework adopted here, ‘hurte(r)’could have then served as a secondary pain term (see below). With time, the notion of physical damage and/or injury was acquired, and this came to embrace the physical body. At this juncture, the form ‘hurte’ acquired, semantically, some of the personal consequences of bodily damage (e.g. suffering, discomfort, pain, etc.), Interestingly, a contemporary realization of the earliest form, ‘heurter’ (to strike), is still extant in French, and it does not connote injury. Some historical linguists speculate that ‘hurt’ came to refer to pain through its association with jousting tournaments [one ‘hurt’ (rammed) his opponent with a lance]. While French, Old English and Middle English had both a noun and a verb form of ‘hurt ’, the noun form has more or less been lost to contemporary English. Thus, the expression ‘I have a hurt in my leg’ is not frequently encountered. ‘Sore ’. This word and ‘sorry’ are etymologically related (see chart). Proto-Germanic had adjective, adverb, verb and noun forms. Like ‘ache’, it has referred to the description of the perceptual experience of pain as far back in linguistic history as its existence can be documented. From the range of its grammatical functions and semantic values it is clear that the base form of ‘sore’ referred to pain located in the self and body. Moreover, from its earliest documented uses, the base form seems to have implicated a special type of pain, namely intense and severe pain. This stands in contrast to its current meaning. Because some form of ‘sore’ is found in a number of non-Germanic languages that have been in contact with Germanic at some point in history, ‘sore’ i s probably the oldest pain term in proto-Germanic still in use. The verb form (They are soring the backs of their horses) has been lost in American English and is in declining use in England; the adverb form (Her leaving sorefly)depressed me) is considered archaic. The noun and adjective forms appear to have assumed a connotation of persistent or prolonged pain or injury. Summary of Historical Analysis of Primary Pain Terms Aside from the nominalizationand predicativization shifts discussed above, there has been a shift within the predicate function involving transitivity-intransitivity. Although originally transitive, the forms ‘hurt ’ and ‘pain ’ have come to embrace distinct intransitive forms which are associated with different meanings. X (a) I hurt in my leg. (Intransitive; involving a state of pain.) (b) My leg hurts me. (Transitive; involving state of pain.) (c) I hurt Sheila. (Transitive; inflicting injury of pain.)

{

(a) I p? I for Sheila. (Intransitive; involvina state of deprivation.) pine I (b) She pains me. (Transitive; involving metaphoric pain.) (c) My head pains me. (Transitive; involving state of pain.) It is perhaps significant that ‘sore’ and ‘ache’, which are transitive and intransitive respectively, have not shifted to include opposing states of transitivity, and that both of these terms are the oldest pain terms in the English language that are still in use. As Fig. 6 illustrates, three of four possible shifts involving transitivity have occurred: a transitive form has expanded to include an intransitive form, and one transitive form and one intransitive form have not expanded. Semantic shifts of significancehave occurred as well. Important is the archaic meaning of our ‘pain ’ which involved, as described, the notion of wrongdoing and punishment. (This same sememe seems to have been a part of the base form of ‘ache’,) It is reasonable to assume that Latin and Greek had terms (presumably verbs) other than ‘poena’ and ‘poinC’for the expression of pain and that these terms have not been passed on to English, at least not with reference to Y

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Fig. 6. Changes in verb form of the primary pain terms Original Pain transitive Hurt transitive Sore transitive Ache intransitive

Present Pain transitive + Pain intransitive Hurt transitive --f Hurt intransitive Sore transitive + Ache intransitive

pain (e.g. n. dolor, v dolere in Latin). In a formal sense, the evolution of ‘poena’ to ‘pain’ involves a metaphorical extension since poena was initially used to refer to phenomena not logically related to those of pain, in much the same way as hurt, which originally referred to a physical force and/or its effects. On the other hand, some terms came to refer to phenomena beyond the realm of pain, as in ‘He gives me a pain’ or ‘That expense will hurt our budget’ or ‘I am pining (i.e. paining) for her ’. This latter type of metaphorical extension is the complement of that mentioned above: poena and hurter moved from non-pain to pain, and thence beyond to pain-related. It can also be observed that the terms ‘sore’ and ‘ache’ once referred to pain in a far different manner than they now do. Currently, ‘pain ’ seems to be a term that is either marked or unmarked for intensity, depending on the linguistic context, as in Unmarked intensity (a) He has a pain (in his leg). Marked intensity (b) He is in pain. It’s a painful injury. There is every reason to believe that both ‘ache’ and ‘sore’ were marked for intensity as is pain above, even though this is clearly no longer the case; that Old English probably had other forms that functioned as ‘ache’ and ‘sore’ do now (i.e. for ‘low’ levels of pain); and that these forms have since been lost to us. Whereas English formerly had at least two terms which were specifically marked for intensity (ache and sore), there are now two terms that are not marked for intensity (hurt and pain, when pain is used as the general term of reference for the experiential phenomenon /pain/) as well as two others (acheand sore) which are clearly marked as specifically not intense. As an aid in clarifying conceptions about mind-body relations, it should be remembered that all of these pain terms have realized both mental and physical kinds of referents; on the one hand, a physical entity, experience, or action was referred to in some cases and later implicated a mental state, while on the other, both a physical process or change of state and its effects, the perception of injury through pain, have been delineated. Important generalizations about the linguistic aspects of pain can be drawn from what is not evidenced in the historical analysis. First of all, it is noted that with the exception of intensity, no other feature of the quality of the perception of pain is marked for reference in any of the contemporary English primary terms. Moreover, historical analysis appears to establish that at no time did these pain terms refer to (or connote) any particular quality of pain save intensity. No relationship can be drawn in English between the pain terms and other attributes of the general condition of pain, such as its location, its possible quality, or its cause (other than that linked empirically or metaphorically to an external physical force). The exception is the tie that ‘pain ’ and ‘ache ’ have with wrongdoing and retribution. At the same time, the terms do not relate to any specific information about unique physical qualities of injury, of associated mood state, or of malaise such as demonstrated by a change in an individual’s appearance, demeanor or behavior. It is feasible to assume that in any language, causes of pain, such as by classification

Injluences in the description of pain

363 of agent of injury or attribution to natural or preternatural processes, could be referred to, but this appears to be so in only a few cases in English. Finally, the states, processes or consequences of disease per se are not implicated semantically in English primary pain terms. This is interesting since disease is thought to be a prominent cause of pain and the principal sources for the description of pain in the English language seem to have been either purely mental phenomena or physical forces and the putative consequential deformations produced by them, which are judged as frequent consequences of disease. Limitations of Historical Analysis of Primary Pain Terms The historical method is one which works backward through time, as if the present were the endpoint of the continuum, in much the same way that a genealogist sketches the transmission of traits. Of necessity, this procedure precipitates the exclusionof materialand terminologywhich no longer bear any relevance to pain because they are now obsolete: the presumption here is that if these terms still bore any reference to pain, they would still be extant. Another limitation is that these data cannot be given any status in regard to the degree to which they are representative of the language as it existed at the time indicated: the only documentation is by literate people whose experience is limited, and at least in this case the documentation was not made for the study of pain, but rather for other purposes to which the reference to pain is somewhat secondary. The documents themselves survive only through chance, so the status of the evidence may be open to question. Finally, a researcher availing himself of historical sources is dependent on the insight of the compiler himself. In a sense, the richness of this person’s conception of pain affects how and what material he will search for and report on. The preceding points seem to have the following implication: generalizations drawn from the historical study of language and communication cannot be expected to offer final or definitive conclusions about a domain or problem of interest. It hardly seems necessary to add that a written language captures only in a relatively abstract form material dealing with communications about descriptions of pain. In other words, the richness with which individuals describe and communicate about as important and elemental a phenomenon as pain is unlikely to be captured in written form. This means, in short, that historical analyses constitute but coarse attempts to clarify a problem as intricate as that involving the relations between language and mental experience. Nonetheless, historical analyses can be the source for hypothesis testing and for theoretical understanding of pain. Secondary pain terms In addition to a small limited inventory of terms that have special and restricted uses with regards the pain experience, those termed primary pain terms, it appears useful to group others which seem to be ‘borrowed’ from the remainder or unrestricted lexicon in order to more fully describe an experience. We have in mind words having wide meanings in the language, but whose principal function vis CZ vis pain seems to be to qualify the primary pain terms and which may in some instances also be used instead of (i.e. synonymously with) them. Analysis suggests that these secondary pain terms refer to what the perceptual experience of pain is being likened to, so that they bear a relation to the problem of metaphor (see below). The following are relevant: cutting, jabbing, pulling, pressing, crushing, sharp, burning, etc. A report of pain, for example, can be rendered as ‘I have a pressing pain in‘my chest ’ or ‘I have a pressure in my chest ’. An ordinary native speaker of English, it seems, finds little difference in equating the latter sentence with pain. Secondary pain terms thus realize criterial features of pain as these are constructed in the language. Analysis of these terms should disclose key semantic features of pain.

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Tertiary pain terms The words in this category are also used to elaborate on the experience of pain, but it seems to be the case that these terms do not bear special connection to pain per se. Instead, these tertiary pain terms appear to be used purely to qualify any experience. Some examples are: deep, intense, mild, simple, steady, shifting, nauseating, depressing, tingling, etc. The sentence ‘I have a steadiness (or intensity) in my chest’ might be judged as syntactically well formed, but semantically does not convey any clear association to pain. Tertiary pain terms could themselves be classified further; for example, as involving intensity, time space, or affective valuation. The importance of the terms is that they refer to general attributes of many types of phenomena, have no special relation to pain, and moreover at a particular point in time cannot be used instead of primary pain terms. The fact that in English pain can be readily qualified in this unrestricted way has implications. For one, it suggests that the English version of pain, although possessed of unique features, nonetheless is not totally unique in that it shares parameters common to other ‘objects’ in the language (e.g. emotions) and by implication is registered like other mental and physical phenomena. In this sense, pain has been partially amalgamated in English, i.e. it approximates or can be equated with diverse phenomena. This open and flexible way of describing pain should not be judged a universal feature of pain. In a strict sense, only those forms of qualificationwhich are available and deemed appropriate in the language and culture can be used. Moreover, it may well be the case that culturally unique sememes are associated with pain and that as a result unrestricted qualifications are not allowed in spite of the fact that these may be available in the language (see below). It seems appropriate to also place in the category of tertiary pain terms those which refer to body parts, such as back, leg, stomach, etc. These do not describe the experience of pain, but do explicitly link it to the body. This linkage to the body represents a necessary feature of pain as defined here. It is appropriate to emphasize that how people partition the body varies cross-culturally. As an anatomic structure, the body of man could be judged as universal; but as cultural structure or system, the body of man must be considered highly variable. Hence, in order to understand a description of pain which includes body part terms, the precise referents to these terms need to be established. Pain Description and Metaphor When having a perceptual experience of pain which they want to describe and report, persons draw on the various pain terms which have been classified above and use them in grammatical constructions (see below). In the process, a version or model of what pain is or stands for in English is revealed. No doubt the words used to describe concrete objects (e.g. tree, sun, car, etc.) gain precision by virtue of the validation that is possible through direct and consensual observation. Tfie words enjoy a seemingly ‘direct’ connection with objects which can be publicly observed, thereby serving to ground their referents. Obviously, no such validation is possible in the case of perceptual experiences arising entirely from within the body. This may constitute an important factor contributing to the metaphorical aspects of descriptions of pain experiences. Analysis of contemporary pain descriptions in English as well as the semantic properties of the forerunners of the primary pain terms suggests that an observable, ‘natural ’ and physical process is implicated. The ‘model’ for pain descriptions in English, in short, has a physical basis, suggesting that the experience itself has and is being likened to a physical process. At the most general level, it seems to be the case that the process implicated involves physical change or alteration of an object. A narrower and more specific version of this process seems particularly relevant to pain and is captured by physical deformation, destruction, damage, and harm.

Influences in the description of pain

365

A negative or injurious physical change of a seemingly equally physical object would certainly embrace semantically the secondary pain terms (e.g. burning, cutting, crushing, etc.) which are critically involved in the elaboration of the experience. This type of damage, then, would seem to constitute important sources for the metaphoricaldescription of pain. Primary pain terms must also be viewed as rooted semantically in a metaphoric transfer, as has been illustrated, although the precise sequences are now blurred. A negative sort of process or entity having physical roots is nonetheless implicated in some of the primary pain terms (e.g. hurt, pain). In other instances, the semantic antecedents are not available, though a state of non-wholeness is suggested in the case of ‘ache’ (i.e. to be wanting, lacking, etc,). In the English language the phenomenon of pain, viewed semantically and metaphorically,has also stood for a condition which implicated suffering, punishment, wrongdoing and justice. This theme is explicit in the early ‘pain’ forms and implicit in the early ‘ache’ forms as was documented. Not linked to the pain terms in an explicit sense was the idea of the specific grounds and sources of this condition. One is left to speculate whether a folk theory of natural or preternatural causality may have underlain this theme. At any rate, a physical process or change which can injure and damage (the ‘how’ of pain), which may have connections with individual wrongdoing, and which may reflect chastisement and retribution (the ‘why’ of pain) would seem to be the principal metaphoricalsources for the elaboration of the pain experience. The preceding negative valuations of pain raise an obvious problem for comparative analyses which have to do with the interplay between cultural-linguisticmatters and neurophysiological ones. To what extent is the negative-disvaluedmeaning given to pain as an experiencedue to purely neurbbiologic features, to what extent is it due to the cultural-linguisticsetting wherein instances of pain are played out and interpreted? Fine-grained answers to this question require investigating the metaphorical sources of pain descriptions in other language systems as well as empirical studies focused on pain behavior among various people. GRAMMATICAL CONSIDERATIONS

An individual who wishes to report an experience of pain avails himself of primary pain terms and ‘places’ these in an appropriate sentence. Any kind of pain experience, of course, can be communicated through extended dialogue. However, it is likely that important insights about how that experience is construed in a language can be learned by concentrating on paradigmatic sentences. In other words, a sentence which realizes a report of pain can be taken simply as a private communication of a subjective state, in which case any and all sentences that get this point across are relevant. However, typical or paradigm sentences for pain reports can also be analyzed abstractly; that is, as linguistic specimens which realize a formal account of pain in the individual’s language community. The former approach simply informs one about the speaker’s experience;the latter informs about pain as an object or entity in the language. When specimens of pain descriptions in several differentlanguage families are compared one is provided with a fuller understanding of pain as a human phenomenon. Fig. 7 outlines several characteristics of English pain descriptions. English sentences which are commonly used to report on the experience of pain were selected for study. As can be observed, the node in the sentence which is ordinarily filled by a primary pain term is left blank. The sentences form the rows of the table. The four columns of the table refer to the four primary pain terms. An ‘xx’ in a column indicates that a particular form of that pain term is, from a grammatical perspective, most acceptable in the given environment, whereas an ‘ x’ indicates a less appropriate use of that form. These judgements were reached following eliciting interviews with native speakers and discussions with American linguists. The form of the pain term, and the grammatical function it serves in the sentence are indicated. The principal sememic import of pain or of a particular pain term can be inferred from the table and will be discussed presently.

through my

(v)

-s

(@MY

(b) It -s

(a) It

in my

me

1-

finger etc.

stomach feels finger

[%

i

is depressing (iii) The - was excruciating nauseating

1, I 1

Thela - e'd jumped leapt

(ii)

-

I am in

(i)

Sentence

Emach body etc.

arm

xx xx xx xx xx xx xx xx xx xx

X

X X X

(-ful) (adj.) (-ful) (-ful) (-ful) (-ful) (-ful) (adj.) (-ful) (-ful) (-ful) (-ful)

xx (verb)$ x (verb)

xx (noun) xx (noun) xx xx xx xx xx (noun) xx xx x(x) (verb) x(x) x(x) x(x)

Pain

x (-ing) x (-in& x (-ing)

xx (verb) xx (verb) xx xx xx xx x (-in& (verb)( x (-in@

XX(X)

xx(x)

XX(N

xx(x) (verb) xx(x)

Hurt

xx xx xx xx xx xx xx xx xx xx

/I

(-ing) (verb)Y (-ing) (-in& (-ing) (-ing)

(verb)

xx(?) (verb) xx( ?) xx(?) xx(?) xx(?)

Ache

Primary pain termst

Fig. 7. Grammatical features of some paradigmatic sentences used in pain description

xx (adj.) xx xx xx xx xx (adj.) xx xx xx xx

Sore

-in

( finger etc.

{ back knee

finger

x (nounltt

X X

X X

X

x (noun)tt

X X X X

xx xx xx (noun) xx xx xx

XY

xx (noun) xx xx xx xx xx (noun) xx xx

xx xx xx xx xx xx

xx (-ness) (noun)$$ xx xx xx xx xx (-ness) (noun)$$ xx xx xx xx xx

$

These variants are grammatically associated in the same way that ‘He runs’ is relatable to ‘He is running ’_In the associated column, parenthetical items refer to the transitive forms. 0 (see note 9 This use can refer to a metaphorical pain, or to pain as defined herein. ll AS a general statement, this use of ‘ache ’ is marginally acceptable (less so for ‘pain ’ or ‘hurt ’). When a lesion or determinable source is contextualized, the sentence becomes appropriate. 1) This is an isolated case where this term can refer to intense discomfort. tt Native speakers of English recognize this as somehow deviant, such as something a child acquiring English might use to refer to pain. $$ Either ‘sore’ or ‘soreness’ could be used here.

t Where two or more possibilities are given, ‘xx’ indicates preferred forms.

(x) I have a -on my

(ix) I have a

head stomach back knee finger etc.

’heart

(viii) The -is in my

(vu) I have a(n)

xx (noun) xx xx xx xx xx (noun) xx xx xx xx xx

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It is important to emphasize that each of the sentences of the chart when properly ‘filled’ by an acceptable or neologized form of any of the four primary pain terms is well formed when viewed purely syntactically; and, also, that the sentence can be judged as informative about an experience of pain. For example, any speaker d f English would recognize the communicative import of a sentence such as ‘I have a head hurt’. Nevertheless, though syntactically acceptable the sentence is semantically deviant. This is the case in any number of instances as can be verified by studying the chart. It is likely that some of these co-occurrence restrictions, which are all semantically based, are vestiges of the semantic import of the terms prior to some of the most recent semantic shifts. We have speculated, for example, that ache and sore probably referred to pain of a much greater degree than they do now, and this is to some extent supported by historical evidence. In this light, one is confronted with sentences similar to (x). The native speaker immediately recognizes: ) (head (1) ‘I have a

{ tLrh }

ache ’

[tooth ) as being semantically well formed but (toe (2) ‘I have a

{ F:tth}

ache’

(ankle as semantically deviant. This is apparently contradictory to (iv b) and (viii), where ache can be used in reference to any part of the body. If one assumes that ache was once marked for intensity and that its use was contingent on a folk theory about the implications of pain, then one can posit that the injuries or pain experiences referred to in the semantically well-formed sentences of (ix) are those which might have been most meaningful when judged in the light of this folk theory. In Fig. 7, the first three sentences depict the degree to which the experience of pain can be rendered in a dynamic and differentiated way. Sentence (i) indicates that the speaker is in a state of experiencing pain and this sentence seems to be marked for intensity. No specific reference to the body is made which renders the experience unfixed. Moreover, any and all kinds of pain are described. In (ii) the experience has been anthropomorphized to the point that the experience can be conceived of as an agent capable of ‘performing’ an action. The implication here is that the experience of pain is active, energized and dynamic. Sentence (iii) serves as a paradigm for the grammatically appropriate rendition of what in English is seen as the qualitative richness of the experience of pain. Sentences (ii) and (iii) are complementary in the sense that when taken together they are but a step removed from those which can be used to metaphorize the experience of pain as an agent or thing which possesses human features (e.g. The pain was evil, mean to me, etc.). The only word that can be appropriately used in these ways is ‘pain’. By extension, then, the other terms imply a more stationary and less dynamic object or entity, which is probably of a lower level of intensity, and qualitatively less differentiated. The only other primary pain term that could be used to directly inform about such an experience is ‘hurt ’, but to ‘get his point across’ the speaker would be forced to use a host of linguistic devices (e.g. pronouns, copulas, simile, etc.). The economy of the term ‘pain’ is thus underscored. In (iv), the use of the object pronoun is optional, which means that the pain terms that can be entered have intransitive and transitive variants that appear to be semantically indistinguishable. (The acceptability of the transitive form of ‘ache’ in this context varies dialectically.) The entity denoted here (i.e. the pain experience in English), while now tied to the body and hence fixed in location, is nonetheless active, and it extends through time as well. ‘Sore’ is

Influences in the description of pain

369 unacceptable in this context; therefore, by implication ‘sore’ must refer to pain of a more static or inert nature. Sentences listed as rows (va) and (vb) connote activity, yet the action referred to is more habitual, persistent or recurring in nature. Only forms of ‘pain’, ‘hurt’ and ‘ache’, however, seem to be appropriate, suggesting a greater degree of richness in these terms when they refer to a pain experience. The metaphorical use of these same two terms, ‘pain’ and ‘hurt’, in (iva) (see footnote)indicates that the general realms of reference of these two terms, roughly suffering and discomfort, are also broader than those of ‘ache ’ and ‘ sore ’ and that they can have a looser connection to the body. All four terms are serviceable in (via), although ‘aching’ and ‘hurting’ connote a level of dynamism and temporal extension which is not as well developed in the uses of ‘sore’ and ‘painful’ in this sentence. These dynamic and durative qualities are conveyed by the special participial form of the verb of ‘ache’ and ‘hurt’, the pain terms which most consistently recur in this form. In (vib), differences between the activity levels of those two setsof terms (i.e. ‘ache’ and ‘hurt ’ as opposed to ‘sore ’ and ‘pain ’) are accentuated. Verbs like ‘be ’ and ‘feel ’ are both considered to be copulas and therefore semantically highly similar, which they are, yet the native speaker can still sense that the quality of dynamism and temporal continuity differs from (via) to (vib). A form of ‘stationary’ pain is again implicated in our term ‘sore’. The fact that the word ‘pain’ can implicate altogether different degrees of dynamism, energy and temporality once again points to its rich and flexible range [compare (vi) with (i)]. Semantic differentiationamong the terms is very evident in (vii) and (viii). Intensity is a quality irrelevant to the use of ‘pain’ in these contexts, but ‘ache’ and ‘sore’ are very clearly marked for non-intensity. Both (vii) and (viii) treat discomfort as fixed, discrete and tangible. This materialization is more emphatically and definitely established in set (viii) than in set (vii). While the experience or entity is materialized in (viii), it is even more so in (ix), to a degree such that the experience is essentially inseparable from its stated locale. (x) completes the spectrum of materialization; it represents the total materialization of discomfort as captured by our concept of pain. In this circumstance, where ‘sore’ refers to an entity far different from any others discussed in (iHix), the experience is now a visible and concrete entity which is physically delimitable. Some terms have come close to handling the pain experience (as defined here) metaphorically (see v a). The degree of versatility of the terms is further evidenced by the extent to which they can be put to an unequivocal metaphoric use. All but one of the terms can be used this way (heartache; it hurt (injured) our budget; she gives me a pain in the neck). The one exception to this extension is sore which, as documented has unique properties insofar as it punctuates the end point of a scale of fixity and boundedness that underlines the terms. The term ‘sore’ can of course be used in other ways, as for example in ‘I am sore at her’ but this, it would seem, is an instance of polysemy. That is, ‘sore ’ in this instance is not serving to instantiatediscomfort or pain like in (iHx). The discussion of this section may be summarized by first re-emphasizing that pain as conceptualizedin this paper constitutes a mental experience that an individual locatesin his body. One then inquires as to how this experience is reported and made an ‘object’ in a particular language. With this in mind, one can say that in American English pain can be visualized as though it were located in an ndimensional ‘experience’ space. Analysis of the grammaticallyappropriate uses of the primary pain terms suggests that the axes of this space are marked by such bipolar scales as: (a) stationary-static vs. movingdynamic; (6) intense vs. non-intense; (c) complexdifferentiated vs. simple-undifferentiated;( d ) body-fixed vs. body-unfixed; (e) temporally extended vs. temporally circumscribed; (f) pain-like vs. true-pain-experience; and finally (g) discrete-materialized vs. vague-formless. Each primary pain term of American English, when 13

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‘placed ’ in a grammatically appropriate sentence which reflects an economic use of the language, fills out this experience space in a reasonably clear manner. The most restricted space is that which belongs to ‘sore’ (i.e. that space which proper uses of ‘sore’ comes to delineate), whereas the broadest most encompassing one belongs to ‘pain’. The spaces of a term overlap and many are contained in those of the richer terms. SUMMARY OF PAIN DESCRIPTIONS I N ENGLISH

Several lines of argument have been pursued in the attempt to study the meanings of pain descriptions in English. First, the component terms of pain descriptionswere heuristically classified into primary, secondary, and tertiary groups. Attention was then given to historical features of the primary pain terms. These were handled as morphological structures possessed of a history which has included their entry into the lexicon and their progressive modifications. Besides constituting morphological structures, the primary pain terms are also semantic categories;the history of this ‘meaning ’ dimension was given attention. The sememes which have been bound together with the various primary pain terms were discussed. Brief attention was then given to the contemporary meanings of the secondary and tertiary pain terms. This emphasis on the meanings of the component terms of pain descriptions paved the way for a synchronic analysis of pain descriptions in contemporary English. In this instance, attention was given to the meanings which descriptions of a pain experience seem to have currently. Two modes of analysis were followed. First, the metaphorical roots of pain were explicated. Analyses of the ways in which native speakers use the various pain terms suggest that a ‘model’ of pain lies behind these descriptions; this model is of a physical process. What pain is being likened to, and what can be likened to pain, in other words, involves a common semantic matrix which is rooted in historical and cultural factors. Many of the sememes originally linked to the various primary pain terms are still ‘alive’ and implicated when native English speakers describe pain and ‘pain-related’phenomena. The sememes which were originally tied to early uses of the primary pain terms no longer have the specific association which they once had with the term; however, it appears that the sememes do enter into the overall contemporary meanings of English pain. Metaphorical transfers implicit in English pain descriptions realize one important semantic component of pain in this language. The second way of analyzing semantic components of English pain involved a grammatical analysis of paradigmatic sentences which realize pain descriptions. A pain experience space was posited on the basis of this grammatical analysis. Each well-formed English sentence describing pain may be seen as associated with a small portion of this space. The sum of the spaces which a pain term can claim constitutes the overall meaning space of that term. The various pain terms were associated with different segments of the posited English pain space. It is important that the various spaces of the primary English terms were not sharply bounded and separated one from the other. Instead, the spaces of many terms seemed to be largely contained in the spaces of others. This, in essence, means that English primary pain terms are not semantically disconnected one from the other, but instead that they share much in common and are distinguished by their flexibility and range of application. REFERENCES

ANTTILA, R. (1972).An Introduction to Historical and Comparative Linguistics. New York: Macmillan. BEECHER, H.K. (1959).Measurement of Subjective Responses: Quantitative Efect of Dncgs. New York: Oxford University Press.

Buss, A. H. & PORTNOV, N. W. (1%7). Pain tolerance and group identification. J. Person. soc. Psychol. 6 (l),106108. CHOMSKY, N. (1%5). Aspects of the Theory of Syntax. Cambridge, Mass.:MIT Press. ENGEL,G. L. (1970).In C. M.MacBryde & R. S. Blacklow (eds.), Pain in Signs and Symptoms.

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