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Pain, Suffering and Healing
P26994_Radcliffe_Gorman_ccp.indd 1 03/08/2011 15:42

Pain, Suffering
and Healing
insights and understanding
Edited by
Peter Wemyss-Gorman
Retired Consultant in Anaesthesia and Pain Medicine,
Princes Royal Hospital, Haywards Heath, UK
Foreword by
John D Loeser
Professor Emeritus of Neurological Surgery and Anesthesiology and
Pain Medicine, University of Washington, Seattle, WA, USA

First published 2011 by Radcliffe Publishing
Published 2016 by CRC Press

Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
” 2011 Peter Wemyss-Gorman

CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-84619-326-2 (pbk)
Peter Wemyss-Gorman has asserted his right under the Copyright, Designs and Patents Act
1998 to be identified as the author of this work.
This book contains information obtained from authentic and highly regarded sources. While all
reasonable efforts have been made to publish reliable data and information, neither the author[s] nor
the publisher can accept any legal responsibility or liability for any errors or omissions that may be
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Typeset by Phoenix Photosetting, Chatham, Kent, UK

Cover designed by Andrew Magee Design, Banbury, Oxon, UK

Contents
Foreword ix
Preface xi
Introduction xiii
About the editor xx
Contributors xxi
1 The Tao of Pain 1
Willy Notcutt
2 Suffering and choice 31
Michael Bavidge
3 The questions of pain 41
Michael Hare Duke
4 ‘Bundling with big pharma’: ethics and the drug industry 47
Willy Notcutt
5 What are pain clinics for? 63
Ian Yellowlees
6 Management of the complex patient in the pain clinic 71
Diana Brighouse
7 Exploiting the placebo response: culpable deception or a neglected
path in the search for healing? 85
Peter Wemyss-Gorman
8 Prostituting pain 97
Kate Maguire
9 Michelle 117
Andy Graydon
10 ecovery from alcoholism and other addictions: a model for
R
managing spiritual pain 123
Paul D Martin and Paul Bibby
11 Learning to accept suffering 133
Peter Wemyss-Gorman
Index 141

To my wife Jean, with thanks for the hours she spent helping to turn my prolix
phraseology into readable English, and for her unfailing love and support
through all the long years when it seemed that this project would never
reach fruition.
Royalties from this book will be donated to Freedom from Torture, formerly
the Medical Foundation for the Care of Victims of Torture.

Foreword
Although modern medicine has made some progress in the treatment of pain,
we have clearly fared less well against suffering. Indeed, the contemporary
push to make healthcare providers more ‘efficient’ has put great pressure on
primary care practitioners to see more patients per hour and has minimised the
opportunities to deal with the patient’s suffering, as well as many of the other
effects of pain. Listening to a patient’s narrative takes time, and suffering can
only be addressed through the patient’s narrative. Biomedicine has no place for
suffering; a biopsychosocial perspective is the underpinning for this book. Our
predecessors thought of the nervous system as hard-wired, and functioning in
a stimulus–response organisation. Pain was the by-product of a disease state;
treatment of the disease should eliminate pain and the associated suffering. We
now know that the nervous system has enormous flexibility and that all sensory
inputs are strongly modulated. We also know that eye witnesses are notoriously
unreliable; a patient is the epitome of an eye witness. What we experience
is coloured by our past experiences and the anticipated consequences. The
placebo response demonstrates this with clarity. Unfortunately, there are still
those who think the old way about pain and suffering, and that is why this
book deserves a wide audience.
Cassell defined suffering as the threat to the physical or psychological
integrity of the individual.1 Healthcare providers have, all too often, looked
only at the physical aspects of suffering and have overlooked the psychological
issues. In the past, other types of providers dealt with suffering; but in the 21st
century in the developed countries, they are sparse. Religious answers appear
to be less satisfying; people want happiness and freedom from suffering in this
life, not one yet to come. Physicians are now expected to identify and resolve
suffering in the absence of training to do this and without time to interact
with the patient. What was swept under the rug is now publicly discussed. The
healthcare provider is expected to deal with issues that used to be brought to
religious leaders or grandmothers. Healthcare is going to have to broaden the
approach to patients who suffer from chronic pain. Education of physicians
and nurses must be expanded to deal with issues such as suffering.
Chronic pain is an existential condition that probably will never be resolved
by biomedicine. It is the suffering engendered by chronic pain that mandates

x Pain, Suffering and Healing
that healthcare providers address the issues. Suffering cannot be found in

a laboratory test or imaging study; it is only observable by communicating
with the sufferer. The 11 chapters in this book approach this conundrum
from vastly different perspectives, some highly personal and others broadly
social. Membership in the Special Interest Group of the British Pain Society
for Philosophy and Ethics has stimulated the authors to create a text for
both professionals and lay persons. Issues such as the interface between the
physician and the pharmaceutical industry are also presented. Each chapter
author describes a facet of the problems of suffering and some of the available
paths to recovery. There are no simple answers to complex questions, and there
is no single way to enlightenment. It is always the patient who must do the
work to resolve his or her suffering; the healthcare provider can only act as a
guide and provide encouragement. The authors of the chapters in this book
have provided a collection of narratives which readers can use to pursue their
own truths.
John D Loeser, MD
Professor Emeritus, of Neurological Surgery and Anesthesiology
and Pain Medicine, University of Washington, Seattle, WA, USA
July 2011
Reference
1 Cassell EJ. The Nature of Suffering and the Goals of Medicine. New York: Oxford Uni-
versity Press; 1991.

Preface
Pain and suffering have been a major preoccupation of philosophers for

millennia and more has been written on the subject than almost any other. It
may well be asked: what, then, is the need for yet another book on philosophy
and suffering? Aside from the fact that no book can ever provide the last word
on, or even a comprehensive guide to, such a vast and complex subject, this book
is unusual in that it is written mainly by professionals working with suffering
people. Although this of course includes virtually the whole medical and
allied professions, the last half century has seen the emergence of a whole new
specialism engaged specifically in the treatment and management of pain. Daily
contact with people in pain and the frequent difficulty of providing adequate
relief inevitably raises questions that go beyond the clinical, which this book is
intended to address in ways which are both thoughtful and relevant to real life
in the consulting room. Although the readership is anticipated to be mainly
professional, there are countless people who have to live with suffering, either
their own or that of others, and are seeking meaning in it. Some may justifiably
feel let down by the medical professions, and will be encouraged to know that
there are many of us who are also struggling for understanding; and may also
find this book helpful. Critics may detect in my own contributions some lack of
clarity as to whether I am addressing health professionals or patients. I would
contend that this reflects a growing conviction of the relationship between the
two as that of partners, and the vital importance of dialogue between them in
the search for mutual understanding.
The Special Interest Group of the British Pain Society for

Philosophy and Ethics
At the Vienna Congress of the International Association for the Study of Pain
in 1999 we had been, as always on these occasions, bombarded with science
and the message from the multi-million dollar drug industry that no effort or
expense could ever be spared in the battle to defeat pain.
Feeling slightly battered by all this, a colleague and I had taken a day off.
We both admitted to feeling quite depressed by the relatively little obvious
relevance of much of what we had been hearing to the everyday realities of

xii Pain, Suffering and Healing
dealing with distressed human beings in the pain clinic. We recalled how we
had first met some 20 years previously at a conference designed to bring ‘pain’
and ‘hospice’ doctors together, in the tranquil surroundings of Scargill House
in the heart of the Yorkshire Dales, and it occurred to us that it might be useful
to try to arrange some sort of meeting there to reflect on what we were trying
to achieve and should realistically be expecting to achieve, and how to accept
and cope with our relative impotence in the face of so much unrelieved pain.
And so in the summer of 2001 a group of doctors, nurses, psychologists
and others working with people in pain got together at Scargill House to tackle
some of these questions – not perhaps expecting to find answers but at least
to share some of our perplexities and anxieties. This conference, entitled The
Inevitability of Pain?, was intended as a ‘one-off’ but the need for a forum for
further discussion about such things became immediately apparent and has
resulted in a series of annual gatherings. In recognition of the importance of
this activity, the core group was recognised in 2004 as a Special Interest Group
of the British Pain Society.
Several features have made these meetings different. Besides their unusual
subject matter, they have been designed to maximise participation by the
audience, and the remit of speakers is to stimulate rather than to inform the
debate which, both in full session and informal conversation, takes up a major
proportion of the time. The venues, retreat centres in the Yorkshire Dales,
Leicestershire and the Lake District, are in areas of famed natural beauty and
provide an atmosphere particularly conducive to contemplation and reflection,
and to the physical and spiritual recreation so much needed by people wearied
by their daily work with human pain and distress.
So much of value has come out of these meetings that we felt it imperative
to try to share it with a wider audience. And so the idea of this book evolved.
Selection has been difficult and dependant in part on availability and
willingness of potential authors; inevitably much of merit has been omitted.
Every year since this book began its long gestation more material worthy of
inclusion has emerged, and there is already enough for a second volume!
Although all the authors have given talks on the same lines at our meetings,
these chapters are new and may involve some modification of earlier views,
influenced not only by subsequent thoughts but also by the discussion which
followed their presentation.
Peter Wemyss-Gorman
July 2011

Introduction
The development of pain medicine

Although pain is, and presumably always has been, the most common
presenting complaint in all who consult their doctors, pain medicine as a
specialty only emerged in the late 1940s, mainly as the inspiration of John
Bonica of Seattle. His seminal work The Management of Pain appeared in 1953,1
and he established the world’s first multidisciplinary pain clinic in 1960. Since
then there has been an exponential increase in the number of people involved.
At the first meeting of the Intractable Pain Society of Great Britain and Northern
Ireland in 1967 there were 17 doctors – virtually all the people in the UK
working in this field; 10 years later there were still only about 300 members.
Now, membership of the British Pain Society stands at nearly 1700, and the
International Association for the Study of Pain has more than 7000 members
in 106 countries. What started as almost exclusively the domain of anaesthetists
has become truly multidisciplinary and encompasses many other specialisms
and professions including neurology, psychology, nursing, occupational
therapy and physiotherapy. In the UK the number of pain clinics has increased
from a dozen or so in the early 1970s to the present day when there is one in
nearly every hospital, and there is a similar situation in most affluent countries.
This huge expansion of clinical activity has been paralleled by a similar growth
in research in neurophysiology, psychology and pharmacology, as well as in
clinical medicine. There are at least 26 English-language journals devoted to
pain research and practice, and many more in other languages.
Our knowledge about the mechanisms in the brain and nervous system
that underlie the conscious experience of pain has increased enormously (see
Further reading on page xix). Research into the amazing complexities of the
mechanisms of pain perception has led us ever deeper, from whole organisms
to systems, from systems to cells and from cells to molecules. Arguably the most
important aspect of all this has been the realisation that the nervous system is not
‘hard-wired’, with events in one part of it, such as stimulation of pain receptors
beneath the skin, always evoking the same responses in the same parts of the
brain. This picture has been replaced by the recognition of ‘plastic’ changes in

xiv Pain, Suffering and Healing
the function of the pathways between body and brain and in the brain itself
in different circumstances, so that what reaches consciousness is a product of
many different influences. It could be said, however, that although the amount
of information about the mind-boggling complexities of this has multiplied
many times the degree to which this has improved our understanding is another
matter. To dismiss all the research as irrelevant to understanding human pain
and useless in its relief would be absurd, but there are problems. The bulk of
research has of necessity been reductionist, and despite the efforts of writers
such as the late Patrick Wall, rebuilding the pieces into a comprehensible whole
which is relevant to human suffering has not always been easy.
Science is extremely good at answering questions that begin with ‘how’,
such as ‘How are warning signals of injury conducted from the outside of the
body to the brain and consciousness?’, but sometimes less helpful with ‘why’
questions, such as ‘Why do innocent people suffer?’.
Alongside all the research has been the pharmaceutical industry, which has
spent countless billions in the search for better drugs for relieving pain. There
has long been the expectation that any day now we would see the promised
breakthrough from basic science to improved therapeutics, and there have
been many promising developments, but spin-off in terms of new drugs and
interventions has on the whole so far been rather disappointing. (Although we
do at least understand the limitations of existing ones rather better.)
There are indeed some areas, notably the palliation of cancer pain, where
the picture has improved out of all recognition. Joint replacement surgery
has made a huge contribution to the reduction of human suffering (a fact
sometimes overlooked by pain doctors who see only orthopaedic surgeons’
failures). Nevertheless there are many other areas, notably chronic back pain
and neuropathic pain (pain arising within the nervous system), where cure is
rare, prolonged relief unusual and the best that can usually be achieved is some
reduction in pain intensity and improvement in limitation of activity – and
sometimes not even this.
In some ways the most important advance has been the recognition of
the reality that the experience of suffering involves a complex interaction of
physical and emotional influences, and a re-emergence of the ancient concept
of healing the whole person. Many patients are caught up in a vicious circle
of depression, anxiety and limitation of activity as much due to fear of pain
as pain itself. The lives of many have been transformed by pain management
programmes, where teams of psychologists, physiotherapists, occupational
therapists and specialist nurses work together to enable patients to recognise
and deal with self-defeating thought processes and inappropriate behaviour
patterns. But not everybody can be helped even in this way.
Few of the benefits of modern pain medicine, limited as they are, have
devolved to large parts of the world where economic and medical resources are

Introduction xv
poor and even the most basic health needs are inadequately catered for. Indeed
it could be said that all the combined efforts of all the pain professionals in the
world have done little more than scratch the surface of the totality of human
suffering, and show little sign of ever doing much better.
These realities are only too familiar to pain professionals, but rarely faced in
our conventional clinical and scientific meetings. There is so much to be learnt
– so great the pressure to improve our understanding of pain mechanisms,
learn of new drugs and improve techniques – that there is rarely time to stand
back, so to speak, and reflect on what we can realistically hope to achieve, or
even be trying to achieve. We are so busy trying to answer ‘how’ questions, we
fail to address the ‘why’ questions that our patients tax us with. We tell them
that they must learn to accept their pain but fail to face and accept our own
impotence to relieve it.
A foretaste
The inspiration for the first gathering of the Special Interest Group of the British
Pain Society for Philosophy and Ethics in the summer of 2001 derived in part
from an article in Pain Reviews by Willy Notcutt entitled ‘The Tao of Pain’.2 Willy
presented it at that meeting and Chapter 1 is a revised and extended version
of this. He explores the changes in thinking about pain and its treatment over
the last three decades in the terms of Fritz Capra’s Tao of Physics,3 which brings
together physics and Eastern mysticism and parallels the progression from
simple through more and more complex science to mystery, which the search
for understanding suffering involves, and questions the common perception
of pain as an enemy which must be defeated by the most aggressive means
available, rather than trying to reach a deeper understanding of the meaning of
pain for our patients.
The words ‘pain’ and ‘suffering’ are often used either together or more or
less interchangeably, and I plead guilty to having done so already. But they
are not synonymous. They are both of course very difficult to define. As the
much-quoted IASP definition suggests, pain is usually associated with tissue
damage, and although it is a subjective experience and involves ‘mental’ and
emotional processes it is still largely a ‘body’ thing, and can at least in part
be understood by studying the nervous system. It is shared by ‘lower’ animals
and even chronic pain can be looked at in the context of evolutionary biology.
Suffering is much more elusive. Although it is perhaps most often associated
with ‘physical’ pain, it has many other sources both within and outside the
individual. And although it is manifested as distress, sadness, depression and
anxiety the whole seems more than the sum of its parts. It could be said to
be a ‘spiritual’ thing. It appears to have no adaptive function – and indeed
would seem to be in a different category from things that do. (I realise that

xvi Pain, Suffering and Healing
I am in danger of subscribing to a ‘pain/suffering’ dualism which would be

as misleading as ‘mind/body’ dualism and it is clear that in both cases the
concepts are inextricably entwined.) Pain can often be relieved by the doctor as
technician, but suffering demands that he fulfils his role as a healer. Suffering
robs us of choice, and in Chapter 2 Michael Bavidge explores the distinction
between pain and suffering in the context of the influence of suffering on
choice and autonomy.
Suffering raises apparently unanswerable questions all beginning with ‘why’
and although it challenges the concept of a God of love religions have evolved
in large part to try to give it meaning. In Chapter 3 Michael Hare Duke examines
historically changing attitudes to pain and its relief and beliefs such as that the
divine purpose involves personal growth through suffering. He shows that such
questions, which have no clear and easy answers, have always been addressed
through poetry and myth rather than by logical argument.
Readers may have gained the impression so far that our deliberations in the
meetings of the group have been somewhat ‘cerebral’ and divorced from the
realities of everyday clinical practice, but this would be a misleading picture.
The participants are mostly those whose daily work is essentially clinical and
practical. Their first priority is to try to relieve pain. But as well as the limitations
of our ability to achieve this there are many ethical and other dilemmas
involved in the practice of pain medicine which give rise to much uncertainty
and anxiety. These include such issues as the prescription of drugs of potential
abuse for patients who are vulnerable to this problem. Difficulties also arise in
the relationship between the medical profession and the drug industry. While
acknowledging the great contribution of the latter to the provision of drugs
for pain, it has to be recognised that the astronomical costs of research and
development may lead to inappropriate pressures on clinical researchers and
doubtful marketing methods, with inappropriate inducements for doctors to
prescribe new products. Willy Notcutt discusses this in Chapter 4.
Growing recognition of the value and importance of pain medicine has led
to demand outstripping provision, and in many areas waiting lists for pain
clinics are far too long and progression through allied professions such as
physiotherapy and psychology far too slow. The Pain Society and more recently
the Chronic Pain Policy Coalition have long and vigorously campaigned
for better governmental recognition of the inadequacy of provision for pain
services. But however repugnant it may seem, resources will for the foreseeable
future have to be rationed to maximise benefit to the maximum number of
sufferers. This necessitates a clear perception of what pain services are actually
for. Much of the work, for instance, involves interventions such as injections for
back pain which may provide a period of blessed relief but are rarely curative
and arguably may only put off the evil hour of accepting the pain and learning to
live productive lives in spite of it. Both individual clinical decision making and

Introduction xvii
resource allocation are supposed to be grounded in evidence-based medicine

but the application of this to such a complex and unquantifiable a problem as
human suffering is rarely straightforward. In Chapter 5 Ian Yellowlees looks at
changing concepts of pain management and the need for correcting unrealistic
expectations of both patients and referring doctors of what pain clinics can
achieve. He argues that the traditional roles of the doctor to treat the patient
and of the patient passively to accept this needs to be replaced by a partnership
in which the patient also has responsibilities and work to do. But there are
patients with a tendency to dependency who may not benefit from this
approach and for whom repeated interventions may arguably be appropriate.
Currently the type of management a patient receives may depend more on the
doctor’s prejudices and enthusiasms than the patient’s individual needs, and
the need for re-examination of the role of pain services and remodelling of the
way they work, with a clear idea of what they are for, is overwhelming.
Pain clinicians and indeed most health professionals will be only too
familiar with the picture of the patient who arrives with notes several inches
thick, a sorry story of consultations and hospital admissions over many years for
a variety of complaints mainly involving pain, but with a definitive diagnosis
of a specific illness hardly ever having been proved. Such patients have become
highly dependent, demanding of repeated physical interventions, and are
often indignantly dismissive of any suggestion that they might be helped by a
psychological approach. Continuing Ian Yellowlees’ theme, in Chapter 6 Diana
Brighouse suggests that pain clinics should be offering such patients more than
either repeated injections to keep them happy or yet another rejection to add
to their unhappy catalogue. She examines the inadequacies of the reductionist
approach which has dominated modern scientific medicine for dealing with
the complexities of human suffering, and maintains that the inherent problems
of some patients are compounded by the dualistic mindset of doctors who
assume that if symptoms cannot be explained or treated on a biomedical
model they must be psychological, and if they reject or do not respond to
simple psychological measures such as cognitive behavioural therapy, they are
beyond hope. Such patients can, however, be helped by a long-term reparative
relationship with a therapist who over many hours and months tries to enable
them to acknowledge and deal with deep-seated problems which frequently
include a history of childhood abuse.
One of the phenomena which have long puzzled and tantalised both
brain scientists and pain clinicians is that of the placebo response. Its power is
undeniable; it was indeed the main therapeutic tool of our medical ancestors
which we arguably should not discard. It is, however, often regarded as a
nuisance by people trying to design objective assessments of drugs and other
therapies, and presents ethical difficulties in this context. Trying deliberately to
exploit it by encouraging unrealistic expectations of the efficacy of a treatment

xviii Pain, Suffering and Healing
may well be regarded as dishonest. I explore these fascinating but difficult

paradoxes in Chapter 7.
The inclination to try to prevent or relieve suffering in one’s fellows would
appear to be part of human nature. But there is a darker side to this. The desire
to inflict pain and the pleasure taken in witnessing it sometimes seems all
too near the surface. In Chapter 8 Kate Maguire examines a subject most of
us would rather not think about too much, in the light of her experience of
working with the victims of torture. Not only have these people experienced
indescribable pain (from which in many cases they continue to suffer) but they
have been subjected to systematic attempts to rob them of all that makes them
human. The stories are highly disturbing but Kate’s reflections on what she
has learnt from her patients, when she has been able to break down barriers
of communication, contain valuable lessons for anybody trying to help pain
patients who carry the scars of emotional trauma.
Much of the distress experienced by patients suffering in body mind or spirit
is aggravated by their perception that doctors and other health professionals are
failing to listen to what they are really trying to say: we may give the impression
of listening but part of our minds are already occupied by other thoughts and
we may only hear what we choose to hear. In Chapter 9 Andy Graydon contends
that proper listening and effective communication require unfeigned sincerity,
which he calls ‘emotional sincerity’. When there are no barriers between us
we can not only help our patients better but we can also learn and receive
far more from them than we give them. He illustrates this by his accounts of
conversations with Michelle, a woman dying of cancer who was able to accept
her situation with love and joy, and to whom this chapter is dedicated.
It is well recognised that illnesses all have physical, psychological, emotional,
social and spiritual dimensions, and that all of these components need to be
addressed for a state of health to be achieved. This is explicitly recognised in
the diagnosis and therapeutic management of alcoholism and addiction, and
the well-known Twelve Steps of Alcoholics Anonymous have helped countless
sufferers to come to terms with these aspects of their illness. In Chapter 10 Paul
Martin and Paul Bibby describe a similar approach to incurable disease and
intractable suffering.
The first meeting of the group was titled ‘The inevitability of pain?’. People
working in pain management programmes spend much of their time helping
patients to come to terms with and accept the fact that their pain is not going
to go away, that no one has a magic cure for it and that the constant search for
relief is not only futile but gets in the way of progress to more realistic goals
such as restoring activity and coping with depression. Pain therapists also need
to learn to come to terms with their own relative impotence – something which
is very difficult to acknowledge when they have perhaps entered the profession
with unrealistic ambitions and expectations of what they could do for suffering

Introduction xix
humanity, but faced with desperate people who may regard them as their last
hope have found themselves unable to help. But acceptance of this reality is
not the same as therapeutic nihilism, must not involve shoulder-shrugging
detachment, and can be turned into something positive. In the final chapter I
pose some questions raised by the paradox of acknowledging our professional
responsibility to relieve suffering and acceptance of our impotence, not so
much in the hope of providing satisfactory answers, but more to illustrate the
need for these meetings and this book.
(There remains the question as to whether there is some pain or suffering
which is intractable, truly intolerable and completely unacceptable, which in
turn raises the subjects of euthanasia and assisted suicide. The latter would of
course have required a whole chapter to do it justice, and in view of the volume
of existing literature and public debate on the issue it was decided with some
reluctance – and retrospective regret – not to include such a chapter.)
References
1 Bonica J. The Management of Pain. 2nd ed. Philadelphia: Lea & Febiger; 1990.
2 Notcutt, WG. The Tao of Pain. Pain Reviews. 1998; 5: 203–15.
3 Capra F. Tao of Physics. 4th ed. Boston: Shambhala, 1999.
Further reading
The following suggestions are for further reading for the non-specialised or
non-medical reader.
➤➤ Melzack R, Wall P. The Challenge of Pain. London: Penguin Books, 1996.
➤➤ Wall P. Pain, the Science of Suffering. London: Weidenfield and Nicholson; 1999.

About the editor
Peter Wemyss-Gorman was a consultant anaesthetist at the Princess Royal

Hospital, Haywards Heath until his retirement in 2000. He established a pain
clinic in the early 1970s at a time when this was a relatively new concept.
The realisation that ‘medical’ interventions were frequently inadequate to
relieve chronic pain and that much more was needed to help patients live
with their suffering led to the establishment of the first multidisciplinary pain
management programme in the south-east of England. But even this failed
many people, and the consequent dissatisfaction and uncertainty of purpose,
shared by many colleagues, led to the meetings which he has organised since
retirement, and which have provided the material for this book.

Contributors
Michael Bavidge was a lecturer in philosophy at the Centre for Lifelong

Learning, Newcastle University, and ran the adult education programme at the
university for 10 years. He is the author of Mad or Bad? (Bristol: Classical Press;
1989) – a book on psychopaths and the law, and, with Ian Ground, Can We
Understand Animal Minds? (Bristol Classical Press; 1994). He is chairman of the
Philosophical Society of England, which aims to encourage ordinary people
(i.e. people who are not in academic institutions) to involve themselves in the
discussion of philosophical issues. He has been a regular contributor to the
Pain Society Philosophy and Ethics Group.
Paul Bibby was a consultant pain nurse with the Sherwood Forest Hospitals
NHS Foundation Trust until 2009 when he was appointed Clinical Director
of Pain Management Solutions Ltd (a private sector provider to the NHS of
community-based pain clinics); and an honorary research fellow at Sheffield-
Hallam University. He began developing an interest in pain management as
a result of his involvement and post-registration training in palliative care. In
1996 he was appointed as a nurse specialist in acute pain at Doncaster Royal
Infirmary, where he set up inpatient pain services. During this time he became
increasingly involved in assisting clinical teams in managing patients with drug
and alcohol problems. In an attempt to learn more about this group of patients
he investigated various schools of thought, including the Twelve Steps of Alco-
holics Anonymous. His relevant publications include an article on existential
pain in the Nursing Standard (Existential pain. Nursing Standard. 2003; 18(10):
23) and a chapter on Alcoholism and addiction: the management of spiritual
pain in the clinical environment, in the book Beyond Pain (Pat Schofield (ed).
London: Whurr Publications; 2005).
Diana Brighouse was appointed consultant anaesthetist to the Southampton

University Hospitals NHS Trust in 1990. Her interest in chronic pain manage-
ment started as a registrar in Oxford, and she was fortunate to work both as
registrar and senior registrar with Dr John Lloyd (who with Dr Samuel Lip-
ton is regarded as one of the founding fathers of chronic pain management
in the UK). The continuing development of the psychosocial model of pain

xxii Pain, Suffering and Healing
management in Southampton led her to take a one-year course in counsel-

ling and psychotherapy in London. Some of the theoretical basis of the course
resonated with theories of existential philosophy and non-verbal communi-
cation that had formed part of her Master’s degree in comparative spiritual-
ity. These seemed relevant to the complex patients who were being referred
to the pain clinic, where the boundaries between the science and art of medi-
cine are becoming increasingly blurred. She went on to train as an integrative
psychotherapist at Regents College London, during which time the pain clinic
underwent major structural reorganisation, resulting in the majority of work
becoming primary care-based, and invasive pain treatments being dramatically
reduced. The patients attending for secondary care had frequently been given
multiple diagnoses, or were under the care of more than one hospital specialist
Many had a mental health diagnosis.
The multidisciplinary pain team agreed that patients requiring psychological
therapies would not all be suitable for behavioural therapy, and Dr Brighouse
started a clinic offering longer-term psychodynamic therapy. Her chapter is
based on both theoretical models of care and on clinical experience drawn
from this clinic (although it should be emphasised that clinical details do not
relate to any single individual).
The Right Revd Michael Hare Duke was born India in 1925. He read Litterae
Humaniores and Theology at Oxford and completed his ordination training at
Westcott House, Cambridge. He was awarded an honorary DD at St Andrews in
1994. After parish ministry in London and Bury, he was appointed Bishop of St
Andrews, Dunkeld and Dunblane in 1969, where he remained until retirement
in 1994. He has been pastoral director of the Clinical Theology Association,
chairman of the Scottish Association for Mental Health and chairman of Age
Concern Scotland.
His books include: The Caring Church (1963), First Aid in Counselling (1968),
Understanding the Adolescent (1969), The Break of Glory (1970), Freud (1972),
Good News (1976), Stories, Signs and Sacraments (1982), Praying for Peace (1991),
Hearing the Stranger (1994) and One Foot in Heaven (2001).
He continued to work as a hospital chaplain until at 82 he was officially
declared as too old, much to his disgust! Until recently prevented by declining
health, he had attended all the meetings of the Philosophy and Ethics Group
since its inception and had become its ‘resident’ guide in matters theological.
The Revd Father Andy Graydon studied for the RC priesthood at Ushaw Col-
lege, Co. Durham where his specialised subject was spiritual psychology. He
was ordained in 1979 and began hospital chaplaincy in 1988 at the Montagu
Hospital in Mexborough, South Yorkshire. He became involved with the pain
management unit at the Montagu Hospital and joined the team, seeing people

Contributors xxiii
who seemed to be suffering from something deeper than physical or emotional

pain. Working with groups and individuals, he developed forms of meditation,
talking therapies and relaxation exercises. He has recently taken on the mental
health chaplaincy in Rotherham and Doncaster.
Kate Maguire is a social anthropologist and psychotherapist who specialises in

the dynamics of power and pain. She has worked extensively in the Middle East
as an anthropologist during periods of conflict. As a psychotherapist informed
by anthropology, she has worked with survivors of torture and extreme expe-
riences both in the NHS and for Medecins Sans Frontieres. One of her many
roles has been to head the Doctorate in Psychotherapy for the Metanoia Insti-
tute and Middlesex University. She is currently writing on the multidimensions
of pain, its concepts, language and treatment across individuals and cultures
and its relationship to personal and political power. She continues to lecture in
the UK and abroad and has a special interest in qualitative research and the use
of metaphor in therapy to communicate experiences of pain.
Paul Martin worked until retirement as a palliative care physician in Dundee

and Ayrshire. He qualified in 1981 from the University of Manchester Medical
School, UK and after general training pursued a career as a consultant anaes-
thetist. Reflection on what it means to be a doctor as well as a patient and the
notions of care rather than cure led him to change career and train in palliative
medicine. His main clinical interest is in achieving acceptance and resolution
in the face of incurable disease.
Willy Notcutt is a consultant in anaesthesia and pain medicine in Great Yar-

mouth. He qualified in Birmingham in 1970, and specialised in anaesthesia
after working as a flying doctor in Lesotho, and although he has remained
an anaesthetist, his main interest has been in pain relief. Sadly the options
for treatment were often limited and many patients were being left in severe
unremitting pain. This led him to consider the possibility of cannabis (which
he had first come across being used medicinally in the treatment of alcoholism
whilst working at the University of the West Indies in Kingston, Jamaica) for
pain relief. He has played a dominant role in the development of a prescribable
extract of this drug.
He is currently director of pain relief services, the lead clinician for the back
pain team and runs a research team. He is also an honorary senior lecturer at
the University of East Anglia in Norwich and chairman of the Special Interest
Group of the British Pain Society for Philosophy and Ethics.
Ian Yellowlees is currently a consultant in pain management in the Nor-

thumberland Healthcare NHS Trust having previously established a new

xxiv Pain, Suffering and Healing
multidisciplinary pain management service at the Borders General Hospital in

Melrose, which became nationally recognised as a centre of excellence, and a
new service for the management of acute and chronic back pain dropping the
‘classical’ pain management programme in favour of a more flexible approach
using education modules.
Since moving to Northumberland he has been developing a new service
structure separated entirely from secondary care and working mostly on
the telephone. The introduction of electronic patient records has raised the
possibility of ‘virtual’ clinics, with a service for remote areas such as the
Western Isles.

Chapter 1
The Tao of Pain

Willy Notcutt
[The Tao of Pain was originally published in Pain Reviews in 19981 (Pain
Reviews ceased publication in 2002). I decided to revisit it in light of changes in
thinking in the hope that the material presented stimulates further reflection
on the nature of pain and to move on from the simplistic views dating back to
Descartes which continue to limit understanding.]
Tao is a thing that is both invisible and intangible.

Intangible and invisible, yet there are forms in it;
Invisible and intangible, yet there is substance in it;
Subtle and obscure, there is essence in it;
Tao Te Ching, chapter 212
Introduction
Pain is a universal experience and yet still remains poorly understood and
often ineffectively managed. For physicians, some of the difficulties that we
encounter may be the result of the fundamental principles of thought that
govern our western medical science.
The International Association for the Study of Pain (IASP) defines pain in
physical and psychological terms as:
An unpleasant sensory and emotional experience associated with actual or

potential tissue damage, or described in terms of such damage.
An alternative definition of pain can be derived by adapting the quotation from

Tao Te Ching (the main Taoist text) at the start of this chapter:
Pain is felt by all but it cannot be touched. It cannot be seen or directly measured,
but its patterns can be recognised. Elusive and ill defined yet it has substance
and specific characteristics.

2 Pain, Suffering and Healing
This is a very different view but few would disagree with it. Taoism is half
psychology and half philosophy. Some follow it as a religion although it does
not have a central moral code. Instead its principles could simply be described
as a Way (Tao), which, if applied properly, will serve its follower well.
This chapter draws heavily on the work of Fritjof Capra. In his seminal
book, The Tao of Physics, he eloquently explores the broader aspects of physical
science and its parallels within eastern mysticism.3 To explore pain using this
same approach and perspective may deepen our understanding of a complex
and elusive subject thereby helping in our practical management of the patient.
Historical perspective
Throughout recorded history man has struggled to understand pain. In biblical
times it was seen not only as a punishment for sins committed but also as the
means of cleansing one’s soul. Buddha in his First Noble Truth saw pain and
suffering as being an inevitable part of life. As science replaced theology as the
dominant explanation of the natural world, pain came to be seen as the largely
unavoidable and untreatable side effect of disease and therapy. The introduction
of general anaesthesia in the mid-19th century was a historical landmark in the
relief of the anguish of surgery itself. However, little attention was given to
post-operative or other pain problems which remained poorly managed.
Towards the close of the 20th century physicians accepted that pain itself was
a legitimate and necessary target for their therapeutic activity. Cicely Saunders,
the founder of the modern hospice movement in the UK, pioneered the control
of the pain of cancer whilst others started to tackle the often more difficult and
complex problems of the long-standing pain from many chronic diseases. Then
clinicians turned their attention to the acute pain following surgery, injury and
acute illness (some 150 years after the introduction of general anaesthesia!).
Parallel to the increasing therapeutic activity, there has been an explosion of
knowledge about the physiology, pathology, pharmacology, psychology and
sociology of pain over the last 40 years. Now in the 21st century chronic pain
is being recognised as a disease state in its own right. However, whilst some
patients benefit, many do not and all pain management services have huge
reservoirs of unmet need.
Chronic pain is very common, particularly as we get older. In the past the
aches and pains of the degenerative changes that develop as our bodies age
would be accepted as part of life and coped with accordingly. More recently
there have been a number of epidemiological studies showing that the
incidence of pain is more widespread than previously thought. Furthermore,
patients’ expectations nowadays are much higher and increasingly clinicians
apply their skills to help patients control their pain as effectively as possible.
Some excellent results are achieved both with analgesic practice and with

The Tao of Pain 3
surgery such as hip replacement. However, this is only the tip of an iceberg
of patients with unmet needs for the control of symptoms resulting from
irreversible physical and mental decline. Our abilities to provide help for such
patients are often very limited.
The treatment of pain has come far in the last 40 years but is still burdened
by the old Cartesian approach prevalent in much of Western medicine. This
has led to us viewing pain as a target to be located with scanners, bombed
with chemicals, stabbed at with steel or cauterised with ice or fire. Even some
psychologists seem to attack the problems using their own weapons with
similar vigour. Unfortunately, no single approach seems to deliver reliably
the sort of results that we would like. We still seem to focus on attempting to
achieve a cure as we would if treating a hernia, rather than obtaining a fuller
understanding of the patient’s problem. We may also be failing to recognise
our own limitations in therapy.
Medical journals and conferences present the latest knowledge as if new
weapons and targets are being found in a war against a vicious enemy. The
various campaigners document the successes of their newfound technology
and techniques. Pain teams have been recruited to lead the fight on the surgical
battlefields and in multidisciplinary clinics.
However, in the headlong clinical rush to develop the relatively new
specialty of pain medicine, it is reasonable to pause and reflect. Should we
be tackling pain with the same aggressive approaches that are used for more
tangible diseases such as cancer or infections? All too often we find ourselves
‘blindly’ lashing out at the perceived enemy, but failing totally to make contact.
We lose our way and, what is more important, we may fail to help our patients.
I believe that we often fail to reflect on the nature and meaning of the pain
of our patients as they present to us. Instead we focus almost exclusively on
therapies and thereby neglect the deeper understanding of this phenomenon.
The Tao of Physics

The Tao of Physics, written by Fritjof Capra, has been a classic exploration of
the links between eastern mysticism (particularly Taoist thought) and modern
fundamental physics.3 At first sight, these two domains seem to be poles apart.
However, Capra shows that there are parallels and connections between the
two apparent opposites. He demonstrates and concludes that there is a single
reality, but that it is being viewed from very different perspectives.
As we have developed our knowledge about pain and its treatment, we
have fitted it (or constrained it) within our current western model of medicine.
Even though we cannot explain so much of what we see clinically, we hold
on to structures, systems, and concepts that have been laid down over the last
200 years.

4 Pain, Suffering and Healing
Physicians specialising in the management of pain are commonly con-

fronted with the problem of understanding its nature and the variability of the
presentation, and the response to therapy and management. The ‘Gate Theory’
of pain has been a major advance in the unravelling of some of the processes
involved. It provided a simple mechanistic method of explaining some neuro-
physiological processes, whilst also giving some insight into the relationship
between pain and the organism itself. Unfortunately, many have seen the Gate
Theory in terms of a wiring diagram, thereby missing the original objectives of
its authors in explaining some fundamental principles of pain.4 The Western
medical mind struggles in accepting and understanding pain as its effects ripple
outwards into the psychological and social dimensions of the individual.
Might other perspectives exist? An example is the Chinese system of medicine,
developed over the last two millennia but scorned by the West until about 40
years ago. Acupuncture has now gained acceptance as an orthodox treatment,
but the Eastern explanations, based on systems of meridians identified with
visceral organs, are thought to have little basis in reality. However, we now
know that the neural projections from somatic and visceral structures overlap
almost completely within the central nervous system. The viscera are therefore
neurally integrated with the skin and the musculo-skeletal system. We now
accept that there is a complex and continual interaction between somatic and
visceral systems. For example, women who have chronic low back pain may
experience an increase associated with the menstrual cycle. Likewise, women
with dysmenorrhoea may experience severe back pain. When confronted with a
complex pain problem, Western medicine usually focuses on the somatic whilst
barely acknowledging that there may be a significant visceral component or
influence. Unfortunately access to the visceral nervous system for exploration,
testing and therapy is very limited. However, the Eastern acupuncture approach
combines both, and through the system of meridians, the viscera are mapped
to the surface. The practitioner may then work to restore internal harmony
through surface stimulation of visceral projections. Perhaps the Chinese were
ahead of us with their linking of visceral and somatic nervous systems, in
concept if not in physiologically accurate detail.
Interestingly both Western and Eastern approaches may be effective in
both explanation and therapy. Here then, is a demonstration of a single reality
(pain) being understood and treated in radically different ways according to
different traditions and systems of medicine. Yet, at the neuro-physiological
level, we can now see some ways of linking the explanations.
A different approach
In his book The Tao of Physics, Capra presented six new paradigms of scientific
thought, arising from his explorations in physics and in mysticism.3 If these

Another random document with
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divine prerogatives of Jesus. But John deals very little in those
pointed and apt references to the testimony of the Hebrew
scriptures, which so distinguish the writings of Matthew; he evidently
apprehends that those to whom he writes, will be less affected by
appeals of that kind, than by proofs drawn from his actions and
discourses, and by the testimony of the great, the good, and the
inspired, among those who saw and heard him. The work of Matthew
was, on the other hand, plainly designed to bring to the faith of
Jesus, those who were already fully and correctly instructed in all
that related to the divinely exalted character of the Messiah, and only
needed proof that the person proposed to them as the Redeemer
thus foretold, was in all particulars such as the unerring word of
ancient prophecy required. Besides this object of converting the
unbelieving Jews, its tendency was also manifestly to strengthen and
preserve those who were already professors of the faith of Jesus;
and such, through all ages, has been its mighty scope, enlightening
the nations with the clearest historical testimony ever borne to the
whole life and actions of Jesus Christ, and rejoicing the millions of
the faithful with the plainest record of the events that secured their
salvation.
Beyond the history of this gospel, the Fathers have hardly given
the least account, either fanciful or real, of the succeeding life of
Matthew. A fragment of tradition, of no very ancient date, specifies
that he wrote his gospel when he was about to leave Palestine to go
to other lands; but neither the region nor the period is mentioned.
Probably, at the time of the destruction of Jerusalem, he followed the
eastward course of the Jewish Christians; but beyond this, even
conjecture is lost. But where all historical grounds fail, monkish
invention comes in with its tedious details of fabulous nonsense; and
in this case, as in others already alluded to, the writings of the monks
of the fourteenth century, produce long accounts of Matthew’s labors
in Ethiopia, where he is carried through a long series of fabled
miracles, to the usual crowning glory of martyrdom.
Ethiopia.――The earliest testimony on this point by any ecclesiastical history, is that of
Socrates, (A. D. 425,) a Greek writer, who says only, that “when the apostles divided the
heathen world, by lot, among themselves,――to Matthew was allotted Ethiopia.” This is
commonly supposed to mean Nubia, or the country directly south of Egypt. The other
Fathers of the fifth and following centuries, generally assign him the same country; but it is
quite uncertain what region is designated by this name. Ethiopia was a name applied by the
Greeks to such a variety of regions, that it is quite in vain to define the particular one meant,
without more information about the locality.
But no such idle inventions can add anything to the interest which
this apostolic writer has secured for himself by his noble Christian
record. Not even an authentic history of miracles and martyrdom,
could increase his enduring greatness. The tax-gatherer of Galilee
has left a monument, on which cluster the combined honors of a
literary and a holy fame,――a monument which insures him a wider,
more lasting, and far higher glory, than the noblest ♦achievements of
the Grecian or the Latin writers, in his or any age could acquire for
them. Not Herodotus nor Livy,――not Demosthenes nor
Cicero,――not Homer nor Virgil,――can find a reader to whom the
despised Matthew’s simple work is not familiar; nor did the highest
hope or the proudest conception of the brilliant Horace, when
exulting in the extent and durability of his fame, equal the boundless
and eternal range of Matthew’s honors. What would Horace have
said, if he had been told that among the most despised of these
superstitious and barbarian Jews, whom his own writings show to
have been proverbially scorned, would arise one, within thirty or forty
years, who, degraded by his avocation, even below his own
countrymen’s standard of respectability, would, by a simple record in
humble prose, in an uncultivated and soon-forgotten dialect,
“complete a monument more enduring than brass,――more lofty
than the pyramids,――outlasting all the storms of revolution and of
disaster,――all the course of ages and the flight of time?” Yet such
was the result of the unpretending effort of Matthew; and it is not the
least among the miracles of the religion whose foundation he
commemorated and secured, that such a wonder in fame should
have been achieved by it.
♦ “achievments” replaced with “achievements”
THOMAS, DIDYMUS.
The second name of this apostle is only the Greek translation of
the former, which is the Syriac and Hebrew word for a “twin-brother,”
from which, therefore, one important circumstance may be safely
inferred about the birth of Thomas, though unfortunately, beyond
this, antiquity bears no record whatever of his circumstances
previous to his admission into the apostolic fraternity.
Nor is the authentic history of the apostles, much more

satisfactory in respect to subsequent parts of Thomas’s history. A
very few brief but striking incidents, in which he was particularly
engaged, are specified by John alone, who seems to have been
disposed to supply, by his gospel, some characteristic account of
several of the apostles, who had been noticed only by name, in the
writings of Matthew, Mark, and Luke. Those in particular who receive
this peculiar notice from him, are Andrew, Philip, Nathanael,
Thomas, and John himself,――of all whom, as well as of Peter, are
thus learned some interesting matters, which, though apparently so
trivial, do much towards giving a distinct impression of some of the
leading traits in their characters. Among those facts thus preserved
respecting Thomas, however, there is not one which gives any
account of his parentage, rank in life, or previous occupation; nor do
any other authentic sources bring any more facts to view on these
points. The only conclusion presented even by conjecture, about his
early history, is, that he was a publican, like Matthew,――a notion
which is found in some of the Fathers,――grounded, no doubt,
altogether on the circumstance, that in all the gospel lists, he is
paired with Matthew, as though there were some close connection
between them. This is only a conjecture, and one with even a more
insignificant basis than most trifling speculations of this sort, and
therefore deserving no regard whatever. Of the three incidents
commemorated by John, two at least, are such as to present
Thomas in a light by no means advantageous to his character as a
ready and zealous believer in Jesus; but on both these occasions he
is represented as expressing opinions which prove him to have been
very slow, not only in believing, but in comprehending spiritual truths.
The first incident is that mentioned by John in his account of the
death of Lazarus, where he describes the effect produced on the
disciples by the news of the decease of their friend, and by the
declaration made at the same time by Jesus, of his intention to go
into Judea again, in spite of all the mortal dangers to which he was
there exposed by the hatred of the Jews, who, enraged at his open
declarations of his divine character and origin, were determined to
punish with death, one who advanced claims which they pronounced
absolutely blasphemous. This mortal hatred they had so openly
expressed, that Jesus himself had thought it best to retire awhile
from that region, and to avoid exposing himself to the fatal effects of
such malice, until the other great duties of his earthly mission had
been executed, so as to enable him, at last, to proceed to the bloody
fulfilment of his mighty task, with the assurance that he had finished
the work which his Father gave him to do.
But in spite of the pressing remonstrances of his disciples, Jesus

expressed his firm resolution to go, in the face of all mortal dangers,
into Judea, there to complete the divine work which he had only
begun. Thomas, finding his Master determined to rush into the
danger, which, by once retreating from it for a time, he had
acknowledged to be imminent, resolved not to let him go on, alone;
and turning to his fellow-disciples, said, “Let us also go, that we may
die with him.” The proposal, thus decidedly made, shows a noble
resolution in Thomas, to share all the fortunes of him to whom he
had joined himself, and presents his character in a far more
favorable light than the other passages in which his conduct is
commemorated. While the rest were fearfully expostulating on the
peril of the journey, he boldly proposed to his companions to follow
unhesitatingly the footsteps of their Master, whithersoever he might
go,――thus evincing a spirit of far more exalted devotion to the
cause.
The view here taken differs from the common interpretation of the passage, but it is the
view which has seemed best supported by the whole tenor of the context, as may be
decided by a reference to the passage in its place, (John xi. 16.) The evidence on both
views can not be better presented than in Bloomfield’s note on this passage, which is here
extracted entire.
“Here again the commentators differ in opinion. Some, as Grotius, Poole, Hammond,
Whitby, and others, apply the αὐτου to Lazarus, and take it as equivalent to ‘let us go and
die together with him.’ But it is objected by Maldonati and Lampe, that Lazarus was already
dead; and die like him they could not, because a violent death was the one in Thomas’s
contemplation. But these arguments seem inconclusive. It may with more justice be
objected that the sense seems scarcely natural. I prefer, with many ancient and modern
interpreters, to refer the αὐτου to Jesus, ‘let us go and die with him.’ Maldonati and
Doddridge regard the words as indicative of the most affectionate attachment to our Lord’s
person. But this is going into the other extreme. It seems prudent to hold a middle course,
with Calvin, Tarnovius, Lyser, Bucer, Lampe, and (as it should appear) Tittman. Thomas
could not dismiss the idea of the imminent danger to which both Jesus and they would be
exposed, by going into Judea; and, with characteristic bluntness, and some portion of ill
humor, (though with substantial attachment to his Master’s person,) he exclaims: ‘Since our
Master will expose himself to such imminent, and, as it seems, unnecessary danger, let us
accompany him, if it be only to share his fate.’ Thus there is no occasion, with Markland and
Forster, apud Bowyer, to read the words interrogatively.” (Bloomfield’s Annotations, vol. III.
p. 426, 427.)
In John’s minute account of the parting discourses of Christ at the

Last Supper, it is mentioned, that Jesus after speaking of his
departure, as very near, in order to comfort his disciples, told them,
he was going “to prepare a place for them, in his Father’s house,
where were many mansions.” Assuring them of his speedy return to
bring them to these mansions of rest, he said to them, “Whither I go
ye know, and the way ye know.” But so lost, for the time, were all
these words of instruction and counsel, that not one of his followers
seems to have rightly apprehended the force of this remark; and
Thomas was probably only expressing the general doubt, when he
replied to Jesus, in much perplexity at the language, “Lord, we know
not whither thou goest; and how can we know the way?” Jesus
replied, “I am the way, the truth, and the life: no man comes to the
Father but by me.” But equally vain was this new illustration of the
truth. The remark which Philip next made, begging that they might
have their curiosity gratified by a sight of the Father, shows how idly
they were all still dreaming of a worldly, tangible and visible kingdom,
and how uniformly they perverted all the plain declarations of Jesus,
to a correspondence with their own pre-conceived, deep-rooted
notions. Nor was this miserable error removed, till the descent of that
Spirit of Truth, which their long-suffering and ever watchful Lord
invoked, to teach their still darkened souls the things which they
would not now see, and to bring to their remembrance all which they
now so little heeded.
The remaining incident respecting this apostle, which is recorded

by John, further illustrates the state of mind in which each new
revelation of the divine power and character of Jesus, found his
disciples. None of them expected his resurrection;――none would
really believe it, until they had seen him with their own eyes. Thomas
therefore showed no remarkable skepticism, when, hearing from the
others, that one evening, when he was not present, Jesus had
actually appeared alive among them, he declared his absolute
unbelief,――protesting, that far from suffering himself to be as lightly
deceived as they had been, he would give no credit to any evidence
but that of the most unquestionable character,――that of seeing and
touching those bloody marks which would characterize, beyond all
possibility of mistake, the crucified body of Jesus. “Except I shall see
in his hands the print of the nails, and put my finger into the print of
the nails, and thrust my hand into his side, I will not believe.” After
eight days, the disciples were again assembled, and on this
occasion Thomas was with them. While they were sitting, as usual,
with doors closed for fear of the Jews, Jesus again, in the same
sudden and mysterious manner as before, appeared all at once in
the midst, with his solemn salutation, “Peace be with you!” Turning at
once to the unbelieving disciple, whose amazed eyes now for the
first time fell on the body of his risen Lord, he said to him, “Thomas!
Put thy finger here, and see my hands; and put thy hand here, and
thrust it into my side; and be not faithless, but believing.” The
stubbornly skeptical disciple was melted at the sight of these
mournful tokens of his Redeemer’s dying agonies, and in a burst of
new exalted devotion, he exclaimed, “My Lord! and my God!” The
pierced hands and side showed beyond all question the body of his
“Lord;” and the spirit that could, of itself, from such a death, return to
perfect life, could be nothing else than “God.” The reply of Jesus to
this expression of faith and devotion, contained a deep reproach to
this slow-believing disciple, who would take no evidence whatever of
the accomplishment of his Master’s dying words, except the sight of
every tangible thing that could identify his person. “Thomas! because
thou hast seen me, thou hast believed: blessed are they, who though
not seeing, yet believe.”
“Put thy finger here.”――This phrase seems to express the graphic force of the original,
much more justly than the common translation. The adverb of place, ὧδε, gives the idea of
the very place where the wounds had been made, and brings to the reader’s mind the
attitude and gesture of Jesus, with great distinctness. The adverb “here,” refers to the print
of the nails; and Jesus holds out his hand to Thomas, as he says these words, telling him to
put his finger into the wound.
Not seeing, yet believe.――This is the form of expression best justified by the
indefiniteness of the Greek aorists, whose very name implies this unlimitedness in respect
to time. The limitation to the past, implied in the common translation, is by no means
required by the original; but it is left so vague, that the action may be referred to the present
and the future also.
Beyond this, the writings of the New Testament give not the least
account of Thomas; and his subsequent history can only be
uncertainly traced in the dim and dark stories of tradition, or in the
contradictory records of the Fathers. Different accounts state that he
preached the gospel in
Parthia,――Media,――Persia,――Ethiopia,――and at last, India. A
great range of territories is thus spread out before the investigator,
but the traces of the apostle’s course and labors are both few and
doubtful. Those of the Fathers who mention his journeys into these
countries, give no particulars whatever of his labors; and all that is
now believed respecting these things, is derived from other, and
perhaps still more uncertain sources.
India is constantly asserted by the Fathers, from the beginning of

the third century, to have very early received the gospel, and this
apostle is named as the person through whom this evangelization
was effected; but this evidence alone would be entitled to very little
consideration, except from the circumstance, that from an early
period, to this day, there has existed in India, a large body of
Christians, who give themselves the name of “St. Thomas’s
Christians,” of whose antiquity proofs are found in the testimony,
both of very ancient and very modern travelers. They still retain
many traditions of the person whom they claim as their
founder,――of his place of landing,――the towns he visited,――the
churches he planted,――his places of residence and his retreats for
private devotion,――the very spot of his martyrdom, and his grave.
A tradition, however, floating down unwritten for fifteen centuries, can
not be received as very good evidence; and the more minute such
stories are in particulars, the more suspicious they are in their
character for truth. But in respect to the substance of this, it may well
be said, that it is by no means improbable, and is in the highest
degree consistent with the views, already taken, in former parts of
this work, of the eastward course of the apostles after the destruction
of Jerusalem. The great body of them, taking refuge at Babylon,
within the limits of the great Parthian empire, the more adventurous
might follow the commercial routes still farther eastward, to the mild
and generally peaceful nations of distant India, whose character for
civilization and partial refinement was such as to present many
facilities for the introduction and wide diffusion of the gospel among
them. These views, in connection with the great amount of
respectable evidence from various other sources, make the whole
outline of the story of Thomas’s labors in India very possible, and
even highly probable.
The earliest evidence among the Fathers that has ever been quoted on this point, is that
of Pantaenus, of Alexandria, whose visit to what was then called India, has been mentioned
above; (page 363;) but as has there been observed, the investigations of Michaelis and
others, have made it probable that Arabia-Felix was the country there intended by that
name. The first distinct mention made of any eastward movement of Thomas, that can be
found, is by Origen, who is quoted by Eusebius, (Church History, III. 1,) as testifying, that
when the apostles separated to go into all the world, and preach the gospel, Parthia was
assigned to Thomas; and Origen is represented as appealing to the common tradition, for
the proof of this particular fact. Jerome speaks of Thomas, as preaching the gospel in
Media and Persia. In another passage he specifies India, as his field; and in this he is
followed by most of the later writers,――Ambrose, Nicephorus, Baronius, Natalis, &c.
Chrysostom (Oration on the 12 Apostles) says that Thomas preached the gospel in
Ethiopia. As the geography of all these good Fathers seems to have been somewhat
confused, all these accounts may be considered very consistent with each other. Media and
Persia were both in the Parthian Empire; and all very distant countries, east and south,
were, by the Greeks, vaguely denominated India and Ethiopia; just ♦ as all the northern
unknown regions were generally called Scythia.
♦ removed duplicate “as”
Natalis Alexander (Church History, IV. p. 32,) sums up all these accounts by saying, that
Thomas preached the gospel to the Parthians, Medes, Persians, Brachmans, Indians, and
the other neighboring nations, subject to the empire of the Parthians. He quotes as his
authorities, besides the above-mentioned Fathers, Sophronius, (A. D. 390,) Gregory
Nazianzen, (A. D. 370,) Ambrose, (370,) Gaudentius, (A. D. 387.) The author of the
imperfect work on Matthew, (A. D. 560,) says, that Thomas found in his travels, the three
Magi, who adored the infant Jesus, and having baptized them, associated them with him, in
his apostolic labors. Theodoret, (A. D. 423,) Gaudentius, Asterius, (A. D. 320,) and others,
declare Thomas to have died by martyrdom. Sophronius (390,) testifies that Thomas died at
Calamina, in India. This Calamina is now called Malipur, and in commemoration of a
tradition, preserved, as we are told, on the spot, to this effect, the Portuguese, when they
set up their dominion in India, gave it the name of the city of St. Thomas. The story reported
by the Portuguese travelers and historians is, that there was a tradition current among the
people of the place, that Thomas was there martyred, by being thrust through with a lance.
(Natalis Alexander, Church History, vol. IV. pp. 32, 33.)
A new weight of testimony has been added to all this, by the statements of Dr. Claudius
Buchanan, who, in modern times, has traced out all these traditions on the spot referred to,
and has given a very full account of the “Christians of St. Thomas,” in his “Christian
researches in India.”
On this evidence, may be founded a rational belief, though not an

absolute certainty, that Thomas actually did preach the gospel in
distant eastern countries, and there met with such success as to
leave the lasting tokens of his labors, to preserve through a course
of ages, in united glory, his own name and that of his Master. In
obedience to His last earthly command, he went to teach “nations
unknown to Caesar,” proclaiming to them the message of divine
love,――solitary, and unsupported, save by the presence of Him,
who had promised to “be with him always, even to the end of the
world.”
JAMES, THE LITTLE;
THE SON OF ALPHEUS.
his name.
It will be observed, no doubt, by all readers, that the most

important inquiry suggested in the outset of the most of these
apostolic biographies, is about the name and personal identification
of the individual subject of each life. This difficulty is connected with
peculiarities of those ancient times and half-refined nations, that may
not, perhaps, be very readily appreciated by those who have been
accustomed only to the definite nomenclature of families and
individuals, which is universally adopted among civilized nations at
the present day. With all the refined nations of European race, the
last part of a person’s name marks his family, and is supposed to
have been borne by his father, and by his ancestors, from the time
when family names were first adopted. The former part of his name,
with equal definiteness, marks the individual; and generally remains
fixed from the time when he first received his name. Whenever any
change takes place in any part of his appellation, it is generally done
in such a formal and permanent mode, as never to make any
occasion for confusion in respect to the individual, among those
concerned with him. But no such decisive limitation of names to
persons, prevailed among even the most refined nations of the
apostolic age. The name given to a child at birth, indeed, was very
uniformly retained through life; but as to the other parts of his
appellation, it was taken, according to circumstances, chance or
caprice, from the common name of his father,――from some
personal peculiarity,――from his business,――from his general
character,――or from some particular incident in his life. The name
thus acquired, to distinguish him ♦ from others bearing his former
name, was used either in connection with that, or without; and
sometimes two or more such distinctive appellations belonged to the
same man, all or any of which were used together with the former, or
separate from it, without any definite rule of application. To those
acquainted with the individual so variously named, and
contemporary with him, no confusion was made by this multiplicity of
words; and when anything was recorded respecting him, it was done
with the perfect assurance, that all who then knew him, would find no
difficulty in respect to his personal identity, however he might he
mentioned. But in later ages, when the personal knowledge of all
these individual distinctions has been entirely lost, great difficulties
necessarily arise on these points,――difficulties which, after tasking
historical and philological criticism to the highest efforts, in order to
settle the facts, are, for the most part, left in absolute uncertainty.
Thus, in respect to the twelve apostles, it will be noticed, that this
confusion of names throws great doubt over many important
questions. Among some of them, too, these difficulties are partly
owing to other causes. Their names were originally given to them, in
the peculiar language of Palestine; and in the extension of their
labors and fame, to people of different languages, of a very opposite
character, their names were forced to undergo new distortions, by
being variously translated, or changed in termination; and many of
the original Hebrew sounds, in consequence of being altogether
unpronounceable by Greeks and Romans, were variously
exchanged for softer and smoother ones, which, in their dissimilar
forms, would lose almost all perceptible traces of identity with each
other, or with the original word.
♦ replace word omitted from text “from”
These difficulties are in no case quite so prominent and serious as

in regard to the apostle who is the subject of this particular
biography. Bearing the same name with the elder son of Zebedee,
he was of course necessarily designated by some additional title, to
distinguish him from the other great apostle James. This title was not
always the same, nor was it uniform in its principle of selection. On
all the apostolic lists, he is designated by a reference to the name of
his father, as is the first James. As the person first mentioned by this
name is called James, the son of Zebedee, the second is called
James, the son of Alpheus; nor is there, in the enumeration of the
apostles by Matthew, Mark or Luke, any reference to another
distinctive appellation of this James. But in one passage of Mark’s
account of the crucifixion, it is mentioned, that among the women
present, was Mary the mother of James the Little, and of Joses. In
what sense this word little is applied,――whether of age, size, or
dignity,――it is utterly impossible to ascertain at this day; for the
original word is known to have been applied to persons, in every one
of these senses, even in the New Testament. But, however this may
be, a serious question arises, whether this James the Little was
actually the same person as the James, called, on the apostolic lists,
the son of Alpheus. In the corresponding passage in John’s gospel,
this same Mary is called Mary the wife of Clopas; and by Matthew
and Mark, the same James is mentioned as the brother of Joses,
Juda, and Simon. In the apostolic lists given by Luke, both in his
gospel, and in the Acts of the Apostles, Juda is also called “the
brother of James;” and in his brief general epistle, the same apostle
calls himself “the brother of James.” In the beginning of the epistle to
the Galatians, Paul, describing his own reception at Jerusalem, calls
him “James, the brother of our Lord;” and by Matthew and Mark, he,
with his brothers, Joses, Juda and Simon, is also called the brother
of Jesus. From all these seemingly opposite and irreconcilable
statements, arise three inquiries, which can, it is believed, be so
answered, as to attribute to the subject of this article every one of the
circumstances connected with James, in these different stories.
James, the Little.――This adjective is here applied to him in the positive degree,
because it is so in the original Greek, [Ιακωβος ὁ μικρος, Mark xv. 40,] and this expression
too, is in accordance with English forms of expression. The comparative form, “James, the
Less,” seems to have originated in the Latin Vulgate, “Jacobus Minor,” which may be well
enough in that language; but in English, there is no reason why the original word should not
be literally and faithfully expressed. The Greek original of Mark, calls him “James, the Little,”
which implies simply, that he was a little man; whether little in size, or age, or dignity, every
one is left to guess for himself;――but it is more accordant with usage, in respect to such
nicknames, in those times, to suppose that he was a short man, and was thus named to
distinguish him from the son of Zebedee, who was probably taller. The term thus applied by
Mark, would be understood by all to whom he wrote, and implied no disparagement to his
mental eminence. But the term applied, in the sense of a smaller dignity, is so slighting to
the character of James, who to the last day of his life, maintained, according to both
Christian and Jewish history, the most exalted fame for religion and intellectual
worth,――that it must have struck all who heard it thus used, as a term altogether unjust to
his true eminence. His weight of character in the councils of the apostles, soon after the
ascension, and the manner in which he is alluded to in the accounts of his death, make it
very improbable that he was younger than the other James.
First: Was James the son of Alpheus the same person as James
the son of Clopas? The main argument for the identification of these
names, rests upon the similarity of the consonants in the original
Hebrew word which represents them both, and which, according to
the fancy of a writer, might be represented in Greek, either by the
letters of Alpheus or of Clopas. This proof, of course, can be fully
appreciated only by those who are familiar with the power of the
letters of the oriental languages, and know the variety of modes in
which they are frequently given in the Greek, and other European
languages. The convertibility of certain harsh sounds of the dialects
of southwestern Asia, into either hard consonants, or smooth vowel
utterances, is sufficiently well-known to Biblical scholars, to make the
change here supposed appear perfectly probable and natural to
them. It will be observed by common readers, that all the consonants
in the two words are exactly the same, except that Clopas has a
hard C, or K, in the beginning, and that Alpheus has the letter P
aspirated by an H, following it. Now, both of these differences can,
by a reference to the original Hebrew word, be shown to be only the
results of the different modes of expressing the same Hebrew letters;
and the words thus expressed may, by the established rules of
etymology, be referred to the same oriental root. These two names,
then, Alpheus and Clopas, may be safely assigned to the same
person; and Mary the wife of Clopas and the mother of James the
Little, and of Joses, was, no doubt, the mother of him who is called
“James the son of Alpheus.”
Clopas and Alpheus.――It should be noticed, that in the common translation of the New
Testament, the former of these two words is very unjustifiably expressed by Cleophas,
whereas the original (John xix. 25,) is simply Κλωπας. (Clopas.) This is a totally different
name from Cleopas, (Luke xxiv. 18, Κλεοπας,) which is probably Greek in its origin, and
abridged from Cleopater, (Κλεοπατρος,) just as Antipas from Antipater, and many other
similar instances, in which the Hellenizing Jews abridged the terminations of Greek and
Roman words, to suit the genius of the Hebrew tongue. But Clopas, being very differently
spelt in the Greek, must be traced to another source; and the circumstances which connect
it with the name Alpheus, suggesting that, like that, it might have a Hebrew origin, directs
the inquirer to the original form of that word. The Hebrew ‫( חלפא‬hhalpha) may be taken as
the word from which both are derived; each being such an expression of the original, as the
different writers might choose for its fair representation. The first letter in the word, ‫ח‬,
(hhaith,) has in Hebrew two entirely distinct sounds; one a strong guttural H, and the other a
deeply aspirated KH. These are represented in Arabic by two different letters, but in
Hebrew, a single character is used to designate both; consequently the names which
contain this letter, may be represented in Greek and other languages, by two different
letters, according as they were pronounced; and where the original word which contained it,
was sounded differently, by different persons, under different circumstances, varying its
pronunciation with the times and the fashion, even in the same word, it would be differently
expressed in Greek. Any person familiar with the peculiar changes made in those Old
Testament names which are quoted in the New, will easily apprehend the possibility of such
a variation in this. Thus, in Stephen’s speech, (Acts vii.) Haran is called Charran; and other
changes of the same sort occur in the same chapter. The name Anna, (Luke ii. 36,) is the
same with Hannah, (1 Samuel i. 2,) which in the Hebrew has this same strongly aspirated
H, that begins the word in question,――and the same too, which in Acts vii. 2, 4, is changed
into the strong Greek Ch; while all its harshness is lost, and the whole aspiration removed,
in Anna. These instances, taken out of many similar ones, may justify to common readers,
the seemingly great change of letters in the beginning of Alpheus and Clopas. The other
changes of vowels are of no account, since in the oriental languages particularly, these are
not fixed parts of the word, but mere modes of uttering the consonants, and vary throughout
the verbs and nouns, in almost every inflexion these parts of speech undergo. These
therefore, are not considered radical or essential parts of the word, and are never taken into
consideration in tracing a word from one language to another,――the consonants being the
fixed parts on which etymology depends. The change also from the aspirate Ph, to the
smooth mute P, is also so very common in the oriental languages, and even in the Greek,
that it need not be regarded in identifying the word.
Taking into consideration then, the striking and perfect affinities of the two words, and
adding to these the great body of presumptive proofs, drawn from the other circumstances
that show or suggest the identity of persons,――and noticing moreover, the circumstance,
that while Matthew, Mark, and Luke speak of Alpheus, they never speak of Clopas,――and
that John, who alone uses the name Clopas, never mentions Alpheus,――it seems very
reasonable to adopt the conclusion, that the last evangelist means the same person as the
former.
Second: Was James the son of Alpheus the same person as

“James, the brother of our Lord?” An affirmative answer to this
question seems to be required by the fact, that Mary the wife of
Clopas is named as the mother of James and Joses; and elsewhere,
James and Joses, and Juda and Simon, are called the brothers of
Jesus. It should be understood that the word “brother” is used in the
scriptures often, to imply a relationship much less close than that of
the children of the same father and mother. “Cousins” are called
“brothers” in more cases than one, and the oriental mode of
maintaining family relationship closely through several generations,
made it very common to consider those who were the children of
brothers, as being themselves brothers; and to those familiar with
this extension of the term, it would not necessarily imply anything
more. In the case alluded to, all those to whom the narratives and
other statements containing the expression, “James the brother of
our Lord,” were first addressed, being well acquainted with the
precise nature of this relationship, would find no difficulty whatever in
such a use of words. The nature of his relationship to Jesus seems
to have been that of cousin, whether by the father’s side or mother’s,
is very doubtful. By John indeed, Mary the wife of Clopas is called
the sister of the mother of Jesus; but it will seem reasonable enough
to suppose,――since two sisters, daughters of the same parents,
could hardly bear the same name,――that Mary the mother of
James, must have been only the sister-in-law of the mother of Jesus,
either the wife of her brother, or the sister of her husband; or, in
perfect conformity with this use of the term “sister,” she may have
been only a cousin or some such relation.
The third question which has been originated from these various
statements,――whether James, the brother of Jesus and the author
of the epistle, was an apostle,――must, of course, be answered in
the affirmative, if the two former points have been correctly settled.
All the opinions on these points are fully given and discussed by Michaelis, in his
Introduction to the epistle of James. He states five different suppositions which have been
advanced respecting the relationship borne to Jesus by those who are in the New
Testament called his brothers. 1. That they were the sons of Joseph, by a former wife.
2. That they were the sons of Joseph, by Mary the mother of Jesus. 3. That they were the
sons of Joseph by the widow of a brother, to whom he was obliged to raise up children
according to the laws of Moses. 4. That this deceased brother of Joseph, to whom the laws
required him to raise up issue, was Alpheus. 5. That they were brothers of Christ, not in the
strict sense of the word, but in a more lax sense, namely, in that of cousin, or relation in
general, agreeably to the usage of this word in the Hebrew language. (Genesis xiv. 16: xiii.
8: xxix. 12, 15: 2 Samuel xix. 13: Numbers viii. 26: xvi. 10: Nehemiah iii. 1.) This opinion
which has been here adopted, was first advanced by Jerome, and has been very generally
received since his time; though the first of the five was supported by the most ancient of the
Fathers. Michaelis very clearly refutes all, except the first and the fifth, between which he
does not decide; mentioning, however, that though he had been early taught to respect the
latter, as the right one, he had since become more favorable to the first.
The earliest statement made concerning these relations of Jesus,

is by John, who, in giving an account of the visit made by Jesus to
Jerusalem, at the feast of the tabernacles, mentions, that the
brethren of Jesus did not believe in him, but, in a rather sneering
tone, urged him to go up to the feast, and display himself, that the
disciples who had formerly there followed him, might have an
opportunity to confirm their faith by the sight of some new miracle
done by him. Speaking to him in a very decidedly commanding tone,
they said, “Depart hence, and go into Judea, that thy disciples also
may see the works that thou doest. For there is no man that does
anything in secret, while he himself seeks to be widely known; if thou
do these things, show thyself to the world.” The whole tenor of this
speech shows a spirit certainly very far from a just appreciation of
the character of their divine brother; and the base, sordid motives,
which they impute to him as ruling principles of action, were little less
than insults to the pure, high spirit, which lifted him so far above their
comprehension. The reply which Jesus made to their taunting
address, contained a decided rebuke of their presumption in thus
attacking his motives. “My time is not yet come, but yours is always
ready. The world can not hate you, but me it hates, because I testify
of it that its works are evil. Go ye up to this feast; but I am not going
yet; for my time is not yet fully come.” They might always go where
mere inclination directed them, nor was there any occasion to refer
to any higher object. But a mighty scheme was connected with his
movements, to which he directed every action. In his great work, he
had already exposed himself to the hatred of the wicked, and his
movements were now checked by a regard to the proper time for
exposing himself to it; and when that time should come, he would
unhesitatingly meet the results.
By a passage in Mark’s gospel, it appears also, that at the first

beginning of the ministry of Jesus, his relations generally were so
little prepared for a full revelation of the character and destiny of him
with whom they had long lived so familiarly as a brother and an
intimate, that they viewed with the most disagreeable surprise and
astonishment, his remarkable proceedings, in going from place to
place with his disciples,――neglecting the business to which he had
been educated, and deserting his family friends,――preaching to
vast throngs of wondering people, and performing strange works of
kindness to those who seemed to have no sort of claim on his
attention. Distressed at these strange actions, they could form no
conclusion about his conduct that seemed so reasonable and
charitable, as that he was beside himself, and needed to be
confined, to prevent him from doing mischief to himself and others,
by his seemingly extravagant and distracted conduct. “And they
came out to lay hold on him, for they said ‘He is beside himself.’”
With this very purpose, as it seems, his brothers and family relations
had come to urge and persuade him back to their home if possible,
and stood without, utterly unable to get near him, on account of the
throngs of hearers and beholders that had beset him. They were
therefore obliged to send him word, begging him to stop his
discourse and come out to them, because they wanted to see him.
The request was therefore passed along from mouth to mouth, in the
crowd, till at last those who sat next to Jesus communicated the
message to him,――“Behold thy mother and thy brethren stand
without, desiring to speak with thee.” Jesus fully apprehending the
nature of the business on which their ill-discerning regard had
brought them thither, only suspended the train of his discourse to
make such a remark as would impress all with the just idea of the
value which he set upon earthly affections, which were liable to
operate as hindrances to him in the great work to which he had been
devoted; and to convince them how much higher and stronger was
the place in his affections held by those who had joined themselves
to him for life and for death, to promote the cause of God, and to do
with him the will of his Father in heaven,――in the striking language
of inquiry, he said, “Who is my mother or my brethren?” Then looking
with an expression of deep affection around, on those who sat near
him, he said, “Behold my mother and my brethren! For whosoever
shall do the will of God, the same is my brother, and my sister and
mother.” It appears by this remark, as well as by another passage,
that he had not only brothers, but sisters, who lived at Nazareth at
that time, and were well known as his relations. No mention however
is any where made of his father; so that it would appear that Joseph
was now dead.
This remarkable faithlessness on the part of the brothers of Jesus,

may be thought to present an insuperable difficulty in the way of the
supposition that any of them could have been numbered with the
apostles. But great as seems to have been their error, it hardly
exceeded many that were made by his most select followers, even to
the time of his ascension. All the apostles may be considered to
have been in a great measure unbelievers, until the descent of the
Holy Spirit,――for until that time, on no occasion did one of them
manifest a true faith in the words of Jesus. Times almost without
number, did he declare to them that he should rise from the dead;
but notwithstanding this assertion was so often made to them in the
most distinct and solemn manner, not one of them put the slightest
confidence in his words, or believed that he would ever appear to
them again after his crucifixion. Not even the story of his
resurrection, repeatedly and solemnly attested by the women and
others, could overcome their faithlessness; so that when the risen
Lord, whose words they had so little heeded, came into their
presence, moved with a just and holy anger, “he upbraided them with
their unbelief and hardness of heart, because they believed not
those who had seen him after he was risen.” So that his brothers at
this early period, can not be considered any worse off than the rest
of those who knew and loved him best; and if any are disposed to
oppose the view that his brethren were apostles, by quoting the
words of John, that “neither did his brethren believe in him,” a
triumphant retort may be found in the fact, that neither did his
apostles believe in him.
There were, however, other “brothers” of Jesus, besides those

who were apostles. By Matthew and Mark is also mentioned Joses,
who is nowhere mentioned as an apostle; and there may have been
others still, whose names are not given; for, in the account given, in
the first chapter of Acts, it is recorded that, besides all the eleven
apostles, there were also assembled in the upper room, Mary the
mother of Jesus, and his brethren. It is very likely, that Jesus may
have had several other cousins, who followed his fortunes, though
they were not considered by him, qualified to rank among his chosen
apostles. But a very prominent objection to the notion that they were
the children of his mother, with whom they are mentioned in such
close connection,――is, that when Jesus was on the cross, he
commended her to the care of John, his beloved disciple, as though
she were destitute of any immediate natural protector; and certainly,
if she had at that time several sons living, who were full-grown, she
could not have needed to be intrusted thus to the kindness of one
who claimed no relationship whatever to her; but would, of course,
have been secure of a home, and a comfortable support, so long as
her sons could have worked for her. These also may have been
those brethren who did not believe in him, and who considered him
beside himself, though there seems no good reason to except any of
those who are mentioned by Matthew and Mark, as his
brethren,――James, Juda, Joses and Simon.
Beyond these allusions to him, in connection with others, the

gospels take no notice whatever of this apostle; and it is only in the
Acts of the Apostles, and some of the epistles of Paul, that he is
mentioned with any great distinctness. In all those passages in the
apostolic writings where he is referred to, he is presented as a
person of high standing and great importance, and his opinions are
given in such a manner as to convey the impression that they had
great weight in the regulation of the apostolic doings. This is
particularly evident in the only passage of the Acts of the Apostles
where his words are given, which is in the account of the
consultation at Jerusalem about the great question of communion
between the circumcised and uncircumcised. On this occasion,
James is mentioned in such a way as to make it evident that he was
considered the most prominent among those who were zealous for
the preservation of the Mosaic forms, and to have been by all such,

Textbook Pain Suffering and Healing Insights and Understanding 1St Edition Peter Wemyss Gorman Ebook All Chapter PDF

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Pain Suffering and Healing Insights and

Understanding 1st Edition Peter

Healing Chronic Pelvic Pain and Dysfunction Forever

Without Shame The Addict s Mom and Her Family Share

Suffering and Virtue Michael S Brady

Delusions Understanding the Un understandable 1st

Understanding Higher Education Internationalization:

Disciplined Growth Strategies : Insights from the

Understanding Business Ethics 3rd Edition Peter A.

Meaningless Suffering: Traumatic Marginalisation and

P26994_Radcliffe_Gorman_ccp.indd 1 03/08/2011 15:42

P26994_Radcliffe_Gorman_ccp.indd 3 03/08/2011 15:42

Published 2016 by CRC Press

” 2011 Peter Wemyss-Gorman

ISBN-13: 978-1-84619-326-2 (pbk)

Visit the Taylor & Francis Web site at

and the CRC Press Web site at

British Library Cataloguing in Publication Data

Typeset by Phoenix Photosetting, Chatham, Kent, UK

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that healthcare providers address the issues. Suffering cannot be found in

P26994_Radcliffe_Gorman_ccp.indd 10 03/08/2011 15:42

Pain and suffering have been a major preoccupation of philosophers for

The Special Interest Group of the British Pain Society for

P26994_Radcliffe_Gorman_ccp.indd 11 03/08/2011 15:42

P26994_Radcliffe_Gorman_ccp.indd 12 03/08/2011 15:42

The development of pain medicine

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I am in danger of subscribing to a ‘pain/suffering’ dualism which would be

P26994_Radcliffe_Gorman_ccp.indd 16 03/08/2011 15:42

resource allocation are supposed to be grounded in evidence-based medicine

P26994_Radcliffe_Gorman_ccp.indd 17 03/08/2011 15:42

may well be regarded as dishonest. I explore these fascinating but difficult

P26994_Radcliffe_Gorman_ccp.indd 18 03/08/2011 15:42

P26994_Radcliffe_Gorman_ccp.indd 19 03/08/2011 15:42

Peter Wemyss-Gorman was a consultant anaesthetist at the Princess Royal

P26994_Radcliffe_Gorman_ccp.indd 20 03/08/2011 15:42

Michael Bavidge was a lecturer in philosophy at the Centre for Lifelong

Diana Brighouse was appointed consultant anaesthetist to the Southampton

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management in Southampton led her to take a one-year course in counsel-

P26994_Radcliffe_Gorman_ccp.indd 22 03/08/2011 15:42

who seemed to be suffering from something deeper than physical or emotional

Kate Maguire is a social anthropologist and psychotherapist who specialises in

Paul Martin worked until retirement as a palliative care physician in Dundee

Willy Notcutt is a consultant in anaesthesia and pain medicine in Great Yar-

Ian Yellowlees is currently a consultant in pain management in the Nor-

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multidisciplinary pain management service at the Borders General Hospital in

P26994_Radcliffe_Gorman_ccp.indd 24 03/08/2011 15:42

The Tao of Pain

Tao is a thing that is both invisible and intangible.

An unpleasant sensory and emotional experience associated with actual or

An alternative definition of pain can be derived by adapting the quotation from

P26994_Radcliffe_Gorman_ccp.indd 1 03/08/2011 15:42

P26994_Radcliffe_Gorman_ccp.indd 2 03/08/2011 15:42

The Tao of Physics

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