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Salud mental

Print version ISSN 0185-3325

Salud Ment vol.29 n.4 México Jul./Aug. 2006

 

Artículos originales

En torno al sentido del dolor

Otto Dörr-Zegers1 

1Unidad Docente de la Facultad de Medicina de la Universidad de Chile en el Instituto Psiquiátrico, Av. La Paz 841. Facultad de Medicina de la Universidad Diego Portales, Av. Ejército 233. Santiago de Chile.

Resumen:

El dolor y el sufrimiento han acompañado al hombre desde siempre. Lo encontramos en los mitos más antiguos y en el Libro del Génesis. Yahvé le dice a la mujer "Parirás con dolor' (Cap. 3, Vers. 16) y al hombre, "Ganarás el pan con el sudor de tu frente" (Cap. 3, Vers. 19) y poco antes le había dicho que de ahora en adelante la vida le daría "espinas y abrojos" (Cap. 3, Vers. 18).

Hay al menos dos tipos de dolores: el dolor-sensación y el dolor-sentimiento (Auersperg). El primero es más localizado, brusco en su aparición y pasa sin dejar huellas. Es el caso del dolor provocado por un pinchazo o una quemadura. El segundo es más difuso y pático, tiene una duración mayor y pasa en forma paulatina. Es el caso de la cefalea, del colon irritable, del dolor de columna, etc. Este tipo de dolor físico abunda en las enfermedades psíquicas, particularmente en la depresión. En sus formas enmascaradas, todo el cuadro gira en torno a la experiencia dolo-rosa, permaneciendo el compromiso del ánimo y el de los ritmos vitales en una suerte de penumbra. En el dolor es el cuerpo el que duele. En el sufrimiento, en cambio, lo que duele es el significado de lo que me ocurre. Ambos tienen al menos dos rasgos en común: el primero es su carácter pático, vale decir, que nos suceden, que no dependen de nuestra voluntad, y el segundo es que ambos aíslan, interrumpen nuestra relación con el mundo. El autor intenta responder la pregunta por el posible sentido del dolor desde una perspectiva histórica y una hermenéutica.

Perspectiva histórica: para los antiguos semitas el dolor era una consecuencia del pecado, falta cometida ya sea por nosotros mismos, por nuestros antepasados o por nuestros primeros padres (pecado original). En el Nuevo Testamento el dolor ocupa un lugar central en la vida y muerte de Jesucristo. Por su sacrificio los humanos hemos sido redimidos y reconciliados con Dios. El men saje de la cruz termina por convertirse en un mensaje de resurrección y de vida. En consecuencia, para el cristiano el dolor no puede sino pertenecer a la esencia misma de la vida. Esta concepción se mantuvo vigente hasta el siglo XIX. Cinco descubrimientos van a hacer tambalear entonces los cimientos de esta cosmovisión: el de la angustia por Kierkegaard, el de la evolución por Darwin, el del poder de las fuerzas económicas por Marx, el del absurdo por Nietzsche y el del inconsciente por Freud. Luego sobrevino la secularización, la "muerte de Dios" y el olvido de su Providencia; más tarde los totalitarismos, con las consecuencias de todos conocidas, y ahora nos encontramos en plena postmodernidad, con su alta tecnificación, la destrucción del medio ambiente, la manipulación genética y un falso sentido de libertad, donde todo parece estar permitido, hasta el punto de vivir rodeados de las formas más extremas de la obscenidad.

Perspectiva hermenéutica: para ello el autor recurre a algunos textos del poeta Rainer Maria Rilke (1815-1926). Así, en uno de los Sonetos a Orfeo (XIX, 1a Parte), él dice: "No se ha reconocido el dolor / ni se ha aprendido el amor / y lo que nos aleja en la muerte / no ha sido develado aún. / Sólo el canto sobre la tierra /santifica y celebra". Según Heidegger en este poema se nos muestra la "copertenencia" del dolor, del amor y de la muerte. Su sentido permanece oculto al hombre moderno. Pero todavía nos queda el canto, allí donde se juntan la palabra y la música, canto que santifica y celebra la vida.

En el segundo soneto elegido (VIII, 1a Parte), el poeta afirma que "Sólo en el espacio de la celebración cabe la queja, / la ninfa de la llorada fuente, / velando sobre nuestro sedimento / para que se aclare ante la misma roca / que sostiene pórticos y altares". Aquí la ninfa vela para que el arroyo de nuestras lágrimas (de sufrimiento) -el que a su vez constituiría nuestro "sedimento", vale decir, nuestra esencia- se purifique al chocar con la misma roca sobre la cual están construidos nuestros templos. Hacia el final este dolor personificado en ese ser que el poeta llama "la Queja" se transforma en el verdadero intermediario entre los hombres y los dioses.

En la Novena Elegía el sufrimiento aparece como uno de los valores superiores. Pocas veces le ha sido otorgada al dolor una categoría más elevada. El es mucho más importante que todo lo visto, oído o experimentado a lo largo de la vida. Y lo único que está a su altura es "la larga experiencia del amor".

La idea de la trascendencia del dolor vuelve a aparecer en la Décima Elegía: "Oh, cómo me agradaréis entonces, noches de aflicción. / Que no os haya acogido de rodillas, hermanas incon solables... Nosotros, pródigos en dolores...". Y más adelante el poeta nos enseña que el dolor constituye el sentido último de la existencia humana: "... Pero ellos son nuestro follaje / invernal y perenne, nuestro verdor oscuro del sentido, / una de las estaciones del año secreto, mas no sólo tiempo, / sino lugar, poblado, campamento, suelo, residencia...".

Palabras clave: Dolor; sufrimiento; depresión; fenomenología; hermenéutica

Abstract:

Pain and suffering have always accompanied man. We find them in the most ancient myths and particularly in the Book of Genesis. Pain is apparently something innate in man and to a certain extent peculiar to him. This is clear when Yahweh tells the woman, "In sorrow thou shalt bring forth children" (Chapter 3, Vers. 16) and the man, "In the sweat of thy face shalt thou eat bread" (Chapter 3, Vers. 19) and not long before he had told him that from now on life would give him "thorns and thistles" (Chapter 3, Vers. 18). Now, how could man, who in Paradise lived in a state of full happiness, not know pain before his "fall", when he also had body, like the animals? Or is it perhaps a matter of different kinds of pain?

One possibility of understanding this biblical assertion is to think that the mythical text refers to suffering and not to pain. We would share the latter with animals, while suffering would be peculiar to the human being. But it just happens that, as we will see later, the boundary between suffering and pain is very diffuse and there are pains that are neither the result of action of an external agent nor identifiable with suffering (due to something lost, for example).

Alfred Prinz Auersperg, disciple and collaborator of Viktor von Weizsácker in the development of the Circle of the Form's Theory (Gestaltkreis), published in 1963 a book entitled "Pain and painfulness", where he clearly distinguishes two types of pain, sensation-pain and feeling-pain. The former is more localized, abrupt in its presentation and passes without leaving traces. Examples of this kind of pain are those caused by a stabs or burns. The latter is more diffuse and comes about gradually. It is the case of migraine, of the irritable bowel syndrome, of lower back pain, etc. This second type of pain is common in psychic diseases, particularly in depression. In its masked forms, the enti-re syndrome revolves round the painful experience, with the alteration of patient's mood and vital rhythms trapped in a sort of semi-darkness.

Moving up from the most somatic, now we should ask ourselves about the role of pain as suffering in depression. Here we see a sort of paradox, because the facies of the depressive patient represents in a way the maximum expression of suffering, but at the same time one often hears these patients complaining about a freezing of emotions, an inability to feel and thus to suffer and so, some come to believe they are incapable of loving their children, their spouses or their lovers. The difficulty we experience when trying to apprehend vital feelings is really that of separating our-selves from them, because they are continuously determining what we are thus our way of looking at the world. In pain, be it exteroceptive or interoceptive, it is the body that hurts. In suffering, on the other hand, what hurts is the meaning of what occurs to me. The two forms have at least two features in common: one is their pathic nature, that is, that they are outside forces that happen to us, they do not derive from our will like movement and action. The second feature is that both isolate, interrupt our commitment relationship with the world. Pain, because it causes a lose of body transparence and suffering, because the reason for it completely absorbs our attention.

Count the former as a previous explanation to the question about the possible sense of pain and/or of suffering. We will try to give an answer to this question from two different perspectives: one historical and another hermeneutic. The latter consists of resorting to the later works of Rainer Maria Rilke, a poet who in his work has illuminated many contexts, but one in a masterful way: suffering and pain.

For the ancient Semites pain was a consequence of sin, fault committed either by ourselves, by our ancestors or by our first parents (original sin). In New Testament pain occupies a central place in the life and death of Jesus Christ. By His sacrifice the human race has been redeemed and reconciled with God. The message of the cross eventually becomes a message of resurrection and of life. In consequence, for the Christian pain cannot but belong to the very essence of life. This conception was valid during the first nineteen centuries of Christian-Western civilization. Starting from the second half of the 19 Century, five discoveries will shake up the very foundation of this conception of the world: a) anxiety, described by Kierkegaard, b) evolution, Darwin's theory, c) power of economic forces described by Marx, d) the absurd, put forward by Nietzsche, and e) the unconscious, studied by Freud. Rapidly appeared secularization, the "death of God" and the oblivion of His Providence; then totalitarianisms, with the consequences known by all and now we are in the midst of postmodernity, with rampant technological development, the destruction of the environment, genetic manipulation and a false sense of freedom, where everything seems to be allowed, up to the point of living surrounded by the most extreme forms of obscenity.

The author appeals then to the later poetry of Rilke to answer the question of the possible sense of pain. The author tries to make a hermeneutical analysis of some poems, that is to say, an interpretation as unprejudiced as possible, in the sense of allowing the text to speak for itself. Thus, for example, in Sonnet XIX from the First Part of the Sonnets to Orpheus, the poet says: "Pain is beyond our grasp, / love hasn't been learned, / and whatever eliminates / us in death is still secret. / Only the Song above the land / blesses and celebrates." According to Heidegger, this poem reveals to us the "co-belonging" of pain, of love and of death, an idea of which modern man remains oblivious. But we still have the song, there where the word and the music meet, a song that sanctifies and celebrates life and that will allow us to illuminate that "abyss of the being" where pain, love and death cobelong.

In the second sonnet chosen, Number VIII of the first part, the poet says: "Only in the sphere of praise may Lamentation walk, / water-spirit of the weeping spring / who watches closely over our cascading / so it will be clear even on the rock / that supports the gates and altars". In these verses the nymph watches to ensure that the spring of our tears (of suffering) -which in turn constitute our "sediment", that is, our essence- is purified when passing or colliding with the same rock on which our temples are built. Later on he will assert that suffering and celebration, like thankful prayer to the gods, always go together. Toward the end of the sonnet this pain embodied in that being called the Lamentation by the poet is transformed into the true intermediary between men and gods.

In the Ninth Elegy suffering appears as one of the highest values, together with love: "Ah, but what can we take across / into the realm? Not the power to see we've learned / so slowly here, and nothing thafs happened here. / Nothing. And so, the pain; above all, the hard / work of living; the long experience of love - / those purely unspeakable things." Seldom has pain been so exalted. It is much more important than everything seen, heard or experienced, more than everything done and consummated throughout life. And the only thing that is at the level as pain is "the long experience of love".

The idea of the transcendence of pain appears again in the Tenth Elegy, that represents the culmination of the cycle and whose subject is precisely the transit from this world to the next: "And then how dear / you'll be to me, you nights of anguish. / Sisters of despair, why didn't I kneel lower / to receive you, surrender myself more loosely / into your flowing hair. We waste our sufferings...". And further on the poet shows us that pain constitutes the ultímate sense of human existence: "... But they' re nothing more / than our winter trees, our dark evergreen, one / of the seasons in our secret years - not just a season, / but a place, a settlement, a camp, soil, a home".

Key words: Pain; suffering; depression; phenomenology; hermeneutics

Texto disponible solo en PDF

Referencias

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Recibido: 27 de Febrero de 2006; Aprobado: 18 de Mayo de 2006

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