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Pain, Suffering and Healing
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
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
made. The publishers wish to make clear that any views or opinions expressed in this book by individual
editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions
of the publishers. The information or guidance contained in this book is intended for use by medical,
scientific or health-care professionals and is provided strictly as a supplement to the medical or other
professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s
instructions and the appropriate best practice guidelines. Because of the rapid advances in medical
science, any information or advice on dosages, procedures or diagnoses should be independently
verified. The reader is strongly urged to consult the relevant national drug formulary and the drug
companies’ and device or material manufacturers’ printed instructions, and their websites, before
administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does
not indicate whether a particular treatment is appropriate or suitable for a particular individual.
Ultimately it is the sole responsibility of the medical professional to make his or her own professional
judgements, so as to advise and treat patients appropriately. The authors and publishers have also
attempted to trace the copyright holders of all material reproduced in this publication and apologize to
copyright holders if permission to publish in this form has not been obtained. If any copyright material
has not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced,
transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying, microfilming, and recording, or in any information storage
or retrieval system, without written permission from the publishers.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation without intent to infringe.
A catalogue record for this book is available from the British Library.
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
Royalties from this book will be donated to Freedom from Torture, formerly
the Medical Foundation for the Care of Victims of Torture.
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
Reference
1 Cassell EJ. The Nature of Suffering and the Goals of Medicine. New York: Oxford Uni-
versity Press; 1991.
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
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
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
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.
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).
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
[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.]
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:
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.
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
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.
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
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.
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.)
“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.
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.
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.”
his name.
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.
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.