Born Liars (21 page)

Hodgson's findings would come as no surprise to Frederic Brochet, a cognitive psychologist at the University of Bordeaux who, several years before, had served fifty-seven French wine experts from two bottles, one with a Grand Cru label, the other with the label of a cheap table wine. The experts greatly preferred the Grand Cru and explained why with great eloquence – though both bottles contained the same wine. According to Brochet, the lesson of his experiment is that the brain is incapable of sending us objective reports on the world; what we experience is always a mixture of the raw data coming in and our expectations, which ‘can be much more powerful in determining how you taste a wine than the actual physical qualities of the wine itself'. These expectations are, of course, inherited from others. Brochet's subjects were wine critics; if they'd been from a culture where the name Grand Cru meant nothing, the wine would have tasted differently.

The same goes for that frequent accompaniment to wine, cheese. The psychologist Edmund Rolls presented twelve subjects with an ambiguous, cheesy-smelling odour that was labelled either ‘cheddar cheese' or ‘body odour'. People rated the smell as much more pleasant when it was labelled cheese. In fMRI scans, the brain regions involved in interpreting smells and connecting them to feelings were activated more strongly by the positive label. The food scientist Harold McGee has pointed out that the pungent smell of certain cheeses, like Vieux Boulogne, is the smell of decay – something we are hard-wired to find disgusting (and thus to avoid for our own good). That some people, in certain countries – especially France, of course – find such smells appetising is testament to the extent that our senses are in thrall to the beliefs we inherit from the culture in which we live.

One of our beliefs is that more expensive wine tastes better. Researchers at the California Institute of Technology and Stanford organised a wine-tasting for members of the Stanford Wine Club, serving them five different cabernet sauvignons that were only distinguishable by price. What the subjects didn't know was that there were only three wines – so sometimes they'd be tasting the same wine with a different price label. They consistently reported that the same wine tasted better when the label said it was more expensive. Similar experiments have been carried out before, but in this one the subjects sipped wine while lying supine inside an fMRI machine (the wine was pumped through tubes into the subjects' mouths). When subjects thought they were drinking more expensive wines, the scans revealed more activity in the brain region that determines whether or not we find an experience pleasurable. Higher prices primed them for pleasure, and so pleasure is what they experienced.

When we take a sip of Grand Cru (if we're lucky enough to do so), we're drinking a belief first and a liquid second. The same goes for when we go and see a well-reviewed film or look at a painting we're told is by Picasso. Of course, if the film is really bad or the painting is truly appalling, we might notice, and adjust our response accordingly. But our beliefs (preconceptions, assumptions, expectations and desires) determine our responses much more than we like to think. What's more, we don't even originate these beliefs; they are stories that come to us through the cultural ether – Picasso is a great artist, expensive wines taste better – and are written by other people, living and dead. Our conviction that we can escape these shared preconceptions and experience the world purely as individuals is just another of the stories we tell ourselves.

During his stint in the combat zone, the potency of deception wasn't the only thing by which Henry Beecher was amazed. Men bearing the most terrible injuries seemed to feel far less pain than he would have expected. Given that Beecher wanted to preserve his limited supplies of morphine for those most in need, he started to ask his patients if they wanted a painkiller injection before giving it to them, being careful to phrase the question so that they could accept it without embarrassment. ‘Are you in pain?' he would ask. If the answer was yes, he would then say, ‘Could you do with some help for it?' Time and again came the answer – from men with fractured bones, burnt skin, and stomachs ruptured by shrapnel – ‘No Doc, I'm OK.' Keen to further his research even in battle, Beecher kept a tally of their responses. Three-quarters of the badly wounded men said they felt no need for a painkiller, long after the effects of their last morphine injection had worn off.

In a paper published after the war, Beecher presented his puzzling findings and speculated on their cause. He compared the situation of these injured soldiers to the kind of case he was used to dealing with as a hospital anaesthetist back in Boston. A man who crashed his automobile on the highway might suffer exactly the same wounds as one of the soldiers at Anzio, yet his pain would be far more intense. Perhaps, thought Beecher, this had something to do with how each man regarded the significance of his injury. Almost as soon as the car accident happens, a civilian begins to think about a future that has been radically transformed, and not for the better: possibly permanent physical damage; insurance claims; time off work leading to financial problems; the strain that all this will put on his wife and family. By contrast, when a soldier in a war zone is hit by a bullet, he is suddenly released from a dangerous and terrifying environment. He knows that he will be taken to the safety of the hospital and allowed to recuperate at his own pace, and, thinking further ahead, he envisages himself returning home, acclaimed as a war hero. ‘His troubles are over,' wrote Beecher, ‘or at least he thinks they are.' The civilian's accident represents a calamity and the beginning of uncertainty; the soldier's injury is a dignifying liberation from chaos.

There is no sensation more physical, visceral or immediate than pain; it requires no language skills or education to know the feeling of being slapped, or burned, or struck by a speeding lump of lead. Yet Beecher was suggesting that the pain we feel is deeply affected by the meaning we attach to it. The soldier and the civilian can suffer identical injuries, and their experience of it – their
physical
experience – depends on how they see the injury fitting into the story of their lives. The empirical truth or falsity of the story is less important than its potency – the power of the idea of a war hero, for example, or a crippled husband.

For years after World War II, America's hospitals were dealing with its human cost. Wards, surgeries and beds were occupied by veterans lucky enough to have survived the war, but struggling to cope with the long-term injuries it bequeathed them. In the 1950s these patients were joined by men who had been injured fighting in Korea. All of them were attempting to put their lives back together while dogged by persistent, sometimes unbearable pain. While resting, or waiting to see the doctor, patients at Knightsbridge Veterans Hospital in the Bronx and, later, Mount Zion hospital in San Francisco, would find themselves approached by a slight, pale, softly spoken man with large, soulful eyes and a thick Russian accent, asking whether they would be prepared to take part in an interview about their condition. Although he worked for the hospital, the man explained, he wasn't a doctor. He was an anthropologist.

Mark Zborowski was born in Ukraine in 1908. When he was a young boy his family moved to Poland to escape the Russian Revolution. As a student, Zborowski joined the Communist Party, to the dismay of his parents. In 1928 he left Poland, possibly to avoid imprisonment for radical activities, and travelled to France, where he studied anthropology at the University of Grenoble and worked as a waiter. In 1933 he moved to Paris and became deeply involved in anti-Soviet Trotskyite politics, working for a group led by Trotsky's son Lev Sedov which agitated to undermine Stalin's regime. Quiet, unassuming and a tireless worker, Zborowski became Sedov's most trusted lieutenant.

In 1941, as Europe was torn apart by war, Zborowski moved to the United States, his path smoothed by wealthy New Yorkers sympathetic to Trotsky. One of them introduced Zborowski to the most prestigious cultural anthropologist of the day, Margaret Mead. Impressed by his first-hand knowledge of the culture of European Jewry, Mead offered him a post as her research assistant, a position from which he was able to launch a successful academic career.
²⁷
In the mid-1960s, with Mead's support, he was appointed staff anthropologist at Mount Zion hospital, where he resumed work on a topic he had begun investigating in New York: the ways in which people from different backgrounds cope with pain. He later published his research in the form of a book, called
People In Pain
.

For the purposes of his study Zborowski classified his patients in four groups: Irish, Italian, Jewish and Old American, or what we'd now call WASP (White Anglo-Saxon Protestants). He was interested in how ex-soldiers coped with their pain, and whether or not their coping strategies reflected their cultural heritage. He expected a high degree of homogeneity in their responses to the pain itself: after all, they had all suffered injuries fighting for the same army, most of them in the same war, and it would seem a truism that a heart attack experienced by an Italian Catholic feels the same as one suffered by a Polish Jew. But as he carried out his interviews with patients and spoke to the hospital's doctors and nurses, he found that something surprising: ‘People responded to their pain not only as individuals,' he later wrote, ‘but also as Italians, Jews, Negroes, or Nordics.'

The Italians and Jews were often grouped together in the minds of the hospital's staff, because they were regarded as highly emotional, and as having a ‘lower pain threshold' (though Zborowski pointed out that previous research demonstrated such variations in pain thresholds were a myth). They were more likely to express their pain with theatrical gestures, florid language and loud cries, both at moments of peak intensity (when a nurse removed a bandage, for example) and in conversations with the doctor about their condition. Jews and Italians wanted and needed to talk about their pain, to describe the sensation of it but also its effect on their families and careers. They were demonstrative, unembarrassed to shed tears.

Zborowski found significant differences between the two groups, however. The Italian patients were mainly concerned with the immediate sensation of pain as it was experienced in the moment, while the Jews were more focused on its
meaning
. Italians expressed concerns about how their pain itself would affect their immediate situation (their job and family life); Jews were much more likely to talk, not about the pain itself so much as what it signified for their underlying condition, and for their future – they practised a hermeneutics of pain.

The two groups also had different attitudes to treatment. Italian patients would call out for relief when in pain, but once an analgesic had been administered they would forget their suffering immediately and display ‘a happy and joyful disposition'. Jewish patients were more reluctant to accept medication. They would express concern about side-effects and worry that the drug might be habit-forming, and that though it alleviated their symptoms it would not treat the underlying cause. Sometimes they would only pretend to take the pill, hiding it underneath the pillow. Even when they did take it, they remained anxious and downcast, waiting balefully for the pain to return. Whereas the Italians were sublimely confident in the ability of their doctors to banish their pain, Jewish patients worried that a doctor's recourse to painkilling drugs meant he wasn't skilful enough to cure the illness itself, and they frequently sought second and third opinions from specialists.

The biggest contrast to the Jewish and Italian responses to pain was provided by WASPS, who were determinedly unemotional in their responses. They would refer to their pain in a way that minimised its impact. It's just cramp, they would say, a sore muscle or a backache. They avoided all discussion of it whenever possible. They feared being seen as over-dramatic, and often made remarks to the effect that complaining ‘won't help anybody'. When pressed, they might quietly admit that the pain sometimes became unbearable, even that it drove them to tears. But they would never cry in the presence of others, and so they sought out solitude. In Zborowski's clinical but heartbreaking words, ‘Withdrawal from society seems to be a frequent reaction to strong pain.'

Unlike the Jews or Italians, the WASPs much preferred the impersonality of hospital treatment to home treatment. When with the doctor, they assumed the role of a detached observer of their own body, providing an objective description of their state so as to facilitate the correct diagnosis and treatment. Emotionalism was seen as a hindrance in a situation requiring knowledge and skill. WASPs talked about their bodies as if they were cars that needed to be checked periodically and, when out of order, taken to a specialist to be fixed. Their faith in doctors was formed from a respect for scientific knowledge. They were optimists – though their suffering continued, it would only be a matter of time before medical science found the answer for it.

The Irish, like the WASPs, preferred to suffer quietly, but their conception of pain was not without drama. When Zborowski asked Irish patients what they did to relieve their pain, they said things like:

–
Well, what can you do? Have to take it.

– Just have to take it, that's all.

– I don't mind taking it. I can take it if I had to.

For the Irish, pain had to be ‘taken' as a fighter must learn to take a punch; it was an opponent, worthy of respect. It would batter them, but it would never take them down. To absorb pain wasn't passive suffering but a character-forming action in itself, one that bred courage and heroic endurance. ‘Taking it' was a refusal to surrender, a redemptive act of overcoming. Zborowski contrasted this approach to that of Jewish patients. Here's how one Jewish interviewee described his experience: