[Δημοσιεύθηκε στο British Medical Journal]
The Greek word “stigma” literally means a visible mark on the skin. It is also used to designate the characterisation of a person in a negative way that leads to discrimination. Leprosy carried a stigma from Biblical times well into the 20th century. This stigma had its roots in the external deformities that gave patients a repulsive look. A dysmorphic appearance combined with fear of contagion leading to epidemics made patients outcasts. Literature and cinema (for example, Ben Hur, Papillon) perpetuated the idea of leprosy as a “curse of God.” Eventually the name itself was replaced by the politically inoffensive “Hansen’s disease.”
The traditional view was that the flesh of leprosy patients rotted away and fell off. This belief was challenged in the 1950s by Paul Brand (1914-2003). Born to missionary parents in India, Brand was a rare combination of a brilliant scientist and humble, humane person. After training as a surgeon in London during the Blitz he returned to India where Robert Cochrane, a famous leprologist, drew his interest in the orthopaedic problems of his patients. Brand was surprised by the grip strength of a patient’s clawed hand, which proved that his muscles were anything but useless. He meticulously studied hundreds of patients and realised that all their deformities could be traced to the loss of perception of pain caused by leprosy. This deficiency made even trivial everyday injuries a source of infection, gangrene, and eventual mutilation. When he taught patients to inspect their painless limbs regularly for new injuries and to protect themselves from potential trauma, no further deformities developed.
It took Brand years to convince the medical and social establishment that leprosy itself did not cause “rotten flesh.” Brand did not stop at the discovery of the cause but went on to correct the deformities. He developed surgical procedures for the functional correction of claw hands, thus facilitating the rehabilitation of patients. He designed special padded shoes to prevent foot injuries. He also used plastic surgery techniques for the elimination of the facial stigmata of leprosy, thereby making patients once again acceptable to their own families and communities.
His observations on the consequences of “painlessness” led Brand to an appreciation of the protective role of pain. Pain: the Gift Nobody Wants, written in cooperation with author Philip Yancey, is a gripping combination of autobiography, medical history, philosophy, and self help advice. Brand takes us from his childhood in India, through his studies in England, on to his fascinating journey of discovery in Indian leprosy hospitals, and finally to America where he continued his pioneering research on pain. His book should be read by everybody who has ever questioned the need for this unpleasant sensation. Brand is an optimist—“I hurt, therefore I am” is his cheerful message. We cannot prevent pain, but we can stop it from dominating and ruining our lives. This book shows us how to prepare for its inescapable visits.