‘”Relax!” Historical reflections on pain management’ – a contribution to our special edition collection of pain in the medical humanities, by Ayesha Nathoo.
Through my current project studying therapeutic forms of relaxation in twentieth-century Britain I hope to provide a new perspective on the history of pain and its management.
Relaxation practices are now routinely and specifically employed to alleviate pain in clinical and non-clinical contexts, including for childbirth, migraines and musculoskeletal disorders, and within psychotherapeutic contexts to address both physical and emotional pain. But how did relaxation therapies become so prevalent within pain and stress management?
The starting point for my research is the inter-war period and the application of relaxation practices to aid ‘natural childbirth’ – a term coined by the obstetrician Grantly Dick-Read in his 1933 exposition of labour pain. Influenced by the Chicago physician Edmund Jacobson’s work on Progressive Muscle Relaxation, Dick-Read considered that relaxation exercises were a crucial means of breaking cycles of fear, tension, and pain: Anxiety and fear preceding birth caused muscular and psychological tension, he proposed, and resulted in painful labour. This pain was not innate, he argued, but culturally acquired. In the context of the eugenically influenced pronatalism of the time, Dick-Read believed that Western middle-class women were discouraged from reproducing, largely because of the fear and pain associated with childbirth, and that his ‘natural childbirth’ ideas and techniques could help provide a solution (also see Moscucci 2003).
Dick-Read’s fostering of therapeutic relaxation was largely theoretical and philosophical, but pioneering physiotherapists and midwives helped to devise, teach and systematise relaxation training for childbirth in Britain from the 1930s. In the postwar period, the National Childbirth Trust, originally founded to advocate Dick-Read’s teachings, placed relaxation firmly into both antenatal and post-natal preparation. Techniques originally learnt for dealing with labour pain could later be used to help cope with the demands of motherhood, domestic and working life.
In the middle decades of the twentieth century, yoga and meditation classes, self-help books, radio and television programmes increased popular access to relaxation instruction and ideas surrounding stress management (also see Newcombe 2007). Meanwhile, health educators, psychotherapists and physiotherapists created, adapted and disseminated relaxation techniques for various clinical populations, including those suffering from chronic pain. Techniques have built on physiological principles that muscle groups cannot be both tense and relaxed at the same time and that tensing one group of muscles necessitates the relaxation of opposing muscle groups, as well as the premise that physical relaxation produces mental calmness (see, for example, Mitchell 1977).
Whatever the specific technique, therapeutic forms of relaxation have been advocated as skills to be learnt and cultivated. Relaxation practitioners have variously used this pedagogic requirement as a means to differentiate therapeutic relaxation from related terms, activities and meanings such as ‘rest’ and ‘leisure’. Through uncovering the ways in which relaxation has entered into medical and popular arenas in the course of the twentieth century, my research therefore pays close attention to the means and modes in which it has been taught and practised: in books, through courses and classes, on records, cassettes, radio and television, digital recordings and now online. I hope that a focus on these forms of communication will offer new insights into the experiential side of relaxation and pain management. How, for example, does the voice on a guided meditation recording, mentally and physically affect the user’s experience of pain control? How do different media and technologies impact on the spaces and contexts in which relaxation and pain management can take place: for example, home practice using a record player or television in a sitting room, versus recordings listened through headphones on portable audio devices, or face-to-face with an instructor in a group class? The analysis of sound culture, as well as visual and material culture, provides a rich and challenging direction within the medical humanities, in terms of research resources, methodologies, and outputs – all traditionally focussed on written texts.
I very much welcome contact from readers of this post with shared methodological interests, such as those working within the growing field of sound studies, as well as those with overlapping subject interests, or experiences of using or teaching relaxation for pain management.
This guest contribution was written by Dr Ayesha Nathoo, who has a Wellcome Trust Research Fellowship on “Cultivating Relaxation in Twentieth-Century Britain” at the Centre for Medical History, University of Exeter. Here she is also collaborating on Professor Mark Jackson’s Wellcome Trust Senior Investigator Award: “Lifestyle Health and Disease: Changing Concepts of Balance in Modern Medicine”. She is also a collaborator with the Hubbub group at the Wellcome Collection, London – an exploration of rest and its opposites – led by Dr Felicity Callard, Durham University.
Correspondence to Ayesha Nathoo.
Particularly influential in establishing the field of obstetric physiotherapy and relaxation-based antenatal instruction was Minnie Randall, a nurse, midwife, and principal of the school of physiotherapy at St Thomas’ Hospital from 1911-45.
Dick-Read, G. 1933. Natural Childbirth. London: Heinemann.
Jacobson, E. 1929. Progressive Relaxation. Chicago: University of Chicago Press.
Moscucci, O. 2003. Holistic obstetrics: the origins of ‘natural childbirth’ in Britain. Postgraduate Medical Journal, 79(929): 168-173.
Newcombe, S. 2007. Stretching for health and well-being: yoga and women in Britain, 1960-1980. Asian Medicine, 3:37-63.
Mitchell, L. 1977. Simple Relaxation: The Physiological Method for Easing Tension. London: J. Murray.