Pain | Alma Gottlieb

What a Brown Recluse Spider Has Taught Me

August 29, 2017 by Alma Gottlieb 5 comments

After having recently received a venomous bite by a brown recluse spider in NYC, I’ve spent some time researching my arachnid aggressor and discovering how to recover from the poisonous attack. Along the way, I’ve learned some life lessons.

Brown recluse spider

Statistical odds provide unrealistic reassurance.

Brown recluse spiders normally live in South America and a few southern and midwestern states of the U.S. They’re also loners and rarely approach humans. Yet, somehow, one managed to find its way to Manhattan, and to me.

Rational choice theory is alive and well, even in those who challenge it

When in NYC, if I worry at all about the risks to life and limb, I probably focus (unconsciously) on getting hit by a speeding taxi, or crushed by a collapsing construction site, or shot in a terrorist attack. What I have most certainly neglected to worry about is getting bit by a subtropical spider far from its home territory. In this, my calculations must implicitly revolve around a rational choice model of risk/benefit assessment.

But, really, I should have known better. Back in 1975, my graduate fellowship had me assisting in (and once lecturing to) a course that highlighted Mary Douglas’ theory of risk–a far different perspective that emphasizes individual perception shaped by complex social and cultural factors well beyond “simple” (especially economic) costs and benefits. Mark Twain’s insight is an earlier (and pithier) way of saying: statistical odds, at best, provide likelihood rather than certainty.

Still

, to be honest, there aren’t enough hours in the day to worry about every catastrophe that could conceivably befall us. So, we pick and choose our worries based on statistical odds that turn out not to be all that rational.

Globalization works for creatures beyond humans, too.

From infestations of invasive species elsewhere, we know that humans hardly claim a monopoly on traveling the world. Other creatures manage to hitch rides on ships, in wooden crates and palettes, and even in people’s suitcases. In fact, tens of thousands of species have migrated in this way. In recent years, Mediterannean and tropical spiders have found their way to the British Isles, causing an alarming spike in spider bites.

Knowing that brown recluse spiders rarely hang out on the streets of Manhattan doesn’t rule out the possibility that one just might find its way to a bench in Madison Square Park. Or that, of the 2.9 million people or so who were probably in Manhattan that Saturday, that one spider just might decide to attach itself to my dress.

We are hardier than we may fear.

After surviving a herniated disc/back surgery, 15 months of intestinal parasites, and two unmedicated childbirths (my choice) a couple of decades ago, my pain threshold apparently remains pretty high. Okay, the partly-necrotic tissue now disfiguring a big chunk of my leg might have reminded me of a Green Day song about taking Novacaine. Still, wincing from the throbbing wound on my leg, I’ve managed to keep up with e-mail and other work tasks while popping only a few ibuprofens.

Despite the above-mentioned point: Our life plans are frailer than we may hope.

Scheduled errands, meetings, outings, and dinners with friends are all on hold. My doctor predicts that my bite may take anywhere from a few days to a few weeks to heal. The Internet warns me it could even be a few months. That’s a lot of iCal events to tentatively reschedule.

I now know what bit me while living in a small village in Ivory Coast.

Back in 1980, a mysterious wound showed up on my ankle that worsened alarmingly, nearly causing gangrene. The local Senegalese doctor prescribed nine antibiotic treatments a day (3 shots + 6 pills) . . . and declared me lucky to avoid amputation of my foot.

In Parallel Worlds, Philip Graham and I wrote that my wound’s origins stumped the doctor, although he thought it might be an allergic reaction to an insect bite. But the symptoms resembled those of my current spider bite so closely that I am now certain it must have been a spider, not an insect, that assaulted me. Perhaps it was a kind of violin spider–the Loxosceles lacroixi, which lives in Ivory Coast and belongs to the same Loxosceles family as my more recent nemesis, the brown recluse. Of the violin spider, one website notes: “Their venom destroys tissue, causing a specific kind of skin necrosis known as loxoscelism in 66% of cases. The danger of secondary infection is high if left untreated.” Yep.

Snakes loom larger in the popular imagination than do spiders.

Ounce for ounce, the hemolytic and cytotoxic venom of a brown recluse spider is more potent than that of a rattlesnake. In fact, “[t]heir venom contains enzymes that have great similarities to the poison found in snakes. These enzymes include protease, hyaluronidase, phosphohydrolase, phospholipase, alkaline phosphatase, and esterase.” (Also, deoxyribonuclease, ribonuclease, and lipase.) And yet, in the US, we have antivenin readily available for snake bites, but much less for spider bites–and only for black widows, not brown recluses.

That could be a sign that Americans (including medical researchers) are more nervous about snake bites than spider bites. Or it could be, as my scientifically minded nephew opines, that it’s because spiders are smaller than snakes, so it’s harder to catch them . . . and harder to catch enough of them to extract sufficient venom to produce antivenin. Plus, their name–recluses.

I am now officially nervous around spiders.

In any case, arachnophobia is a thing (not just a horror movie), and it’s definitely gendered. Until now, I’ve never had much patience for girls who screamed at the sight of a (harmless) spider. Hmm–is it too late for a feminist to enthusiastically embrace demeaning gender stereotypes?

Speaking of gender . . . turns out my poison was probably deposited by a devoted spider mom looking out for her kids’ interests.

That’s what Nobel Prize-winning chemist, Kary Mullis, wrote in his 1998 memoir, Dancing Naked in the Mind Field: “It’s a mother spider that first gets you and she wants a hole in you that oozes and expands and doesn’t ever heal. The females have the most powerful venom . . . . She wants that hole because her babies need a place to feed. They can dip their ugly little heads into the pool of nutrients that you are exuding and suck your vital fluids through their sucking tubes, and they can live. . . After making the hole, she moves away and lays her eggs. It’s elegant biotechnology from the point of view of the spider.”

I find this alarming. As a devoted mother of two, myself, I should sympathize with any mom’s efforts to nourish her children and give them the best foundation she can for their health and well-being. I have certainly tried to do that for my kids. Somehow, though, there’s a cross-species sympathy chasm I’m simply unable to traverse. I guess that’s a second blow to my identity as a feminist.

Brown recluse spiderling on an egg sac (photo by Sturgis McKeever)

Conclusion: Maybe it’s time for a new approach to studying pain.

Pain is a biological fact; it’s also culturally constructed.

Once, when I shrieked and moaned after being stung in Ivory Coast by what I now know was a Campodesmus alobatus millipede (containing hydrochloric acid and cyanide, among other toxins), my Beng friend Yacouba teased me, “Amwé, that’s nothing. If you got stung by a scorpion, you’d be on the next plane back to America.”

Yacouba knew pain. He had withstood several months-long, disabling infestations of Guinea worm, showing me a scarring map of the paths that the worms (up to 4′ long) took inside his legs, starting in childhood. In this, he was no different from most of his village-mates. (Thankfully, Guinea worm is now nearly eradicated, thanks to systematic efforts by health professionals, and spurred on by Pres. Jimmy Carter’s awesome Carter Center.)

Campodesmus alobatus (millipede in Côte d’Ivoire)

When you live with long-term, disabling pain from childhood, how does that shape your brain, your temperament, your world view? Your sense of self, and your sense of being subject to, and capable of overcoming, hardships? By contrast, when pain invades your life only rarely, and briefly, what sort of identity forms surrounding notions of (in)vulnerability?

Anthropologists: We have explored how plenty of other somatic experiences are influenced by factors beyond biology. Pregnancy and childbirth, menstruation, diseases from cancer to mental illness, and sports from walking to basketball have all claimed our attention. Yet, we live in a world of many people who experience pain routinely or even chronically. And when we’re not actively suffering from pain, we may spend much time thinking back on past episodes with amazement that we survived . . . or anticipating future episodes with dread. Puzzlingly, few anthropologists have put that fundamental human experience front and center. True, some scholars discuss pain in investigating particular topics such as childbirth, endometriosis and acupuncture. But to date, the 48 sections and interest groups contained within the American Anthropological Association–which focus on topics ranging from visual anthropology, music, and museums to agriculture, corporations, and tourism–do not include a group dedicated to exploring the world of pain.

In a rundown of selected global perspectives on pain, anthropologist Mary Free has crafted a superb opening for a new subdiscipline. The brown recluse spider that deposited its poison in my leg this past weekend has suggested to me: it may be time for a systematic and dedicated anthropology of pain.

Postscript (Oct. 5, 2017): I’ve now been in touch with two entomologists who specialize in spiders, one of whom is a leading expert on brown recluse spiders. Both are quite skeptical that a brown recluse could have found its way to a park bench in Manhattan. My doctor and I are revisiting the diagnosis. Stay posted.

arachnophobia, Biological anthropology, Childbirth, Cultural Anthropology, life lessons, Mary Douglas, medical anthropology, Medical issues, Pain, risk, spiders Read more

The “Ow” of Pain

February 2, 2015 by Alma Gottlieb Leave a comment

New research claims that saying “Ow” really can ease the pain.

Why am I skeptical?

Or, rather, why am I skeptical that this works globally?

For one thing, in Côte d’Ivoire, when Beng folks I’ve known slash a finger while chopping wood, or feel the effects of parasites churning in their stomachs, they don’t say “Ow,” they say “Aba” (“Father”)–or, if it really hurts–“Aba-eyyyyyyyy!” (“Daaaaaaaad!”)

But beyond whatever specific words or sounds we might say when we’re in pain, more striking are the cases of people who stringently avoid uttering any sounds, even moaning, when they’re in pain.

That would include many laboring West African women, whose elders teach them that they will bring tremendous shame on themselves and their families if they vocalize pain during childbirth.

Traditionally, Asante women in Ghana were told that going into labor is the feminine version of going to war. Under such training, withstanding pain is not just a matter of personal pride; it’s a cultural necessity. There’s even something about gender parity going on here. In anthropology, the Asante have a reputation for having one of the most gender-egalitarian societies around. Asante queens were fierce political rulers, and kings’ mothers were accorded the highly respected title of Queen Mothers. In 1900, an Asante queen mother, Yaa Asantewaa, led a major military rebellion against the British colonial powers. Down the social hierarchy, ordinary market women continue to be respected by all. Showing vocal restraint in the face of pain during childbirth seems to be part of an overall package of demonstrating power over many arenas, including one’s bodily experience.

And let’s not even talk about the common expectation that girls undergoing genital surgery for ritual reasons in some parts of sub-Saharan Africa must remain silent to demonstrate self control . . . and train themselves to withstand the pain they will undoubtedly experience later, in childbirth.

Gendered expectations about complaining about pain operate in Western societies, too. How many men remember being told, “Buck up/be a man/don’t complain like a girl” from a young age? Later in life, alcohol may offer men a socially acceptable means to cope (quietly) with pain.

I don’t doubt that moaning, screaming, or “Ow-ing” can alleviate pain–in societies that train people to complain about bodily discomfort, as many Western societies train women to do. (I speak from experience here. During the last minutes of my second childbirth, my nurses chided me that I could be heard loudly by their colleagues down the hall.)

But there’s the rub. Our cultural expectations about our most intimate bodily experiences are taught to us from so early on that by the time we’re aware of them, they feel “natural.” And maybe they are–in a culturally shaped way.

* * *

A postscript: A recent NPR piece sensitively explores the hard work of cultural listening required of health professionals who aim to treat people suffering from “depression,” “anxiety,” and other emotional disturbances. What cultural and linguistic forms do such deep-seated experiences take? Three psychiatrists and psychologists profiled in the piece (treating Asian and Asian-American patients) get it.