Book Review: The Modulated Scream: Pain in Late Medieval Culture (Esther Cohen) — by Melissa Ridley Elmes

Esther Cohen, The Modulated Scream: Pain in Late Medieval Culture. Chicago & London: Chicago University Press, 2010. 384 pp (cloth) $49.00. ISBN: 978-0226112671

Esther Cohen’s study of pain in the medieval era is an erudite, engrossing, and compulsively readable work of social and intellectual history. Working from a stunningly broad and deep array of primary source texts in religion, politics, and medicine alongside an exhaustive list of secondary materials, this book presents a comprehensive account of the medieval culture of pain as it was recorded by those who worked most closely with it – clerics and Church officials, judicial officers and torturers, and physicians. While Cohen’s subtitle suggests that the book’s focus is on late medieval culture; the first three chapters include substantial contextual information presented from late Roman and early medieval sources, rendering the book potentially useful to scholars working across the entire medieval period.

Cohen’s overall argument is that in medieval culture, pain was suffered individually but was also a social construction that was shared, discussed and transmitted in a variety of forms.  She arranges this argument in two parts. The first half of the book, “Manipulating Pain,” deals with the social aspects of her subject, focusing on the uses and purposes of pain and suffering, how pain might be alleviated, and how people in pain were expected to behave. The second half of the book, “Knowledge From Pain,” is a more theoretical discussion of the taxonomy and classification of pain, its importance in the history of humanity, and its role in differentiating the divine from the profane in Scholastic and Humanist thought. This organization permits the reader first to see the scope and reception of forms of pain in medieval society, and then to delve into the presence of pain in medieval intellectual thought. It is entirely possible to read one or the other section according to personal interest or scholarly need without losing her overall argument; however, in both sections the subject matter and examples are so compellingly presented that few readers will be content not to finish the whole book.

In chapter one, “The Uses of Suffering,” Cohen presents three approaches to suffering according to human will: some, such as the Christian martyrs and ascetics, deliberately sought pain out; some suffering from pain accepted it as a form of imitatio Christi; and some, as those suffering from illness or torture, fought against pain. Examples are culled from religious, legal and medical texts to show that fear of pain armed people against temptation or helped them repent when they succumbed, which in turn aided in the maintenance of justice and social order.

Chapter two, “Torture and Truth Finding,” traces the evolution of the use of pain to extract confession in the legal system, from the ordeals of the early medieval era as an arbitrary means of acquiring truth through medieval torture as a local and private practice limited to extracting a confession, and finally to a discussion of the excessive application of torture during the Inquisition.

In chapter three, “Alleviating Pain,” Cohen argues that from a medical standpoint “there was a universal acceptance in the Middle Ages that pain was an integral part of life and there was much to praise in feeling it” while “throughout the period pain alleviation was written about and practiced extensively, with sporadic attempts at totally eradicating pain” (87). While theology and law saw pain as a positive and useful thing, medieval medical culture viewed it as an evil that could not necessarily be banished solely through human resources.

Chapter four is a fascinating look at the concept of “scripted pain.” Cohen points out that despite a proliferation of behavior manuals, none of these addresses how one ought to respond to pain or demonstrate suffering, and argues that the normative behavior for suffering actually is scripted in documents such as the testaments of witnesses to births and acts of torture. This chapter delves into the expressive and performative nature of pain in particularly compelling and provocative ways and suggests rich research possibilities for those working with visual and literary constructs of pain.

The next four chapters are an intellectual approach to the subject of pain grounded in Scholastic and Humanist modes of thought, with chapter five comprising a succinct and absorbing history of attempts made at the taxonomy and classification of pain from Avicenna and Archigenes through Galen and Villanova, among others and chapter six presenting an intellectual history of the ages of man constructed through the presence and degree of pain each stage suffered or was capable of suffering, according to medieval theological belief.

Cohen’s discussion of scholastic writing and thinking on human and divine passion in chapter seven is groundbreaking work. She argues that scholastic thought has more to do with the incarnation than the Passion that tends to occupy the devotional meditations and writings of those more focused on the Crucifixion as a point of human intersection with Christ’s pain. Her conclusion – that a scholastic focus on the perfectly balanced complexion of Christ as the source of his acute (sensory) pain on Earth existed alongside the devotional idea of Christ as suffering because of his virginal female origins and the compassion he feels for his grieving mother – is an important and compelling alternate reading of the source of Christ’s incarnate pain. Finally, in chapter eight, Cohen treats the concept of impassibility, arguing that martyrs were granted suffering on Earth and the wicked were denied Earthly pain, whereas in the Afterlife these roles were reversed, to support her point that pain was valorized in the medieval era.

While there are a few passing infelicities of expression and moments at which Cohen might have more fully developed her argument or provided more specific evidence for minor claims, these ultimately do not detract from what is on the whole an admirable book. The overall argument is carefully laid out and convincing, handled with the mastery of a scholar writing for scholars, while remaining accessible to a lay audience.

The Modulated Scream fills a glaring hole in medieval scholarship as the only current full-length treatment on the subject of pain in medieval culture, and works well as an important corollary to recent titles on the subject of torture (Larissa Tracy, Torture and Brutality in Medieval Literature, D.S. Brewer, 2012); medieval medical knowledge and practice (Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice, Chicago UP, 1990; Faith Wallis, Medieval Medicine: A Reader, Toronto UP, 2010) and Art History (Richard Viladesau, The Beauty of the Cross: The Passion of the Christ in Theology and the Arts, Oxford UP, 2005.) Cohen’s volume is an important resource for scholars working on the subject of pain in any field of medieval studies, with particular implications for specialists in medical, theological, and legal matters. Although Cohen does not directly deal with literary and visual representations of pain, scholars interested in examining the presence and construction of pain and suffering in medieval literature and art could benefit enormously from this study as a blueprint for thinking about the normative, expressive, and performative aspects of pain in medieval culture. The book should also appeal more widely to those interested in general social and intellectual histories or the history of pain, torture, or medicine in western culture.

Melissa Ridley Elmes


Melissa Ridley Elmes is a doctoral student in English at the University of North Carolina at Greensboro working in post-Conquest-15th century literatures and cultures, with special emphasis on Arthuriana and the rhetorical and cultural functions of textual feasts. She also writes on monstrosity, magic and the supernatural, gender, and violence. Her most recent publication, “Species or Specious? Authorial Choices in the ‘Parliament of Fowls'” appeared in Rethinking Chaucerian Beasts (Palgrave, 2012) and she is currently at work on essays on women and violence in Sir Thomas Malory’s Morte Darthur and Television Arthur.

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