Writing Physical Pain

Pain is extraordinarily hard to write about. Chronic pain is hardest of all. How do you write about a character whose every day, every moment, is shaped around constant pain? And not wear out the reader’s sympathy.

It can be done. It has been done.

And when it is done convincingly; those are often difficult books to read.

Half the time we don’t want to know about the pain of people we know in real life. Part of us wants them to suffer in silence. We’re embarrassed by others’ suffering, bored by it, made to feel helpless in the face of our inability to do anything about it, afraid it might be contagious, upset by it, angered, and a gazillion other complicated feelings.

It’s even hard to write about relatively minor injuries. There are gazillions of books out there where the character suffers an injury only for the writer to forget about it for the rest of the book or totally minimise it. I am guilty of this. Reason is injured in the first book of the Magic or Madness trilogy. Somehow telling the story kept getting in the way of showing Reason’s injury and how she dealt with it. (Since the book takes place over a short period of time the injury would not have healed entirely.) If I could go back and rewrite the trilogy that’s one of the many things I would fix.

Pain is something we all go through to a lesser or greater extent. It’s something we all know intimately. Yet it’s so hard to describe and write about. It’s hard to push beyond “it hurts” and not wallow in it and also hold your reader.

I’d be curious to hear about your experience writing characters in physical pain. (For some reason emotional pain is easy as pie.) And also your experiences reading characters in pain. Are there any writers or books you think handle it particularly well?


  1. robin on #

    I read once that there’s no real connection between the language/memory centers of our brain and whatever it is that senses pain, which is why it’s so difficult for us to articulate how it feels or remember what it was like once it’s over. (No idea whether or not this is true.) An old professor of mine is actually doing a long-range oral history of children in chronic pain, that “tries to understand how our subjects in pain construct the narrative of their lives.” — http://www.historians.org/perspectives/issues/2005/0511/0511rec1.cfm.

  2. Justine on #

    robin: Thanks for the link! Fascinating stuff.

    It definitely feels like it’s true that there’s “no real connection between the language/memory centers of our brain and whatever it is that senses pain.” I can recall sights and smells from years and years ago but I cannot describe to you the pain of past accidents. I can remember that it was bad but not the specificity of that pain. I suspect there’s a survival reason for those lack of memories. πŸ™‚

  3. Mary Anne Mohanraj on #

    Lois McMaster Bujold does it beautifully, both with physical/emotional pain, and ongoing disability. Curse of Chalion is a prime example.

  4. Nicholas Waller on #

    Childbirth is often, or usually, extremely painful while it is going on, but if there were no “forgetfulness” mechanism you’d imagine no-one would go through it twice.

    Similarly a friend of mine went through that Parkinson’s operation where they clamp and drill through your skull while you’re awake in order to emplace electrodes for deep brain stimulation controlled by a brain pacemaker (you’re awake as you have to comment on what the electrodes make you feel as they’re being positioned, and the whole thing took 14 hours). His wife reported from his bedside just after the op that he’d said it had been an extremely painful and horrible experience, and just thinking about it makes me wince, but when he was home some weeks later he had largely “forgotten” or suppressed it.

    If you’re writing or doing continuity for film you soon get irritated by the sort of visible injury to a character that requires a regular scar or unsightly bandage; film forces you to remember those kind of injuries for pages and/or months on end, hide them under clothing or the hairline, or just make them not too obvious, bloody etc., otherwise makeup takes ages.

  5. Anne KG Murphy on #

    I remember thinking that Jo Walton did that well in her Logic series – partly in that someone is given a would in order to make them remember, and so the pain of it is brought up.

    David Gemmell also wrote some believable war veterans.

    I don’t know. The older I get, the more chronic pain I have, and the more I wish writers would write about something other than the knee or back that aches with wet or cold weather. My old injuries don’t ache with the weather, they ache if I don’t move around and exercise and stretch them enough. (I’m only 34, but I sustained a bad knee injury when I was 14, sprained my ankles a few times (soccer did in both the ankles and the knee), threw out my back when I was 16, and tore the rotator cuff in my shoulder 4 years ago.) My left ankle was sprained often enough it got unstable, and now the bottom of that foot cramps terribly every so often, especially if I point the foot too much. But if I do my physical therapy the injuries don’t ache.

    My worst chronic pain is my headaches, and honestly you can block those out of conscious awareness, probably in a similar way to how you can block them out of memory. Not always possible, but often. I try not to think about it too often, and I don’t talk about it much except to those closest to me. It does get boring. Well, and people tend to interpret indications of pain as indications you need help or shouldn’t be active or doing something. Sometimes, it’s true, you need to rest or do self-care, but sometimes self-care is being active.

    And, well, people misinterpret admissions of pain. My mom was once complaining to me about how Sometimes, they’ll be over for dinner, and I’ll sit down and get a pained look on my face like I’m hoping someone will take care of me. She thought I was purposefully doing that as an indicator to those around me and was surprised to have me point out that, no, it’s just that I’m tired and the mask falls. I’m almost always in pain. I’m not asking for help, I’m just failing to hide it. But I intended to hide it.

    With a fresh injury, assistance can be good and important. With chronic conditions, however, being treated as an invalid just gets annoying. Especially when people give you unsolicited advice.

    So you say other people want people in pain to suffer in silence, well sometimes we want to suffer in silence ourselves. Sympathy and fuss don’t make it easier to be in chronic pain. Massage, a cup of tea, etc – those things might, though. πŸ™‚

  6. scott neumyer on #

    Some of the most powerful writing on physical pain I’ve ever read is in Hubert Selby Jr’s REQUIEM FOR A DREAM. When he’s describing the hole in the main character’s arm (from intravenous drug use) near the end of the book, I nearly threw up. It was so descriptive, painful, and scary. It’s something I’ve now read multiple times for an example on how to write pain.

  7. Lauren McLaughlin on #

    I think our inability to tolerate overlong descriptions of physical pain may be related to our overall amnesia on the experience of pain itself. I opened my book, Cycler, with a grim and detailed description of extreme physical pain, which I drew directly from personal experience. But when it’s over, it’s over. Evaporated and forgotten. I didn’t describe it that way to be kind to the reader. I described it that way because that’s what it feels like. When you’re in pain, you can’t imagine there was ever a time when you weren’t in pain. And when it’s gone, you can’t imagine it will ever happen again, even though you know, on some level, that it will. Weird and probably adaptive stuff, I think.

  8. Nicholas Waller on #

    “Are there any writers or books you think handle it particularly well?”
    JG Ballard wrote a good evocation of physical pain in Concrete Island. As with many Ballardian characters the hero Maitland – marooned on a traffic island between fast, wide and busy roads after a car accident – develops a psychological attachment to his situation.

    But to allow plausible time for that to develop he first has Maitland try to escape, in the course of which he gets hit by a car and gets a rather nasty leg injury (“The hip joint appeared to have been driven into the basin of his pelvis”). Ballard doesn’t forget it but keeps coming back to it: it’s painful, it’s stiff, it affects Maitland’s ability to do stuff and get around, and it makes him reliant on the other characters he meets.

    There’s talk of a movie of it with Christian Bale (who played “Ballard” in Empire of the Sun) in the role.

  9. Jennifer on #

    Ellen Emerson White in Long May She Reign. Meg had her knee and hand smashed to bits in the previous book.

  10. Eric Luper on #

    I spent an entire day writing a scene in which my character gets kicked in a very sensitive area. It was quite a challenge to write but I enjoyed it. It is one of my favorite scenes in my third book.

    Although, the research in getting it right is something I’d prefer not to talk about. Or think about.

  11. mb on #

    Ooh, the Attolia books. And I think what makes it work is how hard Gen is always trying to hide his pain. So it’s never actually described, you just infer it.

    Writing pain in first person is harder, but I guess I have a better sense memory than some of the other commenters. I continually call on what that severely sprained wrist was like, how I couldn’t close my fingers properly, and how the dislocated knee made thought and speech impossible until it snapped back into place.

  12. Julia Rios on #

    I’ll second the Bujold nomination. This is an interesting question, and one I haven’t ever really examined. I generally want to forget pain when I read, so I don’t seek out really vivid descriptions of it, but It does definitely seem like something worth doing well if one sets out to include chronic pain. I’m going to post a link to this in case any of my friends with chronic pain want to weigh in. I get headaches and assorted back and neckaches, but I can’t think of any fiction offhand that describes that sort of thing really well. If I could, I’m not sure I’d want to read it!

  13. Linda Urban on #

    Two folks I’ve read who do this well: Wendy Orr in Peeling the Onion and Richard Russo in Straight Man. Each deals with the pain in a way that reveals character, which makes them extra-instructive examples, I think.

  14. Linda Urban on #

    Two folks I’ve read who do this well: Wendy Orr in Peeling the Onion and Richard Russo in Nobody’s Fool. Each deals with the pain in a way that reveals character, which makes them extra-instructive examples, I think.

  15. Kate on #

    Linda – I was thinking Richard Russo too, but “Straight Man”, where the narrator has a painful and frustrating urinary issue. And same goes in terms of revealing character – there’s a complete denial aspect of his problem that is, not to overuse the word, painful to read.

    On the comedy side, Douglas Adams’ Dirk Gently series (can’t remember which of the two books – I think the first) has Mr. Gently with a broken nose for a good chunk of the book. The reader is reminded of this through Gently’s speech which is significantly altered by the injury.

    I agree with most others that my own physical pain has been sharp at the time but not particularly memorable afterward (including childbirth) – but for some reason the times I’ve been really, really sick (as opposed to injured) – I can remember what that felt like (the sore throats, clogged head, etc). I wonder why that is.

  16. Diana Peterfreund on #

    I do like the opening of Cycler.

    One thing that often bothers me in books and movies is when an action hero is wounded and then pretty much just shakes it off. I took great care in my series that — even though sometimes, the character’s wounds heal incredibly fast — other times they get wounds that put them out of commission for weeks or months. It’s not easy to have holes torn in you. It’s not even easy when they are planned, carefully controlled and lovingly healed holes (i.e. surgery). You don’t just bounce back.

  17. Brian on #

    Books in the last year or so I’ve read which I’ve enjoyed (fiction or otherwise) which deal with chronic conditions and/or pain (physical, mental or a combination therein) in a way that struck me:

    Annie Ernaux – I Remain In Darkness
    William Styron – Darkness Visible
    Bob Flanagan – The Pain Journal
    Tory Dent – HIV, Mon Amour
    John Berger – To The Wedding
    Rebecca Brown – The Gifts Of The Body
    Audre Lorde – The Cancer Journals
    Denton Welch – A Voice Through A Cloud
    Jean-Dominique Bauby – The Diving Bell & The Butterfly
    Alphonse Daudet – In The Land Of Pain
    Arthur W. Frank – The Wounded Storyteller

    Kathlyn Conway – Illness & Limits Of Expression

  18. Rafael on #

    Coincidentally, I just started writing a story yesterday, and bumped with this problem. On the layout it didn’t seem that hard: I wanted to describe the pain of a woman that is giving birth and seeing her baby dying. So, both kinds of pain appear there: the physical one of giving birth, the emotional one of watching your son die. After some efforts, I was still unable to make the pain seem “real”, so I am giving it a break until tonight; hopefully something good will come out then.

  19. Olivia on #

    I suppose the only novel I’ve read so far that strikes me as being full of pain is The Bell Jar by Sylvia Plath. Plath includes both: the emotional and the physical, and yes, it’s an uncomfortable read but is intriguing none-the-less because of that pain. It is consistent; something both feared and embraced by the Heroine. It’s hard to actually forget the pain, whilst reading it.

  20. Karen Healey on #

    I think the Adoration of Jenna Fox does a great job with this, although it’s somewhat easier to read because she does get better.

    I’m always smashing up my characters and then having to deal with it; in Guardian I gave the protagonist an injury at one point that I really needed healed before she did the next thing on her dance card. I spent two weeks of thinking-time trying to work out how to do it and not make the healing an obvious piece of plot contrivance. It ended up being a character point for the healer, and I promptly reinjured the protagonist, but I’m still not sure I managed to pull it off.

  21. Kelly McCullough on #

    In my first published novel I wrote a good bit about a knee injury my central character incurs in the first couple of chapters and about how it affects everything he does from there on out. In that case I was writing from the personal experience of the aftermath of a torn cartilage injury that I lived with for more than a decade before I had the insurance necessary to get surgery.

    Rather than focus on the pain itself (which sucks but isn’t all that interesting) I focused on the things that it simply made impossible. With my injury the pain was intermittent depending on whether a bit of the torn cartilage had flopped into the cup for the end of my knee bones or not. If not, I could do many things just fine, but always with the awareness that might suddenly change. If so, there were all sorts of things that were simply too painful to do–long walks, walking any distance more than about 50 feet without my cane, running, stairs, etc.

    I think the random length cyclic nature of being able and unable to do things was the most interesting thing about the injury, so that’s what I focused on. Since that’s a component in many injury type pains it’s not a bad departure point.

  22. Mali on #

    Awhile ago I had a really bad cold and felt awful. Somewhere in middle of the horribleness, I had the presence of mind to sit down at the computer and write EXACTLY what it felt like, so I could use it later. πŸ˜€

    I would also be sure to write about all the pain besides for the major injury. For example, in a car crash where the survivor’s only major injury is a broken arm, she’s bound to be cut or at least scratched from broken glass, have a lump from banging her head, a bruise from the airbag inflating, etc. Writers often forget about all the little details surrounding an injury. Instead of focusing on just the broken arm, maybe also mention that it hurts to laugh because of the airbag bruise, etc.

  23. Meredith on #

    Not a fictional character, but I’ve gotta say Autobiography of a Face by Lucy Grealy. Such an amazingly powerful book, both in terms of describing the physical pain caused by the cancer that took most of her jaw as a child and the never-ending surgeries to reconstruct her face that continued through adulthood, and in terms of the emotional pain of going through life with a severely disfigured face.

  24. Kirsten on #

    Pain is subjective and hard to pin down. One person’s agony is another person’s intolerable suffering. Just to give a trivial example: imagine working a 60-hour week and continue to put in nightly 45-min. runs whilst suffering from combined bronchitus/pneumonia. If a person could “tune out” hacking up a lung, why wouldn’t they? Especially in a situation where there might not be a cure, as “Wild Horse Annie’s” husband may have done in Mustang! by Marguerite Henry.

    What appear to be cheerfulness-in-the-face-of-suffering, may be a natural resiliance to the particular pain. One wouldn’t, in that case, care to be smothered by the solicitous.

  25. Q on #

    I really hate it when authors forget about injuries, to be honest. “Your character just fell off a five story building yesterday and now he’s kicking bad guy trash??” I say in disbelief.

    Writing physical pain is hard, I think, because there seem to be so few words to describe it. (Then again, now that I check my handy dandy dashboard thesaurus and it gives me a whole bunch, I realize that I just can’t think of very many off the top of my head. Bad writer girl.) Because pain is persistent, using the same words over and over again makes them lose their effect and gets really boring. The good writers seem to repeat it just enough to remind the reader the character is in pain, but not enough that it gets redundant.

    Which is hard.

  26. Robyn on #

    I rather liked how Sarah Monette handled Mildmay’s injury in “The Virtu”. It seemed like it was always there, affecting the decisions he made, limiting his choices and his movements. He still did things, but with a kind of fatalism that they were probably going to go wrong.

    As far as the real world goes, I think Anne KG Murphy (above) captured my experience of pain. Except I’d be Felix to her Mildmay… In my case, I live with someone who’s had something on the order of 19 surgeries on one knee, and maybe 15 on the other… and he gave up on the whole process, because it seemed more like they were experimenting than going in with a plan at some point. So he’s in constant pain (still) and I’m always asking why he doesn’t want to go for a midnight hike across the golf course or something, totally insensitive to the stumbling, ranting about the pill-seeking (which I know isn’t fair, because the pain is real), asking why he’s just lying there with the remote…

    I suppose my point is, good writing about pain would have other people reacting to it, too. It’s not just the person in physical pain who experiences the pain. It’s there in some form for everyone, even when we’re bitchy and forget.

  27. Thomas on #

    Definitely agree on Bujold in ‘Curse of Chalion’.

    Emma Bull does it well in ‘Bone Dance’ and ‘Falcon’.

    Also, though it’s not quite the same, the viewpoint character in Laurie King’s ‘Folly’ has fairly disabling mental illness (depression, panic, auditory hallucinations) described very well. King is also very good at emotional trauma (the Vietnam veteran in ‘Keeping Watch’, the separation between lovers in ‘With Child’)

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