Pain, neurogenesis and reparations

By Professor Janine Natalya Clark

Hannah Arendt described pain as the ‘most private and least communicable’ of all human experiences [1]. The body in pain is thus distanced from other bodies, separated by a bridge ‘from the most radical subjectivity …to the outer world of life’ [2]. I thought of Arendt’s words last week, in Luxembourg, as I listened to a Ugandan survivor of conflict-related sexual violence. Speaking at the international conference ‘Stand, Speak, Rise Up to End Sexual Violence in Fragile Environments’ (#StandSpeakRiseUp), she repeatedly underlined the theme of violated bodies suffering pain – and dying in silence.

Buildings on the edge of sloped woodland

Pain impacts not only on bodies but also on the brain. In particular, pain can interfere with the fundamental properties of the hippocampus, and research has shown that hippocampal volume loss may occur in patients suffering from chronic pain [3]. This, in turn, can inhibit hippocampal neurogenesis, namely the creation of new neurons within the hippocampus. Other factors, including stress and gene-environment interactions, can also affect processes of neurogenesis within the hippocampus. However, what is significant is that enhanced neurogenesis has been linked to resilience, including resilience to pain [4]. This linkage arguably gives the concept of neurogenesis a broader application and relevance.

Rarely is the word ‘resilience’ used in the context of conflict-related sexual violence. In Luxembourg, however, the word was used several times and various speakers referred to the resilience of survivors. Yet, it is necessary to go beyond this and to ask what are the factors and processes that foster and facilitate resilience. If the environment in which survivors live constitutes the hippocampus, what is needed for the creation of new neurons that enable processes of repair and regeneration within this environment? This question underscores the importance of giving greater attention to the social-ecological contexts in which survivors live, including their families and communities. Both are potentially crucial resilience resources that should be harnessed and strengthened.

I recently interviewed a female survivor in Brčko District. As we walked through her village, she pointed out all the empty houses whose owners are now living in Germany, the UK and other countries. The village felt empty and devoid of life. It was striking how the interviewee spoke little about the present but became far more animated when speaking about the war and specifically the events that she experienced in 1992. As I listened to her, I realized that the present felt absent. Nothing was happening; everyday life was monotonous; what was there to talk about on a daily basis? The absence of the present had clearly constricted the rejuvenation of the community. It felt dead and lifeless. When I asked the interviewee a question about reparations, and what sort of reparations would mean most to her – and why – she said that she would like something for the community, and in particular for young people. Maybe a youth centre or a playing field would help to bring the community back to life, she reflected. Relatedly, I wondered whether a neurogenesis-like process within the environment would, in turn, help to create a ‘present’ present.

During the ‘Stand, Speak, Rise Up to End Sexual Violence in Fragile Environments’ conference, the importance of reparations was consistently underlined. Reparations are often narrowly understood primarily as individual monetary compensation, but it is imperative to think more creatively. Sexual violence affects not just individuals but also entire families and communities. In other words, it creates not only direct but also referred pain. Fostering resilience to these extended layers of pain, it is argued, calls for an ‘ecological’ approach to reparations that focuses on survivors in the framework of their wider environments. In practical terms, this highlights an important collective dimension of reparations, aimed at a broader process of neurogenesis that seeks more than just individual repair.

[1] Hannah Arendt, The Human Condition, 2nd ed. (Chicago: University of Chicago Press, 1958) 50-51.

[2] Ibid., at 51.

[3] Verica Vasic and Mirko H. H. Schmidt, ‘Resilience and Vulnerability to Pain and Inflammation in the Hippocampus’, International Journal of Molecular Sciences 18 (2017), 5.

[4] Ibid., at 7.