The Face of Pain

Eric Lis

Is it possible that elves and dwarves experience pain in fundamentally different ways?

Back when I was working in obstetrics as a medical student, the staff had an oft-repeated joke: when a Greek woman is screaming, you can walk to her room, but when a Chinese woman is screaming, you run. Casual racism aside, the joke is meant to get at an important observation: people from different cultures react to things differently. Some societies teach that it's okay to be very emotionally expressive; people who grow up in that kind of society tend to be a lot more expressive, both in good times and bad. Other societies teach that expression of emotion  is inappropriate or selfish, and people who grow up in those societies tend to be more stoic and reserved, which can lead to an air of dignified nobility or can lead to a pathological inability to express feeling. Neither extreme is necessarily better or worse, but there can be wide-ranging consequences, not the least of which is influencing how a creature perceives, experiences, and copes with pain.

There a huge body of research out there on ethnic and racial differences in perception of pain. It's a complicated area to study, because 1) by and large there's a lot of disagreement as to what constitutes 'race' and 2) a carelessly-worded paper and make an author look like a racist, which may or may not be true. More importantly, it's complicated because we're not very good at measuring pain in a scientific and reproducible way. From neuroimaging studies, we know that the degree to which pain makes a person's brain light up doesn't correlate very well with the degree of pain they're actually in and how tolerable they find it. No blood test can measure how severe their pain is. We're mostly limited to exposing people to interventions that ought to cause a similar amount of physical damage and then let them tell us how much it hurts or how much more they can handle. As with any other topic, though, if you can get enough people working on a question, some of them will eventually find a way to approximate an answer, and that's how we end up with some findings on how your ethnicity affects your pain threshold.

One thing we know is that the reported severity of a pain doesn't tell us how someone will react to the pain. A study published last year showed that compared to Italian children, Chinese children undergoing the same medical procedure reported higher levels of pain but were none the less better able to control their reaction to it. Similarly, chronic pain seems to be much more common in some peoples, but their higher degree of pain doesn't necessarily lead to a lower quality of life. Certain Native American groups have been repeatedly shown to resist pain better than Caucasians, but this doesn't hold true for all groups and is complicated by the generally lower quality of medical care many Native populations receive. The biggest and best studies tend to agree that for the most part, people of different ethnicities experience and deal with pain similarly, but that there are potentially big differences in the emotions that get expressed around it. That's kind of reassuring in a way; it probably underlines the fact that human beings all suffer in the same way, even though some people choose to be louder about it.

The thing about ethnicity, of course, is that although skin colour and nose shape might differ between countries, a human being is still a human being. In fiction, and especially in medieval fantasy, this might not be so simple. There are certain differences in toughness and durability that have been pretty universal to different fantasy universes ever since they were set down by Tolkien himself: dwarves are tough and stoic, elves are brave but delicate, orcs are volatile but indomitable and so forth. An individual game system might express this as bonuses and penalties to a Fortitude save, a Constitution save, or hit points, but at the end of the day the gnome usually remains more combat-ready than the halfling. Since these are actual different races with inborn different strengths and weaknesses, it’s reasonable to imagine that the differences between them are greater than the differences between two tribes of humans. If hit points and Constitution in your game partly represent a creature's pain threshold, then it's logical that a race with higher average Constitution scores cope better with pain; they may take the same amount of tissue damage from a spear wound, but they'll allow it to affect them less. What the data on humans tells us, though, and what might be great fun for a storyteller to explore a bit, is whether the differences between elves and dwarves are purely biological, or like they are with us, more cultural than anything else.

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on February 22, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system