COVER ESSAY

The Scream by Edvard Munch:A Profound Portrayal of Existential Suffering

Effective with this issue, each cover of theJournal of Pain & Palliative Care Pharmaco-therapy will feature a work of art that reflectsthe suffering of pain and palliativecare patientsor the calm that can result from relief of agoniz-ing symptoms. We begin this new traditionwith what is perhaps the most profound artisticdepiction of existential suffering ever painted,The Scream.

This most famous work by the great Norwe-gian artist Edvard Munch was the “jewel in thecrown” of the Munch Museum in Oslo. Thoseof us who have been fortunate to see this paint-ing have found it to be far more impressive “inperson” than in the reproductions. Internationalheadlines recently announced the theft of thismasterpiece from that museum. The daringdaytimerobbery reflects thecruelway in whichundertreated pain can rob persons of their abil-ity to function, their dignity, and even theirsense of self.

The Scream is done in tempera and pastel onboard, 91 � 73.5 cm2. It is signed in the lowerleft: E. Munch 1893. This magnificent workhas gained enormously in popularity, espe-cially since World War II. Perhaps that reflectsthat the existential fear so brilliantly renderedby the artist has become more widespread in re-cent decades.

In the foreground, we see a road with a rail-ing along it. On the road is a figure whose handsare raised to his head, with eyes staring and

mouth gaping. Further back, one can make outtwo gentlemen in top hats, and behind them alandscape of fjord and hills. Munch first de-scribed the experience which gave rise to thispainting in Nice, France. Munch wrote the fol-lowing inhis literarydiaryonJanuary22,1892.

“I was walking along the road with twofriends.The sun was setting.I felt a breath of melancholy–Suddenly the sky turned blood-red.I stopped, and leaned against the railing,deathly tired–looking out across the flaming cloudsthat hung like blood and a swordover the blue-black fjord and town.My friends walked on-I stood there,trembling with fear.And I sensed a great, infinite screampass through nature.”

Art historians often describe Munch, to-gether with artists like Van Gogh, as “thefounder of Expressionism,” Surely, this paint-ing is a great part of reason for that designation.TheScreamdepictsnot somuchan incidentoralandscape as a state of mind. The drama is an in-ner one, and yet the subject is firmly anchoredin the topography of Oslo. The setting of thepainting is in theviewis fromNordstrand(NorthBeach) towards the two bays at the head of the

Journal of Pain & Palliative Care Pharmacotherapy, Vol. 19(1) 2005http://www.haworthpress.com/web/JPPCP

2005 by The Haworth Press, Inc. All rights reserved.Digital Object Identifier: 10.1300/J354v19n01_01 1

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Oslofjord, with the Holmenkollen (the venuefor the Oslo Olympics ski jump competition) inthe background. As the sun is setting, the land-scape has been distilled into an abstract rhythmof wavy lines. The road with its railing, leadingdiagonally inwards, creates a powerful per-spective in the composition and intensifies thedisquieting atmosphere in the picture.

Existential suffering is a far too common ex-perience for patients suffering from chronicpain and end-of-life disease when their symp-toms are not sufficiently managed. A majortheme of this Journal is that suffering can

nearly always be ameliorated with appropriatemanagement. Pharmacotherapy remains thecornerstone of much–if not most–of that symp-tom control. The Journal of Pain & PalliativeCare Pharmacotherapy remains committed toeffectively communicating new and timely in-formation to assist clinicians in the manage-ment of symptoms associated with acute andchronic pain, and in the palliation of symptomsassociated with end-of-life care.Arthur G. Lipman

Arthur G. Lipman, PharmD, FASHPEditor

2 JOURNAL OF PAIN & PALLIATIVE CARE PHARMACOTHERAPY

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