Pain has a geography in the body. Suffering is a bigger category and existential?
This is tricky territory, hence the question mark.1
My view is that in pain there is an explicit representation that involves the body. Considering suffering as initially experienced through thoughts and emotions is a broader category that acknowledges that thoughts feel primarily psychological. Of course mental events have correlates in body physiology, they have to; there is no such thing as a pure thought or pure mind outside of body.2 However it is an achievement to be embodied. Tracking psychology, thought, or emotion in our bodies is a skill that requires practice and discipline.
It is not efficient to always track every sensation associated with a thought, in exactly the same way that it is not efficient to track every muscle we contract to pick up a glass of water. The goal of the brain is predictions and outputs that work quickly in nature. When we are suffering and in pain then retraining our brain to operate differently necessitates bringing awareness to the steps that make up our thoughts and movements. Only then can we can chose to assemble the simple building blocks of how we think and move in more optimum, non painful ways.
‘I think this is a quote from Antonio Damasio that is worth repeating: “The mind is embodied, not embrained.”
Let’s consider some of the evidence that shows how important the body is to the mind. For example, the role of emotion. We’ve talked in the past about the importance of the parts of the brain that monitor the body’s internal state. Antonio Damasio is the one that has shown that when parts of the frontal lobe that are involved with getting emotional input are damaged, a person can’t even make decisions. So we need the body’s input. That’s why separating the brain out by itself is a dangerous example of reductionism. It’s the whole person that has experiences, not the brain.’ Ginger Campbell (2009)3
Pain is a conscious experience
‘Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body.’ Lorimer Moseley4
You cannot be in pain and not know about it. Your body can be working poorly, be inhibited, have silent tumors growing, and have metabolic disorders humming away all outside of your awareness. That is disease. Pain is something that grabs attention as the brain decides the information it is receiving is dangerous. The goal of acute pain is to change behaviour to protect.
The body has other ways of changing behaviour. Tiredness is an output that limits behaviour, it is also a conscious perception like pain. Interestingly inflammation is increasingly being understood as a protective output, in parallel to pain but led by the immune system.5 However inflammation has the difference of running outside of our awareness and is non-conscious.
A consequence of embodied awareness is that as you pay attention and learn to feel you may suffer more. What you learn to feel is your suffering. Often as people come out of dissociation what they encounter is pain. The strategy of cutting off from sensation occurred because something was too much. This is why pacing and resources and are essential when meeting the body if there has been trauma. Levine (2010)6 offers that health is the ability to hold increasingly intense sensations and not get activated.
‘Let me tell you something really, really shocking. As late as the 1970’s young infants in hospitals, having major operations, including amputations, are having them without any form of anaesthetic, let alone analgesic.’ Jonna Bourke7
In the 18th century the baby was seen as exquisitely sensitive, there was a shift in 1870’s to infants being considered not at all sensitive and this continued for another century. Small children were not perceived to experience pain in the same ways as adults, it was thought you needed to have the capacity to suffer to feel pain. Presumably babies were thought to have no self consciousness and no memory. Oh dear, a sad example of why clear understanding of pain matters.
1 Bourke (2014 p60-62) gives a good discussion of pain versus suffering and relates it to an historical split between mind and body:
‘Finally, astute readers will already have noticed that I am using the terms pain and suffering interchangeably. It used to be radical to question the distinction between the mind and the body. Not any more. The assumption that there is a clear distinction between the mind (characterized as disembodied, rational, computational, and male) and the body (caricatured as presocial, emotional, impetuous, and female) has been attacked from all sides. Feminists have led the assault on the representation of the mind as some kind of superior, active, unique entity, which ‘feeds’ information to a passive, universal, and inferior physiology. In more recent decades, though, anthropologists, social scientists, and cognitive scientists have enthusiastically joined in the skirmish. Historians have been relatively slow to commit themselves.
Of course, people-in-pain typically highlight one aspect of the pain-event over another (I am in physical pain because I burnt myself while making coffee; I am psychologically suffering because I have fought with my lover). The Cartesian distinction between body and spirit or soul is deeply embedded in our culture. Nevertheless, mental pain always involves physical events – neurochemical, muscular nervous, and so on – and physical pain does not exist without a mental component. My burn depresses me; my sadness weighs down my body. As physician and writer David Biro astutely argues in ‘Is There Such a Thing as Psychological Pain? And Why it Matters’ (2010), ‘psychic distress can itself be painful in a meaningful sense, that it can be phenomenologically akin to physical pain, and, therefore, should be categorized under the same rubric’. Furthermore, the Cartesian distinction made between ‘bodily pain’ and ‘psychological distress’ (often denigrated as the difference between ‘real pain’ and its ‘psychosomatic’ variety) has done a vast amount of ideological work for physicians, psychiatrists, psychologists, the pharmaceutical industry, and chronic pain patients. For researchers in the arts and humanities as well as in the sciences, however, mind/body dichotomies have been an impediment to scholarship. There are many grounds to be suspicious of them, including the vast scientific and medical scholarship that demonstrates the interconnectedness between physiological and mental processes. Bodies are actively engaged in the processes that constitute painful sensations. Mindfulness is engaged in a dialogue with physiological bodies. And culture collaborates in the creation of physiological bodies and linguistic systems. The body is mind-ful and the mind is embodied.’
2 Another very tricky bit: no pure, independent mind is the materialist view. Dualists and religions argue that mind/soul is distinct and independent from the body.
3 Campbell, G. (2009) Did My Neurons Make Me Do It? Brain Science Podcast Episode #53: Aired January 17, 2009
4 Mikkelsen S. (2014) Notes on Lorimer Moseley lecture 7 June 2014. Facebook post. https://www.facebook.com/ManuellterapeutSigurdMikkelsen?fref=ts. Accessed 17 July 2014 Manuellterapeut Sigurd Mikkelsen
6 Levine P. (2010) In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.
7 Bourke J. (2014) The Story of Pain: From Prayer to Painkillers. Oxford University Press. http://www.bbc.co.uk/programmes/b046j8z5 Interview July 2014 @10.00mins.