PRAGMATICS, PAIN AND FORMS OF LIFE. PHILOSOPHICAL INVESTIGATIONS ON CHRONIC PAIN (original) (raw)
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A perspective on the role of language about pain
Frontiers in Pain Research, 2023
This article contributes a perspective on pain motivated by the philosopher Ludwig Wittgenstein. According to Wittgenstein, the child learns from others that the occasions on which it manifests certain reactions - the reactions that human beings manifest when injured - make it appropriate to self-ascribe 'pain'. When the child can signal correctly that she is in the requisite bodily state, then she has a conception of pain. Using the concept pain to symbolise an experience also makes it possible to tell other people what is going on and to solicit their help in managing the pain. In pain discourse, we can say "Sam can tell that Jason is with pain", or "She could tell you that Jason is with pain if she wanted to". These uses are linked to social milieu where rules are learnt for the application of concepts, such as the concept stoicism. In many rural communities, adults tell other adults about pain when it interrupts work or social activities. Otherwise, it is normative to "carry on". The rural stoic who tells another about pain only if he wants to can complicate clinical pain management, which can undermine the patient's special authority. In contrast, convergence in pain definitions and judgements between the patient and health professional can protect the authority of the patient and improve the clinical interaction. Pain is not simply a quale that is privately perceived; it must be capable of being expressed. Thus, pain has a social role, which is learnt. The study of linguistic rules in pain discourse could help explain the learning and application of the concept pain.
The World of Chronic Pain: A Dialogue
Abstract: This chapter investigates the phenomenology of chronic pain, with an emphasis on the relationship between a bodily feeling of pain and interpersonal / social experience. We focus on the first author’s experience of chronic pain, and on his increasingly desperate search for a clear diagnosis and effective medical treatment. In so doing, we argue that how one experiences chronic pain is bound up with what one anticipates from other people. To be more specific, erosion of a form of interpersonal trust is inseparable from an all-enveloping feeling of distress and helplessness, a feeling that is itself integral to the experience of pain. We further argue that certain pains challenge a commonplace philosophical assumption about intentionality: that an intentional experience is either directed at something specific or more diffuse in character. Kusch’s pain was both: a feeling in a part of his body was at the same time a change in his overall relationship with the world. In considering the implications of this, we turn to Heidegger’s discussion of ‘attunement’ [Befindlichkeit] in Being and Time.
Chronic pain as a posture towards the world
Scandinavian Journal of Psychology, 2000
This article discusses what chronic pain is``about'', what the intentional object is of pain, and what is the intentional relation like? My approach is based on Maurice Merleau-Ponty's phenomenology, with an aim is to understand a two-way relationship: how the sufferers bestow meaning on chronic pain, and how pain, on the other hand, signifies peoples' life. In contrast to biomedical and cognitive-behavioral theories, chronic pain is not only meaningful, but as an intentional emotion as well; it does not simply``happen'' in the nervous system. I analyzed meanings assigned to pain through the narratives of three patients with chronic pain. Pain is described as creating a discontinuity in the patient's Lebenswelt at the narrative level. When attempting to find meaning to their pain, patients point both to everyday life and biomedical referents. The structure of bestowing meaning is, metaphorically, like a necklace with everyday world and biomedical interpretations strung like beads, one after the other. The intentional object of pain, on the contrary, is constituted of the patients' world in its wholeness. My results don't confirm Drew Leder's idea of disrupted intentionality, but underline directness as the basic relation of human experience also in case of pain and disease. Pain in itself is an e-movere, an intense passionate movement, an intentional relation with and a bodily posture taken towards the world.
A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient's subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being's integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain. Resumo Uma característica marcante do modelo biomédico é a visão de homem compartimentalizada na qual se embasa. Esta forma de ver o ser humano teve origem no pensamento grego, foi afirmada por Descartes e permanece até hoje como sendo este ser composto por entidades distintas que se combinam em determinada sorte. Como fruto desta constatação passou-se a acreditar que o foco da atenção de um tratamento de saúde poderia ser dado especificamente à área do corpo acometida, sem que fosse necessária atenção à subjetividade do doente. Compreendendo a dor como mera resposta sensorial, este modelo não pôde alcançar o que seria a dor crônica, por esta se tratar de um processo complexo podendo existir independente de lesão tecidual. A partir da segunda
Meanings of Pain Volume 2: Common Types of Pain and Language
Meanings of Pain Volume 2, 2019
Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. “It is my opinion that this ... work will stand as the definitive reference work in this field. I believe it will enrich the professional and personal lives of health care providers, researchers and people who have persistent pain and their family members. The combination of framework chapters with chapters devoted to analysing the lived experience of pain conditions gives the requisite breadth and depth to the subject.” - Dr Marc A. Russo, MBBS DA(UK) FANZCA FFPMANZCA, Newcastle, Australia, from the Foreword
“The Voice of Pain: The Semiotic and Embodied Subjectivity”
This paper seeks to explore the way in which pain can find expression. Pain is invisible. It is difficult for us to express and recognize pain, and also it is very hard for us to explain what kind of pain we are in or how painful it is. Perhaps, it is time to seriously reconsider how we express our painful body and how medical practitioners can read our pains. Pain outruns and disrupts language and defies capture in medical discourse. We often feel vulnerable in front of medical practitioners, because we cannot explain how we feel. I aim to explore the expressions of those who suffer from chronic pains. This exploration of pain sufferers’ voices may enable strategies for the diagnosis and treatment of pain. In this paper I draw upon the work of Ludwig Wittgenstein and Julia Kristeva. First, I shall begin with a brief account of Wittgenstein’s account of bodily expression and question his argument that pain must always be publicly expressible. Second, I shall draw on Kristeva’s account of the semiotic, that is, an emotive realm of expression, deriving from to the body and bodily instincts. This paper develops the idea that the expression of pain is semiotic, that is, something that the ‘symbolic’ (language) constantly attempts to restrain and fix, because pain disturbs cautiously fixed conceptions of the ‘healthy (normal) self’. In order to describe a Kristevan way of expressing pain, I shall examine how embodied experience is depicted in Deborah Padfield’s photographic art work Perceptions of Pain (2003).
We naturally seek to avoid pain, so it is a subject we tend to avoid. The problem is it remains cloaked in misunderstanding, and unknowing. This results in fear, which results in further avoidance, which results in a cyclic process. The investigation which follows is one person's attempt to remove the cloak of misunderstanding and unknowing, to reveal pain for what it is, and gain some understanding, then show this to the reader. The discussions present in the investigation delve into such things as the definition of pain, types of pain, historical conceptions of pain, pain's societal aspect, pain assessment, the psychology of pain, and finally the philosophy of pain. Each of these subjects attempts to gain an understanding of the subject from a different perspective. The purpose, to illuminate pain, so the reader may gain a greater understanding.
The subject’s relationship with pain and its impact on identity and existence
2012
What is pain, what does it mean that the subject has a relationship with it, and how does this affect his identity and existence? My definition of pain is derived from that proposed by scientists such as Melzack and Wall, and Freud. Pain is a dynamic, multilayered, diverse collection of experiences which impact and influence the subject throughout life. Pain is a kind of conglomerate of past, traumatic, neurobiological, psychological and emotional imprints-pain as in suffering or being in pain. The aim of this thesis is to argue that it is not pain, as such, but the relationship of the subject to (his/her) pain which is most significant to his/her processes of life. In examining the combination of two theories of pain, namely, Freud's psychosexual theory of development and Melzack's theory of the Neuromatrix, my thesis endeavours to evidence my theory by using case study methodology. The similarities in the theories which are a hundred years apart have sparked my interest to propose that there is the distinct possibility for the existence of what I have named a Psychomatrix-patterns of pain (loss-abandonment, grief, rejection, desire) imprinted from infancy within an innate matrix that are specifically translated by their own 'psychological and emotional neural loops' and therefore, similar to the neuromatrix concept. As pain is triggered these 'loops' become more ingrained as information is analysed and coded to create a continuous (subjective) experience of suffering or being in pain. This is also true for positive emotions, such as love and joy, however I suggest that pain is the primary, and most significant emotion that needs to be understood in order to understand the others which are triggered by the same neuralpsychological and physicalpathways as incidental emotions of the quality of existence. A vast spectrum of (on-going) research has identified the impact of cultural, religious, social and political factors on pain and pain management. I suggest that all of these figure in the conglomerate. Using a psychoanalytical frame of reference this is a theoretical and conceptual thesis. My final conclusion is that pain becomes an object that compels the subject to respond accordingly and consequently, from birth to death, defining his/her identity and existence.