Wednesday, May 27, 2009

Feeling Pain and Being in Pain by Nikola Grahek

A good little book. I quite enjoy when philosophers think explorations should be driven by the findings of science, so it is unsurprising that I liked Grahek’s brief exploration of what pain means and how we understand it. Feeling Pain and Being in Pain uses clinical neuroscience studies to explore different experiences of pain and what they might mean for philosophical stances on the issue.
The book’s title indicates the main idea: that it is possible to feel pain without being in pain as well as be in pain without being able to feel much pain. What does that all mean? How could someone feel pain without being in pain? The foundation of the work is analyses of pain asymbolia patients who, usually due to brain lesions, can detect the intensity, duration and other aspects of painful stimuli, but they do not experience the stimuli as a negative, painful thing. They will say, “I’m in pain but it doesn’t bother me.” They do not show aversive reactions to noxious stimuli, the approach of noxious stimuli or are able to learn to avoid noxious stimuli. Such a phenomenon is contrasted with those who are congenitally unable to feel pain (they don’t describe the experience of noxious stimuli as painful), patients who have had types of lobotomies and briefly those on morphine. Grahek makes a tenable case that all these situations are slightly different and all help parse out and delineate what we might mean by pain and what he thinks we should mean.
An excerpt from the Introduction might help:
The first lesson is that although pain appears to be a simple, homogeneous experience, it is actually a complex experience comprising sensory-discriminative, emotional-cognitive, and behavioral components. These components are normally linked together, but they can become disconnected and therefore, much to our astonishment, they can exist separately. The second lesson is that pain, once deprived of all its affective, cognitive, and behavioral components, loses all of its representational and motivational force: it is no longer a signal of threat or injury, and it no longer moves one’s mind or body in any way. The third lesson is that pain deprived of its sensory-discriminative components comes to such sensory indeterminacy that it cannot be distinguished from other unpleasant sensations, or sensations of other quality, and loses all informational power with regard to the location, intensity, temporal profile, and nature of harmful stimuli. (p.20)
The book successfully reminded me of the positive side of pain; the life preserving aspect of negative experience. “People may not only be deprived, genetically or by disease, of that precious gift of the ability to feel pain; they may also become overwhelmed by it to such a degree that the whole mechanism of pain becomes maladaptive and, instead of signalling threat or danger, starts to threaten, endanger, or even terrorize the unfortunate patients.” (p.14)
Through the exploration of so many neurological findings, I was once again reminded how we are just so much amazing physical stuff, wound together in staggeringly complex ways. Additionally, it seems like almost anything is possible. For example, there was a case where a patient would only react to pain if he saw someone approach his vulnerable arm, but not if the arm was touched without visual awareness. Additionally, there are “multisensory neurons are capable of learning and relearning the threatening significance of visual stimuli.” (p. 20)

The final chapter of the book was the most challenging because it explored both the neuroscience findings and their philosophical implications to a greater depth than previously explored in the book. For example:
Generally speaking, it seems that we are allowed to rely on something that is already intelligible to us in order to bestow intelligibility upon something that does not wear that mark or distinction on its sleeve. The intelligibility of the relationship between C-nociceptive fiber firing (as well as A-Delta nociceptive fiber firing) and pain is just such a conferred of second-order intelligibility, established via the first-order or conferring intelligibility of the functional-phenomenal relationship between noxious or potentially noxious stimuli and pain. If the relationship between pain and stimuli as adequate or appropriate stimuli both for pain and for the activity of C- and A-Delta nociceptive fibers will imbue, through conceptual mediation, homogeneity between phenomenal and physiological concepts which are (thus far) normally thought to be inherently heterogeneous. (p.157)
Whew! Grahek is making bold claims against various philosophical notions of pain, but I do not have the time nor competence to go into them. Suffice to say that he is arguing that it makes sense that pain and injury are linked and that to keep thinking there is more explanation necessary is sometimes a misstep towards understanding.

Finally, the story of curare, which was thought to be an analgesic but was really just a paralytic (so people having surgery would experience the horror but just couldn’t say or do anything about it), reminds that one has to be careful with medical processes and things aren’t always what they seem.


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