Each person we encounter in the world is a unique perspective that is not the body, but the “self”, which is lodged in the face.
“Thousands of photographs from the heart of China’s highly secretive system of mass incarceration in Xinjiang, as well as a shoot-to-kill policy for those who try to escape, are among a huge cache of data hacked from police computer servers in the region.
The Xinjiang Police Files, as they’re being called, were passed to the BBC earlier this year. After a months-long effort to investigate and authenticate them, they can be shown to offer significant new insights into the internment of the region’s Uyghurs and other Turkic minorities.”
First book to describe what pain means in vulnerable or special groups of people
Clinical applications described in each chapter
Provides insight into the nature of pain experience across the lifespan
This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time.
Immediate pain warns of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair.
Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions.
This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management.
Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019.
Request a sample by emailing me: simon.vanrysewyk@utas.edu.au, or vanrysewyk@hotmail.com
Buy the complete book on Springer’s website, here.
Imagine two communities. One community predicts the seasonal weather following the science of meteorology. Another community predicts the same through consulting the trusted indigenous oracle. The two communities could be members of the same society, but this is not relevant to the story.
Suppose it turns out that meteorology is far more accurate at forecasting the seasonal weather than the oracle. The community that uses meteorology to predict the weather cultivates a disdain for the oracle community, and criticises it as foolish and irrational.
Should the oracle community therefore abandon its customary oracle practice?
Even if we grant that the oracle community is irrational in adhering to its oracle practice, this does not mean that the community must discontinue the practice, since its adherence could be based on particular needs, priorities, or others factors.
For example, the oracle practice could be influenced by the previous generations’ observations and experimentation, which are highly valued. The oracle forecasts are derived from local experiences and communicated in local languages by the indigenous oracle, who is well-known and trusted in the community. The practice is simple, recognisable, and coherent to the community, compared with the complex and probabilistic nature of scientific forecasts.
In the Last Writings on the Philosophy of Psychology(Volume I), philosopher Ludwig Wittgenstein invites the reader to imagine a tribe unfamiliar with the concept of simulated pain. They
… pity anyone who indicates that he is feeling pain. They are unfamiliar with the suspicious attitude toward expressions of pain. A traveller coming from our culture to theirs frequently thinks that a complaint is exaggerated, indeed, that its only purpose is to generate pity; the natives don’t seem to think that way.
A missionary teaches the people our language; in the process he also educates them and under his tutelage they learn to distinguish between a genuine and a pretended expression of pain … They learn our expression: “to feel pain”, and also “to simulate pain”, and the question is: were they taught a new concept of pain?
Had those people overlooked something, and did the teacher bring something to their attention?
And how could they remain unaware of the difference if sometimes they would complain when they were in pain, and sometimes when they were not? Am I to say that they always thought it was the same thing? – Certainly not. Or am I to say that they didn’t notice the difference? – But why not say: the difference wasn’t important to them? (Last Writings on the Philosophy of Psychology, Volume I, 203-205)
In On Certainty (286), Wittgenstein discusses the possibility that a community could incorporate a different world view into its own practices. Thus, it is possible that the oracle community could use both oracle and meteorological information for weather forecasting. If we assume that agriculture in the community is rainfed and vulnerable to climate extremes and change, meteorological information could help farmers and pastoralists in the community cope with climate variability or adapt to climate change. Still, the community could regard the oracle as superior in relation to specific, important indicators, such as onset of rainfall, or amount of rainfall.
Further, if the oracle community is geographically remote, meteorological weather forecasts may not be downscaled or location-specific, thus less effective in addressing the local needs of community farmers and pastoralists. The forecasts could lack reliability, or capacity in the community to interpret them is limited. Here, the oracle practice would continue to have an essential, or predominant, role in the community.
Meanings of Pain(Springer International Publishing, 2016) was created to advance understanding of pain experience as a bearer of meaning. Progress in modern biomedicine is necessary to explain pain and to aid in its treatment; yet, preference for biomedical explanation of pain in the field has meant that research and clinical attention to the experience of pain and to common factors of pain, such as meaning, as both a clinical topic and a research method, mostly remains a blind spot in knowledge.
Meaningful changes that we notice in others are often subtle and small changes in facial expression, and are similar to features of clinicians that patients find meaningful, such as aspects of clinician demeanour (enthusiasm, positive personality, attentiveness), which are often embodied in subtle facial expressions, gestures, or particular tones of voice (e.g., Gracely et al. 1985). Pain is a personal experience, not an action; yet it displays itself in those actions in which a human person in pain is revealed to observation (Craig et al. 2010). Body-parts are subject to involuntary changes during pain, such as reflexive withdrawal, but in the social transaction of pain, the involuntary changes revealed in the face are more meaningful than in other body-parts (Prkachin et al. 1983; Craig, 2009). This is because body-parts do not have the individuating meaning of the face: the meaning of revealing me, here, now. The expression on a human person’s face is largely determined by involuntary facial actions; yet, it is the living picture of the person that “peers” from it, and hence a concentrated symbol of the “self”. In facial expressions of pain, the face is not a mere bodily part, but the whole person: the self is spread across its surface, and there displayed.
Intentional control of pain through facial actions is normally judged by observers to be an insincere expression of pain, and open to doubt (Hill & Craig, 2002). The controlled pain face is perceived as a mask, which conceals the person lying “behind” it. The expressions on the human face are not always transparent effects of the personal experiences that elicit them, as perhaps they are in nonhuman mammals. Human beings can deceive through their faces, and children and adults can use the face to fake, as well as exaggerate, or suppress, pain (Williams, 2002). It is possible that deception is possible because we do not distinguish a human person from his or her face. Protective acts such as withdrawal reflexes, guarded postures, and disabled behaviour, can communicate pain to sensitive observers (Sullivan, 2008). But when I observe another’s pain face, I am not meeting a physical part of him, as I am when I notice his injured arm or leg. I am meeting him, a real person, who reveals himself in the face as one like me. There are deceiving faces, but not deceiving arms or legs.
Facial expressions of pain call on you to respond to me. As soon as I notice pain in another person, my responsibilities are engaged. I am held to account for it. The face has this meaning for us because it is the boundary at which the other in pain appears, offering “this person” as one in need of help. This feature is perhaps at the heart of what it means to treat pain. Care of persons in pain would be impossible without the assumption that we can commit ourselves through promises, take responsibility now for some event in the future or the past, and enter into obligations that we hold as not transferable to other persons—all of which are perceived in the face.
We may separate pain from its social meaning, and assign to it an impersonal, “bodily” meaning. However, an observation of pain which, whether or not intentionally, focuses exclusively upon the body-parts of another, but which neglects the preliminary changes in the face, as well as in the voice, hands and posture, perhaps is unethical. The failure to recognise the personal existence of the other in pain is therefore an affront, both to him and to oneself. In separating pain from its social meaning, we remove it from the interpersonal world of social relations, which compels us to recognise human beings as persons and sometimes to compromise or risk ourselves for them.
The most meaningful feature in displays of pain is the eyes, followed by brows, eyelids, mouth, head, forehead, and then other body-parts (Prkachin et al. 1983). Although glances are normally voluntary, they participate in the pattern of involuntary social communication where one person in painful distress is “revealed” in his body to the one who observes him. To turn my eyes to you is a voluntary act; but what I receive from you is not anything I voluntarily do. The eye enables the human person in pain to be displayed to another in his body, and in the act of display to call on the observer to intervene on their behalf. The complex transaction of pain involves the voluntary and the involuntary to co-mingle on the surface of the human body. The joining of minds that begins when an expression of pain is answered with a reciprocated response is partly fulfilled in “me seeing you seeing my pain”, which is not the reciprocity of normal cooperation, but of meaning. I believe many patients with pain desire to experience first-hand this more concentrated form of social recognition.
References
Craig KD. A social communications model of pain. Canadian Psychology/Psychologie Canadienne 2009; 50:22-32.
Craig KD et al. Perceiving pain in others: automatic and controlled mechanisms. J Pain 2010; 11(2):101-8.
Hill ML, Craig KD. Detecting deception in pain expressions: The structure of genuine and deceptive facial displays. Pain 2002; 98:135-144.
Prkachin KM et al. Judging nonverbal expressions of pain. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement. 1983; 15(4):409.
Sullivan MJL. Toward a biopsychomotor conceptualization of pain. Clin J Pain 2008; 24:281-290.
van Rysewyk S (ed). Meanings of Pain. Springer International Publishing: Switzerland, 2016.
Williams AC. Facial expression of pain: An evolutionary account. Behav Brain Scien 2002; 25:439-488.
As organisms, human beings interact with the world and each other through causal mechanisms that control us and every other physical thing. As persons, we act in the world through our thoughts, emotions, attitudes, or desires.
Accordingly, human beings are describable in two distinct, but complementary ways: in terms of the way the world is, through scientific descriptions of the causal mechanisms and laws that explain physical things, or, in terms of the way the world seems, through descriptions of personal experiences and meanings.
One or the other way of describing human beings comes into focus depending on the questions we ask about ourselves or the world. The features of personal experience—thought, feeling, speech and action—are amenable to standard scientific explanation as specific changes in the body. Traditionally, scientific research has had much to say about the physical nature of pain, but much less about the personal experience or meaning of pain. Indeed, the meaning of pain remains a blind spot in knowledge.
A description of a human being as a person means that there is a way of understanding of human beings in which personal experience and meaning, rather than physical causation alone, is needed to answer the question, “What is happening?”
Human persons can distinguish between how things are in the world and how things seem to me. I can recognise within myself a perspective or point of view on the world and identify it as belonging to me. Every person has such a unique perspective; this is partly what it means to be a person rather than a physical thing. In contrast, a scientific description of the world does not presuppose any personal point of view. Physical science does not use words like “I”, “here,” or “now”. Does this mean that “persons” are unobservable to standard quantitative science?
Possibly. Imagine a complete explanation of pain according to the final neurophysiology of pain—whatever it turns out to be. Such an explanation of pain would, to put it very crudely, accurately map specific neurophysiological changes in physical parts in the living human organism and all their true causal interactions across time. However invaluable such an explanation would be to pain medicine, it could not describe the way pain seems to the person who experiences it, for which of the physical objects described in this explanation is me with pain, here, now? Immediate pain always seems a certain way to persons, and this “seeming” determines the experience of the person with pain. In describing personal pain, human beings use language with other meanings than the language used in neurophysiology. The final neurophysiological explanation of pain therefore could explain only one dimension of pain in human beings—the physical dimension—in language that could not capture the personal experience, burden, or meaning of pain.
A philosophical assumption of neurophysiology is that a person is identical with his or her body. Person and body are one and the same thing. In terms of personal experience, however, the identity between person and body escapes personal understanding. For example, when I feel a pain, there is no information or evidence, or nothing that I could discover about my body subsequent to the experience of pain, that could demonstrate it to be false. When I feel a pain, I simply know that I am in pain.
In person to person interactions, we commonly respond to each other as though we are not identical with the human body, but in a compelling sense operating “through” the body, which seems to be a vehicle of thought, emotion, pain or suffering. We feel that each person we encounter in the world is a unique perspective that is not the body, but the “self”, which peers out through the face. The human face is the social instrument of persons. In seeking to understand you, or adjust how the world or your experience seems to you, I interact with you through your embodied perspective.
In pain experience, it is my loss of personal control over my body, and its dominion over me, that create the compelling sense, for me and for others, of an “incarnate” person. Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person, and the person’s significant others, feel answerable for what he or she experiences.
How do we think about reality in a way that improves upon the old ways?
There is good news here: it is not entirely up to you to improve reality. Your children, and their children will do the job. So, sit back a little. Enjoy the ride!
Human beings have the unique capacity to play life’s ‘ratchet game’. Children learn the best society has to offer, and can improve upon it. And, your children’s children can start where your children left off. And so on.
My kids are already way ahead of me, since they started where I left off long, long ago, and also vastly ahead of cro-magnon humans. By contrast, chimpanzees start where their ancestors left off, and stay there. They don’t move from this place (chimps are still very cute, though).
Thus, humans can produce science and technology, and pass it on to their descendents. This gives human beings the chance to deploy science and AI tech to create increasingly accurate representations of ‘mind’, ‘DNA’, ‘autism’, ‘pain’, ‘happiness’, and so on. The ratchet game takes us beyond the familiar into exciting new territories.
(I wonder: Can academic philosophy play life’s ‘ratchet game’? It seems to me that philosophy is not terribly good at reaching out to other disciplines, and learning from them in the way that children naturally learn from parents.)
An artificially intelligent computer will say, “that makes me happy.”
Will it feel happy? Assume it will not.
Still: it will act as if it did. It will act like an intelligent human being. And then what?
My hunch is that adult human beings will view intelligent computers as simplified versions of themselves (child-like). Human children will view them as peers; ‘friendships’ will form between children and intelligent computers.
Why? I am reminded of Wittgenstein’s remark: ‘The human body is the best picture of the human soul’.
Look at this video of ASIMO.
How would you interact with ASIMO? What would your reactions be?
It is also remarkable that ASIMO does not possess any physiology.
I am too honest to be religious. Religion lains waste to honest reflection and questioning.
Many people claim to be religious. How many are pretenders?
There may be good reasons why a person pretends to be religious. A religious son adores his devout mother so much that he could not bare her to learn of his atheism. However, unknown to him and family, the mother is an atheist, and has been for decades. Like the son, she became a religious pretender in order to protect her mother’s feelings, and so on.
How to break this circle of lies? Honest reflection and questioning. And that takes great courage.
I cannot predict your every thought and action for the simple reason that most of my own thoughts and actions are completely spontaneous.
I cannot predict what I will do in most instances. I cannot know myself, so I cannot know you. True enough? We are both in the dark, it seems.
That sounds a bit bleak.
Is there any good news?
Yes: A person is not a vacuum. Human thought and action is shared. Shared, copied, modified, suppressed, distilled – we live in each other’s facial expressions.
Academics sometimes lament that the number of scholars working in their chosen field is less than the population density per square kilometer of Antarctica. They may have forgotten that to be considered interesting by the half-dozen other researchers in the field is already achievement enough.
Simon van Rysewyk 