On Psychological Pain

David Biro, who is doing some excellent work on pain from a humanities perspective, has a new article out in Culture, Medicine, & Psychiatry (vol. 34, no. 4) entitled Is There Such a Thing as Psychological Pain? and Why It Matters.  Here is the Abstract:

Medicine regards pain as a signal of physical injury to the body despite evidence contradicting the linkage and despite the exclusion of vast numbers of sufferers who experience psychological pain. By broadening our concept of pain and making it more inclusive, we would not only better accommodate the basic science of pain but also would recognize what is already appreciated by the layperson—that pain from diverse sources, physical and psychological, share an underlying felt structure.

This is an excellent article, and well-worth reading, which puts a number of good challenges to dominant conceptualizations of pain in both medical and lay culture in the U.S.  However, I generally remain concerned with efforts that proceed by accepting any dichotomy at all between psychological and so-called somatic pain, because there is excellent reason to believe the distinction between these two is ridiculous.  Biro, I think, is well aware of the incoherence of the distinction, but I admit to anxiety about even referring to categories of pain in context of "physical" or "somatic" and "mental" or "psychological" pain.  Using such categories, even to challenge them, risks conceding too much of importance, in my view.  Howard Fields, who is both a clinician and one of the leading neuroscientists in the world on the subject of pain, said it best in a seminal 2007 essay: "All pain is mental."

One additional point is that there is a very real phenomenological difference to be drawn between different kinds of pain.  Pain and suffering are phenomenologically distinct; it is possible to suffer without pain, and it is also possible, albeit perhaps less likely, to experience pain without suffering.  So the idea Biro presents above, that psychological and physical pain are "flip sides of the same coin," as he puts it, does not commit him to the dubious position that the lived experiences of pain are invariant.  Rather, the point is that the very real and significant phenomenological differences -- the many meanings of pain -- do not license a metaphysical distinction between mental and physical pain.  If I am correct in attributing this position to him (which I flesh out at some length in my own work), he is exactly right.

Thoughts?

   

Comments

[Kelly Hills]

Pain and suffering are phenomenologically distinct; it is possible to suffer without pain, and it is also possible, albeit perhaps less likely, to experience pain without suffering.

Hey, that sounds familiar. ;-)

I think it would definitely help if medicine stopped separating the brain out as something different or special, at least when it comes to function. When a tendon in my hand snaps, we go "ack, lack of expected function - bad! fix!" We should stop thinking of a misfiring brain as anything other than another example of lack of expected function, and work on fixing it.

Something going 'wrong' in the brain is just as physical as something going 'wrong' in my wrist - the difference is just the location, and shouldn't be viewed as any differently as any other location-specific injury or disruption on the body.