PAIN AND THE WHOLE BODY: THE SCIENCE OF SUFFERING
When thinking about pain, we naturally concentrate on our conscious awareness and tend to ignore all the other associated events. We use put-down words such as 'reflex', 'automatic' and 'mechanical' to distinguish them from the main event that dominates us: the conscious experience of pain. We should be cautious at this stage of our search. If pain is a puzzle, we should not throw away pieces of the jigsaw just because we are obsessed with a preconceived single solution.
William James, brother of the author Henry, was a brilliant professor of psychology at Harvard at the end of the nineteenth century. He proposed that some of our emotions were an awareness of our general body reactions to an event, rather than to the event itself. Fear, for him, was an awareness of sweaty palms, a dry mouth, trembling and a pounding heart. Many dismiss this approach as a Victorian mechanical attitude to the mind because they wish to preserve the mind as a self-contained independent entity. We should, however, examine the possibility that pain is a syndrome that joins together a coincident group of signs and symptoms, rather than a single phenomenon. It could be that we are aware of the combination of events rather than of pain as a single, separate event. Some of these associated reactions have the huge advantage that we can detect them in other people, adults and babies, and in animals which have no recourse to verbal communication.
Alerting and startle
We observe this when something new happens in the world which could be important but which has yet to be identified or located. Each species is marked by its special sign. The blackbird in the tree shouts a series of brief chirps. Chicken chuckle. Deer run. The dog freezes in its tracks, one foot lifted, tense, trembling and silent. Humans show their alertness by a posture that is the opposite of relaxation. If the novel event is large, we produce a startle response. The eyes open wide and the head flicks back, the arms flex and the legs extend. This startle response is apparent in the newborn baby and is used as a diagnostic test of how much of the brain is working. A gun unexpectedly fired behind you produces one hell of a startle. If the gun goes on firing, the startle drops with each explosion because it is no longer a novel event, and the startle is replaced with a steady, alert tension which persists long after the gun stops firing, sometimes even for a lifetime.
Orientation and exploration
Once alerting has occurred, there follows behaviour that attempts to locate and identify the stimulus. Even Descartes showed the victim's face and eyes turning towards the stimulus. He reasonably interpreted this orientation as aligning the sense organs of eyes, ears and nose to maximize the collection of as much data as possible about the object that has triggered alerting. These movement patterns are also species specific. A rat with a small skin wound sniffs at it and bites. A dog sniffs, licks and scratches. We and our monkey relatives look and then probe with our fingers. All of this goes beyond simply locating the problem. We carry out active movements to explore the site of the stimulus and to collect all the sensory data possible to identify the nature of the stimulus. While this is going on, all other movement is interrupted.
Attention
These movement patterns are the outward signs of attention. We know in ourselves that attention goes beyond identification because it merges with an assessment of meaning and consequences. Attention is an integral part of pain. Pain captures and monopolizes attention and includes an interruption of any activities not directly related to pain relief. Many therapies, as we will discuss, attempt to recapture the attention from its imperial domination by pain. 'Mummy will kiss it better' is a highly effective pain therapy which unfortunately fades as doubts rise about mummy's omnipotence. For adults, we have to invent more and more elaborate methods of distraction to liberate the brain from its pain master. In an emergency, the attention may be occupied by high-priority demands, such as escape, and pain may not be permitted to attract attention. In these situations, pain does not occur, as we saw in many examples in humans and animals.
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