Definition of pain (English version)
DEFINITION OF PAIN BASED ON INTROSPECTIVE PHILOSOPHY
Davide Corvi
Palliative Care Physician
Gruppo Don Gnocchi Monza
ABSTRACT
An analysis of recent attempts to define the word “pain” shows that ideas coming from pathophysiological world has been associated to psychologic-introspective ideas. This choice, and also some logic errors (mainly the hidden presence of the term inside the definition itself) make these attempts unsatisfactory, cause they miss logical and philosophycal accuracy. We propose a new definition (“pain is simultaneous arising of a bodily sensation and a a volitive avoidant thought, connected by a causal link”), which appear more fruitful.
The author discomposes conscious phenomena into their indivisible constituents (called “mental atoms”), which are phenomena that can’t be broken up into more basic conscious phenomena and proposes also the definition of the word “thought” (“ thoughts are all conscious phenomena that are neither visual nor auditory, neither bodily sensations , nor visual/auditory/bodily phantasms”) and of the word “emotion” (“emotion is simultaneous arising of a bodily sensation and a volitive thought, connected by a causal link”). Therefore pain turns out to be a subset of emotions.
Key words: Definition of pain, pain medicine, introspective philosophy, definition of emotion, philosophy of self, definition of thought, psychiatry, mental philosophy
Introduction
An effective definition of the word “pain” requires a broad and profound philosophical analysis. In fact, the theme cannot be addressed only in neuro-physiological terms, since pain is a subjective experience and subjectivity cannot be expressed using exclusively physical and biological concepts.
The terminology that the International Association for the Study of Pain (IASP) proposed in its most recent definition (1) contains a circular definition error: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”
The word 'unpleasant' should be further defined, and in the definition of 'unpleasant' are found the connotates of the pain itself.
Also the definition proposed by Tiengo (“Pain is the mental state associated with the activation of the circuits of conscious nociception” , 2 ) contains, better concealed, a circularity, in the concept of nociception.
The opinion expressed in this article is that since pain is a subjective phenomenon, it is necessary to resort to subjectivity, in the form of philosophy of the introspective mind, to define it.
As William James wrote, questioning the fundamentals of psychology, 'introspective observation is what we must rely on the most, first and foremost' (3). This view seems more than reasonable, taking into account how subjectivity is in fact the subject of psychology's study, but many authors have raised doubts about the scientificity of an introspective study, especially if the introspective reports are elaborated by subjects poorly trained in analytical and rational introspection (3). However, Wundt believed that it was possible to study and report one's own inner processes without the process of observation distorting the observed objects, provided that they fell within the field of perceptions, memory, feelings and volitions (ibidem).
Therefore, an introspective classification of mental phenomena is proposed here based on simple self-observation and partly inspired (only for the general approach, deviating from it in terms and purposes) to the Buddhist philosophy of mind (in particular to the analysis of the “aggregates” present in many texts, including the Anattalakkana Sutta (4) and the Visuddhimagga (5)). On the basis of this classification it will then be possible to unequivocally define pain.
DECOMPOSITION OF MENTAL PHENOMENA INTO INDIVISIBLE COMPONENTS
For classification purposes, each moment of consciousness can be broken down into its sensory and cognitive constituents. From the consideration that on a subjective level (and not anatomical-physiological) some phenomena can be divided into simpler phenomena (for example, an emotion can be experienced as a set of bodily sensations, thoughts, etc.) while other phenomena are not (for example, visual images cannot be broken down into components that are not of a visual nature), emerges the possibility of classifying the latter as “indivisible”, elements, that the author of this article has identified in the following:
View
Hearing
Body sensations
Visual sensory ghosts
Hearing sensory ghosts
Body sensory ghosts
Thoughts
To understand why these 'indivisible' and that unusual nomenclature ('ghosts') were chosen, it is necessary to take a step back and list what commonly appears to our consciousness in everyday life, and then further simplify this list.
Each phenomenon (excluding perhaps some rare and particular realities such as mystical experiences) can be broken down through a correct introspective reading into a sum of the following:
View
Hearing
Taste
Smell
Body sensations
Sensory imaginations
Sensory memories
Thoughts
Each of them deserves a treatment in its own.
We will leave out, because it is not useful for the purposes of this text, the analysis of the first two senses, while taste and smell as specified below are subsets of bodily sensations. The latter occupy a decisive role in the genesis of emotions.
BODY SENSATIONS
The fundamental connotation of bodily sensations, seen, it is good to reiterate it, from a subjective point of view, is the fact that they are localizable in the body, that is, they are in direct relation to our mental body pattern. That is, these are perceptions of certain areas of our body that appear to consciousness without the help of the other senses. In summary, bodily sensations are perceptions of parts of the body not mediated by sight and hearing. Clarification on sight and hearing is necessary to rule out perceptions such as 'sight of one's arm' being mistakenly included in this group.
TASTE AND SMELL
On an experiential level it can be observed how the sensations induced by food or scents / smells can be located in some body areas (predominantly cranial), therefore the phenomena of taste and smell can be part of the body sensations.
SENSORY IMAGINATIONS AND MEMORIES
Sensory impressions leave in the mind traces, footprints that were called by Aristotle “phantasmata”(6), while David Hume (7) used the term, perhaps too nonspecific, of “ideas”. It appears simpler, and will initially be proposed here, the term 'sensory rememories'. These memories, as well as the imaginations described below, appear on average less vivid, but this characteristic is precisely only statistically true, because cases of memories and imaginations just as vivid as real phaenomena are known in medicine (just think of the hallucinations present in some pathologies, or evoked under hypnosis, or in the fervent creative imaginations described in Nikola Tesla's autobiography, (8)). As for the phenomenological distinction between memory and sensory imagination, Oliver Sacks (9) tells of a false memory of him so vivid that it was transcribed by him with conviction in an autobiographical account, then denied by his brother, who assured him that he -Oliver- had never witnessed this fact.
Imaginations, which, as well as memories, can be visual, auditory or corporeal (and therefore the use of the simple term 'mental images', used in introspective philosophy, (10) is not a proper term) are not always clearly distinguished subjectively from memories. In other words, the only element that causes a “ghost” (we will now use this Aristotelian term to define these phenomena) can be defined as “remembrance” or “imagination” is the thought or conglomerate of thoughts associated with it. Without anticipating the following definition of thought, we can conclude for now like this: it is the belief (thought) that something really happened or not that causes a ghost to be definable as a memory or imagination.
Interesting is the relief that some subjects would not be able to visualize mental images: they have been called 'aphantasic' (10). These are probably only cases of predominance of bodily and auditory memories over visual ones, but this is only an opinion of the author that deserves further study (in this case they would be 'partial and not complete aphantasics').
THOUGHTS
The most complex definition to be addressed is precisely that of the word 'thought', which after centuries of philosophy still escapes a shared terminology. To introduce the proposal elaborated here we report the definition of John Haldane (11): 'There is agreement between the realist and the anti-realist that thoughts are cognitive entities with particular intentional content'. In this choice the word “intentional” should not be read with the colloquial meaning of intention but rather with its deep philosophical meaning, already analyzed (12) by ancient thinkers such as Avicenna, Averroes and Thomas Aquinas, for whom reference is made to the texts of the sector. For the mainly medical purposes of this article it will be sufficient to reflect on what we usually mean by the word thought, separating, almost “distilling” that entity from the mental indivisibles that we have analyzed above. We perceive a 'thought' every time we perceive a particular connection between sensory phenomena, that is, whenever what we perceive is not simply summarized in a set of sensory experiences or memories or sensory imaginations. A thought is any phenomenon that appears outside the senses and their mnestic reworking. So the definition proposed here proceeds by successive negations: any phenomenon that appears to consciousness and is not visual, nor auditory, nor bodily sensation, and that is not even a visual, auditory or corporeal ghost, is called thought.
The apparent complexity of this definition can be understood through the following example: if the vision of a madeleine, with her perfume, arouses me concern because I did not return Proust's novel to the library, of all the phenomena that appeared to my consciousness (the image of the dessert, its perfume, the volume of Proust, the image of the irous face of the librarian, the verbal or non-verbal content of the phrase “It is appropriate to return the book”) only the latter is a thought. It can be summarized in one sentence but can appear to the mind even without words.
To express this concept even more precisely, it can be said that any sentence of complete meaning is an expression of a thought, but thought is faster than the sentence itself and can present itself without words.
It could be argued that there is no demonstration, beyond the author's personal conviction, of the fact that there really is a similar phenomenon (non-visual, non-auditory, non-corporeal etc...). In reality, this demonstration is not at all complex: it is enough to show a case in which the subject unequivocally perceives something different from the 'indivisibles' mentioned. Take for example the following verbal communication: “If it rains, close the window.” Those who receive this message and internalize this operational instruction would become aware of something that is completely distinct from the sound of the words heard and cannot even be reduced to a set of visual ghosts (the image of the rain, the hand that closes the window) because it is possible to perceive identical visual ghosts without having any inner operational instruction: for example in the case of memory of such events or visualization of them while listening to a story. What that subject is aware of (“if it rains I will have to close the window”) is a thought.
A deeper criticism might argue that what is perceived does not appear as a sensory ghost just because it is the memory of multiple previous memories, a “ghost of ghosts of ghosts” that appears in a different essence just because it is more complex and less vivid. On this last point the author leaves the debate to the philosophers.
MENTAL ATOMS AND MOLECULES
It is therefore possible to return to the proposal of the mental 'indivisible' seven, which can also be called metaphorically mental 'atoms':
View
Hearing
Body sensations
Visual sensory ghosts
Hearing Sensory Ghosts
Body sensory ghosts
Thoughts
If you wanted to further simplify, you could classify the perceived phenomena and their ghosts into a single set, since they are similar entities of greater or less sharpness. In that case the atoms would be only four:
View
Hearing
Body sensations
Thoughts
One can personally observe with one's introspective experience that each of these phenomena cannot be broken down into phenomena different from itself. Sight cannot be subjectively split into non-visual phenomena, a thought cannot be split into phenomena that are not thoughts. To proceed now to the definition of pain it will be appropriate to mention an important family of mental 'molecules': emotions.
William James stated: “our feeling the changes [of the body] as they manifest themselves IS the emotion” (13)
The long history of attempts to define emotion (13) shows many uncertainties and debates, which in our view can be overcome through the theory of mental atoms.
The purely introspective definition of emotion that is proposed here is as follows:
Emotion is the contemporary presentation of a bodily sensation and a volitional thought. It is therefore a 'molecule' that is born by associating a subset of the atom 'bodily sensations' with a particular subset of thoughts: volitional thoughts. The latter are thoughts that can be expressed in a sentence that contains the word “I must” or “I want” or “It is necessary that”: for example “I have to run away from here”, “I want to hug this person”...
A possible problem with this definition is that even the occurrence of events that are not related to each other (such as an itch in one hand at the same time at the thought 'I have to go to the bank') would fall within the definition itself. To avoid this poor terminological specificity we will add a further clarification:
Emotion is the contemporary presentation of a bodily sensation and a volitional thought, connected to each other by a causal link.
That is, the sensation is caused by thought or vice versa or the causal link is bidirectional (thought causes the sensation which in turn reinforces thought, and similar processes).
DEFINITION OF PAIN
After these rapid premises of an introspective philosophy that deserves elsewhere, in philosophical debates, many more insights, the following definition of pain can be reached:
Pain is the contemporary presentation of a bodily sensation and an avoidant volitional thought, connected to each other by a causal link.
Where avoidant volitional thoughts are a subset of volitional thoughts in which the message that the mind perceives can be summarized with phrases such as “It is necessary to avoid this” “You must immediately escape from...” etc.
Discussion
The decomposition of the human personality for descriptive, psychological or medical purposes has long been present in the history of Western and Eastern thought.
Catholic mystical thinkers such as Teresa of Avila (14) spoke of the three powers of the soul (memory, intellect and will), and it can be noted that, unlike our proposal, volitional thoughts were placed in a different place of the soul than analytical thoughts. Each of these powers according to Teresa was modified differently during the deepest prayers, on the occasion of the encounter with the Divinity.
In the East Buddhist mental philosophy shows this decomposition of personality, aimed at showing the inexistence of the Atman (the Self) that would emerge as an agglomeration of these parts:
Rupa (the body/matter)
Vedana (the sensations)
Sanna (the perceptions of objects of meaning)
Sankhāras (mental formations)
Viññāṇa (the conscience)
None of these components according to the Anattalakkara Sutta (4) is the true Self, therefore the monk should detach himself from each of them to achieve Liberation.
Influenced by these philosophers, but with different purposes, the author of the article wanted to show, with this terminological dissertation in which the phenomena of conscious experience are broken down into their elementary components, a void present in Western medicine: the lack, in psychiatry and in pain medicine, of simple and shareable classification schemes on the simplest components of personality. The text does not intend to delve into the most complex discourse on the mind/brain relationship, and does not want to suggest a reductionism that debases the person to the sum of automatic impersonal phenomena, since the simplification presented here is only intended to describe phenomena of everyday life for medical purposes, leaving open reflections on the deeper and most difficult to probe aspects of the human soul.
Such a classification also allowed an original definition of the word thought and the word emotion.
[Article published only on my personal blog in italian language]
Conflitto of interest: none.
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3) https://plato.stanford.edu/entries/introspection/#GenFeaInt
4) https://www.canonepali.net/sn-22-59-anattalakkhana-sutta-sul-non-se/
5) https://www.canonepali.net/anatta-il-non-se/
6)Aristotle. Works, vol. 4, Of Generation and Corruption, Of the Soul, Small Treatises of Natural History, translated by A. Russo and R. Laurenti, Roma-Bari 1983.
7) David Hume, Treatise on Human Nature (trad. A. Magliocco)
8) Nikola Tesla, My inventions. Autobiography of a genius (Trad. A. Tozzi)
9) Oliver Sacks, The River of Consciousness, Adelphi Library 682
10) https://plato.stanford.edu/entries/mental-imagery/
11) John Haldane, Reasonable Faith, Routledge
12) Treccani, Dictionary of Philosophy, 2009
13) https://plato.stanford.edu/entries/emotion/
14) Teresa d'Avila, All the works, Bompiani, edited by M. Bettetini
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