Pain and bodily care: Whose body matters
Frederique de Vignemont
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Abstract
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The paper explores the relationship between pain, bodily care, and the concepts of self-ownership in the context of pathological cases such as pain asymbolia. It challenges the idea that caring for one's body is essential for experiencing pain as unpleasant, particularly in instances where individuals perceive parts of their body as alien. Through examining various interpretations of bodily care and their implications for our understanding of pain, the study highlights significant complexities in the motivational role of pain and raises questions about the necessity of first-personal ownership in pain perception.
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Pain and the Own Body
This is a working paper, as you can see from the notes to myself in the text. The next phase of developing these thoughts is to work further on the paradoxical conclusion of this version. This may turn out to be a book chapter.
PAIN: Pain and Bodies
2011
Various paradoxes coalesce around pain, "one of the most controversial areas in neuroscience… rife with philosophical problems" (Aydede and Guzeldere 2002: S266). For example, while pain is conventionally seen as aversive and unwanted, biologically speaking, pain is indispensable. Pain warns of injury or organ malfunction, and helps heal a wound by motivating the individual to tend to and protect the site. Many textbooks on pain begin by describing the extremely unhappy lives of those rare individuals born with a congenital inability to feel pain. Pain medicine plays with this contradiction: one book is titled Pain: The Gift Nobody Wants (Brand and Yancey 1993), and one article's title is "When good pain turns bad" . Both an aspect of mind (experience) and brain (produced by neurological structures and processes), pain illustrates some of the problems associated with mind-body dualism. Murat Aydede and Guven Guzeldere note that the "fundamental tension between what can be quantified as the 'objective' measure of pain as characterized in terms of tissue damage and the 'subjective' criterion of when to categorize a given experience as pain is in fact prevalent in pain research" (2002: S267). Medical science's traditional definition of pain as sensation provides an example. Francis Keefe and Christopher France's definition, "a sensory event warning of tissue damage or illness" (Keefe and France 1999: 137) nicely elides the nature of that warning; while pain is certainly a sensation, its bedrock meaning -and what distinguishes it from nonpainful sensations -is aversiveness, which, being an emotion, does not fit within biomedicine's underlying biologistic foundational premises (see Kleinman 1995: 27-34). Another example: although emotions are always embodied (this is precisely what distinguishes them from cognitions), because we tend to see emotions as an aspect of "the mind," the body's fundamental role in emotions is often obscured, phrases like "heartbroken" notwithstanding.
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The aim of this article is to show how the inseparability of its objective and subjective dimensions renders pain such a complex phenomenon that it poses a challenge for both the biomedical sciences and philosophy. Neurophysiology has ascertained the variability of the relationship between damage and pain, showing that it is the result of interaction between the sensory and affective-emotional constituents of the human being. However, the process of defining the clinical concept of suffering appears comprehensively laborious and ongoing. Philosophy, while declaring the impossibility of identifying the essence of pain, makes a valuable contribution to the discovery of the singularity of the experience, thanks to the phenomenology of the homo patiens. Finally, we examine the debate on the possibility and the different ways of narrating and appraising suffering, a need with obvious ethical implications, perceived more and more within the field of care, also given the chronicity of many medical conditions.
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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License THE CONCEPTION OF "PAIN" BETWEEN RHEUMATOLOGY AND MEDICAL ANTHROPOLOGY: A NEW WAY OF CONCEIVING PAIN
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In this brief article we have to start looking at the patient as a person and at the complexity of the situation he or she is handing over to us. After setting some coordinates on medical anthropology, we will try to understand how it can be of help to the rheumatologist, what new perspectives arise from the dialogue between these two disciplines. Medical Anthropology shows how every individual in every social context perceives, interprets, and deals with illness and health in a manner closely linked to personal experience and the socio-cultural environment of which he or she is a part; it recovers the old holistic paradigm of ancient and primitive and folk medicine, the reunification of soul and body, the global study of the person. In this perspective, the issue of pain emerges, particularly in rheumatology (we have to consider that in Italy there are about 4 million patients with arthrosis, the most widespread chronic degenerative rheumatic disease, about 400,000 those with rheumatoid arthritis, and at least 600,000 who are affected by other diseases of great clinical relevance, such as psoriatic arthritis, ankylosing spondylitis, lupus and scleroderma). Starting from the assumption that man is not a machine, nor is his pain the result of a series of mechanisms, we could assume that between man and his pain there is the ambivalence of the relationship that unites man to the world. Pain affects man's identity, often shattering it, thus becoming the disease to be cured. In this perspective, it can never be considered as something good, something that adds to a person's life. Pain, therefore, being a multiple reality, needs to be inserted in the relationship that the subject has with himself, the socio-cultural uses that he has assimilated, elements from which the physician cannot prescind.
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What I understand best, which is not saying much, are my pains. (Beckett 1974: 20) The task of diminishing pain is at the centre of much biomedical research and healthcare practice. Physical pain is conventionally understood as an unpleasant sensation resulting from illness, injury, or other harmful physical contact. In most contexts, it is regarded as a problem to be overcome or managed through various curative and palliative methods. In recent decades, some of the most interesting and important phenomenological work has focused on the devastating impact of extreme pain on subjectivity. Although it is rarely examined outside of illness or injury, pain is an important feature of everyday bodily experience. In mild forms, it is near ubiquitous. In this essay, I explore the nature of pain in the context of ordinary, nonpathological bodily stresses and strainsexperiences that are commonly referred to as "aches and pains". By looking at the role of pain in what might be termed world-formation, I explore the experience of mild corporeal pain as a positive force that is crucial to the way the body experiences the world.
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Over recent decades, pain has received increasing attention as – with ever greater sophistication and rigour – theorists have tried to answer the deep and difficult questions it poses. What is pain’s nature? What is its point? In what sense is it bad? The papers collected in this volume are a contribution to that effort ...
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When my wife was pregnant, our birthing coach asked the class " What is pain? " I thought I might finally get to display some of my philosophical training, but alas, the correct answer was: " Pain is whatever she says it is. " The coach's " sufferercentric " definition echoes the one offered by the International Association for the Study of Pain (IASP)— " Pain is always subjective " —as well as the definition of pain offered by the philosopher Saul Kripke in his argument against identity theory— " Pain. .. is picked out by the property of being pain itself, by its immediate phenomenological quality " (1972/1980, p. 152). These subjective conceptions of pain pose problems for the scientific study of pain, as Price and Aydede point out in the introduction of their chapter. If the essence of pain is its phenomenological quality, then it seems the only way to study it directly is through introspection and subjects' verbal reports...
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What is pain, what does it mean that the subject has a relationship with it, and how does this affect his identity and existence? My definition of pain is derived from that proposed by scientists such as Melzack and Wall, and Freud. Pain is a dynamic, multilayered, diverse collection of experiences which impact and influence the subject throughout life. Pain is a kind of conglomerate of past, traumatic, neurobiological, psychological and emotional imprints-pain as in suffering or being in pain. The aim of this thesis is to argue that it is not pain, as such, but the relationship of the subject to (his/her) pain which is most significant to his/her processes of life. In examining the combination of two theories of pain, namely, Freud's psychosexual theory of development and Melzack's theory of the Neuromatrix, my thesis endeavours to evidence my theory by using case study methodology. The similarities in the theories which are a hundred years apart have sparked my interest to propose that there is the distinct possibility for the existence of what I have named a Psychomatrix-patterns of pain (loss-abandonment, grief, rejection, desire) imprinted from infancy within an innate matrix that are specifically translated by their own 'psychological and emotional neural loops' and therefore, similar to the neuromatrix concept. As pain is triggered these 'loops' become more ingrained as information is analysed and coded to create a continuous (subjective) experience of suffering or being in pain. This is also true for positive emotions, such as love and joy, however I suggest that pain is the primary, and most significant emotion that needs to be understood in order to understand the others which are triggered by the same neuralpsychological and physicalpathways as incidental emotions of the quality of existence. A vast spectrum of (on-going) research has identified the impact of cultural, religious, social and political factors on pain and pain management. I suggest that all of these figure in the conglomerate. Using a psychoanalytical frame of reference this is a theoretical and conceptual thesis. My final conclusion is that pain becomes an object that compels the subject to respond accordingly and consequently, from birth to death, defining his/her identity and existence.
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This work proposes that pain meets the requirements of being characterized as a secondary quality, as it covers, like a color, a determined extension. The argument seeks to establish a literal pain-color analogy through an inquiry into the intensity and location of the pain. From the classic intensity/location relationship reported by patients with acute appendicitis, three degrees of pain are distinguished: mild, moderate, and severe. The objective is only achieved by examining the Body's extensional determinations (primary quality) insofar as each of these degrees of pain covers three particular measures. Once these three measures have been explored according to the perforation process (tissue damage), the work ends by identifying pain as a transcendent moment.
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One use of the noun ‘pain’ is exemplified in sentences like ‘There is a pain in my foot’. According to the Experiential Theory, ‘pain’ in this context refers to an experience located in the mind or brain. According to the Bodily Theory, it refers to an extra-cranial bodily occurrence located in a body part. In this paper, I defend the Bodily Theory. Specifically, I argue that pains are proximal activations of nociceptors that cause experiences of pain. This view is preferable to the Experiential Theory, because it accords better with common sense and offers a better interpretation or semantics of ordinary pain reports.
Pain as the Performative Body
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Stapleton M. (2022) Pain as the performative body. Constructivist Foundations 17(2): 156–158. https://constructivist.info/17/2/156 Commentary on Smrdu M. (2022) Kaleidoscope of pain: What and how do you see through it. Constructivist Foundations 17(2): 136–147. https://constructivist.info/17/2/136 I unpack Smrdu’s kaleidoscope metaphor, putting it into dialogue with enactive work on the performative body in order to cash out how it can capture the qualitative differences of the experience of chronic pain.
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