Claiming Multidimensionality of Pain: Part II
Claiming Multidimensionality of Pain: Part IIAll pain is "physical" and all pain is "mental"
by Ma'ayan Simon
"Defining pain tests our understanding of the relationship between the body and the mind" (Thernstrom 282).Essential to understanding the fundamental nature of pain is that all pain is physical and all pain is mental. Neurobiologically, pain knows no boundaries between "physical" or "mental": like the notion of body and mind as separate, delineation of pain as either the domain of the "physical" or that of the "mental" is falsely constructed (Butler and Moseley 19; Cohen et al. 1638; Edwards 17).All pain is physical, which is to say that all pain has tangible and measurable physiological impacts on the body (Butler and Moseley 19, 36-38, 70); all pain is mental, in that without the perception of pain as part of what encompasses and defines the reality of pain, the pain would not be experienced as pain (Butler and Moseley 19, 70, 102). Even so, faulty dichotomizing of the physical and mental continues to undermine effective understanding and treatment of people in pain (Cohen et al. 1638-1639; Butler and Moseley 70). To this point, I use the terms "anatomical pain" and "emotional pain" for what are traditionally described as "physical" pain and "mental" pain, respectively.Stigmas and prejudices unjustly attached to mental illnesses feed the false physical–mental dichotomy, simultaneously undermining the legitimacy of anatomical “idiopathic” pain in which no apparent "physical" rationale or answer is evident, and pathologizing emotional pain when it deviates from or is experienced beyond what is judged "normal" or acceptable (Cohen et al. 1638-1639; Edwards 11). This is especially true in the case of women* with chronic pain, as well as people of color, especially black people (Edwards 19-21, 74-75, 110, 114-115, 119, 125; Thernstrom 141, 148, 154-155, 168). As the authors of “Stigmatization of Patients with Chronic Pain: The Extinction of Empathy” put it,
The scientifically inappropriate imputation of a mental disorder upon the person in pain can be a potent cause of iatrogenic stigmatization, not only because it invokes another stigma—that of the ‘weak mind’—but also because such mislabeling can lead to inappropriate treatment… (Cohen et al. 1638)
No single "pain center" exists within the brain, which means that pain is processed through a neuromatrix (Butler and Moseley 38, Thernstrom 286, 324) and the "processing" of anatomical pain and emotional pain functions in much the same way (Butler and Moseley 19). Additionally, emotional pain registers in the brain as an injury, a physiological response that can be seen and measured. Furthermore, it is well documented that many "psychological" and “mental” illnesses have substantial biological and genetic factors that contribute to brain chemistry imbalances: in other words "physical" causes and processes (Thernstrom 129).Take biochemical depression, for example, which can include anatomical pain, fatigue, digestive disturbances, and additional nervous system dysregulation, resulting from biophysiological processes and not manifestations of “irrational emotion” (Thernstrom 129-130, 156-157). Historically, the frequency of depression and "unexplained" anatomical pain coinciding has been used as a basis to further pathologize people in pain (women*, disproportionately) and promote suspicion of self-reports of pain (Thernstrom 59, 60, 148-149; Edwards 74-76, 85-86, 115, 119). However, research demonstrates that the incidence of people prone to biochemical depression also being more vulnerable to chronic pain conditions is not evidence of a character or personality flaw, but that of shared genetic precursors. As Thernstrom notes,
There is increasing evidence that both conditions involve abnormalities in the neurotransmitters serotonin and norepinephrine, which play a role not only in mood disorders but in the gate-control mechanisms of pain. (157)
Even so, psychological/psychiatric conditions and "mental illnesses" are by and large ghettoized and not acknowledged as chronic pain, or even chronic illnesses/diseases in general. This is not to generalize that every person with a psychological condition experiences pain as a result, or wants their experience to be assigned or assumed as painful to the exclusion of other elements, and even benefits, of the experience.With that said, many people in pain (anatomical and/or emotional) have their experiences rendered "invisible" or “not real” because pain cannot readily be detected and measured. The experience of having one’s pain misunderstood, dismissed, unacknowledged, disbelieved, stigmatized, and judged, becomes a source of pain and trauma in and of itself (Cohen 1638-1639; Thernstrom 149). For those whose chronic conditions are subject to more scrutiny, such as "nonspecific pain,” fibromyalgia, chronic fatigue syndrome, headaches, and environmental illnesses, which predominantly affect women, the incidence of marginalization only increases (Edwards 20). This is to say nothing of the traumatizing effects of ostracism, isolation and discrimination.Reductionist thinking that stems from mind-body dualism also generates many inaccurate and oversimplified notions of how the mind and body work in tandem (Thernstrom 282-283). For example, “mind over matter” platitudes that infer all it takes is a change in perspective or “attitude” encourages misunderstandings and prejudices about the role of the mind to "overcome" persistent pain, be it anatomical, emotional or otherwise. Certainly, our minds can be quite powerful and it behooves us to use our capacities of cognition to our benefit. It is critical, however, to recognize that the emphasis of using our minds to "will" our perceptions can harmfully reinforce the dualism and dichotomizing of physical and mental pain. (For more on what comprises perception of pain, see part I of this series)*Note that while “women” in this case refers to those of an assigned gender of “female” I believe all people who identify as female (including non-binary) are impacted by these prejudices and more.Anatomical and emotional pain comprise only two of the ways pain is enacted. Come back next week for a new installment going deeper into the multidimensionality of pain.
Works Cited
Butler, David S. and Moseley, G. Lorimer. Explain Pain. Noigroup Publications, Adelaide, Australia, 2003.
Cohen, John et al. “Stigmatization of Patients with Chronic Pain: The Extinction of Empathy.” Pain Medicine, Wiley Periodicals, Inc., 2011, pp. 1637-1643.
Edwards, Laurie. In the Kingdom of the Sick: A Social History of Chronic Illness in America. Walker & Company, Inc., New York, New York, 2013.
Thernstrom, Melanie. The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering. Farrar, Straus and Giroux, New York, 2010.