This is something I wrote Way back in the day. I thought I would share it. It is a philosophical look at the pain experience.
Drew Leder in “The Absent Body” (1990) has some interesting insight to the lived experience of pain. According to Leder, normally the body is experienced as an absence, in a continual process of self-concealment and temporary revealing. When a part of the body is not being used it falls into the background and we hardly know it is there. Likewise, our internal body is rarely felt, aside from grumbling in our stomach and so forth. With the eruption of pain, the background region becomes thematized. Leder points out that pain has an episodic structure. Leder states, “Even pain of a more chronic nature are often marked with an episodic nature, changing in their character and intensity according to one’s activity, position, or visceral periodicities.” (p.72). Interesting enough pain does not follow the process of adaptation as does other stimuli. The sun may blind a person walking out of darkness, but soon the eyes adapt. Leder claims, “Pain receptors, on the other hand, adapt a little or not at all.” (p.72).
I think there is a process of adaptation in the chronic pain sufferer, although it is hard to be aware of the process since the pain remains although at a different intensity. An example to show this would be the use of pain killers. While the person is on the pain killers they feel little pain, or less than usual anyway. As soon as they cease to take the pain killers they are soon confronted with the full intensity of their pain; this then dims as the body adapts and the mind copes. It would seem that since painkillers dim the pain they also nullify the adaptation the chronic sufferer has developed. When they go off the painkillers the body again feels the full intensity of the pain physically present within the body. This will lower in intensity as the person ‘gets used to the pain’ or the body adapts as best it can to a stimulus that does not end when it should.
In regards to chronic pain, Leder does suggest that a person can become accustomed to a particular level of pain. Therefore the longer someone endures pain the more one develops a certain pain tolerance. The chronic pain sufferer constantly experiences some pain, and mild to moderate pain is easier to ignore and tolerate than more uncommon episodes of severe pain. Mild pain becomes the normal lived experience of the body. This is a curious phenomenon but one I quite understand. People always ask how someone with chronic pain can function in the day to day world and perhaps part of the answer, but not the only one, is simply that the baseline pain is part of their normal life. In the sense that Leder says the body is experienced as an absence, the lived experience of the chronically pained body simply is not. That baseline pain makes the chronic pain person aware of their body constantly and thus it is more extreme pain that is Thematized. Imagine what that must be like for a moment. If you are the ghost in the machine, you really don’t pay attention to the machine when it is running well. You can walk through the world and not have a bodily or spatial awareness like those in chronic pain do. They feel movement, they are aware of how position increases discomfort and they specifically alter their movements according to this awareness without thought. That lived experience of pain is quite different for just that fact alone, but then there also consequences to baseline pain physical awareness in that it distracts a person. Pain demands focus and even mild to moderate chronic pain demands.
Leder then goes on to discuss how pain has an ‘affective call’ and a ‘quality of compulsion’. Pain calls us to act because that is the normal functional role it has in the body. Pain has an intentional disruption: “Prior to the onset of pain, the lived body of the (person) is an openness upon the world” and s/he “lives from his (or her) body to the world.” (p. 74). When in pain, however, “the painful body becomes that to which he (she) attends.” (p.74). This creates an “absolute split between one’s sense of one’s own reality and the reality of the other persons.” (p.74).
Pain also has what Leder calls a spatiotemporal constriction. Pain creates limitations and “We are no longer out there in the world, but suddenly congealed right here.” (p.75). This involves motor restriction as “Space loses its normal directionality as the world ceases to be the locus of purposeful action.” (p. 75).
Finally pain “exerts a telic demand upon us,” (p.77) and we seek the means to end the sensation. Within this demand, Leder draws a distinction between the hermeneutical and the pragmatic moment. In the hermeneutical moment, “Suffering gives rise to a search for interpretation and understanding.” (p. 79) We try and discover the cause of the pain and involve ourselves in a quest for diagnosis through medical professionals, friends or other means. And naturally, there is the pragmatic goal, to rid ourselves of the pain through some treatment, or to master it. I would say that the pragmatic goal is an obvious response to pain, but the interpretation of the experience often plays a greater role, especially if the pain is in fact and endless condition within the body.
Pain is an important factor, as a disruption, to our lived experience. The hermeneutical and pragmatic goal Drew Leder refers to in the Absent Body are indeed important aspects to the pain experience. It is only natural that when we are struck suddenly with such a physical disruption we would seek the cause of it and fix the problem. A problem arises when the quest for meaning, diagnosis and understanding is inhibited, simply because the pragmatic goal of ending the pain sensation does not exist. We are faced with the dire fact that the pain will always be there. Obviously, this is a concern that arises with chronic pain. Because pain is private and cannot be measured, it can be doubted. If a medical professional cannot find the physical cause for the sensation, they may suggest it is psychological. This leads to a greater struggle for meaning and understanding within the sufferer. Is it possible to doubt your own pain? In a way, it is. When no explanation can be found, no concrete verification of the experience, even the patient may begin to believe it is ‘all in their heads’.
Not only can pain not be shared, to the point of being doubted, but it can also severely affect a person’s relationship with others. This means, although the experience is private, it can be inter-subjective as chronic pain can affect family, co-workers, friends and care-givers “and such persons in turn shape the experiential world of the sufferer.” (p9, Good, Pain as Human Experience) People close within the sufferers’ support group may doubt the reality of their pain, to the point that they may be accused of being chronic complainers, or feel as such.
Isolation is not entirely due to the fact that pain cannot be shared, but because the lived world of the chronic pain sufferer is what someone else can only understand through a transitory moment of pain. Normally when the pragmatic goal of ending the pain is achieved, the memory of it fades with perhaps only an echo of what it felt like emotionally as a reminder of it. How does one then extrapolate from that brief moment in time to imagine that moment extended indefinitely?
As Drew Leder points out, pain has a way of fixing us in the moment; it fixes us into the now and so “With chronic suffering a painless past is all but forgotten.” (p76, Leder, Absent Body) Although the experience of pain may be demanding of the attention, in the moment, once the pain diminishes the memory of it soon dims. Someone cannot comprehend how it is to live with enduring pain, because they cannot clearly recall how pain affected them in the moment of the experience, let alone a moment of longer duration. Often our memory of past physical pain is the memory of what caused the incident and how it was resolved, rather than living the moment of pain clearly. Perhaps it is equally difficult for a chronic pain sufferer to image a pain-free existence. If our baseline pain changes how we physically become aware of our bodies, how then do we remember a time when we were not so aware of how we moved in the world?
Even though pain is usually episodic, the chronic pain sufferer is always aware of some pain in some location at some intensity. They are constantly aware of their ‘pained body’, such that a certain amount of discomfort or consideration to position and intensity of pain because automatic, with some minor pain being just a barely noticed background to everything else. This ‘attention’ and awareness of the body that is lacking in normal functioning. And this makes the pained body grounded into the present state of affairs, where they can no longer bodily remember what it felt like to have no pain, nor can they conceive of a future with no pain. They may recall being able to do activities they no longer can, but they cannot remember how it felt to move without being quite aware of that movement through pain.
However, being grounded in this pained awareness of body does not mean they are fixed in the present moment. Not quite ‘living in the moment’. In fact, the pained body, and even the body experiencing episodic pain experiences time itself differently. Because of this grounded feeling in the body, perception of reality outside the body is altered. Time, in particular, becomes distorted. When experiencing intolerable pain, time seemed stretched to infinity and moving unbearably slow. The sufferer is locked into that pained experience, to the point of excluding all other considerations. With enduring pain, everything becomes a time-consuming act. At other times, time seems to be rushing while they are unable to keep the pace. A great deal of guilt can result from not being productive or filling time as efficiently.
Pain gains it immediateness of our attention from its intensity and the intensity determines how much focus we pay to it, how much effort we put into making adjustments because of it. Mild pain becomes tolerable and easy to ignore experience and thus it really does not exert that much of a demand for attention in the chronic sufferer. It might not even be mentioned. Moderate pain would be seen as pain that exerts a constant demand for attention, thus impairing focus and ability to function, perhaps limiting movement. Yet for the chronic sufferer, even this is pain that there remains a level of functionality, which becomes the more important factor within the scale. Function and Cannot Function.