The Phenomenology of Pain. Saulius GeniusasЧитать онлайн книгу.

      INTRODUCTION

      PAIN AS EXPERIENCE

      We can say about pain what Augustine (2006, 242) has said about time: “What is pain? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know.” Concessions of this kind are common in pain research. For instance, Thomas Lewis begins his Pain with the following admission: “I am so far from being able satisfactorily to define pain . . . that the attempt could serve no useful purpose” (1942, v). So also, Johannes J. Degenaar remarks: “I thought I knew what pain was until I was asked to say what the word ‘pain’ means. Then . . . I realized my ignorance” (1979, 281).

      Such statements might take one by surprise, especially in light of the overabundance of literature on pain that we come across in various sciences. The available literature, however, consists largely of empirical research on various neurological mechanisms as well as other factors that elicit a painful reaction on the part of some organisms. We are flooded with intricate and fascinating details about pain mechanisms, although we know little about the nature of pain experience.

      In the phenomenology of medicine, it is common to draw a distinction between illness and disease and to maintain that while the nature of the disease is determined neurophysiologically, the nature of illness must be fixed phenomenologically (see, for instance, Toombs 1993). We come across no analogous distinction in pain research. Should we take this to mean that the concept of pain is equivocal, that insofar as we think of pain as a biological mechanism, it must be determined neurophysiologically, while insofar as we think of it as experience, it must be determined by some other means? We would avoid much confusion if we conceded that pain as such is not neurophysiological in any sense of the term. At its best, pain biology can clarify the neurophysiological causes that give rise to pain as well as provide effective means to minimize pain or even eliminate it. Pain biology, if successful, can shed light on the neurophysiological mechanisms that, presumably, accompany pain experience. However, irrespective of its practical utility, pain biology cannot clarify the nature of pain experience.

      Pain biology presupposes that we know from experience what pain as experience is. Presumably, what we do not know are the causes that trigger it or the influences that shape it. It thus appears that we are in need of knowledge about matters that lie beyond the boundaries of experience. It seems that we are in need of pain biology, not what one might call “pain phenomenology.” How legitimate is such a view? To be sure, experience by itself tells us little about the neurological mechanisms that trigger pain experience. For this reason alone, there can be no question about pain phenomenology replacing pain biology. Yet what exactly do we know about pain as experience from experience? As soon as we try to articulate what is entailed in this implicit understanding, we come to the realization that we are dupes of our own ignorance. What is pain as experience? For this, we appear to lack words.¹

      In 1979, with the aim of determining the concept of pain with precision and thereby resolving various ambiguities that have arisen in the science of pain, the International Association for the Study of Pain (IASP) offered the following definition of pain, which continues to be the guiding definition to this day: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey and Bogduk 1994, 209). Thus, according to the nowadays-dominant definition, pain is an experience.² Yet what kind of experience? To qualify it as unpleasant is hardly sufficient to grasp its nature, for, clearly, such a determination is too broad and does not serve to distinguish pain from various forms of psychological suffering. The further stipulation that pain is not just an emotional but also a sensory experience does not resolve the problem, since nausea, vertigo, heartburn, the sensations of excessive heat and cold, of hunger and thirst, even itches and pressure can also be qualified as “unpleasant sensory and emotional experiences.”