3.2 Prolonged Pain leads to Cascades

Our idea about how Suffering works is that any severe and prolonged pain leads to a cascade of mental change that disrupts your other plans and goals. By thus suppressing most other resources, this narrows your former interests—so that most of your mind now focuses on one insistent and overwhelming command: No matter what else, get rid of that Pain.

This machinery has great value indeed—if it can make you remove whatever’s disturbing you, so that you get back to what you were trying to do. However, if that pain remains intense after you’ve done all you can to relieve it, then it may continue to keep the resources that it has seized—and further to proceed to capture yet more—so that you can scarcely keep anything else ‘on your mind’. If left to itself, that spreading might cease—but so long as the pain refuses to leave, that cascade of disruption may continue to grow, and as those other resources get taken away, your efforts to think will deteriorate, and what remains of the rest of your mind may feel like it’s being sucked into that black hole of suffering.

Now, goals that seemed easy in normal times get increasingly harder to achieve. Whatever else you try to do, pain interrupts with its own demands and keeps frustrating your other plans until you can barely think about anything but the pain and the trouble it’s caused. Perhaps the torment of suffering comes largely from depriving you of your freedom to choose what to think about. Suffering imprisons you.

Neurologist: These ideas about disruptive cascades are suggestive, but have you any evidence that processes like these exist? How could you show that these guesses are right?

It would be hard to demonstrate this today, but when scanners show more of what happens in brains, we should be able to see those cascades. In the meantime, though, one scarcely needs more evidence than one sees in the diversity of the complaints from the victims of suffering:

Frustration at not achieving goals. Annoyance at losing mobility. Vexation at not being able to think. Dread of becoming disabled and helpless. Shame of becoming a burden to friends. Remorse at dishonoring obligations. Dismay about the prospect of failure. Chagrin at being considered abnormal. Resenting the loss of opportunities. Fears about future survival and death.

This suggests that we learn to use words like ‘suffering’, 'anguish', and 'torment' to try to describe what happens when those disruption cascades continue: as each new system becomes distressed and starts to transmit disturbing requests, your normal thoughts get overcome, until most of your mind has been stolen from you.

Citizen: I agree that these all can come with suffering. But that doesn’t explain what suffering is. To be sure, resentment, remorse, dismay, and fear are all involved with reactions to pain—and can help to cause us to suffer. But why can’t we just regard ‘suffering’ as just one more kind of sensation?

When we talk about ‘sensations’ we usually mean the signals that come from sensors that are excited by conditions in the external world. However here, I think, we’re talking about signals that come, not from outside, but from special resources that detect high-level conditions inside the brain. Later, in section §4-3, we’ll suggest how such resources might actually work.

In any case, when suffering, it is hard to think in your usual ways. Now, torn away from your regular thoughts, you can scarcely reflect on anything else than on your present state of impairment—and awareness of your dismal condition only tends to make things worse. Pain, as we said, deprives you of freedom, and a major component of suffering is the frustration that accompanies the loss of your freedom of mental choice.

Of course the same is true, to a smaller degree, in our more usual states of mind: our thoughts are always constrained by the goals that we hold, which try to engage different processes. Those processes sometimes cooperate, but they also frequently clash and conflict. We never have enough time to do all the things that we want to do—and so every new goal or idea that we get may make us abandon, or put aside, some other ambitions we want to achieve.

Most times, we don’t mind those conflicts much, because we feel that we’re still in control, and free to make our own decisions—and if we do not like the result, we’re still ‘free’ to go back and try something else. But when an aching pain intrudes, those projects and plans get thrust aside, as though by an external force[ii] —and then we end up with more desperate schemes for finding ways to escape from the pain. Pain’s urgency is useful to us when we need to deal with emergencies—but if it cannot be soon relieved, it then can become a catastrophe.

Indeed, suffering can affect you so much that your friends may see you being replaced by a different personality. It may even make you so regress that you cry out and beg for help, as though you've become an infant again. Of course, you may see yourself as still the same, and imagine that you still possess your old memories and abilities. But you won’t be able to use those well until you switch back to your regular Self.

The primary function of Pain is to make one remove whatever may be causing it. To do this, though, it needs to disrupt most of one’s other usual goals. Whenever this leads to a large-scale cascade, then we use words like ‘suffering’ to describe what remains of its victim’s mind.

The Machinery of Suffering

“The restless, busy nature of the world, this, I declare, is at the root of pain. Attain that composure of mind, which is resting in the peace of immortality. Self is but a heap of composite qualities, and its world is empty like a fantasy.” —Buddha

“Life is full of misery, loneliness, and suffering – and it’s all over much too soon.” – Woody Allen

Yesterday Joan tripped on a step. She didn't suspect that she’d injured herself—but today she has just become aware of a terrible pain in her knee. She's been working on an important report and tomorrow she plans to deliver it. “But if this keeps up,” she hears herself think, “I won't be able to take that trip.” She tries to make herself get back to work, but shortly she drops her pen and moans, “I really must get rid of this pain.” She attempts to visit her medicine shelf, to find a pill that could bring some help, but a stab of pain makes her sit back down, and instructs her not to use that leg. She clutches her knee, catches her breath, and tries to think about what to do next—but the pain so overwhelms her mind that she can't seem to focus on anything else.

How does Joan know where her pain is located? That’s easy to do for each place on her skin—because she is born with ‘maps’ of her skin in various different parts of her brain, like this one in the sensory cortex.

www.sm.luth.se/.../ Sensory%20homunculus.png

Many textbooks about the brain explain that those maps help us to determine the locations of tactile sensations—but those books don’t ask what advantage we gain from having those maps—considering that the skin itself could serve for that. (We’ll discuss this in TopoQualia.) However, we are not nearly so good at locating the causes of interior pains. It seems that our brains do not come equipped to represent the locations of structures inside our skins. Presumably, good maps for these have never evolved because they would not have been of much use to us: before the era of medicine, there was no way to protect one’s spleen, except to guard one’s whole abdomen—hence all one actually needed to know is when one had a bellyache. In particular, one never says, "I feel a terrible pain in my brain,” because we never had any remedies for injuries to the brain itself—so we never evolved any sense of pain in our brains, or of the spatial locations of mental events.

In any case, for Joan's pain to be useful to her, it must make her focus her thoughts on that knee—while also postponing her other goals. “Get rid of Me,” Joan’s pain demands, “and get back into your Normal State.” She won’t be able to work on her report until she can satisfy that imperative.

How does our sense of pain actually work? Our scientists know quite a lot about the very first few events that result when a part of your body is traumatized. First, the injured cells release chemicals that cause a special type of nerve to send signals to your spinal cord. Then certain neural networks send other signals up to your brain. However, our scientists understand much less of what happens, then, in the rest of the brain. In particular, I’ve never seen any good high-level theories of how or why pain leads to suffering. Instead we find mainly descriptions like this:

The sense of pain originates when special nerves react to high temperature, pressure, etc. Then their signals rise up to your thalamus, which sends them to other parts of your brain—in ways that on various ways involve hormones, endorphins, and neurotransmitters. Eventually, when some of those signals reach your limbic system, this results in such emotions such as sadness, anger, and frustration.

However, that doesn’t explain what suffering is—because it isn’t enough only to know which parts of the brain are involved with pain. We must also know what those parts do and how each affects the other ones, both when we’re in our most usual states and (to make sense of suffering) when we’re subject to larger cascades. Ronald Melzack and Patrick Wall, who pioneered theories of how pain works, cautiously note that:

“An area within the functionally complex anterior cingulate cortex has a highly selective role in pain processing, consistent with an involvement in the characteristic emotional/motivational component (unpleasantness and urgency) of pain."[iii]

But we also know that that pain is involved with many other parts of the brain.[iv] Thus Melzack and Wall go on to say,

"The concept [of a pain center] is pure fiction unless virtually the whole brain is considered to be the ‘pain center’ because the thalamus, the limbic system, the hypothalamus, the brain stem reticular formation, the parietal cortex, and the frontal cortex are all implicated in pain perception."

Furthermore, our reactions to pain depend on other mental conditions:

Daniel Dennett: “Real pain is bound up with the struggle to survive, with the real prospect of death, with the afflictions of our soft and fragile and warm flesh. ... There can be no denying (though many have ignored it) that our concept of pain is inextricably bound up with (which may mean something less strong than essentially connected with) our ethical intuitions, our senses of suffering, obligation, and evil.” [v]

In general, we still do not know much about how physical pain leads to suffering. For although we have learned a good deal about where many functions are done in the brain, we still know very little about how each of those brain-parts actually work—because we still need theories (like those in this book) about what those resources actually do.

Perhaps we’ll find more clues about such things in a rare condition that results from injuring certain parts of the brain: the victims of ‘Pain Asymbolia’ still recognize what the rest of us describe as pain—but do not find those feelings unpleasant, and may even laugh in response to them. Perhaps they have lost some resources that cause what, in others, are cascades of torments.

Physical vs. Mental 'Pain'

Citizen: Physical pain is just one kind of pain—and emotional pains can be just as intense; they can even drive people to suicide. How could your theory also explain those other kinds of agonies?

Are mental and physical pains the same? They frequently seem to have similar ways to make changes in our mental states. What kind of relation could there be between how we react to, say, pinching or burning of the skin, and ‘painful’ events inside our minds, like,

The pain of losing a long-term companion. The pain of watching the pain of others. The pain of sleep deprivation. The pain of humiliation and perceived failure. The pain of excessive and prolonged stress.

Suppose that you were to hear Charles say, "I felt so anxious and upset that it felt like something was tearing my gut.” You might conclude that Charles’s feelings reminded him of times when he had a stomachache.

Physiologist: It might even be true that ' your stomach crawled' —if your mental condition caused your brain to send signals to your digestive tract.

Similarly, we often speak as though 'hurt feelings' resemble physical pains, no matter that they originate from such different situation-types. This could be because, although they begin in different ways, both may end up by seizing control of the same higher-level machinery. Thus, disrespect on the part of a friend can disrupt your brain in much the same way as a deep, aching pain. And sometimes, what starts with physical pain can get amplified ‘psychologically’:

Student: As a child, I once I hit a chair with my head, and covered the area with my hand. Although the pain was intense, I was not much disturbed. But when I looked and saw blood on my hand, then I really panicked and started to cry.

In any case, most kinds of feelings are hard to describe because we know so little about how their machinery works. However, it can be easy to recognize a mental state (either in yourself or in someone else) because you may only need to detect a few features of that particular mental condition. And this will often be enough to help us to communicate—by using what we call ‘empathy.’ For if two minds have enough structure in common, then just a few clues could lead each one to recognize some of the other’s condition.