Tuesday, June 18, 2013

Melzack & Katz, Pain. Part 8c: Getting objective about subjectivity

The paper, Pain

Part 1 First two sentences Part 2 Pain is personal Also Pain is Personal addendum., Neurotags! Pain is Personal, Always.

Part 3a Pain is more than sensation: Backdrop Part 3b Pain is not receptor stimulation Part 3c: Pain depends on everything ever experienced by an individual

Part 4: Pain is a multidimensional experience across time

Part 5: Pain and purpose

Part 6a: Descartes and his era; Part 6b: History of pain - what’s in “Ref 4”?; Part 6c: History of pain, Ref 4, cont.. : There is no pain matrix, only a neuromatrix; Part 6d: History of Pain: Final takedown Part 6e: Pattern theories in the history of pain Part 6f: Evaluation of pain theories Part 6g: History of Pain, the cautionary tale. Part 6h: Gate Control Theory.

Part 7: Gate control theory has stood the test of time: Patrick David Wall;  Part 7bGate control: "The theory was a leap of faith but it was right!"

Part 8: Beyond the gate: Self as mayor Part 8b: 3-ring circus of self

How to be objective about matters so subjective?

Science doesn't seem to like "experiences" or experiential verbs in general, very well, because it's hard to measure them or compare them. Science is a bit stand-offish that way... unless something can be reliably and repeatedly measured, it can't be said to actually "exist" - everything must be turned into a noun, or at least, a number, a "score"- before it can be acknowledged (responsibly!) as reality. See reification (knowledge representation)

Pain is always and forever a personal experience.  Pain is what the patient says it is. Pain is "a personal, subjective experience influenced by cultural learning, the meaning of the situation, attention, and other psychological variables."(from the abstract). The only thing that can be measured is output. Pain behaviour.

Enter Melzack: Let's sit back and admire what Melzack accomplished: He took a Cartesian-imbued fact of human life, i.e. "pain"; he studied it as best he could using the clunky tools that were available to his investigative inquisitive self, i.e., the ones that had been developed over the 20th century, the same ones all the labelled-line researchers had been using from the time of von Frey. These tools and that mindset had developed to be congruent with "science" as something that "discovered" and "measured" so-called objective reality, a current within science that began back in the time of Descartes and had had a lot of self-reinforcing success. McGilchrist has a great deal to say about this trend in his book on the human brain and the at-odds viewpoints of its hemispheres (blogposts here).

But Melzack remained dissatisfied; at least one corner of his mind remained properly skeptical about all of it. He hasn't been the only researcher dissatisfied with how study of the most intimate experiences of life were forced into objectifying frames that sucked them dry and meaningless - Jaak Panksepp's work with animal consciousness comes to mind. The scientific tools - the entire scientific mindset -  for studying both pain, and consciousness, were pretty clunky; they either completely missed the point (i.e. study of pain), or else denied the obvious completely (i.e., Skinnerian study of animal behaviour denied intrinsic conscious motivation/animal emotion/purpose). 

Perhaps the best thing Melzack ever did was develop, test, validate and unleash some questionnaires out into the world, that managed the impossible: assign numbers to something as personal and changeable and nebulous as personal pain experience. He did it by wading right into the middle of it, writing down everything anyone describing their pain experience had to say, as a descriptor, then figuring out how to assign predictive values to it, and validating the responses, scoring them. Here are the fruits of his labour.
Confession time
I have to admit, I've never used these tools in my everyday work, personally.. I'm just not that nerdy. I think it's overwhelmingly important to understand them (and science methodology in general) if one is actually conducting science, or working in some sort of interdisciplinary setting, where scores can become conversational code for complete sets of interchangeable information.. someone says, "so-and so scores a 4 on the xyz scale.." and everyone in the room regardless of their discipline immediately infers what is being implied. Having a common language breaks down interprofessional silos - this sort of collective understanding is important in collective, team-delivered patient care. 
I, however, remain an introverted solo practitioner of very basic sensory-motor interactive human primate social grooming, and I'm old, and in a rut, and don't want to change my own life... my own brain doesn't want to learn to speak or comprehend this language, for the same reasons it never wanted to learn to comprehend or speak ortho-ese (which is another example of reification, somewhat different though). 

What I really appreciate is that mutually agreeable objectified testing of deeply personal subjectivity has helped/is helping turn the overall objectifying scientific tide away from the old idea of imagining pain as some "thing" that could one day be "found,"carried by some fibre in the body - toward locating it where it belongs, as a percept, a conscious experience, non-consciously constructed but experienced by a conscious individual, personally. 

It's nothing short of a revolution. Really. 


Carol Lynn Chevrier added a couple important links to a share of this post on Facebook: 

Metaphors actually trigger the sensory parts of our brains, and this quote:

  • “Pain is subtle. He has cold grey fingers. His voice is horse from crying & screaming... When people try to avoid him, he follows them silently & turns upas the bartender, or the bus driver... Pain has an elaborate filing system for keeping track of everyone... Pain respects people who are willing to take risks. If you... face him directly, he will give you a special ointment so your wounds don't fester.”
    ― J. Ruth Gendler, The Book of Qualities
    She also wrote,
    "It is. A revolution I mean. The pain questionnaire is what got me into studying metaphors. The descriptions are so very poignant. So many times I've seen people go '' Yes, that's exactly it. It is nauseating/burning/etc. Yes. Yes. '' And then the look, that look in their eyes that says '' Oh. I've been heard. I've been seen. Oh."

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