Education *IS* Medicine
Lorimer Moseley presented recently at APLAR-ARA 2019 (The 21st Asia Pacific League of Associations for Rheumatology Congress in conjunction with the Australia Rheumatology Association – good idea to use an acronym for that one). While there he was interviewed by Felicity Nelson for the Rheumatology Republic.
Felicity opened the interview with something simple to break the ice, so to speak,
“Do you want to start by explaining, What is pain?”
Classic Lorimer responding,
“That is a brutal question to start with…”
It’s a jam packed 20 minutes (headphones, cup of coffee, bit of toast, make your bed, brush your teeth – that’ll do it) and you can listen to the whole thing below:
Or find the original at the Rheumatology Republic website
In my opinion, the question was a pointless one. It would be like asking a scientist (or anyone) to describe the colour “red”.
A rather extraordinary statement! Debate on the nature of colour dates back to the Greeks. The metaphysical status of colour has influenced enquiry into physical reality and the mind. One of the most famous modern philosophical thought experiments – Mary the colour scientist – asks about colour, red in particular (a coincidence?). How is it a pointless question? Haven’t you and your colleagues attempted to answer (something similar to this) question in suggesting that pain constitutes an aporia?
Tim, I thought the question was pointless because (almost) everyone comes to know what “pain” is, through their own experience.
Yes, we did make the claim that pain is an aporia and this is still our position when we are asked to describe the experience.
However, as has Lorimer, we attempted to improve upon the IASP’s current definition of pain, because that definition may not be readily transferable to the clinical context where no tissue damage can be detected in those complaining of persistent pain. Our emphasis is more on the existential dimensions of the experience, both to patient and clinician.
Lorimer’s response to the question “What is pain?” – “pain is a protective feeling that is generated when the brain thinks protective action is going to be a good thing to do” – perpetuates what might be called the “homuncular theory of pain”. To the best of my knowledge, there is no little man residing in the brain and directing operations.
Attributing properties to the brain when they are those of the entire person constitutes a serious logical flaw in his argument. As I have said elsewhere, brains do not know anything and cannot make decisions.
I’m with you on everyone coming to know what pain is through their won lived experience. But I still think the question is a useful one to ask anyone whose life is spent researching the phenomenon, perhaps as much for how they answer as for what they say.
I’m with you again on it being a mereological fallacy that brains think, or decide, or know. I find that i need to be on alert for slipping in to this short hand though. A corollary then is just what is it that the brain does do? I’m sympathetic to Karl Friston’s ideas about what the brain is as a first step towards answering what it does.
Tim, I take your point about the relevance of thought experiment involving “Mary the colour scientist”.
Mary doesn’t know what it like to experience red until she discovers it when she leaves the room.
Therefore, no matter how exhaustive an analysis of what goes on in my brain is available to me, when I hit my thumb with a hammer, I experience the pain … not my brain.
Thank you for helping me to clarify this matter.
As you may well be aware while Frank Jackson, the Australian philosopher who originally posed this thought experiment, has himself moved away from it and some of the possible propositions that come out from it (the existence or not of non-physical facts about conscious experience for example), and others have severely critiqued the very premise (that Mary can know all the physical facts about colour vision), as thought experiments go it seems to have bene wildly successful in stimulating thought and debate.
I have often wondered about a nociceptive analogy – Mary’s sister Jane is a leading neuroscientist who in some possible future has come to learn all the physical facts about nociception, pain, how they are related/not related etc. By some weird twist of fate, she has lived her life in an entirely nociception-free bubble and has furthermore never experience pain herself (it is a thought experiment so these hypothetical situations, however unlikely, can still obtain). One day, she is released from this bubble and steps on a thorn attached to a red rose that her sister Mary has carelessly discarded (having learnt something/nothing knew about the experience of seeing red for the first time???)…. What does Jane feel? Does she learn anything new about the experience of pain…?? Of course the danger with these ‘knowledge arguments’ is the spectre of some form of dualism creeping in.
No doubt it is always Jane experiencing whatever it is she might experience (not her brain) !
Tim, I was rather hoping that someone in the NOI group would reassure me it now accepts the proposition that there is much more to the experience of pain than is apparent from studying and trying to understand the ways in which brains function.
John, i am happily a card carrying 4E (enactive, embodied, embedded and extended) cognitivist (most days). I can see no reason why the experience of pain would not also arise from the dynamic interaction of an embodied agent (including their body, brain, limbs other organs) with other agents embedded in an ecological niche.
Whether this is reassuring or not….
Tim, perhaps you might like to remind Lorimer that some 5 years ago, he publicly repented for the sin of being “A neurocentric”.
In Lorimer’s own words “I repent my neurocentric ways and hold aloft the banner of biocentricity”.
What has happened in the meantime to account for his reversion to neurocentrism?
Here is the link: https://bodyinmind.org/time-to-embrace-bioplasticity/
Ah yes, I recall that post and the ensuing discussion well and have just enjoyed reading back over many parts of it – heady stuff – Biosemiotics, autopoiesis, Bateson, Maturana, Varela… sadly these ideas and giants of thought seem to have faded once again into an obscure corner of the study of the experience we label pain. Alas, the closure of the BiM comments was a sad day for a deeper discourse.
I believe that Pat Wall once said something along the lines of ‘it is nearly impossible to replace a simple schema with a more complicated (but more correct) one, once the simple ideas have been accepted’. Perhaps this fits here…
Tim, thank you for responding to my questions.
However, my ongoing concern is with item number 3 on the list of five critical conceptual change issues that constitute the “essence of NOI”.
It reads as follows: “Pain, stress and performance are outputs of the brain”.
I would argue that all three are attributable to the whole person and not to his or her brain.
This conceptual confusion does need to be addressed, as it appears to pervade NOI’s approach to pain education.
Personally, I can’t argue with any of that John. Have made at least one small change.
The mereological fallacy pervades a lot of neuroscience – the recent clamour of excitement over the ‘dead’ pig’s brains is testament to that. https://www.theatlantic.com/science/archive/2019/04/scientists-partly-restore-activity-dead-pig-brains/587329/
I wasn’t sure if this part was serious or not:
“Though individual neurons could fire, there were no signs of the coordinated, brainwide electrical activity that indicates perception, sentience, consciousness, or even life. The team had anesthetics on standby in case any such flickers materialized—and none did” (emphasis added)
Just what exactly were the anesthetics for!!?? Were they worried that this disembodied brain in a vat would start to ‘hurt’.
And then this:
“It’s also unclear why the pig brains never regained coordinated activity”
I could hazard a guess…
Thanks for your ongoing engagement and challenges John
My very best
Tim, I am pleased to find that we are in agreement.
However, with the rapid rise of modern pain neuroscience, and the aggressive reduction of mind (and consciousness) to brain events, it can too easily be forgotten that the person experiencing pain who is deliberating about possible choices wishes to feel that “he” or “she” rather than mere circuits of neurons is doing the deciding.
A process of deliberation has its own internal momentum and agency and is guided by the individual in question and not solely by his or her brain [Scheurich 2002].
I hope the NOI Group moves quickly to clarify its position and its policy on this fundamentally important matter.
Reference: Scheurich N. Moral attitudes and mental disorders. Hastings Cent Rep. 2002; 32(2): 14-21.