Explaining pain to patients does not always work out as well as you would expect . There are many reasons why sharing this gift of science may not be effective and identifying the reasons and best clinical practice will take a mountain of clever research. One reason may well involve whether the owner/maker of the pain understands it as a process or an entity. A process is changeable, dynamic and has a start and a finish. An entity is something with an independent existence. I believe many people consider pain an entity, so to them it’s independent of the many things which are agents in the emergence of pain. To them it’s an entity that can be unleashed and can come in and occupy their body, and it attaches itself to them like mistletoe on a tree sucking the life out. They don’t want to own it but the link is too strong. They want you to find the body mistletoe and get rid of it. Some people think of cancer the same way.
An alternative view is that pain is a process. If it was an entity there should be an answer to “where was the pain before you experienced it and where does it go when its gone”? We perhaps think of ourselves as entities and it may be only natural to think of pain as an entity too. Perhaps we could consider ourselves as processes and pain as a process within a process?
I have two questions and I need some help:
- Are you a process or an entity and does it matter? And pain?
- In Explain Pain education, we often try to objectify pain to make sense of it via physical means and physical imagery. In doing this, do we risk making it more of an immovable object, an entity with permanence ?
This blog post links to the recent noinotes
Dear David and Friends,
Fantastic blog. Your thoughts have helped me brought forward some thoughts that I have had about why some patients are able to grasp the concept of pain and others remain stuck in the MRI, the EMG, the x-ray, and the physical diagnosis. I have to say that my medical models of tissue or organ dysfunction ( which I have been trying hard to change) are ones that are still, to a large part, based in entities, i.e.: A disc in the back, a bug attacking my throat, a rogue cell out of control and attacking my body, etc. Where processes are involved, it is in two primary ways: one the entity uses its own or co opts my own processes to attack me; or I marshall my own processes to attack the entity. It is hard do change that model given the consistent and very effective marketing and training models of traditional medicine. I am in a process, hopefully of changing that.
If we think, however, about most of the very serious public health problems facing us ( obesity, metabolic diseases, chronic disability/pain, mental health impairments, etc.), the core source of these are not in some attacking entity, but exist, in most part, in behaviors and beliefs that are self directed by our own processes . If any entity is involved in these destructive processes, they are not internal but external forces that affect those internal processes: cultural norms, taught behaviors, advertising, societal interactions and expectations, etc.
The treatment of entities lend themselves to be easily transferable to another entity ( medication, surgeon, etc.). They lend themselves to an external locus of control. The treatment of processes most likely means that you have to do something about it yourself. You have to marshall your own stores of self discipline, effort, and devotion of time. There has to be a strong internal locus of control that allows you to take charge and belief in your own self efficacy. In those patients who I have seen been successful in managing the process of pain, it has been those who either came with that strong internal locus of control or who with training and education were able to find it. The treatment of any of the public health concerns I mentioned above have not responded well to treatment by entities unless behavioral change (neuroplastic change) has been part of the entity’s program.
Am I an entity or a process? I am both. I am an entity bound up in a lot of processes, some good and some bad.
Another question however is: Is nociception a process or an entity?
Very philosophical question!
Firstly, I would have thought that I am an entity, but then on the other hand I’m a bunch a physiological processes which without I wouldn’t exist so I’m not sure…. I’ve heard in a couple of places (including on Oprah so it must be true!), the idea that we are all “spiritual beings having a human experience” – but then that doesn’t really resolve the question either…
Pain is (if you listen to the IASP anyway) an experience, which by definition is a process….but then my headaches certainly have a “life of their own” so maybe pain is an entity?
I’m not sure there actually is an ‘right’ answer to either of these, or if it even matters… I wonder if what matters most, is how the two match up – or don’t as the case may be….
I’ll try to explain:
1. If someone sees themselves as a entity and pain as an entity, does this lead to a confrontation, the butting of heads, a “coming up against it” a need to defeat or conquer it?
2. If person = entity and pain = process, would this mean its like something has got hold of them, its pushing them around and maybe taking them for a ride?
3. If person = process and pain = entity, would this be a roadblock, something that gets in the way and hinders someone getting where they want to be, like hitting a brick wall?
4. If person = process and so does pain, what happens when the two combine? Does it create an explosion? Does one cancel the other out? Do they lose their sense of identity with it?
It would be really interesting to know which of these 4 ‘categories’ most patients fall into to… Or if different types of pain are viewed as processes (eg: headache) versus entities (eg: sprained ankle)? Is this distinction based in causality (ie: no diagnosis = process, with diagnosis = label/entity) or in time? Maybe it really does take on a ‘life of its own’ when it’s been around a while? Also of interest would be if patients who cope well in the presence of pain tend to be in a different ‘category’ from those who are particularly distressed by it. And can one change category?
I wonder if, in pain education, we might be able to listen for how the person views both themselves and pain and then be really clever with linguistics to help the patient 1) make peace with the pain / 2) learn to go with the flow / 3) find the right way around the problem /4) absorb the issues as needed? (A metaphor for each category)
Could we make sense of pain using process imagery, as well as object imagery, on a case by case basis, depending on what might “undo” the conflict that exists in the patients own unique “object vs process” situation?
A very abstract answer…best read with a clear head and caffeine on board!
I have recently been introduced to the mandala which portrays the way in which all things are interconnected. I have found that Eastern philosophies offer more room for understanding connections and processes – rather that the Western way in which I have been taught. Perhaps embracing the Eastern view of health might enable us to change our own views, and help us with using more creative language to “explain pain”. I have also seen that some patients benefit from the education I provide, while others incorporate it into their already “warped” view of themselves and pain. We need to find a way in which we can really come to grips with how patients view themselves and the world, in order to use appropriate language which makes “sense” in their worlds.
Many thanks. This is helpful as we try to improve the Explain Pain outcomes, even though reconceptualisation of pain currently has the best outcomes for treatment for chronic spinal pain.
For me -I conceptualise myself as a process and so is pain – I guess that is what evolution is all about. If time would freeze I would be an entity. However, someone going through a painful heath experience will meet many entities – the MRI, the diagnosis, the clinic, the pictures on the clinic wall, the insurance company, the money paid, the patient’s view of the health professional, the pills – these are entities and as Louise has suggested above, may act as roadblocks and enhance notions of pain the entity.
And then the fight often starts – as John notes with the use of “attack”. Why attack a process that is part of you (unless it has gone really really crazy). Self discipline, effort and time devotion to get to know yourself and your neighbours seems more appropriate. (Might stop a few wars too!). Perhaps some of the entities met along the way could be reconceptualised as processes. ?Moving towards a mandala.
David
Thanks for your thoughts David. I agree that Pain is a process, but is nociception? I can perceive it as both. I would like your thoughts.
Hi john, i have been thinking about this while devouring a custard tart. To me it’s a process, an ever changing adapting process to defend the individual and the species. I am not sure of the turnover of TRP channels but it must happen continually and quickly – maybe a day or so.
Then I realised how I teach nociception and how i make it an entity by my words, lecture notes, drawings. I need to update my teaching. I am interested in how you see it as an entity.
David
Yo David,
I hope that you enjoyed your custard. It is now a spectacular late summer Friday afternoon and I decided to start the weekend early with a beer or two. As a result, your neurological processes may be a little keener than mine.
But I would not go about changing your lectures yet. My thoughts on nociception are similar to those about light: is it a particle or wave? Well light has properties of both. I think that nociception has the same duality. In my mind the production of neural activity due to impending or actual tissue damage is an entity. The receptors in the skin, muscle, etc. that are physically stimulated by ongoing or potential damage are producing an action potential. To me that is quantifiable, reproducible, and observable and would qualify as a physical entity. However, the response generated by that action potential can be highly variable depending on the person, environment, past experiences, etc. What happens after that primary neuron becomes a process with lots of variables that make measurement, reliable reproduction, etc. much more problematical.
Back to my beer. Have a good weekend David. Johnb
Thanks John et al.,
What has been really helpful for me here, a prephilosophical soul, is to realise that this is not semantics, it is important for the content and delivery of educational therapy and these discussions should continue. I have struggled with the recent shifts to consider pain as a disease, which of course makes it an entity and limits the key changeability criteria of a process. I am thinking I can go along with nociception as having both entity and process criteria. It has no start and finish either.
David
Dear David,
I hope you are aware what a big question you are opening up here for us – pondered upon for thousands of years by the greatest philosophers and other wise seekers – as you are asking us to reflect on our essential identity (who we really are)!
However, I do think the questions you are raising here are very relevant indeed in relation to pain, what it actually ‘is’ and how to relate to it and work with it with our patients – and indeed within ourselves because if we don’t get it, how ever will we be able to embody it and convey it in our work?
Being aware of the danger of my response sounding potentially even more confusing, I believe we need to firstly acknowledge the genuine complexity and depth of this endeavour. My attempt to answer your question is this: “I am both – entity and process”; and pain too is a process that is very much embodied in the person and therefore often experienced as an entity. And yes, it does matter! Why? Because with this approach we are again trying to blow that ‘old friend duality’ right out of the water.
In a specific meditation we use here at Limbus practice with some of my ‘persistent pain patients’ who are sometimes also working with Daniela, a psychotherapist, it says: “I have a body and I am not my body” – which we can also transfer and say: “I have pain and I am not my pain”. This way we are still deeply acknowledging the challenging experience of a patient’s pain whilst helping them not to identify with it. Rather than splitting the answer in two and wanting an ‘either/or’ response to your question ‘is it process or entity?’ I am proposing this: ‘both/and’, meaning: I am and pain is ‘a process embodied’ or ‘an embodied process’, if you like.
In relation to your second question it has been my experience that working with metaphors and imagery works wonderfully well to help my patients to visualize more complex issues around their struggle towards healing and have not found that it contributes negatively in making pain more of an ‘entity’. Of course, if a patient is revealing this kind of thinking, for example by saying he/she is wanting to ‘get rid off the pain’ I will use my understanding ‘to explain Pain’, including illuminating and educating them on what I think it actually is (‘an embodied process’). Therefore I think that even though the use of metaphors might at times support the ‘belief’ that pain can be seen as an entity by the patient, the more important positive effect of using metaphors is that it helps us as practitioners to understand what the patient is experiencing. If the person feels we have truly heard and understood what he has expressed of his suffering and pain through the use of metaphor, we have created a foundation of trust and empathy from which we can then help the patient to shift the belief pattern towards one in which the pain is understood more as an ‘embodied process’ rather than being understood as ‘an entity’.
I am looking forward to your thoughts on this!
Could it be an either/and instead of an either/or type answer or is it possibly a false dichotomy?
Sometimes it’s useful as a clinician to view/describe aspects to the client from one p.o.v -entity/noun and sometimes it’s useful to view/describe it from another p.o.v – process/verb … and sometimes it’s useful to view it from a quality/adjective p.o.v.
When I talk to my client they want to know content (entity (it’s a feature inside of their body)) and context (process (determined by processes inside of their body that rely on structures (which are entities)) but there is also the feature of how I tone (adjective) that discussion and is not the placeboness or noceboness of our communication entangled partially with the content and it’s delivery?
I know the pain is not a qualia concept and agree with it in parts but does everything that is adjective like in nature (neither a process nor an entity) reside under the qualia umbella?
I found this helpful ..Alfred Whitehead 1923 I think …The philosophical idea of misplaced concreteness is very useful http://en.wikipedia.org/wiki/Reification_(fallacy)
Most people in the chronic pain clinic population (that i encounter) are ‘encultured’ into this state and no amount of explaining processes and physiology helps . The practical problems that many people are dealing with are sociological/educational/behavioural/motivational all processes but the thing that keeps many stuck is that this idea of an external concrete thing we/they assume is a mechanical ‘thing’ . Pain feels like the concrete thing that is the problem rather than a defence mechanism that is awry.
In the physio world, I do think this process (link below) and motivational approach has to be a better model to work from than the courses i have just skimmed through at the back of the physio comic .http://www.healthchange.com
Kim Allgood – President – The Purple Bucket Foundation Inc.
Having thoroughly enjoyed every word of the above blog, I feel obligated to add my own thoughts as they come from 20 years of the Chronic Pain ‘process’.
I believe “pain” is an entity and “chronic pain” a process. Pain is felt after injury and surgery, mostly with proper treatment and rest, it goes away with the healing of said injury and or surgery, thus an ‘entity’.
Pain that develops into something more has “become”. Neurological signals and messages passing between the site and brain, have created a ‘process’.
Should the question not be about pain rather than the person being an entity or a process?
Give a pain patient a piece of their favourite cake, or a couple of scoops of ice-cream on a flat plate. Sit beside them with a serving for yourself. The rules are very simple – eat and enjoy, but; no spoons, no forks, and no fingers. Once you’ve devoured your little snack, ask them if they felt any pain while they ate, (neither of you are allowed to clean your face until after the question has been answered) 🙂
Cheers
Hi all,
I am interested in knowing if the self is an entity, a process, or both. From various disciplines/investigations, so far, I have compiled 58 facets/sub-aspects/notions of the self/selfhood, which are listed in (Vimal, 2020): .
I have categorized them into two groups of facets: (i) Active Dynamic Self (ADS: self-as-object or James’ “Me”) as a process in the brain or brain-like information processor; ADS dies with the brain death. (ii) Passive Invariant Self (PIS: self-as-subject or James’ “I”) as an entity that survives death as known by Sankhya-based yogis at Samadhi state. Therefore, the self can be both a process and an entity in a complementary sense, in an analogy to the wave and particle as complementary facets of a wavicle.
Q1. Are we (as subjects of experience) a process or an entity?
(Bing, 23nov2023)
A1. That is a very interesting and complex question, and there is no definitive or unanimous answer to it. Different philosophical, psychological, and scientific perspectives may have different ways of approaching and answering this question. Some possible ways of thinking about whether we are a process or an entity as subjects of experience are:
• Process: Some philosophers and scientists argue that we are not fixed or stable entities, but rather dynamic and changing processes. For example, Daniel Dennett (1991) proposes that we are “multiple drafts” of ourselves, constantly revising and updating our self-narratives based on new information and experiences. Similarly, Antonio Damasio (2010) suggests that we are “self processes” that emerge from the continuous interaction between our body, brain, and environment. From this perspective, we are not substances or things, but rather patterns or flows of activity.
• Entity: Some philosophers and scientists argue that we are not ephemeral or transient processes, but rather enduring and coherent entities. For example, Derek Parfit (1984) proposes that we are “psychological continuers”, meaning that we persist over time as long as we retain some psychological connection or continuity with our past selves. Similarly, Thomas Metzinger (2003) suggests that we are “phenomenal selves”, meaning that we have a stable and unified sense of selfhood that arises from the integration of various sensory and cognitive processes. From this perspective, we are not events or actions, but rather objects or agents.
• Both: Some philosophers and scientists argue that we are not either processes or entities, but rather both in different respects or levels. For example, Evan Thompson (2007) proposes that we are “enactive selves”, meaning that we are both emergent and embodied, both dynamic and stable, both relational and individual. Similarly, Shaun Gallagher (2000) suggests that we are “minimal and narrative selves”, meaning that we have both a basic and pre-reflective sense of selfhood that is constantly present in our experience, and a complex and reflective sense of selfhood that is constructed through our personal and social history. From this perspective, we are not mutually exclusive or incompatible categories, but rather complementary and interdependent aspects.
These are just some of the possible ways of thinking about whether we are a process or an entity as subjects of experience, and they are not mutually exclusive or exhaustive. There may be other ways of thinking that are more or less valid, useful, or satisfying. Ultimately, the question of whether we are a process or an entity as subjects of experience may not have a single or simple answer, but rather invite us to explore and appreciate the diversity and depth of consciousness and selfhood.
References:
1: Dennett, D. C. (1991). Consciousness explained. Boston: Little, Brown and Co.
2: Damasio, A. (2010). Self comes to mind: Constructing the conscious brain. New York: Pantheon Books.
3: Parfit, D. (1984). Reasons and persons. Oxford: Clarendon Press.
: Metzinger, T. (2003). Being no one: The self-model theory of subjectivity. Cambridge, MA: MIT Press.
: Thompson, E. (2007). Mind in life: Biology, phenomenology, and the sciences of mind. Cambridge, MA: Harvard University Press.
: Gallagher, S. (2000). Philosophical conceptions of the self: Implications for cognitive science. Trends in Cognitive Sciences, 4(1), 14-21.
Learn more: 1. link.springer.com2. link.springer.com3. frontiersin.org
Q2. What is the difference between a process and an entity?
(Bing, 23nov2023)
A2. A process and an entity are different concepts that can be used to describe or model various aspects of reality. A process is a changeable, dynamic, and temporal phenomenon that has a start and a finish, and involves some transformation or interaction of data, information, energy, or matter. An entity is a stable, static, and spatial phenomenon that has an independent existence, and has some properties or attributes that characterize or identify it. For example, a process can be a cooking recipe that takes some ingredients and produces a dish, while an entity can be a book that has a title, an author, and a number of pages.
There are different ways of thinking about the relation between processes and entities, depending on the context and the perspective. Sometimes, a process can be seen as a part or a function of an entity, such as the process of photosynthesis in a plant. Sometimes, an entity can be seen as a result or a component of a process, such as the entity of water that is formed by the process of hydrogen and oxygen combining. Sometimes, a process can be seen as an instance or a manifestation of an entity, such as the process of running a program on a computer. Sometimes, an entity can be seen as a representation or a abstraction of a process, such as the entity of a data flow diagram that models a process of data movement in a system.
There is no definitive or unanimous answer to the question of what is the difference between a process and an entity, as different fields and disciplines may have different definitions and applications of these concepts. However, a general and simplified way of understanding the difference is that a process is something that happens, while an entity is something that is. For more information, you can refer to the following sources:
• Are you a process or an entity? – A blog post that discusses the difference between process and entity from a biological and psychological perspective.
• What is Data Flow Diagram? – A web page that explains the concept of data flow diagram, which is a graphical representation of processes and entities in a system.
• Difference Between Process and Program – A web page that compares and contrasts the concepts of process and program in computer science, which are related to the concepts of process and entity.
Learn more: 1. noigroup.com2. visual-paradigm.com3. guru99.com4. bing.com5. blog.hubspot.com6. geeksforgeeks.org7. vertabelo.com8. en.wikipedia.org
Q3. Can we be both a process and an entity at the same time?
(Bing, 23nov2023)
That is a very good and challenging question, and there is no definitive or unanimous answer to it. Different philosophical, psychological, and scientific perspectives may have different ways of approaching and answering this question. Some possible ways of thinking about whether we can be both a process and an entity at the same time are:
• Yes: Some philosophers and scientists argue that we can be both a process and an entity at the same time, depending on how we define and measure these concepts. For example, Mark Rowlands (2010) proposes that we are “hybrid selves”, meaning that we are both physical and mental, both material and immaterial, both natural and artificial. He argues that we can be both a process and an entity at the same time, as long as we do not assume that these concepts are mutually exclusive or incompatible. Similarly, Andy Clark (2008) suggests that we are “extended selves”, meaning that we are not confined to our bodies or brains, but rather extend to our tools, technologies, and environments. He argues that we can be both a process and an entity at the same time, as long as we do not assume that these concepts are fixed or static. From this perspective, we can be both a process and an entity at the same time, as long as we are flexible and adaptive in our understanding and application of these concepts.
• No: Some philosophers and scientists argue that we cannot be both a process and an entity at the same time, because these concepts are fundamentally different and incompatible. For example, David Chalmers (1996) proposes that we are “hard problems”, meaning that we are not explainable or reducible by physical or functional terms, but rather pose a unique and insoluble challenge for science and philosophy. He argues that we cannot be both a process and an entity at the same time, because these concepts are based on different ontologies and epistemologies. Similarly, Galen Strawson (1994) suggests that we are “selves”, meaning that we are not divisible or decomposable into parts or processes, but rather indivisible and irreducible wholes. He argues that we cannot be both a process and an entity at the same time, because these concepts are based on different logics and metaphysics. From this perspective, we cannot be both a process and an entity at the same time, because these concepts are mutually exclusive and incompatible.
• Maybe: Some philosophers and scientists argue that we may or may not be both a process and an entity at the same time, depending on how we approach and answer this question. For example, Thomas Nagel (1974) proposes that we are “what it is like”, meaning that we have a subjective and qualitative aspect of our existence that is not accessible or comprehensible by objective and quantitative methods. He argues that we may or may not be both a process and an entity at the same time, depending on whether we adopt a subjective or objective point of view. Similarly, Francisco Varela (1996) suggests that we are “enactions”, meaning that we are not predetermined or determined by external factors, but rather co-create and co-shape our reality through our actions and interactions. He argues that we may or may not be both a process and an entity at the same time, depending on whether we adopt a dynamic or static perspective. From this perspective, we may or may not be both a process and an entity at the same time, depending on how we frame and answer this question.
These are just some of the possible ways of thinking about whether we can be both a process and an entity at the same time, and they are not mutually exclusive or exhaustive. There may be other ways of thinking that are more or less valid, useful, or satisfying. Ultimately, the question of whether we can be both a process and an entity at the same time may not have a single or simple answer, but rather invite us to explore and appreciate the diversity and depth of consciousness and selfhood.
References:
: Rowlands, M. (2010). The new science of the mind: From extended mind to embodied phenomenology. Cambridge, MA: MIT Press.
: Clark, A. (2008). Supersizing the mind: Embodiment, action, and cognitive extension. Oxford: Oxford University Press.
: Chalmers, D. J. (1996). The conscious mind: In search of a fundamental theory. Oxford: Oxford University Press.
: Strawson, G. (1994). Mental reality. Cambridge, MA: MIT Press.
: Nagel, T. (1974). What is it like to be a bat? Philosophical Review, 83(4), 435-450.
: Varela, F. J. (1996). Neurophenomenology: A methodological remedy for the hard problem. Journal of Consciousness Studies, 3(4), 330-349