The Phenomenology of Pain. Saulius Geniusas

Чтение книги онлайн.

СКАЧАТЬ 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.” The IASP definition qualifies pain as experience, yet it does not clarify what kind of experience it is. This definition places pain in the genus of sensory and emotional experience, yet it does not provide us with the differentia.³

      Although it is undeniable that at its core, pain is an experience, our current knowledge of pain is marked by the failure to understand pain as experience. This failure is not accidental. The dominant methodological standpoints in pain research do not provide us with a suitable methodological framework to conceptualize pain as experience. Broadly speaking, naturalism and social constructionism constitute the two dominant methodological standpoints in pain research (see Geniusas 2013). While the naturalist focuses on the specific neurological mechanisms that trigger pain experience, the social constructionist traces the social, cultural, and historical influences that shape the experience of pain. In different ways, both the naturalist and the social constructionist conceptualize pain experience as a psychological effect that is activated by different kinds of mechanisms. What both methodological standpoints are interested in is not pain experience as such (they both presuppose that we already know what pain as experience is), but the various neurological mechanisms that trigger it and the particular sociocultural influences that shape it. Yet clearly, if one claims that pain is triggered by these mechanisms and shaped by these influences, then one must have some kind of understanding of what pain as such is. We are thus forced to ask: What can we say about pain as experience, considered independently from the mechanisms that trigger it and the influences that shape it? Contemporary pain research does not have the methodological basis to answer this question.

THE PHENOMENOLOGICAL APPROACH

      In light of these circumstances, the following study contends that phenomenology is indispensable for pain research. Neither pain biology nor pain sociology can clarify the nature of pain experience, and, therefore, they must be supplemented with pain phenomenology. In a general and preliminary way, we can conceive of phenomenology as a method designed to study experience and the different ways in which phenomena manifest themselves in experience. Thus, the often-cited phenomenological refrain, “Zurück zu den Sachen selbst” (Back to the things themselves), must be understood as a solicitation to return to the field of experience, conceived of as the fundamental field within which phenomena manifest themselves and their multifaceted meanings originate. According to one of the central phenomenological claims, in the natural course of life, as well as in the sciences, we misconstrue phenomena by transforming them into what they are not, and we do so precisely because we misunderstand how they manifest themselves in experience. Phenomenology’s chief ambition is to liberate us from falsifications, which consciousness itself gives rise to in virtue of its absorption in the world of things and its inherent self-forgetfulness, which manifests itself through its tendency to misunderstand itself as a thing among other things. The goal of phenomenology is to liberate consciousness from its self-opacity, to clarify the fundamental structures of experience and recover the lost world of concrete life. Phenomenology proves to be indispensable for pain research because it offers a highly useful methodology to determine the nature of pain experience, irrespective of the specific natural causes that might trigger it and the specific cultural influences that might shape it.⁴

      Phenomenology is neither the first nor the only philosophical tradition to be qualified as a philosophy of experience. Various brands of empiricism and pragmatism also merit the same qualification. Are there any reasons to privilege phenomenology over these other philosophical traditions, as far as the philosophy of pain is concerned? Arguably, the reasons are methodological. First and foremost, the phenomenological method is designed to study experience from the first-person point of view. In this regard, it is exceptionally well-suited for pain research, since pain itself is conceivable only as firsthand experience (a pain that is not experienced could be qualified as a painless pain—an expression that is no less self-contradictory than a square triangle). The science of pain is thus in need of phenomenology, for with its help it can inquire into the compatibility in the findings obtained using the first-person and the third-person methodologies (see Price and Aydede 2005). Still, one might object that such a clarification does not fully answer the question, since it leaves the possibility open that introspectionist psychology might fit the bill. In this regard, one should stress that not any description of phenomena from the first-person point of view is to be qualified as phenomenological. There is no phenomenology without the epoché and the phenomenological reduction, conceived of as the two complementary methods designed to provide the researcher with access to experience that is purified of naturalistic misconceptions. These sophisticated methods, unique as they are to phenomenology, are designed to suspend the natural way of considering phenomena so as to let them appear without any bias, distortions, or manipulations. As far as pain research is concerned, these methods prove indispensable for any attempt to conceive of pain as pure experience, by which we are to understand the experience of pain, considered independently from pain biology and pain sociology.

      In light of my foregoing remarks, one cannot help but be surprised by the scarcity of phenomenologically oriented book-length studies of pain. All in all, one can single out just two studies. Christian Grüny’s Zerstörte Erfahrung: Eine Phänomenologie des Schmerzes was published in 2004. Abraham Olivier’s Being in Pain appeared in print a few years later, in 2007. Besides Olivier’s and Grüny’s studies, there are no other book-length investigations that have exclusively focused on the phenomenology of pain.⁵ Strangely, a philosophical tradition that prides itself on being attentive to lived-experience, on returning to the things themselves and thereby taking distance from meaningless abstractions that it finds at the heart of many other traditions of thought—this tradition has been remarkably silent as far as the nature of such embodied СКАЧАТЬ