David Pincus

David Pincus Ph.D.

The Chaotic Life

What causes pain?

Pain has nothing to do with punishment, nothing whatsoever.

Posted Nov 12, 2010

Pain comes from the Latin "Poene," which means to punish.  Indeed, when we are in pain, it does feel like a punishment.  But pain does not equal punishment.  It has nothing to do with punishment, nothing whatsoever.  This stigma that comes along with pain is a tragic error of modern culture, making martyrs of the suffering masses, adding to our pain, and limiting our view of our lives which is woven from start to finish with the threads of pain.  The point-prevalence for some clinically significant pain problem is one in five, 20% of the population.  Pain is the most common reason for visiting a health practitioner.  Pain surrounds the process of child-birth, and for most of us it will enshroud us as we die.  Yet when we see or hear about the pain of another person, “just world” distortions lead us to imagine that he or she had it coming, as the “fundamental attribution error” leads us to search for character flaws that would explain his or her punishment.  Such biases make us feel safer, and as if we live in an orderly and predictable world.

We don’t.  What causes pain?  Just about everything.  In the mid to late 1600’s, Rene Descartes, an otherwise brilliant philosopher, mathematician and scientist, concocted the seemingly bone-headed idea that the mind and body are separate, and that god intervenes directly using the pineal gland as a sort of neurological joystick to provide the illusion that the two are seamlessly connected.  God is tinkering in your brain as sexy thoughts make you aroused or as delicious smells make your stomach rumble.  For neurologists it is clear that the pineal gland is a poor choice for divine intervention, and most theologians would agree that god has more important things to do in the universe.  The idea emerged in the context of a necessary political truce in a turf battle between the church and enlightement era scientists, making a clear dividing line between body and spirit.  Nevertheless, the legacy of Cartesian dualist thinking is pervasive in modern culture, leading us to forget that pain is a subjective conscious experience.  The professional legacy is the clear demarcation between body and mind in health care that persists today.  Psychologists are as deferent to the body as medical practitioners are to the mind and emotions of patient.  Yet pain is no more a physical process than mood or emotion.  

Indeed, pain is triggered most readily through some sort of tissue damage.  One cannot induce sadness as readily as applying a finger prick.  Yet there is no objective measure for pain, as there are for other physical processes like cholesterol or blood pressure.  Since Ronald Melczack’s seminal scientific work on the topic in the 1970’s it has become settled science that pain is caused by any factor that influences either:  sensation (nociception), motivation-affect, or cognition-meaning.  Why do children look up at adults faces to see how badly they are hurt?  Because they have not learned the meaning of their pain yet.  For the same reason, my children can go swim in the ocean last weekend, or why people in the Midwest throw shorts on the first time it hits 50 degrees in the spring while Californians wear winter coats in the same weather. 

At a minimum, pain is cause by attention, perception, thoughts, beliefs, emotion, life orientation, values, social role, psychiatric health, and a variety of facets of culture.  Yet how do we treat pain?  Do we incorporate all of those factors into a comprehensive intervention, tailored to fit the particular constellation of causes for each patient?  Forgive me for begging the question so often.  This is not allowed in academic writing J.  Our lack of true understanding of pain is near-delusional.  The research demonstrating the role of complex biopsychosocial cause in pain is clear.  It is settled science.  Furthermore, 20,000 years of healing traditions that pre-date modern science operated under the same understanding.  300 years of Cartesian delusion are long enough. 

What is the prescription for pain?  First of all, medication.  I’m not a total goof.  If it hurts terribly, and medications help, and the side-effects are tolerable then great.  Zealotry and health do not mix well together.  Beyond medication:  1)  Accept yourself and your pain.  Fighting it will make it worse.  And questions like “Why me?” are pointless distractions from the life you have left to live.  If you are very religious, you will find out “why you” later when god tells you right?  So stop questioning god.  That’s not your role.  If you are less religious, you know that god won’t answer you.  And if you are an existentialist, you know that there is no answer to that question.  You are in pain because you had a 1 in 5 roll of the dice and you lost.  And yes, that does suck.  2)  Find the choices that you can still make.  Pain will make you feel powerless in many areas.  Don’t allow it to hijack everything.  Keep as much of your life as yours as you can.  This means make decisions.  Live with intention.  Free will is a human prerogative.  When something like pain renders us helpless, we lose our humanity.  Our pain becomes metaphysical, and our suffering is magnified.  Even the tiniest choices are medicine for the soul.  3)  Connect.  a) Connect to yourself.  Seek what it is that you are here to do.  Start doing whatever that is, and do it “with yourself.”  Living intentionally will help with self-awareness.  Unfortunately, the misguided shame of pain leads us to avoid self-awareness.  Don’t let it.  b) Connect to others.  Pain makes us want to avoid being around others.  Or to complain or relate to others in a helpless manner.  Choose your interactions with others.  Decide who you enjoy, and cultivate those relationships in an intentional manner.  Just as it can lead to avoidance, pain can also drive us toward deeper human compassion.  This is a gift to be shared.           

About the Author

David Pincus

David Pincus is a licensed clinical psychologist and assistant professor of psychology at Chapman University in Orange, CA.

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