2. The suffering syndrome
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In 1968 Ronald Melzack and Kenneth Casey re-imagined physical pain as more than just a sensation,[1] and their conceptual model still informs modern pain neuroscience and pain psychology. They described three dimensions of pain:
- sensory-discriminative: sense of the quality,[2] location, duration and intensity of the pain
- affective-motivational: unpleasantness and urge to escape the unpleasantness
- cognitive-evaluative: cognitions such as appraisal, expectations, cultural values, distraction and hypnotic suggestion.
In 1976, Fordyce proposed adding a behavioral dimension,[3] and Williams and Craig in 2016[4] and Craig and Mackenzie in 2021[5] proposed adding a social component to pain.
In this chapter I discuss the affective-motivational dimension, the unpleasantness and the urge to escape or mitigate the unpleasantness.
Unpleasantness is also called, in various contexts, "suffering", "aversiveness", "negative affect", "negative valence", "discomfort", "torment", "hurt", "negative hedonic tone", "dysphoria" and "distress". I'll mostly use "suffering" here.[6]
What is suffering?
Suffering is the unpleasant, aversive, attention-consuming element of our threat-detection system. When we perceive a change in our biological or social state that threatens the integrity of our biological or social systems, that perception of threat is accompanied by unpleasantness and a motivation to mitigate or escape the unpleasantness, and, often, a specific drive aimed at mending or protecting the threatened system using apt behaviour.
These latter specific behaviours might include eating in a state of hunger, resting in a state of fatigue, protecting a damaged body part in pain, comforting a suffering friend in response to empathy, or making a phone call in response to a percieved social slight.
Suffering is found in three classes of feelings:
1. It is a dimension of negatively-valenced homeostatic feelings like pain, hunger, fatigue and hyperthermia. Negatively-valenced homeostatic feelings torment us with suffering until we satisfy them with behaviour aimed at maintaining the body in its ideal state.
2. Suffering is an essential part of some social feelings (e.g., empathy, rejection, shame, loneliness, moral disgust).
3. Suffering is also associated with negative moods like depression, anxiety and irritability and negative emotions like grief, fear and rage.
Suffering likely evolved first and was attached to negative homeostatic feelings, emotions and social feelings as they emerged later in animal evolution.[7] It is likely that just one neural network generates suffering, and every unpleasant feeling engages this one suffering network.[8]
What does suffering do to us?
I am studying the effect of suffering on human emotion, cognition and social engagement. It's early days and I'm not there yet but here's where I've got. I have focussed on three causes of suffering, three negative homeostatic feelings—hunger, sleep deprivation and pain—because each of these has a body of scholarship addressing, to some extent, its affective, cognitive and social impacts.
It seems to me, based partly on science, partly on anecdotes, and partly on introspection, that each of these distressing homeostatic feelings generates in humans the same set of symptoms, the same syndrome:
- Increased frequency, intensity and duration of negative mood states (e.g., depression, anxiety, irritability) and negative emotional events (e.g., grief, anger, fear), and heightened affective response to noxious stimuli (neuroticism): things that hurt, hurt more.
- Slowed mental processing speed, reduced working memory capacity and impaired attention control, impulse inhibition and emotion regulation.
- Impaired social feeling and social engagement.
Until someone finds an instance of suffering that does not cause this cluster of symptoms, I shall assume all suffering, regardless of its cause, produces this syndrome.
Eventually, I'll populate this with footnotes, and then it might turn into something other than musings. I've put it here now, prematurely, because it seems obviously true to me and I think it's an hypothesis worth stating.
References and notes
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- ↑ Melzack, Ronald; Casey, Kenneth (1968). "Sensory, Motivational, and Central Control Determinants of Pain". In Kenshalo, Dan (ed.). The Skin Senses. Springfield, Illinois: Charles C Thomas. p. 432.
- ↑ "Quality" in pain science means the unique sensation that distinguishes pain from other feelings like itch and warmth, or the characteristic that distinguishes one pain from another, e.g., tingling pain vs. burning pain.
- ↑ Fordyce, Wilbert E. (1976). Behavioral methods for chronic pain and illness. Saint Louis: Mosby. ISBN 978-0-8016-1621-1.
- ↑ Williams, Amanda C. de C.; Craig, Kenneth D. (2016). "Updating the definition of pain". Pain. 157 (11): 2420–2423. doi:10.1097/j.pain.0000000000000613. ISSN 1872-6623. PMID 27200490.
- ↑ Craig, Kenneth D.; MacKenzie, Nicole E. (2021). "What is pain: Are cognitive and social features core components?". Paediatric & Neonatal Pain. 3 (3): 106–118. doi:10.1002/pne2.12046. ISSN 2637-3807. PMC 8975232. PMID 35547951.
- ↑ On language
- "Negative affect" is often used to refer to negative moods (e.g., depression, irritability and anxiety) and negative emotions (e.g., grief, anger, fear), but it is also used by some to refer to the unpleasantness of any negative feeling and that is how I use "negative affect" here.
- From 1988 to 1996, Wade, Price and others tried to establish a linguistic convention: they proposed using "unpleasantness" for the negative affect that is usually a dimension of pain, described by Melzack and Casey above, and "suffering" for the negative affect attending thoughts and emotions that are consequent to pain.
They defined "a second stage of pain-related affect that can be conceptualized generally as 'suffering'. [...] It is composed of evaluations and beliefs [...] and consequently of negative emotions related to these evaluative components (such as depression, fear, anxiety, anger, frustration)."
Cited in:
Gatchel, Robert J.; Weisberg, James N., eds. (2000). Personality characteristics of patients with pain. Washington, DC: American Psychological Association. p. 89. ISBN 978-1-55798-646-7.
I'm not aware of widespread adoption of this convention and I don't make their proposed distinction here. For now, I treat "negative affect", "unpleasantness", "suffering", "distress" and all the other terms listed above as synonyms.
- ↑ Antonio Damasio in his 2021 book, Feeling and Knowing, puts the appearance of basic discomfort and wellbeing before the emergence of homeostatic feelings in evolution.
- ↑ Damasio, ibid, says, "But we often overlook the fact that our psychological and sociocultural situations also gain access to the machinery of homeostasis in such a way that they too result in pain or pleasure, malaise or well-being. In its unerring push for economy, nature did not bother to create new devices to handle the goodness or badness of our personal psychology or social condition." P.127.