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What a Decade of the Mind Affords the Decade of Pain Control and Research

This retrospective observational study of patients with unresolved wrist pain noted improvements in many quality of life parameters after Hackett-Hemwall dextrose prolotherapy.
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“…man consists of mind and body. From this we understand not only that the human mind is united to the body, but also what must be understood by the union of mind and body…”

- Benedictus de Spinoza

Pain, Brains, and Minds

A philosophy of pain and an ethics of pain care are incontrovertibly bound to a definition of pain as both an event of the nervous system, and as an experience of the individual in which that nervous system is embodied.2 Given that ethics both studies and guides the activities of agents in interaction (with each other, and within the milieu of their socio-cultural environments),3 then an authentic neurophilosophy of pain and neuroethics pain care cannot be divorced from a knowledge of the functions and properties of the brain that give rise to cognition, emotion, and behaviors. In other words, considerations of “mind.”

But what is the “mind”? Despite the efforts and progress achieved by the Congressionally–declared Decade of the Brain (DoB; 1990-1999), the “hard questions” of neuroscience persist.4 We continue to ponder the nature of consciousness, reality of the self, viability of experience, and validity of independent action. Still, brain research has pressed on, despite—or perhaps because of —ambiguity in the term and construct of “mind” and, in striving for betterment of the human condition, has sought to unravel the enigma of pain.

Such dedication has been the impetus for, and the focus of, the Decade of Pain Control and Research (DPCR; 2000-2009). But while these investigations have explained mechanisms of pain sensation and the actions and effects of various therapeutics, each and all of these strivings must eventually confront the limitations incurred by the question of how the experience of pain is evoked by and/or arises from the neurological events of nociception or, more simply put, how the brain “makes” the mind. Taken independently or in intersection, the problem of pain with its resultant manifestations and the hard questions of neuroscience engage medicine, philosophy, theology, sociology, ethics, and law.

Posing the Essential Question

The ti esti (i.e.- “what is the essence of it?”) question of both pain and mind remains contingent upon informational gaps between what we know about the brain, and how we interpret the phenomenological experience of the body and world. These gaps have fueled speculation and debate in both meta-physical (“what does it mean to be?”) and practical terms (“do we have free will?”) and incurred profound implications not only for philosophy and ethics but for society at-large.

As one of the sequelae of the DoB, such broad speculation has led to a preponderance of things “neuro”—somewhat sarcastically, what might be referred to as “neuro-ubiquity”—in a number of fields and disciplines. And so we now encounter neuroeconomics, neuromarketing, neuro-law, neuroanthropology, neurotheology, etc. In some way, all of these are relevant and being applied to medicine, in general, and pain medicine, more specifically. In theory, this is valid, at least in part. As I claimed at the beginning of this essay, any realistic discussion or treatment of pain and pain care must be grounded to a contemporary knowledge of what it means to have, and be in pain. But if a neurophilosophy of pain is to be pragmatic and have practical worth, then it must also be aware of, and responsive to, what Matthew Crawford has called the “limits of neuro-talk.”6
In fact, I believe that the “neuro” prefix has become synecdoche—a representation of an entirety through depiction of one of its parts (e.g.- “Wall Street”)—and bespeaks the reductionist/non-reductionist debate as relevant to the fields in which it is applied. So when we consider a neurophilosophy of pain and neuroethics of pain care, axiomatically we enter into this debate and must appreciate what is known, unknown, and as yet un-knowable about the brain-mind. We must recognize that what we know about the brain does not provide sufficient evidence to disregard the mind. That is not to say that we should adopt some dualistic stance. To the contrary, it seems to me that the natural extension of any attempt to explain pain should endeavor to understand the mind, not merely as a folk construct, but as a process of brain function, core of consciousness, and essence of our subjective experience(s).

Decade of the Mind: Toward a Consilient Agenda

This is the focus the Decade of the Mind (DoM)—an agenda proposed in 2007 by my colleagues at Krasnow Institute for Advanced Study at George Mason University, Va.7,8 To date, this undertaking has conjoined scholars from our group at Georgetown University and the Center for Neurotechnology Studies of the Potomac Institute for Policy Studies, Sandia, and Los Alamos National Laboratories, The University of New Mexico, Santa Fe Institute, and the Mind Research Network. By both intent and scope, the project is obviously trans-disciplinary and seeks to generate up to $4 billion in federal subsidy over the next ten years in support of cooperative, consilient research aimed directly at the “hard questions” and problems of brain science.9
Specifically, the DoM seeks to: 1) understand the basis of the brain-mind relationship, and in this way provide bridge(s) across the extant explanatory gaps; 2) develop and use analytic and technological models of mind to further this understanding; 3) employ these models and this knowledge to develop new and novel treatments for a variety of brain-mind disorders, including pain; and 4) facilitate educational paradigms and protocols that utilize brain science not only to augment scholastic learning, but to instill a more comprehensive public awareness of the mind, strengths and limitations of neuroscience and neurotechnology, and the implications and responsibilities that arise from this new information and knowledge.10

Last updated on: January 5, 2012
First published on: January 1, 2009