Clinical Bioethics
We have come to recognize pain as both
a physiological event of the nervous system and as an emergent psychological phenomenon of
consciousness.1,2 As such, while the objective properties of the sensation of
pain may be quantifiable, the qualitative dimensions of the experience of pain are
individually variable and, in many ways, are unique to the person who
suffersreflective of the ongoing interaction of hereditary and environmental
interactions throughout the lifespan that are both pre-dispositional to, and affected by
pain (and its broadly bio-psychosocial manifestations). The event of pain is inextricable
from the event of consciousness.2,3 As conscious process, it manifests
subjectivity and transparency (only) to self.
This first-person experience of the subjective self is grounded in personal circumstance, and bounded by place and time. But what is this self? Polymath Douglas Hofstadter claims that an I is an abstract pattern that arises naturally in human brains.4 To be sure, as I have previously noted, our selves arise from our brains, and our brains are nested within, and are the stuff of our universe.5 Yet, try as we might, attempts to reduce consciousness and/or self-consciousness to the mechanisms of interacting molecules or even atoms have failed (at least to date). It may well be, as Hofstader states, that life resides on a level that no being could survive if it concentrated on that level.6 Hence, the experiences of body, brain, and world are essential to the self, and these experiences assume meaning based upon circumstance(s) and manifestation(s). Our self is what Damasio has called the feeling of what happens,7 not simply on a sensory level, but on levels of cerebral function that involve concomitant temporal and intentional interpretation, as relevant to each persons history and anticipations of the future.8 Thus, it is this abstract self that allows metarepresentations of what we are, allows interactions with others, and becomes the basis of interacting with the world at large.
Pain, the Self and Spirituality
Given that the physical process of pain can affect the brain substrates of consciousness,
and thereby affect this self, we may view pain as an phenomenal event that can
trap the person within a lived bodyto which they have become
dis-attunedand limit the capacity for other experiences of the inner and outer
environment that constitute each persons life world.8,9 In this way, the
existential reality of pain can be both an intrinsic part of the person, and a way of
being in the world. It becomes a part of the self, may define the self, and can become
something greater than the self.
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