The tension in the auditorium was palpable as the doctor donned his mask and gloves and prepared to take his needle and thread to the conscious patient's strapped-down leg. As he pushed the needle through the flesh, the patient let out an almighty cry of pain. But once the needle had passed through, he seemed unnaturally calm.
"How was that?" asked the doctor.
"Fine," replied the patient, to gasps from the audience. "It's just as you said, I remember you putting the needle through me, but I don't remember any pain."
"So do you have any objection if I do the next stitch?"
"Not at all. I'm not at all apprehensive."
The doctor turned to the audience and explained: "The process I have developed does not, like an anaesthetic, remove the sensation of pain. What it does is prevent the memory of the pain being laid down in the patient's nervous system. If you are not going to remember your momentary pain, why fear it? Our patient here shows this is not just theoretical sophistry. You witnessed his pain, but he, having forgotten it, has no fear of repeating the experience. This enables us to conduct surgery with the patient fully conscious, which in some instances is extremely useful. Now if you'll excuse me, I have some stitching to do."
Baggini, J., The Pig That Wants to Be Eaten, 2005, p. 76.
Anyone who has watched a movie set in the days when biting down on a stick was all you got from your doctor in preparation for the amputation of a diseased limb knows what a major reduction in suffering for humanity it was to discover anaesthesia. You might be surprised when asking "How does anaesthesia work?", that the answer is we don't really know — "although we know a great deal about the physiologic effects and macroscopic sites of action, we don't yet know the molecular mechanism(s) of action for general anaesthetics." This is why discoveries in this field still have much to teach us about consciousness. We do know that the effects of anaesthesia had better be reversible though. People with a very rare congenital insensitivity to pain have been reported to be at great risk of self-inflicted trauma such as chewing their own tongue off or continuing to walk around on broken bones. But what of Baggini's thought experiment? Would an inability to remember pain allow us to keep walking right back into a painful situation? Some have joked that women's ability to forget the pain of childbirth is what keeps us repopulating the world (although the scientific evidence of that is mixed at best), so sure, this type of mental anaesthesiology would probably do the job if it really worked.
But if that's true, what does that imply about any concern we might have for other creatures who may or may not feel pain, let alone remember it later? In my blog post on Descartes, I wrote how "Descartes believed that only humans have minds. This led him to the belief that animals cannot feel pain, and Descartes' practice of vivisection (the dissection of live animals) became widely used throughout Europe until the Enlightenment." This seems undoubtedly a sad chapter in our history and we hail Jeremy Bentham for being "widely recognized as one of the earliest proponents of animal rights - he argued that the ability to suffer, not the ability to reason, should be the benchmark in determining their proper treatment."
Over at the website reducing-suffering.org, there are many essays discussing how the ability to suffer extends all the way up and down the animal kingdom. In "The Importance of Insect Suffering", the author points out that:
"Insects have numerous sensory systems, including for vision, smell, taste, touch, temperature, and humidity. While it’s sometimes claimed that insects lack pain sensors, these have been discovered in a few species of bugs, including fruit flies. And even insects that lack pain sensors specifically may still respond aversively to other kinds of stimuli. Insects show negative reactions to, among other things, excess heat, electric shock, and poking and pinching. As in humans, opiates can affect insect responses to pain. Crickets were slower to escape a heated box when given morphine, and this effect was blocked if the crickets were given the anti-opioid drug naloxone. The effect of morphine decreased over time (“drug tolerance”), and when morphine was stopped suddenly after four days of administration, the crickets jumped more aggressively in response to vibration than usual (“drug addiction”). ... Those who accept some form of utilitarian theoretical framework, in which the basic moral currency consists of frustrations and satisfactions of desires and preferences, will find it difficult to resist the conclusion that sympathy is owed to at least some invertebrates, just as it is owed to other human beings. ... When making ethical decisions, we shouldn’t wait for conclusive proof. Rather, we should take precaution by assessing different possibilities and evaluating the consequences if each turned out to be true. Even if your probability for insects feeling conscious pain is low, if insects do suffer, the moral consequences are significant."
But in a recent long, dense essay, in Scientia Salon called "Why fish (likely) don’t feel pain", Brian Key, a professor of developmental neurobiology, argued that the conclusive scientific proof *is* rolling in that many animals can't suffer. First, he establishes some key terms.
"We must be very clear in our definition given the claim that fish do not feel pain. Pain is the subjective and unpleasant experience (colloquially referred to as a “feeling”) associated with a mental state that occurs following exposure to a noxious stimulus. The mental state is the neural activity in the brain that is indirectly activated by the stimulation of peripheral sensory receptors. A noxious stimulus is one that is physically damaging to body tissues (e.g., cutting, cold and heat) or causes the activation of peripheral sensory receptors and neural pathways that would normally be stimulated had the body been physically damaged."
So Professor Key is making a distinction between mere reflexive avoidance of harm, and the mental feeling of suffering pain. He continues:
"To feel pain requires that you are aware or conscious of your own mental state. To be aware first requires that you attend to the stimulus. ... In humans, the cerebral cortex in the frontal and parietal lobes of the brain is intimately involved in attending to input from our sensory receptors. In summary, feeling pain requires the activity of neural circuits associated with attention. Once the brain is attending to a sensory stimulus then it becomes possible to subjectively experience a specific sensation. ... If the signal is strong enough and if sufficient information is transferred and integrated, then the feeling of pain emerges (at present, how this occurs remains a mystery). In summary, to the best of our knowledge, for any vertebrate nervous system to feel pain it must be capable of transferring and integrating a certain level of neural information."
After a very in-depth tour of the sections of the brain that are involved in conscious processing, Key finishes by saying:
"On this basis it should be concluded that fish lack the prerequisite neuroanatomical features necessary to perform the required neurophysiological functions responsible for the feeling of pain. ... What, then, does it feel like to be a fish? The evidence best supports the idea that it doesn’t feel like anything to be a fish. They are non-conscious animals that survive without feeling; they just do it."
Although it is impossible to know the subjective experience of another animal with certainty, the balance of the evidence suggests that most invertebrates do not feel pain. The evidence is most robust for insects, and, for these animals, the consensus is that they do not feel pain.
Yet in Britain, the RSPCA now formally prosecutes individuals who are cruel to fish. So the evidence and conclusions are very much mixed on this issue and the formation of norms in society are still being played out. Meanwhile, back in "The Importance of Insect Suffering", the author concedes:
"There’s no a priori reason why life in the wild should be good on balance. As Richard Dawkins wrote in River out of Eden: The total amount of suffering per year in the natural world is beyond all decent contemplation. ... The universe we observe has precisely the properties we should expect if there is, at bottom, no design, no purpose, no evil and no good, nothing but blind, pitiless indifference."
Yes. Any objective review of evolutionary history would suggest that pain in life is unavoidable. Heck, remember Westley's words from The Princess Bride.
The other big question that Baggini's thought experiment raises is what, if anything, should we do about our own mental pain if it can be eliminated? This subject has a large literature of its own, but I'll just bring up some fascinating modern issues that were described in a long Wired article titled "The Forgetting Pill Erases Painful Memories Forever." Here is a selected summary:
"In the very near future, the act of remembering will become a choice. ... For years scientists have been able to change the emotional tone of a memory by administering certain drugs just before asking people to recall the event in detail. New research suggests that they’ll be able to target and erase specific memories altogether. ... In one 2010 clinical trial, subjects suffering from PTSD were given MDMA (street name: ecstasy) while undergoing talk therapy. Because the drug triggers a rush of positive emotion, the patients recalled their trauma without feeling overwhelmed. As a result, the remembered event was associated with the positive feelings triggered by the pill. According to the researchers, 83 percent of their patients showed a dramatic decrease in symptoms within two months. That makes ecstasy one of the most effective PTSD treatments ever devised. ... They work OK, but their effect is indirect. What reconsolidation therapy really needs is a drug that can target the fear memory itself. The perfect drug wouldn’t just tamp down the traumatic feeling. It would erase the actual representation of the trauma in the brain. Here’s the amazing part: The perfect drug may have already been found. The chemistry of the brain is in constant flux, with the typical neural protein lasting anywhere from two weeks to a few months before it breaks down or gets reabsorbed. How then do some of our memories seem to last forever? It’s as if they are sturdier than the mind itself. Scientists have narrowed down the list of molecules that seem essential to the creation of long-term memory—sea slugs and mice without these compounds are total amnesiacs—but until recently nobody knew how they worked. ... A form of protein kinase C called PKMzeta hangs around synapses, the junctions where neurons connect, for an unusually long time. And without it, stable recollections start to disappear. ... What does PKMzeta do? The molecule’s crucial trick is that it increases the density of a particular type of sensor called an AMPA receptor on the outside of a neuron. It’s an ion channel, a gateway to the interior of a cell that, when opened, makes it easier for adjacent cells to excite one another. (While neurons are normally shy strangers, struggling to interact, PKMzeta turns them into intimate friends, happy to exchange all sorts of incidental information.) This process requires constant upkeep—every long-term memory is always on the verge of vanishing. As a result, even a brief interruption of PKMzeta activity can dismantle the function of a steadfast circuit. ... The trick was finding a chemical that inhibited PKMzeta activity. “It turned out to be remarkably easy,” Sacktor says. “All we had to do was order this inhibitor compound from the chemical catalog and then give it to the animals. You could watch them forget.” ... While scientists have long wondered how to target specific memories in the brain, it turns out to be remarkably easy: All you have to do is ask people to remember them. ... By coupling these amnesia cocktails to the memory reconsolidation process, it’s possible to get even more specific. ... The careful application of PKMzeta synthesis inhibitors and other chemicals that interfere with reconsolidation should allow scientists to selectively delete aspects of a memory. ... And PTSD isn’t the only disease that’s driven by a broken set of memories—other nasty afflictions, including chronic pain, obsessive-compulsive disorder, and drug addiction, are also fueled by memories that can’t be forgotten. ... The problem with eliminating pain, of course, is that pain is often educational. We learn from our regrets and mistakes; wisdom is not free. If our past becomes a playlist—a collection of tracks we can edit with ease—then how will we resist the temptation to erase the unpleasant ones?"
(Of course, this article was written by Jonah Lehrer who was disgraced for fabricating quotes from Bob Dylan, so take it all with a tiny grain of salt. I'm going to choose to forget that though because I like this piece of work...)
So it looks like Baggini's treatment method is closer to becoming reality than I thought. If it does become available though, we should be careful in how we use it and remember that wisdom really isn't free. In fact, this type of drug treatment could render us insane, according to my definition of insanity:
Insanity is the inability of reason to control the emotions, either through brain chemistry that does not respond to cognitive appraisals or cognitive appraisals that refuse to respond to reality. This lack of control also ranges from mild (neurotic) to extreme (psychotic). Treatment for insanity must be based on the correct cause and severity of the affliction.
When this was discussed in a blog post on Psychology Today's website, Professor John Johnson said:
"I like this definition because it meshes well with what we know at this point in time concerning the most effective therapies for psychological problems. Two of the most common problems that lead people to seek therapy are anxiety and depression. Feeling anxious or depressed is a normal, adaptive response to certain situations, but sometimes these emotions get out of control, becoming inappropriately pervasive and/or intense. For all but the most severe forms of these disorders, cognitive therapy tends to be the most effective treatment. In cognitive therapies, people learn how to reappraise their situation. When people can think about their situations in ways that are possibly more realistic than the narrow, distorted appraisals that leave them mired in anxiety or depression, they have a chance of reducing or even dispelling the inappropriate feelings that are making them miserable. Sometimes, though, anxiety or depression can be so severe that the person cannot engage in cognitive reappraisals. In these cases, medication can improve brain chemistry to a point where the person can start using cognitive techniques to improve their condition. The bottom line is that being able the reason realistically in order to avoid loss of control over feelings turns out to be a pretty good definition of sanity."
But how will we be able to cognitively reappraise events in our lives if we decide to just forget them? Should we be happy if our life has been filled with repeated mistakes that we will just keep on repeating? It will take great wisdom to know for certain what if any scenario should be permanently left unremembered. In another fantastic article that I've mentioned before--Metaphors are Us--the professor of biology and neurology at Stanford Robert Sapolsky shows another reason why the feeling and remembering of pain is so important:
Consider the following: you stub your toe. Pain receptors there send messages to the spine and on up to the brain, where various regions kick into action. This is the meat-and-potatoes of pain processing, found in every mammal. But there are fancier, more recently evolved parts of the brain in the frontal cortex that assess the meaning of the pain. Maybe it’s bad news: your stubbed toe signals the start of some unlikely disease. Or maybe it’s good news: you’re going to get your firewalker diploma because the hot coals made your toes throb. Much of this assessing occurs in a frontal cortical region called the anterior cingulate. This structure is heavily involved in “error detection,” noting discrepancies between what is anticipated and what occurs. And pain from out of nowhere surely represents a discrepancy between the pain-free setting that you anticipate versus the painful reality. Now let’s go a little deeper, based on work by Naomi Eisenberger at UCLA. While lying in a brain scanner, you play a game of virtual catch, where you and two people in another room toss a cyberball around on a computer screen. (In reality, there aren’t two other people, only a computer program.) In the control condition, you’re informed mid-play that there’s a computer glitch and you’re temporarily off-line. You watch the virtual ball get tossed between those two people. Now in the experimental setting, you’re playing with the other two and suddenly they start ignoring you and only toss the ball between them. Hey, how come they don’t want to play with me anymore? Junior high all over again. And the brain scanner shows that the neurons in your anterior cingulate activate. In other words, rejection hurts. “Well, yeah,” you might say. “But that’s not like stubbing your toe.” It is to your anterior cingulate. Both abstract social and literal pain impact the same cingulate neurones. We take things a step further with work by Tania Singer and Chris Frith at University College London. While in a brain scanner, you’re administered a mild shock, delivered through electrodes on your fingers. All the usual brain regions activate, including the anterior cingulate. Now you watch your beloved get shocked in the same way. The brain regions that ask, “Is it my finger or toe that hurts?” remain silent. It’s not their problem. But your anterior cingulate activates, and as far as it’s concerned, “feeling someone’s pain” isn’t just a figure of speech. You seem to feel the pain too. As evolution continued to tinker, it did something remarkable with humans. It duct-taped (metaphorically, of course) the anterior cingulate’s role in giving context to pain into a profound capacity for empathy. We’re not the only species with an anterior cingulate, but studies show the human anterior cingulate is more complex than in other species, with more connections to abstract, associational parts of the cortex, regions that can call your attention to the pains of the world, rather than the pain in your big toe. And we feel someone else’s pain like no other species. We extend it over distance to help a refugee child on another continent. We extend it over time, feeling the terror of what are now mere human remains at Pompeii.
Yes. Pain in life is unavoidable, and may be so for all of the wisdom and empathy it gives us. When I explored life in my blog posts about how to know thyself, I mentioned this aspect of pain:
Adversity may be required for growth - it is certainly an opportunity. Do not try to cope with adversity by avoidance, by denying events, or blunting emotions through substance abuse or distraction - the adversity will only return in the long term. You must cope with crises by direct action to fix them, or reappraisal to get your thoughts right. You emerge from introspection when you develop internal consistency / reflective equilibrium. You triumph over adversity when you get your thoughts right.
And with that, I'll stop this long post, hopefully before it became too painful. It's time I left this subject and went to go get my own thoughts right about some pains I've been feeling lately. Let me know if you ever want to talk about any of yours. I won't ignore or forget it.