User:Anthonyhcole/Sandbox/Pain

Pain
Stephen and I were happy twin toddlers: playful, affectionate, curious, beginning to string words into sentences when, Mum said, "Anthony just went quiet." I became miserable, irritable, anxious, inattentive and solitary, and stayed that way.

Constant pain from a botched and unnecessary medical intervention caused me life-long emotional, cognitive and social damage. It comes from a spot halfway up my back, to the left of my spine where there is a scar. The muscle beneath that scar is atrophied and the muscle around it is a little bulky.

It starts soon after I engage that muscle, when I sit or stand. It's "tonic" pain: constant, rising and falling only slowly in intensity. The longer I'm up, the more it hurts and it takes hours for the pain to resolve after I lie down.

Most people in chronic pain experience periods of intense pain (like an endometriosis flare or moving an arthritic joint) between periods of less or no pain. With me, the pain is nearly always present and when the intensity changes it changes very, very slowly and predictably. Pain, for me, is like a trait. My perspective may be very different from yours, very different, even, from most chronic pain sufferers. This tonic pain, this lens through which I experience the world, distorts everything that matters.

It slows my thinking speed, reduces my working memory capacity, impairs my concentration and undermines my self-control. It increases the intensity, frequency and duration of negative moods and negative emotional events, and it numbs my social feelings. It isolates me from others and leaves me disengaged from my surroundings.

I've searched the pain science journals, textbooks and other literature to see if pain affects others in this way:

Cognition: The negative impact of pain on mental processing speed, working memory capacity, attention control, impulse inhibition, emotion regulation and other cognitive processes is well-attested in the pain literature.

Mood and emotion: Pain science has focussed on misery (depression) and, to a lesser extent, anxiety and it pays least attention to irritability and neuroticism (exaggerated affective response to negative stimuli) but it has found all of these are amplified by pain.

Social feelings: I'm not aware of any scientific research into the impact of pain on social feelings (empathy, compassion, shame, guilt, rejection, affection etc.) but pain obliterates my social feelings. Here, Michael Schatman, editor-in-chief of the Journal of Pain Research, recently told me, "I agree with you regarding the lack of study in this area."

In 2004 I read an fMRI brain study that found the distress of physical pain shares grey matter with the distress of rejection — a social feeling. I don't know whether that's been confirmed but it might explain, neurologically, how physical suffering can interfere with social feelings.

After I lie down the pain slowly recedes and, in time, social feelings begin to emerge, but I'm usually  alone and asleep by then. In my dreams, I feel others' feelings and respond with my own. I love my dreams.

When I rise the next day and the pain begins, social feelings fade again into impotent, vague notions, distant memories, not the visceral affective guardrails I need to successfully navigate society.

Emotional facial semaphore and intersubjectivity: Don't read these three bullet points and the following two paragraphs unless you can do so carefully, attentively. Skip them. Move on to "Inattention" which you can read with half a mind and little care and interest and still, easily get the gist. This section explains a disturbance of affective contact, the symptom, autism, in me.
 * When I make eye contact, I can't convey appropriate feelings by facial expression. I can't return a timely, sincere smile when suffering is swamping my sensorium. Failure to display a timely sincere (Duchenne) smile elicits distrust in the observer.
 * The human male (but not female) face in pain activates the human observer's amygdala. The amygdala is involved in, among other things, the processing of fear and aggression.


 * People in pain are excessively reactive to negative stimuli so, when I'm in pain, negative facial expressions from others, like distrust, fear and aggression, hurt a lot ... so much that I can't look at you for fear of seeing that face.

If we make eye contact when I'm in pain, you will see my pain and my failure to display a timely sincere smile, and I will see your emotional response: distrust, fear and aggression. It's an ugly emotional moment for both of us but especially so for me.

So, the interplay of emotional facial expression, the universal semaphore of displayed, exchanged feelings, is disabled in me and its absence marks me out as remote, shifty and strange and I miss important social cues. No one is studying the impact of pain on emotional facial semaphore or intersubjectivity. Inattention: The present is usually so toxic, I retreat into distraction and absent-mindedness. My surroundings are still available to that part of me that drives my car and opens the fridge door but conscious, deliberate me is mostly absent and lives by glimpses. "Death is preferred over prolonged severe pain but even mild to moderate pain, if continued long enough, will bleed life of its pleasure, transforming the individual into a sufferer whose overriding goal is to drive this experience from consciousness." — Kenneth L. Casey. 2019."

The impact of distraction on pain intensity and unpleasantness is well-attested in the pain literature. Inattention, poor eye contact, blunted social feeling, emotion dysregulation, negative mood states, significant cognitive impairments. This is a seriously disabling set of symptoms. I watch them come and go, rise and fall with the pain, day after day. It's not been easy. The pain is awful, of course, and all that stuff above is too, but I'm also heartbroken and have been since I lost my family's affection and the world turned away when I was a toddler. My family were very patient and kind and took good care of me and I am so grateful for that. But they couldn't give me sincere, spontaneous affectionate smiles and shared feelings. No one could. I've spent most of my life not being smiled upon and not sharing feelings. The heartbreak from this affective isolation never remitted in my childhood and only for a few moments in my adult life. My family could have talked to me and listened to me, though. They could have engaged me in uncomfortable, clumsy, embarrassing conversations, which would have been enormously rewarding and helpful for me, but nobody did that back then with kids like me.

And then there's emotional contagion. You feel my pain. It hurts you to be around me.