The Mind/Body Revolution: Chronic Pain

My grandchildren learned in their high school biology classes the two fundamental ideas of medicine that I learned in mine: The human body is a machine, and the diagnosis and the treatment of a physical disease can ignore the emotions and the mind of the patient. Most of us share the “collective delusion that the human body is a simple machine that can be repaired by the medical profession when it breaks down.”^[1]

The typical doctor sits at a small table with fingers on a laptop, eyes focused on the screen, seldom making eye contact with the patient. She asks questions, first seeking the symptoms and then the physical cause and finally the cure — medications or surgery.

Like most adults, my grandchildren have no inkling that the study of chronic pain over the last thirty years demonstrated that not all pain is caused by tissue damage. Surprisingly, the common understanding that a person with chronic lower back pain must have a physical malady, such as a herniated disc or high pressure of the cerebrospinal fluid, is seldom true.

In 1994, Maureen Jensen and her fellow researchers reported in The New England Journal of Medicine on their examination of ninety-eight people without back pain. Magnetic resonance imaging (MRI) scans revealed that sixty-four percent of the people had disc bulges, protrusions, herniations, or disc degeneration, suggesting that these structural changes are quite normal and usually unrelated to pain.^[2]

A follow-up to this study required a large clinical trial that compared those patients receiving surgery, a common treatment for chronic pain, with those administered a placebo. In this case, the placebo would be sham (faked) surgery, where a participant in the study may receive anesthesia, an incision and closure, pre- and post-operative care, everything but actual surgical intervention. In a 2019 meta-analysis of twenty-five such clinical trials, done between 1959 and 2013, with a total of 2,000 participants, researchers found “little evidence” that invasive surgery was more effective than sham procedures in reducing chronic pain: “Quantitative pooling of outcomes for seven studies on low back pain and three on knee osteoarthritis showed no difference in pain at six months compared with sham procedures.” The researchers concluded that “it seems prudent that invasive procedures for chronic pain be avoided unless done as part of a clinical research study.”^[3] The illusion that the patient has a body separate from her mind and emotions rather than being an integrated whole leads to ineffective treatment of chronic pain.

Pain: The Materialistic Model Fails

That a person can have chronic lower back or knee pain for five or ten years without any tissue damage means that the mechanical model of pain introduced by René Descartes is not universally true. In his 1664 Treatise of Man, Descartes claimed that the body is a machine and postulated that invisible but corporeal particles he called “animal spirits” are excited by the movements of the senses and course through tiny pores into the brain, where they flow through nerves to instigate muscle contraction, thereby causing the movements of the body. He argued pain was a disturbance that passed along nerve fibers until the disturbance reached the brain, causing pain irrespective of the emotional or mental state of the person. Figure 1 is Descartes’ illustration of both pain and muscle contraction that he used in Treatise of Man.^[4]

“Animal spirits” quickly vanished from modern medicine, but the image of the body as a machine and the notion that medicine could be practiced ignoring the emotions and the mind of the patient lasted for over three hundred years until researchers discovered that the intensity of pain is not directly related to the extent of tissue damage. A person’s perception of pain is influenced by his early childhood and inherited cultural norms. If the body experiences an injury, the brain generates the feeling of pain according to the history of the person. The latest research reveals chronic pain is largely a mental and emotional construct because no tissue damage exists to cause the pain. According to Howard Schubiner, Director of the Mind-Body Medicine Program in Southfield, Michigan and a clinical professor at the Michigan State University College of Human Medicine, “Whether pain is triggered by stress or physical injury, the brain generates the sensations. And — this is a mind-blowing concept — it’s not just reflecting what it feels, it’s deciding whether to turn pain on or off.”^[5]

Abdul-Ghaaliq Lalkhen, a member of the Faculty of Pain Medicine affiliated with the Royal College of Anesthetists, concurs: “Most people, including doctors, do not appreciate that the organ that produces pain is the brain. It is not the broken bone or the damaged tissue or the bleeding wound. The experience of pain is the sum total of more than just the physical injury — it is the result of this information being filtered through the individual’s psychological makeup, genetics, gender, beliefs, expectations, motivations, and emotional context.”^[6]

Western medicine is now shaking off the Cartesian view that the body is a machine independent of the emotions and mind. Medicine today is much like physics was in 1920 before the discovery of the Schrödinger equation and the Copenhagen interpretation of quantum mechanics. While many doctors and medical researchers are clueless, others are struggling to incorporate the emotions and mind — the nonmaterial — into medical diagnosis; as a result, much like physics in 1920, medicine is a mess, with no common vocabulary or treatment protocols. In our modest attempt to bring some clarity to the current revolution in medicine, we must first address a more fundamental intellectual error that Descartes committed.

Undivided Wholeness

Descartes began his philosophical investigations by dividing the universe into two irreconcilable categories, mind and matter, a division that seems obvious to us but one that causes immense difficulties that we still struggle with today. The Cartesian philosophic starting point was repudiated by the central tenet of quantum mechanics: Undivided wholeness is the new fundamental principle of physics because the observer cannot be separated from what is observed^[7], or said another way, mind and matter cannot be disassociated and placed in separate categories, as Descartes assumed, and as many scientists still do today.

Undivided wholeness applies even to our perceiving. Consider a landscape painter. Suppose sunlight is reflected from a red apple into his eye. The sunlight passes through the lens of the eye and strikes the retina, a sheet of closely packed receptors — 4.5 million cones and 90 million rods. Activated by the incoming sunlight, chemical changes occur in the rods and cones, which are then translated into electrical impulses that travel along the optic nerve to the brain. Further electrical and chemical changes take place in the brain. In terms of the physiology of seeing, this description is complete; however, the sensation red has not entered this scientific account of perception. The landscape painter experiences the red of the apple, not the myriad chemical and electrical changes that are necessary for seeing. A detailed understanding of the eye and the brain does not include the perception of color.^[8]

Francis Crick, the co-discoverer of the double-helix structure of DNA, confesses, “We really have no clear idea how we see anything. This fact is usually concealed from the students who take such courses [as the psychology, physiology, and cell biology of vision].”^[9]

What is true for seeing is true of the other senses: Physical-chemical changes in the brain are insufficient to explain any sensory perception. The sensible qualities a person perceives never appear in the brain as such.The brain itself is shrouded in complete silence, even while a person hears the deafening roar of a jet aircraft engine.Likewise, the brain, encased in the skull, is covered with darkness even while a person perceives the brilliance of the sun’s glare.Our brains do not become colder when we touch snow or harder when we touch iron.The brain tissue itself takes on none of the sourness of a tasted lemon or the acrid odor of a skunk’s spray.

Mechanical, chemical, and electrical changes themselves are not thoughts, desires, and emotions. The toolbox of physical science is limited to air pressure, chemical changes, electrical impulses in nerves, brain cell activity, and other measurable properties of matter. Science is mute about hearing, seeing, smelling, tasting, and touching. The reason is obvious: The interior life of a person is nonmaterial — perceptions, emotions, and thoughts cannot be touched, smelled, tasted, heard, or seen.

The error that modern scientists make is adhering to Descartes’ division of the world into matter and mind (the nonmaterial). The experience of red results from the undivided wholeness of a person’s eye, brain, and interior life. How we experience red is ultimately a mystery, for our scientific attempts at understanding violate undivided wholeness, which causes red to disappear. Something similar happens in quantum mechanics: Why an individual experiment yields a particular result is a mystery; the Schrödinger equation applies to an ensemble of identical experiments, all with different outcomes.^[10]

We now see that Descartes’ illustration of pain in Figure 1 is incorrect, for the subject would not experience pain. In our materialistic culture, we have a strong desire to say that the brain assesses what pain we experience (as I previously did) and thus alienate a person from his body. The undivided wholeness of the nonmaterial interior life and the material body means that brain function alone cannot explain our interior life.

The Divided Self

Undivided wholeness applies to our perceiving, feeling, and thinking, yet our self is divided. Unlike all the other animals, we humans have two ways of appraising what is good for us — the mind and the emotions — and neither appraisal is determined by nature; the mind and the emotions often give opposite appraisals of what is good for us. Paul Johnston knows that he should lose weight, but he likes crusty French bread, camembert cheese, and wine; to further his career, he should volunteer to give the next public presentation at work, but the thought of speaking in front of a group terrifies him; he should join a gym or a reading group to make new friends but lacks hope the effort will pay off.

Virtually every sentence we speak to ourselves or to others has a subtext, a thought or feeling hidden behind it. Paul Johnston, who knows he should lose weight but refuses to do so, had a controlling mother. If anyone in the household crossed his mother or didn’t do what she wanted, she would fly into an insane rage, breaking dishes, wildly throwing pots and pans out of the cupboards. Whenever his mother became angry with someone or ridiculed a family member, the subject of the attack always deflected it to someone else. Since Paul was at the bottom of the pecking order, he often ended up receiving anger or ridicule that had nothing to do with him. Paul lived in a world that made no sense. The great authoritarian figure — his mother — was totally unpredictable. Out of the blue came irrational commands that had to be obeyed; the consequence of revolt was an almost unbearable emotional pain; his mother would reduce him to a loathsome, disgusting wretch, shouting at him that he was stupid, dirty, and not fit to live with her or anyone else. He concluded that he was unlovable.

The only thing that made sense and gave him pleasure was his mother’s gourmet cooking. In the crazy, pointless world Paul inhabited, eating his mother’s food prepared from Julia Child’s Mastering the Art of French Cooking was his only pleasure. Every time he tasted an excellent soufflé or clafoutis, he knew his mother loved him. To give up the pleasure of eating as an adult would make the absurdity of existence unbearable.

[Next episode: All of us construct internal maps of who we are and what the world is, and these maps are often faulty.]

Endnotes

[1] Abdul-Ghaaliq Lalkhen, An Anatomy of Pain: How the Body and the Mind Experience and Endure Physical Suffering (New York: Scribner, 2021), pp. 6-7.

[2] Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross, “Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain,” The New England Journal of Medicine, 331, No.2 (July 14, 1994): 69-73.

[3] Wayne B. Jonas, Cindy Crawford, Luana Colloca, Levente Kriston, Klaus Linde, Bruce Moseley and Karin Meissnerkj, “Are Invasive Procedures Effective for Chronic Pain? A Systematic Review,” Pain Medicine, 20, No. 7 (2019): 1281–1293.

[4] René Descartes, Treatise of Man, trans.  and commentary Thomas Steele Hall (Amherst, NY: Prometheus Books, 1972).

[5] Howard Schubiner, quoted by Juno DeMelo, “I Have to Believe This Book Cured My Pain,” New York Times, Nov. 9, 2021.

[6] Lalkhen, p. 6.

[7] See George Stanciu, The Great Transformation: How Contemporary Science Harmonizes with the Spiritual Life, Ch. 11, Quantum Physics and Mind.

[8] This argument is from Erwin Schrödinger, What is Life? with Mind and Matter and Autobiographical Sketches (Cambridge: Cambridge University Press, 1992), p. 153. Also see C. F. von Weizsäcker, The History of Nature, trans. Fred D. Wieck (Chicago: University of Chicago Press, 1949), pp. 142‑43.

[9] Francis Crick, The Astonishing Hypothesis, (New York: Scrib­ner’s, 1994), p. 24.

[10] See George Stanciu, The Great Transformation: How Contemporary Science Harmonizes with the Spiritual Life, Ch. 11, Quantum Physics and Mind.