Clinical Bioethics
by James Giordano, PhD
 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
suffers—reflective 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 person’s 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 body—to which they have become
dis-attuned—and limit the capacity for other experiences of the inner and outer
environment that constitute each person’s 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.
Please refer to the April 2007 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2007
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