Is pain “in the body or the mind”?

“Take your mind off your pain” is a common phrase you will hear from compassionate family members, disparaging strangers and even from the doctor within the clinic. You’ll see this approach in action when you aggressively hum the theme to Eastenders after stubbing your toe, or when you distract yourself from your back pain by getting absorbed into the guitar solo of your favourite song (Slash- Anastasia, for those wondering).

However, here are two different ways of thinking about what happens when you alleviate your pain in these ways: If you view pain in a ‘mind-centric‘ way, you are genuinely reducing or eliminating your pain when you distract yourself from it. But a ‘body-centric‘ view, where pain is identified based on some type of tissue damage, you aren’t actually reducing or eliminating your pain when you’re distracted from it. Your attention is just directed somewhere else. Does one or the other of these conceptions better capture the way that we ordinarily think about pain?

As I think I’ve mentioned before, the definition of pain given by the International Association for the Study of Pain (IASP) does not come down decisively in favour of a mind-centric or body-centric view of pain. The IASP definition involves both tissue damage (actual or potential) and a mental, affective component: Pain is “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage, or described in terms of such damage”. Among pain researchers and pain practitioners this is a widely accepted definition, so we were surprised when we came across some experimental work by Justin Sytsma (2010) and Kevin Reuter and colleagues (2014) that argued that the way people think about pain is body-centric, in contrast with the received professional view that pain is a hybrid of bodily and mental factors.

These experimental results, suggesting that people have an exclusively body-centric view of pain, are highly surprising and contradict some of the most fundamental premises of the clinical scientific study of pain. If these experimental findings stand up to scrutiny, they should have far-reaching consequences for how practitioners should understand patients’ pain reports. Common complaints from pain patients are that they feel unheard, or that they clinicians do not understand the real problems underlying their conditions. The body-centric experimental results suggest a potential cause of this disconnect: Maybe the general public view pain as body-centric, whereas experts view it as mind-centric? The group talking about oranges aren’t being heard by the group listening out for apples.

Consider a vignette that Sytsma (2010) gave to participants to evaluate how they thought about pain: Bobby and Robby are conjoined twins who share a leg. While running through a park, they hit their shared leg on a large rock and both grimace and say “ouch!”. In this situation, did Bobby and Robby feel one and the same pain? Or did they feel two different pains? People tended to respond that Bobby and Robby feel one and the same pain. Sytsma argues that it “is the number of afflicted appendages, not the number of perceiving brains, that best corresponds with the number of pains reported”.

Our group of psychologists, neuroscientists, and philosophers set out to investigate these surprising findings. Our hypothesis was that, consistent with the received wisdom built into the IASP definition according to which pain has both mental and bodily aspects, the public can view their pain as being body-centric or mind-centric, depending on how questions about pain are framed. We completed a three-stage study that we think indicates that people think of pain as a hybrid of mental and bodily aspects, rather than as purely body-centric (or mind-centric).

First, we replicated Sytsma’s (2010) results using his experimental materials. This is crucial, because we need to make sure that our online data collection strategy was reliable and provided the same results. Happily, it did!

Second, we looked at whether a different set of vignettes than those used by Sytsma would elicit a different, more mind-centric response from our participants. We developed eight new vignettes that were designed to pull apart the experience of the subjects in the vignettes from their injuries. If you’d like to read the full set of vignettes, you can find them in this paper (https://tinyurl.com/z6a6er4r). For now, compare one of Sytsma’s original vignettes that produces what he interprets as a body-centric response, with one of our vignettes that elicits a more mind-centric response:

Sytsma’s body-centric vignette: Bobby and Robby are conjoined twins who share a leg. While running through a park, their shared leg accidentally kicks a large rock and both grimace and say “ouch!”. In this situation, did Bobby and Robby feel one and the same pain? Or did they feel two different pains? People tended to respond that Bobby and Robby feel one and the same pain. Sytsma argues that it “is the number of afflicted appendages, not the number of perceiving brains, that best corresponds with the number of pains reported”.

Our mind-centric version: Adam and Zed are conjoined twins who share a leg. While running through a park, their shared leg accidentally kicks a large rock. Adam, but not Zed, grimaces and says “ouch!”. They examine their shared leg and agree that there is tissue damage (it is scraped where it hit the rock), but only Adam says that it hurts; Zed insists that it doesn’t. When we asked participants to indicate whether in this vignette Adam has pain, or Zed has pain (or both), participants tended to respond that only Adam has pain. That response is inconsistent with a purely body-centric view of pain.

So, together, we firstly replicated Sytsma’s findings of a body-centric view of pain using his vignettes. Secondly, our vignettes that painted a more plausible mind-centric viewpoint provided data that were inconsistent with a purely body-centric view of pain. This supports our hypothesis that, “while the general public can view pain as being body-centric, they don’t have an exclusively body-centric view of pain”. Given the right framing, they can also conceptualise pain as a mind-centric phenomenon.

The results from our first two studies prompted a follow-up question. We know what happens when we deliver independent sets of vignettes which encourage body- or mind-centric responses, but what happens what they are delivered together? Do responses remain stable or does the combination of vignettes that encourage body-centric and mind-centric responses alongside one another moderate participants’ responses in any way? We designed a study to evaluate this question, and we found that participants still had mind-centric responses to vignettes designed to encourage a mind-centric response, though the responses were less mind-centric than when the vignettes appeared by themselves. One potential explanation of this result is that the presence of the vignettes that encourage body-centric responses are moderating participants’ responses to the vignettes designed to encourage mind-centric responses. Additionally, it may be that in the body-centric vignettes, there is a very clear path between injury and pain, and this is highly intuitive. The mind-centric vignettes sometimes have more obscurity than this, and so when presented together, the participant’s conviction on their ratings on these was challenged and they were more uncertain.

Altogether, our results challenge the surprising claim that the general public endorse a purely body-centric perspective. The bodily aspect of pain can be made salient in the right kind of context, but our results support the received wisdom among pain theorists and practitioners that people’s view of pain is a hybrid combining both mental and bodily aspects.

Unlike my other blog pieces, this blog was supported and written by the entire research team. As I’m mentioned in my more casual pieces before, interdisciplinary research is a core pillar of my work, and personally, one the favourite parts of my jobs. This project would not have been possible without the skill and specialism of every member of the team, from philosophers, to psychologists, to clinicians. This project is currently in the clinical stage, and we are collecting data from chronic pain patients, to understand if this spectrum relates to how people view their treatment options and respond to them. Undoutedly, I’ll be updating you all about this in due course, but for now, thank you for reading and continue to stay safe!

Salomons, T.V., Harrison, R., Hansen, N., Stazicker, J., Sorensen, A.G., Thomas, P., Borg, E. (202`1). Is Pain “All in your mind?” Examining the general public’s views of pain. Review of Philosophy and Psychology, Doi: https://doi.org/10.1007/s13164-021-00553-6

Can be accessed at : https://link.springer.com/article/10.1007/s13164-021-00553-6


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