Pain and Suffering:
Some years ago I came across and was very impressed by Shinzen Young’s approximate algebraic formulation of the relationship of suffering to actual physical pain and psychological factors (see http://www.shinzen.org for relevant writings or his book, Break Through Pain: A Step-by-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain). Having a scientific and psychological mindset similar to his, I have been thinking about and conceptualizing variations and extensions of this for years. Young’s formulation was
S = P * R
S is a psychological factor, experienced suffering,
P is a physical factor, pain, the actual physical magnitude of a painful sensation (or sensations), and
R is a psychological factor, resistance to experiencing the painful sensation(s).
The asterisk (*) is the computer-standard symbol for multiplication.
Simply put, his equation succinctly illustrated that the degree to which we suffer from any pain, physical or emotional, is not simply a matter of how strong that pain actually is, but our suffering is strongly (thus multiplication, *, rather than simply addition) affected by how we respond to the painful sensation. Assuming we had a useful way to measure P and R on 10 point scales, e.g., then a painful sensation of, say, magnitude 4 would be experienced as suffering at level 4 if our resistance was at level 1. If we strongly resisted (voluntarily or involuntarily) the pain, on the other hand, say at R = 4, then our suffering would be much greater, at level S = 16. On the other hand, if we had learned meditative skills of concentration, clarity and equanimity, which reduced our resistance to, say, a level of 1/4, then our suffering would only be a level 1 in spite of the pain being at level 4. Even more importantly, Young noted from his own experience, as well as that of his students, if our resistance was reduced to or close to zero, we would not experience suffering at all, even with intense pains, just sensations, not suffering. This is of immense practical importance to people who suffer from chronic pain that cannot be controlled by current medical interventions. Young describes a general vipassana meditative approach (developing concentration, clarity and equanimity) for doing this, as well as many more specific methods for enhancing the general vipassana approach.
Although I am not particularly skilled at meditation practices, my own experience with low to moderate levels of pain confirms this formulation. Lowering my resistance to a pain does indeed reduce my suffering, changing the experience of “suffering” to more one of “sensation.”
Young recognized that the relationship might not be exactly a multiplicative one, but he wanted to emphasize the great importance of the attitude of resistance in affecting our experience of suffering, and a simple additive model, on the order of
S = P + R
was, in his experience, generally inadequate. I can imagine, but hopefully never personally experience, that where R is greater than one, much worse cases like
S = P * R2
It is also clear to me that R may be a variable that is itself composed of several other, interacting variables, such as self-esteem, previous experiences with pain, confidence that you can make a difference, subconscious factors, etc., but I will not pursue that line of exploration here.
Expanding Relationships: Experience, Reality and Attitude:
In describing Young’s work to various classes of mine at the Institute of Transpersonal Psychology (www.itp.edu) over the years, I have often expanded his basic equation to a more general form of
E = f(R, A)
where E is the psychological variable of Experience, which at any time is some kind of function of the Reality one is experiencing, interacting in various possible ways with the Attitude one takes toward the current state of Reality. Reality includes both the external physical situation of the moment and one’s bodily state. The exact form of the functional relationship is to be determined by observation and experiment.
As an example almost everyone has probably experienced, your ordinary life may seem full of obstacles, unfairness, difficulties and disappointments, then you meet the right person and go on with that same life while in love. Then all those aspects of reality which seemed so negative and difficult before are hardly noticed as you float through in your state of love. Then, an example I hope far fewer people ever experience, your lover leaves you or betrays you, and those same negative aspects of life become enormous, leading to sadness and depression.
Adding in Sleep, Pain and Focus:
The specific factor that I want to add to my above equation came into my mind when I woke at 5am on a recent morning because my arthritic shoulder. It had been completely pain free for several days, but this morning it woke me with it’s nagging pain and made it impossible to go back to sleep. This addition is an attentional factor, A, with at least two dimensions of specification at any time, viz. location, where one’s attention is focused, and intensity, what percentage of your total attention is concentrated in any one location. I’ll represent this additional factor as F for Focus, since A has already been used for Attitude. Thus I would expand the above general equation as follows:
E = f(R, A, F)
Thus the nature of Experience in general is a function of the Reality of the situation of the moment, both in terms of the external situation and your bodily state, of your Attitude toward your sensory and bodily sensations/perceptions, and Focus, where and how intensely your attention is focused.
I’ll apply this specifically to my arthritic shoulder waking me and keeping me from going back to sleep, and I suspect it this application will apply to many other sources of pain that disrupt sleep.
I’ve noticed, every time I’ve scanned it while writing this essay, that my shoulder has been paining me with about the same intensity of pain that woke me that night – but the vast majority of the time I’ve been writing, I haven’t noticed that this shoulder pain exists. My focus, F, has been on my writing, the keyboard and screen in front of me, and thinking about how to best express these ideas, and my level of concentration on these two foci has generally been good. The values one could put in the expanded equation are large for F, focus, and small for R, external and bodily reality. A, my attitude toward R, is consequently naturally small as I’m not consciously experiencing most of R, I’m not stimulated to develop an attitude about it. So this equation becomes a way of expressing, hopefully eventually leading to more precision in understanding, the oft observed fact that we can get involved in thoughts and tasks with a consequence of becoming less aware of events outside these focused tasks, including pain.
This formulation also makes clearer something that has puzzled me for years. The actual magnitude of my arthritic shoulder pain is usually small. On a 10-point scale for me, where 8 is the (largely forgotten, thank God!) agony I went through when I was passing a kidney stone years ago, zero is no perceptible pain, and one is the lowest level of sensation I would call pain, my shoulder pain, both night and day, varies between 0 and about 2 or 3. With my normal levels of focus, F, on various tasks during the day I have no trouble with the pain, I’m generally not even aware of it. But going to sleep, or trying to go back to sleep after waking at night is a different story.
My best, current scientific understanding of our ordinary state of consciousness (see my States of Consciousness book [not the same as my earlier Altered States of Consciousness book] plus updated journal articles which will be on my main web site, http://www.paradigm-sys.com/cttart/ when the current server crash is fixed) is that it is a complex system of sub-functions interacting to produce the emergent property we call “ordinary consciousness.” These interactions are generally so habituated and automated, so much in the background, that we don’t notice they exist, but they maintain and stabilize our waking state. There are many habitual, automated foci of attention, Fs, configurations of consciousness that are our efficient coping mechanisms for dealing with life. How do we go to sleep, then, or, in general, go into any altered state of consciousness? (see Chapter 7 of States of Consciousness for a detailed discussion of the induction of altered states)
Besides factors like physically relaxing, cutting down external stimulation, being tired or sleepy, etc., I’ve noticed in myself that a crucial psychological factor is letting go of all foci, all F, of relaxing the idea that there is anything to accomplish, that it is important to think in certain, productive ways but not others. My thoughts are allowed, as best I can, to wander wherever, there is no goal they should serve. When I do this kind of “mental relaxation,” visual imagery starts to arise as I slip into a hypnagogic state. The integrated structure of waking consciousness is breaking down. I may remain in the hypnagogic state for only a few moments or for long periods, but it shifts into full sleep. Put another way, “trying” to go to sleep for me is not like trying to do something while awake, it means to stop trying to accomplish anything in particular, let F go.
But if my arthritic shoulder is active, there is no focus factor to draw attention away from the pain, so I become much more aware of it than I usually am when awake and engaged in normal life. Indeed since I am relaxing F, the otherwise small magnitude pain can take involuntary control of ability to focus, keeping my attention focused on the pain. Thus the ability (I’m tempted to write “curse” rather than “ability!”) of a pain easily ignored in waking disrupting sleep…….
But if I try to more actively focus somewhere else than the pain, as can be helpful in a fully awake state, this activation of the focus process inhibits going to sleep!
Mentioning this insight to my wife Judy this morning, she immediately suggested that what I need when my shoulder has taken over focusing this way is a passive distraction, something to absorb attention, create another focus location for F than my shoulder, but not require conscious effort on my part – like a pillow speaker under my head and a radio talk show playing. Not some show that’s so interesting I want to stay awake so as not to miss anything that is being said, but attractive enough to focus my attention away from my shoulder pain…….
Sounds like a good idea to try. Now how do I find a middle of the night radio show that is not filled with doom and gloom (otherwise known as the “news”), as I’m not sure I want that stuff poured into my head, even if I’m not giving it much conscious attention…..
Something I have been trying, with only limited success so far, is to meditate on “flow,” on “impermanence” when the shoulder pain occurs, as this reduces suffering, but finding the balance between being awake enough to my meditation is at least partially effective – which keeps me from going to sleep – and doing it so casually and relaxedly so as not to interfere with going to sleep – which means it may not be at all effective in reducing my suffering – is very tricky!