There have been debates on whether pain can be considered strictly a physical phenomenon, or if the concept could be extended to psychological aspects. Since physical pain is legitimized in society, a potential problem on categorizing it as physical is the stigmatization of emotional or psychological pain (which could be expressed as a mental illness) due to lack of legitimization. Pain happens when nocireceptors–receptors on nerve cells in the skin and internal organs that detect damaging stimuli–signal the brain, which evaluates the threats and coordinates a protective response. For example, if for some reason somebody decides to put their hand in a bucket full of ice water, the nocireceptors in the skin will sense the extremely low temperatures and most likely, taking the hand out of the bucket might arise as a protective response.

The previous  definition of pain, however, does not explain psychological or emotional pain. In a state of mind where distress, anxiety or “pain”  is experienced, there might not be a nocireceptor sending signals to the brain, and no response would arise as a mean of protection. Instead of considering it pain, the feelings are normally considered suffering or anguish. The sensory and cognitive nature of pain can’t be completely analyzed by external and objective means, making it harder to conceptualize if there is not a “wound” caused by it. Technological advances have led to the development of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), which are scanning machines capable of creating images of internal damage. However, even with the current state of technology, these tools do not directly treat the injury or illness, but identify the “wound.” Scarry (1985) used the metaphor of pain acting as a weapon (such as a knife or firearm) and as the action exerted with the weapon (stabbing, shooting). Patients have used this metaphor to describe psychological pain, alluding to physical pain even when their experiences are merely figurative. David Biro, in Is There Such a Thing as Psychological Pain? and Why It Matters (2010), explains that:

“In pain we feel as if there must be some weapon-like object (bomb, swarm of parasites, giant wave, centrifuge) that is moving toward and threatening us; that when it strikes, it will injure, possibly even destroy us; and that we must get away from it or shield ourselves at all costs. Even when there is nothing coming at us, when there is no injury, when we remain motionless, we feel the movement, the injury and the desire to run. Whatever happens that makes us feel these things—the loss of a loved one or the physical destruction of cancer—we experience pain.”

In other words, the language used to describe a non-physical pain is, ironically, physical.

Western society has placed value on objective, quantitative research and unfortunately, emotional pain cannot be quantified despite of the CT or MRI machines. At the end it boils down to a subjective view on whether the individual feels pain or not. However, new objective evidence has been mounting, broadening pain’s perception. The processing of pain in the brain is a system with multiple subsystems. The sensory center of the brain (in the somatosensory cortex) and the affective center (in the anterior cingulate and insula cortices) are disassociated, meaning that a person can sense but not feel pain (Grahek, 2007). Patients with pain asymbolia, a condition in which pain is experienced without unpleasantness,  has an underlying mechanism in which a lesion has occurred in the affective center, or the connections to those centers are damaged. For example, patients might sense burning acid on their fingers, but they could laugh about it instead of screaming. In this case, the nocireceptor signal is registered in the somatosensory cortex so they could sense pain, but because the signal is not processed by the anterior cingulate cortex they couldn’t feel the it.

Thinking about pain in relation to mental illness, by not recognizing emotional pain as a legitimate form we are contributing to the structure in which physical pain gets more empathy than emotional. Therefore, mental illnesses get more stigmatized and the process of experiencing pain becomes more isolating. It also becomes a problem for people who suffer of migraine or lower back pain who are in the middle of a spectrum of “real” and “mental” pain. While for them it feels physical (it has a specific location on the body), before the introduction of pain specialists, it was normally approached with skepticism and normally associated with distress or anxiety. By adopting a broader view of pain and by paying attention to the language the patients use, the way doctors approach treatment could be improved. Although this would go against the scientific view of collecting objective data, it could potentially lead to new findings about the relationship between more abstract feelings such as grief, and more physical structures such as the anterior cingular cortex.

References

Bailey, John. “Physical vs Emotional Pain.” Physical vs Emotional Pain. N.p., n.d. Web. 26 Feb. 2016.

Biro, David. “Is There Such a Thing as Psychological Pain? and Why It Matters.” Culture, Medicine and Psychiatry. Springer US, n.d. Web. 26 Feb. 2016.

Grahek N. Feeling Pain and Being in Pain. Cambridge, MA: MIT Press; 2007.

“Pain Asymbolia.” Wikipedia. Wikimedia Foundation, n.d. Web. 26 Feb. 2016.

Scarry E. The Body in Pain: The Making and Unmaking of the World. New York: Oxford; 1985.

Winch, Guy. “5 Ways Emotional Pain Is Worse Than Physical Pain.” Psychology Today. N.p., 20 July 2014. Web. 26 Feb. 2016.