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The Language of Pain - Theoretical Medicine and Bioethics Volume 6 Issue 2 1985

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  KONRAD EHLICH THE LANGUAGE OF PAIN* ABSTRACT. The expression pain refers to a phenomenon intrinsic to individuals. The object of the language of pain is restricted to an individual experience which excludes any form of direct access by others. Speaking about pain is thus one of the most difficult forms of linguistic activities, as has been repeatedly pointed out by Wittgenstein. The difficulties involved in this type of communication are not only dependent upon individual linguistic ability but are also clearly reflected in the state and structure of the linguistic means which are at the disposal of the speakers of a language. Linguistic means vary in status and complexity with respect to the ends which they can be used for. In this paper, I discuss two aspects of communicating pain: types of expression which are involved in speaking about pain, and linguistic activities which are carried out when speaking about pain. The two aspects are interrelated. My analysis makes use of categories belonging to the theory of linguistic activity and to the extended field theory of language (an expansion of Biihler s concept of symbolic and deictic field analysis of language). 1. MEDICAL COMMUNICATION Language has to do a variety of jobs. It was when philosophy turned its attention to ordinary language that linguistics - perhaps for the first time - learned to take seriously into consideration the wide variety of functions language performs in social life. One of the domains of social life where language plays an important part is medicine, and one of the most salient aspects of medical discourse is communicating pain. It is to that function of language this paper addresses itself. Medical communication is a highly specific type of discourse. It has its own history from the ancient medicine man s mysterious formulae taken from old spells and wisdom down to the 20th century doctor s mysterious formulae, part of a jargon with hybrids of Latin and Greek srcin, producing the fascina- tion with Science, curer (and causer) of our diseases . Medical communication is not taught - it happens. Actually, institutions of medical training seem to assume that speaking goes without saying . Doctor-patient communication is a type of functional communication: the goal of doctor-patient interaction - to put it very simply - is to contribute to, or even to achieve the patient s cure. In tiffs paper, I want to concentrate upon a very common and widespread form of consultation communication, as it takes place in the consulting-room of ordinary general practitioners and specialists. This type of communication forms part of a general course of interaction There is a standard structure to this interaction (see Figure 1). The standard course runs from phase I to phase V. The goal of the whole structure lies in V. Phase V determines the substructures of the course of interaction. Ia and Ib need not co-occur. Whereas V is the TheoreticaIMedicine 6 (1985), 177-187. 0167-9902/85.10 © 1985 by D Reidel Publishing Company  178 KONRAD EHLICH ill j ~b p feels ill j ............ 1 i P presents the symptoms of his disease to D II ....... D identifies the disease v II V ........ D cures P ] V~ P is healthy j Fig. t. Consultation communication. P stands for patient and D for doctor . final goal of the doctor-patient interaction, the transition from Ia to Ib, in many cases, is a condition for entering into the medical apparatus. 2. PAIN AND INTERACTION As soon as the patient has identified the disease (Ib in Figure 1) and has over- come the obstacles which hinder him from entering the socially established apparatus of healing, the linguistic means which are at his disposal become of major importance. In the doctor s consulting room tile patient s verbalization competence can be crucial for the phase to follow. One of the most important difficulties the patient confronts concerns the language of pain which arises when he wants to use language for transmitting a picture of his problems to the doctor. Whatever the psychological charac- teristics of pain may be, in most theoretical accounts, pain is conceptualized as a, if not th form of individual sensation. 1 As pain is seen as an individual sensation, the problems of pain appear as a consequence of its individualized character. Pain seems to be conceived of as an intrinsically personal and in- dividual experience which isolates the pain-suffering individual from his/her surroundings. The pain-suffering individual thus is a very good example for the traditional philosophical conceptualization of man - the individual man. Philosophical thinking on pain largely depends on the vocabulary which is supplied by everyday language. Whereas there are differentiated, well-de- veloped terminological distinctions for sense phenomena perceived visually and  THE LANGUAGE OF PAIN 179 acustically, the situation is problematic for other domains of perception such as smell (cf. Weisgerber 1928), and becomes even more difficult for domains beyond sensual perception in the traditional philosophical sense of the term. Pain is one of the most prominent of these non-extrinsic phenomena. Theoretical analysis resulted in a broad spectrum of opinions on the characteristics of pain. Nevertheless, none of the 'definitions' proposed in the course of philosophical, psychological or ethnological analysis has achieved a status of general acceptance which could be compared to that of vision or other modes of sensual perception. Even the description of what one is looking for when discussing the concept of pain is vague and far from being generally accepted. The insufficiency of theoretical analyses of pain is a reflection of the lack of elaborated terminology for the phenomenon. One important tradition of thought on pain is that of Ryle and Wittgenstein. Their ideas concentrate on some of the linguistic aspects of the problem. Whereas Ryle uses the language of pain for an analysis of the language of moods, etc., Wittgenstein, much more radically, shows that the language of pain is something very different from the language of usual descriptions (Philosophical Investiga- tions, §290). 2 To disregard this difference would mean to eliminate completely the phenomenon of pain: ... if we construe the grammar of the expression of sensation on the model of 'object and designation' the object drops out of consideration as irrelevant (Philosophical Investigations, § 293) (cf. yon Morstein 1964). This is a negative statement. It tells us a lot about what the language of pain is not it does not tell us very much about what characterizes the language of pain. As in so many other instances, Wittgenstein does not really answer the positive question. He is an aporetic thinker, a thinker who makes obvious the shortcomings and dead ends of traditional thinking; however, he does not go further - an insufficiency he felt to such an extent that he never published, e.g., the 'Philosophical Investigations'. Nevertheless, his discovery is of great importance for a closer analysis of the language of pain. In his discursive manner of thinking and writing, Wittgenstein involves the reader in a sort of 'inner dialogue' which, in quick sequence, changes from 'thesis' to 'antithesis'. This 'role-taking' is often not indicated at all in his texts, and in only a few instances does he offer a sort of meta-statement which can help the reader find his way out of the dead ends his 'dialogue' has led the reader into. One of these few instances refers to the problem of the language of pain. In § 304, Wittgenstein says: The paradox disappears only if we make a radical break with the idea that language always functions in one way, always serves the same purpose: to convey thoughts - which may be about houses, pains, good and evil, or anything else you please . The important hint in this self-commentary of Wittgenstein with regard to the language of pain is that it would be helpful, if not necessary, to look for the functions of the language  180 KONRAD EHLICH of pain in its use Wittgenstein, making this hint, seems to have come to the farthermost point possible for him in a theoretical situation in which such an idea was nearly unthinkable. Since we find few specifications of what the functions of the language of pain are in his text and it would lead us too far astray to try to elaborate these, let us consider, instead, where the hint Wittgenstein gives could lead us. It may appear somehow puzzling: nevertheless, if one regards pain from a linguistic point of view, things are quite different from traditional philosophical concepts on pain. Whereas pain has appeared as one of the most outstanding solipsistic phenomena in philosophical analysis, from a linguistic point of view, pain is primarily an interactional phenomenon, not a solipsistic sensation. A pain which is experienced is in most cases expressed There are different modes for doing this expression of pain; nevertheless, all of them are but special cases of the fact that pain is expressed. The expression of pain in its various forms makes pain accessible to the audience , to the addressees of that expression. Pain is a form of mental processing of physiological and/or psychic experiences. The processing is a transformation of sensations into expressions. Pain can be ex- pressed acustically or visually. Both modes combine expression and appeal , to use Btihler s (1934) terms. For the sake of brevity, I do not discuss visual nonverbal expressions of pain here. 3. THREE TYPES OF EXPRESSING PAIN In the following, I would like to make a distinction between three types of expressing pain: (1) crying and groaning; (2) pain interjections; and (3) pain descriptions. 3 1 Crying and Groaning Crying and groaning are part of a whole series of instinctive reactions to painful injury. These forms, though belonging to the biological equipment of human beings, can be influenced, i.e., partially controlled, by the person. On the one hand, it is possible to repress cries, to restrain or control them, while on the other hand, it is possible to cry without a cause. Thus, the biological form of expression is not fully automatic. Nevertheless, there is a biological program which is executed in case of pain. It is one of the earliest forms of expression the young human being has at its disposal. The cries of a baby who feels uncomfort- able, i.e., who feels pain, makes clear the (biological) function of this type of expression: the function of activating the mother in order to achieve relief. In other words, even this very elementary function of crying is an interactive one?

MFMRI

Jul 25, 2017
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