I suspended, suspended others, interviewed the clients - and found out two evident constants of each suspension - it is fear and pain. Depending on time, place, pose, experience and individual specific of the person, these constans are displayed in different extent, but their overcoming is always the core of the ritual. In this artical I'll consider pain as from general accepted scientific viewpoint, as psyhological viewpoint, and answer the question why we are not equal before it. Start from the begining.
Definition
Definition of the word "pain" has also suffered some changes.
Three and a half centuries ago Rene Decart, soldier and scientist, formulated the conception of pain and it satisfied the needs of science and practical medicine for almost two centuries. Such vitality of Decart's theory is explained by it's simplicity: "If the fire approaches to the leg, the tiny fire particles are able to move that little skin piece which they will touch. Thus, they will stretch the thin veil attached to this skin piece, and at that moment the brain valve will be opened where this veil ends. It's like as you would pull a rope tied to the big bell clapper".
More detailed definition replaced the simple and notional Decart's model. Here is the formulation published by one international committee in the jornal "Pain" (1976) : " Pain is an unpleasant sensor and emotional expirience, connected with true or potential tissue damage or dicribed by terms of such damage. " Per this defination, pain is as a rule, something more than clear expirience, as it is usually accompanied by unpleasant feeling. In this defination it is also clearly stated that pain felt when the force of tissue stimulation creates the danger of its distruction. Further, as indicated in the last part of the defination, although each pain is connected with tissue distruction or its risk, for pain expirience it is not important at all, if the damage really takes place.
International association for pain study (IASP) gave the following pain definition: "Pain is an unpleasant sensor and emotional experience, connected with true or potential tissue damage or discribed by terms of such damage".
From evolionary viewpoint, pain is an evolutionary fixed signal to the elimination of pain annoyance formed and directed to the individuum and spiece survival.
Pain theories
Till present time the unique pain theory explaining the different pain effects, doesn't exist. The most important meaning for understanding pain mechanisms have the following modern pain theories.
Pain transmitting scheme, where:
1. arising of pain stimulus
2. proposed organ on which the effect is made
3. cerebrum
4. cerebrum stem
5. spinal brain
6. transmission of inciting stimulus
Intensivity theory was proposed by english doctor E.Darwin (1794), according to which pain is not a specific fuling and doesn't have special receptors, but arises at superstrong stimulus effects to receptors of five known sense-organs. In pain formation convergion and summoning of pain impulses in cerebrum and spinal brain take place. In such way, specific pain receptors and transmittal parhs were denied. Specifics theory was formulated by german physician M.Frey (1894). According to this theory, pain is the specific feeling (sixth feeling), having its own receptoral apparatus, transmitting paths and cerebrum structures, processing pain information. M.Frey theory further recieved fuller experimental and clinical confirmation.
"Gates control" theory of Melzak and Wall.
The popular pain theory is the theory of "gates control" developed in 1965. According to it, in system of affercut entry in spinal brain there is a mechanism of control for transit impulses transmission from perephery. Such control is effected by brake neirons of gelatine substance which are activated by impulses from perephery by thick fibers, and also descending effects from the side of supraspinal sectors, including cerebrum cortex. This control is, figuratively, the "gates" regulating the pain impulses flow. Currently the theory of "gate control" system has been completed by many details, but important for clinicist core of this theory is actual and has wide acknowledgement.
Pain components
Different from another types of experience, pain is something more than simple experience, it has multi-component character.In different situations pain components may have not equal manifestation.Sensor component of pain is the ability of organizm to fix the pain localisation, time of begining and finishing, intensiveness of pain.
Affective (emotional) component. Any sensor feeling (warmth, sky sight, etc.) may be emotinally neutral or evoke pleasure or displeasure. Pain feeling is always accompanied by arising of emotions and almost always unpleasant. Motivotional component of pain characteryses is as negative biological requirement and launches the organizm behavior aimed at recovery .
Motor component of pain is represents by different motional reactions: from unconditional reflexes till motional programs of antipain behavior. It means that the organism tends to escape from pain stimulus effect (avoiding reflex, defendance !!! reflex). Motional reaction is developted even till the moment of pain recognition.Vegetative component characteryses violation of internal organs functions and metabolism. It evokes a range of vegetative reactions (nausea, contraction/expansion of vaskulars, expension of eye-apples, palpitation acceleration).
Cognitive (mental conception and processing of information) component is connected with pain self-estination and motivotional component.
Subjective attitude to pain
"We are not equal before pain" (Lerish).
The subjective attitude to pain is formed on the base of many factors, which can be grouped in the following categories: social ( sex, age, background) and individual (personal sensivity to pain, temperament type, personality pecularities, motivation).
Social factors
Age
Having analyzed the results recieved on a big material of longs years of researchs, the scientists have discovered the surprising fact: pain perception is changed with years. The tenderest age is from 10 till 30 years. In this period people are most sensitive to pain sensations, altrough they bear them comparatively easy. At yonger or older person the pain sensivity is decreased, but it's far difficult for them to bear sufferings.
Background
We should acknowledged that subjective attitude to illness is formed on the base of family backgroundand, particulary!, formed attitude to diseases, ways of pain tolerance, definition of place of health-disease parametr in values hierarchy of the child.
There are two contradictory ! family traditions of upbringing of subjective attitude to diseases - "stoical" and "hypochrondrical". In the frames of the first the child is constantly rawarded for behaviour aimed atindependent overcoming of diseases, bad condition. He is praysed when he, taking no notice of existing pain, continues to make the things, which he has been doing before. "Stoical" tradition is based is based on the slogan: "Don't whine!" The opposite family tradition is to form supervaluable attitude to health, when the parents raward for attentive relation to child's health, detailed estimation ! of desease manifistations, discoveryng of first symthoms of illness. In family the child is taught at the slight change of his condition to draw his own attention and attention of the surrounding ( at first, parents and them tutors, teachers, spouses and others) to desease manifistations.The slogan in this case is the expression : "Be vigilant, otherwise you'll get ill and die."
Sex
The differences between men and women in response to pain are confirmed by many epidemiological and experimental data. In most cases, it is discovered that women and girls complain for pain more often, than men and boys. These differences are explained mostly by biological traits of men and women. Last time the works have appeared
demonstrating the important impact of psysochological and social factors in difference of pain response at men women.
Gender theory ( from latin "genus" - "clan" - social sex).
The parents, especially farthers, more encourage boys for adherence to gender stereotypes and punish them stricter if they violate them norms of behaviour. If the boys acting "not as men" are mocked by peers, scolded by parents, the girls violatin from gender role can more often be ignored (boys "whiners" and girls "romps"). This leads to the fact that he boys strive more vehemently to correspond to their gender role, including pain tolerance. As male gender role presumes high pain tolerance, gender theory presumes the motivetion of men, chosen the men behaviour pattern, to firm pain tolerancenot to appear "not masculine". In D. Mechanick observations, boys of 4 and 8 years definetely more, than girls, demonstrated that they don't fear to recieve injury and don't attach importance to pain to corresponed to gender
stereotype of "masculinity". Women demonstrated bigger alertnes to pain and bigger readiness to compalain for it while men do it unwillingly. According to F.Levine and L.De Simone, men reported about less pain strengh when the experimentator was a young pretty girl in clothes underlining her feminity than when the experementator was a men. At the same time, men and women didn't show the difference in pain control execution.
Individual factors
Pain threshold and tolerance threshold.
It's considered that different pain perception at different people depends on their "pain thresholds". Pain threshold - it's the level of irritation for nerrous system when the person feels pain. Pain threshold is individual for each person, the same irriation level may manifest as in incosiderable, as in strong pain for different people. In first case, it is the high pain threshold, in second - the low. In physocophysics the minimal stimulus power which in 50% of effect evokes pain.
Pain tolerance threshold is defined as the biggest pain force which the person is ready to bear in concrete conditions.
It's often that the pain threshold correlates with emotionality level. In the frames of known temperament types the lowest pain threshold have choleric and melancholic in comparison to sangvinic and flegmatic. Numerous researches are didicated to study of conditions definiy !!! pain experience intensiveness. They showed that pain experience of a person depends on irritation extent ( first of all, from its strength, duration and quality) and on individual organism reaction and nervous system coondition, depending from the range of factors, including
psyhological. In the range psyhological factors having big meaning in pain experience it is necessary, at first, to indicate the following: attention distraction
and concentration on pain, pain expectation, personal traits (persistence and endurance or effeminacy), social and moral attitudes,contents and direction of life relations and motivations of the person defining his attitude to pain.
Pain expectation
Important role in pain experience place the pain expectation and attitude to it, from which is considerable extend depend pain tolerance threshold and possibility of it's overcoming. Expectation, "pain fear", by Astvatsaturov, is the primitive form of fear emotion in general. He writes that functional purpose of pain feeling is not a function of differeutiation of quality of external effect, but in affective experience of unpleasant feeling, being the stimulus to withdrawal from appopriate object. Identification of pain sensivity with emotion evoked objections of some researchers. Boris Ananiev ( Soviet Union psyhologist ! creator and leader of Petersburg scientifical psyhological school ) indicates that pain is an integral personal reaction expressed as in subjective feelings, as in objective activity.
It was ascertained in the researches that even in the rather emotional pain experience, despite intence expectation, colored by fear, the subjects defined the irritation extent absolutely correct and, despite intended disorientation from experementator, kept full feeling adequacy. They showed that under the influence of conceptions of this pain type and intense pain expectation arised in this regard, strongly emotionally (negatively) colored, the sensivity considerebly increased, which corresponded to decrease of threshold of pain sensivity. But along with it, the endurace increased, which expressed in enlarging of upper thresholds of pain sensivity. It occured due to inclussion into experience of pain of will mechanisms: aspiration of the subjects to inteutions execution formed at them in the process of experiment ( cheking of own endurance, compavison of himself, with other subjects, etc.) These data show the most important role of pain conception and formed on it's base pain decrease in individual order. The sensivity to pain at subjects was the higher, the stronger pain expectation was and emotional and affective tension connected with it. In the same way the endurance increased.
Some psyhologists also notted the important role of studying of observation of pain bahaviorof others. K.Craig and S.Weiss remarked three times increase of pain threshold after the subjects recieved the model of good endurance identical pain stimulus.
Life attitude and motivation
As you understand yourself, suspension has not been the subject of any researches and psychology has paid attention to this aspect rather recently, so in this chapter I'll use the observations of doctors and field surgeons.
The significance of life attitude in pain experience was pointed by Myasishev, Ananiev, Karvazarsky, Bicher, etc. More than one hundred years ago the famous French surgeon Dupuitren wrote: "What is the moral difference of those who are treatcd in civil hospitals from the persons receving fire wounds? The military man got used that he should forget himself and the family and he may end by being disabled. He considers himself happy in saves his life loosing the limb and as he is sure in safety, he firmly, even gladly, meets the surgeon's scalpel. But look at the unhappy worker, farmer, crafter, who is the only wage-earner of the big family. He is surpressed by fear, misery awaits him, he is deep despair, he lost hope. Sorrowfully, he agrees with surgeon's insistence. We shoudn't be surprised by the different results."
Bicher stidied the correlation between wound expressiveness and intensity of pain experienceat civil persons and soldiers put into the hospital for surgical threatment. There was no dependency between wound size and pain experience. The main in pain experience was the attitude of the patient towards it. For soldiers who had come to hospitals from the war zone where they had been constantly bombarded for several days, coming to the hospital and operation meant relative safety, release from desperate death fear and subsequent transfer to the rear. Only 32% from them suffered strong pain and asked morphine. At civil persons less operative interpontion was accompanied by considerably more expressed pain experience. Morphine application due to strong pain was required by 88% of these patients. Bicher comes to a conclusion that in pain experience wound size has lesser meaning than emotional component of suffering defined by patient's attitude.
On the base of the psyhological pain researches , Davidova makes the conclusuion about defining role in pain experience person's attitude to it. "Pain, - she writes, - itself doesn't have the main force because emotions accompagning pain feelings are fitered through certain life contents." In observation of the autor the different pain tolerance is showed by two wounded. In first case the operation was aimed at arm restoration (bullet remowal ). The ssick claimed: " I was waiting for this operation with impatience, it was return to life again". Second wounded attitude was different who was waiting for operational aim ! resection due to gangrene: " I thought, I wouldn't survive this day, everything dimed in my life." These two attitudes varied rapidly, and due to that another was attitude to pain, emotional experience of it. In first case: " I don't remember it the pain was strong, it seems, no." In second case: " Everything was painfull ! from begining to the end, before and after."
As at functional pains, as at paines caused by organic changes, person's attitude play important part (not in arisal!, but in extent of pain experience). Pain often reaches the maximal expressiveness ! at patients with personal problems, purpose absence and other unsolved conflicts. Ananiev also mentions the meaning of pain control, change of tolerance threshold by conscious attitude of the person.
I'll mention from my side that control over pain and emotions connected with it, it's necessary to learn for each person, as you'll meet it not once - be it a small scrape, serious wound or death. Pain may be enemy and helper, servant and master and only in your forces to settle our own relations with it. I think, the same can be told about fear, but about it in the next post :)
