'Pain is a reminder that the body is valuable': David Fajardo, Colombian philosopher

Standing. That's how he had to write the first version of this book. David Fajardo couldn't sit down: the pain in his sciatic nerve wouldn't let him. The crisis lasted two years. It was a sharp, penetrating, oppressive, electric pain that immobilized him, as he describes in the first pages. " I was fortunate that this happened when I was researching the nature of pain, while studying for my doctorate." Fajardo is Colombian, with a degree in philosophy from the Universidad del Valle. He holds a master's degree and a doctorate in philosophy from UNAM. He currently lives in Mexico. He has been a visiting scholar at the University of Arizona and the University of Cincinnati in the United States. While there in 2017, the pain began. First, he felt a violent stabbing pain. He couldn't bend down or sit down. The pain was in one place one day, and another the next.

Fajardo didn't understand. He asked himself questions. "My own investigation became an existential quest: I demanded from the world of ideas an explanation of the purpose of experiencing this pain." The result of this investigation is Grieving Flesh , a book in which he reflects on the nature of physical pain through the lens of science, philosophy, history, psychology, anthropology, and, of course, his own experience.

Something I've found fascinating, as well as very productive in terms of research, is the inexhaustible nature of pain in terms of the different perspectives from which it can be studied. Sometimes it seems like it's a subject that only concerns the health sciences or medicine. But it goes beyond that dimension. Pain is a psychological reality; it's a topic for sociologists and historians. Because it holds such a dominant place in human life, it appears as an object of study for countless disciplines.

That definition was developed by the International Association for the Study of Pain in the 1960s—it was recently revised slightly, changing just a few words—and it marked a turning point. It was very important to arrive at it because previously, everyone who dealt with pain took it for something different. On the one hand, it was an epistemic advance—in our way of understanding suffering, because it allowed for a dialogue between disciplines—but it was also a moral advance, in the sense that this definition emphasizes understanding pain as a psychological, subjective experience. It speaks, for example, of considering any expression of pain that is manifested as such as pain. This is important because, for a long time—even now—healthcare personnel treated some pains with distance. They said, well, let's see if it's true or not.

Exactly. And that also implies a comparison. Could this pain have been a little higher than yesterday's? These kinds of questions made me question a lot when I started hearing them. From what I've observed, and in conversation with healthcare professionals, it's important for them to elicit that internal conflict in the patient. This concern is valuable for seeing what changes occur in the person's experience. These are scales that aren't taken literally. But they are a tool for reading what's happening with that particular patient based on those questions.

That's right. The very production of pain, the internal interactions in the body, in the brain, that give rise to pain, are influenced by a host of psychological issues. From neuroscience, we've known for quite some time that there's no specific part of the brain that's activated to produce pain. There's no pinpoint, no pain area. On the contrary, what happens is a dialogue between different brain areas responsible for very different issues. There's the area that deals with the representation of the body, which is the somatosensory cortex. There's the area that deals with memory: the way the organism—the animal, the person—has experienced pain before affects how it feels in the present. There are areas related to movement, which influence how we respond and react to pain. The areas linked to threat assessment, also what we know as the brain's reward system, which rewards us for doing things that help us survive—not putting any weight on our painful foot, for example. Pain is a sum of factors, many of which are linked to the psychological context of the person experiencing it.

There's research on this in all directions. We know how fear can affect the experience of pain, for example. If what one feels is a fear of injury or the pain one is experiencing at the time, the pain is likely to be magnified. But if our fear isn't of pain or injury, but of something external, the experience changes. Think of an animal running terrified because a predator is about to catch it. That fear for survival makes the pain it's feeling—because, for example, it's broken a leg—disappear, and it continues running. The interesting thing about pain is this way it adapts to the context. That's what makes it very convenient for survival. Because if pain only restricted movement, in this case, the result would be death. Pain helps because it finds a way to appear in tune with what's happening in the person's mental life.

That's a very beautiful question, and it occupies the minds of philosophers. There are two ways of looking at it—sometimes philosophy is frustrating because it has no answers. There's the question of whether pain can exist even if we're not aware of it. One way of thinking about it is that the pain is there, but the focus of attention is on another activity, and that's why it's not felt. But despite that, it remains there. Another way of looking at it is that attention determines what's in the mind. So, by not being focused on the pain, the pain is no longer there. Each of these perspectives obeys different theoretical commitments. If the existence of pain is only mental, conscious, the answer would be that in that case there is no pain. But if we think of pain as more than just its conscious presence, we would say that it's still there even if you're not feeling it. I tend to favor the second way of thinking about the matter.

For a long time, in the history of our Western thought, the distinction between mind and body has been very useful for certain things. But in other respects, such a sharp division seems more artificial. When we ask ourselves about pain, this becomes very clear. Pain disturbs the mind. Concentration is affected by experiencing it. It occupies an important place in the subjectivity of the sufferer. But the body is also clearly affected. It seems connected to what is felt. Pain is like a hinge between these two realities. There is also a way of understanding the mental as the result of a very complex bodily activity. They are not two separate issues. It is the same reality, but we call the result of the interaction of our brain, the nervous system, the body it embodies, etc., "mind." From that perspective, pain is like a virtual body that the brain produces to provide a representation of what happens in the body.

Exactly, that's what you find in these cases. People who have had an amputation, a mutilation, continue to experience or begin to feel pain in a place where there is no longer a limb. How can it be that an arm that I no longer have hurts? The arm, indeed, isn't there. But in that virtual representation of the body that the brain has been constructing over all the years of life, that arm is still there, and that's where the pain occurs.

The observation of this syndrome points to that. One way to analyze what purpose something serves us is to look at what happens in cases where that something is missing. Congenital analgesia is serious. It's a very difficult way to enter the world, and few reach adulthood with this condition. It creates challenges, especially in childhood. A child who doesn't have access to the knowledge that they can potentially harm themselves can suffer dangerous accidents. Pain has a very important contribution: it's a constant reminder that the body is valuable. That's key, because it's often seen as a weakness, a defect. Vulnerabilities remind us that we have great value. The fragility of the body, among other things, is what makes us who we are. Human life is about having these bodies that deteriorate, that decay, that will eventually perish. Pain is there, to a large extent, as a way in which nature gives us self-recognition: I have to take care of myself. It's a guideline regarding the limits of our carnality.

There's a tension in that. Because when someone suffers from pain, what they want is relief. Especially from chronic pain. But beyond that longing in specific situations, a pain-free society is a society without bodily limits that preserve the organic integrity of its members. Byung-Chul Han, in his book The Palliative Society, talks about something similar to what you're suggesting: that contemporary societies are probably the first and only ones to have considered that not having pain is a right. This applies especially to societies with high incomes. In fact, in Latin America, the reality is that we have no way to relieve pain. Our healthcare systems are deficient, as is the supply of medications. So that doesn't apply to our countries. On the contrary, here we have developed strategies that range from the personal to the community to be able to cope and live with it.

Yes, very much so. Beyond whether it's written or verbal, the experience of having the phenomenon under control is helpful. It may be illusory. But that feeling helps. We largely recognize this during doctor visits. When something hurts and you don't know what it is, the worry is not having the words to explain it. The moment the health expert says, "Look, what you have is this," a kind of relief is already generated. It's been said that what's horrible is that which we can't put into words. That which exceeds our capacity for language, which doesn't even have limits. So by finding words, you can at least give it a place. You can interact with it. You make it manageable.

It has to do with words. The spiritual dimension is often equated with the religious, but it goes much further. The spiritual is related to meaning, significance. We give meaning primarily through the use of language. The spiritual challenge that pain generates in people is what place we are going to give it in our personal narrative. With what words are we going to describe this experience? What is this pain for me? Is this pain the end of my life, is it the beginning of another life? The social dimension is also important. It's not just about what role I give to my pain, but what role others give to my pain. When we see a person complaining of pain, we feel an internal motivation to help. It's almost natural. An anthropology and psychology study took two groups of strangers. One was given sweet food; the other spicy food, with the understanding that it would cause them pain. While the former behaved like strangers—which they were—the group that ate spicy food showed a willingness to cooperate. Going through the painful experience together brought people closer together. You see that in everyday life. Pain brings us closer.