it didn't hurt before, yet was so much less painful when it was fixed

A while ago a friend told me that, before he had his hip replaced, he wasn't experiencing discomfort - yet that, after he'd had the replacement, he was so much more comfortable! This, from a philosophical point of view, is an interesting experience. We typically use here phrases like become 'unaware of', or 'habituate to', (the pain) here to try to explain what was going on, to make good an apparent contradiction, but it's not obvious that they get us very far. To make the explanation work we construe discomfort on the model of our awareness of an object ... but since discomfort and our awareness of discomfort just aren't two different phenomena, one an experience and the other that experience's object, the explanation rather falls apart on us.

That life is like this, though: this is undeniable. No amount of Sartrean objections to the Freudian unconscious, the unknown experience, obviate the observation. And, let's face it, something similar happens with regard emotional rather than physical pain too. A patient, prior to developing a capacity for self-sympathy, typically remains oblivious to such hurts as can not only later be acknowledged but also then be acknowledged to - in some sense - have been alive earlier too. This happens, and far more widely than is typically acknowledged.

I don't raise this issue to try to psychologically explain it. It is, perhaps, not ultimately something that even requires explanation: it may instead simply be "there like our life", something in which we must acquiesce, an aspect of life to which we must just offer acknowledgement. And yet, if that's so, and if we're to not feel cheated of understanding, we shall surely instead at least require some explanation as to why it's hard so to do.

My own favourite metaphor for unconscious emotional life is owed not to the psychoanalysts but to the existential phenomenologists. We indwell unconscious affect like a fish which knows not of water yet endlessly swims within it; we can't get the distance from it to mentalise it. This water, though, runs all the way through us, so shaping the seeing eye that it can't itself be pulled into view. It structures the Lichtung's fabric, rather than shows up within it - and yet, being part of our very 'flesh' in this way, it's alive within every encounter we have. We could pile up the metaphors here, and they're useful both for bringing into view the phenomenon in question and for avoiding an unhelpful, personal/subpersonal-levels-muddling, pseudo-explanation in terms of (say) 'interoception'. And yet, let's face it, they're not really explanations. They don't really explain how it's possible; they just provide a picture which offers the phenomenon acknowledgement.

I've no doubt that my friend with the hip replacement was, before his operation, also walking in such a manner as would minimise discomfort without realising that he was even doing this. (Thomas Fuchs writes well about this sort of phenomenon in his treatment of unconscious mental life.) This too provides a helpful fact, as it were, with which to bolster our stand against the idea that Sartre's apt critique of the Freudian idea of the censor takes us far by way of refuting the notion of unconscious experience. We motivatedly veer away from that which we yet don't even experience. We don't need to think on what we yet somehow know to avoid. 

The ACT idea that it's futile to try to avoid such thoughts or feelings ("whatever you do, don't think about a pink elephant") as (in particular) make for misery, so we should instead make room for them whilst defusing from them, is ultimately perhaps somewhat limited. For people do, it seems, manage rather well to intentionally not think about or engage with affective 'pink elephants'. In fact I'm happy to here report some results newly in: that I myself have succeeded in very intentionally not thinking on a certain topic, and maintaining instead a clear mind, for a few minutes at a time. If the very idea seems paradoxical then it may be high time to update our sense of what it is to direct our attention away from that which inwardly vexes us. And in truth, certain depressed and procrastinating patients are, in fact, the ultimate masters of this: their affective ostrich heads remain resolutely buried in the unmentalising sands.

One tempting but ultimately vacuous option here would be to talk of 'levels of consciousness'. We say something like 'my friend's pain did not "rise to the level" of a truly conscious experience, but instead plied its trade under the radar of self-conscious suffering'. This Freudian submerged iceberg metaphor, however, doesn't really get us anywhere. It just rehearses the fact of the phenomenon in question, whilst once again inviting us to occupy an epistemic perspective on our own suffering even as it denies that suffering can be understood ('thetically' / 'positionally') as its own intentional object.

Wilfred Bion

Now Bion, it seems to me, is onto something important when he distinguishes mental pain and mental suffering. (He's talking about patients who he wants to say "experience pain but not suffering. They may be suffering in the eyes of the analyst because the analyst can, and indeed must, suffer. The patient may say he suffers but this is only because he does not know what suffering is and mistakes feeling pain for suffering it.") Self-solicitude and the capacity to suffer typically come along together, I believe, and the first may be born of the experience of 'internalising' the parent/analyst's solicitude. And yet we get nowhere here if at this point we just invent and pile on faculties and mechanisms, symbolisation, alpha function, etc. Whilst there's nothing wrong with the analytic concepts, there is something wrong with such of their users as take themselves to now be in possession of a causal explanation as to how disturbances of thought and feeling obtain - rather than, more modestly, a phenomenological articulation of clinically important facts.

Christopher Bollas talks of the 'unthought known', a concept I've found of value in my own life. One has an emotionally charged realisation regarding a significant fact or happening from earlier in life and can now attest that that about which one can now think, one nevertheless in some sense knew about all along. Is it just that the significance of the newly appreciated fact is now more clearly available to one? Well, it is that (but not the 'just'), but what this way of putting it misses is the significance of the knowledge in question. This knowledge is indwelt, it structures one's relationships like an inexorable yet by-oneself-unformulable a priori (Jonathan Lear writes well on this) rather than as one thinkable way of being among other possibilities.

The underappreciated Bede Rundle once suggested that it's intelligible that withdrawing one's hand from a pricking pin need not constitute a response to pain - if 'to' here means 'caused by'. Instead it could be that the pain and the response were effects of a common cause. 'I winced with pain' might, he said, be as or more apt a locution, in this regard, than 'The pain made me wince':

Compare an explanation which puts the shaking of a man's hand down to nervousness. 'Because he is nervous' does not here amount to a causal claim, but locates the behaviour within a larger set of circumstances, within a cluster of reactions whose causal structure has yet to be disentangled. / Closely analogous to pain is the example of sound: the hearing of a loud bang can actually succeed a startled reaction associated with it, minute though the time lag is. Note that, while this rules out the auditory experience as cause of the reaction, it does not necessarily contradict the claim of the sound to be cause, since, despite the different grammars of 'sound' and 'sound wave', their points of contact may allow the sound to be credited with causing whatever is attributable to the agency of the waves.  

This is interesting. It's natural to object: but were he to not have felt pain, he shouldn't have withdrawn from the pin. And yet: is this not an empirical claim? Isn't it at least intelligible, that is, that the body's reflexive movements be sometimes a response to injury rather than to injury's sensation? Similarly: I remember that I once saw a huge snake on the path and jumped in fright - and that the jumping, the startle, obtained before I'd got a clear idea of what I was looking at. Here, however, we're rather far from 'unfelt pain', and rather closer to 'unfelt injury'. For what we'd instead be analogically after here, let's recall, is the idea of a body with/from which one disidentifies, as it were, when one's injured, and so avoids feeling pain - and with which one reidentifies at a later time - at which time one can not only feel pain again but also newly acknowledge its prior presence.

Thinking about the relation of mood to emotion might help here. Thus when in a true mood one's not typically suffering a discretely emotional experience - but out of a mood can crystallise a particular emotion, at which point the mood ceases and one instead starts to genuinely suffer the emotion. Looking back at the moody time we might say: 'I now can see how much pain I was in / how angry I was before'. Looking back to times of what we call 'dissociation' can be like this too. My proposal now is that this isn't simply a subjunctive/hypothetical claim: that were I to not have been dissociated, I should then have felt pain / anger. For what that misses is that there's a whole new ease of being now in play which itself bespeaks a prior unregistered pain.

So how can we understand why it's hard to acknowledge what's manifestly true: what I'm calling 'the fact of unfelt pain'? My proposal is as follows: We tend to misconstrue nouns as inexorably referring to things - and it's characteristic of our concepts of things to have but a few criteria of identity and, moreover, criteria of identity which inexorably co-occur. It's also the case that when we think of intense physical pain, we tend to think it's impossible that we wouldn't be alive to it. Finally, we tend to imagine that the later acknowledgement of an earlier psychological truth (about ourselves) amounts to a kind of memory judgement - a recognition of the truth of a proposition which concerns an earlier state of affairs. Pain, both physical and mental, is however not at all like this.

First of all, there are several criteria for pain, and these can come apart. There's the behavioural response (move away from pain-inducing stimuli). There's the expressive response (the grimace). There's the pre-emptive avoidant behaviour. There's the expressive or reportative present-moment self-ascription. And then there's the later acknowledgement of the earlier pain. (I leave out the body's physiological activity which to my mind is extrinsic to the concept.) The meeting of any of these may be enabled by somewhat different physiological mechanisms. (Wincing, now, becomes criterial for pain - rather than something which, as Rundle suggests, may merely be an effect of a common cause. Thinking about what it is to wince, i.e. about the internal relation of 'wincing' and 'pain', should also help us out here!) The wrong way to think about these criteria is as evidence for the obtaining of a singular inner fact. Pain is not, as it were, an inner torchlight that is either on or off - the behaviour in question being evidence that the switch is in one or the other position. That is to make of pain what, following Wittgenstein, we may call a mythical 'beetle in a box', and once we've done that the temptation will be to think our denial of the torchlight makes of it 'a nothing' rather than 'a something'. Whereas what we ought to do is to here reiterate our question: ok, let's assume for the sake of argument that your talk of a torchlight beam is cogent: when do we properly say of someone that their torchlight beam is on?

Second, we typically find the pain of significant injury to be so intrusive and unresponsive to the will that we find it hard to imagine not being able to avow (i.e. express through self-ascribing) it. Yet why should that be? I simply have had patients who only came to be able to acknowledge the pain caused by significant injury after we looked together at their pain with ordinary respectful sympathy.

Finally, we need to acknowledge that a 'delay' in the avowal of a psychological fact needn't turn it into an empirical (i.e. merely factive, potentially erroneous) claim, i.e. needn't turn it into the expression of a judgement about one's own past state. I form a resolution, but do so while out hiking. My immediately calling my friend and sharing it is no more truly criterial for the fact of the resolution than is my finally doing so the next day - or six months later. I may of course never share it; I may forget about it; none of this, however, turns the times when I do share of it into something less than an avowal (i.e. when I voice the earlier resolution, rather than simply voice a judgement that I once made that resolution. Which isn't, of course, to say that I couldn't do the latter: as I might when I've quite forgotten it, and even on looking at the declaration of it in my diary cannot form an 'inner connection' with it - but yet have no cause to reject my diary entry.).

To conclude, I want to ask whether, to sustain the attribution of pain to he who sincerely doesn't avow it, we must posit the operation of a defeating condition. Is it intelligible that my friend, or my patients, who were not, as we say, 'aware' of their pain at t1, but at t2 can offer a belated avowal for t1's pain, be properly said to have yet been in pain at t1 unless we also have an explanation as why they couldn't avow it at t1? Must we refer to a broader character trait of self-neglect, or (what needn't be an entirely different matter) the operation of a dissociative defence mechanism, in order to sustain the attribution of unavowable pain at t1? Or will a later acknowledgement suffice? Well, it may differ from case to case as to where our shared intuitions as to intelligibility lie - and in fact there also need be no universally shared set of intuitions here either. There may be an indeterminacy in the very concept, that is, perhaps especially when we come to mental pain.