When pain overwhelms the self: A phenomenological study of a new mode of suffering, based on adults' recollections of their worst pain episodes.

Pain-related suffering can occur through an immediate, disruptive impact on one's sense of self, even without self-reflection. Interviews with 12 adults across Canada living with various pain conditions revealed that during their worst pain episodes, the experience overwhelmed thoughts and self-reflective capacities, disrupting foundational aspects of self-experience such as agency, bodily ownership, and time. Participants described these experiences as incapacitating, dehumanizing, and dissociating. The accounts closely resemble first-hand reports of torture, supporting a new mode of pain-related suffering that does not require self-reflection. This expands traditional understandings, which have exclusively anchored suffering to self-reflective thought, to include two inter-related modes.

Study at a glance

Abstract

Suffering is a foundational yet understudied construct within the field of pain. There is general agreement that pain-related suffering involves disruption to one's sense of self. The selfhood literature characterizes two inter-related modes of self-experience. One mode entails in-the-moment experiences that shape one's stream of consciousness; another involves self-reflective thoughts about the past or expected future, related to self-narratives and identity. The field's current conceptualization of pain-related suffering is exclusively anchored to the latter, self-reflective mode of experience. Our past work argues that this framing fails to account for pain's immediate, disruptive impact and denies the potential for suffering among individuals without self-reflective capacities (e.g. infants). The purpose of this theoretically-informed, phenomenological study was to explore a new potential way by which people living with pain can suffer. We conducted in-depth, qualitative interviews with 12 adults across Canada living with various pain conditions. Interviews focused on understanding the moment-to-moment experiences of their worst episodes of pain. Results revealed important accounts of pain that overwhelmed thoughts and self-reflective capacities and disrupted foundational aspects of self-experience, including senses of agency, bodily ownership and time. Participants reported that these experiences were incapacitating, dehumanizing and dissociating. The findings are remarkably similar to first-hand accounts of torture and support a new mode of pain-related suffering that does not require self-reflection and is characterized by an immediate, disruptive impact on one's sense of self. Findings will inform the development of the first theoretically-informed and evidence-based definition of pain-related suffering and help advance pain theory and practice. PERSPECTIVE: This qualitative phenomenological study characterizes how pain can radically transform one's in-the-moment sense of self. Results reveal a new mode of pain-related suffering that does not require self-reflection. This supports the expansion of traditional understandings of suffering, exclusively anchored to self-reflection, to now include two inter-related modes of pain-related suffering.