Words, meaning, and thought 3: pain and primes

Following my first article and the second looking at problems with linguistic relativity and ‘missing words’, I continue to work through ideas put forward in the book Words & Meanings, by Cliff Goddard and Anna Wierzbicka (Oxford UP, ISBN 978 0 19 966843 4).

As promised (a regrettably long time ago), I move on to pain, which is not represented by any of the proposed semantic primes, but which is important enough to merit a whole chapter in the book.

Before discussing pain itself, I would like to remind you of the important clarification made over the meaning of the prime FEEL (last article). Goddard and Wierzbicka recognise that the English word has polysemy which includes ‘feel by touch’, but make it clear that the prime FEEL is illustrated in the simple sentences
(When this happened), I felt something good/bad.
I don’t feel well today.
I often feel like this.
At that time (then), I didn’t feel anything.

Despite that, they consistently use the prime FEEL in its sensory meaning, for example starting many explications of sensations which are not covered by primes thus:
a. this thing is like this:
b. if a part of someone's body touches this thing.
c. this someone can feel something in this part of the body because of it

Thus they use FEEL in the senses of both emotion and sensation. I do not consider that such an English polysemy could be universal, and would therefore be very interested to see similar explications in languages in which the terms for emotional and sensory pain are clearly discriminated.

Pain as sensation

Chapter 6, on pain, starts with an unrecognised but fatal problem: the fact that the English term pain is the most generic word for pain in the language, and is therefore abundantly polysemous. The OED, for instance, distinguishes:

  1. a penalty or punishment, on pain of death;
  2. the sensation of hurt or suffering;
  3. a distressing sensation as of soreness;
  4. specifically the pain of labour and childbirth;
  5. as an abbreviation for pain in the neck (or arse), an annoying or tiresome person or thing;
  6. mental suffering or sorrow;
  7. trouble, as in to take pain in doing something (and similarly its plural).

Of those, I would like to single out the third (including the fourth), that of the sensation of pain, which I consider does need inclusion as a prime. Other meanings of the word reflect emotional conditions, legal matters, and more figurative uses which will inevitably be variable across different languages and cultures, and should be perfectly expressible through explication.

In the 300 and more years which have elapsed since Robert Locke’s theory of mind, we have come to learn a great deal about the facts of pain as a sensation. Our skin, and many internal organs, have sensors which are specific to the modality of pain, and our brains (connected to those sensors by specific afferent nerve fibres) have specific neural circuits which handle the sensation of pain.

Specific neurotransmitters and receptors are involved in this, notably opioid receptors which can receive substances such as endorphins. A family of drugs, the opiates, are known to stimulate those receptors, and one (naloxone) is a specific competitive antagonist, used clinically to reverse some of the effects of opiate overdose.

We know that many other animals, particularly mammals, appear to suffer pain in much the same way that we do, and unsurprisingly they have the same sensory and neural apparatus, transmitters, and receptors.

Although the sensation of pain is usually perceived as being unpleasant, that is a gross oversimplification of a very complex system. You only have to observe athletes completing very demanding performances, such as the mountain-top finish of a stage in the Tour de France, to recognise that pain is far more complex and contextual than simply ‘feeling something bad’. I am also informed (but have not of course personally experienced) that the pain of labour and childbirth is quite different.

Pain sensation is thus not only universal among humans, but also appears to extend to many animals too, even though they cannot express it in any verbal language.

Before I am accused of being Anglocentric in this approach (for no chapter in their book passes without such accusations), I should point out that pain and its pharmacological relief were studied and recorded by the ancient Greeks, Arabian scientists, and further east in Asia.

Many of the leading studies in more recent years were carried out in Germany, and I would single out the great Spanish neuroscientist Santiago Ramón y Cajal, who was awarded a Nobel prize for his work jointly with the Italian Camillo Golgi. Since then details have been provided by scientists around the world, with particularly important work undertaken in Japan and in more recent years China.

Pain as condition

As Goddard and Wierzbicka point out, pain is also a presenting symptom of many medical conditions. In a teleological sense, it is intended to be, as pain receptors are stimulated by most injuries and many illnesses. If your broken leg did not hurt, you would continue to try to walk on it, rather than letting the bones set first.

Unfortunately their lack of insight into the elicitation of symptoms and diagnostic process in medicine mars much of their discussion too. While I agree that the specific pain questionnaire which they examined (p 135 ff) is not particularly appropriate for self-administration by patients, there are others which are, but which they ignore.

They also ignore the fact that the medical literature has extensive discussion of the need to adapt pain terms and tools to suit cultures, even within those who speak the same language. Pain questionnaires and other working tools have been converted (not simply translated) into many different languages accordingly. Goddard and Wierzbicka do significant disservice to the many dedicated specialists in pain and its management who have been particularly careful to ensure that their written and spoken materials are designed to communicate most effectively with people from different languages, cultures and communities.

For (personal) example, there is a particular type of neuropathic pain (generated as a result of damage to nerves) which British English-speaking whites (yes, those Anglocentrics again) recognise as being appropriately termed pain. However the same type of pain is more widely recognised as burning by many African-Caribbeans, even though they are English-speaking and in many cases have lived and worked in British communities for many years. Furthermore, some will not accept that their burning is pain at all, and others describe it as being pins and needles, rather than burning or pain.

Having spent the last 35 years and more of my life speaking to patients about pain, trying to determine what is causing their pain, and how to treat the underlying condition, I also know well how doctors are not lawyers or investigative scientists, but need to ask leading questions. If they do not, the diagnostic process becomes an interminable game or 20 (or 2000) questions, and seldom reaches the right conclusion.

For example, there is a distinct type of abdominal pain which comes and goes (a phrase understood by even very young children) in a phasic manner, at fairly regular intervals (much as labour pains do). Strangely most patients who are suffering from this pain recognise it as being rhythmic or periodic, just as our ancestors would have recognised the term used to describe it: colic.

This pain arises from the regular contractions of the bowel or other tube which is the source of the pain, and will be only too familiar to anyone who has suffered from a bad bout of diarrhoea, for instance. In its most severe form, as occurs when a stone is lodged in the ureter of a kidney, it is intense at its peak, but vanishes altogether in between: that is renal colic. There are less intense colics which result from stones in the gall bladder and its connections: biliary colic.

Colicky pain is quite different from more constant abdominal pain, which more usually arises from inflammation such as appendicitis or peritonitis.

So the elicitation of symptoms, particularly those of pain, is not some abstract exercise in semantics, but an embedded part of the diagnostic process. Asking open questions and using words which appear semantically impeccable is not useful. Your patient will have died of peritonitis long before you have reached a diagnosis. Far from being “liberating”, Goddard and Wierzbicka merely appear unreal.

The moral is to see a doctor when you have pain in the gut, not to consult a linguist.

Pain as prime

So how would Goddard and Wierzbicka explicate a continuous pain in the abdomen, for instance? According to page 141:
a. something bad is happening to a part of someone's body
b. this someone feels something very bad in this part of the body because of this
c. this someone thinks like this about this at this time: "I don't want this"

Knowing what we do about pain, I do not think that ‘feeling something very bad’ is adequate or specific enough to mean pain. There are other sensations such as nausea which could equally fit this explication. In the absence of pain as a semantic prime, there is no way of explicating it away, and the claim that this trims “the definition to the conceptual core” is thoroughly misconceived.

Primes surveyed

Having tackled what I consider to be several missing semantic primes, I will not attempt any further discussion as to what should or should not be included in the list of primes. However there is one important issue which I will finish this article with.

Attempting to build the semantics of all language and all languages using a core of less than a hundred primes is a very similar enterprise to that of trying to model the world using LEGOⓇ bricks. It is possible in a sort of fashion, if you overlook the crude and often overelaborate assemblies which result. However it is a reductionist illusion that merely combining those primes in explications can ever “elucidate very subtle semantic distinctions drawn by particular languages.” (op. cit. p 155.)

The underlying limitation of using LEGOⓇ bricks or semantic primes is that the bricks or primes either have to be so multi-function that they mean several different things (as with FEEL), or that they are too crisp to reflect the subtlety of reality (as with GOOD and BAD).

In the next article I will explore these problems when I consider how well explications work in practice.