This month we are revising the problem of causation on Pain Geeks with another chapter from the Cause Health book, a short article and a poem by Rudyard Kipling.
Plan your reading: This month we have a whole chapter from the Cause Health book which may ask a little more of your time than usual.
The problem of Pain and Causation
“To be in pain is to be sure, to witness another in pain is to doubt”, Elaine Scarry The Body in Pain.
The conflict between doubt and sureness is a well known experience for those in the medical and therapeutic professions. We may feel this conflict when it comes to diagnosis, treatment planning, advice and education - what do we say to someone that is both true and helpful about their pain?
Much of our science and evidence is concerned with telling us what is more true, but is this the right question? And how do we go about exploring this question. What is the right method to get us closer to the truth?
Philosophy of science gives us a language to navigate these discussions that many of us may never have been given or explored before. This helps us to frame our ‘bits of knowledge’ into a wider framework:
“So many people today—and even professional scientists—seem to me like somebody who has seen thousands of trees but has never seen a forest.”
- Albert Einstein in a letter to Robert Thornton 1944.
Philosophy of Science allows us to zoom out from individual questions, problems and methodologies to a wider perspective. Understanding complex constructs like causation, epistemology and ontology is important if you want to be able to develop elegant and effective research, but also know when the methodology is simply not the right one for the type of question being asked.
This is important for several reasons:
It helps you develop a reliable filtering system
You will be able draw out from the data and text that is appropriate and useful for your question
You will develop a more critical or skeptical way of reading that will mean you gain more than just the presented information in each piece you read - simply more bang for your buck.
Developing a more reliable filter system
Why do we need one? Well, the one thing I have consistently been overwhelmed with as a clinician is volume. The absolute volume of available texts is simply too much for me to read enough to stay abreast of all the updates and information out there in literature-land about pain, clinical practice and physiology.
I needed a filter system. Turning to philosophy has helped me to choose which parts of the evidence landscape I need to look in for particular types questions. For example, when I’m exploring a question about the experience of someone with pain, I know that I need a research group that is skilled at exploring pain from a phenomenological perspective. If I want to know something about the proposed mechanism of neuropathic pain from a purely physiological perspective, I will need to head into the world of biomedicine and animal models.
Both of these tell me something about pain but they are telling me very different pieces of information.
Understanding epistemological, ontological and causation problems and pitfalls helps you to filter out or adjust your reading styles of papers that are making claims beyond the remit of their methodology and question.
Randomised Control Trials full of the promise of ‘the right exercise for knee pain’ are the equivalent of ‘click-bait’ for clinicians with little time. It simply will not deliver on its
This helps me be more directed in my reading and invest my time more wisely and effectively.
Draw appropriate and recent information the data and the text
If I am looking to find out what to do for the person sat in front of me, I will need to be able to bring these pieces of information together and be the conduit for that person. Because there is no research available to me in the huge and overwhelming literature-land that tells me anything about the person in front of me. It is all a ‘best fit’ approach.
Everything we read and learn to integrate into our practice is shaped by the assumptions and rules within the philosophical perspective through which it was written. It is not enough to say biomedical research is reductive, becuase that’s not entirely accurate. Biomedical science is often reductive, as researchers overly identify one mechanism with causative powers for example a particular receptor for a type of pain.
Many researchers however, present their data as a part of the overall picture and recognise that one mechanism can never explain the entirety of a complex human experience. So we need to get better at navigating these issues in our reading and choosing what we read in an informed way.
Nurturing healthy skepticism
The word skepticism comes from the greek word skepsis meaning ‘to investigate’ or enquire about a topic or question (Vogt, 2010 revised 2021: Ancient Skepticism. Stanford Encyclopedia of Philosophy accessed 31.10.22 ).
When we are reaching out into the evidence landscape for information and guidance on a particular topic, we should come from the position of enquiry rather than problem solving or answer-seeking. The research does not have the answer to our question, but it can help us to construct one. I always think of this as being gentle with the research, not asking too much or violently holding a piece up as truth. This is faith. This is what faith asks of us. Not science. Science wants you to disagree, to look for the areas where it is weak and to have an honest relationship with it.
Skepticism is the suspending of judgement so that you can read more critically and place the information within a wider framework.
Not to be confused with cynicism - when a person acts within their own agenda - looking to prove that a particular exercise for knee pain works, because it makes me feel better about giving all people with knee pain that exercise.
Or a kind of clinical or scientific nihilism - truth and knowledge are impossible to achieve or perhaps even less helpful, we don’t know what works therefore nothing works.
Adopting a position of good faith enquiry means that we don’t ask the research to answer questions that it simply can’t whilst also reaching out into the research that is most appropriate for our question.
Causation: the relationship of influence that one event has on producing another event.
Epistemology: The theory of knowledge and the method through which knowledge is obtained and developed Ontology: an area of metaphysics within philosophy exploring what it is to be and concerned truth about the nature of existence.
This is the month where we explain and struggle with these concepts when it comes to pain and we have curated some readings for you to facilitate that process!
Rocca, E., & Anjum, R. L. (2020). Complexity, reductionism and the biomedical model. In Rethinking Causality, Complexity and Evidence for the Unique Patient: A CauseHealth Resource for Healthcare Professionals and the Clinical Encounter (pp. 75–94). Springer International Publishing.
Haynes, R. B., Sackett, D. L., & Tugwell, P. (1983). Problems in the Handling of Clinical and Research Evidence by Medical Practitioners At one time, it made little difference whether a medical. In Arch Intern Med (Vol. 143).