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Ouch!

Disease, Pain and Sacrifice

by David Bakan
Chicago, 134 pp., $5.95

Individuality in Pain and Suffering

by Asenath Petrie
Chicago, 153 pp., $5.00

Although both these books are about pain and suffering and are written by psychologists, they are as unlike as chalk and cheese. Dr. Bakan’s is concerned with the philosophy of pain, and with its biological and existential meaning, while Dr. Petrie’s is concerned with experimental data about pain, with techniques for measuring it and elucidating the ways in which different temperamental and diagnostic groups experience it. Dr. Bakan conceives ideas about pain; Dr. Petrie reports observations on it. Dr. Bakan assumes that his readers are persons of wide and high culture, equally at home in evolutionary theory, psychoanalysis, and theology; Dr. Petrie is writing primarily for research workers and describes in detail her experimental methods and the statistical analyses of her results.

Disease, Pain and Sacrifice consists of three essays, concerned with the biological, psychological, and existential aspects of pain respectively. The blurb asserts that they form a triptych, each essay a single entity, and the whole a unity, but many readers, I suspect, will find that the third, an interpretation of the Book of Job, is based on presuppositions (of which more later) that prevent their retaining the sense of unity of theme.

In his first essay, “Disease as Telic Decentralization,” Dr. Bakan argues that disease can be conceptualized as a manifestation of disruption of the whole, as a failure in communication between the central, higher and peripheral, lower structures of complex organisms, as a result of which the former lose their control over the latter; or, as he himself puts it, “disease is to be conceived of as decentralization of this higher telos of the organism, and its loss of dominance over the lower telê,” This formulation, which applies most aptly to cancer and (though Dr. Bakan does not mention them) congenital disorders, implies that organisms possess an inbuilt drive toward the creation and maintenance of their own inherent form, that they are actuated by “something” which determines their nature. This “something” Bakan calls “telos”—the “tel” is that in teleology not that in telegraph—which he explicitly states to be a concept similar to entelechy, to Bergson’s élan vital, and to McDougall’s hormé.

ALTHOUGH THE DEVELOPMENT of the biological sciences in the nineteenth century was largely based on an explicit rejection of any such notion—in 1842 the physiologists Brücke and du Bois-Reymond “pledged a solemn oath to put into effect this truth: No other forces than the common physical and chemical ones are active in the organism….” Dr. Bakan’s hypothesis is not, I think, nowadays either remarkable or novel; his telos has, for instance, affinities with Koestler’s holon. In one respect, however, the use he makes of it is new.

This is Dr. Bakan’s assumption that the species is itself a telos and that disease may be a manifestation not only of the organism’s individual failure to maintain integration but also of his isolation from the social telos. Disease, he argues, can be the result of “separation-estrangement” and he cites an impressive amount of evidence suggesting that this can indeed be so: the higher incidence of cancer in experimental animals reared in isolation than in those reared with cagemates, the high death rate of infants deprived of all mothering even if otherwise well cared for, the high incidence of somatic disease in persons who have suffered traumatic disruption of their social relations, the improved therapeutic results obtained by hospitals which train their nursing staff to establish and maintain rapport with their patients. “Observations such as these suggest that such efforts as man can devise and apply to overcome telic decentralization on the social level can work against the processes associated with disease and death, although they cannot overcome the inexorability of the latter.”

BAKAN ALSO OFFERS an interpretation of Freud’s theory of the life and death instincts, the life instincts corresponding to the tendency to unite and centralize inherent in the telos, the death instincts to the tendency to decentralize which is inevitable in complex, differentiated organisms. On this basis Bakan suggests an explanation of the therapeutic effect of transference:

If the isolation of the individual from the larger social telos could be overcome, if contact and communication between the individual and at least one other person in the larger social body could be established, the person might be healed. In other words, if the social telos could again be brought into play so as to integrate the individual organism into the larger society, the latter equally conceived of as an organism, the telic decentralization within the organism might be overcome.

In Bakan’s view, then, we are indeed all members of one another. One is, however, left with the conviction, which his earlier Freud and the Jewish Mystical Tradition supports, that he has always believed this and that he has sought out the facts which fit in with his beliefs, rather than that recent developments in the biological and psychological sciences have compelled him to question the bourgeois, Rousseauan conception of the individual who is complete unto himself and whose membership in society is contractual not organic—the conception of man which has dominated Western science, including psychoanalysis. (Vide the remark of the Swiss pastor-analyst Pfister that Freud’s rationalism was “basically the idea of the eighteenth-century Enlightenment in proud, modern guise”; and the concern of classical psychoanalysis with the integrity of the individual ego.)

This having been said, it is necessary to add that Bakan could have found further evidence in favor of his thesis in branches of science other than those which he has in fact surveyed; notably in ethology, which provides convincing evidence that the behavior and well-being of animals are entirely dependent on their membership in the group and on their role in it. He could also have adduced the recent discovery of pheromones, substances secreted and exuded by one organism which exert a physiological effect on its neighbors.

BAKAN’S THESIS does, however, raise a number of puzzling questions which he fails to answer. If disease is the result of telic decentralization, one would expect the predisposition to it to be greater in complex organisms and in members of complex societies than in simple organisms or members of simple societies, but Bakan offers no evidence suggesting that this is so. Can infectious diseases, which in Bakan’s view must comprise a struggle between the telê of the invader and the host (victim), be explained only by the tendency to telic decentralization of the host? And can degenerative processes be ignored in explaining death? According to Bakan,

Telic decentralization processes take place through all the stages [of life], although in the early stages they are more often identifiable as growth and in the later stages as disease and finally death itself. Death occurs because the fission-like processes continue, and continue beyond a point where they are coordinated by the telos of the total organism.

But deaths due to cancer are the only ones which can in any sense be described as being the result of unco-ordinated fission-like processes; Bakan’s thesis runs directly counter to contemporary biological theories of ageing, which explain it by a decrease in the frequency of fissions, by the gradual failure and eventual death of cells which are not replaced.

The impression that Bakan is a philosopher who seeks for evidence to support theories, and not a scientist who proposes hypotheses to explain facts which he has encountered, is increased by his second essay, “Pain and the Functions of the Ego.” In it he rejects the orthodox, medical view that pain is a sensation mediated by nerve fibers, which serves the biological function of compelling the organism to withdraw from noxious agents and to rest injured parts, and insists that it is a purely psychological phenomenon. “Pain is,” he writes, “the psychic manifestation of telic decentralization … [it] is the demand on the conscious ego to work to bring the decentralized part back into the unity of the organism. Pain is the imperative to the ego to assume the responsibility of telic centralization, the ego itself having emerged as a result of telic decentralization.” The obscurity and complexity of this formulation derives from the fact that Bakan assumes, first, that pain is always conscious and is never part of an automatic, reflex action, and, secondly, that it is always “phenomenally ego-alien,” i.e., that it is always “It’s hurting me” and never “I’m in pain.”

Bakan’s reason for insisting that pain is a purely psychological phenomenon, an experience not of the body but of the ego, is however apparent. It derives from the central position occupied by pain in religious thinking. It is “the price man pays for the possession of a conscious ego as the biblical story of Adam and Eve suggests: Eve, having eaten of the Tree of Knowledge, must bear her children in pain.”

A hint as to why pain presents greater problems to the religiously minded than do other sensations such as sight and hearing is perhaps provided by Bakan’s assertion that “the ego has emerged as a result of telic decentralization,” already quoted above. If the ego is thought to be inherently alienated from the body, if it is conceived as a would-be autonomous soul rather than as a quintessential expression of the body, then pain, which reminds us so urgently of our physical nature, requires more explaining away than do other less clamorous sensations. For individuals who lack the conviction that they are, their bodies’ pain becomes a mystery demanding special rationalization.

BY NOW it will have become apparent that Bakan is not so much a philosopher, or even a psychologist, as that puzzling modern phenomenon, an atheistic theologian seeking to preserve the traditional wisdom of Judaism and Christianity by transplanting it into scientific soil. In his last essay, “Sacrifice and the Book of Job,” he aligns himself with modern thinkers who “have leaned toward an anthropocentric theology” and assumes that it is legitimate to “presume a kind of biblical mind which expressed itself in writing the Bible.” Readers who, like myself, feel unable to follow him in this will have difficulties in grasping his argument, but it is clear that he regards the Book of Job as an allegory expressing the resistance of the human ego to accepting the inevitability of its own death. “Job knows that it is sinful to believe that God rewards the righteous with immortality; he knows that it is not true; he knows that death is inexorable.”

Dr. Petrie’s study of individual differences in pain-sensibility is in many ways a refreshing contrast to Dr. Bakan’s preoccupation with death. In it she supplies convincing evidence for a fact which clinicians have often suspected, viz., that individuals differ in their basic reactions to pain. By an ingenious experimental technique which enabled her to correlate subjective responses to painful stimuli with objective measurements of the accuracy with which subjects could assess the size of an object held blind-fold, she shows that three types of personality emerge from a study of “perceptual reactance”: “augmenters” who increase the size and intensity of all perceptions, “reducers” who decrease them, and “moderates” who do neither. Augmenters overestimate the size of an object held blindfold by as much as 50 percent; they find mounting pain unbearable sooner than do moderates and are liable to be distressed by bright lights and loud noises which moderates tolerate easily, while reducers differ from moderates in the opposite direction. Extreme reducers may, indeed, suffer distress due to sensory lack.

Dr. Petrie also shows that these differences in perceptual reactivity may have important practical consequences. For instance, delinquents tend to be reducers and it is possible, she suggests, that their high tolerance of pain contributes to their readiness both to receive and inflict pain and that their low tolerance of sensory deprivation may make them abnormally disturbed by solitary confinement. In this connection she cites the example of prisoners who burn themselves with cigarettes in order to relieve the distress of having no incoming sensations. Alcoholics, on the other hand, tend to be augmenters, and she suggests that the attraction of alcohol for them may reside in its capacity to reduce their tendency to augmentation. They choose a “cure” for their hypersensitivity which may prove worse than the original disability.

Dr. Petrie also suggests that the wellknown insensitivity to pain of schizophrenics may in fact be defensive, an attempt to protect themselves from an excessive tendency to augment by rendering themselves insensitive. Her reasons for thinking this are partly clinical—notably the contrast between the “exquisite sensibility” of the future schizophrenic and the insensitivity to external sensations of patients in the midst of their acute illness—and partly experimental and statistical. Schizophrenic subjects were strikingly inconsistent in their responses to tests of kinaesthetic perception, augmenting on one occasion and reducing on another, and doing both to an extreme degree. This oscillation suggests that two opposed processes are at work, one enhancing stimuli and the other reducing them, the former being part of the schizophrenic’s original hypersensitive endowment and the latter part of a learned defensive maneuver.

Dr. Petrie clearly believes that augmentation and reduction, which are significantly correlated with introversion and extraversion respectively, are inborn temperamental differences of personality, but her findings will remain of the first importance even if they turn out to be manifestations of individually determined differences in maturity and development.

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