
When your doctor points to the chart and asks you to rate your pain from 0 to 5, does your answer mean anything? In a way, yes: the more pain you are in the higher number you will report. So if last week you were 2 and this week you are 3 then she knows you are in more pain this week than last.
But she also wants to know your absolute level of pain and for that purpose the usefulness of the numerical scale is far less clear. Its unlikely that your 3 is equal in terms of painfulness to the next guy’s 3. And words wouldn’t seem to do much better. Language is just too high-level and abstract to communicate the intensity of experience.
But communication is possible. If you have driven a nail through your finger and you want to convey to someone how much pain you are in that is quite simple. All you need is a hammer and a second nail. The “speaker” can recreate the precise sensation within the listener.
Actual mutilation can be avoided if the listener has a memory of such an experience and somehow the speaker can tap into that memory. But not like this: “You remember how painful that was?” “Oh yes, that was a 4.” Instead, like this: “You remember what that felt like?” “OUCH!”
Memories of pain are more than descriptions of events. Recalling them relives the experience. And when someone who cares about you needs to know how much help you need, actually feeling how you feel is more informative than hearing a description of how you feel.
So words are at best unnecessary for that kind of communication, at worst they get in the way. All we need is some signal and some understanding of how that signal should map to a physical reaction in the “listener.” If sending that signal is a hard-wired response it’s less manipulable than speech.
Which is not to say that manipulation of empathy is altogether undesirable. Most of what entertains us exists precisely because our empathy-receptors are so easily manipulated.

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January 31, 2011 at 11:11 pm
twicker
Interesting. A couple of thoughts (on two quotes, taken out of order):
First – I completely agree with this:
Memories of pain are more than descriptions of events. Recalling them relives the experience. And when someone who cares about you needs to know how much help you need, actually feeling how you feel is more informative than hearing a description of how you feel.
If what we want is empathetic understanding, then absolutely – this is the way to go. 100%. And, in the vast, vast majority of cases, this is exactly what we’re looking for.
But she also wants to know your absolute level of pain and for that purpose the usefulness of the numerical scale is far less clear. Its unlikely that your 3 is equal in terms of painfulness to the next guy’s 3. And words wouldn’t seem to do much better. Language is just too high-level and abstract to communicate the intensity of experience.
But communication is possible. If you have driven a nail through your finger and you want to convey to someone how much pain you are in that is quite simple. All you need is a hammer and a second nail. The “speaker” can recreate the precise sensation within the listener.
Actually, the fact that your 3 is not the same as someone else’s 3 is exactly the point. The doctor doesn’t want to feel your pain; she wants your pain to be at a manageable level for you. She very much wants to manage your pain on an individual level – which would include whether or not that nail through your foot is tolerable pain (requiring an NSAID) or is absolutely unbearable (requiring Darvocet).
I’m known for having a ridiculously high tolerance to pain; the same thing that would have many people running for a narcotic is a nuisance to me. If you tried to treat me based on what you think my pain feels like, you’d be treating me based on your perception of the event – and you’d probably give me something where the side effects of the medication are worse than the original pain (and, yes, I’ve put a nail through the bottom of my foot before). For this kind of treatment, you need to know how perceive it; knowing and acting on your perception does no one any good, and may cause a good bit of harm.
So – for situations where we need to convey empathetic understanding (e.g., where I need for you to be aware that X really is a PROBLEM and not an annoyance), then yes – I want to say, “Imagine that I just put a nail through your foot.” Even I can feel, viscerally, that that’s a PROBLEM.
For situations where I need to rely on your expert knowledge to provide the best treatment for me as an individual, I need you to baseline it against a more objective criterion (e.g., your face scale above), so you have an idea of how much treatment to provide.
January 31, 2011 at 11:17 pm
twicker
GAH. My apologies; I meant to use the blockquote tag, but forgot the formatting and just used the word quote … mea culpa …
For all, here are the two quotations (that don’t appear that way in what I wrote above):
—————-
#1
—-
#2
———–
Boy, do I feel dumb …
February 1, 2011 at 6:49 am
k
this is the basic problem with surveys that ask people to rate something on a scale from 1 to 5 or 1 to 10 – it’s hard to know what any answer really means. assuming the opinion sought to be collected has a distribution, does the answer given correspond to the mode? the median? the mean? how are we to know?
February 1, 2011 at 9:35 am
azmyth
A related post, on pain scales.
http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html