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Speaker 1: Hey, you pressed play you guys, somebody pressed play battle stations. Everybody,

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Speaker 1: It's time to podcast. Welcome. I'm Dessa And this is

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Speaker 1: deeply human where we trapes off through the wilderness of

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Speaker 1: our own minds to find out why we do the

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Speaker 1: things we do. The star of this episode is pain,

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Speaker 1: how we perceive it, and how it can change the

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Speaker 1: way that we perceive ourselves. When I was a teenager,

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Speaker 1: a coffee shop called Muddy Waters was where all the

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Speaker 1: art and trouble happened. Muddies was full of X addicts,

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Speaker 1: stick and polke tattoos, poets with their sketch pads, rappers

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Speaker 1: and their skateboards, everybody falling in and out of love

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Speaker 1: with one another, and almost nobody paying full price for

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Speaker 1: the coffee. Sarah was one of the women who ran

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Speaker 1: the place. She had long, messy raspberry colored hair, was

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Speaker 1: part p J. Harvey, part Little Mermaid, and she tolerated

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Speaker 1: zero insolence for many body, but if you got evicted

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Speaker 1: or fired or pregnant, she was supporting the storm. A

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Speaker 1: lot of regulars Harvard crushes on Sarah. People respected her

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Speaker 1: because she was clever and principled and brave, and she

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Speaker 1: had this extra gravitas because we all knew that she

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Speaker 1: was really, really sick and in a lot of pain.

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Speaker 1: I became acutely aware of this mystique thing, like the

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Speaker 1: iconic sick white female. It always reminds me of little

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Speaker 1: women that like tragically ill, pretty one who coughs up blood,

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Speaker 1: talks really quietly, and she's sickly and everyone loves her.

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Speaker 1: And I found it so irritating. Sarah was diagnosed with

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Speaker 1: diabetes when she was eighteen months old, and with several

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Speaker 1: autoimmune diseases after that. She ended up needing a bunch

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Speaker 1: of surgeries. The extreme abdominal pain started when I was

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Speaker 1: probably sixteen. Eventually I got a diagnosis that kind of

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Speaker 1: explained it, but there's no real treatment for it, so

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Speaker 1: I was in just constant, pretty excruciating abdominal pain. To

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Speaker 1: hurt is a private experience and difficult to discuss. I

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Speaker 1: can't hold my pain up to the light for you

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Speaker 1: to examine, or drape it around your shoulders to see

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Speaker 1: how it might fit. Pain is a room for one

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Speaker 1: only you can enter, and sometimes you can't leave. Also,

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Speaker 1: we don't have a great vocabulary for pain. We shave

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Speaker 1: our perceptions of red into very fine slices for millions

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Speaker 1: scarlet Crimson Maroons series, but we don't name discreete pain

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Speaker 1: sensations in the same way. This is pretty graphic, but

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Speaker 1: the only way I could ever think of describe it

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Speaker 1: was that it felt like I was rotting in my mind.

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Speaker 1: If you cut open my abdomen, you would find just

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Speaker 1: everything infected and flamed, cramping and rotting. I felt like death,

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Speaker 1: but slow. But of course, no matter how vivid the description,

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Speaker 1: the only pain you can know intimately is your own.

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Speaker 1: So let's burn you, Okay, then let's burn me. That's

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Speaker 1: Irene Tracy, a neuroscientist at Oxford. She studies exactly how

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Speaker 1: humans perceive pain, which means she's often got to hurt

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Speaker 1: them herself. We generally have a sort of torture chamber

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Speaker 1: suite of every device man into man, where we can burn,

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Speaker 1: or we freeze, or we poke, or we put like

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Speaker 1: either mustard oil on or chili pepper cream on. So

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Speaker 1: what we have here is a little homebuilt device on

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Speaker 1: the table between us. Irene's got a device about the

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Speaker 1: size of a lunchbox. It's gray metal with dials and buttons,

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Speaker 1: some duct tape and a long black wire comes out

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Speaker 1: one side that's connected to like a little circuit board

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Speaker 1: looking thing, a shiny square roughly the size of a

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Speaker 1: postage stamp. Irene presses it against the bare skin on

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Speaker 1: the inside of my right forearm. So I can zip

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Speaker 1: up thirty degrees in less than a second, and it'll

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Speaker 1: be a lot of nobody's been scarred or blistering. Um, well,

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Speaker 1: we've had the open I'm not gonna lie you know that.

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Speaker 1: You get the old thing happened to be over twenty

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Speaker 1: five years right, there'll be a lot of deep right,

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Speaker 1: are you ready? I am? That hurts. So I would

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Speaker 1: say that if one is just on the threshold of

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Speaker 1: being codd is pain, I would say that was I

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Speaker 1: don't know. Three okay, okay, So we can go up

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Speaker 1: a little bit more than which is always good. So

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Speaker 1: we'll take it up just a wee bit. Okay, quick

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Speaker 1: freeze frame Here for a comment on pain scales in

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Speaker 1: medical environments, people are often asked to rank their pain

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Speaker 1: on a scale of one to ten. You might have

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Speaker 1: been asked to do it by your doctor, but here's

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Speaker 1: Sarah on why that's a problem. Everyone's scale is different

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Speaker 1: because your ten is always the worst pain you've ever had,

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Speaker 1: but it's not the worst pain you could have. So

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Speaker 1: your ten changes over time, and over the course of

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Speaker 1: ten surgery. As that ten, the bar for a ten

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Speaker 1: got very high. You know. That's where I can't take

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Speaker 1: a full breath, I can't cry, I can't talk, and

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Speaker 1: then down to I can still live my daily life.

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Speaker 1: And then sometimes I can't talk for thirty seconds because

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Speaker 1: I'm in so much pain, but it's going to go away.

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Speaker 1: I would give that four, but someone else might give

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Speaker 1: it a seven because it is so painful in that moment.

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Speaker 1: Your standard for what's high changes. It's easy to see

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Speaker 1: how this sort of variance and patient reports could pose

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Speaker 1: a challenge for their health care. If my four is

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Speaker 1: your seven, how is the doctor supposed to know what

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Speaker 1: sort of pain killer we need and in what dosage?

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Speaker 1: One of us might be grinding your teeth till morning.

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Speaker 1: Well the other winds up loopy and flirting with the

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Speaker 1: night nurse. Okay, back to the lab. Wow Okay, wow

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Speaker 1: was not the first word that came to mind. That

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Speaker 1: is absolutely me trying to active in front of a

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Speaker 1: microphone on the BBC. Well like experiencing an unexpectedly intense

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Speaker 1: dose of pain which left to mark. But let zoom

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Speaker 1: in on what exactly is going on inside the body

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Speaker 1: at a moment like this. We come equipped with three

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Speaker 1: distinct kinds of pain receptors, thermal, chemical, and mechanical. The

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Speaker 1: thermal receptors respond to temperature. The chemical ones sense harmful

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Speaker 1: substances like the pepper cream that Irene uses, and the

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Speaker 1: mechanical ones are for when you just cut or bang

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Speaker 1: or smash yourself. When you get hurt, these receptors send

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Speaker 1: off a distress signal, and the signals go whizzing in

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Speaker 1: a long nerves in your arms or your legs to

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Speaker 1: your spinal cord, which is this big sort of channel

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Speaker 1: sending signals up to the brain. It's not till the

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Speaker 1: brain gets those signals that pain emerges. Think of an

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Speaker 1: orchestral score. You've got a lot of notes on paper,

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Speaker 1: but until they're sounded by an instrument m there's no music.

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Speaker 1: My burned arm doesn't actually hurt directly. The nerve signals

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Speaker 1: have to be processed by my brain. If it doesn't

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Speaker 1: register in the brain, there is no pain. And her

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Speaker 1: brains take a lot of artistic license and the interpretation

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Speaker 1: of these signals if you're tired, the same signal might

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Speaker 1: be amplified to hurt more. If you're distracted, say by

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Speaker 1: a pain researcher who is asking you to count backwards

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Speaker 1: by sevens, you might hurt less. Let's see one, twenty one,

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Speaker 1: one oh six. Distraction is great, and that's a big

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Speaker 1: sort of free analgesia call pain relief you can get.

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Speaker 1: So you've got these incredible systems in the brains them

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Speaker 1: whose sole job it is is to communicate down to

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Speaker 1: the bottom of the spain called where the signals are

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Speaker 1: coming in, and just stop them at that point so

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Speaker 1: they don't come up. They don't come in the brain

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Speaker 1: and feel pain. Distraction actually works chemically to turn down

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Speaker 1: the perception of pain. Even the fact that we think

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Speaker 1: something is going to hurt can affect how much it

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Speaker 1: really does. Cooling expressional muses, you know, you get the

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Speaker 1: pain you expect and you really do. To prove this point,

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Speaker 1: Irene's done some very clever experiments with placebos. In one study,

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Speaker 1: she recruited a bunch of research subjects willing to let

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Speaker 1: her inflict painful burns on their legs. She asked them

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Speaker 1: to rate their pain and recorded all their answers. Then

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Speaker 1: she gave them an opioid through an IVY drip, and

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Speaker 1: as you'd expect, participants reported less pain while receiving the drug.

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Speaker 1: If Irene stopped the IVY, the pain ratings went up again.

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Speaker 1: But here's the tricky bit. Irene occasionally deceived her subjects

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Speaker 1: so that they thought they were receiving an opioid when

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Speaker 1: really they were just getting saline. And lo and behold,

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Speaker 1: when they believed they were on drugs, they really did

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Speaker 1: feel less pain even though they were essentially just getting

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Speaker 1: an armful of contact solution, and brain scans supported this finding,

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Speaker 1: showing less activity in pain sensing regions of the brain

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Speaker 1: when the participants were all plus e boat up. Irene's

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Speaker 1: also tested the opposite scenario, where people who were receiving

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Speaker 1: the opioid were told they were getting saline. So you've

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Speaker 1: got most powerful drug in two thousand years and in

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Speaker 1: an instant, I can just manipulate their expectations, and by

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Speaker 1: driving a negative expectance, if we can just have it

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Speaker 1: override the brain. For fellow word nerds, that's called the

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Speaker 1: no sebo effect. Hey, a lot of variables influence pain perception,

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Speaker 1: which means identical injuries do not necessarily hurt identically. If

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Speaker 1: you and I got matching neck tattoos on the same

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Speaker 1: day from the same artist, we might have totally different

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Speaker 1: levels of pain, And if we returned in a week

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Speaker 1: for a touch up, we might have completely different experiences

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Speaker 1: than on the first visit. What the science has told

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Speaker 1: us for twenty years is you cannot make a judgment

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Speaker 1: call about what pain somebody should be having based on

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Speaker 1: what you can measure out in their tissue damage. What

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Speaker 1: they say it is is one it is because it

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Speaker 1: is this private subject of experience. So far, we've talked

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Speaker 1: about acute pain, the garden variety that surges in whenever

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Speaker 1: we damage our bodies somehow, but chronic pain functions differently. Historically,

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Speaker 1: by ten fifteen years ago, we thought if we fixed

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Speaker 1: the thing that calls the pain, then the chronic pain

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Speaker 1: will go away. And that model hasn't worked. Nobody is

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Speaker 1: sure by some injuries just go on hurting and hurting

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Speaker 1: for months or years. You can't predict who's going to

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Speaker 1: go chronic or why. In the US, chronic pain affects

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Speaker 1: something like one in five adults, just a huge number

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Speaker 1: of people. So the pain field has sort of had

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Speaker 1: a parallel shift in their thinking. Is that when somebody has,

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Speaker 1: after three four months, gone chronic, so to speak, that's

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Speaker 1: a whole new set of problems in its own right.

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Speaker 1: All your life's journey, all your bumps and scrapes and

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Speaker 1: stresses and emotional experiences, the way that the environment changes

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Speaker 1: and colors your genetics, so all that is changing, the

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Speaker 1: way because your central livst in your brain is wildly

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Speaker 1: developing throughout this period, you know, growing, worrying up different bits.

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Speaker 1: Literally literally your life's jury changes your brain. My friends,

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Speaker 1: Sarah's pain confused her doctors for a long time. I

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Speaker 1: think I had an experience that many women have that

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Speaker 1: I was told that it literally was impossible that I

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Speaker 1: was in pain because the disease i'd finally been diagnosed

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Speaker 1: with doesn't cause pain. There's not like an m r

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Speaker 1: I or a cat scan or a pet scan or

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Speaker 1: anything that can point to what it was. But what

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Speaker 1: it was I realized later it was an inflammation of

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Speaker 1: my entire digestive tract from my throat all the way

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Speaker 1: down through my colon. Talking about pain is challenging because

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Speaker 1: it's a private experience, and because we've got a poverty

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Speaker 1: of language for it, but also it just sucks socially.

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Speaker 1: There's a whole bunch of taboos around illness and speaking

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Speaker 1: about it, even in your most intimate relationships. So there

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Speaker 1: is pressure on the patient to pretend like they are okay,

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Speaker 1: and there is pressure on the other people in the

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Speaker 1: room two also pretend it's okay. Family and friends act weird.

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Speaker 1: Acquaintances treat you with kid gloves. Even rivals go soft

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Speaker 1: when they hear you're in the hospital, and I'm like, dude, no,

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Speaker 1: it's okay. Like if you hated me on Wednesday, you

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Speaker 1: can hate me on Thursday. It's fine. The illness didn't

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Speaker 1: make me a better person, So carry on with whatever

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Speaker 1: your normal opinion of me was. I respect that some

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Speaker 1: of my best philosophical conversations have been with you, and

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Speaker 1: I wanted to know how pain affects cognition, because I

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Speaker 1: think that's something that bothers you more than most. Yes,

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Speaker 1: I can't prove it, but I am distinctly dumber than

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Speaker 1: I was. My brain is different ten years of constant

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Speaker 1: adrenaline and cortis I'll do alter the way that you

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Speaker 1: think it fries certain pathways. Sarah's brain hands down one

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Speaker 1: are the best brains I know, and I hate the

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Speaker 1: idea of its sizzling and all this suffering. Ah, we're

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Speaker 1: gonna swivel to a researcher who studies pain from a very,

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Speaker 1: very different vantage point. So let's fade up onto a

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Speaker 1: scene unfolding on the island nation of Mauritius. Or An

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Speaker 1: anthropologist is standing next to a bed of coals, preparing

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Speaker 1: to photograph a firewalking ritual, and at some point some

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Speaker 1: of the locals they called me and they said, Dave Trius,

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Speaker 1: we think you're now one of us. You should do

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Speaker 1: the fire walking ritual just like we do. And my

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Speaker 1: response to that was, well, look, I don't want to

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Speaker 1: pretend to be one of you. I'm still a foreign

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Speaker 1: anthropologist who was here to do my job. I'm here

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Speaker 1: to learn about your customs and it's very important for

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Speaker 1: me to be able to observe what you're doing as

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Speaker 1: you're doing it. They immediately said, that's fine, Okay, if

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Speaker 1: God wants you to do it, then he'll do it.

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Speaker 1: And I said, trust me, God does not want me

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Speaker 1: to walk on fire. Apparently I was wrong, because on

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Speaker 1: the day of the fireworking ritual, somebody tapped me on

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Speaker 1: the shoulder and I turned around, and I looked at

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Speaker 1: the entire village looking at me, expecting me to walk

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Speaker 1: on fire. Dmitris Lots has spent his career studying extreme rituals.

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Speaker 1: And I decided it was either to humulation and the

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Speaker 1: major disruption of the ritual or just going through with it.

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Speaker 1: And when I came out, people are actually asking me

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Speaker 1: the same kinds of ethnographic questions that I were asking them.

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Speaker 1: Demitris has traveled the world trying to understand why people

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Speaker 1: voluntarily subject themselves to tortuous levels of pain. So, for example,

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Speaker 1: you have in the Philippines you have Catholics who on

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Speaker 1: Good Friday would nail themselves on crosses. Similarly, on the

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Speaker 1: day of Assura, you have Muslims who will whip themselves

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Speaker 1: with whips that have blades attached to them. Just reading

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Speaker 1: Demetrius's work can get pretty intense. At the Poquette Vegetarian festival,

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Speaker 1: for example, celebrants pierced their cheeks, and some of these

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Speaker 1: piercings are so long and heavy, so that the big

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Speaker 1: skewers that might be three meters across that they will

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Speaker 1: have to bite down on them at all times and

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Speaker 1: hold them with both hands, because otherwise they might just

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Speaker 1: rip their face off. Man. Okay, So I think for

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Speaker 1: a lot of us, the question is why. I have

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Speaker 1: asked thousands of people why they perform the rituals, and

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Speaker 1: the most common responses some kind of sense of puzzlement.

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Speaker 1: They look at you and say, well, well, what do

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Speaker 1: you mean. We just we just do them. That's what

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Speaker 1: we do, that's who we are. At a firewalking festival

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Speaker 1: in Greece, Demitrius asked a bunch of first time participants

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Speaker 1: why they decided to remove their shoes and proceed barefoot

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Speaker 1: over a bed of hot coal. Some of them reference tradition,

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Speaker 1: Some people explained they just had an urge. Some said

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Speaker 1: they weren't really sure why. But when he asked people

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Speaker 1: much later about why they had gotten involved at first time,

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Speaker 1: they gave very specific motives. They'd been looking to be

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Speaker 1: healed from some malady or to become fertile. Well, once

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Speaker 1: you've done it, once you put a skewer through your cheeks,

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Speaker 1: then you have to ask yourself, why did I do that?

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Speaker 1: This uh effort triggers a search from meaning, and this

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Speaker 1: way we construct these post hoc justifications of our actions

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Speaker 1: and our experiences. When we do something that's very taxing,

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Speaker 1: that doesn't have need discernible benefit, we feel really uncomfortable

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Speaker 1: about it, and to feel better we engage in what's

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Speaker 1: called effort justification, where we retroactively deem the activity is

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Speaker 1: meaningful or important. Do you think that there's potentially like

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Speaker 1: a parallel to even the conversations that we have in

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Speaker 1: a daily basis. Right, if I talked to a friend

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Speaker 1: like ten years after her divorce, well, I remember when

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Speaker 1: she was getting that divorce, right, she turned herself inside out.

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Speaker 1: She would have done anything to make that marriage work.

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Speaker 1: But now ten years later she goes, oh my gosh,

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Speaker 1: that was like the best thing that ever happened to me.

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Speaker 1: I'm so glad Michael left. Absolutely, And this is something adaptive.

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Speaker 1: It helps us cope with over their life, it helps

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Speaker 1: us move on. Yes, we have a need to justify

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Speaker 1: our actions. Demitrius also suggests painful rituals confer real benefits.

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Speaker 1: During the Cavety Festival and Mauritius, he measured the stress

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Speaker 1: levels of participants who walked down nails, carried heavy loads

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Speaker 1: in the hot sun, and pierced their bodies so times

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Speaker 1: with hundreds of needles. As you might imagine, there's stress

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Speaker 1: levels spiked, but a month later they reported feeling better

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Speaker 1: healthier than before the cavity. Things get more interesting when

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Speaker 1: we look at who is performing the ritual and how

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Speaker 1: so we see that people of low soci economic status,

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Speaker 1: as well as those who suffer from chronic illness, are

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Speaker 1: actually more likely to perform the ritual, and when they do,

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Speaker 1: they will put more needles in their body and they

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Speaker 1: will suffer more. He explains that extreme rituals provides social benefits.

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Speaker 1: Getting involved demonstrates a commitment to the group and puts

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Speaker 1: you in better standing within the community. He thinks that's

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Speaker 1: why people of low status are likely to participate enthusiastically.

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Speaker 1: They could use the social boost. And don't be tempted

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Speaker 1: to imagine that extreme rituals only happen in faraway places.

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Speaker 1: Fraternity hazing, gang initiations, military traditions, lots of similar formulas.

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Speaker 1: In elementary school, I remember when kids used to pass

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Speaker 1: around packs of big red gum and we'd all take

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Speaker 1: a piece and then we would lick the foil wrapper,

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Speaker 1: would stick it to our foreheads, and within a minute,

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Speaker 1: the cinnamon flavoring would start to burn, and we sat

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Speaker 1: there looking at each other with like garbage on our

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Speaker 1: foreheads for as long as we could take the pain.

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Speaker 1: Why because it was the thing to do in third

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Speaker 1: grade and we were proving ourselves as baby badasses and

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Speaker 1: it made us giggle and feel connected. Everybody is suffering

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Speaker 1: the same thing at the same time. So one thing

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Speaker 1: you're doing there is you're advertising some individual qualities that

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Speaker 1: have to do with your fitness. You're you're cool enough

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Speaker 1: to with something, You're strong enough to withstand this. At

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Speaker 1: the same time, we're advertising your commitment to the group's norm, because,

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Speaker 1: for whatever reason, if that becomes the norm, then doing

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Speaker 1: something that requires you paying a high price to enforce

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Speaker 1: that norm on yourself that means you're good and come

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Speaker 1: a member of that community. Pain is often cast in

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Speaker 1: a simple role, the character who enters to pull her

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Speaker 1: hand away from the burning stove and then recedes into

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Speaker 1: the wings. But pain is larger and more complex, performing

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Speaker 1: sometimes as antagonist sometimes ally. I'm glad to report that

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Speaker 1: Sarah's life isn't as painful as it used to be.

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Speaker 1: They're still hurt, fatigue, and nausea. I've seen Sarah vomit

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Speaker 1: into an empty soda bottle and moving cars with the

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Speaker 1: sniper's aim. But it's better still, the pain has changed her.

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Speaker 1: What's the biggest single thing that pain has taken away? Uh,

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Speaker 1: it's a lot. A lot takes away your ability to

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Speaker 1: be present to the people that you're fighting the illness

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Speaker 1: to continue to be with. So it is a thief

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Speaker 1: in that way. Is there anything that's given you any upsides? Yes,

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Speaker 1: there's a lot. Actually, like a lot really? Oh yeah,

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Speaker 1: I remember after my first transplant. It was probably a

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Speaker 1: year later, standing in line in the pharmacy, and all

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Speaker 1: of a sudden, he said, tears streaming down my face

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Speaker 1: because I realized it had been four years since I

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Speaker 1: could stand in a line and not have to sit

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Speaker 1: or lay down on the floor while I waited. I found. So,

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Speaker 1: if you have chronic pain and it is a given

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Speaker 1: and it's not negotiable, how do you want to live

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Speaker 1: your life? And then how do you have to change

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Speaker 1: your mind to meet the person that could live this

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Speaker 1: life and enjoy it? So like, how do you rise

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Speaker 1: to the occasion of your own life and take joy

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Speaker 1: in it? Yeah? I want to extend an enormous thank

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Speaker 1: you to Sarah for being so candid and smart, to

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Speaker 1: Demetrius for his time and insights, and of course to

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Speaker 1: Irene Tracy, Queen of Pain, thanks for the hurts. You're welcome.

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Speaker 1: Any that's such a long laugh. All good science stories

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Speaker 1: should end with a cackle and a flesh wound. Next time,

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Speaker 1: on Deeply Human, we're talking about lying why it's a

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Speaker 1: milestone for toddlers but a slippery slope for you. Deeply

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Speaker 1: Human is hosted by Deessa and is a co production

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Speaker 1: of the BBC World Service and American Public Media with

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Speaker 1: I Heart and Me Yeah