The Patient

The third cryptomind discussed in “The Mind Club” is the Patient.  The authors expand the concept of patient well beyond the medical context.  “Patients are perceived to have experiences and to be sensitive and susceptible to the actions of others.  Whereas agents are the thinking doers of the world, patients are the vulnerable feelers.  The word patient is likely to bring to mind the concept of pain.  The experience of pain  forces to focus on the present and how to deal with it.”

The authors wrote “Pain may have overwhelming psychological power, but the physical reality is comparatively unsubstantial.  Pain is a mental construction resulting from a handful of nerve signals.  The intensity of pain  stems only from the microscopic electrical pulses of neurons.  Moreover, pain can be triggered by nothing at all as in the case of people with neuropathic pain who live in constant agony due to a few rogue neurons.

Phantom limb pain, although quite real, indicates the fickleness.  This pain is the pain amputees feel in their amputated limb.  Neuroscientist V.S. Ramachanadran developed a special box with a mirror and two holes into which the patients place each of their arms.  The mirror faced the still-presents right hand and its reflection provided he patient with what appeared to be an intact missing limb.  Seeing this illusion significantly reduced the patient’s pain.

The placebo effect provides strong evidence on the mind’s power to influence pain.  Studies of popular drugs such as Tylenol or paracetamol for back pain, and Prozac, Effexor, or Paxil of mild depression suggest that they are no more effective than the combination of sugar pills and optimism.  Previous healthy memory blog posts have reported research in which placebos are effective even when the patients know they are placebos.

As you should know from previous healthy memory blog posts there is also a nocebo effect.  One study  found that people felt real pain after researchers put sham electrodes onto their heads  and pretended to send electric current through them.

Neuroimaging studies suggest that there is both a sensory component and an affective component to pain.  The sensory component represents actual tissue damage.  The affective component is its felt badness, its aversiveness and unpleasantness.  These components can be dissociated.  For example, morphine eliminates the aversive affect while keeping the sensory experience.    A car-accident victim treated with morphine described his experience of traumatic injury as “Pain…but not painful.”  That is the unpleasantness was dulled, but specific sensations remained intact.

In some circumstances tissue damage does not automatically translate to pain even without drugs as has been found in combat situations where soldiers carry on the battle even after having suffered grievous injuries.

Empathy is an important concept and an important skill.  Proximity is an important factor affecting empathy.   The philosopher Peter Singer formulated this thought experiment.  Imagine you are walking by a pond, wearing a new three-hundred dollar suit, when you see a drowning child.  Should you save the child even if doing so would ruin the suit?  You likely wouldn’t hesitate  to dive in.  Now consider a different scenario.  You are walking down he street after payday when a charity canvasser tells you that twenty dollars will save the life of a starving child.  Chances are you would keep your money and let the child die, even though saving the child costs a fraction of the cost of the suit.  Of course, there are factors in the comparison other than proximity.  You can actually see the drowning child, but you might have questions about the honesty of the solicitor.  But you should get the general point.

Our capacity for empathy is limited.  Although some empathy is helpful, too much can be counterproductive causing our empathy to shut down.  Psychologists Daryl Cameron and Keith Payne did an experiment illustrating the “collapse of compassion.”  They presented participants with pleas from either one or eight suffering victims.  In spite of the objectively greater total suffering of eight victims, the participants were overwhelmed by it and demonstrated less compassion.

The authors note how the Patient Mind can be mistreated as the Machine Mind.  Recent advances in neurobiology have focused attention away from human suffering and feelings and toward drugs that influence brain circuits and neurotransmitters..  Thomas Szasz has described this new psychiatry as mechanomorphic, treating patients like “defective machines” rather than fellow human beings.  The authors note “Paradoxically, physicians of the mind may fail to see their patients as members of the mind club.”

Research by Stephanie Brown of the University of Michigan has revealed that helping others can add years to your life.  She examined the mortality of older people who were the pimrary caregivers of their ill spouses.  This is a highly stressful role as caregiver must manage every aspect of their spouses’s treatment and take ultimate responsibility for the spouse’s life.  In spite of stress being linked to early death, these caregivers lived significantly longer, presumably because of increased feelings of agency.

Some time will be given to plants before ending this post.  Taking care of plants can increase longevity.  In one study,m nursing home residents given responsibility  for a houseplant outlived those who had plants that were looked after by nursing home staff.

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