Lifeworlds in pain: a principled method for investigation and intervention

Abstract

The experience of pain spans biological, psychological and sociocultural realms, both basic and complex, it is by turns necessary and devastating. Despite an extensive knowledge of the constituents of pain, the ability to translate this into effective intervention remains limited. It is suggested that current, multiscale, medical approaches, largely informed by the biopsychosocial (BPS) model, attempt to integrate knowledge but are undermined by an epistemological obligation, one that necessitates a prior isolation of the constituent parts. To overcome this impasse, we propose that an anthropological stance needs to be taken, underpinned by a Bayesian apparatus situated in computational psychiatry. Here, pain is presented within the context of lifeworlds, where attention is shifted away from the constituents of experience (e.g. nociception, reward processing and fear-avoidance), towards the dynamic affiliation that occurs between these processes over time. We argue that one can derive a principled method of investigation and intervention for pain from modelling approaches in computational psychiatry. We suggest that these modelling methods provide the necessary apparatus to navigate multiscale ontology and epistemology of pain. Finally, a unified approach to the experience of pain is presented, where the relational, inter-subjective phenomenology of pain is brought into contact with a principled method of translation; in so doing, revealing the conditions and possibilities of lifeworlds in pain.

Keywords: anthropology; bayesian inference; embodiment; pain; psyciatry; theories and models.

Figure 1.

A principled method for investigation and intervention in pain based on an anthropological stance and the ontology and epistemology of computational psychiatry. Left panel. A lifeworld in pain: a schematic representation of ‘how’ the lines of a lifeworld may become entangled, unveiling relevant points of correspondence (bold), which facilitate directed inquiry (orange dots) into ‘why’ the experience of pain occurs in this way, appealing to levels of explanation. Right panel. A computational framing of a lifeworld: the X axis represents the three ontological levels of organisation that are modelled in Bayesian modelling psychiatry. The Y axis represents Marr’s three epistemological levels of explanation that Bayesian modelling psychiatry refers to explain their modelling rationales. Pain, understood as part of an inter-subjective lifeworld, incorporates processes that are located across the scales of ontology (X) and levels of epistemology (Y).