Contemplative Inquiry

This blog is about contemplative inquiry

Tag: Suffering

HOW WE INTERPRET PAIN

Atul Gawande’s Being Mortal: Illness, Medicine and What Matters at the End (1) is about life when independent living is no longer an option, and also about the end-game. I intend to review the book fully in a later post. Here, I have extracted a passage about how we evaluate the experience of pain and suffering, and how they vary according the the stories we tell about ourselves and our lives. The author draws on his experience as a physician, a teacher and a family member.

“The brain gives us two ways to evaluate experiences like suffering – there is how we apprehend such experiences in the moment and how we look at them afterward – and the two ways are deeply contradictory. … People seem to have two different selves – an experiencing self who endures every moment equally and a remembering self who gives all the weight of judgement to two single points in time, the worst moment and the last one.

“The remembering self seems to stick to the Peak-End rule even when the ending is an anomaly”. In a hospital-based experiment (2) “just a few minutes without pain at the end of their medical procedure dramatically reduced the patients’ overall pain ratings even after they’d experienced more than half an hour of high level pain. ‘That wasn’t so terrible,’ they’d reported afterward. A bad ending skewed the pain scores upwards just as dramatically. …

“Research has also shown that the phenomenon applies just as readily to the way people rate pleasurable experiences. Everyone knows the experience of watching sports when a team, having performed beautifully for nearly the entire game, blows it at the end. We feel that the ending ruins the whole experience. Yet there’s a contradiction at the root of that judgement. The experiencing self had whole hours of pleasure and just a moment of displeasure, but the remembering self sees no pleasure at all.

“If the remembering (or anticipating) self and the experiencing self can come to radically different opinions about the same experience, then the difficult question is which one to listen to. …. In the end, people don’t view their life as merely the average of all of its moments – which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people’s minute-by-minute levels of pleasure and pain miss this fundamental aspect of human experience. A seemingly happy life may be empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves. Unlike your experiencing self – which is absorbed in the moment – your remembering self is attempting to recognize not only the peaks of joy and valleys of misery but also how the story works out as a whole. That is profoundly affected by how things ultimately turn out.”

(1)Atul Gawande Being Mortal: Illness, Medicine and What Matters in the End London: Profile Books in association with Wellcome Collection, 2014 (UK edition)

(2) NOTE: Gawande describes research by Daniel Kahneman and Donald Redelmeier involving 287 hospital patients who underwent colonoscopy and kidney stone procedures while awake. The patients were given a device that let them rate their pain every sixty seconds on a scale of 1 (no pain) to 10 (intolerable pain), a system that provided a quantifiable measurement of a moment-by-moment experience of suffering. At the end the patients were also asked to rate the total amount of pain they experienced during the procedure. The procedures lasted anywhere from 4 minutes to more than an hour. The patients typically reported extended periods of low to moderate pain punctuated by moments of significant pain. A third of the colonoscopy patients and a quarter of the kidney stone patients had a pain score of 10 at least once during the procedure. Patients’ final ratings were not based on the whole experience and its duration but by what Kahneman called the ‘Peak-End rule’, an average of the pain experienced – the single worst moment of the procedure and the very end. This research is described in Daniel Kahneman’s book Thinking Fast and Slow.

EXPLORING ‘EMPTINESS’: CARLO ROVELLI AND NAGARJUNA

A modern western humanist learns from an ancient Buddhist philosopher. Carlo Rovelli’s book Helgoland (1) is mostly about the development of quantum mechanics in the early to mid-twentieth century and the scientists who developed it. The title references ‘Werner Heisenberg’s sojourn on the remote island of Helgoland working on the maths. But one chapter concerns the second century CE Buddhist philosopher Nagarjuna, and how his work has helped Rovelli to frame a philosophical understanding of quantum phenomena.

“When speaking about quanta and their relational nature I had frequently met people who asked: Have you read Nagarjuna? … Though not widely read in the West, the work in question is hardly an obscure or minor one: it is one of the most important texts in Buddhist philosophy. … The central thesis of Nagarjuna’s book is simply that there is nothing that exists in itself, independently from something else.

“The resonance with quantum mechanics is immediate. Obviously Nagarjuna knew nothing, and could not have imagined anything, about quanta – that is not the point. The point is that philosophers offer original ways of re-thinking the world, and we can employ them if they turn out to be useful. The perspective offered by Nagarjuna make perhaps make it a little easier to think about the quantum world (2).

“If nothing exists in itself, everything exists only through dependence on something else, in relation to something else. The technical term used by Nagarjuna the absence of independent existence is ‘emptiness’ (sunyata): things are ‘empty’ in the sense of having no autonomous existence. They exist thanks to, as a function of, with respect to, in the perspective of, something else.

“If I look at a cloudy sky – to take a simplistic example – I can see a castle and a dragon. Does a castle and does a dragon really exist, up there in the sky? Obviously not: the dragon and the castle emerge from the encounter between the shape of the clouds and the sensations and thoughts in my head; in themselves they are empty entities, they do not exist. So far, so easy. But Nagarjuna also suggests that the clouds, the sky, sensations, thoughts and my own head are equally things that arise from the encounter with other things: they are empty entities.

“And myself, looking at the star, do I exist? No, not even I. So who is observing the star? No one says Nagarjuna. To see a star is a component of that set of interactions that I normally call my ‘self’. ‘What articulates language does not exist. The circle of thoughts does not exist.’ There is no ultimate or mysterious essence to understand that is the true essence of our being. ‘I’ is nothing other than the vast and interconnected set of phenomena that constitute it, each one dependent on something else. Centuries of Western speculation on the subject, and on the nature of consciousness, vanish like morning mist.

“Like much philosophy and much science, Nagarjuna distinguishes between two levels: conventional, apparent reality with its illusory and perspectival aspects, and ultimate reality. But in this case the distinction takes us in an unexpected direction: the ultimate reality, the essence, its absence, is vacuity. It does not exist.

“If every metaphysics seeks a primary substance, an essence on which everything may depend, the point of departure from which everything follows, Nagarjuna suggests that the ultimate substance, the point of departure … does not exist.

….

“The illusoriness of the world, its samsara, is a general theme of Buddhism; to recognize this is to reach nirvana, liberation and beatitude. For Nagarjuna, samsara and nirvana are the same thing: both empty of their own existence. Non-existent.

“So is emptiness the only reality? Is this, after all, the ultimate reality? No, writes Nagarjuna, in the most vertiginous chapter of the book: every perspective exists only in interdependence with something else, there is never an ultimate reality – and this is the case for his own perspective as well. Even emptiness is devoid of essence: it is conventional. No metaphysics survives. Emptiness is empty.

“Nagarjuna has given us a formidable conceptual tool for thinking about the relationality of quanta: we can think of interdependence without autonomous essence entering the equation, In fact interdependence – and this is the key argument made by Nagarjuna, requires us to forget all about autonomous essences.

“The long search for the ‘ultimate substance’ in physics has passed through matter, molecules, atoms, fields, elementary particles … and has been shipwrecked in the relational complexity of quantum field theory and general relativity. Is is possible that a philosopher from ancient India can provide us with a conceptual tool with which to extricate ourselves?”

“The fascination of Nagarjuna’s thought goes beyond questions raised by contemporary physics. His perspective has something dizzying about it. It resonates with the best of much Western philosophy, both classical and recent. … He speaks about reality, about its complexity and comprehensibility, but he defends us from the conceptual trap of wanting to find it an ultimate foundation.

“His is not metaphysical extravagance: it is sobriety. It recognizes the fact that to inquire about the ultimate foundation of everything is to ask a question that perhaps simply does not make sense.

“This does not shut down investigation. On the contrary, it liberates it. Nagarjuna is not a nihilist negating the reality of the world, and neither is he a sceptic denying that we can know anything about that reality. The world of phenomena is one that we can investigate, gradually improving our understanding of it. We may find general characteristics. But it is a world of interdependence and contingencies, not a world that we should trouble ourselves attempting to derive from an Absolute.

“I believe that one of the greatest mistakes made by human beings is to want certainties when trying to understand something. The search for knowledge is not nourished by certainty: it is nourished by a radical absence of certainty. Thanks to the acute awareness of our ignorance, we are open to doubt and can continue to learn and learn better. This has always been the strength of scientific thinking – thinking born of curiosity, revolt, change. There is no cardinal or final fixed point, philosophical or methodological, with which to anchor the adventure of knowledge.

“I am not a philosopher; I am a physicist: a simple mechanic. And this simple mechanic, who deals with quanta, is taught by Nagarjuna that it is possible to think of the manifestation of objects without having to ask what the object is in itself, independent from its manifestations.

“But Nagarjuna’s emptiness also nourishes an ethical stance that clears the sky of the endless disquietude: to understand that we do not exist as autonomous entities helps us free ourselves from attachments and suffering. Precisely because of its impermanence, because of the absence of any absolute, the now has meaning and is precious.

“For me as a human being, Nagarjuna teaches the serenity, the lightness and the shining beauty of the world: we are nothing but images of images. Reality, including ourselves, is nothing but a thin and fragile veil, beyond which … there is nothing.”

(1) Carlo Rovelli Helgoland global.penguinrandomhouse.com 2020 (Translated by Erica Segre & Simon Carnell, 2021) Carlo Rovelli is a theoretical physicist who has made significant contributions to the physics of space and time.

(2) The Fundamental Wisdom of the Middle Way: Nagarjuna’s Mulamadhyamakakarika: Translation and commentary by Jay L. Garfield. Oxford: The University Press, 1995. Nagarjuna, who lived in South India in approximately the second century CE, is the most important, influential and widely studied Mahayana Buddhist philosopher. At the time of publication Jay L. Garfield was Professor of Philosophy and Director of the Hampshire in India Program, an exchange program with the Tibetan Universities in exile, at Hampshire College, Amherst, Massachusetts. His translation is from a Tibetan, rather than Sanskrit, text.

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