Pain Is a Mind Game
On Toothache, Placebos, and the Unconscious
Catch-up service:
Who The Hell Is Wesley Streeting?
Thinking By Hand
How To Save Centrism
What the Fuck Are We Talking About When We Talk about Love?
Arteta vs Guardiola
Moon Joy
I have of late been going through a Martin Amis phase. I don’t mean that I’ve been reading him, or, God forbid, trying to write like him. I mean that I’ve been having teeth trouble.
Amis’s memoir, Experience, is deeply concerned with teeth. The famously expensive dental surgery he undertook in middle age was not a matter of cosmetics, but pain relief, and it made him reflect deeply on the interaction of body and mind. As one critic has argued, the whole book can be read as proposing that “people are first and foremost bodies”, and that our ideas and feelings, including our ideas and feelings about other people, proceed from this ground truth.
Amis had a theory of why, despite knowing his teeth were dodgy, he stopped going to the dentist for decades, until it was too late to avert a crisis in middle age. Unconsciously, he had believed that losing them would enable him to effect a deep change in his personality - to grow up.
”It was a bad plan [not going to the dentist], but it had worked. My unconscious mind might not have thought much of the plan either, but it worked around that and made its preparations. Really, the conscious mind can afford to give itself a rest. The big jobs are done by the unconscious. The unconscious does it all.”
My teeth trouble is not on the scale of Mart’s but it’s enough to make me understand why he devoted so much of Experience to it. When you’re in the middle of teeth trouble it’s difficult to think about anything else.
Toothache is a mind game. If you get knocked in the knee, the pain is easy to comprehend; you intuitively know trigger and cause. Dental pain is more mysterious. You might know it’s something to do with spotty dental hygiene, sugar or smoking, but you don’t know why this particular tooth is hurting and not that one, and the answer is not always physical. ‘Referred pain’ can be felt in a tooth which isn’t even near the tooth that’s the source of the problem.
A few months ago I had a long-running dispute with a molar on the upper right. After my regular dentist had tried and failed to resolve it I went to a specialist - an endodontist. The operation seemed to go fine but a couple of weeks later I was in quite a lot of pain. I convinced myself that the operation had failed, and felt quite anxious about it. So I called my endodontist, who exuded an air of effortless mastery. “It’s just an after-effect”, he said, in his reassuringly confident tone. “It’ll fade.” Almost the moment I got off the phone, the pain subsided, and soon disappeared for good.
I’m sure you’ve had similar experiences, whether it’s teeth or some other part of the anatomy. The mere act of having a worrying pain or ache explained, contextualised, made mundane by a doctor often goes some or all of the way towards alleviating the pain itself. The idea that physical pain has a mental component shouldn’t be surprising, but the mental part often counts for more than I expect.
The neuroscientific mechanism behind this phenomenon is explored in Andy Clark’s book The Experience Machine (I wrote about Clark’s book a couple of weeks ago and will return to it again - it’s very rich). Clark discusses an extraordinary case study from the British Medical Journal, about a builder who jumped from some scaffolding to the ground, only to land on a fifteen-inch nail.
After the jump - the rest of this piece plus a note on the race to depose Keir Starmer, plus a glorious Rattle Bag. The Ruffian depends on paid subscriptions. Many thanks to those of you who already support it.
