Pain: Universal but Culturally Shaped

I am grateful to all the commentators for engaging with my arguments across the boundaries between our home disciplines. Horacio Fabrega’s (2012) fascinating commentary, which shows a deep understanding of the purposes and functions of the natural semantic metalanguage (NSM) as a neutral conceptual framework for discussing humans (and hominins), fills one with renewed optimism regarding the prospects of multidisciplinary cooperation and interdisciplinary dialogue across the wide range of human sciences including psychology, anthropology, medical sciences, and linguistics. It is also greatly encouraging to see that in Devon Hinton’s (2012) view, the use of NSM allows us to improve on the widely used McGill Pain Questionnaire and that the NSM analysis of “pain” is “a key beginning” for a fruitful interdisciplinary exploration of this vital area of human experience. Ephrem Fernandez’s (2012) spirited defense of the International Association for the Study of Pain (IASP) definition of “pain” highlights different disciplinary perspectives on pain and thus helps along interdisciplinary dialogue.

“Pain” is widely regarded as a human universal, and of course with good reason: roughly speaking, all people, in all places, often experience feelings associated in English with the word pain. It is not widely recognized, however, that pain is an English word which imposes a certain language-specific perspective on this universal human experience (as do also other English words such as ache, sore, hurt, and suffer). The closest equivalents of pain in other languages (e.g., douleur in French, bol’ in Russian, or pika in Pitjantjatjara) impose other perspectives on it. Such differences highlight the need for a language-independent perspective on the range of human experiences associated in English with the word pain.

The target article shows that such a neutral perspective can be achieved through the natural semantic metalanguage (NSM), operating with universally cross-translatable components such as “someone feels something (very) bad in the body,” “something bad is happening to a part of someone’s body,” or “this someone thinks: I don’t want this.”

This “universalist” emphasis of the target article is not incompatible with the view that the construal of “pain-like” experiences is culturally shaped. On the contrary, the use of NSM allows us to document the cultural shaping of such experiences by providing a tertium comparationis, a conceptual common measure (see my analysis of different versions of Jesus’ agony in the Garden of Olives in the English and Russian translations of the Gospels in Wierzbicka, 2009).

At the same time, I would reiterate the point that to analyze the cultural shaping of emotions in a non-Anglocentric way we need a culture-neutral analytical framework. For example, to interpret the idiom of “pain” in Cambodia in a way both faithful to the perspective of the insiders and intelligible to outsiders we need to go beyond technical and culturally shaped labels such as “trauma,” “panic,” or “distress” and build intercultural conceptual bridges through simple and cross-translatable concepts (such as “feel,” “bad,” “body,” “happen,” “think,” and “want”). The use of a universal conceptual currency allows us to explore the cultural shaping of pain in particular societies without imposing on them categories derived from our own culture.

As Hinton (2012) argues, some understanding of the cultural aspects of pain is crucial to building empathetic bonds between patients and doctors within particular societies. By combining a universalist conceptual framework with close attention to the cultural specificity of feelings and emotions in general and pain in particular, NSM can, I believe, be an effective tool for exploring the cultural shaping of pain in a culture-neutral, non-Anglocentric way, and thus can facilitate empathetic communication between patients and doctors in multicultural societies.

The use of simple and universal human concepts, on which NSM relies, allows us to find a middle way between the scientific language of the medical profession and the fully idiomatic everyday English—the first often incomprehensible to “ordinary” people, and the second, often tied to Anglo cultural perceptions.

Fernandez’s (2012) interesting commentary highlights the need for a more comprehensive discussion of four methodological issues. The first one concerns the distinction between ordinary meaning of words and their technical meaning, for example, between “pain” in normal usage and what Fernandez calls “pain defined scientifically” (2012, p. xxx). For example, when he says “Actually, ‘unpleasant’ simply means any negatively valenced emotion on negative effect” (2012, p. xxx), he is evidently referring to a stipulated scientific sense of the word unpleasant, not to its ordinary meaning. There will never be successful communication about pain between sufferers and doctors if the doctors insist that they know what words like unpleasant mean and “ordinary” people don’t.

The second issue concerns the role of prototypes in definitions. The definition of “pain” that was put forward in the target article does not imply that “pain involves concurrent tissue damage and unpleasant feeling,” but only that something like “tissue damage” (Fernandez, 2012, p. xxx) (combined with feeling something bad in a part of the body) provides a conceptual reference point for the “naive” concept of pain. This is why “bad feelings” like nausea and other “aversive sensations” are not regarded by speakers as pain: they do not fit the prototype which is encoded in the ordinary meaning of the word pain. The same applies to the concurrence (or otherwise) of the “tissue damage” (or other bodily harm) and the bad feeling: such concurrence is not a necessary condition, but a part of the conceptual prototype of pain.

The third issue concerns the number of universal concepts. Fernandez (2012, p. xxx) says that “NSM has only 60 or so words, many of which do not mirror universal concepts.” He doesn’t say, though, which of the NSM primes he thinks do not mirror universal concepts or why. The NSM set of universal semantic primes is based on many years of systematic cross-linguistic investigations and is supported by extensive empirical evidence (which is publicly available in NSM publications).

In the same context, Fernandez (2012, p. xxx) asks about the concepts “birth,” “mother,” “father,” and “child” which he calls “Jungian archetypes” and which, he points out, are “conspicuously missing” from the NSM list of primes. Empirical evidence suggests that three of these four are indeed universal human concepts: in all languages we find “mother,” “father,” and “to be born” (the relational concept “child of . . .” is not universal). These concepts are not, however, conceptual primes: they can be defined in terms of concepts such as “body,” “part,” “inside,” “happen” and several others. In NSM, such complex but universal concepts are called “universal semantic molecules,” and they are distinguished from conceptual “atoms” such as “body,” “part,” or “inside” (cf. Goddard, 2010).

The fourth issue concerns the effectiveness of simple words like “bad” (which NSM relies on in preference to “noxious” and the like) for conceptual analysis. Fernandez (2012, p. xxx) is quite right of course when he says that “the word ‘bad’ has such breadth of meaning [that] it extends to anything from ‘sprouting a pimple,’ to ‘losing hair,’ or ‘developing a paunch.’” To understand the import of the word bad in a particular definition one has to see it as a part of a configuration of elements, not as the sole element.

The NSM distinction between “bad” and “very bad,” combined with other distinctions such as that between “the body” and “part of the body,” allows us to capture very subtle semantic differences, usually ignored in psychological literature, such as that between the prototype of the English pain (“someone feels something bad in a part of the body”) and that of the French douleur (“someone feels something very bad in the body”). (For a fuller discussion of this and several other questions raised by the reviewers, see Wierzbicka, in press.)

Once again, many thanks.