Expected Pain Parameters

post by Alicorn · 2018-07-14T19:30:16.370Z · score: 85 (38 votes) · LW · GW · 12 comments

A problem I sometimes have is that someone will suggest that I do something uncomfortable - physically or emotionally, whichever - and they'll acknowledge that it's not going to feel good.

And then they won't follow up by explaining exactly how much and in what way it's supposed to hurt, let alone why or how to mitigate that.

Look: if you're going for a run, you might get a stitch in your side, your legs might cramp, your lungs might burn.  If you feel a sudden stabbing pain in your foot, that's not the run.  You've stepped on something sharp and you need to stop and call for a ride, not tough it out.  If you've been told that running might hurt and that's a good thing, a sign of weakness leaving the body or whatever, and there's any ambiguity between "stepped on something sharp" and "this is how it's supposed to hurt" - are you supposed to have blisters or do you need better-fitting shoes?  Are you supposed to have a headache or do you need to drink way more water than you have been? Is a sunburn just part of a healthy experience that means you're making vitamin D, or should you be wearing sunscreen next time? - then you're blundering into a problem that you would have noticed and solved if you had encountered it by sitting on the couch.

If you're apologizing for something you've done wrong, you might feel guilty, stared-at, awkward, resentful.  If you feel like the walls are closing in and you're going to puke, then you have a more serious problem and might want to get that looked into, not chalk it up to "well, acknowledging that you've made a mistake can be painful".  If you're apologizing to someone who's abusing you, then how much it hurts is a red flag.  If you're in a badly facilitated therapeutic or moderated conversational environment, and you don't know how much it's supposed to hurt, then when it hurts more than it's supposed to you won't notice that you need to fix or leave the setup.  If you're apologizing for something that isn't wrong, because you've been indoctrinated in a normset that's unhealthy about what things are violations, then by letting that normset also tell you that it's supposed to feel bad you're losing a signal that could tell you to bail.

Even things you aren't actively doing can have this issue: it took me a long time to be really sure that most people don't experience pain when they have their blood pressure taken, because every time I complained about it, an indifferent nurse would say "yep, lots of pressure, mm-hm, it squeezes pretty tight" and not "actually, while you're unlikely to be in medical danger, that is not typical; we might make different tradeoffs about how often to recommend this test if it hurt everyone like it does you".*

And if you don't know how something is supposed to hurt, and know that you don't know it, you will need some risk-aversion there to avoid blundering into sharp objects and mental health triggers and cost-benefit analyses that were not designed for how you're put together.  So this can cut off opportunities to try things, the opposite problem from trying too hard at something that isn't working.

If you are recommending that people do something that might be uncomfortable or painful, tell them what normal tolerances are, and what the things that might be causing abnormal responses might be.  Demand this of people telling you to do uncomfortable or painful things too.  Pain responses have a purpose; ignoring them outright for the duration of an activity which flirts with the damage that aversion is meant to prevent is insane.

*If you have this problem and might give birth and might have an epidural while you do, have them put the blood pressure cuff on your numb leg.  Hat tip to Swimmer963.

12 comments

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comment by Dagon · 2018-07-15T05:21:57.789Z · score: 7 (4 votes) · LW · GW

Relevant XKCD: https://xkcd.com/883/

Pain experience is idiosyncratic, and very often this process of communication about what pain is "walk it off" and what is "stop and call an ambulance" is assumed to have been learned over decades of youth. In reality, everyone's learned different subsets of it, and we don't actually KNOW what's problematic. All advice of this sort, including most non-specialist physicians, and excluding most physical therapists and professional athletic coaches, is suspect.

comment by bbleeker · 2018-07-16T07:46:36.252Z · score: 3 (2 votes) · LW · GW

A better pain scale: https://i.imgur.com/S2R4pzI.png

comment by Peter Gerdes (peter-gerdes) · 2018-07-15T02:58:57.615Z · score: 4 (3 votes) · LW · GW

Also, I think there is a fair bit of tension between your suggestion that we should be taking advice from others about how much things should hurt and the idea that we should use the degree of pain we feel as a way to identify abusive/harmful communities/relationships. I mean the more we allow the advice from those communities to determine whether we listen to those pain signals the less useful they are to us .

comment by Alicorn · 2018-07-15T04:53:51.820Z · score: 8 (5 votes) · LW · GW

What I mean is more like "if someone is suggesting that you do something painful, they should present you with a model of why and how that pain is okay". This doesn't rule out misappropriation - I'm sure cult leaders and certain brands of interpersonal abusers do it handily, especially if they're weaponizing guilt - but it's at least robust against generic, opaque commands to "suck it up", and if you go in with that expectation you'll have an opportunity to notice something is wrong if someone tells you that you shouldn't be in pain and your pain is invalid (they don't have a model that describes the thing you are in fact feeling, so they don't have a good model of the situation as a whole).

comment by jimmy · 2018-07-16T01:57:36.256Z · score: 10 (4 votes) · LW · GW

I agree with the idea that it's important for people to understand their pain when they aren't going to just flinch from it.

The framing you chose seems odd to me though. Instead of saying "if you're going to suggest people do something painful, you should present them with a model/make sure they understand" or saying "if someone is suggesting you do something painful, make sure you have a model", you say "*they* should present *you* with a model". Are you intending to suggest to your audience that they should feel *entitled* to having a model accompany the initial request, above and beyond the fact that it's important to understand?

comment by Benquo · 2018-12-03T13:28:36.202Z · score: 8 (1 votes) · LW · GW

If you don’t demand an explanation, you will at least sometimes confabulate one. This is part of how hazing works.

comment by Alicorn · 2018-07-16T23:47:11.241Z · score: 4 (2 votes) · LW · GW

Hm, I guess that's a slightly stronger claim, but I do endorse it now that I think about the distinction; not to the point where every single such piece of advice should come bundled with an unsolicited painfulness model, but to the point where if you're giving painful advice you should have the model on hand.

comment by Peter Gerdes (peter-gerdes) · 2018-07-15T02:56:55.838Z · score: 3 (2 votes) · LW · GW

It's hard to identify and convey degrees of pain which I suspect was part of your problem communicating with the nurses. Ultimately, with physical pain we can often muddle through with something like the 10 point pain scale doctors use as most of us have experience roughly equivalent truly intense pain and there isn't that much interpersonal variation in how unpleasant we find different kinds of physical pain.

However, with emotional pain it's almost impossible to convey how uncomfortable something should be to other people. For instance, we all dislike being called out but my wife finds it almost unbearable that a veiled suggestion she's being insensitive to X people on an anonymous internet comment of hers can bother her for days. I'll deliberately jump into such fights but the thought of unknowingly violating a social protocol and being seen as presuming more than my due bothers me enough that I go to great lengths to avoid having to ask people if they speak English (temporarily living in Israel). Both of us find intellectual disagreements completely troubling but I know people who can't stand being in that kind of aggressive confrontation.

So how could I possibly give someone advice on how much apologizing will hurt? If they're the type of person who takes embarrassment super seriously it will be totally different than if it's not big deal.

I think it's quite possible I'm misunderstanding what your suggesting. Maybe you could describe the kind of advice you think would be helpful.

comment by ChristianKl · 2018-07-24T12:34:23.023Z · score: 9 (1 votes) · LW · GW

What makes you think that different people experience the same kind of pain the same way? One thing that produces a kind of pain is to go swimming in a river in spring. Depending on how your body reacts when you touch the water that experience can be both healthy or unhealthy and I don't think that's a simple matter of degrees of pain.

When Taber Shadburne teaches Radical Honesty he often makes the point that an essential part of Radical Honesty is to become a connoisseur of pain who can tell different kinds of emotional pain apart the way the proverbial wine connoisseur can tell apart the taste of different wines.

A wine connoisseur usually doesn't simply judge a wine on a one-dimensional scale and the one-dimensional nature that's implied by the "how much apologizing will hurt" isn't a useful way to think about the emotions either.

Taber also used a Yoga metaphor where experienced Yoga practitioners need to be able to tell apart different kinds of pain. The pain of stretching a muscle is an essential part of Yoga and welcome while the pain from overturning an ankle is bad and has to be avoided.

I talked about this with one LW'ler who does Yoga and the person said that they are able to tell 7 different kinds of pain apart in their Yoga practice.

comment by jimmy · 2018-07-16T02:42:16.941Z · score: 6 (4 votes) · LW · GW
So how could I possibly give someone advice on how much apologizing will hurt? If they're the type of person who takes embarrassment super seriously it will be totally different than if it's not big deal.

It's not so much "how much will this hurt" as it is "how much should this hurt". In other words, "how much does it have to hurt before I reconsider". In the running case, for example, you can't know before their run if they'll experience mild muscle soreness of if they'll step on a nail. You want them to know that if it feels like they've stepped on the nail, this isn't what you're talking about, and you shouldn't try to run through that.

There is a distinction between "this is how intense the sensations might be" and "this is the thing they signify, and how bad it is". A lot of the subjective experience of "pain" has to do with the meaning attached to it, and the reaction to that meaning.

In jiu jitsu for example, beginners are often not taught heel hooks in part because the sensation of a knee ligament about to rupture doesn't always stand out as a big deal, and so people will sometimes hurt themselves because they don't notice the warning signs. At the same time, you can get people screaming in pain once their foot is turned the wrong way because all of a sudden the meaning has changed and they no longer feel "okay". Other people can have the same thing happen to them and just kinda look at it like "oops, I screwed that up" because they simply aren't overwhelmed by the idea that their ligaments just tore and their limb isn't pointing the right way anymore.

When you're talking to someone who is in pain (or needs to do something which will be painful), there's two things you want to communicate. One is that it's okay, even though whatever the bad thing is that happened, and the other is what the bad thing is. When you can do those two things, their entire experience can change dramatically.

The same principles apply to emotional concerns. For example, if someone is going to feel embarrassed by something to a degree which seems appropriate and okay, then all you are going to need to communicate is "Yes, this is going to be embarrassing. It's okay". If they're going to be way more embarrassed than is called for (in your opinion), then you *also* want to be communicating that the damage isn't as severe (or call for such an extreme aversion) as it seems. It's the "this sensation means your knee is about to explode" training in reverse. In this case, you aren't just saying "embarrassment is okay", you're also saying "it's not even that embarrassing". Be prepared for people to not just take your word on this, of course, but that is the point of contention.

One way to deal with it is to actually paint them a picture of what it's like from your perspective so that they can see that it's not that big a deal (if they find your story convincing). Another is to just show awareness that it seems super horrible and worth being embarrassed over, and that you don't expect them to be convinced, but that you actually don't think it's that big a deal, for what it's worth. If your opinion means something to them, this can still have a significant effect.

As I read it, the advice Alicorn is giving here relates to the part where you don't want to miss the fact that someone might perceive an embarrassing event as way worse than you do (accurately or not) and then tell them "you should put up with it so that you can do X" without noticing that you might be asking them to endure a much bigger perceived (and maybe real) cost than you actually think it's worth. For example, you might want to say "I'd probably apologize to them if I were in your shoes. And yeah, it's kinda gonna suck. I wouldn't be smiling about it for sure, and I might have a hard time being in a good mood for the rest of the evening, but it's not like it's worth traumatizing yourself over. If it feels like something you can't handle, then that's fine too. It's not the end of the world if this person doesn't get their apology".

comment by Benquo · 2018-12-03T13:34:53.244Z · score: 2 (1 votes) · LW · GW

One is that it’s okay, even though whatever the bad thing is that happened

This is only meaningful if it’s sometimes false. Seems better to check whether you can honestly offer that assurance, and if not, do something about it before assuring someone that it’s okay.

comment by jimmy · 2018-12-14T19:06:52.491Z · score: -1 (2 votes) · LW · GW

This is not the test for whether a statement has meaning. If I say "this vaccine you're getting does not cause autism", that would be meaningful even if it's not sometimes false when applied to other vaccines. It has meaning whenever "this vaccine causes autism" describes a different world than "this vaccine does not cause autism".

It may not convey any information to you if you already know "there are no vaccines about which that statement is false", but not everyone shares that certainty, and the people who don't might benefit from reassurance.

This definitely depends on you being right about the "this vaccine doesn't cause autism" thing, of course. You have to be able to honestly and justifiably state “this vaccine does not cause autism”, as encouraging people to take vaccines under false or unjustified premises is bad. You have to maintain openness to checking the data with them and changing your own mind if you do not find what you expect to find, because if you’ve closed your mind to the data not only does that make your job of persuasion harder, it makes your job of actually being reliably right harder. I'd even go so far as to say that not only should you be willing to put your money where your mouth is, you should even be able to do it *without flinching*. This means being able to put yourself in their shoes and actually experience "okayness" yourself.

Yes, if you can't do all of these things then you should do something about it before assuring them that it's okay. However, if you have good reason to believe that the statement is always true, that just means "figure out how to do all these things" is the thing you do about it before assuring them that it's okay.