I got thinking about sensations the other day. Patients talk to me every day about their sensations – pain, dizziness, nausea, itch, numbness and so on. The medical concept of such sensations is “symptoms”. Interestingly, not a single one of these symptoms are objective. Nobody can know them, experience them or measure them apart from the person who has them. But what are they? According to psychologists, sensations are the effects of sensory stimuli, and perceptions are our awareness, or understanding of them.
So, are sensations in the mind?
Well, that’s not where we tend to situate them. We situate them in the body. Pain is usually described as being felt in particular parts of the body. Pain in the leg, an itchy arm, a numb patch on the back of the hand….and so on. That suggests sensations are in the body, not the mind. But what about phantom limb pain? A sensation which is specifically located in a part of the body which no longer exists?
Where do doctors look for a problem when someone describes a sensation? The part of the body the sensation “belongs to”. If someone has chest pain, doctors go looking at the chest and its contents for an explanation of the pain. If they can’t find any abnormalities there, then the focus shifts to the mind – “it’s not in his chest, it’s in his head”. In other words, in the absence of physical pathology in that part of the body, the explanation given is a disorder of the mind.
Do you find this an adequate understanding?
I don’t.
It seems to me that sensations are phenomena of the person, and shouldn’t be attributed to either the body or the mind. They should be situated in a person’s story, because it’s the narratives we tell ourselves and others which create not only a sense of self, but all of our sensations too. Sensations may have locality, but that doesn’t make them the markers of pathology. They can be the expressions of meaning.
If you’re not sure what I’m on about here, check out this post. And if you’d like to read more about the idea of meanings behind sensations, you could start with the excellent “Why do People Get Ill?” or “Meaning-full Disease“.
Heroes Not Zombies 
Bob, in many cases I agree with you but I do think modern neurophysiology and brain based understanding of body maps for example can add more scientific understanding. Subtle dysfunctions in the nervous system for example will not show up on any scan or gross orthopaedic examination. However, understanding how for example ischeamia and low levels of oxygen affect peripheral nerve function can add to understanding (i.e much of modern life)…add in understanding of things like central pain mechanisms/substance P and how stress physiology affect a dynamic system than many problems become more understandable perhaps?
I would recommend ‘Your body has a mind of its own’ by Sandra Blakeslee a fascinating account of how these maps change and are altered by disease/distress and critically how we interact.
I read recently about Porges Polyvagal theory http://www.stephenporges.com/
perhaps this approach would enhance understanding and give credibility to non pharmacological interventions in health care?
I agree entirely with your points on meaning and narratives —there was an excellent radio four programme on metaphor and healing which gave some great examples on how this can be used in practice .
ian
Oh, I’m sure we’re going to greatly increase our understanding of these things through neurobiological approaches, but what I feel is it won’t be enough. I’m more and more taken by the more ecological, holistic approaches to understanding these phenomena…..along the lines of Bateson, Varela, Maturana, Alva Noe and so one. Add to that the model of the extended mind from the likes of Andy Clark, and the triad of brain, mind and relationships as beautifully described by Dan Siegel – who so clearly distinguishes between the phenomena and the “neural correlates” of phenomena.
And, yes, the “polyvagal theory”, like, psychoneuroimmunology, psychoneuroendochrinology, the whole developing science of complexity and chaos, are all contributing to a more “joined up” or “holistic” understanding of living creatures.
For me, in clinical practice, story remains the key. Every patient I meet has an amazing story to tell, and in the telling, both in the narrative forms and the embodied metaphors that are used, I find not only a way of understanding someone, their health and their illness, but a means to engage with them and to facilitate change.