Pain, Laughter and Crying : Part 3

Origin and Nature of Emotions
by George W. Crile, M.D.

(Page 5 of 13)

The simultaneous, but severe application of the boot to the blindfolded victim takes complete and exclusive possession of the final common path and the hair is painlessly plucked through the triumph of the boot stimulus over the hair stimulus in the struggle for the possession of the final common path. Another argument in favor of this hypothesis that pain is an accompaniment of the release of energy in the brain- cells is found in the fact that painless stimuli received through the special senses may completely submerge the painful stimuli of physical injury; for although the stimuli to motor action, which are received through the senses of sight, hearing, and smell, cause even more powerful motor action than those caused by physical contact stimuli, yet they are not accompanied by pain.

Examples of this triumph of stimulation of the special senses over contact stimulation are frequently seen in persons obsessed by anger or fear, and to a less degree in those obsessed by sexual emotion. In the fury of battle the soldier may not perceive his wound until the emotional excitation is wearing away, when the sensation of warm blood on the skin may first attract his attention. Religious fanatics are said to feel no pain when they subject themselves to self-injury. Now, since both psychic and mechanical stimuli cause motor action by the excitation ofprecisely the same mechanism in the brain, and since the more rapid release of energy from psychic stimuli submerges the physical stimuli and prevents pain, it would seem that pain must be a phenomenon which is associated with the process of releasing energy by the brain-cells.

Were physical injury inflicted in a quiescent state equal to that inflicted in the emotional state, great pain and intense muscular action would be experienced. Now the emotions are as purely motor excitants as is pain. The dynamic result is the same the principal difference being the greater suddenness and the absolute specificity of the pain stimuli as compared with the more complex and less peremptory stimuli of the emotions. A further evidence that pain is a product of the release of brain-cell energy is the probability that if one could pierce the skin at many points on a limb in such a manner that antagonistic points only were equally and simultaneously stimulated, then an equilibrium in the governing brain- cells would be established and neither pain nor motion would follow.

An absolute test of this assumption cannot be made but it is supported by the obtainable evidence. We will now turn to a new viewpoint, a practical as well as a fascinating one, which can best be illustrated by two case histories: A man, seventy-eight years old, whose chief complaint was obstinate constipation, was admitted to the medical ward of the Lakeside Hospital several years ago. The abdomen was but slightly distended; there was no fever, no increased leukocytosis, no muscular rigidity, and but slight general tenderness. He claimed to have lost in weight and strength during the several months previous to his admission.

A tentative diagnosis of malignant tumor of the large intestine was made, but free movements weresecured rather easily, and we abandoned the idea of an exploratory operation. The patient gradually failed and died without a definite diagnosis having been made by either the medical or the surgical service. At autopsy there was found a wide-spread peritonitis arising from a perforated appendix. A child, several years old, was taken ill with some indefinite disease. A number of the ablest medical and surgical consultants of a leading medical center thoroughly and repeatedly investigated the case. Although they could make no definite diagnosis they all agreed that the trouble surely could not be appendicitis because there was neither muscular rigidity nor tenderness.

The autopsy showed a gangrenous appendix and general peritonitis. How can these apparently anomalous cases be explained? These two cases are illustrations of the same principle that underlies the freedom from pain which results from the use of narcotics and anesthetics, the same principle that explains the fact that cholecystitis may occur in the aged without any other local symptoms than the presence of a mass and perhaps very slight tenderness; and that accounts in general for the lack of well-expressed disease phenomena in senility and in infancy. The reason why the aged, the very young, and the subjects of general paresis show but few symptoms of disease is that in senility the brain is deteriorated, while in infancy the brain is so undeveloped that the mechanism of association is inactive, hence pain and tenderness, which are among the oldest of the associations, are wanting. Senility and infancy are by nature normally narcotized.

The senile are passing through the twilight into the night; while infants are traversing through the dawn into the day. Hence it is that the diagnosis of injury and disease in the extremes oflife is beset by especial difficulties, since the entire body is as silent as are the brain, the pericardium, the mediastinum, and other symptomless areas. For the same reason, when a patient who is seriously ill with a painful disease turns upon the physician a glowing eye and an eager face, and remarks how comfortable he feels, then the end is near. This is a brilliant and fateful clinical mirage. When one reflects on the vast amount of evidence as to the origin and the purpose of pain, he is forced to conclude that pain is a phenomenon of motor stimulation, and that its principal role is the protection of the individual against the gross and the microscopic enemies in his environment.

The benefits of pain are especially manifested in the urgent muscular actions by means of which the body moves away from physical injury; obstructions of the hollow viscera are overcome; rest is compelled in the acute infections - the infected points are held rigidly quiet, the muscles of the abdomen are fixed, and harmful peristalsis is arrested in peritonitis; while there is absolutely no pain in the diseases or injuries which affect those regions of the body in which in the course of evolution no pain receptors were placed, or in those diseases in which muscular inhibition or contraction is of no help. In a biologic sense pain is closely associated with the emotional stimuli, for both pain and the emotions incite motor activity for the good of the individual.

About the Author

George Washington Crile (1864 - 1943) was a significant American surgeon. Crile is now formally recognized as the first surgeon to have succeeded in a direct blood transfusion. He also contributed to other procedures, such as neck dissection.