Reminding myself just how awful pain can get (plus, an experiment on myself)

By Ren Ryba @ 2023-03-15T22:44 (+301)

Content warning: This post contains references to extreme pain and self-harm, as well as passing references to suicide, needles, and specific forms of suffering (but not detailed descriptions). Please do not repeat any of the experiments I've detailed in this post. Please be kind to yourself, and remember that the best motivation is sustainable motivation.

Summary

• Out of curiosity, I exposed myself to safe, moderate-level pain to see how it changed my views on three particular topics. This article is mostly a self-reflection on this (non-scientific) experience.
• Firstly, I got a visceral, intense sense of how urgent it is to get it right when working to do the most good for others.
• Secondly, I gained a strong support for the position that the most morally important goal is to prevent suffering, and in particular for preventing extreme suffering.
• Thirdly, I updated my opinion on the trade-offs between different intensities of pain, which I give in this article as rough, numerical weightings on different categories of pain. Basically, I now place a greater urgency on preventing intense suffering than I did before.
• I conclude with how this newfound urgency will affect my work and my life.

My three goals

I began this experiment with three main goals:

• To remind myself how urgent and important it is to, when working to help others as much as I can, to get it right.
• Some people think that preventing intense pain (rather than working towards other, non-pain-related goals) is the most important thing to do. Do I agree with this?
• If I experience pain at different intensities, does this change the moral weight that I place on preventing intense pain compared to modest pain (i.e. intensity-duration tradeoff)?

I think it is useful to test my intellectual ideas against what it is actually like to experience pain. This is not for motivation - I already work plenty in my role in animal advocacy, and I believe that sustainable motivation is the best motivation (I talk about this more at the end).

My "experiment"

I subjected myself to two somewhat-safe methods of experiencing pain:

• Firstly, I got three tattoos on different parts of my body - my upper arm, my calf, and my inner wrist. I had six tattoos already, so I was familiar with this experience. I got these tattoos all on one day (4/2/23) and in one location (a studio in London).
• Secondly, I undertook the cold pressor test. This is basically holding my hand in a tub of near-freezing water. This test is commonly used in scientific research as a way to invoke pain safely. I also did this on one day (25/2/23) and in one location (my home in Australia). Please do not replicate this - the cold pressor test causes pain and can cause significant distress in some people, as well as physical reactions that can compromise your health.

I wish I had a somewhat-safe way to experience pain that is more intense than these two experiences, but these are the best I could come up with for now.

During both of these experiences, I recorded the pain levels. I recorded the pain in three ways:

• A short, written description of my thoughts and feelings.
• The McGill Pain Index Pain Rating Intensity (PRI) Score. This score is calculated from a questionnaire (which I accessed via a phone app) that asks you to choose words corresponding to how your pain feels. The words are then used to calculate the numeric PRI score. I chose to use this tool as there is a review paper listing the approximate PRI scores caused by different human health conditions, which lets me roughly compare my scores to different instances of human pain. This list is given below, so you can have some idea of what scores mean. 
• The PainTrack category. This divides pain into four categories - annoying, hurtful, disabling, and excruciating - based on qualitative descriptions (given below). I chose to use this tool as PainTrack has been used to measure the pain experienced by farmed animals, which lets me roughly compare my scores to different instances of animal pain. I also use PainTrack in my day-to-day work in animal advocacy research. The definitions of each category are given below.

The McGill Pain Index

Here is a visual summary of how the McGill Pain Index PRI scores are calculated, as well as some typical scores associated with human health conditions. I do assume, but I haven't checked, that the scores would vary somewhat from person-to-person and depending on the specifics of the condition. This is illustrated with childbirth, which is given three scores (the pain varies depending on the experience and preparation level of the birthing parent).

I gather that the McGill PRI scores range between 0 and 78 (that's how it worked on the app that I used). Most images in the literature and on the internet only go up to 50. I'm assuming they're the same scale, but please point out if I've misinterpreted something and I'll fix it.

(Credit: Scale on the right adapted from Wong (2022), in turn reproduced from Melzack (1984). Sample words from Wikipedia.)

The Pain-Track Framework

For Pain-Track, the article by Alonso and Schuck-Paim gives the definitions of each category in the Pain-Track framework:

• Excruciating: Threshold of pain under which many people would choose to take their life rather than standing the pain. This is the case, for example, of severe burning events, which may make victims jump from buildings, or other conditions associated with suicidal attempts by sufferers (e.g., cluster headaches). Many forms of torture have been designed to inflict pain at this level. Behavioral patterns can include loud screaming, involuntary shaking and extreme restlessness
• Disabling: Most forms of functioning or enjoyment are prevented as the direct result of pain. Symptoms are continuously distressing. Individuals affected often substantially reduce activity levels and refrain from moving. Pain at this level can disrupt or prevent sleeping. Only strong analgesia can relieve it
• Hurtful: Pain experiences that most would consider disruptive of daily routine. Although not entirely preventing individuals from functioning, their ability to do so is impaired as the direct result of pain, and often accompanied by the desire to take painkillers or seek treatment. Frequent complaints are often present. The possibility to enjoy pleasant experiences is impaired, as is performance on mentally demanding tasks, alertness and attention to ongoing stimuli
• Annoying: Pain experiences are not intense enough to disrupt the routine or daily activities of individuals, their possibility to enjoy pleasant (positive) experiences, or their ability to conduct mentally demanding tasks that require attention. Sufferers do not think about this sensation most of the time, and when they do they can adapt to it

Raw results

• The following table shows the pain levels that I recorded at different stages in the experiment.
• I've also put the rough McGill PRI scores on a chart showing how different human health conditions compare.
• I've adjusted my scores downwards a little bit for the below chart. It should be obvious that this approach, from an experimental perspective, suffers from numerous limitations. I write more about that below. Most notably, some of my McGill PRI scores seem a little bit too high (e.g. comparable to digit amputation). While these scores are plausible, I find it more likely that my scores are indeed slightly too high. An experiment conducted by researchers actually trained in this tool, using a larger sample size, would probably obtain slightly lower average scores. So, you might want to adjust the numbers downwards in your head a little bit.
• Also note that I subsequently tidied up the subjective descriptions, as my capacity for spelling and grammar during each experience was severely compromised.
   

(Credit: Scale and scores on the left of the column are adapted from Wong (2022), in turn reproduced from Melzack (1984).)

Question 1: The importance of getting it right

The goal

• I was curious whether experiencing this level of pain would help bring home the urgency of getting it right when working to do the most good for others.

Outcome

• Yes, while I was experiencing the pain, this urgency became crystal clear to me.
• I also gained a much deeper appreciation for the need to be modest about what I believe. If there is suffering this intense happening on a colossal scale in the world, I need to get over my silly hang-ups and work really hard to make sure I believe the correct things, no matter how emotionally uncomfortable and intellectually challenging that process can be.
• It's hard to explain more than this - after all, the purpose was to get a personal, visceral feel for the urgency of getting it right. By definition, this is hard to explain in the form of an elegant argument.
• I've experienced this general level of pain before, which suggests that it might be easy to forget once I stop feeling the pain. But it's not exactly a good idea to subject myself to this level of pain on a regular basis. For more on how I plan to resolve this dilemma, see the Afterword section of this article.

Question 2: Is preventing suffering the most important thing?

The question

• According to suffering-focused ethics, the most important thing is to prevent suffering. For example, Brian Tomasik quotes one author, who writes something along the lines of: it's easy to worry about principles like exploitation, oppression, liberation, and so on, but once you truly experience intense suffering, all of those concerns seem ridiculous.
• I'm not a philosopher, but I understand that other philosophical systems can lead to the conclusion "the most important thing is to prevent suffering". I'm most interested in this claim, not defending any particular philosophical system as a whole.
• Is this claim true?

Background - opinion before the experiment

• I disagree with the claim that most principles, abstractions, etc are ridiculous compared to preventing suffering.
• I definitely care about a lot of abstractions: democracy, freedom, equality, gender and queer rights, Indigenous rights, animal rights, women feeling safe in public, kindness, generosity, digital privacy, scientific advances, my gender expression, my hobbies, my social reputation, my pension fund, and so on. This claim suggests that caring about any of these things - and some of the items at the beginning of that list are things that people have given their lives for - is ridiculous. That is a very strong claim, and I find it difficult to agree.

Outcome - opinion after the experiment

• I changed my mind. I now basically agree with that claim.
• Obviously many of the social conditions (democracy, freedom, rights) and personal things (hobbies, finances) from my list can be instrumental in helping to prevent suffering. In particular, if numerous people throughout history have given their lives, exposed themselves to great hardship, and even placed their friends and families at risk in the fight for rights, freedom, equality, and so on, then it's probably safe to conclude that those things have some instrumental value. (For this reason, it might be worthwhile for the EA community to investigate the value of these humanitarian principles from an instrumental perspective.)
• But apart from that instrumental value, it now seems completely crazy to worry about anything other than preventing extreme suffering as much as possible.
• This definitely doesn't mean I intend to work for every minute of every day. I still fully intend to rest, spend time with friends and family, walk the dog, play the guitar, attend therapy, participate in my religious community, and so on. A human body needs to rest well to work well - but apart from the need to rest well, this does make many of the things I worry about on a day-to-day basis seem pretty silly. Likewise, this is not an argument in favour of unrestricted consequentialism - it should go without saying that I still intend to obey laws and ethical norms.

Some further thoughts

• I experienced "disabling"-level pain for a couple of hours, by choice and with the freedom to stop whenever I want. This was a horrible experience that made everything else seem to not matter at all.
• Let's consider, for a moment, just farmed chickens - a group of animals that I consider daily in my research.
• A single laying hen experiences hundreds of hours of this level of pain during their lifespan, which lasts perhaps a year and a half - and there are as many laying hens alive at any one time as there are humans. How would I feel if every single human were experiencing hundreds of hours of disabling pain? 
• A single broiler chicken experiences fifty hours of this level of pain during their lifespan, which lasts 4-6 weeks. There are 69 billion broilers slaughtered each year. That is so many hours of pain that if you divided those hours among humanity, each human would experience about 400 hours (2.5 weeks) of disabling pain every year. Can you imagine if instead of getting, say, your regular fortnight vacation from work or study, you experienced disabling-level pain for a whole 2.5 weeks? And if every human on the planet - me, you, my friends and family and colleagues and the people living in every single country - had that same experience every year? How hard would I work in order to avert suffering that urgent?
• Every single one of those chickens are experiencing pain as awful and all-consuming as I did for tens or hundreds of hours, without choice or the freedom to stop. They are also experiencing often minutes of 'excruciating'-level pain, which is an intensity that I literally cannot imagine. Billions upon billions of animals. The numbers would be even more immense if you consider farmed fish, or farmed shrimp, or farmed insects, or wild animals.
• If there were a political regime or law responsible for this level of pain - which indeed there is - how hard would I work to overturn it? Surely that would tower well above my other priorities (equality, democracy, freedom, self-expression, and so on), which seem trivial and even borderline ridiculous in comparison.
• There exist detailed descriptions of particularly awful instances of suffering where people may experience pain at/beyond the "excruciating" level for long periods (warning for extreme/traumatising content if you follow these links - but I'm talking about Brian Tomasik's article and video and Simon Knutsson's article). I won't repeat these descriptions here, and I haven't even looked at these myself, as it would be damaging to my mental health. But this might be a useful piece of information if you're mostly concerned about human suffering (I've discussed mostly animal suffering as that is most relevant to my own work).

Question 3: How does intense pain compare morally to mild pain?

The question

• I work as a researcher in the animal advocacy movement. In my job, I need to make trade-offs between different intensities of suffering to advise which campaigns the movement spends its money and resources on. (Note: my weightings are not the same as my organisation's weightings. While this helps advise my position when discussing this at work, the weightings that my organisation arrives at also consider many other pieces of evidence and many other people's views.)
• To give just one example, I recently had to recommend the most effective fish advocacy campaign for several countries in Europe - do we want to improve welfare throughout a fish's life even if many of those improvements might be mild, or would we prefer to implement stunning to minimise extreme suffering at slaughter?
• Concretely, you can express these trade-offs as quantitative weightings associated with the PainTrack categories. Somebody might think that preventing 1 hour spent in 'hurtful' pain is morally equivalent to preventing 15 hours spent in 'annoying' pain, in which case the weighting on 'hurtful' pain could be expressed as the number 15.

Background - opinion before the experiment

• I wrote down my rough weightings before the experiment:

Outcome - opinion after the experiment

• I wrote down my rough weightings after the experiment (and at a couple of intermediate stages).
• After the tattoo, my weightings changed to put a much higher weighting on the intense pain categories. In comparison, the cold pressor tests didn't change my weightings that much from their original position.

Miscellaneous thoughts and takeaways

• Right now, putting the final touches on this article a month later, I can hardly remember the cold pressor test, but the thought of getting the tattoos still makes me shiver. This might indicate that the cold pressor test actually wasn't a very bad experience, which could be one reason why it didn't really change my weightings that much from the original ones. (See my above point about forgetting how bad the pain actually is.)
• How would I define extreme or intense pain - the pain that I (now) consider to be the most morally urgent? Placing weightings on the Pain-Track categories does avoid the need for making a qualitative distinction between morally urgent and morally-not-urgent pain. However, if I were pressed, I would say that the morally urgent pain is anything in the category of "disabling" or worse. This is entirely intuitive and subjective, and my reason is explained in the next dot point. Notably, my cutoff does feel roughly similar to that tentatively suggested for the "Hell Index" in this article: 20 on the McGill scale.
• Of the four PainTrack categories (annoying, hurtful, disabling, and excruciating), I personally have developed the opinion that there might be a qualitative distinction separating hurtful pain and disabling pain. Annoying and hurtful pain are both bad, but they are manageable, and it's possible that you could live a good life even while regularly experiencing these levels of pain. Disabling pain, to me, is hell on earth. (There may also be a further qualitative distinction between disabling pain and excruciating pain. But by definition, excruciating pain is so painful that I have no way to voluntarily give it a go.)
• I'm privileged enough that they have rarely or never experienced extreme pain. There's nothing inherently wrong with this - after all, it is wonderful to be able to use one's privilege to benefit the lives of others. But this does serve as a reminder that we probably know little about what life is actually like for the beings we are trying to help. Asking the people we are trying to help for their subjective experiences, wherever possible, seems like a really important part of actually helping them. Basically, this experience has given me a strong sense of humility about what we think we know.
• If preventing suffering is indeed the most important thing, this does give us a very useful strategy for animal advocacy. We may not necessarily need to mount a moral revolution, political revolution, or social transition, despite these having been a large part of the animal advocacy movement's strategy to date. What we need (if this is correct) is to prevent suffering. This is very actionable, especially compared to those more challenging strategies - it's easier to install humane slaughter equipment or to ban fast-growing chicken breeds than to overthrow a state or transform a food system.
• This article is mostly a personal reflection, which others have done on this topic in different ways. It's interesting to note that I arrived at some conclusions that very closely mirror Brian Tomasik's articles, despite not having read those articles closely until after I wrote this one.

Limitations and future directions

• Obviously, this was not a scientific experiment. It should go without saying that I do not claim that the measures I took are scientifically accurate relative to the scales being used. I wasn't trained in administering or understanding the McGill PRI questionnaire beforehand. Obviously, my sample size is n = 1, and I'm influenced by my own experiences, genetics, history, beliefs, and so on.
• There is no way for me to voluntarily experience really intense pain - by definition, if somebody is experiencing pain in the "excruciating" Pain-Track category, they would often rather end their life than continue experiencing that pain. There is no way for me to plausibly replicate that experience.
• I've only considered pain, not other experiences that aren't exactly pain but can still cause intense suffering and even death. I have no idea how intense pain relates to these other experiences (e.g. sexual abuse, nausea, hunger/thirst, grief, bullying, humiliation, shame, fear, trauma, loneliness, and so on). How does extreme physical pain relate to extreme psychological pain? I have no insight or data to go on - though I also haven't looked into this, and I think this would be a valuable area of future research.
• I went through these experiences voluntarily and with the knowledge that I have the freedom to stop whenever I want. People suffering from painful disease, children dying of hunger, chickens being electrocuted to death, fish being asphyxiated to death - for these individuals, such experiences are a horrific reality, not an experiment. I can only imagine that these experiences would feel senseless, meaningless, and terrifying.
• It would be interesting to experience the concrete practices that animals do, like different forms of transport or mutilations. Obviously, there is a very strong limit on how closely I could replicate most of those practices when experimenting on myself.
• I did consider using a TENS machine as another safe way to experience pain. People have used these machines before to simulate the pain of periods or childbirth. I basically didn't want to spend the couple of hundred dollars purely for this article, and I'm less confident in my ability to use a TENS machine safely.
• I would also be interested in experiencing the sting of a bullet ant or a tarantula hawk wasp, if that could be achieved without causing harm to the animal stinging me. These are the highest-scoring insects on the Schmidt sting pain index. In Schmidt's book, he writes: "Stung by a tarantula hawk? The advice I give [...] is to lie down and scream. [...] The pain is instantaneous, electrifying, excruciating, and totally debilitating." As for the bullet ant, which Schmidt claims has the Holy Grail of stings: "... absolutely excruciatingly painful and debilitating. [...] my hand was throbbing, sending crescendos of pain, followed by easing a bit, only to be repeated with renewed ferocity. All the while the forearm was uncontrollably vibrating up and down." You can watch a bullet ant sting in action in this video by Australian comedians Hamish and Andy, which shows one of the pair have a go at the Sateré-Mawé people's coming-of-age ritual.
• I did speak to somebody who - voluntarily, and as a casual experiment - subjected themselves to water torture. Without getting into specifics, that conversation led me to have greater confidence in the broad conclusions I've drawn in this article.

Afterword: Sitting at the edge of the lake

• My conclusions from this experience presents me with a strange dilemma.
• Suffering is so urgent that it demands our immediate, unrelenting attention - but I need to maintain that attention for my whole career. There is an emergency, but it's long and drawn-out. The building is burning, but it will continue to burn for a long time. This is a weird position to be in.
• I need to remember the insights and opinions that I've developed throughout this experience, but it would not be sustainable to agonise over them on a day-to-day basis. I need to trust in what I've written here, and perhaps revisit it occasionally in case I need to make a course correction. But I cannot spend every day agonising over the severity and urgency of suffering.
• One of my contacts told me the metaphor of the lake of suffering - we need to sit at the lake and help others who are drowning, without falling in and drowning ourselves.
• It's absolutely critical to make sure my theory of change is sound and robust, and to focus all of my (work) energy on working to implement that theory of change. It would be good to keep in mind the insights I've described in this article while I develop and test my theory of change. But once it comes to the day-to-day work of actually implementing that theory of change, I can think about my goals slightly differently. Rather than agonising over extreme suffering from Monday to Friday, I can just enjoy doing the specific tasks, like research and writing, that are dictated by my theory of change. 

Notes and acknowledgements

As a disclaimer, I chose to do this experiment myself, and nobody encouraged me. My views do not represent the views of my employer.

I would like to thank my friends and professional contacts who helped guide my thinking and writing on this topic.