On Presentism, Persistent Pain, and Turkey Dinners

Among the worst things about pain, my patients often tell me, is uncertainty regarding how long it will last. 

Whether it’s caused by something serious or benign, the experience of pain is commonly accompanied - and intensified - by a foreboding sense of permanence. 

Now, the fact is that with time and good care, most pain does go away. 

Why, then, are we so stricken by the fear that it will stick around forever? 

Consider, by analogy, the feeling of nausea after one (or three) too many servings of thanksgiving dinner.

As you stumble from table to couch in a turkey coma, some part of your brain genuinely believes ‘I will never eat again’ (of course you will, usually within the hour).

The unbearable sensation of fullness after a big meal is not unlike the unbearable sensation of pain after an injury. 

Both are so perceptually potent in the present that they hold our imagination hostage, preventing us from logically forecasting the future. In his wonderful book Stumbling on Happiness, the Psychologist Dan Gilbert calls this quirk of our perceptual programming “Presentism.”

At the root of presentism is the fact that memory and imagination share a common operating system with the cognitive circuitry that generates emotions.

Whenever we try to imagine the future or remember the past, we’re (obviously) doing so from the present. The images and words our minds conjure, therefore, are powerfully influenced by the emotional "feeling-tone" of our mind as it’s doing the conjuring. This is Presentism. And the issue with Presentism, as Gilbert points out, is that our imagined tomorrows inevitably resemble "twisted versions of today."

This is why, for instance, when patients are asked how intense their headache was yesterday, their current level of pain is a strong predictor of the intensity they remember from the day before. 

It's why when people in a certain city are asked how generally happy they are with their life, they rate it as significantly worse when it happens to be cloudy out on the day they are asked. 

It’s also why, I think, we so often worry that little aches and pains will be everlasting, when odds are they won’t. 

Being aware of this phenomenon doesn’t grant us immunity to it. 

But in embracing the absurdly fallible, fluid nature of perception, I wonder if we might find temporary solace from the negative stories which play inside our heads on loop. 

We can't escape presentism. But maybe, by stepping back and acknowledging its existence, we can open ourselves up to a new perspective, one from which we can navigate the inevitable currents of pain, discomfort, and worry with a bit more self-compassion.

References

[1] Gilbert, D. (2009). Stumbling on happiness. Vintage Canada.

[2] Eich, E., Reeves, J. L., Jaeger, B., & Graff-Radford, S. B. (1985). Memory for pain: relation between past and present pain intensity. Pain, 23(4), 375-380.

[3] Schwarz, N., & Clore, G. L. (1983). Mood, misattribution, and judgments of well-being: Informative and directive functions of affective states. Journal of personality and social psychology, 45(3), 513.