Why the Right Philosophy Is the Best Pain Medication

Want to stay current with Arthur’s writing? Sign up to get an email every time a new column comes out.“The art of life lies in taking pleasures as they pass,” said the ancient Greek philosopher Aristippus, “and the keenest pleasures are not intellectual, nor are they always moral.” In other words: If it feels good, do it.Aristippus was a student of Socrates who founded a minor school of philosophy called Cyrenaicism. As Cyrenaic thinking evolved, it centered on two ideas. First, objective reality is unknowable, so we should pay attention only to our own subjective experience of that reality. Second, that experience should be as pleasant as possible, meaning that we should maximize immediate pleasure and avoid pain. Aristippus himself focused especially on the first part, pleasure—preferably involving young courtesans and old wine.Cyrenaic hedonism still pops up as a significant cultural influence from time to time, as it did during the hippie era in America. That pleasure-first principle sounds a bit quaint today, given all the talk of a sex recession and young people being less adventurous than they used to be. But another form of Cyrenaicism is currently very strong: the idea that besides seeking pleasure, we should avoid pain.The memetic way that such an idea can spread means that you may have fallen into this philosophy without even realizing it. This column is intended to help you recognize that possibility, and understand why it can be so damaging for your health and well-being—and how you can break free.[Arthur C. Brooks: There are two kinds of happy people]A Cyrenaic belief in hedonistic abandon might sound harmless and even fun until we grasp how pleasure works in the brain. Charles Darwin reasoned that pleasurable sensations, which are primal in the way they involve the brain’s limbic system, evolved to help us survive and pass on our genes. For example, humans crave highly caloric foods and fixate on attractive bodies because our brains are wired to give us a biochemical reward for acting in ways that prevent starvation and help us find mates.Unfortunately, although Mother Nature is good at making us desire what will keep us and our genes alive another day, she does not care at all whether we’re happy. That condition underpins why Mick Jagger sings, “I can’t get no satisfaction … ’cause I try, and I try, and I try.” Or, to put that more scientifically, the gap between wanting and liking is a major neurobiological disconnect. When you think of something that you are programmed to desire, your brain experiences a little spritz of dopamine, which makes you anticipate pleasure—wanting. But if the payoff is what you anticipated, no more dopamine is forthcoming, denying you much liking. In other words, the pleasurable experience has to be better than you expected in order to produce more dopamine. That generally means that you have to keep upping the dose of whatever pleasure you are pursuing, be it booze, candy, gambling, or pornography.Fruitless pleasure seeking thus easily leads to addiction and misery—what we might call the “Cyrenaic paradox.” If all you do is look for gratification, you will no longer find it. As the psychiatrist Anna Lembke, the author of Dopamine Nation: Finding Balance in the Age of Indulgence, puts it, “The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind.”The Cyrenaic paradox works in an inverted way when it comes to suffering. Researchers have demonstrated that when people fear their physical pain and strive to minimize it at all costs, by pulling back from daily activities, the pain tends to remain chronic. This is sometimes called the “fear-avoidance model.” Patients who fear physical pain become hypervigilant and make efforts to elude it. This leads to inactivity and disability, and thus greater pain: The cycle continues and worsens. Say, for example, you hurt your back. Fearing the pain, you baby it and load up on analgesics. Through disuse, your back actually becomes weaker, leading to greater, more constant pain. Many studies have shown this pattern.This cycle of avoidance and worsening pain lies at the center of our drug-abuse epidemic. In the U.S., prescriptions for opioid analgesics to treat pain increased 104 percent from 2000 to 2010. This led to an explosion of opioid addiction and overdose deaths. At that point, crackdowns lowered the prescription levels, but overdoses continued to rise as black-market-opioid use grew.Obviously, pain treatment is necessary and appropriate for many people. The problem comes when this is the first line of defense because pain is considered something that must be eliminated, not a normal part of life to be managed. Just as pleasure seeking tends to make pleasure unattainable, a strategy of pain avoidance can make suffering worse.[Read: Pain doesn’t belong on a scale of zero to 10]The treatment of pain and the avoidance of pain are two very different things. To treat pain effectively requires losing your fear of it and your desire to expunge it as a result. Pain is an unavoidable part of life, and the most effective treatment in many cases involves learning to thrive despite some degree of it. If your back hurts, you may well find healthy ways to increase your mobility and lower your physical discomfort, but your treatment might also include learning to live with that discomfort and manage it at an acceptable level.So far we’ve been talking about physical pain, but mental pain works in a similar way. For example, people who experience depression do well to treat their symptoms, but striving to eliminate them typically makes them worse. According to recent research published in the Journal of Happiness Studies, a belief that happiness requires an absence of pain undermines happiness itself. Other scholars have found that mental-pain avoidance is positively correlated with suicide attempts among those who are depressed. Unfortunately, these mistaken views are reinforced by professionals who tell patients with any mental distress that their discomfort is a pathology, convincing them that they are ill and defective.Therapists and clinicians understand that pain is part of life. They advise their patients not to run away from their reality—and certainly not to self-medicate with recreational drugs and alcohol. This better understanding recognizes that only in facing one’s pain can one learn to live fully and treat it successfully. Particularly if you naturally have high levels of negative affect—if, in other words, you tend to have low moods—part of a full and good life might be accepting this fact about yourself.Several therapeutic treatments explicitly incorporate acceptance, and have proved successful. One is mindfulness-based cognitive therapy, in which patients learn that avoidance can be one of the causes of discomfort itself. This type of cognitive treatment teaches patients to accept their distress as painful but as neither catastrophic nor impossible to lessen. This is very similar to the Buddhist concept that suffering = resistance × pain, which implies that nonresistance is the beginning of effective treatment to reduce suffering. This therapeutic approach is also effective in the treatment of addiction, because it can help an addicted person accept their condition honestly, which facilitates a fuller understanding of the gravity of the problem and a greater capacity to stop using.Another treatment option that has achieved good results is known as acceptance and commitment therapy. Patients are encouraged to acknowledge and accept their pain, but then to shift their attention toward the positive aspects of their life. This technique relies on reversing our innate tendency to focus on what we don’t like rather than what we do—a phenomenon called “negativity bias.” When mental or physical pain is chronic, this evolutionary bias can make us one-track-minded about it, leading to avoidance behaviors and making things worse. Instead, we can recognize that pain is real, but also learn to focus on what is right in our life. For instance, I might wake up with a lot of pain, but I can shift my focus away from the pain to the facts that I wake up in a home where people love me and that I have a job I value.[From the October 2018 issue: How to live better, according to Nietzsche]In either its positive, pleasure-seeking or negative, pain-avoiding forms, Cyrenaicism is a mistaken model for human happiness. Rather than taking the advice of Aristippus, we would do better to follow that of his fellow Greek philosopher, Epictetus the Stoic. In his second-century ethical manual, Enchiridion, Epictetus wrote: “Don’t demand that things happen as you wish, but wish that they happen as they do happen, and you will go on well.”At the start, I called Cyrenaicism a “minor school of philosophy”; Stoicism is better known and far more influential, and justly so. But the larger point is that your philosophy matters—because it will help you exercise control over your life and your happiness. An attitude of acceptance rather than avoidance can empower you to treat your pain appropriately and manage your expectations about what a good life means. That, in turn, will enable you to learn and grow as a person—and truly savor your sweetest experiences.