Dr. Catherine Kerr – Workshop 2009

Feeling without Awareness:
Converging Neuroscientific and Phenomenological
Approaches to Acute Suffering
Part II – Neurosciences
Dr. Catherine Kerr, Neuroscience, Harvard Uni.

Taking seriously the skepticism of efforts to quantify suffering, expressed most piquantly by Arthur Kleinman, the psychiatric anthropologist and ethnographer of suffering, this presentation proposes that neuroscience can contribute to the question of suffering by investigating neural substrates underlying  present moment experience. For, it is this present moment experience (what Kleinman calls the exigency of the here and now) that is reported to be transformed by suffering. Since phenomenological philosophers have long made central the question of present moment experience, this paper draws from (and adds an empirical perspective to) the phenomenological model of the lived experience of suffering presented earlier (for details see Bustan abstract). To operationalize and make Bustans model of suffering concrete, the paper considers an empirical phenomenon called secondary alexithymia as a useful first order proxy for suffering. Secondary alexithymia (literally,no words for feelings) occurs commonly after a life-rupturing event (including serious diseases such as diabetes or cancer or manmade tragedies such as wartime refugee status or sexual assault). Reviewing in detail evidence accumulating in recent neuroimaging studies, the paper suggests that abnormalities in a circuit connecting a complex area of the brain called the insula to portions of the prefrontal cortex may characterize secondary alexithymia. The paper argues that circuitry connecting the insula to the prefrontal cortex can be parsed, from a phenomenological perspective, to mean that there are abnormalities in connecting felt experience (somatic and emotional inputs integrated across different parts of the insula) to cognitive processing of felt experience (taking place in different modules in the prefrontal cortex).  From this perspective, it is suggested that the neuroimaging evidence provides preliminary confirmation of most of the components of Bustans phenomenological model (e.g., the acute sufferers inability to say, narrate, do and correspond [or more colloquially, empathize]). Further studies of neural processes connecting felt experience with the cognitive interpretation of felt experience should shed light on neglected aspects of suffering that have particular relevance for the suffering related to chronic pain.