In an earlier post 'Lines in the road' I stated, "The meanings that have been encoded into the directions for road users are meant to be easy to learn, and it might be interesting to think about how as an artist you could devise various keys for the symbolic use of lines that include emotional and cultural readings that go far beyond the everyday language of the Highway Code. It has taken me some time to get around to responding to the implications of my own thoughts, but I'm getting there.
I have been working in a spinal injuries unit of a local hospital and working with patients to explore how pain and its emotional associations can be visualised. Gradually I have been developing a pain chart that is becoming that emotional highway code I was thinking about back when I wrote that post about road markings.
Existing pain scale
The present pain diagram that is the highway code for the medical profession is the one above.
Highway code road markings
Pain and its perception is an interoceptual experience, one I would argue that is far more complex than the experience of driving that is associated with the system of road marking that we need to learn. When learning to drive we have to take both a theory and a practical test, often spending months of repeated activities, both on the road and sat in front of a screen or book, looking at and trying to memorise what all the different road signs are. In contrast when you have had an accident, often on the very roads, that you spent a long time learning to negotiate, you might be taken into hospital and be asked to use a pain chart to explain the level of your perception of pain. No wonder both patients and clinical staff find these charts of very little use.
The beginnings of a new pain chart
I decided therefore to develop my own pain chart in response to what I was learning from patients as to how they felt we could visually symbolise their various feelings about their existing pain levels. The first issue was the fact that for most people pain is something that is a temporal experience, it is either continuous, episodic, getting worse or getting better. It is also something that has a certain quality, it can be sharp, throbbing, prickly, stabbing or a strange type of numbness. I can also be something that is static or something that moves, either focused on a particular spot in the body, or travelling along an arm or a leg. It is also something that can be at times the thing that takes over all the awareness that you have, being so painful that you can think of nothing else, but at other times it can become something in the background, always there but often forgotten.
Pain chart: Stage two: After critique from patients
Pain is also something bound up with emotion. Sometimes pain can be exhilarating and can drive you on to exert yourself even more, or it can be emotionally debilitating and can drain all your enthusiasm for life away. Pain can feel like an annoyance, but that feeling may itself over time eventually lead to anger. Therefore several aspects of pain and its emotional landscape may be in evidence at the same time. It might feel as if it is a grinding pain, that is dull but also very warm. You might feel as if you have accepted this pain for some time and are pretty calm about it, or you may be becoming more and more alarmed about it.
Pain is something that exists in the mind, for instance you may have pain in a phantom limb, but that pain will be as real as it would be in an actual limb. It is therefore a very complicated phenomenon, associated with how we build an awareness of our bodies but at the same time, not of our bodies, but entwined into our embodied mind. Engrained into my own body schema I have a story from my childhood that perhaps illustrates how these things work. Back in the early 1950s I used to stay with my grandparents for quite long periods of time, so I got to know them very well and was involved with their lives. They lived in a village that lay on the outskirts of the industrial west midlands, a place that has long since been incorporated into the expanding town of Dudley but which was then somewhere that felt quite rural in comparison to the town where my parents lived. When a young boy I had a terrible difficulty working out my left from my right and was constantly confused as to which was which, however I then had an experience that forever fixed the difference into my mind/body. I had developed a carbuncle in the crook of my arm, it was huge, or seemed to be so at the time and I couldn't bend my arm. My gran was very adept at making healing poultices and made one for me, surrounding my arm in a strange concoction that included bitumen and mustard, but which on removal after a few days had done its work. The pain was however now somehow fixed into my mind and ever since then, if I have to think of my left, I feel something in the crook of my left arm, not any more a pain, but a definite sensation, a feeling that singles that very area out as being different to the rest of my body and being forever associated with an idea of left-ness. This very small incident, is still engrained in my mind's idea of my body, an idea that is constructed over time of innumerable similar incidents, from stubbed toes to broken bones, from itchy legs to old wounds, from loving touches to received blows, which is why it is such an emotive body schema or map. The decision for instance to have a tonal scale that goes from dark/heavy to light was an attempt to respond to this, a wound for instance may leave a dark memory that weighs you down, but a recollection of the feeling of kiss may be a light thing, the memory of which buoys you up. I feel that this is still something that is very crude and raw but its for myself a gradual journey, one that is mainly driven by making drawings, but I still spend some time looking for other models that emerge from time to time from alternative fields of research, such as psychology.
I like a good diagram and have recently come across Russel's circumflex model of affect, that sets out the emotions around a circle in a similar way to a colour circle. Pain is also something that is nearly always linked to emotions, therefore Russel's diagram is another ingredient I will in future try to embed into the mix.
Reproduced from “Independence and bipolarity in the structure of current affect,” by L. Feldman Barrett and J.A. Russell, 1998, Journal of Personality and Social Psychology, 74(4), p. 970
Russell suggested that the pleasantness or unpleasantness of an emotional stimulus and the extent of its activation or amplification are independent, bipolar dimensions. Therefore happy and sad are seen as opposites in terms of the unpleasant/pleasant quality of feeling tone and calm and alert are put at the opposite ends of the activation dimension. A mixed emotion is often composed of feelings that relate to each other on the same side of the circle, such as happy and relaxed or happy and excited. These dimensions I am starting to think can be linked up with the emotional mapping of lines as researched by Hu, Lyu and Liu (2021), but that's something for another day, after I have had time to see how my own emotional lines map onto theirs.
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