A Mental Game: Pain

(Author’s note: It’s that time of year again where I’m preparing to teach several sections of Intro Psychology, so I thought I’d try to combine purposes and put something together drawing on the section addressing sensation and perception.  It is apropos of nothing in particular, but does fit with my occasional series on ‘a mental game’ where I’ve written about sports psychology, group conflict, and happiness.)

After an eventful World Cup that likely cost him the first few months of the new club season, how does Holland’s Arjen Robben feel?  I mean that quite literally—I’m not looking for the sideline reporter’s sports clichés, nor the armchair philosopher’s curiosity about what it means to lose a World Cup final.  I want to know about the experience of pain.  Because Robben’s antics during the World Cup were strangely infuriating.  His dramatic facial expressions prompted by any ordinary challenge, his excruciating gesticulation at the mere hint of physical contact, his anguished complaints to anyone that would listen.  It seemed cheap and tawdry—and it reinforced all the superficial critique of soccer-critics who can’t get beyond the perceived dishonor of ‘flopping.’ In a certain odd way, his claims of pain became a litmus test for how we think about the game.

So while my curiosity about pain goes well beyond any one individual case, Robben is particularly interesting because he takes a lot of guff for the way he puts his pain on display.  As Richard Farley noted in a World Cup preview:

“Robben is one of the world’s most dangerous players when he marauds down the right hand flank. However, he comes with some baggage as well – he’s notorious for inviting contact from the opposition and going down too easily, as well as missing far too many games to knocks and niggles. Perhaps he simply has an unusually low pain tolerance?”

While that question was probably sarcastic, it does tap a real issue in the game.  What is pain worth?

Because as it turns out Robben really was playing with a serious injury: his ‘knocks and niggles’ in the World Cup were serious enough to require surgery.   And it turns out that for any player in any sport, because of the nature of pain, we can never exactly know how they feel: the physical pain that is so much a part of competitive sports is less an objective biological reality than a subjective psychological experience.

The psychology of pain

Towards the end of my competitive playing days, pain was a very real part of my own psychological experience in the game.  I was in my twenties, my body was resilient and well-conditioned, and I was fortunate to avoid any ‘serious’ injuries.  But I still woke up nearly every day with gnawing aches shooting through limbs, joints, muscles, and tendons; the hurt was enough to contribute to my decision to give up my soccer-playing dreams (a decision heavily facilitated by the fact that I wasn’t quite good enough).  It also made me wonder about the fact that when top-level players retire we respect them for saying they want to move on to new challenges, to spend more time with their families, that they’ve accomplished all they wanted to accomplish.  But we don’t want to hear that it hurts too much.

Why not?  Isn’t pain a physical experience that we can’t do anything about?  Pain is the body’s way of telling us something is wrong: at a base physiological level there is some kind of damage that triggers neural signals demanding remediation.  It’s not me—it’s my body.  Right?

Yes and no.  Pain, like any human perception, derives from a combination of physical signals and psychological responses.  In fact, in psychological science sensation and perception are meaningfully different phenomena: the physical sensation triggered by a stimulus out there in the world is different from the ultimate psychological perception inside our minds (by wilson santiago).  Psychologists who study sensation and perception talk about this difference as related to efficiencies of the human brain: to avoid having to match and record every one of the millions of available bits of sensory information the brain combines “bottom-up” processing of basic data out in the world with “top-down” processing based on concepts and expectations already programmed (by genetics and experience) in our minds.  When Arjen Robben walked into the stadium for the World Cup final his brain immediately started processing millions of stimuli—blades of grass, specks of white paint, swarthy millionaire Spaniards—but his brain’s well-honed expectation of what a pitch should look like, along with an innate ability to recognize broad spatial patterns, eliminated the need to process every detail (leaving plenty of time to jealously contemplate Carles Puyol’s flowing locks).

I actually find it easiest to make sense of this concept through examples from visual perception.  Optical illusions are perfect examples because they highlight the way the brain adds to and subtracts from the raw visual information in any one scene.  In the lower left corner illustration on the right (which I found at boredville.com—though I don’t know who to credit for its creation), it is nearly impossible for us to perceive the three elephants trailing away in a single file line as being the same size, even though sensation of the images on our retina are exactly the same size (go ahead, measure): our experiences with depth perception tell us to add size to things that are further away.  The “bottom up” processing of the image on our retina negotiates with the “top down” processing of our memory.

It’s also worth noting that while the inclusion in this illustration of Frank Lampard’s infamous “goal” against Germany from the World Cup is clearly intended as a joke, it is not completely irrelevant to the psychological process of sensation and perception.  Presuming the referee and his assistant on the line had a clear view of the goal area for that fateful shot, the image that hit their retinas presented their brain with the raw data of a ball crossing a line.  But that information came so quickly that the brain automatically executed a cross-check using concepts and expectations—based on the way the ball bounced, the reaction of the goalkeeper, the angle of the strike, it seemed an improbable goal.  Unconsciously, automatically, and even (in the grand scheme of things) efficiently, the decision was to play on.  Seconds later, with the benefit of slow-motion replays and still shots that presented irrefutable “bottom-up” data, the soccer world had no more need for “top down” processing and knew the referee had made a dramatic mistake.  But such is the magnificent design of a human brain (and the inevitable limitation of a human referee).

Something similar happens with pain.  When a player such as Arjen Robben is knocked to ground on a tackle, the contact does inflict minute degrees of tissue damage.  That damage, potentially enhanced by increased physiological sensitivity residual from prior injury, results in signaling through the central nervous system that activates the brain: there is a bottom-up sensation.  But the brain simultaneously offers an interpretation of that sensation which depends heavily on context: Robben’s expectations and his schema for how to deal with a sloppy challenge initiate a top-down process.  His eventual perception, deriving from both these processes, is ultimately his own subjective experience—it has surprisingly little to do with the objective severity of the tackle.

But wait, you might ask, don’t many other types of direct stimuli (ie, other sloppy challenges) result in much more reasonable perceptions of pain?  Didn’t Xabi Alonso take the full brunt of the unrepentant leg-breaker Nigel De Jong’s studs to his chest with little noticeable effect?  Yep.  That’s the point: context matters.  It matters so much that it can actually change our experience of pain.

There are, for example, studies that measure brain activity using Magnetic Resonance Imaging (MRI) to show that when volunteer subjects expected a moderate level of heat to be applied to their leg, but actually receive an application of extreme heat, their perception of pain is diminished by a degree equivalent to a dose of morphine (compared to when subjects both expected and received extreme heat—in a 2005 study by Koyama et al.).  Expectations also seem to cause the body to release its own natural pain relievers, including the same endorphins you hear about in association with exercise, further modifying subjective experiences of pain.  And then something as simple as distraction can further decrease pain—in one British study at Keele University, subjects who swore repeatedly were able to keep their hands submerged in ice water for longer than subjects who repeated innocuous words.   Various combinations of these factors likely explain how someone like Ike Opara was able to play 90 minutes for the San Jose Earthquakes without realizing that at some point he had broken his foot so badly as to require surgery.  That had to hurt.

The sociology of pain

Photo mosaic by Steffe (through creative commons) at flickr.com

The factors that influence pain perception also allow for the possibility that Xabi Alonso is just a tougher S.O.B. than Arjen Robben—and that is certainly what generations of coaches would like you to believe.  The culture of competitive sports generally is one which tends to assume that coping with pain is essential  to the toughness required for success.  This is often associated with stereotypical notions of masculinity—when male athletes in American and British sports cultures respond flamboyantly to pain it doesn’t take long for them to be told to “man up” or, alternatively and more pathetically, to “take off their dress” (or worse).  It turns out, however, in some situations women have a higher pain tolerance than men—and that men seem more extrinsically motivated in the ways they cope with pain.  Though research does suggest that on average men seem to have a higher tolerance for acute pain than women (with considerable individual variation), much of that tolerance is likely to be a self-fulfilling prophecy: stereotypical masculinity involves not showing pain, a social pressure which triggers the top-down processes that shape our perceptual experiences.

So when soccer-critics react to the “flopping” in soccer as a lack of toughness, they are failing to appreciate how much context matters to the experience of pain.  The fact that sports such as American football, a home base for many soccer-critics, thrive on the idea that pain is noble may actually shape players’ psychological perceptions.  Not coincidentally, it may also contribute to things like playing through concussions and suffering long-term brain damage.  The absurdity of this dynamic is evident in an essay on “Pigskin, patriarchy, and pain” by sociologist Don Sabo:

“My high school coach once evoked the pain principle during a pregame pep talk.  For what seemed an eternity, he paced frenetically and silently before us with fists clenched and head bowed.  He suddenly stopped and faced us with a smile.  It was as though he had approached a podium to begin a long-awaited lecture.  ‘Boys,’ he began, ‘people who say that football is a ‘contact sport’ are dead wrong.  Dancing is a contact sport.  Football is a game of pain and violence!  Now get the hell out of here and kick some ass.’ We practically ran through the wall of the locker room, surging in unison to fight the coach’s war.  I see now that the coach was right but for all the wrong reasons.  I should have taken him at his word and never played the game!”

Ultimately, in comparison to American football, I think the meaning of pain in world football is a bit more complicated.  In fact, I suspect that if you put injured American football players and injured soccer players into studies such as those I’ve described, you’d find that the soccer players do—on average—experience more pain from less physical trauma.  Their top-down expectations, the cultures of each game, are just too different.  But that doesn’t mean the soccer players are ‘soft’—I suspect some of the anguished responses that appear to be ‘flopping’ actually produce pain in the brain (though I’m not so naïve as to think all of them do; sometimes you just need to hold on for a point on the road, or draw that second yellow).

The comparison with American football also highlights a large piece of what fascinates me about the brain using both top-down and bottom-up processing to create our psychological experience: at the opposite pole from pain, our joy is also crafted by negotiations between what is actually out there in the world and what we’ve come to expect.  Though American football fans and world football fans often debate which sport people should enjoy, from the bottom up all sports offer some basic aesthetic pleasure.  There is artistry and drama both in the pinball ferocity of a long touchdown run and in the weaving tightrope flow of a pacey winger.   Both American football and world football offer the possibility of pleasure with their pain.  But which we prefer has much to do with our top-down concepts and expectations—what our brain has come to appreciate.

And the same probably applies to that conniving thespian Arjen Robben.    Whether or not his dramatics are born of ‘real’ pain, as fans our sympathy depends less on his physical experience than on our own psychology.  We can never know the exact reality of how Robben himself feels; all we can really know is how we as fans feel about him.

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