Pain, Pills & Will

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There are many ways to die, but the public concern tends to focus on whatever is illuminated in the media spotlight. 2012 saw considerable focus on guns and some modest attention on a somewhat unexpected and perhaps ironic killer, namely pain medication. In the United States, about 20,000 people die each year (about one every 19 minutes) due to pain medication. This typically occurs from what is called “stacking”: a person will take multiple pain medications and sometimes add alcohol to the mix resulting in death. While some people might elect to use this as a method of suicide, most of the deaths appear to be accidental—that is, the person had no intention of ending his life.

The number of deaths is so high in part because of the volume of painkillers being consumed in the United States. Americans consume 80% of the world’s painkillers and the consumption jumped 600% from 1997 to 2007. Of course, one rather important matter is the reasons why there is such an excessive consumption of pain pills.

One reason is that doctors have been complicit in the increased use of pain medications. While there have been some efforts to cut back on prescribing pain medication, medical professionals were generally willing to write prescriptions for pain medication even in cases when such medicine was not medically necessary. This is similar to the over-prescribing of antibiotics that has come back to haunt us with drug resistant strains of bacteria. In some cases doctors no doubt simply prescribed the drugs to appease patients. In other cases profit was perhaps a motive. Fortunately, there have been serious efforts to address this matter in the medical community.

A second reason is that pharmaceutical companies did a good job selling their pain medications and encouraged doctors to prescribe them and patients to use them. While the industry had no intention of killing its customers, the pushing of pain medication has had that effect.

Of course, the doctors and pharmaceutical companies do not bear the main blame. While the companies supplied the product and the doctors provided the prescriptions, the patients had to want the drugs and use the drugs in order for this problem to reach the level of an epidemic.

The main causal factor would seem to be that the American attitude towards pain changed and resulted in the above mentioned 600% increase in the consumption of pain killers. In the past, Americans seemed more willing to tolerate pain and less willing to use heavy duty pain medications to treat relatively minor pains. These attitudes changed and now Americans are generally less willing to tolerate pain and more willing to turn to prescription pain killers. I regard this as a moral failing on the part of Americans.

As an athlete, I am no stranger to pain. I have suffered the usual assortment of injuries that go along with being a competitive runner and a martial artist. I also received some advanced education in pain when a fall tore my quadriceps tendon. As might be imagined, I have received numerous prescriptions for pain medication. However, I have used pain medications incredibly sparingly and if I do get a prescription filled, I usually end up properly disposing of the vast majority of the medication. I do admit that I did make use of pain medication when recovering from my tendon tear—the surgery involved a seven inch incision in my leg that cut down until the tendon was exposed. The doctor had to retrieve the tendon, drill holes through my knee cap to re-attach the tendon and then close the incision. As might be imagined, this was a source of considerable pain. However, I only used the pain medicine when I needed to sleep at night—I found that the pain tended to keep me awake at first. Some people did ask me if I had any problem resisting the lure of the pain medication (and a few people, jokingly I hope, asked for my extras). I had no trouble at all. Naturally, given that so many people are abusing pain medication, I did wonder about the differences between myself and my fellows who are hooked on pain medication—sometimes to the point of death.

A key part of the explanation is my system of values. When I was a kid, I was rather weak in regards to pain. I infer this is true of most people. However, my father and others endeavored to teach me that a boy should be tough in the face of pain. When I started running, I learned a lot about pain (I first started running in basketball shoes and got huge, bleeding blisters). My main lesson was that an athlete did not let pain defeat him and certainly did not let down the team just because something hurt. When I started martial arts, I learned a lot more about pain and how to endure it. This training instilled me with the belief that one should endure pain and that to give in to it would be dishonorable and wrong. This also includes the idea that the use of painkillers is undesirable. This was balanced by the accompanying belief, namely that a person should not needlessly injure his body. As might be suspected, I learned to distinguish between mere pain and actual damage occurring to my body.

Of course, the above just explains why I believe what I do—it does not serve to provide a moral argument for enduring pain and resisting the abuse of pain medication. What is wanted are reasons to think that my view is morally commendable and that the alternative is to be condemned. Not surprisingly, I will turn to Aristotle here.

Following Aristotle, one becomes better able to endure pain by habituation. In my case, running and martial arts built my tolerance for pain, allowing me to handle the pain ever more effectively, both mentally and physically. Because of this, when I fell from my roof and tore my quadriceps tendon, I was able to drive myself to the doctor—I had one working leg, which is all I needed. This ability to endure pain also serves me well in lesser situations, such as racing, enduring committee meetings and grading papers.

This, of course, provides a practical reason to learn to endure pain—a person is much more capable of facing problems involving pain when she is properly trained in the matter. Someone who lacks this training and ability will be at a disadvantage when facing situations involving pain and this could prove harmful or even fatal. Naturally, a person who relies on pain medication to deal with pain will not be training themselves to endure. Rather, she will be training herself to give in to pain and become dependent on medication that will become increasingly ineffective. In fact, some people end up becoming even more sensitive to pain because of their pain medication.

From a moral standpoint, a person who does not learn to endure pain properly and instead turns unnecessarily to pain medication is doing harm to himself and this can even lead to an untimely death. Naturally, as Aristotle would argue, there is also an excess when it comes to dealing with pain: a person who forces herself to endure pain beyond her limits or when doing so causes actually damage is not acting wisely or virtuously, but self-destructively. This can be used in a utilitarian argument to establish the wrongness of relying on pain medication unnecessarily as well as the wrongness of enduring pain stupidly. Obviously, it can also be used in the context of virtue theory: a person who turns to medication too quickly is defective in terms of deficiency; one who harms herself by suffering beyond the point of reason is defective in terms of excess.

Currently, Americans are, in general, suffering from a moral deficiency in regards to the matter of pain tolerance and it is killing us at an alarming rate. As might be suspected, there have been attempts to address the matter through laws and regulations regarding pain medication prescriptions. This supplies people with a will surrogate—if a person cannot get pain medication, then she will have to endure the pain. Of course, people are rather adept at getting drugs illegally and hence such laws and regulations are of limited effectiveness.

What is also needed is a change in values. As noted above, Americans are generally less willing to tolerate even minor pains and are generally willing to turn towards powerful pain medication. Since this was not always the case, it seems clear that this could be changed via proper training and values. What people need is, as discussed in an earlier essay, training of the will to endure pain that should be endured and resist the easy fix of medication.

In closing, I am obligated to add that there are cases in which the use of pain medication is legitimate. After all, the body and will are not limitless in their capacities and there are times when pain should be killed rather than endured. Obvious cases include severe injuries and illnesses. The challenge then, is sorting out what pain should be endured and what should not. Since I am a crazy runner, I tend to err on the side of enduring pain—sometimes foolishly so. As such, I would probably not be the best person to address this matter.

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Training the Will

In general, will is a very useful thing to have. After all, it allows a person to overcome factors that would make his decisions for him, such as pain, fear, anger, fatigue, lust or weakness. I would, of course, be remiss to not mention that the will can be used to overcome generally positive factors such as compassion, love and mercy as well. The will, as Kant noted, can apparently select good or evil with equal resolve. However, I will set aside the concern regarding the bad will and focus on training the will.

Based on my own experience, the will is rather like stamina—while people vary in what they get by nature, it can be improved by proper training. This, of course, nicely matches Aristotle’s view of the virtues.

While there are no doubt many self-help books discussing how to train the will with various elaborate and strange methods, the process is actually very straightforward and is like training any attribute. To be specific, it is mainly a matter of exercising the capacity but not doing so to excess (and thus burning out) or deficiency (and thus getting no gain). To borrow from Aristotle, one way of developing the will in regards to temperance is to practice refraining from pleasures to the proper degree (the mean) and this will help train the will. As another example, one can build will via athletic activities by continuing when pain and fatigue are pushing one to stop. Naturally, one should not do this to excess (because of the possibility of injury) nor be deficient in it (because there will be no gain).

As far as simple and easy ways to train the will, meditation and repetitive mental exercises (such as repeating prayers or simply repeated counting) seem to help in developing this attribute.

One advantage of the indirect training of the will, such as with running, is that it also tends to develop other resources that can be used in place of the will. To use a concrete example, when a person tries to get into shape to run, sticking with the running will initially take a lot of will because the pain and fatigue will begin quickly. However, as the person gets into shape it will take longer for them to start to hurt and feel fatigued. As such, the person will not need to use as much will when running (and if the person becomes a crazy runner like me, then she will need to use a lot of will to take a rest day from running). To borrow a bit from Aristotle, once a person becomes properly habituated to an activity, then the will cost of that activity becomes much less—thus making it easier to engage in that activity.  For example, a person who initially has to struggle to eat healthy food rather than junk food will find that resisting not only builds their will but also makes it easier to resist the temptations of junk.

Another interesting point of consideration is what could be called will surrogates. A will surrogate functions much like the will by allowing a person to resist factors that would otherwise “take control” of the person. However, what makes the will surrogate a surrogate is that it is something that is not actually the will—it merely serves a similar function. Having these would seem to “build the will” by providing a surrogate that can be called upon when the person’s own will is failing—sort of a mental tag team situation.

For example, a religious person could use his belief in God as a will surrogate to resist temptations forbidden by his faith, such as adultery. That is, he is able to do what he wills rather than what his lust is pushing him to do. As another example, a person might use pride or honor as will surrogates—she, for example, might push through the pain and fatigue of a 10K race because of her pride. Other emotions (such as love) and factors could also serve as will surrogates by enabling a person to do what he wills rather than what he is being pushed to do.

One obvious point of concern regarding will surrogates is that they could be seen not as allowing the person to do as he would will when he lacks his own will resources but as merely being other factors that “make the decision” for the person. For example, if a person resists having an affair with a coworker because of his religious beliefs, then it could be contended that he has not chosen to not have the affair. Rather, his religious belief (and perhaps fear of God) was stronger than his lust. If so, those who gain what appears to be willpower from such sources are not really gaining will. Rather they merely have other factors that make them do or not do things in a way that resembles the actions of the will.

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Will

As a runner, martial artist and philosopher I have considerable interest in the matter of the will. As might be imagined, my view of the will is shaped mostly by my training and competitions. Naturally enough, I see the will from my own perspective and in my own mind. As such, much as Hume noted in his discussion of personal identity, I am obligated to note that other people might find that their experiences vary considerably. That is, other people might see their will as very different or they might even not believe that they have a will at all.

As a gamer, I also have the odd habit of modeling reality in terms of game rules and statistics—I am approaching the will in the same manner. This is, of course, similar to modeling reality in other ways, such as using mathematical models.

In my experience, my will functions as a mental resource that allows me to remain in control of my actions. To be a bit more specific, the use of the will allows me to prevent other factors from forcing me to act or not act in certain ways. In game terms, I see the will as being like “hit points” that get used up in the battle against these other factors. As with hit points, running out of “will points” results in defeat. Since this is rather abstract, I will illustrate this with two examples.

This morning (as I write this) I did my usual Tuesday work out: two hours of martial arts followed by about two hours of running. Part of my running workout  was doing hill repeats in the park—this involves running up and down the hill over and over (rather like marching up and down the square). Not surprisingly, this becomes increasingly painful and fatiguing. As such, the pain and fatigue were “trying” to stop me. I wanted to keep running up and down the hill and doing this required expending those will points. This is because without my will the pain and fatigue would stop me well before I am actually physically incapable of running anymore. Roughly put, as long as I have will points to expend I could keep running until I collapse from exhaustion. At that point no amount of will can move the muscles and my capacity to exercise my will in this matter would also be exhausted. Naturally, I know that training to the point of exhaustion would do more harm than good, so I will myself to stop running even though I desire to keep going. I also know from experience that my will can run out while racing or training—that is, I give in to fatigue or pain before my body is actually at the point of physically failing.  These occurrences are failures of will and nicely illustrate that the will can run out or be overcome.

After my run, I had my breakfast and faced the temptation of two boxes of assorted chocolates. Like all humans, I really like sugar and hence there was a conflict between my hunger for chocolate and my choice to not shove lots of extra calories and junk into my pie port. My hunger, of course, “wants” to control me. But, of course, if I yield to the hunger for chocolate then I am not in control—the desire is directing me against my will. Of course, the hunger is not going to simply “give up” and it must be controlled by expending will and doing this keeps me in control of my actions by making them my choice.

Naturally, many alternatives to the will can be presented. For example, Hobbes’ account of deliberation is that competing desires (or aversions) “battle it out”, but the stronger always wins and thus there is no matter of will or choice. However, I rather like my view more and it seems to match my intuitions and experiences.

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Breaking Up

Like novels relationships have a beginning and an end. While the beginning of a relationship tends to be a bright, happy and beautiful thing the ending tends to be the exact opposite. When a relationship has reached the point that it is ending, the matter of how to break up becomes a matter of concern. This essay examines various methods of breaking up in terms of how to use them and how to spot when they are being used on you. The various pros and cons of each method will be evaluated.

Since there are many ways to break, this essay does not attempt to provide exhaustive coverage of this subject. Instead some common methods will be examined. Unlike some discussions of breaking up, this essay will include some moral evaluation of the methods.

The Slow Drift Apart

Use: You slowly begin to distance yourself from the other person. You call less. You see the other person less. You are less affectionate. Eventually, the contact drops below the level needed to sustain a relationship and you are broken up.

Spotting: Your partner calls less, sees you less, and is less affectionate. When asked if there is a problem, s/he will typically deny there is a problem and provide plausible alternatives such as a busier work schedule, a need to be spend times with friends, or other commitments. Eventually, however, you will find that the relationship has dwindled to nothing.

Alternative Explanation: It is important to keep in mind that there are often alternative reasons for the other person reducing their contact with you that have nothing to do with intent to breakup. People often have busy times that require some of the attention they once paid to you. Also, relationships tend to go through natural phases. For example, in the early stages of a relationship people tend to find each other new and exciting and often cannot get enough of each other. Eventually, however, they do and things tend to settle back somewhat.

Pros/Cons: In terms of advantages, this method provides for a slow and perhaps less painful method of breakup. To use an analogy, it is like wading slowly into cold water-there is time to adjust and grow comfortable with the change. Also, it provides a safety net-if you decide you do not want to break up, and then you can simply step up your contact and restore the relationship. The more abrupt methods usually make it much more difficult to restore a relationship. Finally, it provides the other person with some input-they have the chance to react to your pulling away. If they let it go, then perhaps they want to break up as well. In terms of disadvantages, this method tends to be, by its very nature, slow. Hence, if you are looking for a rapid breakup then another method would be a better choice. Another potential problem is that the method can be like slow torture to the other person. By pulling away from them without explicitly breaking up you can cause them pain and confusion. Sometimes it is best to simply end things quickly-like pulling off a band aid quickly, rather than slowly pulling it off and thus prolonging the unpleasantness.

Friends/Sibling Downgrade

Use: You tell the person that although you care about them, your feelings towards them are more in line with that of a friend or sibling. The classic lines for this are “I think of you as a friend/brother/sister.” This tells the person that you are no longer interested in a sexual relationship.

Spotting: Your partner tells you that their feelings for you have changed to those they would have for a friend or sibling. They do say that they still want to do things with you; only at some point in the future and that these things will most definitely not involve sex.

Alternative Explanation: People sometimes use this method to put the other person “on hold” rather than completely breaking up with them. This might be the result of confusion or uncertainty on their part. Sometimes it is used when they want to try out another person, but want to keep you around as a safety net.

Pros/Cons: In terms of advantages, this method can allow you to keep the person as a friend. If you truly care about them and do really want them as a friend, then this would be an appropriate method to use. People do sometimes make the transition from lovers to friends. In terms of problems, if you really do not want to be friends with the person, then this method cruelly gives them false hope of friendship or even of getting back together again. If you do really want a clean break with the person, then it is best to send a clear message to that effect and avoid confusing them and causing future problems by trying to be “nice” about it. Of course, even if you do want to remain friends and only friends with them, there is always the problem that they might think that you will want them back in the future-thus potentially giving rise to future problems. If you think the person is incapable of making the transition to friendship, then it might be best to make a clean break. Keep in mind, however, that is natural for people to behave a bit oddly after a breakup so it might seem as if they are unable to make the transition when, in fact, they just need some time to make that change.

Provocation

Use: You mistreat your partner in the hopes that they will decide to initiate the breakup. This mistreatment can be minor-small insults, some coldness, petty arguments and such. It can also be more serious-withholding affection, sleeping on the couch, being insulting or abusive, etc. When the other person is driven away, you are broken up.

Spotting: Your partner starts mistreating you. They insult you, withhold affection, sleep on the sofa, or are cold and distant. They might even resort to more serious physical or emotional abuse.

Alternative: Minor provocations are, of course, natural parts of relations. People are not angels or saints and will do small things to annoy and provoke you even when they have no plans of breaking up. In many cases they are not even aware they are annoying you. More serious provocations, such as withholding affection, are signs of serious problems-but still might not be evidence of the intent to break up. Under stress people tend to behave badly-so your partner’s cold behavior and lack of interest in sex might be do to stress at work or school and have nothing to do with you. Very serious provocations such as emotional or physical abuse might not indicate an intent to break up but do show serious problems that might stem from severe psychological problems. In such cases it is usually best to get away from the abusive person and encourage them to seek help if you think they can be helped.

Pros/Cons: The main advantage of this method is that it tends to be effective. While some people will cling to an abuser, most people get sick of it quickly and leave on their own. I have also been told that this method is sometimes necessary-after all other possibilities have been exhausted in ending a relationship sometimes this is the only thing that works. There are two main problems with this method. First, it is an evil and manipulative method to use that will make you a worse person and will also cause the other person a great deal of pain, suffering and confusion. This method can cause a great deal of harm and is hence immoral to use-with one exception. In some rare cases the only way to drive away someone who is making your life miserable is to make them go away by using this method. However, this method should be employed with great caution and only as a last resort. Second, people often respond to abuse with abuse of their own. Because of this, this method runs the risk of creating an escalating situation that can end in violence.

It’s Not You, Its Me

Use: You break up with the person by telling them that it is not their fault but your fault.

Spotting: Your partner breaks up with you by telling you it is their fault. Common variations include that they are not ready for a serious relationship yet, that they do not think they are good enough for you, or that they are still not over their last relationship.

Alternative: Usually none, but can sometimes indicate some confusion and indecision on their part.

Pros/Cons: On the face of it, this seems like a nice way to break up-you accept the blame and they are the innocent party. They can feel good about themselves and this can cushion the pain of the breakup. If your stated reason is true, then this might be fine. On the downside, the person might decide that they can help you solve the problem that lead to the breakup. For example, they might think they can help you accept a serious relationship or get over your last relationship. In this case, the break up method can backfire. One problem with this method or its application is that people who use it are often lying-people rarely breakup because of some defect they see in themselves. They usually break up because of some flaw they perceive in the other person. Lying, even to make an attempt to spare another’s feelings, is generally not a good thing. In most cases honesty will be the better approach-not only morally but also practically.

eBreakup

Use: You send an email or text message to the person informing them of the breakup.

Spotting: You receive an email or text message from your partner, such as “imbrkinupwitu”, that informs you of the breakup.

Alternative: Unless someone hacked their account or they have a sick sense of humor, there usually isn’t one. Of course, it could be some sort of crazy test.

Pros/Cons: The main advantage of this method is that it gives you distance and a lack of interaction with the person-thus avoiding an emotional scene. If the person is someone who might respond in a dangerous way to a break up, this method can be acceptable. The main problem with this method is that it is cold and impersonal. If you care about the person or even cared about them and they are not prone to violence, then you owe them the courtesy of a face to face breakup. Handling a break up with maturity and respect is part of being a proper human being. Breaking up with a decent person through email is the emotional equivalent of a sniper shot-it is wicked and cowardly.

Phone Breakup

Use: You call your partner and break up over the phone or by voicemail/answering machine.

Spotting: Your partner calls you or leaves a message that they are breaking up with you.

Alternative: Unless someone is impersonating your partner, usually none.

Pros/Cons: The main advantage of this method is that you are at a distance from your partner and can control the interaction by hanging up. In the case of physical distance, this can be acceptable. For example, if you are a student doing a year in Europe, flying back to America to break up might not be a viable option. In the case of legitimate fears, such as a potentially violent partner, this can also be a viable option. The main downside of this method is that it is not a particularly respectful way to handle things. If you cared about the person, you owe them a face to face breakup (assuming it is possible and safe).

One Way Breakup

Use: You break up with the person. The decision is yours and yours alone. They are not permitted any input and there is no discussion.

Spotting: Your partner unilaterally breaks up with you. S/he refuses to discuss things and might not even explain why you are breaking up.

Alternative: Typically none, unless it is some sort of crazy test.

Pros/Cons: The main advantage is that it is quite an ego trip-you are in charge, you make the decision and they have no say in the matter. This method is often used by people who either are arrogant (and hence normally act this way) or indecisive (and hence hope to avoid being persuaded to not break up). There are cases in which this method is necessary-for example, when a person simply cannot go on in the relationship and knows they are too weak to hold out against discussion. On the downside, this method is rather arrogant and treats the other person with disrespect. After all, they are treated as if they do not matter, do not count and have no say in things. In general, this is a bad method to use.

True Dicussion

Use: You discuss the situation with the other person in an open and honest manner. You allow them the opportunity to discuss how they feel, what they think and what they want. You work on the breakup together and agree to end the relationship. They die from shock.

Spotting: Your partner discussions the situation with you in an honest and open manner. You are given the opportunity to discuss your feelings, thoughts, and what you want. You work together and come to a consensus about ending the relationship. You die from shock.

Alternative: Usually none-anyone with the maturity to use this method knows what they want and is open about it. However, some people merely pretend to use this method and are not really interested in a discussion at all-they merely want to appear mature.

Pros/Cons: This is the ideal method to use. It allows input from both parties, permits the chance to discuss things and work out how things will end. While all break ups are painful, the pain tends to be reduced because both partners participate as mature adults and come to a mutually acceptable agreement. The main downside of this method is that it is extremely unlikely that it can be used. Couples who can work together well enough to make the method work will probably be able to work together well enough to make their relationship work.

Test Break Up

Use: You break up with the person, but you are actually testing them. You might want to see if they really love you, to see how they will react to breaking up, or for some other reason. You might be testing yourself to see how you really feel or how you will react to their absence.

Spotting: This is almost impossible to spot since the person will break up with you while secretly intending to test you in some way. Obviously, they are not going to tell you it is a test. You might be able to get some evidence from what they have said about past relationships or from their friends or relatives. This method is apparently used more by women than men.

Pros/Cons: The main advantage of this method is that this can reveal a great deal about the other person. Further, you will learn about how they react to a breakup and their behavior can tell you a lot about them. Great stress, such as a breakup, can reveal a great deal about a person’s real character. However, there are many problems with this method. First, doing this to another human being to learn about them is morally on par with torture and involuntary human experimentation. In other words, it is evil. Second, stress often brings out the worst in a person-so you might not learn about their real character at all-only how they behave when in pain and confusion. Third, they are likely to take the break up seriously and move on to another relationship-thus leaving you alone (as you probably deserve). Overall, this is an evil and callous thing to do to a person. If you want to know another person, spend time with them. Life will present plenty of opportunities to learn what they are like without resorting to such cruel tactics.