I recently traveled to Maine. It wasn’t my first visit, but it was the first time in Maine that I was fully committed to learning all things Maine: the bugs, the use of the word wicked, partaking in the traditional whoopie pie (dessert, not some sort of assault), and the lobster.
I’ve never thought much of lobsters — and had actually never really eaten a lobster before. Lobster seemed an elegant treat, luxurious, and over-the-top. I grew up in a single-parent household in landlocked Kansas. We didn’t do lobster.
But we did in Maine. We schlepped out to the furthest point on the Southwest end of Mt. Desert Island to a little joint heralded by locals. We picked out our lobster. We read the infocard about how to eat them — tear off each claw, break off the thumb, hyperextend the back to break off the tail, extract the meat, dip in butter, enjoy, repeat, etc. — and donned the fantastically cheesy plastic bibs.
And I’m a little embarrassed to admit this, but It was just ok. I don’t have the most refined palate (serve me coffee from a gas station any day and I’ll be happy), so I walked away thinking it didn’t taste much different than shrimp. And since shrimp is less expensive, I really don’t know why I’d ever order lobster again. But at least now I can say I’ve had a lobster — the way Mainers have lobster.
After we returned, my husband got into an interesting conversation with one of our vegetarian friends about the ethics around eating lobsters. For those new to the lobster scene, like myself, it’s important to know that most lobsters are prepared by being thrust into a pot of boiling water while they’re still alive. And they’re probably alive for a little while before the boiling water does its thing, diffusely denaturing and cooking their component proteins and, 20 minutes later, delivering a fully cooked and bright red lobster to your table. We descended into rabbit holes, one thing led to another, and we soon found ourselves trying to figure out — can lobsters feel pain?
In trying to figure this out, we stumbled upon perhaps the most well written description of pain that I’ve ever read:
“The problem with pain is that it’s phenomenological, which is a fancy philosophical term for something made real just by the fact that someone experiences it. If you think that you’re in pain, then you are. No one else gets to tell you that you aren’t in pain, because they cannot possibly know whether you are or aren’t. If you feel it, you’re in it. Pain is not more or less real because other people or organisms might not feel pain in the same circumstances and can’t experience your pain for themselves.”
Chodosh, Sara. “No One Knows If Lobsters Feel Pain, Which Makes Boiling Them Alive Rather Complicated.” Popular Science. Popular Science, 16 Jan. 2018. Web. 15 June 2018.
Though we had started this conversation to talk about the ethics of eating lobster, this succinct paragraph describing pain blew me away. It lays plain the exact problem with modern medicine and pain.
In the early 2000s, a push to “measure pain” and to treat it as the 5th vital sign (accompanying temperature, heart rate, respiratory rate, and blood pressure) took root. It wasn’t long before a combination of legislation and initiatives by the major accrediting organizations brought the now-familiar “How bad is your pain, on a scale of 0-10?” question into the exam room.
But unlike a heart rate or blood pressure — standard, quantifiable metrics — the perception of pain varies differently person-to-person. Pain is perception and, as Ms. Codosh noted above, “If you feel it, you’re in it.” I’ve cared for women who stoically deliver babies without any augmentation of pain; I’ve cared for patients in the ERs who are in hysterics because their pain is so bad, but, on inspection, they have no identifiable organic process taking place. As a physician, I cannot reliably predict a person’s pain score based on their diagnosis. It’s a crapshoot. And even if I could predict that someone was a 7 and not a 5 on that oversimplified pain scale, as practitioners of modern medicine, we have frustratingly few options for pain treatment beyond the acute phase.
We have no good ways to treat unexplained, chronic pain. If we can’t chalk pain up to an arthritic joint, or a torn rotator cuff, or something we can fix, we tend to far short of providing pain relief for our patients.
We certainly try to treat chronic pain with interventions and medicines, but if they’re effective they’re either hard to obtain or have tremendous side effects (opioids carry the unfortunate side effect that they’re highly addictive, potentially lethal, and make pain worse in the long term; effective means like epidural blocks are expensive and hard to obtain, as they require an anesthesia or pain specialist office visit).
If they’re easily attainable, affordable, and without serious side effects, they may not be as effective (acetaminophen, the ingredient in Tylenol, falls into this category). Other things like topical creams, patches, and medicines that argument and modulate the nervous system are all ok — but none of them get us to a point of being pain-free.
So what are we supposed to do about this?
If pain is perception, then do we need to change the way we think about pain? Volumes have been written by people far smarter than I, and the biochemistry and physiology of pain is complex; however, it’s true that all pain must be perceived and perception involves complex neurocircuitry and emotion. This complex neurocircuitry and emotion are what create the experience of pain. There is good evidence to suggest that counseling and cognitive behavioral therapy can help those who have chronic pain overcome some aspects of their pain. Some diagnoses with pain as their principal feature, such as fibromyalgia, see benefit from medications like antidepressants and exercise.
Part of this change in thinking about pain means that we also must recognize, and help our patients understand, that chronic, unexplained pain differs tremendously from acute pain. In contrast to unexplained chronic pain, acute pain may be beneficial and adaptive. Those born without the ability to feel pain (a condition called congenital insensitivity to pain) suffer tremendously from unrealized injuries and must be hypervigilant with their other senses to protect themselves. Acute pain helps us avoid potentially dangerous situations and alerts us to trauma, broken bones, and cuts. It alerts us that we need to pay attention to a stimulus, address it, and survive to the next day.
And this is why it’s hard to say if lobsters feel pain. We know they avoid hot water, and they’ve been shown to tend to their wounds. But both of those things are equally necessary in the context of adaptation and evolution: the lobsters who didn’t tend to their wounds or those who hung out in hot water simply didn’t survive to pass along their genes to the next generation. Avoidance of hot water and tending to wounds was passed down as a trait important to survival. And there’s really no way to ask a lobster about their pain experience or to figure out “if they feel it” to know “if they’re in it.”
So I have no idea if lobsters feel pain, and I think I’ll leave that debate to other scientists — but I do know that the combination of their hefty price tag, my terribly unrefined palate, and the possibility of torture leads me to pass. I’ll just have the shrimp, please.