An enormous and rapidly growing amount of information on the brain and pain exists. For example, there are at least 30,000 books in English on the brain, classic texts such as Kandel et al’s Principles of Neural Science run to 1750 pages, the Textbook of Pain to 1200 pages and there are 2765 pages in Ramachandran’s Encyclopaedia of Human Behaviour. It would be an easy trap, especially for beginners, to believe we know everything about the brain and pain. I and other teachers stand up in front of groups and tell all we know as if it was all there is to know. But maybe, with the goal of advancing knowledge, we should also be realising, teaching and acknowledging what we don’t know?
The case for teaching ignorance
A recent short article by Jamie Holmes in the International New York Times (Aug 25) – The case for teaching ignorance struck a chord. The study of ignorance (agnotology!) is in its infancy and certainly not taking off rapidly. After all who would want to come to a course on ignorance? Holmes mentions some texts and university classes on the subject and in particular introduced me to the delightful book Ignorance: How it drives science by Stuart Firestein, a Columbia University neuroscientist. I couldn’t put it down, which is remarkable as it is actually about scientific method and such books are usually boring, but this is a great read about the place and power of the study of ignorance. “Ignorance” is an evocative word, used here to discuss the unknown.
What don’t we know?
How do we know what we don’t know? It comes down to having questions, the freedom to question, valuing questions and availability of stimuli to construct questions – a theme of Firestein’s book. I think of it as healthy ignorance. We are also reminded about how accepted knowledge can get in the way of healthy ignorance. Examples in Firestein’s book include the tongue maps of regional sensitivities (they just don’t exist despite being in every textbook), the relentless pursuing of brain knowledge via examination of electrical spikes and missing chemical signalling and faulty numbering such as the much repeated 10 times as many glial cells in the brain than neurones (I am guilty here too!)
In my own small way, my contribution to healthy ignorance is to insert an “ignorance” section at the start of an Explain Pain course and summarise it by some of the questions I would like answered. There are plenty and they include:
- How does the brain work?
- Why are things changeable in some people but not others?
- Why in some people are certain homeostatic coping mechanisms selected, while different ones are selected in others?
- What happens in the brain during a ‘revelation’?
- Why can’t apparently clever people accept biopsychosocial thinking?
- How far and fast can information laden synaptic juice in the brain travel?
There are so many questions. I am feeling quite ignorant at the moment!
What questions would you like answered?