Mental Pain and Medical Neglect: When Suffering Has No Object and No Exit
- Dick Gariepy
- Jun 4
- 13 min read
Dick Gariepy | Big Thinky Ouchey
When pain has no object, medicine sees no obligation.
The Mind-Body Divide and the Legacy of Mental Pain and Medical Neglect
When you go to the hospital because your pain is physical—your body bleeding, burning, breaking—they treat you like a patient.
You are stabilized. You are medicated. You are seen.
Emergency room doctors have two jobs:
Stabilize the patient long enough for a specialist to take over.
Manage pain until then.
That’s the baseline. That’s the deal.
But when you go to the hospital because your pain is mental, because anguish has reached a level that feels unlivable, you are not treated like a patient. You are treated like a puzzle. Or worse, a liability.
They sit you down. They ask questions. They write on their dumb little notepad. They nod empathetically. And then they give you a list of community resources and send you home. Maybe you get a crisis line number. Maybe a suggestion for mindfulness. But no pain relief. No real intervention.
None of it touches the pain.
Because pain of the mind does not count the same way.
Mental anguish exists on the wrong side of the mind-body divide, an old philosophical fiction going all the way back to Rene Descartes' Meditations on the first philosophy. The idea that the mind is a distinct and separate non material substance from the body, and medicine still uses it like a sorting hat. If your suffering registers as bodily, you’re eligible for morphine. If it registers as mental, you’re sent to a waiting room with a pamphlet.
They don’t even pretend to manage the pain. Why?
Because mental pain is treated as epiphenomenal, real, but not real-real. Real in the way hallucinations are real: verifiable only to the person experiencing them. It’s unverifiable, unmeasurable, unfalsifiable. And in a medical system built under neoliberal scarcity, that means it’s dismissible.
They don’t deny your pain. They simply don’t allocate resources to it.Why would they? Under neoliberalism, care is not about suffering. It’s about risk. And risk only counts if it threatens someone else. Or the budget.
You go in saying: “This pain is not survivable.” They hear: “The only threat to my life is myself”, They complete a risk assessment and they send you home.
Because as far as they’re concerned, as long as you walk out of that room alive, you are stable. And stable means solved. Even if you are screaming on the inside.
It is a design choice. Mental anguish is treated as optional suffering. And if the system can opt out of treating it, it will.
Because they will never be asked to feel it.
Qualia: The Texture of Experience
Pain is not a metaphor. But try explaining that to an institution.
You can describe where it hurts, when it started, what it prevents you from doing. But the thing itself, the burning, the hollowing, the scream you carry behind your ribs, is yours alone. It doesn’t come across in words. It can’t. That’s not because you’re inarticulate. It’s because what you’re trying to share is a qualia.
Qualia are the felt properties of mental states, the what-it’s-like of experience. The sourness of a lemon. The electric snap of heartbreak. The sense-memory of a childhood scent you can’t name but would recognize instantly. These are not thoughts. They’re not behaviors. They are the raw textures of consciousness, immediate and untranslatable.
Ned Block (1995) defines qualia as
“experiential properties of sensations, feelings, perceptions and, in my view, thoughts and desires as well.”
He notes the controversy not in their existence, most people admit there is something it is like to feel, but in whether that something can be defined functionally, intentionally, or physically. And it’s precisely because qualia resist such reduction that they become disposable under institutional logic.
Take Jackson’s (1982) famous Mary in the black-and-white room: a scientist who knows every physical and functional fact about color vision, but has never seen red. The moment she leaves the room and sees a ripe tomato, she learns something new, not about wavelengths, but about experience. That “something new” is a qualia.
Qualia, then, are not about behavior. They are not about function. They are about perspectival interiority, what it’s like to be a subject, in a moment, undergoing that moment.
Michael Tye (1995) elaborates:
If you subtract the phenomenal feel, there is no experience left at all. Consciousness without qualia is just a CPU running silently.
We do not merely compute, we undergo. And that undergoing cannot be passed along, cannot be mirrored in diagnostic codes or chart notes.
Here’s the crux: because qualia are non-transferable, they are institutionally inconvenient. If pain cannot be independently verified, it becomes suspect. If suffering cannot be charted, it becomes ignorable. If mental anguish has no observable output, it is treated as epiphenomenal, real, but causally irrelevant. And under neoliberal triage logic, what is causally irrelevant is not worth treating, because an effect that has no cause cannot and will not on its own CAUSE you to die.
They ask, “What’s your pain level from 1 to 10?” But if your pain is existential, enduring, rooted not in a torn tendon but in a life unraveled, what number do you assign to that?
They don’t need to deny the qualia. They only need to ensure it has no place in the treatment algorithm.
That’s the point of institutional translation: to convert a scream into a scale score, a breakdown into “low affect,” a spiritual agony into “no acute risk.”
You walk in with a private catastrophe. They reduce it to a spreadsheet variable. And because they can’t feel it, they don’t have to fix it.
The Phenomenology of Pain: Unmaking Of The World
Language is insufficient to express emotional pain and turmoil. We have good words for describing physical pain: radiating, hot, throbbing, sharp, achy and so on. But when it comes to emotional pain we’re “sad.”…It’s not surprising that people don’t get what we’re talking about (Tracey, 2012).
Pain has no object.
That’s what makes it different from every other state of consciousness. Hunger points to food. Thirst to water. Fear to threat. But pain is a pure signal without a referent, a scream that doesn’t say “because”, only “now.”
Elaine Scarry (1985) calls it the most objectless of all experiences. There is nothing to interpret. Nothing to narrate. It does not mean. It hurts.
Most internal states extend outward, into rain clouds, berries, lovers, or wars. Desire projects. Imagination fills gaps. Even grief, that most brutal of losses, conjures the outline of what is gone.
But pain doesn't extend. It contracts. It eats the ground of the world.
Scarry writes:
“It is especially appropriate that the very state which is utterly objectless is also, of all states, the one that, by its aversiveness, most presses the urge to move out and away from the body.”
But there’s nowhere to go.The body is the site of suffering, and the body cannot be exited.
In pain, you don’t just lose comfort. You lose orientation. You lose language. You lose the world.
This is not poetic exaggeration. It is a phenomenological fact. When the pain is intense enough, you cease to be someone in the world. You become a body against the world. The bench beneath you becomes strange. The air seems distant. Language cracks under the pressure. Even your name starts to feel like someone else’s.
Scarry writes that intense pain destroys language. It doesn't just fall outside of metaphor, it shatters metaphor. It silences not only expression but recognition. When you are in pain, you are not misunderstood. You are unavailable to interpretation.
And institutions built on verbal cues, symptom lists, narrative coherence? They don’t know what to do with that.
They need objects. They need symptoms. They need form.
So they demand a story. They require you to perform coherence in order to be eligible for care. They ask you to name the cause, trace the function, chart the arc.
And if you can’t, if you’re too consumed, too flooded, too wordless, they call you unstable. Dramatic. Resistant. Personality disordered.
But pain doesn’t follow rules. It doesn’t start at “A” and end at “Z.” It doesn’t wait for a break in conversation to announce itself. It doesn’t always come with tears or threats. Sometimes it’s just a person sitting calmly in a chair, saying “I can’t live like this anymore,” and meaning every word.
But meaning doesn't matter when it isn't legible.
Because pain, like imagination, is a boundary condition of the self. It marks the limit of expression, and it often exceeds it. But where imagination creates objects to rescue the self from emptiness, pain offers no such relief. It demands a world to counter it, but the world does not reply.
The result? The collapse of shared reality.
When I went to the hospital in pain, I wasn’t asking for comfort. I was asking for recognition. For someone to acknowledge that I was not simply overwhelmed, not dramatic, not manipulative, not dysregulated, but hurting, in the most primitive, pre-linguistic, truth-bearing sense.
What I got instead was a translation.
They took my body’s howl and turned it into a chart note. They turned my silence into a symptom. They treated my unsharable real as irrelevant.
Scarry says that pain and imagination are intentional opposites: one pure state without object, the other pure object without state. But pain, too, demands an object. It demands a listener. It demands a world.
When that world does not respond, the pain does not lessen. The self just breaks more quietly.
The Administrative Logic of Neoliberal Care
Institutions don’t ignore pain. They reclassify it.
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Under neoliberalism, suffering is budgeted.
You arrive in crisis, and they hand you a list of “resources.” They suggest coping strategies. Maybe they fax a referral, if you're lucky. But the pain itself, the thing you named with your whole body, is untouched. Unacknowledged. Uneconomical.
This is doctrine.
In neoliberal health regimes, mental suffering is not framed as a systemic harm, but a deficiency in self-management. Pain is not something done to you; it is something you have failed to properly reframe. The problem is not the structure. The problem is your coping skills (Teghtsoonian,2009) .
And so the burden shifts. From institution to individual. From collective care to private responsibility.
You aren’t given support. You’re given assignments.
You are told to “work on boundaries.” To “build a toolbox.”To “focus on what you can control.”
The implication is clear: if you are still suffering, it is because you haven’t tried hard enough. You haven’t “engaged with the resources.” You haven’t been compliant. You used what little autonomy you have the wrong way according to them, and that makes you deserving of the pain. Why would they treat you to ease your suffering when the suffering is your punishment?
Fitzpatrick (2018) pushes this further. They argue that
Suicide prevention, ostensibly the last line of defence, is structured around risk management, not care
The goal isn’t to alleviate suffering. It’s to avoid liability. The subject becomes a site of forensic evaluation: Are you a threat? Do you have a plan? Are you safe to discharge?
What gets lost in this framework is not just context. It’s meaning.
You say “I am in pain,” and they hear “I am unwell.”You say “I can’t survive this,” and they hear “I need a crisis plan.”You say “The system is killing me,” and they mark “persecutory ideation.”
Your truth is recorded. Then it is disarmed.
This is what neoliberalism does best: it outsources harm while preserving the performance of response.
You are handed mindfulness apps instead of medication. Waiting lists instead of treatment. Resilience workshops instead of structural change.
This is not incompetence. It is designed non-intervention.
You are not left to your pain by accident. You are left to it because it is cheaper to document your suffering than to end it.
Never mind that you are bleeding from the soul. Never mind that the pain has no off-switch. Never mind that they didn’t even try.
Under neoliberal care, it’s not about whether you hurt. It’s about whether they’re obligated to do anything about it.
Mental Pain and Medical Neglect Under Neoliberalism
This is not just an oversight—it is mental pain and medical neglect by design
They tell themselves it’s impossible.
They say, “There’s nothing we can do.”They say, “You’re not in crisis.”They say, “You just need support.”
But what they mean is:“Your suffering does not map to anything we are trained to fix.”
No, its not that they can't, They absolutely could as there is no natural law of science that would stop them from using their voice to say no this is wrong and its hurting my patients health. It's that they won't, because they dont want to. And it violates the core ethical contract of medicine.
The World Health Organization has been clear for nearly a century:
“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity” (WHO, 1948).
But when you go to the hospital in unbearable mental pain, real pain, the kind that corrodes your sense of reality, that distorts time, that makes stairs look like escape hatches, you aren’t treated with urgency. You aren’t offered relief. You’re offered paperwork. Protocol. Discharge instructions.
No pain management. No social remedy. Just the insinuation that your reaction is maladaptive.
I dont believe doctors do this because they are cruel. It’s because they are translating your suffering through the wrong lens.
They still believe that your anguish is a feature of dysfunction, not a signal of injury. That it is caused by your misperception, not by a world that has made your life unlivable. They see symptoms where there is evidence. They see reactivity where there is testimony. They see disorder where there should be a demand for justice.
But if mental illness belongs to medicine, if psychiatry still claims jurisdiction, then physicians do not get to disavow the pain that comes with it. They do not get to claim authority without accountability.
And that’s exactly what they’re doing.
The Canadian Medical Association oath, revised in 2018, contains this line:
“I will work to promote social justice.”
What does that mean if they don’t even try?
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What does it mean to swear to compassion while allowing patients to leave in agony, simply because their pain has no diagnostic code?
What does it mean to say you serve “health” while refusing to recognize that mental pain is a health issue, especially when caused by trauma, discrimination, abandonment, and systemic failure?
They say: “There’s nothing we can do.” But that’s not true.
They could write letters of support. They could challenge policy. They could call out injustice. They could treat anguish like pain and not as personality. They could stand up and say: “This patient is suffering, and their suffering matters.”
That would be medicine. That would be ethics. That would be social justice.
Instead, they offer referrals. Crisis numbers. A tight smile.
And when nothing changes, they call it treatment-resistant.
But this pain isn’t resistant. It’s treatable, with recognition, with protection, with structural intervention.
Anything less is not care. It’s abandonment.
And it breaks their oath.
Refusal: Against Their Translation
I’m not interested in being understood on their terms anymore.
I’ve seen what happens when I speak their language. They take my pain and flatten it. They turn devastation into “affect.” They turn a cry for help into “negative thought patterns.” They convert existential suffering into a compliance issue.
And they call it care.
They claim I’m stable. They say I’m articulate. They note that I maintain eye contact. As if those were metrics of well-being. As if surviving long enough to report my pain invalidates the pain itself.
This is the violence of translation: not that they get the words wrong, but that they refuse the reality those words try to carry.
They believe that because they can’t feel what I feel, they don’t have to act. They believe that because the injury isn’t visible, it must be imaginary. They believe that because I haven’t died, the pain isn’t fatal.
But I will not validate a system that waits for bodies to break before it believes them.
This isn’t a call for empathy. Empathy is a mirror; I don’t need them to feel it. I need them to recognize it.
I need them to stop treating survival as proof that nothing is wrong. I need them to stop translating anguish into irrelevance. I need them to take seriously what they would take seriously in anyone else: unbearable pain, described clearly, documented repeatedly, and ignored categorically.
Their oaths mean nothing if they require blood to be legible. Their ethics mean nothing if they exclude structural harm from the realm of medical concern. Their institutions mean nothing if all they do is metabolize suffering into paperwork and call that resolution.
So no, I don’t accept their notes. I don’t accept their diagnoses. I don’t accept their translations.
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I am not a disorder. I am not a crisis deferred. I am not a system error.
I am in pain. And I will not make it palatable.
Big Thought Thumper Of The Week--> "NO OBJECT, NO EXIT"
Works Cited
Ahmed, S. (2012). On being included: Racism and diversity in institutional life. Duke University Press.
Berlant, L. (2011). Cruel optimism. Duke University Press.
Block, N. (1995). Qualia. In S. Guttenplan (Ed.), A companion to the philosophy of mind (pp. 509–520). Blackwell.
Canadian Medical Association. (2018). CMA code of ethics and professionalism. https://policybase.cma.ca/documents/policypdf/PD19-03.pdf
Dotson, K. (2011). Tracking epistemic violence, tracking practices of silencing. Hypatia, 26(2), 236–257. https://doi.org/10.1111/j.1527-2001.2011.01177.x
Fitzpatrick, S. J. (2018). Reshaping the ethics of suicide prevention: Responsibilisation, self-management and the analytics of health. Sociology of Health & Illness, 40(3), 514–528. https://doi.org/10.1111/1467-9566.12652
Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford University Press.
Han, B.-C. (2017). Psychopolitics: Neoliberalism and the new technologies of power (E. Butler, Trans.). Verso.
Jackson, F. (1982). Epiphenomenal qualia. The Philosophical Quarterly, 32(127), 127–136. https://doi.org/10.2307/2960077
Locke, J. (1975). An essay concerning human understanding (P. H. Nidditch, Ed.). Oxford University Press. (Original work published 1690)Spencer, Lucienne (2021). Breaking the silence a phenomenological account of epistemic injustice and its role in psychiatry. University of Bristol
Scarry, E. (1985). The body in pain: The making and unmaking of the world. Oxford University Press.
Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Scribner.
Teghtsoonian, K. (2009). Depression and mental health in neoliberal times: A critical analysis of policy and discourse. Social Science & Medicine, 69(1), 28–35. https://doi.org/10.1016/j.socscimed.2009.03.037
Tracy, N. 2016. Lost Marbles: Insights into My Life with Depression and Bipolar. Amazon, Great Britain.
Tye, M. (1995). Ten problems of consciousness: A representational theory of the phenomenal mind. MIT Press.
World Health Organization. (1948). Preamble to the Constitution of the World Health Organization. https://www.who.int/about/governance/constitution
Heres a question : What counts as "real" pain and who decides?
Let me know what you think in the common section below.
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