Pain and Perception

This is a slightly more polished version of a presentation I wrote for the Author-Meets-Critics session on Colin's book at the Eastern APA session on Jan 4, 2017, in Baltimore. I’ve decided to post this commentary online pretty much as is -- I am afraid I don't have time to prepare a version suitable for publication. I hope the reader will find it helpful. At any rate, please treat this piece as a rough draft originally intended to be delivered to (...) a live audience. Although my commentary is mostly critical, I admire Colin's book for its originality, breadth, and depth. It stimulated my thought like no other books in recent years. (shrink)

Over recent decades, pain has received increasing attention as – with ever greater sophistication and rigour – theorists have tried to answer the deep and difficult questions it poses. What is pain’s nature? What is its point? In what sense is it bad? The papers collected in this volume are a contribution to that effort ...

This article challenges the orthodox position that some smells are pleasantly fragrant and some tactile sensations are painful. It proposes that the affective components of our experiences are a kind of illusion. Under this alternative picture, experiences that seem to have positive or negative affect never actually do. Rather, the affective component is hyper-illusory, a second-order misrepresentation of the way things actually seem to us. While perceptual hyperillusions have elicited scepticism in other contexts, affective hyperillusions can withstand common critiques. Focusing (...) on the paradigmatic affective experience — pain — the article situates the hyperillusory account within the existing scientific and philosophical literature. Several theoretical advantages of positing a hyper-illusory structure to affective experiences emerge from the discussion. (shrink)

The IASP definition of 'pain' defines pain as a subjective experience. The Note accompanying the definition emphasizes that as such pains are not to be identified with objective conditions of body parts (such as actual or potential tissue damage). Nevertheless, it goes on to state that a pain "is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience." This generates a puzzle that philosophers have been well (...) familiar with: how to understand our utterances and judgments attributing pain to body parts. (The puzzle is of course general extending to all sensations routinely located in body parts.) The present work tackles this puzzle. I go over various options specifying the truth-conditions for pain attributing judgments, and at the end make my own recommendation which is an adverbialist, qualia-friendly proposal with completely naturalistic credentials that is also compatible with forms of weak intentionalism. The results are generalizable to other bodily sensations and can be used to illustrate, quite generally, the viability of a qualia-friendly adverbialist (but naturalist and weakly intentionalist) account of perception. (shrink)

The current IASP definition of pain has come under renewed criticisms recently. There is a new momentum for its revision as reflected by the fact that IASP has now a Presidential Task Force dedicated to look into whether there is enough warrant to update the definition. I critically review all the major criticisms of the current definition in detail, and raise new difficulties rarely discussed before. I show that none of the major criticisms has enough warrant to force us to (...) substantially revise the current definition. Combined with the discussion of the new difficulties, there is nonetheless a need to restate the definition using slightly different terminology that will make the original intent of the current definition clearer and more precise. A restatement of the definition is proposed and its potential is discussed in light of some empirical questions that remain. [The IASP Council has now approved a revised definition and published its rationale here: Pain 2020 Sep 1; 161(9), pp. 1976–1982. The new definition follows (most of) my recommendations.]. (shrink)

I distinguish between two claims of transparency of experiences. One claim is weaker and supported by phenomenological evidence. This I call the transparency datum. Introspection of standard perceptual experiences as well as bodily sensations is consistent with, indeed supported by, the transparency datum. I formulate a stronger transparency thesis that is entailed by representationalism about experiential phenomenology. I point out some empirical consequences of strong transparency in the context of representationalism. I argue that pain experiences, as well as some other (...) similar experiences like itches, tickles, orgasms, hedonic valence, etc., are not transparent in this strong sense. Hence they constitute empirical counterexamples to representationalism. Given that representationalism is a general metaphysical doctrine about all experiential phenomenology for good reasons, I conclude that representationalism about phenomenal consciousness is false. Then, I outline a general framework about how the introspection of phenomenal qualities in perceptual experience works in light of the transparency datum, but consistent with the rejection of strong transparency. The result is a form of qualia realism that is naturalist and intentionalist, and has close affinities to the adverbialist views developed in the latter part of the last century. I then apply this framework to pain experiences and their bodily locations. (shrink)

Accounts of the nature of unpleasant pain have proliferated over the past decade, but there has been little systematic investigation of which of them can accommodate its badness. This paper is such a study. In its sights are two targets: those who deny the non-instrumental disvalue of pain's unpleasantness; and those who allow it but deny that it can be accommodated by the view—advanced by me and others—that unpleasant pains are interoceptive experiences with evaluative content. Against the former, I argue (...) that pain's unpleasantness does indeed have noninstrumental disvalue; against the latter I argue both that my critics’ own desire-theoretic accounts of pain's unpleasantness cannot accommodate such disvalue, and that my evaluativist view can—either by appealing to “anti-unpleasantness” desires or by exploiting pain's perceptuality. (shrink)

This paper assesses whether Evaluativism, as a view about the nature of unpleasant pains, can meet a specific normative condition. The normative condition says whatever candidate state is offered as an analysis of unpleasant pain should be intrinsically phenomenally bad for its subject to be in. I first articulate a method reflecting this condition, called the normative contrast method, and then frame Evaluativism in detail. The view is then tested through this method. I show that Evaluativism can explain why cases (...) of evaluative thought, with the same contents as unpleasant pains, are not intrinsically phenomenally bad for their subjects to be in by appeal to intentional modes. However, I argue the appeal to perceptuality, which is central to this response is problematic, and therefore it remains unclear whether Evaluativism, as standardly articulated, can meet the normative condition on unpleasant pains. (shrink)

This is a Letter to Editor of _Pain_ recommending revision of a pain term ('nociplastic pain') recently added to the IASP Pain Terms. (With a response from the Taxonomy Committee, Eva Kosek et al. PAIN: June 2018 - Volume 159 - Issue 6 - p 1177–1178.

In this thesis I provide an account of the unpleasantness of pain. In doing this, I shed light on the nature of pain and unpleasantness. I propose to understand the unpleasantness of pain based on the determinable-determinate distinction. Unpleasantness is a determinable phenomenal property of mental states that entails badness. I propose that an unpleasant pain experience has two phenomenal properties: i) the phenomenal property of being a pain, and ii) a phenomenal determinate property (u1, u2, u3, etc.) of the (...) unpleasantness determinable. According to this theory unpleasant pains feel bad, and this explains why we are motivated and justified in avoiding them. This explains, for example, why we are motivated and justified to take painkillers. This theory allows us to account for the heterogeneity of unpleasantness, i.e., we can explain how different unpleasant experiences feel unpleasant even if they feel so different. -/- The thesis is organised into seven chapters and divided by three main themes: i) what the unpleasantness of pain consists in, ii) how we can account for the great phenomenal diversity among experiences of unpleasantness, and iii) which cases suggest that there could be pains that are not unpleasant. Broadly, the first two chapters deal with the first theme, where I analyse two reductive accounts of unpleasantness: the content theories and the desire theories. I deal with the second theme in the third and fourth chapter, where I analyse different theories that try to account for the phenomenal property of unpleasantness. In the fifth and sixth chapter, I focus on the third theme, where I consider different cases that suggest the existence of pains that are not unpleasant. In the final chapter, I offer a conclusion of the three main themes by providing my own view on the unpleasantness of pain. (shrink)

[Penultimate draft] I present the perceptualist/representationalist theories of pain in broad outline and critically examine them in light of a competing view according to which awareness of pain is essentially introspective. I end the essay with a positive sketch of a naturalistic proposal according to which pain experiences are intentional but not fully representational. This proposal makes sense of locating pains in body parts as well as taking pains as subjective experiences.

In various papers, Colin Klein has argued that pain experiences are commands. This monograph goes well beyond the papers, re-shaping his ‘imperativist’ view, setting it within a general account of ‘homeostatic sensations’, presenting new arguments, and criticising alternatives. Original, empirically informed, clear, and often persuasive, it is a lovely book.

Evaluativism is best thought of as a way of enriching a perceptual view of pain to account for pain’s unpleasantness or painfulness. Once it was common for philosophers to contrast pains with perceptual experiences (McGinn 1982; Rorty 1980). It was thought that perceptual experiences were intentional (or content-bearing, or about something), whereas pains were representationally blank. But today many of us reject this contrast. For us, your having a pain in your toe is a matter not of your sensing “pain-ly” (...) or encountering a sense-datum, but of your having an interoceptive experience representing (accurately or inaccurately) that your toe is in a particular experience-independent condition, such as undergoing a certain “disturbance” or being damaged or in danger (Armstrong 1962; Tye 1995). But even if such representational content makes an experience a pain, a further ingredient seems required to make the pain unpleasant. According to evaluativism, the further ingredient is the experience’s possession of evaluative content: its representing the bodily condition as bad for the subject. In this chapter, I elaborate evaluativism, locate it among alternatives, and explain its attractions and challenges. (shrink)

This chapter defends an axiological theory of pain according to which pains are bodily episodes that are bad in some way. Section 1 introduces two standard assumptions about pain that the axiological theory constitutively rejects: (i) that pains are essentially tied to consciousness and (ii) that pains are not essentially tied to badness. Section 2 presents the axiological theory by contrast to these and provides a preliminary defense of it. Section 3 introduces the paradox of pain and argues that since (...) the axiological theory takes the location of pain at face value, it needs to grapple with the privacy, self-intimacy and incorrigibility of pain. Sections 4, 5 and 6 explain how the axiological theory may deal with each of these. (shrink)

I argue that pain sensations are perceptual states, namely states that represent (actual or potential) damage. I defend this position against the objection that pains, unlike standard perceptual states, do not allow for an appearance-reality distinction by arguing that in the case of pain as well as in standard perceptual experiences, cognitive penetration or malfunctions of the underlying sensory systems can lead to a dissociation between the sensation on the one hand, and what is represented on the other hand. Moreover, (...) I refute the objection that the allegedly weak correlation between pain and bodily damage forces intentionalist accounts of pain to postulate so many malfunctions (misrepresentations respectively) that such accounts become implausible. I also rebut Murat Aydede’s objection that our linguistic practice supposedly shows that there is a conceptual difference between standard perceptual experiences and pain sensations by challenging Aydede’s premise that we always withdraw standard perceptual reports in case of counterevidence, while we never do that with pain reports. At the end, I propose an explanation as to why we do not express perceptual reports of (potential) bodily damage in objectivist, but in mental terms. (shrink)

The author puts forward and defends a new argument for indirect realism called the argument from pain. The argument is akin to a well-known traditional argument to the same end, the argument from hallucination. Like the latter, it contains one premise stating an analogy between veridical perceptions and certain other states and one premise stating that those states are states of acquaintance with sense-data. The crucial difference is that the states that are said to be analogous to veridical perceptions are (...) pain-states instead of hallucinations. This difference makes the argument from pain immune to the standard objections against the argument from hallucination. (shrink)

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent influences the (...) effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. (shrink)

Sometimes the philosophical armchair gets bumped by empirical facts. So it is when thinking about pain. For good or ill (good, actually, as we shall see) most of us are intimately acquainted with physical pain, the kind you feel when you stand on a nail or burn your hand. And, from the armchair, it can seem blindingly obvious that pain is essentially unpleasant. There are of course unpleasant experiences that aren’t pains – nausea or itches, for example – but surely (...) there aren’t pains that don’t hurt, pains that are neutral or even pleasurable rather than unpleasant. Surely, indeed, there couldn’t be. For it is part of the very concept of a pain that a pain be unpleasant. Or so it has seemed to many. Yet over recent decades philosophers’ confidence in these putative truisms has been shaken by some fascinating cases from the clinic, the lab, and life. (shrink)

Philosophers think of pain less and less as a paradigmatic instance of mentality, for which they seek a general account, and increasingly as a rich and fruitful topic in its own right. Pain raises specific questions: about mentality and consciousness certainly, but also about embodiment, affect, motivation, and value, to name but a few. The growth of philosophical interest in pain has gone hand-in-hand with the growth of pain science, which burgeoned in the 1960s. This is no accident: developments in (...) pain science have prompted philosophers to take account of empirical data, and to revisit their assumptions about pain. Pain, in short, demands interdisciplinary investigation, hence while this entry focuses on the philosophy of pain, it makes liberal reference to empirical literature along the way. This entry’s focus is on physical pains, that is pains that are felt in bodily locations, not emotional suffering more broadly, such as grief or disappointment. The entry also does not address pain’s place in ethical theories; its focus is rather on issues that arise within philosophy of mind. Even so, part of what makes pain such an interesting and important topic is that the questions it raises span boundaries, and normative questions concerning pain’s badness, on the one hand, and its value, on the other, are never far away. (shrink)

Pain asymbolia is a rare condition caused by brain damage, usually in adulthood. Asymbolics feel pain but appear indifferent to it, and indifferent also to visual and verbal threats. How should we make sense of this? Nikola Grahek thinks asymbolics’ pains are abnormal, lacking a component that make normal pains unpleasant and motivating. Colin Klein thinks that what is abnormal is not asymbolics’ pains, but asymbolics: they have a psychological deficit making them unresponsive to unpleasant pain. I argue that an (...) illuminating account requires elements of both views. Asymbolic pains are indeed abnormal, but they are abnormal because asymbolics are. I agree with Klein that asymbolics are incapable of caring about their bodily integrity; but I argue against him that, if this is to explain not only their indifference to visual and verbal threat, but also their indifference to pain, we must do the following: take asymbolics’ lack of bodily care not as an alternative to, but as an explanation of their pains’ missing a component, and claim that the missing component consists in evaluative content. Asymbolia, I conclude, reveals not only that unpleasant pain is composite, but that its ‘hedomotive component’ is evaluative. (shrink)

Compare your pain when immersing your hand in freezing water and your pleasure when you taste your favourite wine. The relationship seems obvious. Your pain experience is unpleasant, aversive, negative, and bad. Your experience of the wine is pleasant, attractive, positive, and good. Pain and pleasure are straightforwardly opposites. Or that, at any rate, can seem beyond doubt, and to leave little more to be said. But, in fact, it is not beyond doubt. And, true or false, it leaves a (...) good deal more to be said: about the nature of sensory affect; its relations to perception, motivation, and rationality; its value; and the mechanisms underlying it. Much is said about these matters in the contributions that follow. Here, in this introductory essay, we map the dialectical landscape and locate our contributors’ papers within it. (shrink)

The unpleasantness of pain motivates action. Hence many philosophers have doubted that it can be accounted for purely in terms of pain’s possession of indicative representational content. Instead, they have explained it in terms of subjects’ inclinations to stop their pains, or in terms of pain’s imperative content. I claim that such “noncognitivist” accounts fail to accommodate unpleasant pain’s reason-giving force. What is needed, I argue, is a view on which pains are unpleasant, motivate, and provide reasons in virtue of (...) possessing content that is indeed indicative, but also, crucially, evaluative. (shrink)

It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With regard to the (...) qualia theory, we argue that it fails to capture the sense in which pain 's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain 's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain 's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)

I argue that an analogy between pains and sounds suggests a way to give an objective account of pain which fits well with a naïve perceptualist account of feeling pain. According to the proposed metaphysical account, pains are relational physical events with shared qualitative nature, each of which is constituted by tissue damage and the activation of nociceptors. I proceed to show that the metaphysical proposal is compatible with platitudes about pains being animate, private, and self-intimating states.

It can seem natural to say that, when in pain, we undergo experiences which present to us certain experience-dependent particulars, namely pains. As part of his wider approach to mind and world, John McDowell has elaborated an interesting but neglected version of this account of pain. Here I set out McDowell’s account at length, and place it in context. I argue that his subjectivist conception of the objects of pain experience is incompatible with his requirement that such experience be presentational, (...) rationalizing, and classificatory. (shrink)

Perceptualists say that having a pain in a body part consists in perceiving the part as instantiating some property. I argue that perceptualism makes better sense of the connections between pain location and the experiences undergone by people in pain than three alternative accounts that dispense with perception. Turning to fellow perceptualists, I also reject ways in which David Armstrong and Michael Tye understand and motivate perceptualism, and I propose an alternative interpretation, one that vitiates a pair of objections—due to (...) John Hyman—concerning the meaning of ‘Amy has a pain in her foot’ and the idea of bodily sensitivity. Perceptualism, I conclude, remains our best account of the location of pains. (shrink)