forthcoming in The Journal of Philosophy.

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, sensory, affective, (...) and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing a multidimensional phenomenal space for pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whose structure reflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes a primitive phenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses the utility of continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

According to pure imperativism, pain experiences are experiences of a specific phenomenal type that are entirely constituted by imperative content. As their primary argument, proponents of imperativism rely on the biological role that pain experiences fulfill, namely, the motivation of actions whose execution ensures the normal functioning of the body. In the paper, I investigate which specific types of action are of relevance for an imperative interpretation and how close their link to pain experiences actually is. I argue that, although (...) imperative theories constitute an apparently promising version of strong intentionalism, they cannot provide an imperative content that meets their own criteria of both sufficiency and necessity. I further argue that this issue cannot be solved by impure imperative theories either. (shrink)

Bodily sensations, such as pain, hunger, itches, or sexual feelings, are commonly characterized in terms of their phenomenal character. In order to account for this phenomenal character, many philosophers adopt strong representationalism. According to this view, bodily sensations are essentially and entirely determined by an intentional content related to particular conditions of the body. For example, pain would be nothing more than the representation of actual or potential tissue damage. In order to motivate and justify their view, strong representationalists often (...) appeal to the reliable causal covariance between bodily sensations and certain kinds of bodily conditions or to the corresponding biological function that these bodily sensations are supposed to fulfill. In this paper, I argue on the basis of recent empirical research that arguments from reliable causal covariance and biological function cannot motivate the introduction of corresponding intentional content. In particular, I argue that bodily sensations are caused by a heterogeneous class of physiological and psychological factors and their biological functions are too diverse to be reduced to the representation of a particular bodily condition. Responses are available to strong representationalists, but they either require substantial alterations to their core assumptions or incur a significant empirical burden. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. We start by examining (...) the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “bodycentric” kind of way, while another thinks of pain in a much more "mindcentric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate— dividing sensory/cognitive/affective factors— needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes. (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)

Philosophers often assume that folk hold pain to be a mental state – to be in pain is to have a certain kind of feeling – and they think this state exhibits the classic Cartesian characteristics of privacy, subjectivity, and incorrigibility. However folk also assign pains (non-brain-based) bodily locations: unlike most other mental states, pains are held to exist in arms, feet, etc. This has led some (e.g. Hill 2005) to talk of the ‘paradox of pain’, whereby the folk notion (...) of pain is inherently conflicted. Recently, several authors have rejected the paradox view, arguing instead that folk hold a univocal, bodily view (i.e. pains are properties of various body parts, not of minds). This paper presents six objections to the bodily view of the folk concept of pain. We then outline a direction for future research – the ‘polyeidic approach’ – whereby the folk notion of pain is held to encompass various divergent (potentially conflicting) strands and we suggest that certain problems surrounding the treatment and communication of pain might be usefully be viewed through the lens of the polyeidic approach. (shrink)

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)

Pain may appear to undermine the radically intentionalist view that the phenomenal character of any experience is entirely constituted by its representational content. That appearance is illusory. After categorizing versions of pain intentionalism along two dimensions, I argue that an 'objectivist' and 'non-mentalist' version is the most promising, if it can withstand two objections concerning what we say when in pain, and the distinctiveness of pain. I rebut these objections, in a way available to both opponents of and adherents to (...) the view that experiential content is entirely conceptual. (shrink)

In What the Body Commands, Colin Klein proposes and defends a novel theory of pain. Klein argues that pains are imperative; they are sensations with a content, and that content is a command to protect the injured part of the body. He terms this view "imperativism about pain," and argues that imperativism can account for two puzzling features of pain: its strong motivating power and its uninformative nature. Klein argues that the biological purpose of pain is homeostatic; like hunger and (...) thirst, pain helps solve a challenge to bodily integrity. It does so by motivating you to act in ways that help the body recover. If you obey pain's command, you get better. He develops his account to handle a variety of pain phenomena and applies it to solve a number of historically puzzling cases. Klein's intent is to defend the imperativist view in a pure form -- without requiring pain to represent facts about the world.Klein presents a model of imperative content showing that intrinsically motivating sensations are best understood as imperatives, and argues that pain belongs to this class. He considers the distinction between pain and suffering; explains how pain motivates; addresses variations among pains; and offers an imperativist account of maladaptive pains, pains that don't appear to hurt, masochism, and why pain feels bad. (shrink)

Recent work on signaling has mostly focused on communication between organisms. The Lewis–Skyrms framework should be equally applicable to intra-organismic signaling. We present a Lewis–Skyrms signaling-game model of painful signaling, and use it to argue that the content of pain is predominantly imperative. We address several objections to the account, concluding that our model gives a productive framework within which to consider internal signaling.

This article develops a phenomenological exploration of chronic pain from a first-person perspective that can serve to enrich the medical third-person perspective. The experience of chronic pain is found to be a feeling in which we become alienated from the workings of our own bodies. The bodily-based mood of alienation is extended, however, in penetrating the whole world of the chronic pain sufferer, making her entire life unhomelike. Furthermore, the pain mood not only opens up the world as having an (...) alien quality, it also makes the world more lonesome and poor by forcing the sufferer to attend to the workings of her own body. To suffer pain is to find oneself in a situation of passivity in relation to the hurtful experiences one is undergoing. In making the body and the world more unhomelike places to be in, pain also tends to rob a person of her language. Severe pain is hard to describe because it pushes the person towards the borderlines of imaginable experience and because it makes it hard to see any meaning and purpose in the situation one has been forced into. The analysis of chronic pain in the article is guided by the attempts made by Maurice Merleau-Ponty, Jean-Paul Sartre, and Martin Heidegger to understand the nature of human embodiment and existence, and also by descriptions of chronic pain found in the Swedish author Lars Gustafsson’s novel The Death of a Beekeeper. (shrink)

Although discussion of social pain has become popular among researchers in psychology and behavioural neuroscience, the philosophical community has yet to pay it any direct attention. Social pain is characterized as the emotional reaction to the perception of the loss or devaluation of desired relationships. These are argued to comprise a pain type and are explicitly intended to include the everyday sub-types grief, jealousy, heartbreak, rejection, and hurt feelings. Social pain is accordingly posited as a nested type of pain encompassing (...) multiple emotional sub-types. Call this the social pain posit. This article focuses on whether we should endorse the social pain posit and, in particular, whether social pain is pain. I present the four lines of evidence for the social pain posit that are currently offered in the literature and I argue that each provides only inadequate support, taken either individually or together. I close by considering the significance of the presented argument for philosophical theo.. (shrink)

Some sensory experiences are pleasant, some unpleasant. This is a truism. But understanding what makes these experiences pleasant and unpleasant is not an easy job. Various difficulties and puzzles arise as soon as we start theorizing. There are various philosophical theories on offer that seem to give different accounts for the positive or negative affective valences of sensory experiences. In this paper, we will look at the current state of art in the philosophy of mind, present the main contenders, critically (...) compare and contrast them. In particular, we want to examine how they handle the reason-giving power of affective states. We will look into two representationalist proposals (Evaluativism and Imperativism) and a functionalist proposal, and argue that, contrary to their own advertisements, the representationalist proposals don’t have good accounts of why and how sensory affect can motivate, rationalize, and justify subsequent behavior and intentional mental activity. We will show that our own functionalist proposal does a much better job in this regard, and that when the representationalist proposals are modified to do a better job, they fare better not because of their representationalist credentials but due to their functionalist ones. (shrink)

The long-standing debate between cognitive and feeling theories of emotion stems, in part, from the assumption that cognition and thought are abstract, intellectual, disembodied processes, and that bodily feelings are non-intentional and have no representational content. Working with this assumption has led many emotions theorists to neglect the way in which emotions are simultaneously bodily and cognitive-evaluative. Even hybrid theories, such as those set forth by Prinz and Barlassina and Newen, fail to account fully for how the cognitive and bodily (...) elements of emotion are integrated. As a result, such accounts are unable to provide an adequate characterization of the intentionality or phenomenology of emotions. I will argue that an enactive account of emotions, one which characterizes them as a way of engaging with and making sense of one’s surroundings, can help us to overcome this false dichotomy between cognitive and body elements. What I call ‘ affective framing’ is at the core of emotional experience. It is the way in which we engage with and appraise our surroundings in and through bodily feelings of caring, so that the bodily and cognitive elements of emotion necessarily are fused. The notion of affective framing not only helps to clarify the relationship between bodily and cognitive elements of emotion, but also offers a useful way to make sense of both the intentional directedness and phenomenal character of emotional experience. (shrink)

This book employs contemporary philosophy, scientific research, and clinical reports to argue that pain, though real, is not an appropriate object of scientific generalisations or an appropriate target for medical intervention. Each pain experience is instead complex and idiosyncratic in a way which undermines scientific utility. In addition to contributing novel arguments and developing a novel position on the nature of pain, the book provides an interdisciplinary overview of dominant models of pain. The author lays the needed groundwork for improved (...) models and targeted treatments at a time when pain science, pain medicine, and philosophy are explicitly searching for both and failing to find them. The Complex Reality of Pain will be of interest to a broad range of researchers and students, including those working in philosophy of mind, philosophy of science, cognitive science, neuroscience, medicine, health, cognitive and behavioural psychology, and pain science. (shrink)

In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of (...) pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification. (shrink)

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when considering (...) pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

"Knowing how we know" is the subject of this book. Its authors present a new view of cognition that has important social and ethical implications, for, they assert, the only world we humans can have is the one we create together through the actions of our coexistence. Written for a general audience as well as for students, scholars, and scientists and abundantly illustrated with examples from biology, linguistics, and new social and cultural phenomena, this revised edition includes a new afterword (...) by Dr. Varela, in which he discusses the effect the book has had in the years since its first publication. (shrink)

Representationalist theories of phenomenal consciousness have problems in accounting for pain, for at least two reasons. First of all, the negative affective phenomenology of pain (its painfulness) does not seem to be representational at all. Secondly, pain experiences are not transparent to introspection in the way perceptions are. This is reflected, e.g. in the fact that we do not acknowledge pain hallucinations. In this paper, I defend that representationalism has the potential to overcome these objections. Defenders of representationalism have tried (...) to analyse every kind of phenomenal character in terms of indicative contents. But there is another possibility: Affective phenomenology, in fact, depends on imperative representational content. This provides a satisfactory solution to the aforementioned difficulties. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to (...) patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain. (shrink)

This paper disputes the theoretical assumptions of mainstream approaches in philosophy of pain, representationalism and imperativism, and advances an enactive approach as an alternative. It begins by identifying three shared assumptions in the mainstream approaches: the internalist assumption, the brain-body assumption, and the semantic assumption. It then articulates an alternative, enactive approach that considers pain as an embodied response to the situation. This approach entails the hypothesis of the sociocultural embeddedness of pain, which states against the brain-body assumption that the (...) intentional character of pain depends on the agent’s sociocultural background. The paper then proceeds to consider two objections. The first questions the empirical basis of this hypothesis. It is argued based on neuroscientific evidence, however, that there is no empirical reason to suppose that the first-order experience of pain is immune to sociocultural influences. The second objection argues that the mainstream approaches can account for sociocultural influences on pain by drawing on the conceptual distinction between narrow and wide content. In response, the semantic conception of pain underpinning the proposal is challenged. Pain experience can occur in pre-reflective, affectively reflective, or cognitively reflective forms, but the semantic conception at most only applies to the last form. The paper concludes that the enactive approach offers a promising alternative framework in philosophy of pain. (shrink)

Though pain scientists now understand pain to be a complex experience typically composed of sensation, emotion, cognition, and motivational responses, many philosophers maintain that pain is adequately characterized by one privileged aspect of this complexity. Philosophically dominant unitary accounts of pain as a sensation or perception are here evaluated by their ability to explain actual cases—and found wanting. Further, it is argued that no forthcoming unitary characterization of pain is likely to succeed. Instead, I contend that both the motivating intuitions (...) behind unitary accounts and the wide range of pain phenomena are best accommodated by a componential view of pain that does not privilege any single component as necessary or sufficient. (shrink)