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)

Multidisciplinary models aggregating ‘lower-level’ biological and ‘higher-level’ psychological and social determinants of a phenomenon raise a puzzle. How is the interaction between the physical, the psychological and the social conceptualized and explained? Using biopsychosocial models of pain as an illustration, I argue that these models are in fact level-neutral compilations of empirical findings about correlated and causally relevant factors, and as such they neither assume, nor entail a conceptual or ontological stratification into levels of description, explanation or reality. If (...) inter-level causation is deemed problematic or if debates about the superiority of a particular level of description or explanation arise, these issues are fueled by considerations other than empirical findings. (shrink)

It is common to characterize pain with touch-related terms, like ‘cutting’, ‘pressing’, ‘sharp’, and ‘pulsing’, or temperature-related terms, like ‘hot’ or ‘burning’. This suggests that many pains are phenomenally multimodal because they are experienced as having some tactile-like or thermal-like character. The goal of this chapter is to investigate the structure of phenomenally multimodal pain experiences. It is argued that the usual accounts of multimodal structure proposed in investigations regarding exteroceptive experiences cannot be plausibly applied to multimodal experiences (...) of pain. Instead, an alternative framework is proposed which characterizes the structure of tactile-like and thermal-like pains by referring to the notion of crossmodal correspondences. (shrink)

Evaluativism about unpleasant pains offers one way to think about unpleasant pain experience. However, extant Evaluativist views do not pay enough attention to the affective dimension of pain experience and the complex relations between the affective, evaluative and sensory dimensions. This paper clarifies these relations and provides a view which more closely reflects the phenomenology of unpleasant pains. It argues that the intentional structure of paradigmatic unpleasant pain is as follows: unpleasant pains essentially involve a (...) proprietary intentional mode—what I call affective-interoception—and a distinctive kind of evaluatively qualified sensory content. The resulting view is Affective-Evaluativism. (shrink)

Tracking representationalism explains the negative affective character of pain, and its capacity to motivate action, by reference to the representation of the badness for us of bodily damage. I argue that there is a more fitting instantiation of the tracking relation – the badness for us of extremely intense stimuli – and use this to motivate a non-reductive approach to the negative affective character of pain. The view of pain proposed here is supported by consideration of three (...) related topics: the pain caused when the body is damaged, reparative pain, and the messenger-shooting objection to tracking representationalism. (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)

It is widely held that it is only contingent that the sensation of pain is disliked, and that when pain is not disliked, it is not intrinsically bad. This conjunction of claims has often been taken to support a subjectivist view of pain’s badness on which pain is bad simply because it is the object of a negative attitude and not because of what it feels like. In this paper, I argue that accepting this conjunction of (...) claims does not commit us to this subjectivist view. They are compatible with an objectivist view of pain’s badness, and with thinking that this badness is due to its phenomenal quality. Indeed, I argue that once the full range of options is in view, the most plausible account of pain is incompatible with subjectivism about value. (shrink)

Reductive representationalist theories of consciousness are yet to produce a satisfying account of pain’s affective component, the part that makes it painful. The paramount problem here is that that there seems to be no suitable candidate for what affective experience represents. This article suggests that affective experience represents the Darwinian fitness effects of events. I argue that, because of affective experience’s close association with motivation, natural selection will work to bring affect into covariance with the average (...) fitness effects of types of event, and that this covariance makes fitness effects a promising candidate for what affect represents. I also argue that this account is to be preferred to Cutter and Tye’s recent proposal that affect represents harmfulness, and answer an objection that Aydede and Fulkerson recently offered against representational accounts of affect. (shrink)

The article examines Wittgenstein’s thought on the language of pain in first and third person. Relevant grammatical differences, according to the typical analytical method of this philosopher, are highlighted not only in relation to the two perspectives, but also regarding the use of cognitive verbs such as ‘feeling’ and ‘knowing’. The exam of many texts suggests some issues concerning the relationship between personal experiences, empathic grasping of other’s feelings and their conceptual translation. A brief comparison with some Thomas Aquinas’ (...) texts complements the proposal of the existence of non intentional knowledge. (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.

- First book to describe what pain means in vulnerable or special groups of people - Clinical applications described in each chapter - Provides insight into the nature of pain experience across the lifespan -/- This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. -/- Immediate pain (...) warns of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair. -/- Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions. -/- This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management. -/- Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019. (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)

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)

Barbara Montero considers whether or not we are able to remember what pain feels like. In order to properly answer this question, she introduces a new type of memory called 'qualitative memory', which seems common to exteroceptive sensations. Having concluded that there is arguably no qualitative memory for pain and other bodily sensations, Montero considers possible philosophical implications for areas including rational choice-making and empathy. In addressing the relationship between pain and memory, the paper raises an issue (...) that has not received much attention and indicates various interesting fields of research for which the apparent inability to remember pain might prove relevant. My comment primarily focuses on the core concepts of pain and qualitative memory which are foundational for the paper. I argue that a deeper engagement with some key aspects of these concepts is necessary. A more fine-grained discussion could have made Montero's argument more convincing. (shrink)

Imperativism is the view that the phenomenal character of the affective component of pains, orgasms, and pleasant or unpleasant sensory experience depends on their imperative intentional content. In this paper I canvass an imperativist treatment of pains as reason-conferring states.

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 paper aims at clarifying the distinctions and relations between pain and suffering. Three negative theses are defended: 1. Pain and suffering are not identical. 2. Pain is not a species of suffering, nor is suffering a species of pain, nor are pain and suffering of a common (proximate) genus. 3. Suffering cannot be defined as the perception of a pain’s badness, nor can pain be defined as a suffered bodily sensation. Three positive (...) theses are endorsed: 4. Pain and suffering are categorically distinct: pain is a localised bodily episode, suffering is a non-localised affective attitude. 5. Suffering can be expressed, pains cannot. As a consequence, we can have compassion for the suffering of others, not for their pains. 6. The relation between pain and suffering is akin to the relation between danger and fear, injustice and indignation, wrongdoing and guilt: suffering is the correct reaction to pain. One upshot is that both the influential view that the experience of pain is incorrigible and the influential view that the ordinary conception of pain is paradoxical are false. (shrink)

What is the best way to account for the badness of pain and what sort of theory of welfare is best suited to accommodate this view? I argue that unpleasant sensory experiences are prudentially bad in the absence of contrary attitudes, but good when the object of positive attitudes. Pain is bad unless it is liked, enjoyed, valued etc. Interestingly, this view is incompatible with either pure objectivist or pure subjectivist understandings of welfare. However, there is a kind (...) of welfare theory that can incorporate this view of the badness of pain and which is very, very close to being a form of subjectivism. Moreover, this hybrid account of welfare is entirely compatible with the deep motivations of subjectivism. I therefore argue that those who lean towards welfare subjectivism should adopt this account of pain, and that we should revise our understanding of subjectivism to count such theories as subjective. (shrink)

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view (...) that is at odds with this conceptualisation. By demonstrating that the public does not necessarily endorse central tenets of the “mental” view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more “body-centric” view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more “mind-centric” view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public’s view is modified when situations emphasizing mental and somatic aspects of pain are presented together. (shrink)

In this article I clarify the concepts of ‘pain’, ‘suffering’. ‘pains of body’, ‘pains of soul’. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis. treatment and research. Next, there is (...) the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfihing these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if anv, should override the right to refuse treatment where pain relief is of paramount concern. (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)

This paper examines perfectionist attempts to explain the prudential badness of pain (its badness for those who experience it). It starts by considering simple perfectionist explanations, finding them wanting, before considering the most sophisticated perfectionist attempt to explain prudential badness: Gwen Bradford’s tripartite perfectionism. The paper argues that Bradford’s view, though an improvement on earlier perfectionist proposals, still does not satisfactorily explain the full set of prudentially bad pains. It ends by showing how this provides grounds for a (...) general kind of pessimism about perfectionism and the badness of pain and how this case undermines a general purported advantage of perfectionism over the objective list theory. (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)

Commentary on Smrdu M. (2022) Kaleidoscope of pain: What and how do you see through it. Constructivist Foundations 17(2): 136–147. I unpack Smrdu’s kaleidoscope metaphor, putting it into dialogue with enactive work on the performative body in order to cash out how it can capture the qualitative differences of the experience of chronic pain.

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 aim of the article is to introduce a new concept of “pain-related bodily doubt,” which complements current concepts currently in use, such as pain-related fear, pain catastrophizing, and pain self-efficacy. This new concept, adapted from recent philosophical work on illness experience, has the potential to positively contribute to pain research and clinical practice by providing a vocabulary for clinicians and patients to discuss implicit or tacit dimensions of pain-related experiences.

I have laid out what seem to me to be the most promising arguments on opposing sides of the question of whether what humans regard as the first-person accessible aspects of pain could also be implemented in robots. I have emphasized the ways in which the thought experiments in the respective arguments attempt to marshal hypothetical first- person accessible evidence concerning how one’s own mental life appears to oneself. In the Chinese room argument, a crucial premise involves the thesis (...) that from a lack of it seeming that one is in pain, one can conclude that one is not in pain. There’s a counterpart thesis playing a crucial role in the prosthetic neurons argument, one asserting an entailment from its seeming that one is in pain to one’s being in pain. I further suggested that by adopting a HOT theory of consciousness, of the sort reviewed in Pereplyotchik’s chapter in the present volume, one is thereby in a better position to endorse the prosthetic neurons argument over the Chinese room argument than to make the opposite appraisal. (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)

What is the relationship between pain and the body? I claim that pain is best explained as a type of personal experience and the bodily response during pain is best explained in terms of a type of mechanical neurophysiologic operation. I apply the radical philosophy of identity theory from philosophy of mind to the relationship between the personal experience of pain and specific neurophysiologic mechanism and argue that the relationship between them is best explained (...) as one of type identity. Specifically, pain is a specific type of personal experience identical to a specific type of allostatic stress response comprised of interdependent nervous, endocrine and immune mechanical operations. (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)

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)

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 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 amultidimensional phenomenal spacefor pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whosestructurereflects 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 aprimitivephenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses theutilityof 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)

This paper is an attempt to spell out what makes the scientific study of pain so distinctive from a philosophical perspective. Using the IASP definition of ‘pain’ as our guide, we raise a number of questions about the philosophical assumptions underlying the scientific study of pain. We argue that unlike the study of ordinary perception, the study of pain focuses from the very start on the experience itself and its qualities, without making deep assumptions about (...) whether pain experiences are perceptual. This in turn puts scientific explanation in a curious position due to pain’s inherently subjective epistemic nature. The reason for this focus on the experience itself and its qualities, we argue, has to do with pain’s complex phenomenology involving an affective/motivational dimension. We argue for the scientific legitimacy of first‐person phenomenological studies and attempts to correlate phenomenology with neural events. We argue that this methodological procedure is inevitable and has no anti‐physicalist ontological implications when properly understood. We end the paper by commenting on a discussion between two prominent pain scientists in the field, Don Price and Howard Fields, about the need to distinguish more dimensions in the phenomenology of pain and how to classify them vis‐à‐vis the recent scientific findings. Our interest in this discussion is not only to introduce some clarifications but also to show how “neurophenomenology” has already been shaping the scientific research and to back our claim about why this methodology is inevitable with an example. (shrink)

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)

Two views on the nature and location of pain are usually contrasted. According to the first, experientialism, pain is essentially an experience, and its bodily location is illusory. According to the second, perceptualism or representationalism, pain is a perceptual or representational state, and its location is to be traced to the part of the body in which pain is felt. Against this second view, the cases of phantom, referred and chronic pain have been marshalled: (...) all these cases apparently show that one can be in pain while not having anything wrong in her body. Pain bodily location, then, would be illusory. I this paper I shall defend the representational thesis by presenting an argument against experientialism while conceding that the appearance / reality distinction collapses. A crucial role in such identification is played by deictics. In reporting that we feel pain here, the deictic directly refers to the bodily part as coinciding with the part as represented. So, pain location is not illusory. The upshot is that the body location is part and parcel of the representational content of pain states, a representation built up from the body map. (shrink)

We present an ontology of pain and of other pain-related phenomena, building on the definition of pain provided by the International Association for the Study of Pain (IASP). Our strategy is to identify an evolutionarily basic canonical pain phenomenon, involving unpleasant sensory and emotional experience based causally in localized tissue damage that is concordant with that experience. We then show how different variant cases of this canonical pain phenomenon can be distinguished, including (...) pain that is elevated relative to peripheral trauma, pain that is caused neuropathically (thus with no necessary peripheral stimulus), and pain reports arising through deception either of self or of others. We describe how our approach can answer some of the objections raised against the IASP definition, and sketch how it can be used to support more sophisticated discrimination of different types of pain resulting in improved data analysis that can help in advancing pain research. (shrink)

The kind of empathy that is communicated through expressions like “I feel your pain” or “I share your sadness” is important, but peculiar. For it seems to require something perplexing and elusive: sharing another’s experience. It’s not clear how this is possible. We each experience the world from our own point of view, which no one else occupies. It’s also unclear exactly why it is so important that we share others' pains. If you are in pain, (...) then why should it matter, and be a good thing, that I am also in the same pain? Our goal in this paper is to address these questions. Specifically, our goal is to clarify how empathy, in the regimented sense of sharing another’s pain, is possible and why it is important. Central to our account is the concept of being acquainted with—that is, directly aware of—pain. When I feel my own pain, and am acquainted with it, I want the pain to stop, and I’m moved—sometimes compelled—to stop it. My acquaintance with the pain is what reveals that it is no good, to be gotten rid of, and to be avoided in the future. Acquaintance also appears to be implicated in our understanding of, and motivation to relieve, others’ pains. When I say “I feel your pain” I express an awareness of your pain, a direct appreciation of its noxious qualities, and, as with my own pain, an understanding of why it ought to be eased. Explaining how empathy is both possible and important therefore involves clarifying the nature of acquaintance: its limits, epistemic role, and motivational significance. What our analysis reveals is that agents have both epistemic and moral reasons to share other people’s pain because pain-sharing is the source of a species of character-building knowledge that we have no other way of accessing except through direct acquaintance with pain. (shrink)

Ambiguity in the athlete’s perception and description of pain that opens the door to a series of reinterpretations of athletic experience and events that argue the development of an increasingly inauthentic relation to self and others on the part of those who consume performance as third parties (spectators) and ultimately those who produce it first hand (athletes). The insertion of the spectator into the sport situation as a consumer of the athlete’s activity and the preference given to spectator (...) interpretation shift control of meaning away from the athlete and encourage a demand for athlete suffering in aid of the spectator’s own need for meaning. Through discussions of the function of narrative in sport spectacle, the witnessing role of spectators, and the phenomenon of vicarious substitution, I discuss the representation of the athlete as a character ideal and moral exemplar. At a more developed level of external interpretation, the athlete (or team) becomes the champion of the spectator, the role model or focal point of civic pride whose victory asserts the ascendence of my team and town over yours; and finally, the athlete or team is the intentional object of fan identification: my team is me. I conclude that the existential commitment of the spectator as devoted fan is an inauthentic one. (shrink)

Ambiguity in the athlete’s perception and description of pain that opens the door to a series of reinterpretations of athletic experience and events that argue the development of an increasingly inauthentic relation to self and others on the part of those who consume performance as third parties (spectators) and ultimately those who produce it first hand (athletes). The insertion of the spectator into the sport situation as a consumer of the athlete’s activity and the preference given to spectator (...) interpretation shift control of meaning away from the athlete and encourage a demand for athlete suffering in aid of the spectator’s own need for meaning. Through discussions of the function of narrative in sport spectacle, the witnessing role of spectators, and the phenomenon of vicarious substitution, I discuss the representation of the athlete as a character ideal and moral exemplar. At a more developed level of external interpretation, the athlete (or team) becomes the champion of the spectator, the role model or focal point of civic pride whose victory asserts the ascendence of my team and town over yours; and finally, the athlete or team is the intentional object of fan identification: my team is me. I conclude that the existential commitment of the spectator as devoted fan is an inauthentic one. (shrink)

Philosophical considerations regarding experiential spatial content have focused on exteroceptive sensations presenting external entities, and not on interoceptive experiences that present states of our own body. A notable example is studies on interoceptive touch, in which it is argued that interoceptive tactile experiences have rich spatial content such that tactile sensations are experienced as located in a spatial field. This paper investigates whether a similarly rich spatial content can be attributed to experiences of acute, cutaneous pain. It is argued (...) that such experiences of pain do not have field-like content, as they do not present distance relations between painful sensations. (shrink)

Is a phenomenal pain a conscious primitive or composed of more primitive phenomenal states? Are pain experiences necessarily or only contingently unpleasant? Here, I sketch how to answer such questions concerning intra-phenomenal metaphysics using the example of pain and unpleasantness. Arguments for a symmetrical metaphysical independence of phenomenal pain and unpleasant affect are presented, rejecting a composite view like the IASP definition and dimensional views. The motivating intuition of these views is explained by common binding mechanisms (...) in consciousness and characterized as fallacious if generalized. There are, however, underlying commonalities between pain perception and unpleasant affect, e.g. formal content or evolutionary ancestry. (shrink)

Learning is fundamentally about action, enabling the successful navigation of a changing and uncertain environment. The experience of pain is central to this process, indicating the need for a change in action so as to mitigate potential threat to bodily integrity. This review considers the application of Bayesian models of learning in pain that inherently accommodate uncertainty and action, which, we shall propose are essential in understanding learning in both acute and persistent cases of pain.

According to the increasingly popular perceptual/representational accounts of pain (and other bodily sensations such as itches, tickles, orgasms, etc.), feeling pain in a body region is perceiving a non-mental property or some objective condition of that region, typically equated with some sort of (actual or potential) tissue damage. In what follows I argue that given a natural understanding of what sensory perception requires and how it is integrated with (dedicated) conceptual systems, these accounts are mistaken. I will also (...) examine the relationship between perceptual views and two (weak and strong) forms of representationalism about experience. I will argue that pains pose very serious problems for strong representationalism as well. (shrink)

Dysmenorrhea, or menstrual pain, is regularly suffered by 45 to 95% of menstruating women. Despite its prevalence, and despite the philosophical importance of pain as a general phenomenon, dysmenorrhea has been all but completely overlooked in contemporary analytic philosophy of mind. This paper aims at rectifying this situation. We single out three properties of what is often considered the paradigmatic case of painful experience, what we call injury-centered pains, and argue that dysmenorrhea does not have any of (...) them, and hence that it does not neatly conform to the injury-centered model of pain. This calls into question the centrality of the injury-centered model, and suggests novel research avenues within theoretical debates on affectivity. (shrink)

This paper aims to provide a theoretical framework for explaining the subjective character of pain experience in terms of what we will call ‘embodied predictive processing’. The predictive processing (PP) theory is a family of views that take perception, action, emotion and cognition to all work together in the service of prediction error minimisation. In this paper we propose an embodied perspective on the PP theory we call the ‘embodied predictive processing (EPP) theory. The EPP theory proposes to (...) explain pain in terms of processes distributed across the whole body. The prediction error minimising system that generates pain experience comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system, maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI ensemble as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. We set out to show how the EPP theory can make sense of how pain experience could be neurobiologically constituted. We take it to be a constraint on the adequacy of a scientific explanation of subjectivity of pain experience that it makes it intelligible how pain can simultaneously be a local sensing of the body, and, at the same time, a more global, all-encompassing attitude towards the environment. Our aim in what follows is to show how the EPP theory can meet this constraint. (shrink)

Understanding the nature of pain depends, at least partly, on recognizing its subjectivity (thus, its first-person epistemology). This in turn requires using a first-person experiential method in addition to third-person experimental approaches to study it. This paper is an attempt to spell out what the former approach is and how it can be integrated with the latter. We start our discussion by examining some foundational issues raised by the use of introspection. We argue that such a first-person method in (...) the scientific study of pain (as in the study of any experience) is in fact indispensable by demonstrating that it has in fact been consistently used in conjunction with conventional third-person methodologies, and this for good reasons. We show that, contrary to what appears to be a widespread opinion, there is absolutely no reason to think that the use of such a first-person approach is scientifically and methodologically suspect. We distinguish between two uses of introspective methods in scientific experiments: one draws on the subjects’ introspective reports where any investigator has equal and objective access. The other is where the investigator becomes a subject of his own study and draws on the introspection of his own experiences. We give examples using and/or approximating both strategies that include studies of second pain summation and its relationship to neural activities, and brain imaging- psychophysical studies wherein sensory and affective qualities of pain are correlated with cerebral cortical activity. We explain what we call the experiential or phenomenological approach that has its origins in the work of Price and Barrell (1980). This approach capitalizes on the scientific prospects and benefits of using the introspection of the investigator. We distinguish between its vertical and horizontal applications. Finally, we conclude that integrating such an approach to standard third-person methodologies can only help us in having a fuller understanding of pain and of conscious experience in general. (shrink)

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider (...) the characterization of placebo analgesia as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)

In a series of recent papers Francesco Orilia has presented an argument for the moral desirability of presentism. It goes, in brief, as follows: since the existence of painful events is morally undesirable, presentism, which denies that past painful events (tenselessly) exist, is morally more desirable than non-presentism, which instead affirms that past painful events (tenselessly) exist. An objection against this argument, which has already been taken into consideration by Orilia, is the ugly history objection or radical objection: what really (...) matters in the moral appraisal of a world is the history of it, and since the presentist and the non-presentist versions of our world share the same ugly history, they are morally on a par. This paper aims at corroborating this objection and defending it from Orilia’s criticisms. This will be done by bringing into play various thought experiments and a distinction between relevance (of an event or a fact about the occurrence of an event) to the moral evaluation of a world and moral (and psychological) involvement (in an event or in a fact about the occurrence of an event). (shrink)