The Routledge Handbook of Philosophy of Pain

Jennifer Corns

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138823181
• eBook ISBN: 9781317585459
• Topic: Medicine
• Subtopic: Anesthesiology & Pain Management

The phenomenon of pain presents problems and puzzles for philosophers who want to understand its nature. Though pain might seem simple, there has been disagreement since Aristotle about whether pain is an emotion, sensation, perception, or disturbed state of the body. Despite advances in psychology, neuroscience, and medicine, pain is still poorly understood and multiple theories of pain abound.

The Routledge Handbook of Philosophy of Pain is an outstanding reference source to the key topics, problems, and debates in this exciting and interdisciplinary subject and is the first collection of its kind. Comprising over thirty chapters by a team of international contributors the Handbook is divided into nine clear parts:

• Modeling pain in philosophy
• Modeling pain in neuroscience
• Modeling pain in psychology
• Pain in philosophy of mind
• Pain in epistemology
• Pain in philosophy of religion
• Pain in ethics
• Pain in medicine
• Pain in law

As well as fundamental topics in the philosophy of pain such as the nature, role, and value of pain, many other important topics are covered including the neurological pathways involved in pain processing; biopsychosocial and cognitive-behavioural models of pain; chronic pain; pain and non-human animals; pain and knowledge; controlled substances for pain; pain and placebo effects; and pain and physician-assisted suicide.

The Routledge Handbook of Philosophy of Pain is essential reading for students and researchers in philosophy of mind, philosophy of psychology and ethics. It will also be very useful to researchers of pain from any field, especially those in psychology, medicine, and health studies.

SECTION I

THE NATURE OF PAIN

What is pain?

PART I-I

Modeling pain in philosophy

1

A brief and potted overview on the philosophical theories of pain

Valerie Gray Hardcastle

Common-sense views of pain analogize it to perception (Aydede 2005b). We see the face of a loved one, or a sprig of basil in the market, and we recognize them as such by their color, size, shape, arrangement of features, and so on. Our perceptual system interacts with our memory and other cognitive systems so that we can readily name and understand our percepts as being about things in the world. So too with pain, or so we normally think. We feel a twinge in our left shoulder, and we interpret it as indicating damage to our tissues where the pain is felt. In both cases, we perceive sensible qualities that, in collaboration with our cognitive systems, tell us about the state of the world. Our assertion that we see basil there on the display table depends upon our perceiving it as such. But what about the case of pain? What makes our assertion that we feel pain true? It turns out that the answer is complicated.

Pain is a weird phenomenon. We can often feel pain where there is (apparently) no injury. The pain in our left shoulder could be due to a shoulder injury, but it could also be a heart attack, in which case our pain is being referred from the chest to another location. Intuitively, we perhaps think that the pain is in our hearts – that is where the tissue damage is – but the sensation of pain locates the dysfunction in our shoulder. Readers are probably familiar by now with instances of phantom limb pain, an extreme example of this case. Folks missing a limb, an arm or a leg, often feel pain that seems to be located in the missing extremity. Obviously, there is no pain there, but the felt pain seems real nonetheless. (It isn’t a delusion, for example.)

What makes these examples challenging is not their weirdness, but that the sensation of pain also appears, to some anyway, to be completely private, subjective, and incorrigible (cf. Kripke 1980; Chapter 20, this volume). If we are unsure about whether we are seeing basil, we can always ask our neighbor to take a look and confirm our suspicions. But we cannot do that with pain. I cannot ask my neighbor to perceive my pain and let me know whether it is referred or not. In addition, there does not seem to be any way to have a pain yet not feel it. To be in pain is to feel pain. Finally, we are each our own authority on whether we are in pain. If I think I am in pain, then I am in pain. There is no appearance/reality distinction. Pain and the sensation of pain is the same thing. But if this is true, then how do we explain referred pains, cases in which our sensation of pain is misleading? How can we be wrong about something that is essentially subjective and private?

And this puzzle is one reason why philosophy is interested in pain. What sort of thing is pain such that it can seem private, subjective, and infallible, on the one hand, yet refer to things in the world about which we can be mistaken, on the other? How is it that pain is both a sort of experience, but also the object of our experience? Philosophers want to sort this out.¹

1 Representationalism

The most common response by philosophers by far has been to accept that pain represents something in the world; it is not just a free-floating sensation. Modern conceptions of this view date back to Franz Brentano (1874, 1907), who held that pain is an emotion, which is intentionally directed to a sensed content. By asserting that pain is an emotion, a complex internal perception of sorts that gives rise to aversion, he believed that it would not fall prey to the difficulty of explaining how it could be incorrigible – we could not be wrong about feeling a pain any more than we could be wrong about feeling sad. In contrast to external experiences, which ascribe perceptions of external “sense-qualities” like color to intentional objects, pain is an internal affective experience, which, according to Brentano, just is an indubitable internal perception (Brentano 1907: 121; see also discussion in Geniusas 2014).

Following the science of the day (cf. Titchener 1973/1908), Brentano also believed that pain was psychical in nature, not physical. Of course, Brentano’s views on intentionality qua psychical phenomenon² raise many of the well-known difficulties attached to sense-data views of mentality, which I shall not rehearse here. Suffice it to say, it becomes very difficult to attach a mental object to the physical body in a principled fashion, which is what one needs for pain to be aligned with damage to the person. Consequently, contemporary representationalists generally opt for physicalist interpretations of pain.

Armstrong (1962, 1968) and Pitcher (1970) were early proponents of contemporary versions of this view and advocated a form of perceptualism (see also Newton 1989; Wilkes 1977).³ In contrast to Brentano’s view of pain as an indubitable emotion, Armstrong and Pitcher held that pain tells us that a part of our body is in a “damaged, bruised, irritated, or pathological state” (Armstrong 1968: 371). What is essential about this perspective is that pain is, or is analogous to, perception. It gives us information about our world, just as our (other) perceptual systems do.

Contemporary representationalism comes in many flavors. More recent accounts include Bain (2003), Byrne (2001), Davis (1982), Dretske (1995, 1999, 2003), Hall (1989), Harman (1990), Kahane (2007), Lycan (1981), O’Sullivan and Schroer (2012), Seager (2002), Shoemaker (1975a, 1975b, 1981), and Tye (1996, 1997). They all start by accepting the perceptual nature of pain, but then (in its purest form) go on to claim that the informational content of the perception exhausts its phenomenal content. Or, put another way, they start with the view that the qualitative character of pain is nothing over and above the content, “Damaged tissue here!” They are, as Tye (1997) puts it, “sensory representations of tissue damage” (333, italics his). That is, a pain is a feeling, which might engender dislike for the feeling, as well as telling us that something is potentially wrong in a particular bodily region. Proponents of these accounts generally just flatly deny that knowledge of pain is incorrigible, despite how it might intuitively seem. We can misrepresent pain – we can miss its location; we could mistake it for another type of experience; we could even have unconscious pains, and so there is nothing fundamentally subjective or private about this type of experience at all.

One can then branch off from the basic structure of a representationalist account of pain, arguing, for example, that the content includes more than just a location for tissue damage; it might also include in its content that such damage is bad (e.g., Bain 2011; Cutter and Tye 2011; see also Chapter 3, this volume), or that the region needs to be protected (e.g., Hall 2008; Klein 2007, 2015; Martínez 2011; see also Chapter 4, this volume), or that it is part of a larger intensity-indicating system (Gray 2014). It might even deny that damage per se is part of the content. But in each instance, the fundamental touchstone is that pain sensation is an information-bearing state. One way to understand these variations is in terms of where one draws the line around the states of affairs associated with pain. We have tissue damage, its possibility, and its aftermath; a negative reaction to the events; and an impulse to protect or nurse the damaged area. Different philosophers include different permutations or subsets of these states under their definition of pain; the remainder then becomes a reaction or response to the primary event.

Objections to this view are numerous and strong (see also Chapter 2, this volume). Most of them boil down to the contention that, while pain may or may not be representational, there is also a phenomenal character to pain that exists over and above any content. It is a sensation as much as, or more than, it is a representation. McGinn (1997) puts this sentiment in stark terms: “Bodily sensations do not have an intentional object in the way perceptual experiences do. We distinguish between a visual experience and what it is an experience of; but we do not make this distinction in respect of pains” (8), as does Rorty (1980): Pains “do not represent, they are not about anything” (22, italics his).

Of course, McGinn and Rorty are expressing their opinion here and not giving an actual argument. But this does demonstrate the clash of intuitions here: one side believes that pains are about things; the other does not. To be fair, McGinn’s and others’ (cf. Block 1995: 234; Gillett 1991; Grahek 1991; Jacobson 2013; Kripke 1980; O’Shaughnessy 1980; Searle 1992) intuitions are that the sensation of pain is what itself hurts or is bad; the hurtiness is not some cognitive reaction to a sensation. In contrast, a representationalist view denies that there can be a sensation of pain beyond the representational content. The representation just is the sensation of pain.

There is an additional challenge that at least some representationalists need to confront. If the phenomenal character of pain just is representational content then it seems that in order to be aware of pain, one has to appreciate what it represents. For if there is nothing to pain over and above its representational content, then there is no pain in any meaningful sense without having the concepts that pain represents available. Either those contents are innate (cf. Tye 2005), which is unlikely, given what we know about cognitive development, or we cannot have the phenomenal experience of pain prior to our having knowledge of what it represents. This too seems unlikely to some (cf. Allen 2004). (To others, it might not seem so improbable. Small children, for example, are often unsure how much it hurts when injured.)

2 The phenomenology of pain

That representationalism means that we cannot experience pain without knowing or being aware of some content raises some phenomenological difficulties. For example, if something like the representational view is true, then how is it that a pain can wake you up while you are soundly asleep? This is an experience I assume most of the readers have had (if not by now, then you will before old age, I can practically guarantee). However, if you have no awareness of tissue damage while you are sleeping (because you are asleep) and hence cannot represent contents to yourself about your environment, how is it that a pain can intrude upon your slumber, as they apparently sometimes do? It would seem that we would have to know and not know that we are in pain at the same time.

Dartnell (2001) argues that this can only happen because we can have a sensation and yet not know that we are having that sensation. The pain was there while you were asleep, even though you were not aware of it. He explains it thus: “Being present in consciousness is not the same as being present to consciousness. The pain sensation that woke you up was in your consciousness but not present to your consciousness” (96, italics his). In other words, Dartnell denies representational views of pain, in which to be in pain is to know that you have tissue damage (and maybe that such damage hurts or that you should nurse it), and supports a traditional sense-data sort of empiricism that identifies basic knowledge with experience itself. This phenomenological view of pain (and other bodily sensations) appears to support the old Myth of the Given (Sellars 1963), that pain is just a raw feel, a quale. But, as a further step, to know that we are in pain, to feel the pain qua pain, means that we have cloaked that raw feel in a conceptualization of pain, and that conceptualization has made it into our conscious awareness and we have recognized it as such. But the pain itself, the thing that wakes us up, is just the bare sensation.

This view of pain as (conscious) sensation traces its roots back to the phenomenological movement and Husserl’s Logical Investigations (Husserl 1984/1901), which provides the first explicit discussion of pain in the phenomenological literature (cf. Geniusas 2014). In contrast to his teacher and mentor Brentano, Husserl believed that there could be feelings without intentionality. Following Stumpf (1907), he called these “feeling-sensations.” Pain was a prime example of such a phenomenon. Feeling-sensations are feelings that we do not ascribe to an object of experience, as we might the feeling of pleasure to seeing a sunset, but to the subject of experience, the person feeling the pain. In that sense, pains lack intentionality.

At the same time, Husserl also believed that pain was intentional – it has a dual nature. We can transform feeling-sensations into something contentful by interpreting it, by conceptualizing it as a pain with a particular location, for example:

our sensations here receive an objective “interpretation” … . They themselves are not acts, but acts are constituted through them, wherever, that is, intentional characters like a perceptual interpretation lay hold of them, and as it were animate them. In just this manner it seems that a burning, piercing, boring pain, fused as it is from the start with certain tactual sensations, must itself count as a sensation. It functions at least as other sensations do, in providing a foothold for empirical, objective interpretations.

(Husserl 1984/1901: 406, as quoted in Geniusas 2014: 12)

Pain then is a complex experience, both a simple feeling-sensation and an intentional object of experience.

Other philosophers have not ignored the importance of characterizing the complexity inherent in our pain experiences correctly (Aydede and Güzeldere 2002; see also Savage 1970), nor have pain researchers (Fields 1999; Price 1988, 2000). As Aydede and Güzeldere comment:

In the case of pain experience, it is most often the experience itself that we are most immediately “presented with” and concerned about. That is, our immediate epistemic and practical focus is different in ordinary perception and in pain. Notice that this is true even if we construe pain experiences in entirely representational or intentional terms … . Our immediate interest remains focused on the experience itself as indicated by the fact that we name the experience itself “pain,” and talk about it when we talk about our pains, rather than apply “pain” to the objects of the pain experience – if it has one.

(S269)

If we are going to understand pain with any depth, whether philosophically or scientifically, then we are going to have to understand its subjective elements. The International Association for the Study of Pain’s definition of pain recognizes this fact as well: “Pain is always subjective. … [It is] always a subjective state” (IASP 1986: 250; see also Chapter 31). A successful analysis of pain has to be sensitive to the phenomenological feel of pain, in all its multifarious glory, as well as perhaps the objective states associated with pain. The challenge, of course, is how to do this without falling prey to the Myth of the Given, without making pain qualia into something either inefficacious or mysterious.

3 Eliminativism

As you...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of illustrations
• List of contributors
• Acknowledgements
• Introduction: Pain research: where we are and why it matters
• SECTION I: The nature of pain – what is pain?
• SECTION II: Theoretical implications – why does pain matter, theoretically?
• SECTION III: Practical implications – why does pain matter, practically?
• Index