Experiencing Pain

A Scientific Enigma and Its Philosophical Solution

Sabrina Coninx

• Publisher: De Gruyter
• Year: 2020
• Print ISBN: 9783110688375
• eBook ISBN: 9783110688474
• Edition: 1
• Topic: Philosophy
• Subtopic: Modern Philosophy

Although pain is one of the most fundamental and unique experiences we undergo in everyday life, it also constitutes one of the most enigmatic and frustrating subjects for many scientists. This book provides a detailed analysis of why this issue is grounded in the nature of pain itself. It also offers a philosophically driven solution of how we may still approach pain in a theoretically compelling and practically useful manner. Two main theses are defended: (i) Pain seems inscrutable because there exists no property that is commonly shared by all types of pain and that is at the same time particular to pain, setting it apart from other bodily sensations. This applies irrespective of whether we consider the psychological dimensions, neural networks, causal relations or biological functions of pain. Consequently, it is impossible to refer to ideal far-reaching and ideal distinct generalizations on the matter of pain. (ii) Despite this challenge, by focusing on the resemblance relations that hold across pains, we can generate scientific progress in explaining, predicting and treating pain. In doing so, the book aims to provide a clear conceptual basis for interdisciplinary communication and a useful heuristic for future research.

1 Stage Setting

Pain is a feeling. Surely that is uncontroversial. To have pain and to feel pain are one and the same. For a state to be pain and for it to feel painful are like-wise one and the same. A theory of what it is for a state to be pain is inescapably a theory of what it is like to be in that state, of how that state feels, of the phenomenal character of that state.

Lewis, 1980, p. 222

The main goal of this book is to develop an empirically anchored theoretical framework of pain that should usefully feed back into the discourse across disciplines. Before engaging with this endeavor some theoretical and methodological groundwork needs to be done to set the stage. What is the phenomenon of pain we will be investigating? How can we reliably identify paradigmatic cases of pain? Which research question guides the investigation? What are the relevant properties of pain to be investigated? How can we study them empirically? Chapter 1 provides this background to get the general project of this book off the ground. Section 1.1 offers an answer to the question: what is the pain phenomenon that constitutes the research subject of this book. Thus, it does the minimal groundwork needed to fix the relevant research subject. Moreover, it outlines the general question that many researchers across disciplines aim to answer in the investigation of pain. Section 1.2 introduces the most common classifications of pain and the empirical perspectives that I consider in the upcoming investigations. Section 1.3 outlines the argumentative structure of the following parts and presents competing theories in recent literature that will be discussed in more detail later on.

1.1 Research Subject & Question

In this section, I outline the presupposed understanding of pain and introduce a functional indicator that allows us to identify instantiations of pain. Moreover, I outline the main research question that guides the following investigations. First, I address the so-called paradox of pain that is deeply rooted in the philosophical debate surrounding the question of what pain is. In the context of this debate, I draw a distinction between two philosophical projects on the matter of pain: one that investigates the folk understanding of the notion of “pain” and one that investigates pain as a natural phenomenon. My project presupposes an understanding of pain as a particular class of mental phenomena with a shared and unique phenomenal character. I consider phenomenal experience as the decisive mark of pain. Second, I introduce pain reports as functional indicators which allow us to determine the class of paradigmatic pain cases. As we shall see, verbal reports are flawed but they are better than the alternative. Third, I outline the general focus of most pain researchers that also lies at the heart of my own project, the search for a certain kind of property satisfying the criteria of both commonality and specificity with respect to pain.

1.1.1 Paradoxical Pain

In the introductory quote, David Lewis (1980) asserts that it is uncontroversial that pain is a feeling with a particular phenomenal character. Independent of his further considerations on the matter of pain, he is at least wrong with respect to this issue. Philosophers’ opinions tend to differ strongly: some claim that pain is a bodily state, i. e., a particular physiological condition, while others claim that pain is a mental state, i. e., a certain phenomenal experience. This debate mainly concerns the apparent paradox that laypeople intuitively attribute two opposite kinds of properties to pain (Hill, 2005; 2017).

Pain appears similar to the objects of exteroceptive sense modalities such as vision, hearing, taste, smell, or touch, which convey information about the accessible features of external objects. Corresponding reports, such as “I see a black cat sitting on the windowsill.” possess a transitive structure and express the directedness towards a particular object with particular features, i. e., a cat of a certain color with a certain location. Statements about pain may exhibit a similar character. Although their reference objects are not situated beyond a subject’s physical borders, they are located in a particular part of the body and possess features normally attributed to external items, such as location and intensity. This aspect is reflected in pain-related statements, such as “I feel a severe pain in my neck.” It might initially seem intuitive to identify pain with a certain sort of physical condition which can, but does not have to be the object of subjective experience (Reuter and Sytsma, forthcoming; Sytsma, 2010).

On the other hand, pain possesses features which seem to distinguish it fundamentally from the physical objects of exteroceptive sense modalities (Pitcher, 1970a). First, pains are subjective inasmuch as their presence depends on them being experienced. Genuine sense modalities refer to items and features that exist independent of a person’s experience of them. A cat is present and has certain properties, even if it is not perceived by an individual. In contrast, pain seems to draw its existence from being felt (Dretske, 2003; 2005). Second, pain does not constitute a public object because no one else has the same privileged epistemic access to it as the person concerned. There is no independent tool to identify pain in the same way as introspection. In contrast, the objects of exteroceptive sense modalities and their physical properties are intersubjectively accessible. Third, pain constitutes a source of incorrigible knowledge (Langland-Hassan, 2017). When people attribute pain due to a corresponding experience, they cannot be mistaken. Pain leaves no room for potential discrepancies between appearance and existence, as the former simply creates the latter (Armstrong, 1962). These three features suggest that pain is not a mind-external object, but a subjective, private, and incorrigible mental state.

Pain presents as a mental state traditionally located in the brain, mind, or soul. It is alternatively considered a physical object spatiotemporally located beyond the brain, mind, or soul, namely within the body. This paradox is characteristic for bodily sensations because it does not occur with respect to experiences of exteroceptive sense modalities which are traditionally understood as referring to publicly accessible conditions of the external world. For instance, it seems implausible to locate the visual experience of a black cat in the leg whereas this seems to be a usual way of thinking and talking about pain (Bain, 2007). So, what is pain?

In the philosophical debate, some authors argue in favor of a mental view claiming that people think and talk about pain in a manner that clearly refers to a certain phenomenal experience. This means that the term “pain” is used in everyday language to describe an experience which is subjective, private, and incorrigible. For instance, there is no intuitive distinction between the appearance and existence of pain (Aydede, 2017; 2019). Other philosophers attempt to show that, according to common sense, the notion “pain” refers to a mind-independent and spatiotemporal located condition of the body. In favor of this bodily view is the fact that people are willing to ascribe unfelt or hallucinated pains (Reuter, 2011; Reuter, Phillips, and Sytsma, 2014; Reuter and Sytsma, forthcoming; Sytsma, 2010; Sytsma and Machery, 2009). Thus, when people ascribe pain to themselves or others, they actually refer to a certain state of the body rather than the brain, mind, or soul.

Without going deeper into this debate, it seems plausible to assume that laypeople might use the term “pain” in everyday speech in different manners. Thus, the notion of “pain” appears ambiguous. Further research might show that its use actually fulfills a variety of communicative purposes depending on pragmatic factors, such as sharing knowledge, justifying one’s own behavior, or influencing the behavior of others. Some authors in the debate seem to be sympathetic to such ideas (e. g., Borg et al., 2020). Whether this constitutes a compelling reason to eliminate a term from everyday language or not must be decided elsewhere (Corns, 2016; Hardcastle, 1999). At first, it appears compelling that the paradox of pain is rather an issue of philosophical nature whereas “the folk already had a way to manage the apparent inconsistencies in their notions of pain as something both subjective and objective.” (Hardcastle, 2017, p. 25)

In any case, the debate between the presented views on pain concerns a term used in everyday language. The philosophical positions previously described constitute mental or bodily views of the notion “pain” and their aim is to carve out the meaning of this particular notion. In contrast, I am not interested in investigating the linguistic rules that determine the use of the notion “pain” in everyday communication and this book does not aim to provide a new definition of the meaning of said notion. I am interested in the identification and empirically structured investigation of a certain natural phenomenon existing in the world. Conceptual analysis or experimental philosophy cannot primarily contribute to this project. The use of the notion “pain” appears to fulfill various communicative functions. Thus, it might not indicate a single state of the world that could become the subject of consistent empirical investigations. Even if the notion “pain” would refer to a single state of the world, bodily or mental, understanding the meaning of the notion “pain” does not necessarily imply a better scientific understanding of the respective bodily or mental state. Of note is that the philosophical discussion surrounding the paradox of pain focuses on the ambiguity of the English term “pain”. Resulting puzzles might be grounded only in the specific surface grammar of this language without actually indicating the nature of a particular thing in the world (Liu and Klein, forthcoming).

Therefore, my project needs to define what paradigmatic cases of pain are and how these cases can be identified in different experimental settings to develop a framework accounting for the occurrence of pain. This book concerns pain understood as a class of phenomenologically unified mental phenomena. Accordingly, subjective experience functions as the decisive mark for the fixation of pain. This understanding presupposes that pain possesses a phenomenal correspondence in the world. There exists a unique phenomenal character of what it is like to experience pains which allows humans to unequivocally identify a certain group of mental phenomena as pains from a first-person perspective. There exists a fundamental feeling of “what it is like” to undergo pain experiences (Nagel, 1974). This understanding implies that concerned people always possess epistemic authority. A case of pain is a case in which the concerned person subjectively experiences pain. It is not a case of pain when a person subjectively experiences fear, anger, itching, hunger, or anything else instead of pain. Subjective experience is the only relevant criterion in the identification of pain.

It should be noted that the understanding of pain in terms of phenomenal experience seems widely accepted in pain research. The identification of pain with a certain class of mental phenomena subjectively experienced as pains is common ground with the many researchers who have regarded pain as a specific conscious experience, subjective feeling, or sensation (e. g., Iannetti and Mouraux, 2010; IASP, 2019; Melzack and Casey, 1968; Melzack and Wall, 1982; Pitcher, 1970a; Price, 1999; Reddan and Wager, 2018). In fact, understanding pain in terms of subjective experience is the lowest common denominator for most researchers across academic disciplines, such as psychology, neuroscience, physiology, and clinical medicine. Moreover, it seems to be presupposed by various philosophers (e. g., Aydede, 2017; Cutter, 2017; Klein, 2015b; Tye, 1997).

This understanding of pain might be called stipulative with respect to the use of the term “pain” in everyday life of native English speakers. In everyday communication, the term “pain” might not always refer to the phenomenal experience my project is interested in, although it appears to be one of the reference objects denoted by this term (Borg et al., 2020; Hill, 2017). As such, I do not presuppose a mental view. However, since pain is commonly considered in terms of subjective experience in pain research and since the corresponding research results are utterly relevant to my own project, henceforth I use the terms “pain” and “pain experience” interchangeably.

Finally, note that I do not consider pain to be identical to displeasure, i. e., the opposite of pleasure. My research project focuses on so-called bodily pain phenomena. This does not mean that pains are bodily states. In contrast, they constitute particular kinds of mental phenomena that phenomenologically differ from other kinds of suffering. Again, I consider this understanding to be common sense with various pain researchers, independent of the theory they ultimately defend with respect to this research subject (e. g., Aydede, 2000; Bain and Brady, 2014; Klein, 2015b). The class of bodily pains includes mental phenomena such as headache, stomachache, labor pain, muscle pain, pain of hitting the funny bone, phantom pain, superficial burn pain, and various others which are addressed in more detail in Section 1.2.1.

Fundamental to present purposes is that my project excludes different kinds of emotional suffering such as grief, sadness, loneliness, or depression. This is important because some researchers have investigated these affective states and disorders under the label of social pain (e. g., Eisenberger et al., 2006; Eisenberger, Lieberman, and Williams, 2003; Eisenberger and Lieberman, 2004; 2005). I also do not consider cases of empathic pain, i. e., those different kinds of emotions experienced while observing another person undergoing an experience of pain (Batson, 2011). I assume that pains, as I understand them, phenomenologically differ from social and empathic pains and that the use of the term “pain” in these cases is rather metaphorical. This approach is suggested by first-person experience as well as empirical research (for a more detailed discussion see Corns, 2015). Moreover, it should be noted that the ambiguous use of the term “pain” with respect to different kinds of experiences might constitute a puzzle solely occurring in some languages, including English (Wierzbicka, 2012). Nonetheless, I will refer back to these affective states called social or empathic pains and their relation to experiences of bodily pain later on in Chapter 5.

1.1.2 Verbal Reports

Based on the previously outlined understanding of pain, a core set of uncontroversial pain cases seems to exist, upon which many researchers from opposite positions agree. Opinions diverge on a theory that adequately accounts for these cases. However, it is common ground that the discussed cases are pains of the relevant kind given that subjects experience them as pains from a first-person perspective. A methodological obstacle arises based on this understanding of pain. Although pain is commonly defined as a phenomenal experience, it is in itself hardly empirically accessible. Phenomenal experiences are not public research subjects in the sense that we have no direct third-person access to them. This is problematic, as most researchers, myself included, are interested in an empirically motivated account of pain which requires intersubjective access. Consequently, a functional indicator is needed which allows us to identify pain cases from an independent third-person perspective. We need to possess an instrument to identify instantiations of pain in different experimental settings before we can investigate it.

What appears to be the best functional indicator for addressing pain is when people report undergoing a phenomenal experience that they subjectively qualify as pain. Verbal reports are particularly precise in distinguishing pain from non-pain cases while being broad enough to cover a huge variety of those cases in which researchers are interested. Verbal reports offer an empirically accessible pragmatic approach which allows us to identify cases of pain. Three objections might immediately arise challenging the usefulness of this functional indicator.

First, one might ask how we can make sure people are reporting pain in the sense that they are referring to their phenomenal experience and not an objective bodily condition given that the meaning of the English term “pain” is ambiguous. This doubt can be easily dissolved. In those studies in which the intuitions of laypeople are tested, the participants have to make decisions of the following kind (e. g., Reuter and Sytsma, forthcoming; Sytsma, 2010): “Imagine a patient who is highly injured. During a certain period of time, she is distracted by an interesting conversation. Afterwards she reports that she has not felt any pain during this time. Do you think that the person had pain but just did not feel it or that the person had no pain at all?” Studies of this kind aim to show that people are willing to ascribe unfelt pain and that they refer to pain as a bodily condition. However, these examples make it quite clear that the described patient is not undergoing a phenomenal experience during the relevant time span.

The term “pain” might be ambiguous but this does not mean that subjects are unable to distinguish between the bodily or mental use of this term. Subjects engaging in an experimental study concerning the occurrence and character of pain experiences are able to report whether they feel pain and how it feels without being confused about the corresponding mental use of the term. Similarly, subjects do not confuse the use of the term “pain” in the distinction between bodily pain experiences and those experiences sometimes labeled as social or empathic pains. In contrast, I assume that subjects can adequately report what kind of experience they are undergoing. For example, when investigating patients in the ambulance about their pain, they report their bodily pains and do not refer to grief or empathy. Moreover, these issues might vanish as soon as we consider subjective reports in languages other than English.

Second, one might object that verbal reports presuppose the qualification of experiences as pain experiences while this qualification might rely solely on social conventions. Accordingly, subjects do not report pains as pains because they share a unique phenomenal character but because they have somehow learned to qualify a certain group of experiences as such. In my view, we have no good reason to believe that this is actually the case. It is uncontroversial that social aspects have an impact on pain experiences influencing, for example, the felt intensity in the light of a certain stimulus (e. g., Montoya et al., 2004; Wiech et al., 2008). This does not contradict the assumption that pains are qualified as pains due to their shared phenomenal character. It only means that the occurrence of pains partly relies on social factors. The best explanation for the fact that subjects qualify and report a certain class of experiences as (bodily) pains is that they share a phenom...

Table of contents

• Title Page
• Copyright
• Contents
• Introduction
• 1 Stage Setting
• 2 Synchronic Properties
• 3 Diachronic Properties
• 4 Family Resemblance
• 5 Conclusion
• Name Index
• Subject Index