Online research in philosophy

How can a pain wake you up? You were not dreaming, nor did any bodily stimuli filter into your consciousness. You did not just wake up and realize you were in pain, as you might wake up and realize it is Saturday. You were deeply, dreamlessly asleep, and suddenly you were awake, and in pain. How is this possible? If pain exists only inasmuch as it is experienced, it seems that the pain did not exist when you were asleep, and so could not have woken you up. I shall argue that you were woken by a pain sensation that you did not know you had, so that the distinction between what is and what is known holds even for the contents of consciousness. This illuminates the relationship between consciousness and attention, and casts light on the Classical Empiricist tradition that identifies the foundations of knowledge with direct experience.

This paper investigates the status of the purported explanatory gap between pain phenomena and natural science, when the “gap” is thought to exist due to the special properties of experience designated by “qualia” or “the pain quale” in the case of pain experiences. The paper questions the existence of such a property in the case of pain by: (1) looking at the history of the conception of pain; (2) raising questions from empirical research and theory in the psychology of pain; (3) considering evidence from the neurophysiological systems of pain; (4) investigating the possible biological role or roles of pain; and (5) considering methodological questions of the comparable status of the results of the sciences of pain in contrast to certain intuitions underpinning “the explanatory gap” in the case of pain. Skepticism concerning the crucial underlying intuitions seems justified by these considerations.

Do animals other than humans feel pain? How do we know? Well, how do we know if anyone, human or nonhuman, feels pain? We know that we ourselves can feel pain. We know this from the direct experience of pain that we have when, for instance, somebody presses a lighted cigarette against the back of our hand. But how do we know that anyone else feels pain? We cannot directly experience anyone else's pain, whether that "anyone" is our best friend or a stray dog. Pain is a state of consciousness, a "mental event", and as such it can never be observed. Behavior like writhing, screaming, or drawing one's hand away from the lighted cigarette is not pain itself; nor are the recordings a neurologist might make of activity within the brain observations of pain itself. Pain is something that we feel, and we can only infer that others are feeling it from various external indications.

Many philosophers and cognitive scientists claim that our everyday or "folk" understanding of mental states constitutes a theory of mind. That theory is widely called "folk psychology" (sometimes "commonsense" psychology). The terms in which folk psychology is couched are the familiar ones of "belief" and "desire", "hunger", "pain" and so forth. According to many theorists, folk psychology plays a central role in our capacity to predict and explain the behavior of ourselves and others. However, the nature and status of folk psychology remains controversial.

Consider the general proposition that normally when people pain-behave they are in pain. Where a traditional philosopher like Mill tries to give an empirical proof of this proposition (the argument from analogy), Malcolm tries to give a transcendental proof. Malcolm’s argument is transcendental in that he tries to show that the very conditions under which we can have a concept provide for the application of the concept and the knowledge that the concept is truly as well as properly applied. The natural basis for applying the concept of pain to someone else is pain-behavior like groaning and crying out. To know that a person pain-behaving is in pain is to rule out countervailing circumstances (smiles, exaggerated cries, winks, absence of plausible cause, and so on). The basic move by Malcolm is to make these special conditions a function merely of the concept of pain.

This essay provides an explanation and interpretation of the undertreatment of pain by discussing some of the scientific, clinical, cultural, and philosophical aspects of this problem. One reason why pain continues to be a problem for medicine is that pain does not conform to the scientific approach to health and disease, a philosophy adopted by most health care professionals. Pain does not fit this philosophical perspective because (1) pain is subjective, not objective; (2) the causal basis of pain is often poorly understood; (3) pain is often regarded as a mere symptom, not as a disease; (4) there often are no magic bullets for pain; (5) pain does not fit the expert knowledge model. In order for health care professionals to do a better job of treating pain, some changes need to occur in medical philosophy, education, and practice.

The aim of this paper is to show that the empirical and conceptual constraints arising from the scientific research on pain phenomena should be taken into account in philosophical discussions concerning the nature and function of pain; otherwise, there is a good chance that philosophers will advocate too simplistic, confused or even outrightly mistaken theories or conceptions of pain. In order to prove this point, one of the most influential philosophical theories of pain—the so-called perceptual view of pain—is put to scrutiny in the light of the psychological, clinical and neurophysiological data coming from the field of pain research. More specifically, these data are presented in such a way as to show that the sensory quality or sensory aspect of pain is, contrary to the objectivistic claims of the perceptual view of pain, a necessary component of our total pain experience.

Pain is not a primitive sensory event but rather a complexperception and a process by which a person interacts with theinternal and external environments, constructs meaning, andengages in action. Because folk beliefs are central to meaning,folk concepts of pain play multiple causal roles in a painpatient's interaction with health care providers and others.In every case, the notion of pain is linked to a goal-directedbehavior that is useful to the person. The wide variation inconcepts of pain across individuals suffering with painunderscores the richness and complexity of the pain experience.In some cases involving chronic pain, the patient may form amaladaptive cluster of behaviors around the concept of pain.Patient beliefs and expectations are an important part of manychronic pain syndromes, and patients can benefit fromintervention directed at revising the individual's folk model of pain. Memetics offers a framework for identifying the memesthat patients hold and determining whether patient memes fitor clash with provider memes.

What follows raises objections to some arguments that claimthat a principle of applicability of ordinary pain talkconstrains developments in the pain sciences. A more apt pictureof lay use of pain language shows its non-theoretic character.Since instrumentalism and eliminativism are philosophical viewsabout the status of theories of pain, neither is a threatto clinical use of standard pain lingo. Perfected pain theoryis likely to enhance and improve pain language in clinicalsettings, should such theory find its way into popular ideasand talk of pain.