Online research in philosophy

A functional interpretation of facial expressions of pain is welcome. Facial expressions of pain may be useful not only for communication, such as inviting help. They may also be of direct use, as parts of writhing pain behavior patterns, serving to get rid of pain stimuli and/or to suppress pain sensations by something akin to hyperstimulation analgesia.

In Stephanie Beardman's discussion of the empirical results of Kahneman and Tversky and Kahneman, et al. on pain preference and rational utility decision she argues that an interpretation of these results does not require that false memory for pain episodes yields irrational preferences for future pain events. I concur with her conclusion and suggest that there are reasons from within the pain sciences for agreeing with Beardman's reinterpretation of the Kahneman, et al. data. I cite some of these theoretical and empirical reasons. I engage in some speculation as to why preferences for pain experiences, which harbor the Peak and Ending profile, make biological sense. Given the results from the pain sciences and the clinical practices based in them, I conclude that the medical ethical issue Kahneman raises and Beardman tries to solve is not a pressing moral demand on medical practitioners.

The point of departure for this essay is the question of why pain is seriously undertreated in the United States. Some kinds of pain (for example, chronic nonmalignant pain) are treated worse than others (acute pain secondary to cancer), but there is excellent evidence that no matter what kind of pain, astonishingly large percentages of pain sufferers are undertreated (Furrow 2001; Hill 1995; Kirou-Mauro et al. 2009; Martino 1998; Morris 1991; NCHS 2006; Resnik, Rehm, and Minard 2001). Although some kinds of pain are difficult to treat, we generally possess the technical armamentarium to significantly ameliorate the vast majority of pain experiences. Yet we do not. And, for as long as anyone in the United States ..

As a product of natural selection, pain behavior must serve an adaptive function for the species beyond the accurate portrayal of the pain experience. Pain behavior does not simply refer to the pain experience, but promotes survival of the species in various and complex ways. This means that there is no purely respondent or operant pain behavior found in nature.

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.

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.

Functionalism cannot accommodate the possibility of mad pain—pain whose causes and effects diverge from those of the pain causal role. This is because what it is to be in pain according to functionalism is simply to be in a state that occupies the pain role. And the identity theory cannot accommodate the possibility of Martian pain—pain whose physical realization is foot-cavity inflation rather than C-fibre activation (or whatever physiological state occupies the pain-role in normal humans). After all, what it is to be in pain according to the identity theory is to be in whatever state that occupies the pain role for us.

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.