Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)
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)
Postulating the subcortical organization of human consciousness provides a critical link for the construal of pain in patients with impaired cortical function or cortical immaturity during early development. Practical implications of the centrencephalic proposal include the redefinition of pain, improved pain assessment in nonverbal humans, and benefits of adequate analgesia/anesthesia for these patients, which certainly justify the rigorous scientific efforts required. (Published Online May 1 2007).
Though pain scientists now understand pain to be a complex experience typically composed of sensation, emotion, cognition, and motivational responses, many philosophers maintain that pain is adequately characterized by one privileged aspect of this complexity. Philosophically dominant unitary accounts of pain as a sensation or perception are here evaluated by their ability to explain actual cases—and found wanting. Further, it is argued that no forthcoming unitary characterization of pain is likely to succeed. Instead, I contend that both the motivating (...) intuitions behind unitary accounts and the wide range of pain phenomena are best accommodated by a componential view of pain that does not privilege any single component as necessary or sufficient. (shrink)
This paper examines pain states (and other intransitive bodily sensations) from the perspective of the problems they pose for pure informational/representational approaches to naturalizing qualia. I start with a comprehensive critical and quasi-historical discussion of so-called Perceptual Theories of Pain (e.g., Armstrong, Pitcher), as these were the natural predecessors of the more modern direct realist views. I describe the theoretical backdrop (indirect realism, sense-data theories) against which the perceptual theories were developed. The conclusion drawn is that pure representationalism about pain (...) in the tradition of direct realist perceptual theories (e.g., Dretske, Tye) leaves out something crucial about the phenomenology of pain experiences, namely, their affective character. I touch upon the role that introspection plays in such representationalist views, and indicate how it contributes to the source of their trouble vis-à-vis bodily sensations. The paper ends by briefly commenting on the relation between the affective/evaluative component of pain and the hedonic valence of emotions. (shrink)
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. (shrink)
This essay concerns what people should do in conflict situations when a doubt of fact bears on settling whether an alternative under consideration is legitimate or not. Its principal audience are those who believe that abortion can be legitimate when not having an abortion gives rise to serious harms that can be avoided by having one, but who are concerned that fetuses might feel pain when being aborted, and who believe that causing unnecessary pain should be avoided when doing so (...) would not pose an undue burden. The essay remains neutral on the substantive questions of the moral status of the unborn and the morality of abortion. The question of fetal pain has taken center stage in the last few years in the .. (shrink)
Affective and cognitive empathy are traditionally differentiated, the affective component being concerned with resonating with another’s emotional state, whereas the cognitive component reflects regulation of the resulting distress and understanding of another’s mental states (see Decety and Jackson, 2004 for a review). Adolescence is a critical period for the development of cognitive control processes necessary to regulate affective processes: it is only in young adulthood that these control processes achieve maturity (Steinberg, 2005). Thus, one should expect adolescents to show greater (...) automatic empathy than young adults. The present study aimed at exploring the neural correlates of affective (automatic) and cognitive empathy for pain from adolescence to young adulthood. With this aim, Event Related Potentials (ERPs) were recorded in 32 participants (aged 11 to 39) in a task designed to dissociate these components. ERPs results showed an early automatic frontocentral response to pain (that was not modulated by task demand) and a late parietal response to painful stimuli modulated by attention to pain cues. Adolescents exhibited earlier automatic responses to painful situations than young adults did and showed greater activity in the late cognitive component even when viewing neutral stimuli. Results are discussed in the context of the development of regulatory abilities during adolescence. (shrink)
When you suffer a pain are you suffering a sensation? An emotion? An aversion? Pain typically has all three components, and others too. There is indeed a distinct sensory system devoted to pain, with its own nociceptors and pathways. As a species of somesthesis, pain has a distinctive sensory organization and its own special sensory qualities. I think it is fair to call it a distinct sensory modality, devoted to nociceptive somesthetic discrimination. But the typical pain kicks off other processes (...) too. For one it can grab your attention in a distinctive way, alerting you to its presence and sometimes obliging you to focus attention on the damaged member. Intense pain can eliminate your ability to think about anything else. Pain typically has direct and immediate motivational consequences: one wants it to stop, has an incentive to do whatever one can to reduce it, and is gratified by its termination. As these desires and motives collide with neural reality, emotional components of mental anguish, anxiety, and dread arise. The suffering involved in suffering from pain has multiple strands: it is not just the painfulness of the sensation, or the frustration of the desire that it end, but also the anguish over the possibility that it will never end, and the impossibility, if the pain is sufficiently intense, of focusing one’s attention on anything else. (shrink)
It can seem natural to say that, when in pain, we undergo experiences which present to us certain experience-dependent particulars, namely pains. As part of his wider approach to mind and world, John McDowell has elaborated an interesting but neglected version of this account of pain. Here I set out McDowell’s account at length, and place it in context. I argue that his subjectivist conception of the objects of pain experience is incompatible with his requirement that such experience be presentational, (...) rationalizing, and classificatory. (shrink)
(1) I see a dark discoloration in the back of my hand. (2) I feel a jabbing pain in the back of my hand.
They seem to have the same surface grammar, and thus prima facie invite the same kind of semantic treatment. Even though a reading of ‘see’ in (1) where the verb is not treated as a success verb is not out of the question, it is not the ordinary and natural (...) reading. Note that if I am hallucinating a dark discoloration in the back of my hand, then (1) is simply false. For (1) to be true, therefore, I have to stand in the seeing relation to a dark discoloration in the back of my hand, i.e., to a certain surface region in the back of my hand marked by a darker shade of the usual color of my skin, a certain region that can be seen by others possibly in the same way in which I see it. Also note that although the truth of (1) doesn’t require the possession of any concept by me expressed by the words making up the sentence, my uttering of (1) to make a report typically does — if we take such utterances as expressions of one’s thoughts. So my seeing would typically induce me to identify something in the back of my hand as a dark discoloration. This is a typical case of categorization of something under a concept induced by perception. Of course, my uttering of (1) does more than attributing a physical property to a bodily region, it also reports that I am seeing it. (shrink)
It has been demonstrated that visual inputs can modulate pain. However, the influence of skin colour on pain perception is unknown. Red skin is associated to inflamed, hot and more sensitive skin while blue is associated to cold. We aimed to test whether the colour of the skin would alter the heat pain threshold. To this end, we used an immersive virtual environment where we induced embodiment of a virtual arm that was co-located with the real one and seen (...) from a first person perspective. Virtual reality allowed us to dynamically modify the colour of the skin of the virtual arm. In order to test pain threshold, increasing ramps of heat stimulation applied on the participants’ arm were delivered concomitantly with the gradual intensification of different colours on the embodied avatar’s arm. We found that a reddened arm significantly decreased the pain threshold compared with normal and bluish coloured skin. This effect was specific when red was seen in the arm, while seeing red in a spot outside the arm did not decrease pain threshold. These results demonstrate an influence of skin colour on pain perception. This top-down modulation of pain through visual input suggests a potential use of embodied virtual bodies for pain therapy. (shrink)
The pain case can 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, I argue. After categorising versions of pain intentionalism along two dimensions, I argue that an “objectivist” and “non-mentalist” version is the most promising, provided it can withstand two objections: concerning what we say when in pain, and the distinctiveness of the pain case. I rebut these objections, in a way that’s available (...) to both opponents and adherents of the view that experiential content is entirely conceptual. In doing so I illuminate peculiarities of somatosensory perception that should interest even those who take a different view of pain experiences. (shrink)
This paper is concerned with a quality space model as an account of the intelligibility of explanation. I argue that descriptions of causal or functional roles (Chalmers Levine, 2001) are not the only basis for intelligible explanations. If we accept that phenomenal concepts refer directly, not via descriptions of causal or functional roles, then it is difficult to find role fillers for the described causal roles. This constitutes a vagueness constraint on the intelligibility of explanation. Thus, I propose to use (...) quality space models to develop a systematic way of studying different modalities of perception and feelings, e.g., visual and auditory perception, pain, and emotion, that can reveal some structural relations among these modalities. It might turn out that topological explanation can be more intelligible than causal explanation in this case. I discuss two accounts of a quality space for color vision (Clark, 2000; Rosenthal, 2010) and propose how to construct a quality space for pain. Daniel Kostic is Associated Researcher at Berlin School of Mind and Brain. (shrink)
How far can one ascribe a spatial meaning to pain? When I have a pain, for instance, in my leg, how should one understand the “in” in the “pain in my leg”? I argue (contrary to Noordhof) that pain does have a spatial meaning, but (contrary to Tye) that the spatiality of pain is not to be understood in the standard sense of spatial enclosure. Instead, spatiality has a special meaning with regard to pain. By defining pain in phenomenological terms (...) as a disturbed form of bodily perception, I contend that the “in” in “pain in my body” has a dual spatial meaning: firstly, it signifies my internal perceptual relation to a disturbing part of my body; secondly, it denotes the external perceptual relation to my environment that the disturbance forces me to take. Once the spatiality of pain is understood in terms of such a perceptual relation, it is not restricted to localisable hurts, but pertains to all forms of pain, such as affliction and agony. South African Journal of Philosophy Vol. 25 (4) 2006: pp. 336-349. (shrink)
The aim of this study is to illuminate the significance of the long-term influence of bodily changes on the perception of self after stroke by means of narrative interviews with 23 stroke survivors. A phenomenological-hermeneutic approach inspired by the philosophy of Merleau-Ponty and Ricoeur is the methodological framework. Zahavi’s understanding of the embodied self and Leder’s concept of dys-appearance along with earlier research on identity guide the comprehensive understanding of the theme. The meaning of bodily changes after stroke can (...) be understood as living with an altered perception of self. Stroke survivors perceive their bodies as fragile, unfamiliar and unreliable and tend to objectify them. The weak and discomforting body that ‘cannot’ demands constant, comprehensive awareness to keep itself in play. These long-term and often permanent consequences of bodily weakness may turn stroke survivors’ intentionality inwards, away from external activities and projects and relationships with others. Negative judgements from others are added to lost roles and positions and threaten the vulnerable self. Stroke survivors try to regain familiarity with their body by their life-long project of testing its boundaries. Mastering important tasks helps them strengthen their self-concept. Health care workers should be aware of the embodied self and engage in long-term dialogues with stroke survivors to strengthen positive perceptions of body and self. More research is needed to understand destructive post-stroke phenomena such as fatigue and pain and to find effective methods to help stroke survivors regain wholeness of body and self. (shrink)
Despite the abundant data on brain networks processing static social signals, such as pictures of faces, the neural systems supporting social perception in naturalistic conditions are still poorly understood. Here we delineated brain networks subserving social perception under naturalistic conditions in 19 healthy humans who watched, during 3-tesla functional magnetic imaging (fMRI), a set of 137 short (~16 s each, total 27 min) audiovisual movie clips depicting pre-selected social signals. Two independent raters estimated how well each clip represented (...) eight social features (faces, human bodies, biological motion, goal-oriented actions, emotion, social interaction, pain, and speech) and six filler features (places, objects, rigid motion, people not in social interaction, non-goal-oriented action and non-human sounds) lacking social content. These ratings were used as predictors in the fMRI analysis. The posterior superior temporal sulcus (STS) responded to all social features but not to any non-social features, and the anterior STS responded to all social features except bodies and biological motion. We also found four partially segregated, extended networks for processing of specific social signals: 1) a fronto-temporal network responding to multiple social categories, 2) a fronto-parietal network preferentially activated to bodies, motion and pain, 3) a temporo-amygdalar network responding to faces, social interaction and speech, and 4) a fronto-insular network responding to pain, emotions, social interactions, and speech. Our results highlight the role of the posterior STS in processing multiple aspects of social information, as well as the feasibility and efficiency of fMRI mapping under conditions that resemble the complexity of real life. (shrink)
It is widely accepted that embodiment is crucial for any self-aware agent. What is less obvious is whether the body has to be real, or whether a virtual body will do. In that case the notion of embodiment would be so attenuated as to be almost indistinguishable from disembodiment. In this article I concentrate on the notion of embodiment in human agents. Could we be disembodied, having no real body, as brains-in-a-vat with only a virtual body? Thought experiments alone will (...) not suffice to answer this Cartesian question. I will draw on both philosophical arguments and empirical data on phantom phenomena. My argument will proceed in three steps. Firstly I will show that phantom phenomena provide a prima facie argument that real embodiment is not necessary for a human being. Secondly I will give a philosophical argument that real movement must precede the intention to move and to act. Agents must at least have had real bodies once. Empirical data seems to bear this out. Finally, however, I will show that a small number of aplasic phantom phenomena undermines this last argument. Most people must have had a real body. But for some people a partly virtual, unreal, phantom body seems to suffice. Yet though there is thus no knockdown argument that we could not be brains-in-a-vat, we still have good reasons to suppose that embodiment must be real, and not virtual. (shrink)
Several recent accounts claim that imagination is a matter of simulating perceptual acts. Although this point of view receives support from both phenomenological and empirical research, I claim that Jean-Paul Sartre's worry formulated in L'imagination (1936) still holds. For a number of reasons, Sartre heavily criticizes theories in which the sensory material of imaginative acts consists in reviving sensory impressions. Based on empirical and philosophical insights, this article explains how simulation theories of imagination can overcome Sartre's critique by paying attention (...) to the motor dimension of imagination. Intending to clarify the status of the sensory in imagination, a motor theory of imagination is presented in which the sensory component of imagination is interpreted in terms of anticipated sensory consequences of preparation for motor action. (shrink)
According to Williams, human facially expressed pain, and its perception by conspecifics, is generated by evolved mechanisms. We argue that a key variable – sex (male, female) – needs to be considered for a complete theory of pain expression and perception. To illustrate, we cite findings on sex differences in pain and pain perception, and in crying and crying responsiveness.