Abstract
This paper disputes the theoretical assumptions of mainstream approaches in philosophy of pain, representationalism and imperativism, and advances an enactive approach as an alternative. It begins by identifying three shared assumptions in the mainstream approaches: the internalist assumption, the brain-body assumption, and the semantic assumption. It then articulates an alternative, enactive approach that considers pain as an embodied response to the situation. This approach entails the hypothesis of the sociocultural embeddedness of pain, which states against the brain-body assumption that the intentional character of pain depends on the agent’s sociocultural background. The paper then proceeds to consider two objections. The first questions the empirical basis of this hypothesis. It is argued based on neuroscientific evidence, however, that there is no empirical reason to suppose that the first-order experience of pain is immune to sociocultural influences. The second objection argues that the mainstream approaches can account for sociocultural influences on pain by drawing on the conceptual distinction between narrow and wide content. In response, the semantic conception of pain underpinning the proposal is challenged. Pain experience can occur in pre-reflective, affectively reflective, or cognitively reflective forms, but the semantic conception at most only applies to the last form. The paper concludes that the enactive approach offers a promising alternative framework in philosophy of pain.
Similar content being viewed by others
Notes
Tye also writes: “In my view, pains are patterns of active cells occurring in topographically structured 3-D arrays to which sentences are attached” (Tye 1995a, 232). Similarly, Dretske holds that pain experiences are “exactly in the same category” (1999, 117) as perceptual experiences, which in his account are “identified with internal states having properties (e.g., ) that make them awareness, experiences, of the properties (e.g., P) that external objects have” (1999, 115). Imperativists tend to be less explicit on this issue, but that they have no issue with internalism is fairly clear from their writings. For example, Klein explicitly develops imperativism to defend intentionalism about pain, that is, the thesis that the phenomenology of pain is fully explained by the intentional content of mental representations (Klein 2007, 2015).
I primarily discuss the cultural embeddedness of pain in the following, but I would like to use the term “sociocultural” to make it clear that the human environment in which we are embedded is not fully captured by the concept of culture. For instance, there are structures of our environment that can only be described by using social, economical, or political terms.
Determining which aspects of the two cultures account for the difference is a tricky issue. Brena et al. (1990) speculates that Japanese patients might be responding to low back pains the way they do because of “the traditional stoicism” characteristic of oriental societies or because of the quantity of “psychosocial support for a chronic pain patient” available in the society (123). Such question can only be resolved empirically, and hence the current proposal is not committed to any specific answer.
It has been suggested by one of the reviewers that proponents of the mainstream approaches might draw on the notion of “cognitive penetration” to account for sociocultural effects on pain experience. To my knowledge, no one has attempted so far to develop representationalist or imperativist accounts of pain in this direction, but I believe this will be a fruitful enterprise for the proponents of this view. In the end, however, I am not convinced that this will allow them to accommodate the sociocultural embeddedness of pain. A full treatment of the issue lies beyond the scope of this paper, but briefly, the reason for this doubt has to do with the nature of sociocultural backgrounds. On a standard definition, ‘cognitive penetration’ is a phenomenon in which cognitive states (such as beliefs, desires, and intentions) affect the content of perceptual experience (Macpherson 2012; Stokes 2013). But an individual’s sociocultural background is not exhausted by a network of cognitive states (Searle 1983; Dreyfus 2012). Accordingly, I find it unlikely for the effect of the sociocultural background on pain to be fully explained in terms of cognitive penetration.
For more discussion, see Geniusas (2017).
Ongaro and Ward (2017) advances an enactive account of placebo effects, which is congruent with the enactive approach to pain advanced in this paper. On their account, placebo treatments can induce changes both in attentional and (even surprisingly) in somatic states, or they “afford healing” (522), because of “the meaning we perceive them to have in virtue of our history of enculturated embodied interaction, and the fact that being intentionally directed towards a meaningful structure in the environment is a bodily and affective relation that entrains specific somatic and attentional patterns” (527).
See also Sartre (2003) who discusses this idea of pain prior to reflective act illustrating it with the famous example of the sore eye (331–9).
For more discussion, see Miyahara “Coping with pain and obeying commands” (under review).
References
Alabas, O., Tashani, O., Tabasam, G., & Johnson, M. (2012). Gender role affects experimental pain responses: a systematic review with meta-analysis. European Journal of Pain, 16(9), 1211–1223.
Bain, D. (2003). Intentionalism and pain. The Philosophical Quarterly, 53(213), 502–523.
Brena, S. F., Sanders, S. H., & Motoyama, H. (1990). American and Japanese chronic low Back pain patients: cross-cultural similarities and differences. The Clinical Journal of Pain, 6, 118–124.
Buytendijk, F. J. J. (1961). Pain (E. O’Shiel, Trans.). London: Hutchinson & Co.
Callister, L. C. (2003). Cultural influences on pain perceptions and behaviors. Home Health Care Management & Practice, 15(3), 207–211. https://doi.org/10.1177/1084822302250687.
Colombetti, G. (2014). The feeling body: Affective science meets the enactive mind. Cambridge: MIT Press.
Cutter, B., & Tye, M. (2011). Tracking representationalism and the painfulness of pain. Philosophical Issues, 21, 90–109. https://doi.org/10.1111/j.1533-6077.2011.00199.x.
De Jaegher, H., & Di Paolo, E. (2007). Participatory sense-making. Phenomenology and the Cognitive Sciences, 6(4), 485–507.
Dretske, F. (1999). The mind's awareness of itself. Philosophical Studies: An International Journal for Philosophy in the Analytic Tradition, 95(1–2), 103–124.
Dreyfus, H. L. (2012). Introductory essay: The mystery of the background qua background. In Z. Radman (Ed.), Knowing without thinking (pp. 1–10). London: Palgrave Macmillan.
Edwards, C. L., Fillingim, R. B., & Keefe, F. (2001). Race, ethnicity and pain. Pain, 94(2), 133–137.
Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L., III. (2009). Sex, gender, and pain: a review of recent clinical and experimental findings. The Journal of Pain, 10(5), 447–485.
Fuchs, T. (2017). Ecology of the brain: The phenomenology and biology of the embodied mind. Oxford: Oxford University Press.
Gallagher, S. (2017). Enactivist interventions: Rethinking the mind. Cambridge: MIT Press.
Geniusas, S. (2017). On pain, its stratification, and its alleged indefinability. Gestalt Theory, 39(2/3), 331–348. https://doi.org/10.1515/gth-2017-0023.
Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., et al. (2003). The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine, 4(3), 277–294.
Hall, R. J. (2008). If it itches, scratch! Australasian Journal of Philosophy, 86(4), 525–535.
Hutto, D. D. (2012). Exposing the background: Deep and local. In Z. Radman (Ed.), Knowing without thinking (pp. 37–56). London: Palgrave Macmillan.
Hutto, D. D., & Myin, E. (2017). Evolving Enactivism: Basic minds meet content. Cambridge: MIT Press.
Hutto, D. D., Gallagher, S., Ilundáin-Agurruza, J., & Hipólito, I. (forthcoming). Culture in mind - an enactivist account: Not cognitive penetration but cultural permeation. In L. J. Kirmayer, S. Kitayama, C. M. Worthman, R. Lemelson, & C. A. Cummings (Eds.), Culture, mind, and brain: Emerging concepts, models, applications. Cambridge: Cambridge University Press.
Klein, C. (2007). An imperative theory of pain. Journal of Philosophy, 104(10), 517–532.
Klein, C. (2015). What the body commands: The imperative theory of pain. Cambridge: MIT Press.
Lipton, J. A., & Marbach, J. J. (1984). Ethnicity and the pain experience. Social Science & Medicine, 19(12), 1279–1298.
Macpherson, F. (2012). Cognitive penetration of colour experience: rethinking the issue in light of an indirect mechanism. Philosophy and Phenomenological Research, 84(1), 24–62.
Martínez, M. (2011). Imperative content and the painfulness of pain. Phenomenology and the Cognitive Sciences, 10(1), 67–90.
Martínez, M., & Klein, C. (2016). Pain signals are predominantly imperative. Biology and Philosophy, 31(2), 283–298. https://doi.org/10.1007/s10539-015-9514-y.
Miller, C., & Newton, S. E. (2006). Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization. Pain Management Nursing, 7(4), 148–152.
Nayak, S., Shiflett, S. C., Eshun, S., & Levine, F. M. (2000). Culture and gender effects in pain beliefs and the prediction of pain tolerance. Cross-Cultural Research, 34(2), 135–151.
Noë, A. (2004). Action in perception. Cambridge: MIT press.
Ongaro, G., & Ward, D. (2017). An enactive account of placebo effects. Biology and Philosophy, 32(4), 507–533. https://doi.org/10.1007/s10539-017-9572-4.
Petrovic, P., Kalso, E., Petersson, K. M., & Ingvar, M. (2002). Placebo and opioid analgesia--imaging a shared neuronal network. Science, 295(5560), 1737–1740.
Regier, T., & Kay, P. (2009). Language, thought, and color: Whorf was half right. Trends in Cognitive Sciences, 13(10), 439–446.
Rippentrop, A. E., Altmaier, E. M., Chen, J. J., Found, E. M., & Keffala, V. J. (2005). The relationship between religion/spirituality and physical health, mental health, and pain in a chronic pain population. Pain, 116(3), 311–321.
Sartre, J.-P. (2003). Being and nothingness: An essay on phenomenological ontology (H. E. Barnes, Trans.). London: Routledge.
Scott, D. J., Stohler, C. S., Egnatuk, C. M., Wang, H., Koeppe, R. A., & Zubieta, J.-K. (2007). Individual differences in reward responding explain placebo-induced expectations and effects. Neuron, 55(2), 325–336.
Searle, J. R. (1983). Intentionality: An essay in the philosophy of mind. Cambridge: Cambridge University Press.
Stokes, D. (2013). Cognitive penetrability of perception. Philosophy Compass, 8(7), 646–663.
Thierry, G., Athanasopoulos, P., Wiggett, A., Dering, B., & Kuipers, J.-R. (2009). Unconscious effects of language-specific terminology on preattentive color perception. Proceedings of the National Academy of Sciences, 106(11), 4567–4570.
Thompson, E. (2007). Mind in life: Biology, phenomenology, and the sciences of the mind. Cambridge: Harvard University Press.
Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377–391.
Tye, M. (1995a). A representational theory of pains and their phenomenal character. Philosophical Perspectives, 9, 223–239. https://doi.org/10.2307/2214219.
Tye, M. (1995b). Ten problems of consciousness: A representational theory of the phenomenal mind. Cambridge: MIT Press.
Tye, M. (2005). Another look at representationalism about pain. In M. Aydede (Ed.), Pain: New essays on its nature and the methodology of its study (pp. 99–120). Cambridge: MIT Press.
Varela, F., Thompson, E., & Rosch, E. (1991). The embodied mind: Cognitive science and human experience. Cambridge: MIT Press.
Wachholtz, A. B., Pearce, M. J., & Koenig, H. (2007). Exploring the relationship between spirituality, coping, and pain. Journal of Behavioral Medicine, 30(4), 311–318.
Wager, T. D., Rilling, J. K., Smith, E. E., Sokolik, A., Casey, K. L., Davidson, R. J., et al. (2004). Placebo-induced changes in fMRI in the anticipation and experience of pain. Science, 303(5661), 1162–1167.
Wiech, K., Farias, M., Kahane, G., Shackel, N., Tiede, W., & Tracey, I. (2008). An fMRI study measuring analgesia enhanced by religion as a belief system. Pain, 139(2), 467–476.
Winawer, J., Witthoft, N., Frank, M. C., Wu, L., Wade, A. R., & Boroditsky, L. (2007). Russian blues reveal effects of language on color discrimination. Proceedings of the National Academy of Sciences, 104(19), 7780–7785.
Zborowski, M. (1952). Cultural components in responses to pain. Journal of Social Issues, 8(4), 16–30.
Acknowledgements
An earlier version of this paper was presented at the conference “Enactivism: Theory and Performance” at University of Memphis. I thank the audience for the helpful feedbacks on the presentation. I also thank Hayden Kee for reading and commenting on the manuscript. This work was funded by the ARC DP project “Minds in Skilled Performance: Explanatory Framework and Comparative Study” (DP170102987).
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Miyahara, K. Enactive pain and its sociocultural embeddedness. Phenom Cogn Sci 20, 871–886 (2021). https://doi.org/10.1007/s11097-019-09630-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11097-019-09630-9