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. (shrink)
The “brain in a vat” thought experiment is presented and refuted by appeal to the intuitiveness of what the author informally calls “the eye for an eye principle”, namely: Conscious mental states typically involved in sensory processes can conceivably successfully be brought about by direct stimulation of the brain, and in all such cases the utilized stimulus field will be in the relevant sense equivalent to the actual PNS or part of it thereof. In the second section, four classic problems (...) of Functionalism are given novel solutions based on the inclusion of peripheral nervous processes as constituents of mental states: The mad pain problem, the problem of pseudo-normal vision, the China-brain problem, and the triviality problem. (shrink)
“Mad belief” (in analogy with Lewisian “mad pain”) would be a belief state with none of the causal role characteristic of belief—a state not caused or apt to have been caused by any of the sorts of events that usually cause belief and involving no disposition toward the usual behavioral or other manifestations of belief. On token-functionalist views of belief, mad belief in this sense is conceptually impossible. Cases of delusion—or at least some cases of delusion—might be cases of (...) belief gone half-mad, cases in which enough of the functional role characteristic of belief is absent that the subject is in an “in-between” state regarding the delusive content, such that it is neither quite right to say the subject determinately believes the delusive content nor quite right to say that she determinately fails to believe that content. Although Bortolotti (2010) briefly mentions such “sliding scale” approaches to the relationship of delusion and belief, she dismisses such approaches on rather thin grounds and then later makes some remarks that seem consonant with sliding scale approaches. (shrink)
Tom Six’s The Human Centipede (First Sequence) (2009) and The Human Centipede II (Full Sequence) (2011) are based on a disturbing premise: people are abducted and stitched together mouth-to-anus. The consequent combinations of faeces and bloodshed, torture and degradation have been roundly vilified by the critical press. Additionally, the sequel was officially banned or heavily censored in numerous countries. This article argues that these reactive forms of suppression fail to engage with the films themselves, or the concepts (such as disgust (...) and offense) on which those judgements are made. Six’s films are far more sophisticated than has been accounted for. These films wear their generic lineage on their grimy sleeves, contextualising conventional motifs such as the mad scientist archetype against contemporary cultural anxieties regarding the body, sex and violence. Furthermore, Six’s constructed persona exposes the interplay between commercial success, grotesquery and censoriousness as a cyclic system that can be abused. Thus, the series epitomises how repulsion can be strategically utilised. Six anticipates his detractors’ offense, and disarms them of their ability to critique his films without adding to their notoriety. The Human Centipede films demonstrate how controversy can be tactically generated to create meaning. (shrink)
Fleshing out Ramsey-sentence functionalism; against Lewis's "mad pain" mixed theory; relating functionalism to the causal theory of properties. Empirical functionalism is chauvinistic so probably false. A terrific, in-depth paper.
Opponents to consciousness in fish argue that fish do not feel pain because they do not have a neocortex, which is a necessary condition for feeling pain. A common counter-argument appeals to the multiple realizability of pain: while a neocortex might be necessary for feeling pain in humans, pain might be realized differently in fish. This paper argues, first, that it is impossible to find a criterion allowing us to demarcate between plausible and implausible cases (...) of multiple realization of pain without running into a circular argument. Second, opponents to consciousness in fish cannot be provided with reasons to believe in the multiple realizability of pain. I conclude that the debate on the existence of pain in fish is impossible to settle by relying on the multiple realization argument. (shrink)
Over recent decades, pain has received increasing attention as – with ever greater sophistication and rigour – theorists have tried to answer the deep and difficult questions it poses. What is pain’s nature? What is its point? In what sense is it bad? The papers collected in this volume are a contribution to that effort ...
Evaluativism is best thought of as a way of enriching a perceptual view of pain to account for pain’s unpleasantness or painfulness. Once it was common for philosophers to contrast pains with perceptual experiences (McGinn 1982; Rorty 1980). It was thought that perceptual experiences were intentional (or content-bearing, or about something), whereas pains were representationally blank. But today many of us reject this contrast. For us, your having a pain in your toe is a matter not of (...) your sensing “pain-ly” or encountering a sense-datum, but of your having an interoceptive experience representing (accurately or inaccurately) that your toe is in a particular experience-independent condition, such as undergoing a certain “disturbance” or being damaged or in danger (Armstrong 1962; Tye 1995). But even if such representational content makes an experience a pain, a further ingredient seems required to make the pain unpleasant. According to evaluativism, the further ingredient is the experience’s possession of evaluative content: its representing the bodily condition as bad for the subject. In this chapter, I elaborate evaluativism, locate it among alternatives, and explain its attractions and challenges. (shrink)
In this paper we1 assess the potential for research on nonhuman animals to address questions about the phenomenology of painful experiences. Nociception, the basic capacity for sensing noxious stimuli, is widespread in the animal kingdom. Even rel- atively primitive animals such as leeches and sea slugs possess nociceptors, neurons that are functionally specialized for sensing noxious stimuli (Walters 1996). Vertebrate spinal cords play a sophisticated role in processing and modulating nociceptive signals, providing direct control of some motor responses to noxious (...) stimuli, and a basic capacity for Pavlovian and instrumental conditioning (Grau et al. 1990; Grau 2002). Higher brain systems provide additional layers of association, top-down control, and cognition. In humans, at least, these higher brain systems also give rise to the conscious experiences that are characteristic of pain. What can be said about the experiences of other animals who possess nervous systems that are similar but not identical to humans? (shrink)
This essay argues that the representation of pain in Beckett’s writing exposes the paradox in his work concerning the relationship of the individual suffering subject and the community. Making reference to studies of pain and literature generally and to salient studies of Beckett, the essay shows how the narration of pain in Beckett’s prose works in particular is closely linked to its more general interrogation of subject-object relations. As the preeminent agent, source as well as repository of (...)pain, writing in Beckett itself comes to occupy, in a transpositional manner, the poles of subject, object and work. If ‘pain’ names the subject-object continuum, that very conjunction exposes the co-habitants to their own mutual espacement – qua subject and object. The common feeling is countermanded in advance by separation. The conjunction gives rise to a sapping, devastating and agonising attempt to conjure an image, an image which holds out the possibility of the felicity, or at least palliation, offered by community. The image is, however, both a wounding regime and a generative regime. The two components, pain and community, are illustrated with specific reference to Texts for Nothing, through an analysis of which a new conjuncture of the themes of pain, community and the role of the work of art is proposed. (shrink)
Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire medication-like (...) effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. (shrink)
[Penultimate draft] I present the perceptualist/representationalist theories of pain in broad outline and critically examine them in light of a competing view according to which awareness of pain is essentially introspective. I end the essay with a positive sketch of a naturalistic proposal according to which pain experiences are intentional but not fully representational. This proposal makes sense of locating pains in body parts as well as taking pains as subjective experiences.
This chapter defends an axiological theory of pain according to which pains are bodily episodes that are bad in some way. Section 1 introduces two standard assumptions about pain that the axiological theory constitutively rejects: (i) that pains are essentially tied to consciousness and (ii) that pains are not essentially tied to badness. Section 2 presents the axiological theory by contrast to these and provides a preliminary defense of it. Section 3 introduces the paradox of pain and (...) argues that since the axiological theory takes the location of pain at face value, it needs to grapple with the privacy, self-intimacy and incorrigibility of pain. Sections 4, 5 and 6 explain how the axiological theory may deal with each of these. (shrink)
Understanding the nature of pain depends, at least partly, on recognizing its subjectivity (thus, its first-person epistemology). This in turn requires using a first-person experiential method in addition to third-person experimental approaches to study it. This paper is an attempt to spell out what the former approach is and how it can be integrated with the latter. We start our discussion by examining some foundational issues raised by the use of introspection. We argue that such a first-person method in (...) the scientific study of pain (as in the study of any experience) is in fact indispensable by demonstrating that it has in fact been consistently used in conjunction with conventional third-person methodologies, and this for good reasons. We show that, contrary to what appears to be a widespread opinion, there is absolutely no reason to think that the use of such a first-person approach is scientifically and methodologically suspect. We distinguish between two uses of introspective methods in scientific experiments: one draws on the subjects’ introspective reports where any investigator has equal and objective access. The other is where the investigator becomes a subject of his own study and draws on the introspection of his own experiences. We give examples using and/or approximating both strategies that include studies of second pain summation and its relationship to neural activities, and brain imaging- psychophysical studies wherein sensory and affective qualities of pain are correlated with cerebral cortical activity. We explain what we call the experiential or phenomenological approach that has its origins in the work of Price and Barrell (1980). This approach capitalizes on the scientific prospects and benefits of using the introspection of the investigator. We distinguish between its vertical and horizontal applications. Finally, we conclude that integrating such an approach to standard third-person methodologies can only help us in having a fuller understanding of pain and of conscious experience in general. (shrink)
There seem to be two kinds of pain: fundamental pain, the intensity of which is a direct function of the intensity of various pain stimuli, and pain, the intensity of which is highly modifiable by such factors as hypnotism, placebos, and the sociocultural setting in which the stimulus occurs.
This chapter (from Routledge's forthcoming handbook on the philosophy of pain) considers the question of whether people are always correct when they judge themselves to be in pain, or not in pain. While I don't show sympathy for traditional routes to the conclusion that people are "incorrigible" in their pain judgments, I explore--and perhaps even advocate--a different route to such incorrigibility. On this low road to incorrigibility, a sensory state's being judged unpleasant is what makes it (...) a pain (or not). (shrink)
This is a Letter to Editor of _Pain_ recommending revision of a pain term ('nociplastic pain') recently added to the IASP Pain Terms. (With a response from the Taxonomy Committee, Eva Kosek et al. PAIN: June 2018 - Volume 159 - Issue 6 - p 1177–1178 doi: 10.1097/j.pain.0000000000001185).
Can we find necessary and sufficient conditions for a mental state to be a pain state? That is, does pain have a nature? Or is the term ‘pain’ ambiguous? I argue here that our expression ‘pain’ lacks necessary use conditions if one considers a range of contexts. As use conditions constrain the reference class, I argue that ‘pain’ does not refer to a natural category, but binds together a bunch of loosely resembling phenomena. This leads (...) to problems for scientific and clinical discourse. To solve these, a method of explication is suggested, based on a discursive combination between analysis of first-person reports and theories of natural science. Lastly, I consider the ethical implications of this ambiguity that lead to a reformulation of the goal of pain science: Not alleviation of all pains ought to be our goal, but only manipulation of conscious and negatively emotionally charged pains. (shrink)
[DOI: 10.1097/j.pain.0000000000000765] Amanda Williams and Kenneth Craig, in a recent article in the IASP official journal _Pain_ (DOI: 10.1097/j.pain.0000000000000613), have argued that it is time to revise the IASP's well-entrenched definition of 'pain'. They propose an alternative definition. We critically discuss their proposed revision and argue that it admits clear counterexamples as both sufficient and necessary conditions. We further discuss the wisdom of replacing 'unpleasant' in the IASP definition with 'distress' as Williams and Craig propose. [Craig and (...) Williams respond to our criticism in DOI: 10.1097/j.pain.0000000000000766]. (shrink)
Consider the following two sentences: " I see a dark discoloration in the back of my hand. 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 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 is simply false. For 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 doesn’t require the possession of any concept by me expressed by the words making up the sentence, my uttering of 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 does more than attributing a physical property to a bodily region, it also reports that I am seeing it. (shrink)
Michael Tye and I are both Representationalists. Nevertheless, we have managed to disagree about the semantic character of ‘in’ in ‘There is a pain in my fingertip’ (see Noordhof (2001); Tye (2002); Noordhof (2002)). The first section of my commentary will focus on this disagreement. I will then turn to the location of pain. Here, perhaps somewhat surprisingly, there seems to be much more agreement between Tye and me. I restrict myself to three points. First, I argue that (...) Tye has not succeeded in providing a decisive consideration against a related theory which takes pains as representationally unmediated objects of pain experiences. Second, I defend Tye against an objection from Murat Aydede. Third, following on from this, I question whether Tye’s characterisation of the content of pain experience is correct. The fact that there is so much to discuss is a testament to richness, interest and exemplary clarity of Tye’s work. (shrink)
Michael Tye argues for two crucial theses: (1) that experiences of pain have representational content (essentially); (2) that the representational content can be specified in terms of something like damage in parts of the body. (Different types of pain are connected with different types of damage.) I reject both of these theses. In my view experiences of pain carry nonconceptual content, but do not represent essentially. Rather they are apt to represent when the subject attends to them. (...) The experiences carry nonconceptual content not only about tissue damage, but about many other qualities as well, including dispositional qualities. (shrink)
Part philosophical meditation, part cultural critique, The Body in Pain is a profoundly original study that has already stirred excitement in a wide range of intellectual circles. The book is an analysis of physical suffering and its relation to the numerous vacabularies and cultural forces--literary, political, philosophical, medical, religious--that confront it. Elaine Scarry bases her study on a wide range of sources: literature and art, medical case histories, documents on torture compiled by Amnesty International, legal transcripts of personal injury (...) trials, and military and strategic writings by such figures as Clausewitz, Churchill, Liddell Hart, and Kissinger, She weaves these into her discussion with an eloquence, humanity, and insight that recall the writings of Hannah Arendt and Jean-Paul Sartre. Scarry begins with the fact of pain's inexpressibility. Not only is physical pain enormously difficult to describe in words--confronted with it, Virginia Woolf once noted, "language runs dry"--it also actively destroys language, reducing sufferers in the most extreme instances to an inatriculate state of cries and moans. Scarry analyzes the political ramifications of deliberately inflicted pain, specifically in the cases of torture and warfare, and shows how to be fictive. From these actions of "unmaking" Scarry turns finally to the actions of "making"--the examples of artistic and cultural creation that work against pain and the debased uses that are made of it. Challenging and inventive, The Body in Pain is landmark work that promises to spark widespread debate. About the Author: Elaine Scarry is Associate Professor of English at the University of Pennsylvania. (shrink)
Should people include beef in their diet? This chapter argues that the answer is “no” by reviewing what is known and not known about the presence in cattle of three psychological traits: pain, desire, and self-consciousness. On the basis of behavioral and neuroanatomical evidence, the chapter argues that cattle are sentient beings who have things they want to do in the proximal future, but they are not self-conscious. The piece rebuts three important objections: that cattle have injury information but (...) not pain; that cattle have goal-directed behavior but not desire; and that the absence of evidence for bovine self-consciousness should not be taken as evidence that cattle lack self-consciousness. In sum, what is known about cattle cognition shifts the moral burden of proof on to the beef eaters. (shrink)
Representationalist theories of phenomenal consciousness have problems in accounting for pain, for at least two reasons. First of all, the negative affective phenomenology of pain (its painfulness) does not seem to be representational at all. Secondly, pain experiences are not transparent to introspection in the way perceptions are. This is reflected, e.g. in the fact that we do not acknowledge pain hallucinations. In this paper, I defend that representationalism has the potential to overcome these objections. Defenders (...) of representationalism have tried to analyse every kind of phenomenal character in terms of indicative contents. But there is another possibility: Affective phenomenology, in fact, depends on imperative representational content. This provides a satisfactory solution to the aforementioned difficulties. (shrink)
Sometimes the philosophical armchair gets bumped by empirical facts. So it is when thinking about pain. For good or ill (good, actually, as we shall see) most of us are intimately acquainted with physical pain, the kind you feel when you stand on a nail or burn your hand. And, from the armchair, it can seem blindingly obvious that pain is essentially unpleasant. There are of course unpleasant experiences that aren’t pains – nausea or itches, for example (...) – but surely there aren’t pains that don’t hurt, pains that are neutral or even pleasurable rather than unpleasant. Surely, indeed, there couldn’t be. For it is part of the very concept of a pain that a pain be unpleasant. Or so it has seemed to many. Yet over recent decades philosophers’ confidence in these putative truisms has been shaken by some fascinating cases from the clinic, the lab, and life. (shrink)
Since nothing about God is passive, and the perception of pain is inherently passive, then it seems that God does not know what it is like to experience pain. Nor would he be able to cause us to experience pain, for his experience would then be a sensation (which would require God to have senses, which he does not). My suggestion is that Berkeley avoids this situation by describing how God knows about pain “among other things” (...) (i.e. as something whose identity is intelligible in terms of the integrated network of things). This avoids having to assume that God has ideas (including pain) apart from his willing that there be perceivers who have specific ideas that are in harmony or not in harmony with one another. (shrink)
That all pleasure is good and all pain bad in itself is an eternally true ethical principle. The common claim that some pleasure is not good, or some pain not bad, is mistaken. Strict particularism (ethical decisions must be made case by case; there are no sound universal normative principles) and relativism (all good and bad are relative to society) are among the ethical theories we may refute through an appeal to pleasure and pain. Daniel Dennett, Philippa (...) Foot, R M Hare, Gilbert Harman, Immanuel Kant, J. L. Mackie, and Jean-Paul Sartre are among the many philosophers addressed. (shrink)
This paper argues that pleasure and pains are not qualia and they are not to be analyzed in terms of supposedly antecedently intelligible mental states like bodily sensation or desire. Rather, pleasure and pain are char- acteristic of a distinctive kind of evaluation that is common to emotions, desires, and (some) bodily sensations. These are felt evaluations: pas- sive responses to attend to and be motivated by the import of something impressing itself on us, responses that are nonetheless simultaneously (...) con- stitutive of that import by virtue of the broader rational patterns of which they are a part and that they serve to de?ne. This account of felt eval- uations makes sense of the way in which pleasures and pains grab our attention and motivate us to act and of the peculiar dual objectivity and subjectivity of their implicit evaluations, while o?ering a phenomenology adequate to both emotional and bodily pleasures and pains. (shrink)
Which nonhuman animals experience conscious pain?1 This question is central to the debate about animal welfare, as well as being of basic interest to scientists and philosophers of mind. Nociception—the capacity to sense noxious stimuli—is one of the most primitive sensory capacities. Neurons functionally specialized for nociception have been described in invertebrates such as the leech Hirudo medicinalis and the marine snail Aplysia californica (Walters 1996). Is all nociception accompanied by conscious pain, even in relatively primitive animals such (...) as Aplysia, or is it the case, as some philosophers continue to maintain, that conscious experiences are the exclu- sive province of human beings? What philosophical and scientific resources are presently available for assessing claims lying between these extremes? (shrink)
Pain, crucially, is unpleasant and motivational. It can be awful; and it drives us to action, e.g. to take our weight off a sprained ankle. But what is the relationship between pain and those two features? And in virtue of what does pain have them? Addressing these questions, Colin Klein and Richard J. Hall have recently developed the idea that pains are, at least partly, experiential commands—to stop placing your weight on your ankle, for example. In this (...) paper, I reject their accounts. Against Klein, I use dissociation cases to argue that possession of ‘imperative content’ cannot wholly constitute pain. Against them both, I further claim that possession of such content cannot even constitute pain’s unpleasant, motivational aspect. For, even if it were possible to specify the relevant imperative content—which is far from clear—the idea of a command cannot bear the explanatory weight Klein and Hall place on it. (shrink)
What does feeling a sharp pain in one's hand have in common with seeing a red apple on the table? Some say not much, apart from the fact that they are both conscious experiences. To see an object is to perceive an extramental reality -- in this case, a red apple. To feel a pain, by contrast, is to undergo a conscious experience that doesn't necessarily relate the subject to an objective reality. Perceptualists, however, dispute this. They say (...) that both experiences are forms of perception of an objective reality. Feeling a pain in one's hand, according to this view, is perceiving an objective condition of one's hand. Who is closer to truth? Because of such metaphysical issues, the subjectivity of pains combined with their clinical urgency raises methodological problems for pain scientists. How can a subjective phenomenon be studied objectively? What is the role of the first-person method in science? Some suggest that the subjectivity of pains is due to their metaphysical irreducibility to purely physical processes in the nervous system. Can this be true? The study of pain and its puzzles offers opportunities for understanding such larger issues as the place of consciousness in the natural order and the methodology of psychological research. In this book, leading philosophers and scientists offer a wide range of views on how to conceptualize and study pain. The essays include discussions of perceptual and representationalist accounts of pain; the affective-motivational dimension of pain; whether animals feel pain, and how this question can be investigated; how social pain relates to physical pain; whether first-person methods of gathering data can be integrated with standard third-person methods; and other methodological and theoretical issues in the science and philosophy of pain. (shrink)
The aim of this article is to explore nuances within the field of bodily self-awareness. My starting-point is phenomenological. I focus on how the subject experiences her or his body, i.e. how the body stands forth to the subject. I build on the phenomenologist Drew Leder’s distinction between bodily dis-appearance and dys-appearance. In bodily dis-appearance, I am only prereflectively aware of my body. My body is not a thematic object of my experience. Bodily dys-appearance takes place when the body appears (...) to me as “ill” or “bad.” This is often the case when I experience pain or illness. Here, I will examine three versions of bodily dys-appearance. Whereas many phenomenological studies have explored cases of bodily dys-appearance, few studies have focused on the opposite of bodily dys-appearance, i.e. on bodily modes of being where the body appears to the subject as something good, easy or well. This is done in this article. When the body stands forth as good, easy or well to the subject, I suggest that the body eu-appears to this person. The analysis of eu-appearance shows that the subject can attend to her or his body as something positive and that this attention need not result in discomfort or alienation. Eu-appearance can take place in physical exercise, in sexual pleasure and in some cases of wanted pregnancies. I also discuss, briefly, the case of masochism. (shrink)
Functionalism of robot pain claims that what is definitive of robot pain is functional role, defined as the causal relations pain has to noxious stimuli, behavior and other subjective states. Here, I propose that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. I argue that what makes a state pain for a neuro-robot at a time is the functional role it has in the robot at the time, and (...) this state is type identical to a specific circuit state. Support from an experimental study shows that if the neural network that controls a robot includes a specific 'emotion circuit', physical damage to the robot will cause the disposition to avoid movement, thereby enhancing fitness, compared to robots without the circuit. Thus, pain for a robot at a time is type identical to a specific circuit state. (shrink)
In this article I clarify the concepts of ‘pain’, ‘suffering’. ‘pains of body’, ‘pains of soul’. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis. treatment and research. Next, there is (...) the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfihing these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if anv, should override the right to refuse treatment where pain relief is of paramount concern. (shrink)
Recent work on signaling has mostly focused on communication between organisms. The Lewis–Skyrms framework should be equally applicable to intra-organismic signaling. We present a Lewis–Skyrms signaling-game model of painful signaling, and use it to argue that the content of pain is predominantly imperative. We address several objections to the account, concluding that our model gives a productive framework within which to consider internal signaling.
It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With regard (...) to the qualia theory, we argue that it fails to capture the sense in which pain 's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain 's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain 's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)
Recent results from the neurosciences demonstrate that pleasure and pain are not two symmetrical poles of a single scale of experience but in fact two different types of experiences altogether, with dramatically different contributions to well-being. These differences between pleasure and pain and the general finding that “the bad is stronger than the good” have important implications for our treatment of nonhuman animals. In particular, whereas animal experimentation that causes suffering might be justified if it leads to the (...) prevention of more suffering, it can never by justified merely by leading to increased levels of happiness. (shrink)
It is widely held that it is only contingent that the sensation of pain is disliked, and that when pain is not disliked, it is not intrinsically bad. This conjunction of claims has often been taken to support a subjectivist view of pain’s badness on which pain is bad simply because it is the object of a negative attitude and not because of what it feels like. In this paper, I argue that accepting this conjunction of (...) claims does not commit us to this subjectivist view. They are compatible with an objectivist view of pain’s badness, and with thinking that this badness is due to its phenomenal quality. Indeed, I argue that once the full range of options is in view, the most plausible account of pain is incompatible with subjectivism about value. (shrink)
Pain is commonly explained in terms of the perceptual activity of a distinct sensory modality, the function of which is to enable us to perceive actual or potential damage to the body. However, the characterization of pain experience in terms of a distinct sensory modality with such content is problematic. I argue that pain is better explained as occupying a different role in relation to perception: to indicate when the stimuli that are sensed in perceiving anything by (...) means of a sensory modality exceed a significant level of intensity. Viewing the system underlying pain experience as an integral and functionally integrated feature of all the senses provides a new perspective on the diverse forms of pain, what it is like to experience pain and the contrasting natures of pain and pleasure. (shrink)
This article develops a phenomenological exploration of chronic pain from a first-person perspective that can serve to enrich the medical third-person perspective. The experience of chronic pain is found to be a feeling in which we become alienated from the workings of our own bodies. The bodily-based mood of alienation is extended, however, in penetrating the whole world of the chronic pain sufferer, making her entire life unhomelike. Furthermore, the pain mood not only opens up the (...) world as having an alien quality, it also makes the world more lonesome and poor by forcing the sufferer to attend to the workings of her own body. To suffer pain is to find oneself in a situation of passivity in relation to the hurtful experiences one is undergoing. In making the body and the world more unhomelike places to be in, pain also tends to rob a person of her language. Severe pain is hard to describe because it pushes the person towards the borderlines of imaginable experience and because it makes it hard to see any meaning and purpose in the situation one has been forced into. The analysis of chronic pain in the article is guided by the attempts made by Maurice Merleau-Ponty, Jean-Paul Sartre, and Martin Heidegger to understand the nature of human embodiment and existence, and also by descriptions of chronic pain found in the Swedish author Lars Gustafsson’s novel The Death of a Beekeeper. (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)
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)
Throughout the Western world people turn towards the health care system seeking help for a variety of psychosomatic/psychosocial health problems. They become “patients” and find themselves within a system of practises that conceptualizes their bodies as “objective” bodies, treats their ill health in terms of the malfunctioning machine, and compartmentalizes their lived experiences into medically interpreted symptoms and signs of underlying biological dysfunction. The aim of this article is to present an alternative way of describing ill health and rehabilitation using (...) the philosophy of Maurice Merleau-Ponty in order to deepen our understanding of the rehabilitation process. I will explore how the experience of chronic pain ruptures the natural connection between body and world and how the rehabilitation process can be understood as the re-insertion of the body into the flow of experience, where the body “disappears” into its natural silence in order to allow the world to once again unfold. The experience of chronic pain places the painful body in focus, resulting in a diminished articulation of both self and world. Persons with illness suffer not only from the physical aspects of pain and discomfort but also from a loss of identity where one feels alienated and detached from things that used to give meaning to ones life. Rehabilitation must not only address the material (medical) body but also the diminished sense of self as well as the retreat from the world outside of the painful body. (shrink)
We present an ontology of pain and of other pain-related phenomena, building on the definition of pain provided by the International Association for the Study of Pain (IASP). Our strategy is to identify an evolutionarily basic canonical pain phenomenon, involving unpleasant sensory and emotional experience based causally in localized tissue damage that is concordant with that experience. We then show how different variant cases of this canonical pain phenomenon can be distinguished, including pain (...) that is elevated relative to peripheral trauma, pain that is caused neuropathically (thus with no necessary peripheral stimulus), and pain reports arising through deception either of self or of others. We describe how our approach can answer some of the objections raised against the IASP definition, and sketch how it can be used to support more sophisticated discrimination of different types of pain resulting in improved data analysis that can help in advancing pain research. (shrink)