[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.

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)

Pain assessment in fish is particularly challenging due toBioscience Building, Liverpool, L69 7ZB their evolutionary distance from humans, their lack of audible vocalization, and apparently expressionless demeanour. However, there are criteria that can be used to gauge whether pain perception occurs using carefully executed scientific approaches. Here, the standards for pain in fish are discussed and can be considered in three ways: neural detection and processing of pain; adverse responses to pain; and consciously experiencing (...) pain. Many procedures that we subject fish to cause tissue damage and may give rise to the sensation of pain. Fish are popular as pets, in animal exhibits, and as experimental models, but are also cultured or caught for food. There is little legislation for the protection of fish welfare. Many countries are now exploring the welfare cost to fish, and current practices may need to be reviewed with respect to the current evidence for fish perceiving pain. (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)

I argue that pain sensations are perceptual states, namely states that represent (actual or potential) damage. I defend this position against the objection that pains, unlike standard perceptual states, do not allow for an appearance-reality distinction by arguing that in the case of pain as well as in standard perceptual experiences, cognitive penetration or malfunctions of the underlying sensory systems can lead to a dissociation between the sensation on the one hand, and what is represented on the other (...) hand. Moreover, I refute the objection that the allegedly weak correlation between pain and bodily damage forces intentionalist accounts of pain to postulate so many malfunctions (misrepresentations respectively) that such accounts become implausible. I also rebut Murat Aydede’s objection that our linguistic practice supposedly shows that there is a conceptual difference between standard perceptual experiences and pain sensations by challenging Aydede’s premise that we always withdraw standard perceptual reports in case of counterevidence, while we never do that with pain reports. At the end, I propose an explanation as to why we do not express perceptual reports of (potential) bodily damage in objectivist, but in mental terms. (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)

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).

The topic of pain and suffering is complex and requires a holistic vision. This article begins by clarifying concepts to understand pain as a biological, psychological, and social phenomenon that has an evolutionary history whose maximum expression arises in humans. Established this common ground, it explores altruism and animal cooperation as incipient phenomena of care for the other, though contextual. Then it points out that the difference with humans is that they perceive caring for the weak, innocent, and (...) marginalized as a moral duty and a path of personal flourishing. Finally, in the face of human weakness and from Christian theology, God shows with deeds a path of care for the weak by making himself weak, suffering and remaining innocent. (shrink)

Nicholas Everitt; VIII*—Pain and Perception, Proceedings of the Aristotelian Society, Volume 89, Issue 1, 1 June 1989, Pages 113–124, https://doi.org/10.1093/ar.

abstract: Anaxagoras is notorious for his view that every perception is accompanied by pain but that not all concurrent pains are distinctly felt by the perceiving subject. This thesis is reported and criticized by Aristotle's heir Theophrastus in his De Sensibus. Traditionally, scholars believe that Theophrastus rejects Anaxagoras's thesis of the ubiquity of pain as counterintuitive, with the appeal to unfelt pain looking like a desperate category mistake given that pain is nothing but a feeling. (...) Contra the traditional view, this paper argues that Theophrastus neither aims to defend ordinary phenomenology nor is bothered by the concept of unfelt pain; instead, he develops a series of new Aristotelian arguments to defend a controversial, optimistic picture about the distribution of affective qualities in animal life. More than a supplement to Aristotle's psychology, his engagement with Anaxagoras reveals an important yet often ignored ethical concern behind the Peripatetic philosophy of perception. (shrink)

Anaxagoras is notorious for his view that every perception is accompanied by pain but not all concurrent pains are distinctly felt by the perceiving subject. This thesis is reported and criticized by Aristotle’s heir Theophrastus in his De Sensibus. Traditionally, scholars believe that he rejects Anaxagoras’s these of the ubiquity of pain as counterintuitive, with the appeal to unfelt pain looking like a desperate category mistake given that pain is nothing but a feeling. Contra the (...) traditional view, this paper argues that Theophrastus neither aims to defend ordinary phenomenology nor is he bothered by the concept of unfelt pain; instead, he develops a series of new Aristotelian arguments to defend a controversial, optimistic picture about the distribution of affective qualities in animal life. More than a supplement to Aristotle’s psychology, his engagement with Anaxagoras reveals an important yet often ignored ethical concern behind the Peripatetic philosophy of perception. (shrink)

Nicholas Everitt; VIII*—Pain and Perception, Proceedings of the Aristotelian Society, Volume 89, Issue 1, 1 June 1989, Pages 113–124, https://doi.org/10.1093/ar.

The ArgumentPain has important biomedical socioanthropological, semiotic, and other facets. In this contribution pain and the experssion of pain are looked at from the perspective of evolutionary biology, utilizing, among others, cross-cultural data from field work in Melanesia.No other being cares for sick and suffering conspecifics in the way humans do. Notwithstanding aggression and neglect, common in all cultures, human societies can be characterized as empathic, comforting, and promoting the health and well-being of their members. One important stimulus (...) triggering this caring response in others is the expression of pain. The nonverbal channel of communication, particularly certain universal — i.e., culture-independent facial expressions, gestures, and body postures, convey much of the message from the painstricken person to the group.These behaviors signal the person's physical and psychical pain, sadness, grief, and despair in ways very similar to the signs given by infants and small children: the body loses tonus and sinks or drops to the ground, the gestures are those of helplessness. Pain and grief may be so strong that control is lost not only over the body's posture but also over the mind's awareness. In such cases the afflicted person may carry out actions endangering himself or others. In general, these behavior patterns resemble those of infants in situations of distress and danger, and it is not surprising that the response of the members of the group is basically parental: taking care, assisting and consoling.Perceptive and behavioral patterns which developed in the course of avian and mammalian phylogeny to serve the well-being of the young have proven, as was shown by Eibl-Eibesfeldt, to be powerful building blocks for actions in other spheres of human interaction. Love is one such field, the reactions to a conspecific suffering pain is another. (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)

Based largely on the so-called problem of “asymmetry in concept application”, philosopher Murat Aydede has argued for a non-perceptual view of pain. Aydede is of course not denying basic neurobiological facts about neurons, action potentials, and the like, but he nonetheless makes a strong philosophical case for pain not being the perception of something extramental. In the present paper, after having stated some of the presuppositions I hold as a physician and pain researcher, and after having (...) shortly described Aydede’s critique of perceptual theories of pain, I make a constructive proposal centred around the concept of pain as the perception of some-one, not some-thing. In doing so, I propose that there often is a problematic duality at work when we think about pain, namely the mental/extramental duality. This pre-reflective mindset creates difficulties when reflecting over pain. Instead, I propose the body/world duality as being more helpful. Two neologisms, cosmoception and egoception, are presented as an alternative to the twin concepts of exteroception and interoception. It is argued that the new concepts have the advantage of not pushing our thought into a mental/extra-mental dichotomy. Hence, when in pain, I get epistemic access to the body that is I, to how I fare in this world. From that perspective, pain is not the perception of something, but of someone–namely, the self. In the final part of the paper, this proposal is discussed in dialogue with a paper from phenomenological thinker Jennifer Bullington. (shrink)

Everyone knows what is feels like to be in pain. Scraped knees, toothaches, migraines, giving birth, cancer, heart attacks, and heartaches: pain permeates our entire lives. We also witness other people - loved ones - suffering, and we 'feel with' them. It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what (...) they describe as 'painful' has changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'. Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment? (shrink)

One of the most promising trends both in the neuroscience of pain and in psychiatric treatments of chronic pain is the focus on mental imagery. My aim is to argue that if we take these findings seriously, we can draw very important and radical philosophical conclusions. I argue that what we pretheoretically take to be pain is partly constituted by sensory stimulation-driven pain processing and partly constituted by mental imagery. This general picture can explain some problematic (...) cases of pain perception, for example, phantom-limb pain, and it also has important consequences for some recent philosophical debates about the nature and content of pain. (shrink)

Perceptualists say that having a pain in a body part consists in perceiving the part as instantiating some property. I argue that perceptualism makes better sense of the connections between pain location and the experiences undergone by people in pain than three alternative accounts that dispense with perception. Turning to fellow perceptualists, I also reject ways in which David Armstrong and Michael Tye understand and motivate perceptualism, and I propose an alternative interpretation, one that vitiates a (...) pair of objections—due to John Hyman—concerning the meaning of ‘Amy has a pain in her foot’ and the idea of bodily sensitivity. Perceptualism, I conclude, remains our best account of the location of pains. (shrink)

Pain has not only sensory, but also emotional and cognitive, components. Some studies have explored the effect of pain on time perception, but the results remain controversial. Whether individual pain-related emotional and cognitive factors play roles in this process should also be explored. In this study, we investigated the effect of electrical stimulation–induced pain on interval timing using a temporal bisection task. During each task session, subjects received one of five types of stimulation randomly: no (...) stimulus and 100 and 300 ms of non-painful and painful stimulation. Pain-related emotional and cognitive factors were measured using a series of questionnaires. The proportion of “long” judgments of a 1,200-ms visual stimulus duration was significantly smaller with 300 ms painful stimulation than with no stimulus and 100 ms and 300 ms non-painful stimulation. The point of subjective equality did not differ among sessions, but the average Weber fraction was higher for painful sessions than for no-stimulus session. The pain fear score correlated positively with the PSE under 100 ms non-painful and painful and 300 ms painful stimulation. Pain catastrophizing and pain anxiety scores correlated significantly with the WF under no stimulus and 100 ms non-painful stimulation, respectively. These results suggest that electrical stimulation–induced pain affects temporal sensitivity, and that pain-related emotional and cognitive factors are associated with the processing of time perception. (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)

Historically, treatment for pain relief has varied according to the social status of the sufferer. A similar tendency to make arbitrary distinctions affecting pain relief was found in an ethnographic study of animal research laboratories. The administration of pain-relieving drugs for animals in laboratories differed from standard practice for humans and, perhaps, for companion animals. Although anesthesia was used routinely for surgical procedures, its administration was sometimes haphazard. Analgesics, however, were rarely used. Most researchers had never thought (...) about using analgesics and did not consider the subject worthy of serious attention. Scientists interviewed for this study agreed readily that animals are capable offeeling pain, but such assertions were muted by an overriding view of lab animals as creatures existing solely for the purposes of research. As a result, it was the exceptional scientist who was able to focus on anything about the animal's subjective experience that might lie outside the boundaries of the research protocol. (shrink)

[Special issue honoring Nikola Grahek] Representationalism in philosophy of perception has become more or less the dominant view. There are various versions of it not all of which are motivated by the same set of concerns. Different metaphysical and epistemological agendas are at work in different strands of the movement. In this paper, I will focus on what has come to be known as strong representationalism. This view has reductive and non-reductive versions, which are usually paired with realist and (...) irrealist versions respectively. First, I will develop a simple, largely empirical, argument against the realist reductive version. Later, rather more briefly, I will extend the argument to cover irrealist representationalism. (shrink)

Perception is one of the most pervasive and puzzling problems in philosophy, generating a great deal of attention and controversy in philosophy of mind, psychology and metaphysics. If perceptual illusion and hallucination are possible, how can perception be what it intuitively seems to be, a direct and immediate access to reality? How can perception be both internally dependent and externally directed? Perception is an outstanding introduction to this fundamental topic, covering both the perennial and recent work (...) on the problem. Adam Pautz examines four of the most important theories of perception: the sense datum view; the internal physical state view; the representational view; and naïve realism, assessing each in turn. He also discusses the relationship between perception and the physical world and the issue of whether reality is as it appears. Useful examples are included throughout the book to illustrate the puzzles of perception, including hallucinations, illusions, the laws of appearance, blindsight, and neuroscientific explanations of our experience of pain, smell and color. The book covers both traditional philosophical arguments and more recent empirical arguments deriving from research in psychophysics and neuroscience. The addition of chapter summaries, suggestions for further reading and a glossary of terms make Perception essential reading for anyone studying the topic in detail, as well as for students of philosophy of mind, philosophy of psychology and metaphysics. (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 (...) class='Hi'>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)

The paper aims at clarifying the distinctions and relations between pain and suffering. Three negative theses are defended: 1. Pain and suffering are not identical. 2. Pain is not a species of suffering, nor is suffering a species of pain, nor are pain and suffering of a common (proximate) genus. 3. Suffering cannot be defined as the perception of a pain’s badness, nor can pain be defined as a suffered bodily sensation. Three (...) positive theses are endorsed: 4. Pain and suffering are categorically distinct: pain is a localised bodily episode, suffering is a non-localised affective attitude. 5. Suffering can be expressed, pains cannot. As a consequence, we can have compassion for the suffering of others, not for their pains. 6. The relation between pain and suffering is akin to the relation between danger and fear, injustice and indignation, wrongdoing and guilt: suffering is the correct reaction to pain. One upshot is that both the influential view that the experience of pain is incorrigible and the influential view that the ordinary conception of pain is paradoxical are false. (shrink)

The paper identifies in Cartesian dualism a common target of the middle Wittgenstein and the early Merleau-Ponty. By relegating pain to mental awareness and location to bodily extension, Cartesian dualism renders common localizations of pain throughout the body as unintelligible ascriptions. Wittgenstein’s and Merleau-Ponty’s efforts to do justice to common localizations of pain illuminate one another. In their light, Cartesian dualism involves an objectification and a deappropriation of one’s body. Further, Wittgenstein’s acknowledgment of a heterogeneous multiplicity of (...) corporeal spaces (e.g. tactile space, feeling space) restores the view, reinforced by Merleau-Ponty, that corporeal pain is intimately related to corporeal localization, while corporeal space is not a continuation of the physical space of things. (shrink)

The measurement of pain depends upon subjective reports, but we know very little about how research subjects or pain patients produce self-reported judgments. Representationalist assumptions dominate the field of pain research and lead to the critical conjecture that the person in pain examines the contents of consciousness before making a report about the sensory or affective magnitude of pain experience as well as about its nature. Most studies to date have investigated what Fechner termed “outer (...) psychophysics”: the relationship between characteristics of an external stimulus and the magnitude and nature of pain experience. In contrast, Fechner originally envisioned that “inner psychophysics” should investigate the relationship between physiological states and subjective experience. Despite the lack of established research tradition, inner psychophysics has a potential utility in elucidating underlying mechanisms for the production of phenomenal self-report. We illustrate this, using causal modeling analyses of the accuracy of self-reported pain ratings from our laboratory. We submit that the results are inconsistent with representationalist assumptions. Converging trends from several domains of consciousness studies seem to suggest that we need to abandon the unquestioned doctrine of representationalism and search for a more viable framework for understanding the generation of subjective self-report. (shrink)

Table of Contents: Olivier Massin, 'Pleasure and Its Contraries'; Colin Klein, 'The Penumbral Theory of Masochistic Pleasure'; Siri Leknes and Brock Bastian, 'The Benefits of Pain'; Valerie Gray Hardcastle, 'Pleasure Gone Awry? A New Conceptualization of Chronic Pain and Addiction'; Richard Gray, 'Pain, Perception and the Sensory Modalities: Revisiting the Intensive Theory'; Jonathan Cohen and Matthew Fulkerson, Affect, Rationalization, and Motivation; Murat Aydede, 'How to Unify Theories of Sensory Pleasure: An Adverbialist Proposal'; Adam Shriver, 'The Asymmetrical (...) Contributions of Pleasure and Pain to Subjective Well-Being'. (shrink)