Bad by Nature: An Axiological Theory of Pain

Journal of Consciousness Studies, 2011

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.

Forthcoming in The Philosophy of Pain, edited by D. Bain, M. Brady, and J. Corns. London: Routledge

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 ...

Review of Philosophy and Psychology

One use of the noun ‘pain’ is exemplified in sentences like ‘There is a pain in my foot’. According to the Experiential Theory, ‘pain’ in this context refers to an experience located in the mind or brain. According to the Bodily Theory, it refers to an extra-cranial bodily occurrence located in a body part. In this paper, I defend the Bodily Theory. Specifically, I argue that pains are proximal activations of nociceptors that cause experiences of pain. This view is preferable to the Experiential Theory, because it accords better with common sense and offers a better interpretation or semantics of ordinary pain reports.

This is a working paper, as you can see from the notes to myself in the text. The next phase of developing these thoughts is to work further on the paradoxical conclusion of this version. This may turn out to be a book chapter.

Filozofia, 2024

The aim of this article is to show how the inseparability of its objective and subjective dimensions renders pain such a complex phenomenon that it poses a challenge for both the biomedical sciences and philosophy. Neurophysiology has ascertained the variability of the relationship between damage and pain, showing that it is the result of interaction between the sensory and affective-emotional constituents of the human being. However, the process of defining the clinical concept of suffering appears comprehensively laborious and ongoing. Philosophy, while declaring the impossibility of identifying the essence of pain, makes a valuable contribution to the discovery of the singularity of the experience, thanks to the phenomenology of the homo patiens. Finally, we examine the debate on the possibility and the different ways of narrating and appraising suffering, a need with obvious ethical implications, perceived more and more within the field of care, also given the chronicity of many medical conditions.

2011

Various paradoxes coalesce around pain, "one of the most controversial areas in neuroscience… rife with philosophical problems" (Aydede and Guzeldere 2002: S266). For example, while pain is conventionally seen as aversive and unwanted, biologically speaking, pain is indispensable. Pain warns of injury or organ malfunction, and helps heal a wound by motivating the individual to tend to and protect the site. Many textbooks on pain begin by describing the extremely unhappy lives of those rare individuals born with a congenital inability to feel pain. Pain medicine plays with this contradiction: one book is titled Pain: The Gift Nobody Wants (Brand and Yancey 1993), and one article's title is "When good pain turns bad" . Both an aspect of mind (experience) and brain (produced by neurological structures and processes), pain illustrates some of the problems associated with mind-body dualism. Murat Aydede and Guven Guzeldere note that the "fundamental tension between what can be quantified as the 'objective' measure of pain as characterized in terms of tissue damage and the 'subjective' criterion of when to categorize a given experience as pain is in fact prevalent in pain research" (2002: S267). Medical science's traditional definition of pain as sensation provides an example. Francis Keefe and Christopher France's definition, "a sensory event warning of tissue damage or illness" (Keefe and France 1999: 137) nicely elides the nature of that warning; while pain is certainly a sensation, its bedrock meaning -and what distinguishes it from nonpainful sensations -is aversiveness, which, being an emotion, does not fit within biomedicine's underlying biologistic foundational premises (see Kleinman 1995: 27-34). Another example: although emotions are always embodied (this is precisely what distinguishes them from cognitions), because we tend to see emotions as an aspect of "the mind," the body's fundamental role in emotions is often obscured, phrases like "heartbroken" notwithstanding.

Pain, 1999

This essay is an attempt to clarify the construct of unpleasantness in the context of the psychophysics of pain. The first critical point is that one aspect of unpleasantness is tightly coupled to stimulus intensity and is therefore a sensory discrimination. Pain has this quality, but so do other somatic sensations such as itch and dysesthesias that are not recognized as painful by most people. A corollary of this is that pain must have a quality other than unpleasantness that allows it to be unequivocally identified. I use the term algosity for that quality. In addition to stimulus bound (primary) unpleasantness, there is an unpleasant experience that reflects a higher level process which has a highly variable relationship to stimulus intensity and is largely determined by memories and contextual features. I have termed this experience secondary unpleasantness. I suggest that the sensory-discriminative/affective-motivational dichotomy has outlived its usefulness and is currently more of an impediment than a guide to neurobiological explanations of pain. In order to increase our understanding of pain we need psychophysical tools designed specifically to differentiate primary unpleasantness from both algosity and secondary unpleasantness. These tools can then be used to determine the neural mechanisms of pain.

In Jennifer Corns (ed.) Routledge Handbook of the Philosophy of Pain, 2017

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.

Like other fundamental experiences, the phenomenal qualities of pain seem to defy description. But unlike these experiences it is difficult to define pain in terms of a consistent relationship with the extra-mental world. The IASP’s solution is to qualify an imprecise characterisation of pain’s phenomenal qualities through an association with tissue damage and an ability to recognise pain sensation. In this paper I will argue that the IASP’s definition lacks the clarity and coherence necessary to provide an adequate definition of pain. I begin by setting out the difficulties of defining pain. I then describe the IASP’s solution and provide a detailed criticism of their approach. I also discuss inconsistencies evident in their wider taxonomy. In the final section I argue that pain can be objectively grounded by reference to pain’s evolutionary role and suggest an alternative definition.