[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, 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)

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)

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).

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)

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)

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)

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)

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.

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)

Over the past few years, over a dozen states have proposed, and almost as many have passed, something referred to as the Pain-Capable Unborn Child Protection Act, a piece of legislation that makes abortion impermissible once fetal pain is possible and that further stipulates the fetus can feel pain at or before 20 weeks of gestation. Some very important questions immediately relevant to the abortion debate, perhaps even to the more complex issue of fetal rights, are raised by this legislation, (...) especially because it would impinge on the second-trimester abortion rights guaranteed by Roe. We first inquire whether the claim of fetal pain perception at or before 20 weeks is true and how such a claim should be substantiated. Next, we inquire whether the fetal capacity to experience pain, at whatever stage of development, reflects on the morality of abortion and whether it should be at all relevant to determining its legality. Finally, we would like to explore the implications that a commitment to a pain-related or sentience criterion of rights might have for a pro-life agenda. (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)

[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)

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 (...) class='Hi'>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)

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)

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)

Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly life quality, (...) social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives. (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)

This chapter focuses specifically on the case of pain. Despite traditional opposition to the representational thesis, the latter has won widespread assent. The most important early proponents of the representational thesis were David Armstrong and George Pitcher, both of whom held that pain is a form of perception. Following Armstrong and Pitcher, intentionalists have traditionally held that the experience of pain has a content with roughly the following form: there is a disturbance with such-and-such features at location L. Since (...) the internal states associated with the experience of pain arguably track local physical properties of disturbances, it seems that the tracking intentionalist must identify the pain qualities represented by pain experience with these physical properties. But there are at least two important objections to the identification of pain qualities with local physical properties of disturbances. (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)

Compare your pain when immersing your hand in freezing water and your pleasure when you taste your favourite wine. The relationship seems obvious. Your pain experience is unpleasant, aversive, negative, and bad. Your experience of the wine is pleasant, attractive, positive, and good. Pain and pleasure are straightforwardly opposites. Or that, at any rate, can seem beyond doubt, and to leave little more to be said. But, in fact, it is not beyond doubt. And, true or false, it leaves a (...) good deal more to be said: about the nature of sensory affect; its relations to perception, motivation, and rationality; its value; and the mechanisms underlying it. Much is said about these matters in the contributions that follow. Here, in this introductory essay, we map the dialectical landscape and locate our contributors’ papers within it. (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)

Bodily pain strikes many philosophers as deeply paradoxical. The issue is that pains seem to bear both physical characteristics, such as a location in the body, and mental characteristics, such being mind-dependent. In this paper I clarify and address this alleged paradox of pain. I begin by showing how a further assumption, Objectivism, the thesis that what one feels in one’s body when one is in pain is something mind-independent, is necessary for the generation of the paradox. Consequently, the paradox (...) can be avoided if one rejects this idea. However, doing so raises its own difficulties, for it is not obvious how anything can possess all of the features we typically associate with bodily pain. To address this puzzle and finally put the paradox of pain to rest, I develop the Embodied View, a novel metaphysical account on which pains are constitutively mind-dependent features of parts of a subject’s body. (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)

The IASP definition of 'pain' defines pain as a subjective experience. The Note accompanying the definition emphasizes that as such pains are not to be identified with objective conditions of body parts (such as actual or potential tissue damage). Nevertheless, it goes on to state that a pain "is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience." This generates a puzzle that philosophers have been well (...) familiar with: how to understand our utterances and judgments attributing pain to body parts. (The puzzle is of course general extending to all sensations routinely located in body parts.) The present work tackles this puzzle. I go over various options specifying the truth-conditions for pain attributing judgments, and at the end make my own recommendation which is an adverbialist, qualia-friendly proposal with completely naturalistic credentials that is also compatible with forms of weak intentionalism. The results are generalizable to other bodily sensations and can be used to illustrate, quite generally, the viability of a qualia-friendly adverbialist (but naturalist and weakly intentionalist) account of perception. (shrink)