The Complex Reality of Pain

Jennifer Corns

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000027907
• Edition: 1
• Topic: Philosophy
• Subtopic: Mind & Body in Philosophy

This book employs contemporary philosophy, scientific research, and clinical reports to argue that pain, though real, is not an appropriate object of scientific generalisations or an appropriate target for medical intervention. Each pain experience is instead complex and idiosyncratic in a way which undermines scientific utility. In addition to contributing novel arguments and developing a novel position on the nature of pain, the book provides an interdisciplinary overview of dominant models of pain. The author lays the needed groundwork for improved models and targeted treatments at a time when pain science, pain medicine, and philosophy are explicitly searching for both and failing to find them. The Complex Reality of Pain will be of interest to a broad range of researchers and students, including those working in philosophy of mind, philosophy of science, cognitive science, neuroscience, medicine, health, cognitive and behavioural psychology, and pain science.

1 Introduction

Pain in Life, Science, and Medicine

1.1 Pain in Everyday Life

What is pain?

The question might seem like an easy one to answer. Don’t we all know what pains are? If someone tells you they are in terrible pain, you aren’t puzzled about what they are telling you. They would rightly find it bizarre if you responded by asking, ‘Pain? What’s that?’.

Pain is ubiquitous in our everyday lives. Unsurprisingly, we thus have a wide range of folk platitudes about it. Folk platitudes are those statements which we take to be obviously true in our everyday lives, and which we assume that roughly everyone—or, at least, roughly everyone with whom we interact in everyday life—also takes to be obviously true. Folk platitudes about pain are truly abundant, and we might think that these decisively settle all interesting questions about both its existence and nature.

Consider just a few statements from our rich corpus of everyday, platitudinous wisdom about pain. Pains, we believe, are typically felt in a certain part of the body, and, we believe, something is typically wrong with that felt place. Pains are unpleasant and come in different degrees of intensity, such that some pains are worse than others. Pain, we furthermore take to be obvious, is something that it is appropriate to avoid. Other things being equal, we act to alleviate our pains and, other things being equal, it is wrong to cause them. We also, however, believe that we would be in serious trouble without pain. We believe that pain is useful in typically alerting us to things which are wrong with the places they are felt and, at least typically, that pain is useful in motivating us to do something about whatever is wrong. We take these statements, and many more, to be obviously true in the normal course of our everyday lives. We expect general agreement, with roughly everyone with whom we interact in our daily lives, that these statements are true.

These platitudes about pain are part of our everyday, “folk” psychological, theory about our mental episodes—our everyday theory about what we think, feel, desire, and so on. And again, we might well think that this everyday theory, with its profundity of pain platitudes, is good enough to settle all questions about the nature of pain. We might, that is, think that questions about the nature of pain are as trivial as the truth of the statements about pain which partly comprise our everyday psychological theory. While much about pain is obvious, it may not be obvious why further questions about pain’s nature—questions about what pain is and what it is not—are of any interest.

While I’ll argue in this book that the success of our everyday theory is sufficient for us to accept the existence of pains as posited by that theory, and to continue to successfully and usefully refer to pains for our everyday purposes, that everyday theory nonetheless leaves some difficult questions about pain’s nature unanswered.

To begin to see the limitations of our everyday theory, consider that it won’t clearly settle whether many episodes which are reported in everyday life are pains or not. When people take morphine, they report pains that they don’t mind. Some masochists report pains that they enjoy. Those suffering from some types of chronic pain conditions report pains in bodily locations where no damage can be found. Those suffering from phantom limb pain report pains in bodily parts of theirs that they simultaneously know they do not have. Are all of these nonetheless pains? Are there pains which we do not mind or even enjoy? Are there pains which are not correlated with any damage, and in body parts of ours that we do not have? Courting yet further controversy, consider whether unpleasant emotional episodes are pains. Are episodes of heartbreak, grief, loss, and rejection all pains? Are instances of these ever pains? The right answers to these questions, whatever they may be, are not folk platitudes.

We might stress the controversy, from the point of view of our everyday theory, by asking whether the pains described in the previous paragraph are really pains. Is grief really pain? Is the pain I experience after taking morphine really pain? If the masochist enjoys the damage to her body, is she really in pain when she sincerely reports her enjoyable experience? Our everyday platitudes do not directly settle these questions. The answers are not trivial or obvious.

Controversy in a wide range of cases like those just mentioned is to be expected. Our corpus of pain platitudes is so extensive that it is unsurprising that there are some cases for which some of these platitudes hold and others fail. Controversy may be expected to ensue across at least some of these cases. If some of our platitudes about pain are true about an episode reported as pain, and some of our other platitudes are false about that reported episode, then there is room for disagreement. These are disagreements that our everyday theory, by itself, cannot settle.

Armed only with our everyday theory, then, we may at best be able to answer questions about the existence and nature of only paradigm cases. I’ll consider paradigmatic pains to be those things about which all of our folk platitudes about pain are true. I’ll consider paradigmatic non-pains to be those things that we take it to be obvious are not pains because so many of the folk platitudes about pain fail for them. My wedding ring is a paradigmatic non-pain; so many of our folk platitudes about pain are false of it that we would not expect anyone to think it was a pain. If someone declared that my wedding ring was a pain, we would think they were speaking metaphorically or were using the word ‘pain’ in an idiosyncratic way, i.e. to refer to something other than the referent of ‘pain’ as posited in our everyday theory. The ache in my hip, from working a bit too hard at the gym this morning, is a paradigmatic pain; all of our folk platitudes are true of it. At best, our everyday theory of pain can settle the question of the nature only of paradigmatic pains and paradigmatic non-pains: it can tell us when something is obviously pain and when something is obviously not pain, but it cannot tell us about non-obvious cases. Not all by itself.

Indeed, our everyday theory has some built-in limitations for decisively settling questions about which things are and are not pains. As above, we think that pains are typically felt to be in bodily locations and that there is typically something wrong with our bodies in those places that we feel the pain to be. Statements about what’s typical of pain are what I take to be obvious, and such statements are also what I take roughly everyone that I interact with to take to be obvious. But I do not assume general agreement that pains are essentially located, or that it is a necessary condition of pain that the body is damaged in the place the pain is felt to be. As us analytic philosophers might put it: everyday theory does not deliver the necessary and sufficient conditions for pain, nor does it identify the essence of pain.

While I will return to this theme in later chapters, it is worth noting at the outset that I do not think that our everyday theory is intended for any such deliverances or appropriately evaluated by its deliverance of them. Our everyday theory is intended for our everyday purposes. As far as I can tell, there is no need for essences or necessary and sufficient conditions to accomplish these purposes. As Jerry Fodor might have put it: Granny gets along just fine without them. Statements which commit one to supposed essences or necessities, though often of interest to philosophers, are not statements that take place from within the grip of our everyday theory or that are required for the utility of that theory.

The inability of our everyday theory to decisively determine the extension of its posits is not unique to pain. Our everyday theory may be deployed to yield a decisive ruling for paradigmatic cases of beliefs, for instance, and paradigmatic cases of non-beliefs. Taken on its own, however, it will not be able to settle questions about those episodes concerning which some platitudes about beliefs are true, while others are false. Similar considerations apply to desires, wishes, sensations, imaginings, and so on. Consider, for a single example, a belief sincerely reported by someone for whom that belief seems behaviourally inert across all relevant circumstances. Or consider, for a second instance, a desire reported by someone who reports also believing that they wouldn’t like getting what they desired. These beliefs and desires may indeed be beliefs and desires, but they are not paradigmatic cases. To stress the controversy, we may ask whether they are really beliefs and desires. Does the person really want the thing that they believe that they wouldn’t like to have? Does a person really believe the thing they say they do, if that belief has no impact on any of their behaviour? In our everyday lives, we assume general agreement that beliefs affect behaviour in relevant circumstances, and we assume that we (at least) believe that we would like to have the things we desire. If beliefs and desires for which these platitudes fail are reported, we should expect disagreement about them. Our everyday theory could not settle these disagreements. Not all by itself. Further work needs to be done.

Returning to pain: not only may our everyday theory fail to deliver a decisive ruling about what is and isn’t pain in all cases, but that theory gives rise to some particular puzzles about the nature of pain. While similar puzzles may arise for other of the posits of our everyday “folk” psychological theory, at least some of the particular puzzles which arise about the nature of pain are more particular to pain.

One much-discussed puzzle about the nature of pain concerns whether pains are mental or extra-mental. We report pains as being located in our bodies: “there is a horrible pain in my foot”. As above, it’s a folk platitude that pains are (at least, typically) felt to be in bodily locations. This platitude, and others like it, suggests that pains are extended, extra-mental things located somewhere in our bodies. We also, however, report pains as being feelings of ours: “I took the aspirin, and my pain went away”. As above, it’s a folk platitude that pains are (at least, typically) feelings—nasty, unpleasant feelings (again: at least, typically). This suggests that pains are mental episodes which are located, if anywhere, in our brains or neural systems. If the doctor asks you where the pain is, you point to your foot; you don’t “point” to your mind. If the doctor asks you whether the pain is better, however, you introspect, i.e. you “look” inside your mind; you don’t look to your foot.

This puzzle about what pain is—is it a mental episode or an extra-mental thing—arises from within our everyday theory, but it isn’t settled by it. While presumably no one thing, including pain, could be both mental and extra-mental (i.e. mental and not mental), our everyday theory of pain allows us to talk about pain as being both. We might settle this puzzle by privileging the platitudes according to which pains are one or the other. To again stress the controversy in everyday language: we might, that is, argue that pains are really in our bodies or, alternatively, argue that pains are really in our minds. Or, we might settle this puzzle by splitting up the platitudes and taking them to be true of two different, if somehow related, things. We might, that is, argue that the word ‘pain’, as deployed in our everyday theory, is ambiguous; our everyday theory posits pain_b, i.e. pains as extra-mental things in our bodies, and also distinctly posits pain_m, i.e. pains as mental episodes such as a feeling. Different philosophers have opted for all three (and further) of these responses.¹ The point for present purposes is that settling which of these, if any, is the right resolution of the puzzle requires argument. Our everyday theory, by itself, does not settle the matter; in our everyday lives, we would not (and should not) assume general agreement about whether pains are really in our bodies, our minds, or both.

Whichever way we solve this particular puzzle, were we limited to our everyday theory, yet further questions about the nature of pain would remain unanswered.

If we opt for holding that pains are mental episodes, our everyday theory will nonetheless not settle questions concerning the kind of mental episode. Are pains sensations? Some of our folk platitudes seem to support this suggestion. Pains, I expect most everyone in my daily interactions to grant (at least typically), feel like something. They are, moreover, typically conscious and feel like something for someone to have—something, yet further, which is unpleasant or even awful for the one who has them (as ever: at least typically). Sho...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• 1 Introduction: Pain in Life, Science, and Medicine
• 2 The Need for Complexity: Rejecting the Orthodoxy of Simplicity
• 3 Mechanistic Explanations: How Complex Idiosyncrasy Undermines Them
• 4 Adopting Scientific Eliminativism: How Complex Idiosyncrasy Undermines Scientific Utility
• 5 Rejecting Traditional Eliminativism: Why Pain Is Still Real
• 6 Conclusion: Living with the Complex Reality of Pain
• Index