The latest issue of the JCS is all about pain. Pain has always been tough to deal with: it’s subjective, not a thing out there in the world, and yet even the most hardline reductionist materialist can’t really dismiss it as an airy-fairy poetic delusion. We are all intensely concerned about pain, and the avoidance of it is among our most important moral and political projects. When you step back a bit, that seems remarkable: it’s easy to see more or less objective reasons why we should want to prevent disease, mitigate the effects of natural disasters, prevent wars and famines – harder to see why near or even at the top of the list of things we care about should be avoiding the occurrence of a particular kind of pattern of neuronal firing.
It’s hard even to say what it is. It seems to be a sensation, but a sensation of what? Of…. pain? Our other sensations give us information, about light, sound, temperature, and so on. Pain is often accompanied by feelings of pressure or heat or whatever, but it is quite distinct and separable from those impressions. In itself, the only thing pain tells us is: ‘you’re in pain’. It seems sensible, therefore, to regard it as not a sensation in the same way as other sensations, but as being something like a kind of deferrable reflex: instead of just automatically moving our arm away from the hot pan it tells us urgently that we ought to do so. So it turns out to be something like a change in our dispositions or a change of weightings in our current projects. That kind of account is appealing except for the single flaw of being evident nonsense. When I’m in the dentist’s chair, I’m not feeling a change in my dispositions or anything that abstract, I’m feeling pain – that thing, that bad thing, you know what I mean, even though words fail me.
If it’s hard to describe, then, is pain actually the most undeniable of qualia? From some angles it looks like a quale, but qualia are supposed to have no causal effects on our behaviour, and that is exceptionally difficult to believe in the case of pain: if ever anything was directly linked to motivation, pain is it. Undeniability looks more plausible: pain is pre-eminently one of the things it seems we can’t be wrong about. I might be mistaken in my belief that my hand has just been sheared off by a saw: that ‘s a deduction about the state of the world based on the evidence of my senses; I don’t see how I could be wrong about the fact that I’m in agony because no reasoning is involved: I just am.
One of the contributors to the JCS might take issue with that, though. S. Benjamin Fink wants to present an approach to difficult issues of phenomenal experience and as his example he offers a treatment of pain which suggests it isn’t the simple unanalysable primitive we might think. In Fink’s view one of the dangers we need to guard against is the assumption that elements of experience we’ve always, as it happens, had together are necessarily a single phenomenon. In particular, he wants to argue for the independence of pain and suffering/unpleasantness. Pain, it turns out, is not really bad after all (at least, not necessarily and in itself).
Fink offers several examples where pain and unpleasantness occur separately. An itch is unpleasant but not painful; the burning sensation produced by hot chillies is painful but not unpleasant (at least, so long as it occurs in the mouths of regular chili eaters, and not in their eyes or a neophyte’s mouth). These examples seem vulnerable to a counterargument based on mildness: itches aren’t described as pains just because they aren’t bad enough; and the same goes for spicy food in a mouth that has become accustomed to it. But Fink’s real clincher is the much more dramatic example of pain asymbolia. People with this condition still experience pain but don’t mind it. It’s not at all that they’re anaesthetised: they are aware of pain and can use it rationally to decide when some part of their body is in danger of damage, but they do so , as it were coldly, and don’t mind needles being stuck in them for experimental purposes at all. Fink quotes a woman who underwent a lobotomy to cure continual pain: many years later she reported happily that the pain was still there: “In fact, it’s still agonising. But I don’t mind.”
These people are clearly exceptional, but it’s worth noting that even in normal people the link between nociception, the triggering of pain-sensing nerve-endings, and the actual experience of pain is by no means as invariable and straightforward as philosophers used to believe back in the days when some argued that the firing of c-fibres was identical with the occurence of pain. Fink wants to draw a distinction between pain itself, a sensation, and suffering, the emotional response associated with it; it is the latter, in his view, which is the bad thing while pain itself is a mere colourless report. As a further argument he notes research which seems to show that when subjects are feeling compassion, some neural activity can be seen in areas which are normally active when the subjects themselves are feeling pain. The subjects, as it were, feel the the pain of others, though obviously without actual nociception.
So is Fink right? I think many people’s first reaction might be that unpleasantness just defines pain, so that if you’re feeling something that isn’t unpleasant, we wouldn’t want to call it pain. We might say that people with asymbolia experience nocition (not sure that’s really a word but work with me on this) but not pain. Fink would say – he does say – that we ought to listen to what people say. Usage should determine our definition, he says, we should not make our definitions normatively control our usage. But he’s in a weak position here. If we are to pay attention to usage, then surely we should pay attention to the usage of the vast majority of people who regard pain as a unitary phenomenon, not to a small group of people with a most unusual set of experiences which might have tutored their perceptions in unreliable ways. I’m not sure it’s clear that asymbolics, in any case, insist that what they’re aware of is proper, echt pain – if they were asked, would they perhaps agree that it’s not pain in quite the ordinary sense?
I’m also not convinced that suffering, or unpleasantess, is really a well-defined entity in the way Fink requires. Unpleasantness may be a slight lapse of manners at a tea-party; you might suffer badly on the stock exchange while happily sipping a cocktail on your sun-lounger. I’m not sure there is a distinct complex of emotional affect we can label as suffering at all. And if there is, we’re back with the sheer implausibility of saying that that’s what the bad stuff is: when I hit my thumb with a hammer it doesn’t seem like a matter of affect to me, it seems very definitely like old-fashioned simple pain.
If we’re going to take that line, though, we have to account for Fink’s admittedly persuasive examples, in particular asymbolia. Never mind now what we call it: how is it that these people can experience something they’re willing to call pain without minding it, if it isn’t that our concept of pain needs reform?
Well, there is one other property of pain which we’ve overlooked so far. There is one obvious kind of pain which I can perceive without being disturbed at all – yours. We may indeed feel some sympathetic twinges for the pain of others, but a key point about pain is that it’s essentially ours. It sticks to us in a way nothing else does: it’s normal in philosophy to speak of the external world, but pain, perhaps uniquely, isn’t external in that sense: it’s in here with us. That may be why it has another property, noted by Fink, of being very difficult to ignore.
So it may be that subjects with asymbolia are not lacking emotional affect, but rather any sense of ownership. The pain they feel is external, it’s not particularly theirs: like Mrs Gradgrind they feel that
‘… there’s a pain somewhere in the room, but I couldn’t positively say that I have got it.’