Abstract: Which nonhuman animals experience conscious pain?1 This question is central to the debate about animal welfare, as well as being of basic interest to scientists and philosophers of mind. Nociception—the capacity to sense noxious stimuli—is one of the most primitive sensory capacities. Neurons functionally specialized for nociception have been described in invertebrates such as the leech Hirudo medicinalis and the marine snail Aplysia californica (Walters 1996). Is all nociception accompanied by conscious pain, even in relatively primitive animals such as Aplysia, or is it the case, as some philosophers continue to maintain, that conscious experiences are the exclu- sive province of human beings? What philosophical and scientific resources are presently available for assessing claims lying between these extremes?

Abstract: In this paper we1 assess the potential for research on nonhuman animals to address questions about the phenomenology of painful experiences. Nociception, the basic capacity for sensing noxious stimuli, is widespread in the animal kingdom. Even rel- atively primitive animals such as leeches and sea slugs possess nociceptors, neurons that are functionally specialized for sensing noxious stimuli (Walters 1996). Vertebrate spinal cords play a sophisticated role in processing and modulating nociceptive signals, providing direct control of some motor responses to noxious stimuli, and a basic capacity for Pavlovian and instrumental conditioning (Grau et al. 1990; Grau 2002). Higher brain systems provide additional layers of association, top-down control, and cognition. In humans, at least, these higher brain systems also give rise to the conscious experiences that are characteristic of pain. What can be said about the experiences of other animals who possess nervous systems that are similar but not identical to humans?

Abstract: As the above quote clearly highlights, it is the responsibility of researchers and research supervisors to be certain that their research staff and students assistants are very familiar with all of the ethical principles and current standards relevant to the research they are conducting. Indeed, they must take an active role in being certain that their research staff and students complete appropriate training in these ethical principles and standards, and how they apply them to the research context in which they are working. This is especially important in areas in which there may be physical harm such as chronic pain research

Abstract: two-dimensional modal framework introduced by Evans [2] and developed by Davies and Humberstone. [3] This framework provides Chalmers with a powerful tool for handling the most serious objection to conceivability arguments for dualism: the problem of..

Abstract: Functionalism cannot accommodate the possibility of mad pain—pain whose causes and effects diverge from those of the pain causal role. This is because what it is to be in pain according to functionalism is simply to be in a state that occupies the pain role. And the identity theory cannot accommodate the possibility of Martian pain—pain whose physical realization is foot-cavity inflation rather than C-fibre activation (or whatever physiological state occupies the pain-role in normal humans). After all, what it is to be in pain according to the identity theory is to be in whatever state that occupies the pain role for us

Abstract: 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: 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

Abstract: This paper examines pain states (and other intransitive bodily sensations) from the perspective of the problems they pose for pure informational/representational approaches to naturalizing qualia. I start with a comprehensive critical and quasi-historical discussion of so-called Perceptual Theories of Pain (e.g., Armstrong, Pitcher), as these were the natural predecessors of the more modern direct realist views. I describe the theoretical backdrop (indirect realism, sense-data theories) against which the perceptual theories were developed. The conclusion drawn is that pure representationalism about pain in the tradition of direct realist perceptual theories (e.g., Dretske, Tye) leaves out something crucial about the phenomenology of pain experiences, namely, their affective character. I touch upon the role that introspection plays in such representationalist views, and indicate how it contributes to the source of their trouble vis-à-vis bodily sensations. The paper ends by briefly commenting on the relation between the affective/evaluative component of pain and the hedonic valence of emotions

Abstract: The ordinary conception of pain has two major threads that are in tension with each other. It is this tension that generates various puzzles in our philosophical understanding of pain. According to one thread, pain is something that we locate in body parts using sentences such as..

Abstract: Understanding the nature of pain depends, at least partly, on recognizing its subjectivity (thus, its first-person epistemology). This in turn requires using a first-person experiential method in addition to third-person experimental approaches to study it. This paper is an attempt to spell out what the former approach is and how it can be integrated with the latter. We start our discussion by examining some foundational issues raised by the use of introspection. We argue that such a first-person method in the scientific study of pain (as in the study of any experience) is in fact indispensable by demonstrating that it has in fact been consistently used in conjunction with conventional third-person methodologies, and this for good reasons. We show that, contrary to what appears to be a widespread opinion, there is absolutely no reason to think that the use of such a first-person approach is scientifically and methodologically suspect. We distinguish between two uses of introspective methods in scientific experiments: one draws on the subjects’ introspective reports where any investigator has equal and objective access. The other is where the investigator becomes a subject of his own study and draws on the introspection of his own experiences. We give examples using and/or approximating both strategies that include studies of second pain summation and its relationship to neural activities, and brain imaging- psychophysical studies wherein sensory and affective qualities of pain are correlated with cerebral cortical activity. We explain what we call the experiential or phenomenological approach that has its origins in the work of Price and Barrell (1980). This approach capitalizes on the scientific prospects and benefits of using the introspection of the investigator. We distinguish between its vertical and horizontal applications. Finally, we conclude that integrating such an approach to standard third-person methodologies can only help us in having a fuller understanding of pain and of conscious experience in general..

Abstract: Consider the following two sentences:

(1) I see a dark discoloration in the back of my hand.
(2) I feel a jabbing pain in the back of my hand.

They seem to have the same surface grammar, and thus prima facie invite the same kind of semantic treatment. Even though a reading of ‘see’ in (1) where the verb is not treated as a success verb is not out of the question, it is not the ordinary and natural reading. Note that if I am hallucinating a dark discoloration in the back of my hand, then (1) is simply false. For (1) to be true, therefore, I have to stand in the seeing relation to a dark discoloration in the back of my hand, i.e., to a certain surface region in the back of my hand marked by a darker shade of the usual color of my skin, a certain region that can be seen by others possibly in the same way in which I see it. Also note that although the truth of (1) doesn’t require the possession of any concept by me expressed by the words making up the sentence, my uttering of (1) to make a report typically does — if we take such utterances as expressions of one’s thoughts. So my seeing would typically induce me to identify something in the back of my hand as a dark discoloration. This is a typical case of categorization of something under a concept induced by perception. Of course, my uttering of (1) does more than attributing a physical property to a bodily region, it also reports that I am seeing it

Abstract: The pain case can appear to undermine the radically intentionalist view that the phenomenal character of any experience is entirely constituted by its representational content. That appearance is illusory, I argue. After categorising versions of pain intentionalism along two dimensions, I argue that an “objectivist” and “non-mentalist” version is the most promising, provided it can withstand two objections: concerning what we say when in pain, and the distinctiveness of the pain case. I rebut these objections, in a way that’s available to both opponents and adherents of the view that experiential content is entirely conceptual. In doing so I illuminate peculiarities of somatosensory perception that should interest even those who take a different view of pain experiences

Abstract: David Bain Abstract: It can seem natural to say that, when in pain, we undergo experiences representing certain experience-dependent particulars, namely pains. As part of his wider approach to mind and world, John McDowell has elaborated an interesting but neglected version of this account of pain. Here I set out McDowell’s account at length, and place it in context. I argue that his subjectivist conception of the objects of pain experience is incompatible with his requirement that such experience be presentational, rationalising, and classificatory.

Abstract: 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

Abstract: Daniel Kahneman and his colleagues have made an interesting discovery about people's preferences. In several experiments, subjects underwent two separate ordeals of pain, identical except that one ended with an added amount of diminishing pain. When asked to evaluate these episodes after experiencing both, subjects generally preferred the longer episode--even though it had a greater objective quantity of pain. These data raise an ethical question about whether to respect such preferences when acting on another's behalf. John Broome thinks that it is wrong to add extra pain in order to satisfy a person's preference for a better ending. His explanation for this intuition is that pain is intrinsically bad. I argue against this explanation, and raise several doubts about the moral intuition Broome endorses. In doing so, I offer alternate interpretations of Kahneman's data, and show that these each yield different values which are relevant to the ethical question

Abstract: The most cursory examination of the history of artificial intelligence highlights numerous egregious claims of its researchers, especially in relation to a populist form of ‘strong’ computationalism which holds that any suitably programmed computer instantiates genuine conscious mental states purely in virtue of carrying out a specific series of computations. The argument presented herein is a simple development of that originally presented in Putnam’s (Representation & Reality, Bradford Books, Cambridge in 1988 ) monograph, “Representation & Reality”, which if correct, has important implications for turing machine functionalism and the prospect of ‘conscious’ machines. In the paper, instead of seeking to develop Putnam’s claim that, “everything implements every finite state automata”, I will try to establish the weaker result that, “everything implements the specific machine Q on a particular input set ( x )”. Then, equating Q ( x ) to any putative AI program, I will show that conceding the ‘strong AI’ thesis for Q (crediting it with mental states and consciousness) opens the door to a vicious form of panpsychism whereby all open systems, (e.g. grass, rocks etc.), must instantiate conscious experience and hence that disembodied minds lurk everywhere

Abstract: : This paper considers whether a physician is criminally liable for administering a dose of painkillers that hastens a patient's death. The common wisdom is that a version of the doctrine of double effect legally protects the physician. That is, a physician is supposedly acting lawfully so long as the physician's primary purpose is to relieve suffering. This paper suggests that the criminal liability issue is more complex than that. Physician culpability can be based on recklessness, and recklessness hinges on whether a physician has taken an unjustifiable risk of hastening death. The authors identify three conditions of justifiability. Their analysis helps to explain the distinction between euthanasia, which is legally banned, and the use of risky analgesics, which is permitted in limited circumstances

Abstract: Pain is an important focus for consciousness research because it is an avenue for exploring somatic awareness, emotion, and the genesis of subjectivity. In principle, pain is awareness of tissue trauma, but pain can occur in the absence of identifiable injury, and sometimes substantive tissue injury produces no pain. The purpose of this paper is to help bridge pain research and consciousness studies. It reviews the basic sensory neurophysiology associated with tissue injury, including transduction, transmission, modulation, and central representation. In addition, it highlights the central mechanisms for the emotional aspects of pain, demonstrating the physiological link between tissue trauma and mechanisms of emotional arousal. Finally, we discuss several current issues in the field of pain research that bear on central issues in consciousness studies, such as sickness and sense of self

Abstract: Pain is not a primitive sensory event but rather a complexperception and a process by which a person interacts with theinternal and external environments, constructs meaning, andengages in action. Because folk beliefs are central to meaning,folk concepts of pain play multiple causal roles in a painpatient's interaction with health care providers and others.In every case, the notion of pain is linked to a goal-directedbehavior that is useful to the person. The wide variation inconcepts of pain across individuals suffering with painunderscores the richness and complexity of the pain experience.In some cases involving chronic pain, the patient may form amaladaptive cluster of behaviors around the concept of pain.Patient beliefs and expectations are an important part of manychronic pain syndromes, and patients can benefit fromintervention directed at revising the individual's folk model of pain. Memetics offers a framework for identifying the memesthat patients hold and determining whether patient memes fitor clash with provider memes

Abstract: Estimating the financial value of pain informs issues as diverse as the market price of analgesics, the cost-effectiveness of clinical treatments, compensation for injury, and the response to public hazards. Such costs are assumed to reflect a stable trade-off between relief of discomfort and money. Here, using an auction-based health market experiment, we show the price people pay for relief of pain is strongly determined by the local context of the market, determined either by recent intensities of pain, or their immediately disposable income, but not overall wealth. The absence of a stable valuation metric suggests that the dynamic behaviour of health markets is not predictable from the static behaviour of individuals. We conclude that the results follow the dynamics of habit formation models of economic theory, and as such, the study provides the first scientific basis for this type of preference modelling

Abstract: The facial expression of pain is the end product of a complex process that is, in part, emotional. The evolutionary study of facial expression must account for the social nature of human consciousness and should address the questions of why empathy exists, the adaptive importance of empathy, and whether facial expression is a mechanism of empathy and second-person consciousness

Abstract: Human pain experience and expression evolved to serve a range of social functions, including warning others, eliciting care, and influencing interpersonal relationships, as well as to protect from physical danger. Study of the relatively specific, involuntary, and salient facial display of pain permits examination of these roles, extending our appreciation of pain beyond the prevalent narrow focus on somatosensory mechanisms

Abstract: How can a pain wake you up? You were not dreaming, nor did any bodily stimuli filter into your consciousness. You did not just wake up and realize you were in pain, as you might wake up and realize it is Saturday. You were deeply, dreamlessly asleep, and suddenly you were awake, and in pain. How is this possible? If pain exists only inasmuch as it is experienced, it seems that the pain did not exist when you were asleep, and so could not have woken you up. I shall argue that you were woken by a pain sensation that you did not know you had, so that the distinction between what is and what is known holds even for the contents of consciousness. This illuminates the relationship between consciousness and attention, and casts light on the Classical Empiricist tradition that identifies the foundations of knowledge with direct experience

Abstract: What differentiates expressions of pain from other facial expressions? Which facial features convey the most information in an expression of pain? To answer such questions we can explore the expertise of human observers using psychophysical experiments. Techniques such as change detection and visual search can advance our understanding of facial expressions of pain and of evolved mechanisms for detecting these expressions

Abstract: We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result — or perhaps take the form — of a variety of states including pain, anxiety, fear, and boredom. Third, pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states

Abstract: The purpose of this paper is to elaborate on the notion of clinical medicine as a hermeneutical enterprise and to bridge the gap between the general perspectives of hermeneutics and the particularities of medical practice. The case of a patient with low back pain is analyzed. The discussion centers around the metaphor of the patient as a text and a model of five social discourses about low back pain. The problems addressed are: (1) the nature of a moral experience, (2) the variety of available texts, (3) the difference between the doctor's and patient's narratives, and (4) the patient's and doctor's responsibility regarding the existential, biographical meaning of an illness. Although many problems are left unsolved, it is argued that from a philosophical point of view the notion of medicine as a hermeneutical enterprise opens up the possibility of gaining insight in the foundations of the clinical encounter

Abstract: Painful stimuli evoke functional activations in the cortex, but electrical stimulation of these areas does not evoke pain sensation, nor does widespread epileptic discharge. Likewise, cortical lesions do not eliminate pain sensation. Although the cortex may contribute to pain modulation, the planning of escape responses, and learning, the network activity that constitutes the actual experience of pain probably occurs subcortically. (Published Online May 1 2007)

Abstract: In the last two decades there have been many critics of western biomedicine's poor integration of social and psychological factors in questions of human health. Such critiques frequently begin with a rejection of Descartes' mind-body dualism, viewing this as the decisive philosophical moment, radically separating the two realms in both theory and practice. It is argued here, however, that many such readings of Descartes have been selective and misleading. Contrary to the assumptions of many recent authors, Descartes' dualism does attempt to explain the union of psyche and soma - with more depth than is often appreciated. Pain plays a key role in Cartesian as well as contemporary thinking about the problem of dualism. Theories of the psychological origins of pain symptoms persisted throughout the history of modern medicine and were not necessarily discouraged by Cartesian mental philosophy. Moreover, the recently developed biopsychosocial model of pain may have more in common with Cartesian dualism than it purports to have. This article presents a rereading of Descartes' mental philosophy and his views on pain. The intention is not to defend his theories, but to re-evaluate them and to ask in what respect contemporary theories represent any significant advance in philosophical terms

Abstract: The expression pain refers to a phenomenon intrinsic to individuals. The object of the language of pain is restricted to an individual experience which excludes any form of direct access by others. Speaking about pain is thus one of the most difficult forms of linguistic activities, as has been repeatedly pointed out by Wittgenstein. The difficulties involved in this type of communication are not only dependent upon individual linguistic ability but are also clearly reflected in the state and structure of the linguistic means which are at the disposal of the speakers of a language. Linguistic means vary in status and complexity with respect to the ends which they can be used for.In this paper, I discuss two aspects of communicating pain: types of expression which are involved in speaking about pain, and linguistic activities which are carried out when speaking about pain. The two aspects are interrelated. My analysis makes use of categories belonging to the theory of linguistic activity and to the extended field theory of language (an expansion of Bühler's concept of symbolic and deictic field analysis of language)

Abstract: Most readers of ancient Greek psychology will agree that the Philebus is where we find Plato’s best attempt to theorize about bodily pain.1 But they will probably also agree that the account he develops there has no real chance of being true, and so should not have much appeal to us today — at least insofar as we are philosophers rather than historians. It’s this second conviction that I want to challenge in what follows. More specifically, I want to argue for two connected claims about the merits of Plato’s account: first, that despite its flaws — which are significant — it is stronger and more subtle than most commentators have yet realized; and second, that it anticipates in interesting ways a view that has become both increasingly popular and increasingly controversial in the last couple of decades: the view that pains — like beliefs, desires, hopes, and fears — are mental states with representational content. I will call this view representationalism

Abstract: Williams argues that humans have evolved special purpose adaptations for eliciting medical attention from others, such as a specific facial expression of pain. She also recognises that such adaptations would almost certainly have coevolved with adaptations for providing and responding to medical care. The placebo response may be one such adaptation, and any evolutionary account of pain must also address this important phenomenon

Abstract: A functional interpretation of facial expressions of pain is welcome. Facial expressions of pain may be useful not only for communication, such as inviting help. They may also be of direct use, as parts of writhing pain behavior patterns, serving to get rid of pain stimuli and/or to suppress pain sensations by something akin to hyperstimulation analgesia

Abstract: In this paper I demonstrate that the "pain problem" Dartnall claims to have discovered is in fact no problem at all. Dartnall's construction of the apparent problem, I argue, relies on an erroneous assumption of the unity of consciousness, an erroneous assumption of the simplicity of pain as a phenomenon ignoring crucial neurophysiological and neuroanatomical information, a mistaken account of introspective knowledge according to which introspection gives us inner episodes veridically and in their totality and a model of consciousness that depicts the mind as an attic of inner objects towards which attention might or might not be directed. Once these errors are dispelled, no problem remains. None the less, given the seductiveness of these errors, and the havoc they wreak in cognitive science, dispelling them is a worthwhile exercise

Abstract: Neuroscience, together with a broadened concept of “mind” has instigated pragmatic and ethical concerns about the experience and treatment of pain. If pain medicine is to be authentic, it requires knowledge of the brain-mind, pain, and the relative and appropriate “goodness” of potential interventions that can and/or should be provided. This speaks to the need for an ethics that reflects and is relevant to the contemporary neuroscience of pain, acknowledgment and appreciation of the sentient being in pain, effects of environment and value(s), and the nature of healing. It may be that neuroethics provides this viable meta-ethic for pain care. This essay describes how an integrative neuroethics of pain care allows, if not obligates, alignment of facts, values, and moral attitudes as a continuing process of re-investigation, analysis, and revision of what we know (and don’t know) about brains, minds, selves, and how we regard and treat the painient

Abstract: Theories of punishment accentuating its communicative dimension have soared for the past years, not only in Europe but also in the U.S. Some academics have criticized their inability to adequately explain the physical dimension of punishment, i.e., the so-called “penal pain”. This essay aims at providing the foundations of a communicative theory of punishment based on constructivist epistemology which conceives of “penal pain” as a communicative artefact used by the legal system

Abstract: By what types of properties do we specify twinges, toothaches, and other kinds of mental states? Wittgenstein considers two methods. Procedure one, direct, private acquaintance: A person connects a word to the sensation it specifies through noticing what that sensation is like in his own experience. Procedure two, outward signs: A person pins his use of a word to outward, pre-verbal signs of the sensation. I identify and explain a third procedure and show we in fact specify many kinds of mental states in this way

Abstract: Orthodox neural materialists think mental states are neural events or orthodox material properties of neutral events. Orthodox material properties are defining properties of the “physical”. A “defining property” of the physical is a type of property that provides a necessary condition for something’s being correctly termed “physical”. In this paper I give an argument against orthodox neural materialism. If successful, the argument would show at least some properties of some mental states are not orthodox material properties of neural events. I argue against the existence of a posteriori identities.

Abstract: That pain and suffering are unwanted is no truism. Like the sadist, the masochist wants pain. Like sadism, masochism entails an irrational, abnormal attitude toward pain. I explain this abnormality.

Abstract: The aim of this paper is to show that the empirical and conceptual constraints arising from the scientific research on pain phenomena should be taken into account in philosophical discussions concerning the nature and function of pain; otherwise, there is a good chance that philosophers will advocate too simplistic, confused or even outrightly mistaken theories or conceptions of pain. In order to prove this point, one of the most influential philosophical theories of pain—the so-called perceptual view of pain—is put to scrutiny in the light of the psychological, clinical and neurophysiological data coming from the field of pain research. More specifically, these data are presented in such a way as to show that the sensory quality or sensory aspect of pain is, contrary to the objectivistic claims of the perceptual view of pain, a necessary component of our total pain experience

Abstract: Williams and the many studies she considers appear to assume that voluntary amplification in facial expression of pain implies dissimulation. In fact, the behavioral ecology model of pain expression is consistent with amplification when subjects in pain are in the presence of others disposed to render aid, and that amplification may well be voluntary

Abstract: In Stephanie Beardman's discussion of the empirical results of Kahneman and Tversky and Kahneman, et al. on pain preference and rational utility decision she argues that an interpretation of these results does not require that false memory for pain episodes yields irrational preferences for future pain events. I concur with her conclusion and suggest that there are reasons from within the pain sciences for agreeing with Beardman's reinterpretation of the Kahneman, et al. data. I cite some of these theoretical and empirical reasons. I engage in some speculation as to why preferences for pain experiences, which harbor the Peak and Ending profile, make biological sense. Given the results from the pain sciences and the clinical practices based in them, I conclude that the medical ethical issue Kahneman raises and Beardman tries to solve is not a pressing moral demand on medical practitioners

Abstract: What follows raises objections to some arguments that claimthat a principle of applicability of ordinary pain talkconstrains developments in the pain sciences. A more apt pictureof lay use of pain language shows its non-theoretic character.Since instrumentalism and eliminativism are philosophical viewsabout the status of theories of pain, neither is a threatto clinical use of standard pain lingo. Perfected pain theoryis likely to enhance and improve pain language in clinicalsettings, should such theory find its way into popular ideasand talk of pain

Abstract: This paper investigates the status of the purported explanatory gap between pain phenomena and natural science, when the “gap” is thought to exist due to the special properties of experience designated by “qualia” or “the pain quale” in the case of pain experiences. The paper questions the existence of such a property in the case of pain by: (1) looking at the history of the conception of pain; (2) raising questions from empirical research and theory in the psychology of pain; (3) considering evidence from the neurophysiological systems of pain; (4) investigating the possible biological role or roles of pain; and (5) considering methodological questions of the comparable status of the results of the sciences of pain in contrast to certain intuitions underpinning “the explanatory gap” in the case of pain. Skepticism concerning the crucial underlying intuitions seems justified by these considerations

Abstract: 1. First person authority: the received explanation Over a wide range of psychological attributes, a mature speaker seems to enjoy a defeasible form of authority on how things are with him. The received explanation of this is epistemic, and rests upon a cognitive assumption. The speaker’s word is a authoritative because when things are thus-and-so with him, then normally he knows that they are. This is held to be because the speaker has direct and privileged access to the contents of his consciousness by means of introspection, conceived as a faculty of inner sense. Like perceptual knowledge, introspective knowledge is held to be direct and non-evidential. Accordingly, the first-person utterances ‘I have a pain’, ‘I believe that p’, ‘I intend to V’ are taken to be descriptions of what is evident to inner sense. Many classical thinkers held such subjective knowledge to be not only immediate, but also infallible and indubitable. The challenge to the received conceptions came from Wittgenstein. He denied the cognitive assumption, arguing that it cannot be said of me at all (except perhaps as a joke) that I know that I am in pain. For what is that supposed to mean — except perhaps that I am in pain?1 If it makes no sense to say that one knows that one is in pain, then the epistemic explanation is a non-starter, since it explains the special authoritative status of a person’s avowal of pain by reference to the putative fact that the subject of pain knows, normally knows, or cannot but know, that he is in pain when he is. It is important to note that Wittgenstein did not mechanically generalize the case of pain across the whole domain of firstperson utterances. The case of pain constitutes only one pole of a range of such utterances. Avowals and averrals of belief and intention approximate the other pole, and require independent analysis and grammatical description..

Abstract: Kripke’s modal argument against the mind-body identity thesis is by now familiar (Kripke 1980): 1. It is possible for there to be pain without C-fiber stimulation, and vice versa.1 2. If pain = C-fiber stimulation, then it is not possible for there to be pain without..

Abstract: The proposal that there are specific adaptations for the expression and detection of pain appears premature on both conceptual and empirical grounds. We discuss criteria for the validation of a pain facial expression. We also describe recent findings from our lab on coping styles and pain expression, which illustrate the importance of considering individual differences when proposing evolutionary explanations

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by Valerie Hardcastle, Ph.D.

_Metapsychology_

Abstract: This paper argues that pleasure and pains are not qualia and they are not to be analyzed in terms of supposedly antecedently intelligible mental states like bodily sensation or desire. Rather, pleasure and pain are char- acteristic of a distinctive kind of evaluation that is common to emotions, desires, and (some) bodily sensations. These are felt evaluations: pas- sive responses to attend to and be motivated by the import of something impressing itself on us, responses that are nonetheless simultaneously con- stitutive of that import by virtue of the broader rational patterns of which they are a part and that they serve to de?ne. This account of felt eval- uations makes sense of the way in which pleasures and pains grab our attention and motivate us to act and of the peculiar dual objectivity and subjectivity of their implicit evaluations, while o?ering a phenomenology adequate to both emotional and bodily pleasures and pains

Abstract: Facial expressions of pain may be best conceptualized as an example of an evolved propensity to communicate distress, rather than as a distinct category of facial expression. The operant model goes beyond the evolutionary account, as it can explain how the (facial) expression of pain can become maladaptive as a result of its capability to elicit attention and caring behavior in the observer

Abstract: It is generally possible to distinguish between the appearance of an empirical phenomenon and the corresponding reality. Moreover, generally speaking, the appearance of an empirical phenomenon is ontologically and nomologically independent of the corresponding reality: it is possible for the phenomenon to exist without its appearing to anyone that it exists, and it is possible for it to appear to exist without its actually existing. It is remarkable, therefore, that our thought and talk about bodily sensations presupposes that the appearance of a bodily sensation is linked indissolubly to the sensation itself. This is true, in particular, of our thought and talk about pain. Thus, we presuppose that the following principles are valid

Abstract: Following Hume’s lead, Paul Draper argues that, given the biological role played by both pain and pleasure in goal-directed organic systems, the observed facts about pain and pleasure in the world are antecedently much more likely on the Hypothesis of Indifference than on theism. I examine one by one Draper’s arguments for this claim and show how they miss the mark

Abstract: I argue that itches, tickles, aches and pains—sensations of all sorts—are generally in the places where we say they are. So, for example, if I say that I have an itch in the big toe on my left foot, then, by and large, that is the very place where the itch is. James denied this in the 1890s; Russell and Broad denied it in the 1920s; Wittgenstein and Ryle denied it in the 1940s; Lewis and Armstrong denied it in the 1960s; and since then various kinds of materialists have denied it. But if itches etc. are states of the sensitive parts of bodies, then it is true

Abstract: Women typically report more pain than men, as well as exhibit specific sex differences in the perception and emotional expression of pain. We present evidence that sex is a significant variable in the evolution of facial expression of pain

Abstract: Amputation of a limb can result in the persistent hallucination that the limb is still present [Ramachandran and Hirstein, 1998]. Distressingly, these socalled ‘phantom limbs’ are often quite painful. Of a friend whose arm had been amputated due to gas gangrene, W.K. Livingston writes: I once asked him why the sense of tenseness in the hand was so frequently emphasized among his complaints. He asked me to clench my fingers over my thumb, flex my wrist, and raise the arm into a hammerlock position and hold it there. He kept me in this position as long as I could stand it. At the end of five minutes I was perspiring freely, my hand and arm felt unbearably cramped, and I quit. But you can take your hand down, he said. (quoted in [Melzack, 1973] 53) In addition to the obvious medical issues, phantom limb pain also presents philosophical problems. Here’s a thorny one: are phantom limb pains hallucinations of pain?

Abstract: Maura Tumulty has raised two objections to my imperative account of pain.1 First, she argues that there is a disanalogy between pains and other imperative sensations like itch, hunger, and thirst. Suppose (with Hall) one thinks that an itch says “Scratch here!”2 Scratch the itch, and it dutifully disappears. Not so with pain. The pain of a broken ankle has the content ‘Do not put weight on that ankle!’ Yet the coddled ankle still throbs: obeying the imperative does not extinguish it. Second, Tumulty argues that the imperative account cannot handle certain pains, particularly pains of the deep viscera. On my account, pains proscribe against taking action with the painful body part. Yet some pains are associated with body parts over which we have no control. Kidney stones cause intense pain, but I cannot (voluntarily) control my kidney. What action, then, could that pain possibly proscribe? Lacking such a story, it is hard to say (as I do) that pains are exhausted by their imperative content

Abstract: According to several prominent philosophers, pleasure and pain come in measurable quantities. This thesis is controversial, however, and many philosophers have presented or felt compelled to respond to arguments for the conclusion that it is false. One important class of these arguments concerns the problem of aggregation, which says that if pleasure and pain were measurable quantities, then, by definition, it would be possible to perform various mathematical and statistical operations on numbers representing amounts of them. It is sometimes argued that such operations cannot be sensibly applied to pleasure and pain, and that sentences expressing such operations must be false or meaningless. The purpose of this paper is to present, explain, and rebut several versions of this argument. In the first section, I present a generic version of the argument. In the second section, I present a defense of its key premise based on a case involving comparisons of relief from pain, and explain why I think it fails. In the third section, I present and rebut another defense, based on a pair of analogies with temperature. In the final section, I present a third defense, based on an analogy with spatial distances. I then present my reasons for rejecting it. Along the way, I explain my reasons for thinking that pleasure and pain are amenable to interval measurement

Abstract: This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement

Abstract:      This Article proffers a consideration of how the expression of pain impacts the interpersonal dimensions of personal injury proceedings, contesting through philosophical logic and textual analyses of case law and legal practitioners' texts the conclusion of scholars such as Elaine Scarry and Robert Cover that pain unmakes both the word and the world. Seeing pain as something that can and must be communicated, albeit in a different form than pain embodied, makes pain a much more profound force, comports with our understanding of pain as a physical yet interpersonally meaningful sensation, and has many evidentiary ramifications. Taking as its premise the perspective that legal constructions of pain are intrinsically relational and empathic, this Article proposes a reformulation of pain as a dual construct, at once experiential and expressionistic, that is supported by both semiotic theory and by Wittgenstein's refutation of the private language argument associated with Cartesian dualism. Pain as a dual construct is the most appropriate model for the legal construction of pain in personal injury litigation. This Article then turns to the implications of reformulating pain as a dual construct, examining how its grounding in social practice demands a more complex analysis than the existing model put forth by Elaine Scarry, who posits that imagination enables nonsufferers to access another's suffering; this model is inadequate because pain-full phenomena must instead be grounded in social practice and structured by and through language. Only then is it possible to elucidate the development of an empathic connection between a sufferer and another and the legal consequences of that relation. This Article concludes by describing how the model of pain that law currently adopts in principle (but not in practice) extinguishes pain's interactive potential, demonstrating the necessity of a conscious recognition of interpersonal pain-full reality

Abstract: Michael Tye argues for two crucial theses: (1) that experiences of pain have representational content (essentially); (2) that the representational content can be specified in terms of something like damage in parts of the body. (Different types of pain are connected with different types of damage.) I reject both of these theses. In my view experiences of pain carry nonconceptual content, but do not represent essentially. Rather they are apt to represent when the subject attends to them. The experiences carry nonconceptual content not only about tissue damage, but about many other qualities as well, including dispositional qualities

Abstract: Facial responses to pain might be the result of evolution but Williams' interesting “Just So” story provides no convincing evidence for her hypothesis. Contrary to her hope, casting facial action in an evolutionary perspective will probably not reduce the common practice of health care professionals blaming patients for their problems; instead, it may discourage appropriate treatment

Abstract: The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity

Abstract: §3-1. Being in Pain.............................................................................................................................................. 1 §3-2. Why does Persistent Pain lead to Suffering?.............................................................................................. 2 §3-3. The Machinery of Suffering....................................................................................................................... 4..

Abstract: “Great pain urges all animals, and has urged them during endless generations, to make the most violent and diversified efforts to escape from the cause of suffering. Even when a limb or other separate part of the body is hurt, we often see a tendency to shake it, as if to shake off the cause, though this may obviously be impossible.” —Charles Darwin[1]

Abstract: Consider our attitude toward painful and pleasant experiences depending on when they occur. A striking but rarely discussed feature of our attitude which Derek Parfit has emphasized is that we strongly wish painful experiences to lie in our past and pleasant experiences to lie in our future. Our asymmetrical attitudes toward future and past pains and pleasures can be forcefully illustrated by means of a thought-experiment described by Parfit (1984, 165) which I will paraphrase as follows: You are in the hospital to have an extremely painful but completely safe operation for which you can be given no anaesthetic. In order to ease recovery, you know that the hospital will give you drugs that cause you to forget your operation as soon as it is completed. You wake up, not remembering having gone to sleep, and ask the nurse if your operation has been completed. She tells you that there were two patients for this operation and she cannot remember which you are: either you already had your operation and it was the longest such operation ever performed, lasting ten hours, or else you are the other patient in which case your operation is imminent, but will last only one hour. 1. I wish to thank Sarah Broadie for comments on a version of this paper and Derek Parfit for conversations on this subject

Abstract: In 1986, I argued that pains are essentially not phenomenal states. Using a Wittgen-steinian son of argument, I showed that the same sort of phenomena can be had on different occasions, and on one occasion persons be in pain, while on another occasion persons not be in pain. I also showed that very different phenomena could be experienced and, yet, organisms have the same sort of pain. I supported my arguments with empirical data from both laboratory and clinical studies. There is nothing about this thesis I would now retract. However, there was a further thesis that needs to be reconsidered. I argued that phenomenal states are only accompaniments of pains, that pains are essentially a combination of cognitive, affective and behavioural/motivational states. This thesis I do now zaish to retract. I now argue that phenomenal states are necessary for pains, but still not sufficient. There must also be a cognitive state which involves an evaluation of the phenomenon as something like, 'Harm to the body'. The evaluation is a kind of de re belief, regarding the phenomenon as itself representing harm to the body. Besides admitting that phenomenal states are necessary for pains, I also now claim that other relevant belief states, affective states, and behavioural/motivational states are not necessary for pain, but normal consequences of pain. This revised theory is preferable to the 1986 one because it fits better with empirical facts (including providing better explanations for anomalous cases), fits better with certain powerful common-sense intuitions, and fits better with a larger theory of consciousness I have been developing. Among other things, it turns out that being in pain is a quite peculiar conscious state and considering it as a paradigm for consciousness is a serious mistake

Abstract: Dennett has maintained that a careful examination of our intuitive notion of qualia reveals that it is a confused notion, that it is advisable to accept that experience does not have the properties designated by it and that it is best to eliminate it. Because most scientists share this notion of qualia, the major line of attack of his project becomes that of raising objections against the ability of science to answer some basic questions about qualia. I try to show that science appeals to qualia and that it in fact adheres to a notion of qualia different from the one that Dennett has attributed to it. It is argued that qualia are amenable to scientific investigation and that this is the reason why science contributes toward the clarification of the notion of qualia. I also try to show that Dennett's skepticism about the abilities of science in answering questions posited by one of his thought experiments is unwarranted. I conclude that we need not accept Dennett's eliminativism about qualia

Abstract: Michael Tye and I are both Representationalists. Nevertheless, we have managed to disagree about the semantic character of ‘in’ in ‘There is a pain in my fingertip’ (see Noordhof (2001); Tye (2002); Noordhof (2002)). The first section of my commentary will focus on this disagreement. I will then turn to the location of pain. Here, perhaps somewhat surprisingly, there seems to be much more agreement between Tye and me. I restrict myself to three points. First, I argue that Tye has not succeeded in providing a decisive consideration against a related theory which takes pains as representationally unmediated objects of pain experiences. Second, I defend Tye against an objection from Murat Aydede. Third, following on from this, I question whether Tye’s characterisation of the content of pain experience is correct. The fact that there is so much to discuss is a testament to richness, interest and exemplary clarity of Tye’s work

Abstract: When I feel a pain in my leg, how should we understand the

Abstract: In his response, Michael Tye writes as if I reject Representationalism about pain. But in my original paper (Noordhof 2001) I hoped to make clear that I did not. For instance, I remarked that I had sympathy with the position (95) and, on the subsequent page, outlined what I thought the Represen- tationalist should say. My proposal was that when we experience a pain in the finger, the experience is veridical only if the cause of this experience is a disordered state of the finger. My appeal to the notion of a state was not made with any ambitions for ontological reduction (e.g. denying that there are pains but only states of having pain). So I’m afraid that Tye’s objections deriving from attributing to me such a view and pointing out that Repre- sentationalism is needed to capture, amongst other things, the fact that we experience pains in phantom limbs are all beside the point

Abstract: In Why pains are not mental objects (1998) Guy Douglasrightly argues that pains are modes rather than objects ofperceptions or sensations. In this paper I try to go a stepfurther and argue that there are circumstances when pains canbecome objects even while they remain modes of experience.By analysing cases of extreme pain as presented by Scarry,Sartre, Wiesel, Grahek and Wall, I attempt to show thatintense physical pain may evolve into a force that, likeimagination, can make our most intense state of experiencebecome a mental object. I shall finally argue that, thoughextreme pains cannot serve as paradigm cases, they do showthe general importance of taking pain states to be objects

Abstract: It is a commonly held view, buttressed by utilitarian considerations, that pain and suffering are valueless and not to be borne. Moreover, it is this thought, that they are valueless, which is often deployed in arguing for euthanasia for the terminally ill or those with mental or physical disability. This essay argues that suffering is inextricably part of the human condition and that it is our response to it that determines whether we are ennobled or degraded by it. While it is not sought for itself, suffering provides human beings with the opportunity to be ennobled, to be given unexpected experiences of love and to gain improbable sources of strength and so it can have a use which can make it valuable

Abstract: No adequate evidence exists for the evolution of facial pain expression and detection mechanisms, as opposed to social-learning processes. Although brain affective/emotional processes, and resulting whole body action patterns, have surely evolved, we should also aspire to monitor human suffering by direct neural measures rather than by more indirect indices

Abstract: An automated system for monitoring facial expressions could increase the reliability, sensitivity, and precision of the research on the relationship between facial signs and experiences of pain, and it could lead to new insights and diagnostic methods. This commentary examines whether the research on facial expression of pain, as reported by Williams, provides a sufficient basis for machine understanding of pain-associated facial expressions

Abstract: We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction

Abstract: A widely accepted theory holds that emotional experiences occur mainly in a part of the human brain called the amygdala. A different theory asserts that color sensation is located in a small subpart of the visual cortex called V4. If these theories are correct, or even approximately correct, then they are remarkable advances toward a scientific explanation of human conscious experience. Yet even understanding the claims of such theories

Abstract: A widely accepted theory holds that emotional experiences occur mainly in a part of the human brain called the amygdala. A different theory asserts that color sensation is located in a small subpart of the visual cortex called V4. If these theories are correct, or even approximately correct, then they are remarkable advances toward a scientific explanation of human conscious experience. Yet even understanding the claims of such theories—much less evaluating them—raises some puzzles. Conscious experience does not present itself as a brain process. Indeed experience seems entirely unlike neural activity. For example, to some people it seems that an exact physical duplicate of you could have different sensations than you do, or could have no sensations at all. If so, then how is it even possible that sensations could turn out to be brain processes?

Abstract: Understanding the nature of pain depends, at least partly, on recognizing its subjectivity (thus, its first-person epistemology). This in turn requires using a first-person experiential method in addition to third-person experimental approaches to study it. This paper is an attempt to spell out what the former approach is and how it can be integrated with the latter. We start our discussion by examining some foundational issues raised by the use of introspection. We argue that such a first-person method in the scientific study of pain (as in the study of any experience) is in fact indispensable by demonstrating that it has in fact been consistently used in conjunction with conventional third-person methodologies, and this for good reasons. We show that, contrary to what appears to be a widespread opinion, there is absolutely no reason to think that the use of such a first-person approach is scientifically and methodologically suspect. We distinguish between two uses of introspective methods in scientific experiments: one draws on the subjects’ introspective reports where any investigator has equal and objective access. The other is where the investigator becomes a subject of his own study and draws on the introspection of his own experiences. We give examples using and/or approximating both strategies that include studies of second pain summation and its relationship to neural activities, and brain imaging- psychophysical studies wherein sensory and affective qualities of pain are correlated with cerebral cortical activity. We explain what we call the experiential or phenomenological approach that has its origins in the work of Price and Barrell (1980). This approach capitalizes on the scientific prospects and benefits of using the introspection of the investigator. We distinguish between its vertical and horizontal applications. Finally, we conclude that integrating such an approach to standard third-person methodologies can only help us in having a fuller understanding of pain and of conscious experience in general..

Abstract: Understanding the nature of pain depends, at least partly, on recognizing its subjectivity (thus, its first-person epistemology). This in turn requires using a first-person experiential method in addition to third-person experimental approaches to study it. This paper is an attempt to spell out what the former approach is and how it can be integrated with the latter. We start our discussion by examining some foundational issues raised by the use of introspection. We argue that such a first-person method in the scientific study of pain (as in the study of any experience) is in fact indispensable by demonstrating that it has in fact been consistently used in conjunction with conventional third-person methodologies, and this for good reasons. We show that, contrary to what appears to be a widespread opinion, there is absolutely no reason to think that the use of such a first-person approach is scientifically and methodologically suspect. We distinguish between two uses of introspective methods in scientific experiments: one draws on the subjects’ introspective reports where any investigator has equal and objective access. The other is where the investigator becomes a subject of his own study and draws on the introspection of his own experiences. We give examples using and/or approximating both strategies that include studies of second pain summation and its relationship to neural activities, and brain imaging- psychophysical studies wherein sensory and affective qualities of pain are correlated with cerebral cortical activity. We explain what we call the experiential or phenomenological approach that has its origins in the work of Price and Barrell (1980). This approach capitalizes on the scientific prospects and benefits of using the introspection of the investigator. We distinguish between its vertical and horizontal applications. Finally, we conclude that integrating such an approach to standard third-person methodologies can only help us in having a fuller understanding of pain and of conscious experience in general..

Abstract: A monolithic model that ignores functional and topographic distinctions among its components has dominated clinical accounts of pain behavior. This model contributes to a pretence of knowledge that affects the treatment of sufferers. This commentary addresses the role of the target article in correcting knowledge-pretence and introduces a complementary caveat about evolutionary psychology concepts

Abstract: Inasmuch as unmitigated pain and suffering areoften thought to rob human beings of theirdignity, physicians and other care providersincur a special duty to relieve pain andsuffering when they encounter it. When pain andsuffering cannot be controlled it is sometimesthought that human dignity is compromised.Death, it is sometimes argued, would bepreferred to a life without dignity.Reasoning such as this trades on certainpreconceptions of the nature of pain andsuffering, and of their relationships todignity. The purpose of this paper is to laybare these preconceptions. The duties torelieve pain and suffering are clearly mattersof moral obligation, as is the duty to respondappropriately to the dignity of other persons.However, it is argued that our understanding ofthe phenomena of pain and suffering and theirrelationships to human dignity will be expandedwhen we explore the aesthetic dimensions ofthese various concepts. On the view presentedhere the life worth living is both morally goodand aesthetically beautiful. Appropriate``suffering with'''' another can help to maintainand restore the dignity of the relationshipsinvolved, even as it preserves and enhances thedignity of patient and caregiver alike

Abstract: Patients with persistent pain who lack adetectable underlying disease challenge thetheories supporting much of biomedicalbody-mind discourse. In this context,diagnostic labeling is as inherently vulnerableto the same pitfalls of uncertainty that besetany other interpretative endeavour. The endpoint is often no more than a name ratherthan the discovered essence of a pre-existentmedical condition. In 1990 a Committee of theAmerican College of Rheumatology (ACR)formulated the construct of Fibromyalgia in anattempt to rectify a situation of diagnosticconfusion faced by patients presenting withwidespread pain. It was proposed thatFibromyalgia existed as a ``specific entity'',separable from but curiously able to co-existwith any other painful condition. Epistemological and semiotic analyses ofFibromyalgia have failed to find any sign,clinical or linguistic, which coulddifferentiate it from other diffusemusculoskeletal pain states. The construct ofFibromyalgia sought to define a discernablereality outside the play of language and topass it off as a natural phenomenon. However,because it has failed both clinically andsemiotically, the construct also fails the testof medical utility for the subject inpersistent pain

Abstract: This paper develops an instrumentalistic argumentagainst an eliminativist approach to using the folkconcept of pain in clinical medicine and draws someimplications for biomedical theories of pain. Thepaper argues that the folk concept of pain plays afundamental role in several aspects of clinicalmedicine, including the diagnosis and treatment ofdiseases and symptoms, relieving human suffering, andthe doctor-patient relationship. Since clinicians mustbe able to apply biomedical theories of pain inmedical practice, these theories should not stray toofar from pain's clinical realities. Biomedicaltheories of pain should at least incorporate an analogof the folk concept of pain, even if this concept isrevised in light of scientific advances

Abstract: At graduation, some North American medical students repeat the Prayer of Maimonides "never to forget that the patient is a fellow creature in pain, not a mere vessel of disease." [2] How could a physician ever forget that a patient is in pain? Don't physicians confront constant reminders­moans, groans, winces, and other obvious manifestations of pain? Yes, but it is those very "reminders," as I shall explain, that provoke at least two kinds of forgetting common among physicians­one, psychological and the other, conceptual. The psychological kind of forgetting is primarily self-protective, but the conceptual kind has deeper roots in the very definition of modern Medicine as curative and life-preserving. If my analysis is right, more lecture time on pain and pain relief in medical schools will do little to correct this "forgetting" of pain. But there may be better remedies for pain-forgetting, some already at work in North American medical practices

Abstract: An ethological analysis suggests that effort and protection actions, which are expressions of distress, are comparable with pain expressions. Distress occurs with uncontrollable pain, and the expressions are ritualized pain responses with exaggerated features and lower thresholds. Pain is a sensory-motor feeling state with aversive motivational (hedonic) value. Distress is an emotional state of failure of pain responses to control the pain

Abstract: It seems that animal pain is an obstacle to belief in a good God, though Christianity has not been much concerned with the issue. A systemic approach to pain is not a complete answer, nor is there any merit in denying that God is subject to moral appraisal. Marilyn McCord Adams recommends that such investigations be located in the specifics of a religious tradition. Her advice eliminates a couple of radical solutions but there appear to be a number of ways in which progress might be made without doing violence to the tradition that is in need of a theodicy

Abstract: Part philosophical meditation, part cultural critique, The Body in Pain is a profoundly original study that has already stirred excitement in a wide range of intellectual circles. The book is an analysis of physical suffering and its relation to the numerous vacabularies and cultural forces--literary, political, philosophical, medical, religious--that confront it. Elaine Scarry bases her study on a wide range of sources: literature and art, medical case histories, documents on torture compiled by Amnesty International, legal transcripts of personal injury trials, and military and strategic writings by such figures as Clausewitz, Churchill, Liddell Hart, and Kissinger, She weaves these into her discussion with an eloquence, humanity, and insight that recall the writings of Hannah Arendt and Jean-Paul Sartre. Scarry begins with the fact of pain's inexpressibility. Not only is physical pain enormously difficult to describe in words--confronted with it, Virginia Woolf once noted, "language runs dry"--it also actively destroys language, reducing sufferers in the most extreme instances to an inatriculate state of cries and moans. Scarry analyzes the political ramifications of deliberately inflicted pain, specifically in the cases of torture and warfare, and shows how to be fictive. From these actions of "unmaking" Scarry turns finally to the actions of "making"--the examples of artistic and cultural creation that work against pain and the debased uses that are made of it. Challenging and inventive, The Body in Pain is landmark work that promises to spark widespread debate. About the Author: Elaine Scarry is Associate Professor of English at the University of Pennsylvania

Abstract: Evolutionary explanations of pain expression require modeling social adaptations in a context where the role of health professionals as potential caregivers, conflicts with their status as relative strangers. As signals of help elicitation or of alarm, facial pain displays and responses to displays, particularly in the upper face, are expected to conform to this evolutionarily novel clinical context

Abstract: Though the vegetarian movement sparked by Peter Singer’s book Animal Liberation has achieved some success, there is more animal suffering caused today due to factory farming than there was when the book was originally written. In this paper, I argue that there may be a technological solution to the problem of animal suffering in intensive factory farming operations. In particular, I suggest that recent research indicates that we may be very close to, if not already at, the point where we can genetically engineer factory-farmed livestock with a reduced or completely eliminated capacity to suffer. In as much as animal suffering is the principal concern that motivates the animal welfare movement, this development should be of central interest to its adherents. Moreover, I will argue that all people concerned with animal welfare should agree that we ought to replace the animals currently used in factory farming with animals whose ability to suffer is diminished if we are able to do so

Abstract: Harvard Review of Philosophy, Vol 15, Fall (2007)

Abstract: While the biomedical model is still theleading paradigm within modern medicine and healthcare, and people with generalised chronicmusculoskeletal pain are frequent users of health careservices, their diagnoses are rated as having thelowest prestige among health care personnel. Anepistemological framework for understanding relationsbetween body, emotions, mind and meaning is presented.An approach based on a phenomenological epistemologyis discussed as a supplement to actions based on thebiomedical model.Within the phenomenological frame of understanding,the body is viewed as a subject and carrier ofmeaning, and therefore chronic pain can be interpretedas a rational reaction to the totality of a person'slife situation. Search for possible hidden individualmeanings in painful muscles presupposes meeting healthpersonnel who view the person within a holistic frameof reference

Abstract: This paper offers an evolutionary account of chronic pain. Chronic pain is a maladaptive by-product of pain mechanisms and neural plasticity, both of which are highly adaptive. This account shows how evolutionary psychology can be integrated with Flanagan's natural method, and in a way that avoids the usual charges of panglossian adaptationism and an uncritical commitment to a modular picture of the mind. Evolutionary psychology is most promising when it adopts a bottom-up research strategy that focuses on basic affective and motivational systems (as opposed to higher cognitive functions) that are phylogenetically deep

Abstract: Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP) in the learning andmemory literature, are forms of neuroplasticity inwhich increased neural activity leads to a longlasting increase in the excitability of neuronsthrough structural modifications at pre- andpost-synaptic sites. Moreover, the synapticmodifications of wind-up and LTP share a commonmechanism: a glutamate N -methyl-D-aspartate(NMDA) receptor interaction that initiates a calciummediated biochemical cascade that ultimately enhancessignal processing at the -amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) receptor. This paper arguesthat chronic pain, which has no adaptive value, canbe accounted for in terms of the highly adaptivephenomenon of activity-dependent neural plasticity;hence, some cases of chronic pain can beconceptualized as a memory trace in spinal neurons

Abstract: A widely accepted theory holds that emotional experiences occur mainly in a part of the human brain called the amygdala. A different theory asserts that color sensation is located in a small subpart of the visual cortex called V4. If these theories are correct, or even approximately correct, then they are remarkable advances toward a scientific explanation of human conscious experience. Yet even understanding the claims of such theories—much less evaluating them—raises some puzzles. Conscious experience does not present itself as a brain process. Indeed experience seems entirely unlike neural activity. For example, to some people it seems that an exact physical duplicate of you could have different sensations than you do, or could have no sensations at all. If so, then how is it even possible that sensations could turn out to be brain processes?

Abstract: This paper discusses recent neuroscientific research that indicates a solution for what we label the ''causal problem'' of pain qualia, the problem of how the brain generates pain qualia. In particular, the data suggest that pain qualia naturally supervene on activity in a specific brain region: the anterior cingulate cortex (ACC). The first section of this paper discusses several philosophical concerns regarding the nature of pain qualia. The second section overviews the current state of knowledge regarding the neuroanatomy and physiology of pain processing. The third section highlights the recent research by Rainville et al. [(1997) Pain affect encoded in human anterior cingulate but not somatosensory cortex, Science, 277, 968-971], which suggests that pain affect is encoded in the ACC. The final section of the paper spells out exactly how these data affect the causal problem of pain qualia

Abstract: As a product of natural selection, pain behavior must serve an adaptive function for the species beyond the accurate portrayal of the pain experience. Pain behavior does not simply refer to the pain experience, but promotes survival of the species in various and complex ways. This means that there is no purely respondent or operant pain behavior found in nature

Abstract: Most modern writers accept that a privation theory of evil should explicitly account for the evil of pain. But pains are quintessentially real. The evil of pain does not seem to lie in an absence of good. Though many directly take on the challenges this raises, the metaphysics and axiology of their answers is often obscure. In this paper I try to straighten things out. By clarifying and categorizing the possible types of privation views, I explore the ways in which privationists about evil are—or should or could be—privationists about pain’s evil

Abstract:      In the last few years, several states have adopts laws requiring that some women seeking abortions be told that their fetus may experience pain. These measures are the latest in a growing body of specific informational requirements for abortion procedures, many steeped in scientific controversy. These laws abandon well-settled principles of informed consent -- which give discretion to medical professionals to determine what information is crucial for patients -- in favor of legislative judgments about what particular facts should be told to patients and how these facts should be shared. This Article argues that, to the extent these laws go beyond flagging topics that should be discussed by health care providers and prescribe specific factual claims that must be conveyed to patients, they should be subject to non-deferential judicial review of their accuracy and fairness. Part I provides an overview of abortion informed consent jurisprudence since Planned Parenthood of Southeastern Pennsylvania v. Casey. Part II suggests a framework for analyzing challenges to specific informed consent provisions. Part II.A argues that false or misleading statements are unconstitutional under either the undue burden or rational basis standards. Part II.B proposes false advertising cases as an instructive analogue, arguing that the accuracy of informed consent provisions should be analyzed similarly. Part II.C considers the principle of judicial deference to legislative fact-finding from several angles, and argues that it should be applied in weak form, or not at all, in the informed consent context. Part III analyzes several states' mandated information on fetal pain within this framework and concludes that they are unconstitutional

Abstract: I appreciate that such a view needs argument which is not appropriate here. However, I think that there are independent reasons to think that Tye’s theses are problematical. It is difficult to see how these theses are consistent both with what we know about pains, and other perceptual experiences, and with the package of claims that are central to Tye's treatment of pain, and more generally of perceptual experiences, whereby phenomenal character is explained in terms of representational content [as presented in Tye (2000)]

Abstract: In children experiencing pain, the study of the social context of facial expressions might help to evaluate evolutionary and conditioning hypotheses of behavioural development. Social motivations and influences may be complex, as seen in studies of children having their ears pierced, and in studies of everyday pain in children. A study of opposing predictions of the long-term effects of parental caregiving is suggested

Abstract: According to Williams, human facially expressed pain, and its perception by conspecifics, is generated by evolved mechanisms. We argue that a key variable – sex (male, female) – needs to be considered for a complete theory of pain expression and perception. To illustrate, we cite findings on sex differences in pain and pain perception, and in crying and crying responsiveness

Abstract: Human rights law inscribes a relation between the political and suffering. This relation is twofold, it facilitates the radical aspect of human rights’ struggle against domination, but at the same time seems to reduce the human rights horizon to the short-term philantropism of humanitarianism. We will argue that this twofold structure is crucial to understanding human rights. We can begin to imagine a different, non-metaphysical, human rights through thinking a different concept of suffering with emphasis on ‘sense’ and ‘vulnerability’. This article is an attempt to think a future of human rights, a future which is not determined by possessive individualism and the closure of the subject

Abstract: Believing in God requires not only a leap of faith but also an extension of people’s normal capacity to perceive the minds of others. Usually, people perceive minds of all kinds by trying to understand their conscious experience (what it is like to be them) and their agency (what they can do). Although humans are perceived to have both agency and experience, humans appear to see God as possessing agency, but not experience. God’s unique mind is due, the authors suggest, to the uniquely moral role He occupies. In this article, the authors propose that God is seen as the ultimate moral agent, the entity people blame and praise when they receive anomalous harm and help. Support for this proposition comes from research on mind perception, morality, and moral typecasting. Interestingly, although people perceive God as the author of salvation, suffering seems to evoke even more attributions to the divine

Abstract: The assessment and management of pain is a significant public health problem in the United States. Long-term care facilities face unique barriers and challenges to pain management due to the large population of cognitively impaired residents, little physician contact and poor pain education for nurses and nurse assistants. In addition, common misconceptions about pain and pain treatment in the elderly along with health professional and resident fears of addiction and drug toxicity, add to the problem of pain management. The basic principles of pain treatment in long-term care are identical to all other health care settings – utilizing a combination of drug and non-drug treatments. Recent efforts to institutionalize improved pain management practices, through assessment procedures and defined pain management policies, standards and education programming, is a promising venue for systemically improving pain treatment in long-term care settings

Abstract: This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, “amplification” could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. Key Words: adaptation; evolutionary psychology; facial expression; pain

Abstract: The experience of pain appears to be associated, from early infancy and across pain stimuli, with a consistent facial expression in humans. A social function is proposed for this: the communication of pain and the need for help to observers, to whom information about danger is of value, and who may provide help within a kin or cooperative relationship. Some commentators have asserted that the evidence is insufficient to account for the consistency of the face, as judged by technical means or in the perceptions of observers, or that facial expression is epiphenomenal to a gross behavioural defensive response to pain. The major criticism is that it is unnecessary to invoke evolutionary mechanisms beyond the emergence of an unconditioned facial response to pain in neonates, subsequently shaped and maintained by instrumental and social reinforcement throughout life. These criticisms are addressed, acknowledging the need for further data to address some, and elaborating the areas in which evolutionary and operant mechanisms would predict different behavioural interactions, rather than acting synergistically. Several supportive commentaries propose extending evolutionarily-based hypotheses to sex differences, the complexities of others' responses within the social relationship, and the role of empathy. A number of commentators provided valuable suggestions for experimental paradigms or methodological issues. Overall, addressing these issues indicates the need for further conceptual development and for collection of data specifically in relation to these hypotheses

Abstract: In his ‘pains and Places’ (Philosophy 78, 2003), John Hyman is right that pains are not located in their causes or effects but in the hurting limbs. However, his position may be consonant with Wittgensteinian expressivism or the view that consciousness is the locus of pain: In producing its own parts, a living organism ‘autopoietically’ sustains itself as an activity functionally present in its limbs. It thus supplies the biological basis for pain consciousness as something wholly present in organs that hurt. (Published Online October 13 2005)

Abstract: In this paper I present a new argument against internalist theories of practical reason. My argument is inpired by Frank Jackson's celebrated Knowledge Argument. I ask what will happen when an agent experiences pain for the first time. Such an agent, I argue, will gain new normative knowledge that internalism cannot explain. This argument presents a similar difficulty for other subjectivist and constructivist theories of practical reason and value. I end by suggesting that some debates in meta-ethics and in the philosophy of mind might be more closely intertwined than philosophers in either area would like to believe

Abstract: It is widely held that it is only contingent that the sensation of pain is disliked, and that when pain is not disliked, it is not intrinsically bad. This conjunction of claims has often been taken to support a subjectivist view of pain’s badness on which pain is bad simply because it is the object of a negative attitude and not because of what it feels like. In this paper, I argue that accepting this conjunction of claims does not commit us to this subjectivist view. They are compatible with an objectivist view of pain’s badness, and with thinking that this badness is due to its phenomenal quality. Indeed, I argue that once the full range of options is in view, the most plausible account of pain is incompatible with subjectivism about value.