Do people draw a distinction between reality and appearance in the case of pain?

Is it the case that we conceive of pain in such a way that one is in pain if and only if one feels pain? Or rather do people distinguish feeling pain and being in pain the way they distinguish being red and looking red, being square and looking square, being salty and tasting salty, etc.?

Over the years, evidence has accummulated suggesting that the latter is in fact the case. Using a clever vignette, Justin Sytsma has shown that people individuate pains by reference to the body rather than the mind (see his paper in the Journal of Conciousness Studies): if conjoined twins hurt their common left foot, people tend to say that there are a single pain instead of two. So pains are states of the body rather than mental experiences. For Justin, people are in fact naive realists about pains.

In an article published in the  Journal of Conciousness Studies, Kevin Reuter has recently provided some further evidence in an ingenious manner. He examined the occurrences of "feeling pain" and "having pain" one the web using several web search engines. It turns out that people are somewhat more likely to use the former when pain is weak, but much more likely to use the latter when it is strong. He takes this to show that people use "feeling pain" when they are not confident (because the intensity is weak) and "having pain" when they are confident. As he rightly notes, this distinction parallels the look/is distinction in the case of colors. It would be interesting to find out whether this effect holds across other languages.

This work on pain is a welcome addition to the growing body of research on lay conceptions of folk consciousness: whether people have a concept of phenomenal consciousness, the relation between embodiment and ascription of consciousness, the role of consciousness ascription in moral standing, etc.

References
Sytsma, J. (2010). Dennett’s theory of the folk theory of consciousness. Journal of Consciousness Studies.
Reuter, K. (2011). Distinguishing the appearance from the reality of pain. Journal of Consciousness Studies.

Comments

[anon]

"...if conjoined twins hurt their common left foot, people tend to say that there are two pains instead of merey one. So pains are states of the body rather than mental experiences."

Huh?

[Edouard Machery]

Right - I mischaracterized Justin Sytsma's findings. This mistake has been corrected! (I guess I let my own intuitions drive my hand!)

[Michael Schmitz]

If the folk were consistent in meaning a bodily condition by "pain" rather than an experience or feeling, they would reject phantom pains, even chronic and intense ones, as genuine instances of pain and think of them as mere illusions of pain instead. That is, they would treat "phantom pain" rather like "hallucinated dagger." I strongly doubt though that they will deny that a person suffering from phantom pains is really in pain. (Of course, I stand ready to be corrected and would be grateful for any pointers to data that might bear on this.)

My hunch is rather that what is going on is that the folk ordinarily do not make a very clear separation between the bodily condition and the experience: they usually go together, and there is no necessity of deciding which one they really mean by "pain", nor even of keeping them apart clearly. But when presented with situations where they do come apart, they might go either with the bodily condition or the experience, depending on the case and how it is presented. In the twin case, where both bodily condition and experience(s) are present and only their number is dissociated, they determine the number of pains by bodily condition, consistent with how we talk of pains as being in the foot and other body parts. But in many contexts we are most interested in the subjective, experiential aspect, so if you take the bodily condition away as in the phantom case, people will I think tend to focus on the feeling as the pain - while continuing to claim that the (phantom) pain is in the (no longer existing) foot. This may drive philosophers mad, but is normally harmless.

Of course, in philosophy or elsewhere we can sharpen the definition of pain in either way, but the idea that we can then ask the folk which of these sharpenings they had in mind, or even which is the 'right one', strikes me as rather misguided - in this as well as in many other cases, though of course this does not mean that these experimental results are not interesting and valuable. The question just is what we expect from them.

[Lucas]

Reminds me of something..."Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever." and that is Lance Armstrong.

[Kevin Reuter]

You are likely to be right, Michael, in claiming that people seem to be inconsistent when using pain language. However, inconsistency does not mean a lack of a semantic structure that can be interpreted. The more interesting question is whether there is an appearance-reality distinction when in comes to pain. And it looks as if there really are certain speech patterns, even if not clear-cut, that point towards that conclusion.

One general point is that the use of the phrase "being in pain" might have a detrimental effect in this discussion. Not only is this phrase an idiosyncrasy of the English language (I checked around 20 other languages none of which has an equivalent expression), but is also syntactically closed and thus semantically impoverished: e.g. we cannot say "she is in throbbing knee-pain". More importantly the phrase "being in pain" is used by some philosophers (e.g. Aydede, Dretske, Hill) to mean "really having a pain" by others (e.g. Bain, Hyman, Papineau) to mean "feeling a pain", and by Grahek and Dennett to be an expression of the emotional-affective component of pain. My suggestion would be to therefore dispense of this expression in philosophical discussions.

Although, as I said, I take the point that people might be inconsistent and thus sometimes refer to a bodily condition and at other times to an experience when saying that they have a pain, a further reason for thinking that people mainly mean the bodily condition when talking about pain, is developmental considerations. Young children learn to use the language of pain without (very likely) having the concept of experience. Thus, their concept of pain seems to denote a bodily condition rather than their experience. The concept of pain might transform later into an ambiguous concept that can be used as an introspective or a perceptual concept. But why believe that? We do have a way to express feelings of pain, e.g. by saying "I feel a stinging pain in my shoulder', and my web analysis at least demonstrates that people, for one reason or another, use these different expressions in different situations in a principled manner.

One last point about the phantom pain case. When people have a red afterimage, they do not shy away from claiming that the afterimage 'really is red'. But nobody suggests that people can't distinguish experiences of red from environmental red. The case of phantom pain is complex, but similar in that just because people are inclined to say that a phantom pain 'really is a pain' does not need to mean that they do not distinguish pains from feelings of pain.

[Michael Schmitz]

Hi Kevin, thanks for your response. Here are a couple of further replies to it and to your paper which I have read in the meantime.

(1) Let me make clear that I agree that there is an appearance-reality distinction with regard to pains. I only meant to object to the thesis that the folk always mean a bodily condition by 'pain'. The two theses are quite independent. In fact, it seems to me the thesis that there is an appearance-reality distinction is more plausible when we apply it to the relation between pains construed as experiences and reports or beliefs about these experiences than if we apply it to the relation between the bodily condition ('tissue damage' or some such) and the experience, as you suggest. For example, when sitting in the dentist's chair, I have sometimes thought I was in pain, though in fact I was only anxious and anticipating pain. By contrast, it is harder to make sense of the idea that the pain experience is an illusory appearance in the sense of a perceptual illusion as you claim because it is difficult to think of the essential affective aspect of pain as being representational.

(2) It is very implausible that people never mean the experience by the word "pain". Indeed it seems obvious that in most cases that is what they are most interested in. For example, there is a growing field in medicine of pain therapy, which is expressly about treating the experience rather than the underlying bodily condition. And for what it's worth - and I think it ought to be worth quite a bit - both Wikipedia and the International Association for the Study of Pain explicitly define pain as a feeling or experience.

(3) Like you, I'm impressed by considerations about learning the word 'pain' and I agree that children understand it before understanding 'experience' or similar terms, but I draw a different conclusion. I think it follows that they do NOT mean a bodily condition by 'pain', at least not how this is usually understood, because usually 'bodily' is defined in opposition to 'mental', or 'experiential' or some such, and so because they do not have a concept of experience or the mental, they do not have a notion of the bodily or of pain as something bodily in the relevant sense either. I think their understanding is rather at a level prior to the mind/body dualism, which unfortunately we always try to read into everything. That the basic competence with the word 'pain' (and many others) is prior to this dualism also helps to explain why people often do not clearly distinguish the mental and physical aspects of pain and sometimes mix them in inconsistent ways even after they have acquired the general distinction between body and experience. In any case, the bottom line is that from the fact that children lack the concept of experience it cannot follow that they use the word "pain" to pick out a merely bodily, non-experiential state.

(4) Your observations about the usage patterns of talking about "having" vs. "feeling" pains are interesting and would require more discussion, but I don't think they can bear the weight of the conclusions you want to rest on them. There may be a pattern that people tend to use "feel" rather than "have" when they lack confidence and/or the pain is less intense, but I don't see how it follows that what they ascribe is not in the overwhelming majority of both kinds of cases something that essentially has an experiential aspect. Finally, in most cases "feeling pain" is plausibly interpreted as an 'inner accusative' akin to "winning a victory", "playing a game" etc. that is, as specifying the way that the person felt rather than an intentional relation to an independently existing object.

[Kevin Reuter]

Hi Michael, some great comments. Thanks for clarifying your position and digging deeper. Let me go through your comments one by one.

(ad 1) I would go so far in claiming that it is hard to understand how people cannot make sense of the dentist's chair example. The question 'did I really have a ringing in my ears or did I merely think so?', seems to be on par with the dentist case. These cases have of course interesting components, but it does not give us the right tool to evaluate whether and how pain perception differs from colour or sound perception. I believe therefore that the issue of making sense of an appearance-reality distinction between bodily condition and pain experience is the more crucial one.

(ad 2) I do not share your opinion that in most cases people are more interested in the pain experience than the bodily condition. Of course, we clearly need to separate the person who is feeling pain from the pain researcher. The person who feels pain seems to me to be clearly concerned with the part of the body in which he feels the pain. Once people think about pain killers and the likes, they certainly make a distinction between their pain experience and the body part that hurts, and might then be more concerned with the feeling of pain. But doesn't this change of attitude presuppose a shift of thinking, and if yes, doesn't this show that people first and foremost are concerned with their bodily condition when focusing on their pain? I grant you that pain researchers are interested in experiences of pain, but colour scientists are also primarily interested in colour experiences. BTW: Wikipedia defines colour as a visual perceptual property (quite ambiguous I know) and not as spectral reflectance property or wavelength property of electromagnetic waves.

(ad 3) I am not sure whether I follow you here. Why should children not develop a concept of the body as a body before they develop a concept of the mind as a mind? Maybe some philosophers and psychologists define body in opposition to the mind, but we don't need to, and clearly children can refer to and talk about body parts and inner states of their body, i.e. tickles, hunger, etc. Take following conversation from Matthews (1982. p.17): "Ursula [three years, four months], 'I have a pain in my tummy'. Mother, 'You lie down and go to sleep and your pain will go away.' Ursula, 'Where will it go?" A fascinating conversation, that clearly shows that Ursula has not yet developed a full understanding of pains, but it suggests that Ursula thinks of the pain as being (at least temporarily) in or part of her body.

(ad 4) The argument in JCS is supposed to highlight an hitherto unnoticed analogy between perception in the traditional sense modalities and pain perception that cannot be well explained by thinking of the sensing of pain as being introspective, and to which no appearance-reality distinction applies. This does not rule out that 'thinking' about pain involves 'thinking' about something that has an affective-motivational component. Take following (what I believe to be an) analogous case: We do classify smelling vomit and tasting rotten food as perception, not introspection, but it seems that in these cases people still ascribe something that has an (essentially ?) experiential aspect.

[Michael Schmitz]

Hi Kevin, thanks for an excellent discussion. We are not that far apart, but I think there is some residual disagreement / need for clarification. If I may voice a general complaint at this point, it seems to me that certainly the presentation of your view, but possibly also its substance could benefit from more attention to, and discussion of, the difference between, and the relation of, the experience of pain and the use of the concept of pain. Now onto your specific points.

(ad 1) I believe we agree that pain experience is largely representational - perhaps even entirely so if we can think of its affective aspect as representational - and that it can misrepresent. However, I think that while pain experience is nonconceptual, the distinction between appearance and reality can only be drawn at the conceptual level of thought. But then if you want to find out whether the folk make an appearance-reality distinction with regard to pain, one fundamental problem is how they understand the word “pain” in the first place.

(ad 2) So while I agree that the feeling or experience of pain presents a bodily condition (in a sense soon to be clarified) and that the person who is experiencing pain is in a sense ‘concerned’ with his body in virtue of this experience, it does not follow that people primarily mean a bodily condition when they think and talk about pain. They will of course still be concerned about their body at the level of thought and talk, but they will distinguish that concern from their concern about their pain. As you hint, that’s probably largely due to their understanding of pain killers etc. So they will understand if, for example, the doctor says something to them like that while it will take time to fix the broken leg, he can give them something against their pain immediately. You don’t have to be a pain researcher to understand that. Every adult and I would guess every normal child of 10 and probably younger will understand this and will in general understand the word “pain” as it used in such a context. Now of course, as your example with Ursula nicely illustrates, and as I have also emphasized from the beginning, there are earlier stages of thought and talk, where this isn’t the case yet, and even in the adult competence there are residues of these earlier stages. These explain why we still say that the pain is in the body part and presumably also why the subjects thought there was just one pain in the conjoined twin vignette. But I don’t see why that should make us deny that most speakers in most contexts primarily have the experience in mind when they use the word “pain.”

(ad 3) I did not object to saying that pain experience and the early stages of using the word represent a bodily state if ‘bodily’ is not defined in opposition to ‘mind’, ‘experience’ or similar terms. Of course people do take pains to be in the body. The point was just that, as you seem to agree, that there is a shift from the early stages as exemplified by Ursula to the later stages where experiential and bodily aspects of pain are distinguished, if imperfectly.

(ad 4) Again, we do agree in holding that pain experience has representational content and in rejecting the traditional ideas that it is introspective and that the appearance-reality distinction does not apply to it. The disagreement is just a fairly subtle disagreement about what the folk mean by the word “pain”. (It may be useful in this context to point out that talk about “pain experience” and “the experience of pain” does not necessarily mean that pain is the intentional object of this experience. Compare “perceptual experience” and “experience of perception”, which do not necessarily or even normally refer to an experience that has perception as its intentional object.)