What the face reveals: the experience of pain

Presented at: De/Constructing the Body: Ancient and Modern Dynamics, Workshop 3:Trans-Formation, April 9, 2021.

Abstract here.

Slide transcript

Slide 2
Human beings are describable in two distinct, but complementary ways: in terms of the way the world is, through scientific descriptions of the causal mechanisms and laws that explain physical things, or, in terms of the way the world seems, through descriptions of personal experiences and meanings.

As a person, I can recognise within myself a perspective or point of view on the world and identify it as belonging to me. Every person has such a unique perspective; this is partly what it means to be a person rather than a physical thing. In contrast, a scientific description of the world does not presuppose any personal point of view. Physical or biological science does not use words like “I”, “here”, or “now”.

Slide 3
The features of personal experience—thought, feeling, speech and action—are amenable to standard scientific explanation as specific changes in the body.

A philosophical assumption held by some neurophysiologists is that a person is identical with his or her body. Person and body are one and the same thing. This assumption is behind the slogan in pain science, “pain is in the brain”.

In terms of personal experience, however, the identity between person and body escapes understanding. For example, when I feel a pain, there is no information or evidence, or nothing that I could discover about my body subsequent to the experience of pain, that could demonstrate it to be false. When I feel a pain, I simply I am in pain.

Slide 4
In person-to-person interactions, we commonly respond to each other as though we are not identical with the human body, but in a compelling sense operating “through” the body, which seems to be a vehicle of thought, emotion, pain or suffering.

We feel that each person we encounter in the world is a unique perspective that is not the body, but the “self”, which is lodged in the face.

Slide 5
Pain is not an action, but a personal experience. Yet, pain reveals itself in those gestures, or expressions, which cannot fail to reveal the person in pain.

People in pain communicate their experience through a range of actions, ranging from self-report, to nonverbal actions, which include paralinguistic vocalisations, bodily activity and facial expressions.

Verbal self-report is mostly voluntary, and relies on reflection and deliberation, whereas nonverbal expression is involuntary and reflexive.

Slide 6
But the involuntary transformations revealed in the face are more meaningful than in other body-parts. This is because body-parts do not have the individuating meaning of the face: the meaning of revealing me, here, now. When I observe another’s pain facial expression, I am not perceiving a physical part of him, as I am when I notice his injured arm or leg. I am meeting him, a real person, who reveals himself in the face.

A person may be perceived by his arm, but not in his arm.

Involuntary facial changes show the person with pain “as he really is”, because he does not fully control them.

We express preference for non-verbal behaviour over verbal behaviour when judging or interpreting the credibility of pain displays.

Slide 7
Pain expressed through the face acquires, for us, an individuality, a personality, that readies us for the human encounter.

Not understanding a face means not seeing where it fits into our gallery of portraits, and therefore not knowing how to properly relate to the person whom it prefigures. One study showed that physicians tended to attribute lower levels of pain to physically attractive patients than physically unattractive patients. Another study found that physically attractive and male patients were perceived as experiencing less pain and disability than physically unattractive and female patients. Finally, in another study, observers judging patient facial pain expressions on video perceived older and less physically attractive patients to be of lower overall functioning.

I can decide to enter into another’s pain expression; or I can decide to remain outside it, as it were, and to see it as a thing apart; perhaps more darkly, as something foreign, or subordinate to my will. How we judge a face may affect the outcomes the patient can achieve.

Slide 8
Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person with pain feel answerable for what he or she experiences. Men who adopt a stoical attitude to their pain are less likely to express pain in the presence of others.

The expression on a face is an offering in the world of mutual responsibilities: it projects into our interpersonal relations a particular person’s “being there”. As soon as I notice pain in another person’s face, my responsibilities are engaged. Facial expressions of pain call on you to respond to me.

The face has this meaning for us because it is the boundary at which the other appears, offering “this person” as one in need of help.

Slide 9
However, expressing pain does not always lead to compassionate reactions, and people are careful about when and with whom they express pain.

Voluntary control of pain through facial actions is normally judged to be an insincere expression of pain, and open to doubt. The controlled pain face is perceived as a mask, which conceals the person lying “behind” it. The expressions on the human face are not always transparent effects of the personal experiences that elicit them, as perhaps they are in non-human mammals. Human beings can deceive through their faces, and children and adults can use the face to fake, and amplify, or suppress, pain.

The capacity to modulate pain expressed through the face has led to difficulty in interpreting the meaning of facially expressed pain. The fidelity with which facial signs mean “pain” is limited to a narrow range of involuntary facial expressions of pain. It is often uncertain whether the presence or absence of information means “pain” or, if they are exaggerated or suppressed consistent with perceived situational demands.

Slide 10
If there is a configuration of facial actions that signals pain, then assessing its presence is amenable to pattern recognition technologies. Substantial progress has been made toward the development of IT-based analysis of pain facial expression.

These systems raise ethical questions about control of patient information.
As these IT systems are used in health care settings, informed consent will need to be obtained for collecting and storing patients’ images, but also for the specific purposes for which those images might be analyzed by these systems.

IT systems can store data as a complete facial image or as a facial template. Facial templates are considered biometric data and thus personally identifiable information. The notion that a photo can reveal private health information is relatively new, and privacy regulations and practices are still catching up. Clinicians should advise patients that there may be limited protections for storing and sharing data when using an facial recognition tool.

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De/Constructing the Body: Ancient and Modern Dynamics

Workshop 3: Trans-Formation, Friday 9 April 2021

Meanings of cancer-related pain – Australian Pain Society Annual Scientific Meeting, April 2021

Australian Pain Society Annual Scientific Meeting, April 2021
virtual event

Topical Session
3C: Meanings of Cancer-Related Pain
Tuesday, April 20, 2021
11:15 AM – 12:30 PM

Session Description: Cognitive factors are important determinants of cancer-related pain experience. Simon van Rysewyk describes how cancer-related is particularly sensitive to cognitive factors and describes some common cognitions that people with cancer-related pain have and how they influence patient outcomes. Xiangfeng Xu (Renee) presents on the cultural and social factors that influence cancer pain management of Chinese migrants and what culturally congruent strategies may be implemented to improve their pain outcomes. Melanie Lovell compares levels of suffering in people with cancer-related pain versus non-cancer chronic pain, highlighting differential meanings of existential or spiritual distress and mood dysfunction. Lovell outlines management approaches to cancer pain and suffering that are not responsive to analgesia, such as meaning- or peace-centred therapies.

Session Objectives:
At the end of the session, attendees will know:
– Common meanings of cancer-related pain and what meanings influence specific patient outcomes
– Common meanings of suffering in cancer-related pain and the relationship between these meanings and non-cancer chronic pain experience and mood dysfunction
– Effective approaches to diagnosis and management of cancer-related pain symptoms, including interventions based on meaning
– Impact of culture on Chinese migrants’ perspectives and responses to cancer pain and recommendations for clinical practice

Presenter Duties
Chair: Dr Simon van Rysewyk, University of Tasmania
Organiser/Presenter 1: Dr Simon van Rysewyk, University of Tasmania
Presenter 2: Dr Renee Xu, University of Sydney
Presenter 3: Associate Professor Melanie Lovell, University of Sydney

Faith and pain intensity: levels, forms, and faith beyond religion

Sculpture by Fabio Viale

Levels of faith and pain intensity
Research studies show significant relationships between strong spiritual well-being, increased pain tolerance[1] and an ability to cope with pain.[2]

A recent study demonstrated that spirituality well-being, and faith particularly, as measured by the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being-Extended scale (FACIT-Sp-Ex), was significantly related to reduced pain intensity in some study participants over a course of pain treatment.[3] What accounts for this relationship? The authors speculated that:

“It may be that a strong element of “faith” is associated with a greater confidence or trust in health professionals and a greater likelihood of following their advice. It is also possible that those with higher levels of “faith” are more likely to improve because they are more likely to engage with a program that seeks to incorporate a spiritual and existential component. It is also possible that they are more eager to please the program providers and report better outcomes. All of these possibilities would need to be explored further and cannot be answered in the present study.”[3]

The quotation suggests that higher levels of faith might be associated with reduced pain intensity in some people with pain.

Forms of faith and pain intensity: a hypothesis
A hypothesis is that, in addition to levels of faith, particular forms of faith, or combinations of faith forms, could reduce pain intensity.

So, what forms of faith are there? The following forms are commonly distinguished in philosophy of religion (Table 1).

Faith formName in philosophy of religion
A feeling of existential confidencethe ‘purely affective’ model
Knowledge of specific truths, revealed by Godthe ‘special knowledge’ model
Belief that God existsthe ‘belief’ model
Believing in (‘trusting in’) Godthe ‘trust’ model
Practical commitment beyond the evidence to one’s belief that God existsthe ‘doxastic venture’ model
Hoping the God who saves existsthe ‘hope’ model
Table 1: Common forms of faith identified in philosophy of religion[4]

Scientific study could investigate if some forms of faith are significantly related to reduced pain intensity compared to other forms, or combinations of forms, of faith. These same forms of faith could be used prognostically by clinicians to predict improvements in pain intensity in some patients, or in other outcomes, such as quality of life or pain-related disability. Qualitative research could investigate if patient conceptions of faith accurately map onto faith forms, as identified by philosophers.

Faith beyond religion
Can faith exist without commitment to any religion? Tennant wrote that: ‘faith is an outcome of the inborn propensity to self-conservation and self-betterment which is a part of human nature, and is no more a miraculously superadded endowment than is sensation or understanding.’[5] He thinks that ‘much of the belief which underlies knowledge is the outcome of faith which ventures beyond the apprehension and treatment of data to supposition, imagination and creation of ideal objects, and justifies its audacity and irrationality (in accounting them to be also real) by practical actualization.’[5]

If faith exists beyond religion, then people who commit themselves to a view based on a particular interpretation of reality exclusive of the objective verification of the truth, are people of faith. Faith of this kind may be religious without being theistic, as in Buddhism or Taoism. Or, it may be scientific when people propose that reality is no more than what is discoverable by the natural sciences (e.g. ‘scientific atheists’, ‘naturalists’).

Conclusion
Study of the interaction between faith and pain could investigate relationships between forms of faith and pain intensity, in addition to other psychosocial outcomes. Such forms span broadly across traditional orthodox religious thesim, relgious non-theism, scientific atheism or naturalism. Interaction between forms and levels of faith, and pain outcomes, is a further possibility. Personal faith could be a useful tool in the clinical armamentarium.

References
[1] Lysne CJ, Wachholtz AB. Pain, spirituality, and meaning making: What can we learn from the literature? Religions 2010;2(1):1.

[2] Keefe FJ, Affleck G, Lefebvre J, Underwood L, Caldwell DS, Drew J, et al. Living with rheumatoid arthritis: The role of daily spirituality and daily religious and spiritual coping. J Pain 2001;2(2):101-10.

[3] McCabe R, Murray R, Austin P, Siddall P. Spiritual and existential factors predict pain relief in a pain management program with a meaning-based component. J Pain Manage 2018:11(2):163-170.

[4] Bishop J. Faith. In: Stanford Encyclopedia of Philosophy. Available at: https://plato.stanford.edu/entries/faith/

[5] Tennant FR. 1943/1989. Faith [Tennant, 1943, Chapter 6]. In T. Penelhum (ed.), Faith, London: Collier Macmillan, 99-112.

“Me seeing you seeing my pain”

Meanings of Pain (Springer International Publishing, 2016) was created to advance understanding of pain experience as a bearer of meaning. Progress in modern biomedicine is necessary to explain pain and to aid in its treatment; yet, preference for biomedical explanation of pain in the field has meant that research and clinical attention to the experience of pain and to common factors of pain, such as meaning, as both a clinical topic and a research method, mostly remains a blind spot in knowledge.

Meaningful changes that we notice in others are often subtle and small changes in facial expression, and are similar to features of clinicians that patients find meaningful, such as aspects of clinician demeanour (enthusiasm, positive personality, attentiveness), which are often embodied in subtle facial expressions, gestures, or particular tones of voice (e.g., Gracely et al. 1985). Pain is a personal experience, not an action; yet it displays itself in those actions in which a human person in pain is revealed to observation (Craig et al. 2010). Body-parts are subject to involuntary changes during pain, such as reflexive withdrawal, but in the social transaction of pain, the involuntary changes revealed in the face are more meaningful than in other body-parts (Prkachin et al. 1983; Craig, 2009). This is because body-parts do not have the individuating meaning of the face: the meaning of revealing me, here, now. The expression on a human person’s face is largely determined by involuntary facial actions; yet, it is the living picture of the person that “peers” from it, and hence a concentrated symbol of the “self”. In facial expressions of pain, the face is not a mere bodily part, but the whole person: the self is spread across its surface, and there displayed.

Intentional control of pain through facial actions is normally judged by observers to be an insincere expression of pain, and open to doubt (Hill & Craig, 2002). The controlled pain face is perceived as a mask, which conceals the person lying “behind” it. The expressions on the human face are not always transparent effects of the personal experiences that elicit them, as perhaps they are in nonhuman mammals. Human beings can deceive through their faces, and children and adults can use the face to fake, as well as exaggerate, or suppress, pain (Williams, 2002). It is possible that deception is possible because we do not distinguish a human person from his or her face. Protective acts such as withdrawal reflexes, guarded postures, and disabled behaviour, can communicate pain to sensitive observers (Sullivan, 2008). But when I observe another’s pain face, I am not meeting a physical part of him, as I am when I notice his injured arm or leg. I am meeting him, a real person, who reveals himself in the face as one like me. There are deceiving faces, but not deceiving arms or legs.

Facial expressions of pain call on you to respond to me. As soon as I notice pain in another person, my responsibilities are engaged. I am held to account for it. The face has this meaning for us because it is the boundary at which the other in pain appears, offering “this person” as one in need of help. This feature is perhaps at the heart of what it means to treat pain. Care of persons in pain would be impossible without the assumption that we can commit ourselves through promises, take responsibility now for some event in the future or the past, and enter into obligations that we hold as not transferable to other persons—all of which are perceived in the face.

We may separate pain from its social meaning, and assign to it an impersonal, “bodily” meaning. However, an observation of pain which, whether or not intentionally, focuses exclusively upon the body-parts of another, but which neglects the preliminary changes in the face, as well as in the voice, hands and posture, perhaps is unethical. The failure to recognise the personal existence of the other in pain is therefore an affront, both to him and to oneself. In separating pain from its social meaning, we remove it from the interpersonal world of social relations, which compels us to recognise human beings as persons and sometimes to compromise or risk ourselves for them.

The most meaningful feature in displays of pain is the eyes, followed by brows, eyelids, mouth, head, forehead, and then other body-parts (Prkachin et al. 1983). Although glances are normally voluntary, they participate in the pattern of involuntary social communication where one person in painful distress is “revealed” in his body to the one who observes him. To turn my eyes to you is a voluntary act; but what I receive from you is not anything I voluntarily do. The eye enables the human person in pain to be displayed to another in his body, and in the act of display to call on the observer to intervene on their behalf. The complex transaction of pain involves the voluntary and the involuntary to co-mingle on the surface of the human body. The joining of minds that begins when an expression of pain is answered with a reciprocated response is partly fulfilled in “me seeing you seeing my pain”, which is not the reciprocity of normal cooperation, but of meaning. I believe many patients with pain desire to experience first-hand this more concentrated form of social recognition.

References

Craig KD. A social communications model of pain. Canadian Psychology/Psychologie Canadienne 2009; 50:22-32.

Craig KD et al. Perceiving pain in others: automatic and controlled mechanisms. J Pain 2010; 11(2):101-8.

Gracely RH et al. Clinicians’ Expectations Influence Placebo Analgesia. Lancet 1985; 1(8419):43.

Hill ML, Craig KD. Detecting deception in pain expressions: The structure of genuine and deceptive facial displays. Pain 2002; 98:135-144.

Prkachin KM et al. Judging nonverbal expressions of pain. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement. 1983; 15(4):409.

Sullivan MJL. Toward a biopsychomotor conceptualization of pain. Clin J Pain 2008; 24:281-290.

van Rysewyk S (ed). Meanings of Pain. Springer International Publishing: Switzerland, 2016.

Williams AC. Facial expression of pain: An evolutionary account. Behav Brain Scien 2002; 25:439-488.

Thoughts on “Reconsidering fetal pain” – by Stuart WG Derbyshire & John C Bockmann

Sculpture by Fabio Viale

“…we propose that the fetus experiences a pain that just is and it is because it is, there is no further comprehension of the experience, only an immediate apprehension.” – Reconsidering Fetal Pain (2019), by Stuart WG Derbyshire, John C Bockmann

I agree with this proposal.

Experiencing pain is being in an animal-like state. But, experiencing pain is not knowing that this is pain. I think experiencing pain becomes a state of knowing only if a person is a competent language user. 

A consequence of this idea is that pain experience is not always immediately transparent or lucid to the person experiencing it. Odd as it sounds, to be in pain is not to know pain. This challenges the Cartesian philosophy of mind.

Following Derbyshire and Brockman, the fetus or neonate experiences pain, but without understanding or recognition.

Emre Ihan asked me: “Do you think learning is a form of recognition? A lot of neonates pull their legs away when nurses and their parents touch their heels, after weeks of heel lancing (heel pricks for blood tests). Could this be an anticipation of pain, and thus recognition that pain is imminent…”

Compare the neonate’s behaviour with a dog walking beside a road with the flow of traffic. The behaviour of the dog conforms to our left-hand drive convention, but it does not do so because it understands that convention.

In the same way, a chicken that stretches its neck and wings as in the mating ritual of the wandering albatross is not stretching its neck because it understands, or has a conception of, this mating pattern.

Point 1. There is behaviour that conforms to a complex pattern.

Point 2. This behaviour is not explained through a conception or understanding of that pattern. The behaviour just accidentally realises part of a complex pattern. 

Point 3. The explanation for the behaviour is explained by its relation to the complex patterned whole.

A plausible explanation of the neonate’s behaviour is in terms of the survival value to groups of humans of this form of behavior. These behaviours are performed because they form part of a hard-wired evolutionary pattern, not because the neonate recognises or follows a set of cognitive rules that are an abstract description of the pattern.

Thus, the neonate, like the dog or chicken, does not engage in their patterned behaviour “on purpose.” The neonate does not intend to follow rules or apply social norms.

Developmentally, that skill emerges later when the neonate is a child and learns, if it is fortunate enough, the concept of pain.

Call for Abstracts: Meanings of Pain, Volume III

Sculpture by Fabio Viale

Volume III Topic: Meanings of pain in vulnerable or special patient groups

Series Editor: Dr Simon van Rysewyk
Publisher: Springer

The Meanings of Pain book series describes how the meaning of pain changes pain experience – and people – over time.

Pain in the moment is experienced as immediately distressing or unpleasant. If pain persists over time, more complex meanings about the long-term consequences, or burden of pain, can develop. These meanings can include existential meanings such as despair or loneliness that focus on the person with pain, rather than pain itself.

Meanings of Pain offers a vocabulary of language about pain and meaning. An objective of the series is to stimulate self-reflection on how to use information about meaning in clinical and non-clinical pain settings. The book series is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers.

Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people and to the question of what pain means to them.

Volume III focuses on describing the meanings of pain in groups of “vulnerable” or “special” people, such as:

  • Infants or children
  • Women
  • Older adults
  • People with a physical or intellectual disability
  • People with a brain injury
  • People diagnosed with a disease
  • Veterans
  • Athletes
  • Workers
  • Addicts
  • People with mental illness or mental disorders
  • Homeless people
  • People in rural or remote communities
  • People in multicultural communities
  • Indigenous peoples

Invited chapter types
The editor Dr Simon van Rysewyk invites contributions for Volume III on the meanings of pain in vulnerable or special patient groups. The following manuscript types will be considered:

  • Original Research (e.g., original clinical, translational, or theoretical research)
  • Reviews (e.g., Systematic Reviews, Meta-analytic reviews, Cochrane type reviews, Pragmatic Reviews)

Authors interested in submitting a chapter for publication in Volume III are invited to submit a 350-word Abstract, which includes the name and contact information of the corresponding author, to:

Dr Simon van Rysewyk
simon.vanrysewyk@utas.edu.au

Abstract Deadline: closed

“It is my opinion that this … work will stand as the definitive reference work in this field. I believe it will enrich the professional and personal lives of health care providers, researchers and people who have persistent pain and their family members. The combination of framework chapters with chapters devoted to analysing the lived experience of pain conditions gives the requisite breadth and depth to the subject.” – Dr Marc A. Russo, MBBS DA(UK) FANZCA FFPMANZCA, Newcastle, Australia, from the Foreword in Volume II

“Meanings of Cancer-Related Pain”

Sculpture by Fabio Viale

Australian Pain Society Annual Scientific Meeting 2020
Hobart Tasmania

Topical Session
Tuesday, April 7, 2020, 3.30-5.00pm

Session Description: Cognitive factors are important determinants of cancer-related pain experience. Simon van Rysewyk describes some common meanings and beliefs that people have about cancer, illness, and pain, and the consequences these meanings have in relation to common help-seeking behaviours or coping strategies people choose to adopt. Suffering is a cognitive and emotional response to recurrent perceived losses experienced in some people with cancer. Megan Best presents on the challenges in assessing people with cancer-related suffering and the relationship of suffering to cancer-related pain. Melanie Lovell compares levels of suffering in people with cancer-related pain versus non-cancer chronic pain, highlighting differential meanings of existential or spiritual distress and mood dysfunction. Best and Lovell outline management approaches to cancer pain and suffering that are not responsive to analgesia, such as meaning- or peace-centred therapies.

Session Objectives
At the end of the session, attendees will know:
– Common meanings of cancer-related pain and how people apply these meanings to cope with their pain
– Common meanings of suffering in cancer-related pain and the relationship between these meanings and non-cancer chronic pain experience and mood dysfunction
– Effective approaches to diagnosis and management of cancer-related pain symptoms, including interventions based on meaning

Presenter Duties
Chair: Professor Jane Phillips, University of Technology, Sydney
Organiser/Presenter 1: Dr Simon van Rysewyk, University of Tasmania
Presenter 2: Dr Megan Best, University of Sydney
Presenter 3: Associate Professor Melanie Lovell, University of Sydney

Humans beings are persons and organisms

Sculpture by Fabio Viale

As organisms, human beings interact with the world and each other through causal mechanisms that control us and every other physical thing. As persons, we act in the world through our thoughts, emotions, attitudes, or desires.

Accordingly, human beings are describable in two distinct, but complementary ways: in terms of the way the world is, through scientific descriptions of the causal mechanisms and laws that explain physical things, or, in terms of the way the world seems, through descriptions of personal experiences and meanings.

One or the other way of describing human beings comes into focus depending on the questions we ask about ourselves or the world. The features of personal experience—thought, feeling, speech and action—are amenable to standard scientific explanation as specific changes in the body. Traditionally, scientific research has had much to say about the physical nature of pain, but much less about the personal experience or meaning of pain. Indeed, the meaning of pain remains a blind spot in knowledge.


A description of a human being as a person means that there is a way of understanding of human beings in which personal experience and meaning, rather than physical causation alone, is needed to answer the question, “What is happening?”

Human persons can distinguish between how things are in the world and how things seem to me. I can recognise within myself a perspective or point of view on the world and identify it as belonging to me. Every person has such a unique perspective; this is partly what it means to be a person rather than a physical thing. In contrast, a scientific description of the world does not presuppose any personal point of view. Physical science does not use words like “I”, “here,” or “now”. Does this mean that “persons” are unobservable to standard quantitative science?

Possibly. Imagine a complete explanation of pain according to the final neurophysiology of pain—whatever it turns out to be. Such an explanation of pain would, to put it very crudely, accurately map specific neurophysiological changes in physical parts in the living human organism and all their true causal interactions across time. However invaluable such an explanation would be to pain medicine, it could not describe the way pain seems to the person who experiences it, for which of the physical objects described in this explanation is me with pain, here, now? Immediate pain always seems a certain way to persons, and this “seeming” determines the experience of the person with pain. In describing personal pain, human beings use language with other meanings than the language used in neurophysiology. The final neurophysiological explanation of pain therefore could explain only one dimension of pain in human beings—the physical dimension—in language that could not capture the personal experience, burden, or meaning of pain.


A philosophical assumption of neurophysiology is that a person is identical with his or her body. Person and body are one and the same thing. In terms of personal experience, however, the identity between person and body escapes personal understanding. For example, when I feel a pain, there is no information or evidence, or nothing that I could discover about my body subsequent to the experience of pain, that could demonstrate it to be false. When I feel a pain, I simply know that I am in pain.

In person to person interactions, we commonly respond to each other as though we are not identical with the human body, but in a compelling sense operating “through” the body, which seems to be a vehicle of thought, emotion, pain or suffering. We feel that each person we encounter in the world is a unique perspective that is not the body, but the “self”, which peers out through the face. The human face is the social instrument of persons. In seeking to understand you, or adjust how the world or your experience seems to you, I interact with you through your embodied perspective.

In pain experience, it is my loss of personal control over my body, and its dominion over me, that create the compelling sense, for me and for others, of an “incarnate” person. Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person, and the person’s significant others, feel answerable for what he or she experiences.


Call for Papers: Pain Medicine Special Issue, “Meaning in the Context of Pain”

Sculpture by Fabio Viale

Dear reader,

Pain Medicine is planning an interdisciplinary Special Issue, “Meaning in the Context of Pain.” I am the lead guest editor; Dr John Quintner and Prof Milton Cohen are guest editors.

Meaning is an essential dimension of the experience of pain. Empirical evidence from qualitative and mixed method studies suggests that pain is not only associated with a common meaning of “threat” or “danger,” but also is experienced as immediately distressing or unpleasant. If this combined meaning persists over time, people’s concerns may shift from the experience of pain onto themselves as persons. As a result of this shift, powerful existential meanings such as hopelessness or loneliness may develop. Such experiential meanings interact with desires to reduce or eliminate pain, and with expectations about the perceived efficacy of a particular treatment for pain. These meanings may in turn result in a spectrum of negative moods, such as depression or despair, and negative beliefs such as fatalism. Such negative components of the emotional dimension are often at the core of the lived experience of pain.

Despite this evidence, the preference for and consequent overwhelming dominance of biomedical explanations in pain clinical practice and research has meant that this other dimension of the experience of pain has been overlooked.

Special Issue Themes and Sub-Themes

Themes of the “Meaning in the Context of Pain” Special Issue include, but are not restricted to, the following:

  • Common experiential meanings of pain in different contexts
    • Chronic non-cancer pain or cancer-related pain
    • Pain in special or vulnerable groups
    • Pain and mental illness
    • Pain and substance abuse
    • Pain and fatigue
  • How meaning modifies the experience of pain
    • Pain and personal identity over time, including stigmatisation
    • Family meanings and the experience of pain (e.g., “psychosomatic families”)
    • Perceived meaningfulness of life, including suicidality
    • How symbolic manipulation of meaning (e.g., verbal instruction) can change pain experience
    • Perceived meaning of different types of medical treatment
    • “Catastrophising” and “fear-avoidance” as expressions of meaning
    • The limits of meaning: when no meaning can be given to an experience of pain (e.g., “medically unexplained pain”)
    • Coming to terms with “pain acceptance”
  • Therapeutic implications of meaning
    • Similarities and differences in meanings of pain between the person in pain versus observers
    • The influence of meaning on pain scale ratings
    • Implications of meaning-making for self-control or self-management of pain
    • How patients’ meanings of pain can inform treatment planning
    • Strategies patients use to find meaning in their pain
    • Work rehabilitation and returning to work

  • Experiential research methods to study meanings of pain
    • Ethnography, narrative, phenomenology, grounded theory, and single-case study methods
    • Other research methods: Neurophenomenology, The Descriptive Experience Sampling Method, The Experiential-Phenomenological Method, The Elicitation Interview Method, quantitative designs, quantitative-qualitative designs

The meaning of “meaning” and clinical applications or implications of meaning in the context of pain must be addressed in detail in all contributions.

Keywords: pain, meaning, patient experience, pain management

Invited article types

Within the scope of the themes and sub-themes described above, the guest editors invite contributions considered in the form of the following manuscript types, in order of importance:

  • Reviews (e.g., Systematic Reviews, Meta-analytic reviews, Cochrane type reviews, Pragmatic Reviews)
  • Original Research (e.g., original clinical, translational, theoretical or philosophical research)

See Instructions to Authors in Pain Medicine.

If you wish to submit an article for consideration in this Special Issue, please let me know at: simon.vanrysewyk@utas.edu.au. Then, email me a 400-word description/summary/abstract by November 1, 2019.

Thank you for your time.

Does “pain” need redefining?

By Simon van Rysewyk,1 John Quintner,2 Milton Cohen3
1School of Humanities, University of Tasmania, Australia; 2Arthritis & Osteoporosis Western Australia; 3St Vincent’s Clinic and Clinical School, University of New South Wales, Australia

Presented at the 2019 Patient Experience Symposium, April 29-30, 2019, Sydney, Australia.

Introduction: The widely accepted definition of pain promulgated by the International Association for the Study of Pain (IASP), although useful in a clinical context, is written mainly from the perspective of the “observer”.  As such it fails sufficiently to capture the perspective of the “experiencer” of pain.
Methods: This presentation briefly analyses the historical development of the IASP definition, and some of the commentaries and suggested modifications to it over almost 40 years. Common factors of pain that patients experience are described, together with theoretical insights from philosophy and biology.
Results: Major problems with the IASP definition of pain include: (i) the stance of the observer is privileged over that of the experiencer of pain; (ii) the obligatory linking with “tissue damage” focuses attention on the body as distinct from the person; and (iii) the validity of the experience when there is no obvious “cause” is questioned. A revised definition of pain is offered: Pain is a mutually recognisable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity.
Conclusion: This definition integrates the subjectivity or “first-person” level of experience of pain, and the challenge for the “second-person” of clinical evaluation (if not also intervention) towards objective “third-person” goals. This redefinition of pain is compatible with that of the IASP but more philosophically sound, biologically relevant, clinically applicable, and meaningful for people experiencing pain and for health care professionals who engage with them.

Download here.

Meanings of Pain, Volume II: Common Forms of Pain and Language (2019, Springer)

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  • Provides a study of pain in which meaning is essential to the way pain is felt
  • Describes meanings of pain in patients with common forms of chronic pain
  • Discusses the importance of meaning in pain assessment, diagnosis, clinical language and medical stigmatisation

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself.

This interdisciplinary book – the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk – aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain.

Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter.

This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers.

“It is my opinion that this … work will stand as the definitive reference work in this field. I believe it will enrich the professional and personal lives of health care providers, researchers and people who have persistent pain and their family members. The combination of framework chapters with chapters devoted to analysing the lived experience of pain conditions gives the requisite breadth and depth to the subject.” – Dr Marc A. Russo, MBBS DA(UK) FANZCA FFPMANZCA, Newcastle, Australia, from the Foreword

Review the Table of Contents and buy now on Springer.

Meanings of Pain, Volume II, follows on from Meanings of Pain, Volume I, published in 2016 by Springer.

Reasons for Investigator-Participation and Introspection in Pain Research

Reason 1: Historical Cases of Investigator-Participation in Pain Research

In the early twentieth century, scientists commonly viewed self-experimentation an essential part of medical research. Self-exposure to untested interventions was believed the most ethical way to assess human responses to those interventions, and to catalyse further research (Dresser 2013). Some of this research helped to found new scientific fields. Respiratory physiology was one such field, formed in the 1920s through self-experiments conducted by scientist John Haldane and colleagues. In 1984, physician Barry Marshall ingested Helicobacter pylori, which helped to establish the link between H. pylori and gastric pathology, and in 1992, self-experiments conducted by Mike Stroud and Ranulph Fiennes in Antarctica advanced understanding of nutrition in extreme conditions.

Self-experiments to study pain experience have been published by Sir Head (1920), Woollard and Carmichael (1933), Landau and Bishop (1953), Price (1972), Price et al. (1977), and Staud et al. (2001, 2008), to name only a few significant investigator-participants who studied pain. William Landau and George H. Bishop conducted standard psychophysical research on themselves to study the qualitative differences between “first pain” and “second pain” (i.e. “double pain”; later termed epicritic and protopathic pain) (Landau and Bishop 1953). Initially, Landau and Bishop identified through introspection the differential experiential qualities between first and second pain, followed by scientifically informed speculation about the mechanistic difference between the two types of pain. They discovered that first pain was sharp or stinging, well localized, and brief, whereas second pain was dull, aching, throbbing, or burning, and poorly localized, and longer lasting. The qualities of second pain were felt when skin C-nociceptors were stimulated.

These findings were subsequently confirmed by Price (1972) based on researcher and naïve participant introspective reports. Temporal differences between first and second pain were introspected on and mechanistically explained in terms of central temporal summation in studies by Price et al. (1977), and Staud et al. (2001, 2008), using investigator- and naïve-participants.

Conducting self-experiments to study referred pain, collaborators Herbert Woollard and Edward Carmichael observed that 300 g of weight placed on the right testicle produced slight discomfort in the right groin, while 650 g on the right testicle caused severe pain on the right side of the body. They confirmed that injury to the testicles caused pain to be referred throughout the body. For instance, as the weight on the testicle increased to over 900 g, they reported pain “of a sickening character” not only in the groin but also spreading across the back (Woollard and Carmichael 1933).

Self-experimentation on pain has on occasion led to surprising results. The psychologist B. Berthold Wolff self-experimented in his pain psychophysics laboratory, varying thermal pain which was produced at that time by briefly shining a strong light on a spot on the forearm blackened with candle black for a calibrated time and intensity of exposure (Hardy et al. 1940). On one occasion, Wolff pushed the button to deliver the noxious stimulus, but then something unexpected happened: he screamed with pain, which was brief but intense and filled his whole body. He described it as the most intense whole-body pain he had ever experienced. Wolff later discovered that the light stimulus had been knocked off its correct aim, and had missed his forearm altogether and instead diffused onto the opposite wall where it created a very strong flash of light throughout the normally dark room. Wolff speculated that, as he was expecting to feel pain, the unexpected flash of strong light had the same effect, producing an experience of pain.

It is unclear if investigators today independently conduct self-experiments or co-participate in their own pain studies. The convenience of recruiting participants from university classes and the internet may have made self-experimentation or co-participation of pain seem somewhat redundant to researchers. The Declaration of Helsinki advises on conducting ethical research using patients and healthy volunteers, although it is unclear if this is reason enough for challenging independent self-experimentation or investigator co-participation. In self-experiments, the researcher is both investigator and single participant, so the requirement for informed consent could be waived. Still, there is clear historical precedent for scientific investigators successfully observing and analyzing their own experiences of pain. The results of such published self-experiments have been integrated into the body of knowledge of pain, and replicated in numerous studies using naïve participant introspective reports and standard scientific methods.

References

Dresser R (2013) Personal knowledge and study participation. J Med Ethics. doi:10.1136/medethics-2013-101390.

Hardy JD, Wolff HG, Goodell H (1940) Studies on pain: a new method for measuring pain threshold: observations on spatial summation of pain. J Clin Investig 19(4):649–657.

Head H (1920) Studies in neurology. Oxford University Press, London.

Landau W, Bishop GH (1953) Pain from dermal, periosteal, and fascial endings and from inflammation: electrophysiological study employing differential nerve blocks. AMA Arch Neurol Psychiatry 69(4):490–504.

Price DD (1972) Characteristics of second pain and flexion reflexes indicative of prolonged central summation. Exp Neurol 37(2):371–387.

Price DD, Hu JW, Dubner R, Gracely RH (1977) Peripheral suppression of first pain and central summation of second pain evoked by noxious heat pulses. Pain 3(1):57–68.

Staud R, Vierck CJ, Cannon RL, Mauderli AP, Price DD (2001) Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain 91 (1):165–175.

Staud R, Craggs JG, Perlstein WM, Robinson ME, Price DD (2008) Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls. Eur J Pain 12(8):1078–1089.

Woollard HH, Carmichael EA (1933) The testis and referred pain. Brain 56(3):293–303.

Should investigators introspect on their own pain experiences as study co-participants? – Simon van Rysewyk and Carl L. von Baeyer

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van Rysewyk S, von Baeyer CL. Should investigators introspect on their own pain experiences as study co-participants? In: van Rysewyk S (2016). Meanings of Pain. Springer International Publishing AG: Switzerland.

Abstract

The question of investigators introspecting on their own personal pain experiences in pain studies has received little attention in the literature. Study of this question may reflect ethical reservations about the many points at which self-interest may lead us to introspect on personal experiences through personal biases that in turn impair professional decision-making and perception. Despite this valid concern about research co-participation, we offer three reasons why investigators can introspect on personal pain as co-participants in their own pain studies. First, there is historical precedent for investigator participation and co-participation in scientific pain research using introspection as a study method. Second, general concerns about variability in self-report based on introspection on pain experience partly derive from true fluctuations in personal pain experience and perceived interests in self-reporting pain, not simply error in its scientific measurement. Third, the availability of the Experiential-Phenomenological Method, a mixed research method for the study of human experiences, allows investigators to co-participate with naïve participants in their own studies by encouraging passive introspection on personal pain experiences.

Download a copy of the chapter here.

 

Reconsidering the International Association for the Study of Pain definition of pain

Cohen M, Quintner J, van Rysewyk S (2018). Reconsidering the IASP Definition of Pain. Pain Reports, 3(2).

Abstract

Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain.

Methods: This essay reviews the historical development of the IASP definition, and the commentaries and suggested modificationsto it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology.

Results: A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language.

Conclusion: Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity.

Associated Commentaries:

Osborn M. Situating pain in a more helpful place. PAIN Reports 2018:e642.

Treede RD. The IASP definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. PAIN Reports 2018:e643.

Download a copy of the paper here.

‘Meanings of Pain in Patients with Cancer’ – Cancer Pain Symposium 2017

Cancer Pain Symposium, 9 December, 2017

Sydney Vital

Abstract

Pain due to cancer, a common effect of the disease and its treatment, makes the experience of cancer more distressing for patients and their families. The meaning of cancer-related pain has been referred to as the “feared consequence of cancer”, and associated with pathology and death. However, if cancer-related pain is related to (non-cancer) pain and its common factors, of which the meaningfulness of pain is one, and not the cancer disease, then the meaning of cancer-related pain is clinically relevant. The meanings of personal experiences are important to human beings, and influence how we respond to life’s changing circumstances. A neglected aspect of the clinical management of cancer is the patient’s ability to make the experience of cancer meaningful, despite the presence of disabling pain. This presentation provides an overview of the meanings of pain, and some pilot data based on Lipowski’s meanings of chronic illness, which suggests that cancer-related pain is qualitatively closer to chronic non-cancer pain than to cancer. Ideas are provided for health care professionals to make cancer and cancer-related pain more meaningful to patients and their families.

Meanings of Pain, Volume I (2016, Springer)

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van Rysewyk S (2016). Meanings of Pain. Springer International Publishing AG: Switzerland.

  • First book devoted to study of the meanings of pain
  • Explains why meaning is important in the way that pain is felt
  • Promotes integration of qualitative and quantitative research methods to study meanings of pain
  • Includes insights that can aid in the clinical management of patients with pain

About Meanings of Pain, Volume I

Although pain is widely recognized by clinicians and researchers as an experience, pain is always felt in a patient-specific way rather than experienced for what it objectively is. This fact makes perceived meaning important in the study of pain. The book contributors explain why meaning is important in the way that pain is felt and promote the integration of quantitative and qualitative methods to study meanings of pain. For the first time in a book, the study of the meanings of pain is given the attention it deserves.

All pain research and medicine inevitably have to negotiate how pain is perceived, how meanings of pain can be described within the fabric of a person’s life and neurophysiology, what factors mediate them, how they interact and change over time, and how the relationship between patient, researcher, and clinician might be understood in terms of meaning.

Though meanings of pain are not intensively studied in contemporary pain research or thoroughly described as part of clinical assessment, no pain researcher or clinician can avoid asking questions about how pain is perceived or the types of data and scientific methods relevant in discovering the answers.

Reviews of Meanings of Pain

“Meanings of Pain offers an intriguing investigation into the implications of the psychological, sociological, and personal lived meanings of pain for the overall management of patients struggling with this chronic condition. … it may prove invaluable to the physician struggling to understand the intricacies of the patient pain experience, facilitating improved comprehensive pain therapy.” (Emily E. Smith-Straesser and Amanda M. Kleiman, Anestesia & Analgesia, Vol. 125 (5), November, 2017)

Pain Science and Sensibility Episode 29: Discussion of the book “Meanings of Pain”

Meanings of Pain – Book Review by Josie Billington (University of Liverpool), Andrew Jones, and James Ledson (The Royal Liverpool and Broadgreen University Hospitals NHS Trust)

Meanings of Pain – Book Review by Christin Bird

The Science and Philosophy of the Meaning of Pain – Review of Chapter 7, “A Scientific and Philosophical Analysis of Meanings of Pain in Studies of Pain and Suffering” in Meanings of Pain by Smadar Bustan – by Tim Cocks

Meanings of Pain – Book Review by Asaf Weisman

N=1 as a reference for general concepts of experiencing pain by Morten Høgh

New Developments

Springer is considering publishing Meanings of Pain in a multiple volume series. Watch this space for an update on this development.

I am sitting on a veranda

I am sitting on a veranda on a summer afternoon.

The trees gently sway in the sunlight.

A quiet joy beings to arise in me,

a rejoicing in the world that includes myself,

these swaying trees, this blue sky,

and everything else that unfolds beyond all that I am perceiving.

The world, completely, and all at once, is fulfilled.

A Hybrid Bottom-Up and Top-Down Approach to Machine Medical Ethics: Theory and Data by Simon Peter van Rysewyk and Matthijs Pontier

Abstract

The perceived weaknesses of philosophical normative theories as machine ethic candidates have led some philosophers to consider combining them into some kind of a hybrid theory. This chapter develops a philosophical machine ethic which integrates “top-down” normative theories (rule-utilitarianism and prima-facie deontological ethics) and “bottom-up” (case-based reasoning) computational structure. This hybrid ethic is tested in a medical machine whose input-output function is treated as a simulacrum of professional human ethical action in clinical medicine. In six clinical medical simulations run on the proposed hybrid ethic, the output of the machine matched the respective acts of human medical professionals. Thus, the proposed machine ethic emerges as a successful model of medical ethics, and a platform for further developments.

Here.

A neurobehavioral-polyvagal theory of pain facial expression

The personal experience of pain produces a reliable effect on facial behavior in humans and in nonhuman mammals. Why should pain have a face? What is it for? I will attempt to head towards answering this question by invoking a theoretical framework: polyvagal theory (Porges, 2001, 2006).

1 Polyvagal Theory

According to polyvagal theory (Porges, 2001, 2006), evolution of neural control within the autonomic nervous system (ANS) has tracked three stages, each revealing a specific behavior, and a specific function:

In the first stage, the ancient unmyelinated visceral vagus nerve that enables digestion could respond to danger and pain only by reducing metabolic output and producing immobilization behaviors.

In the second stage, the sympathetic nervous system (SNS) made it possible to increase metabolic activity and inhibit the visceral vagus nerve, thus allowing fight/flight behaviors following perceived threat or pain.

The third stage, which is uniquely mammalian, involves a myelinated vagus that can rapidly control cardiac and bronchi output to enable spontaneous interaction (i.e., engagement or disengagement) with the environment. The interaction of the autonomic nervous system (ANS) with the hypothalamo-pituitary-adrenal (HPA) axis, nervous and immune systems change to maximize response to stressors such as nociception. During nociception, the ANS operates together with nervous, endocrine and immune systems to produce stress (Chapman et al. 2008; Porges, 2001, 2006). In terms of polyvagal theory, pain facial expression is a dynamic autonomic response caused by noxious signaling. In terms of polyvagal-type identity mechanistic theory pain facial expression is a type of behavior that is identical to a type of neurophysiological mechanism; namely, the phylogenetically recent brain-heart-face mechanism.

The expansion of cortex in the third stage increased innervation and neural control of the mammalian face: upper face innervation is bilateral and arises from the supplementary motor area (M2) and the rostral cingulate motor area (M3). Lower face innervation is contralateral and arises from primary motor cortex (M1), ventral lateral premotor cortex, and the caudal cingulate motor cortex (M4) (Morecraft et al. 2004). Human pain facial movements of the eyebrows and upper lip are type identical with negative emotional aspects of pain and activation of M1, M2, M3, whereas facial movements around the eyes are type identical with somatosensory aspects of pain, and activation of M2 and M3 (Kunz et al. 2011). Thus, evolution of cranial anatomy enabled a highly integrated facial representation of the multidimensional experience of pain.

2 Why Pain Should Have a Face

In clinical and experimental settings, the pain face is observed to rapidly appear following noxious stimulation, and diminish concurrent with cessation of the noxious stimulus, or when analgesics are administered (e.g., Craig & Patrick, 1985). The brain-heart-face mechanism is an integrated system with both a somatomotor part controlling the striated facial muscles and a visceromotor part controlling the heart through a myelinated vagus nerve (Porges, 2001, 2006). When the vagal tone to the cardiac pacemaker is high, the myelinated vagus acts as a brake or restraint limiting heart rate. Rapid inhibition and disinhibition of vagal tone to the heart supports the rapid mobilization of facial muscles and formation of the pain face concurrent with pain onset. In humans and nonhuman mammals, the main vagal inhibitory pathways in the myelinated vagus originate in the nucleus ambiguus.

The vagal brake supports the low-metabolic requirements involved in the rapidly appearing and disappearing pain face. Withdrawal of the vagal brake is strongly correlated with the rapid appearance of the pain face; reinstatement of the vagal brake is strongly correlated with the rapid diminishing of the pain face. These correlations are not unique to pain facial expression; similar relationships hold with regard to the vagal brake and the timing and duration of aversive, but non-noxious emotional facial expressions (e.g., Pu et al. 2010), and positive emotional facial expressions (e.g., Kok & Fredrickson, 2010).

In terms of the function of rapid pain face onset and offset, the vagal brake makes it possible for the individual in pain to quickly disengage from source of wounding and pain, concurrent with the rapid appearance or diminishing of pain facial expression, which may offer temporary access to additional metabolic resources to aid healing, recovery and self-soothing behaviors, with likely involvement from care givers.

Concerning aid from others, the vagal brake reliably maps onto specific interaction types observed in mammalian pain events. In pain events comprising the individual in pain and care givers, mammalian behavior is typed according to interpersonal communication through facial expressions, vocalizations, head and hand gestures (Hadjistavropoulos et al. 2011; Porges, 2001, 2006; Williams, 2002). A relevant feature is the rapid ‘switching’ of temporary engagement to temporary disengagement behaviors between the individual in pain and care givers. This interaction type may involve care givers speaking to the one in pain, and then quickly switching to listening; for the one in pain, looking into the face of the care giver, and then quickly switching to vocalizing (Craig et al. 2011; Hadjistavropoulos et al. 2011; Porges, 2001, 2006; Williams, 2002). The brain-heart-face mechanism thus allows the one in pain and the care giver to get the timing right. Some philosophers and neuroscientists claim that evolutionary neurobehavioral solutions to timing problems such as these are implicated in the origin of empathy and ultimately consciousness itself (Churchland, 2002; Cole, 1998; Engen & Singer, 2012; van Rysewyk, 2011).

However, if pain is severe or chronic and the vagal brake is withdrawn (or dysfunctional), the concurrency of increased pain facial expression, cardiac output, and other mobilization behaviors (i.e., increased SNS and HPA output), means that, if care giving is to succeed in promoting healing and recovery, the care giver’s vagal brake must be dynamically reinstated. By applying their own vagal brake, care givers may regulate their own visceral distress and thereby succeed in allocating valuable metabolic resources to communicate safety to the one in pain (and themselves) through calming facial and head behaviors, eye gaze, and prosodic vocalizations (i.e., increasing the vagal brake decreases SNS and HPA output). Since the vagal brake of the person in pain has been provisionally withdrawn, the care giver is effectively an integrated external brain-heart-face mechanism (cf. Tantam, 2009, the ‘interbrain’).

Thus, the pain facial muscles function as neural timekeepers detecting and expressing features of safety and danger that cue the one in pain to quickly disengage from the source of wounding and pain, simultaneous with the rapid appearance or attenuation of pain facial activity, and also cue others who can help.

References

Chapman, C. R., Tuckett, R. P., & Song, C. W. (2008). Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. Journal of Pain, 9(2), 122-145.

Churchland, P. S. (1989). Neurophilosophy: Toward a Unified Science of the Mind-Brain. Cambridge, Mass.: MIT Press.

Cole, J. (1998) About face. Cambridge, Mass.: The MIT Press.

Craig, K. D., & Patrick, C. J. (1985). Facial expression during induced pain. Journal of Personality and Social Psychology, 48(4), 1080-1091.

Craig, K. D., Prkachin, K. M., & Grunau, R. E. (2011). .The facial expression of pain. In D. C. Turk, & R. Melzack, Handbook of Pain Assessment, 2nd Edition (pp. 117-133). New York: The Guilford Press.

Engen, H. G., & Singer, T. (2012). Empathy circuits. Current Opinion in Neurobiology, 23, 1-8.

Hadjistavropoulos, T., Craig, K. D., Duck, S., Cano, A., Goubert, L., Jackson, P. L., Mogil, J. S., Rainville, P., Sullivan, M. J. L., de C. Williams, Amanda C., Vervoort, T., & Fitzgerald, T. D. (2011). A biopsychosocial formulation of pain communication. Psychological Bulletin, 137(6), 910-939.

Kok, B. E., & Fredrickson, B. L. (2010). Upward spirals of the heart: Autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness. Biological Psychology, 85(3), 432-436.

Kunz, M., Lautenbacher, S., LeBlanc, N., & Rainville, P. (2011). Are both the sensory and the affective dimensions of pain encoded in the face? Pain, 153(2), 350-358.

Morecraft, R. J., Stilwell-Morecraft, K. S., & Rossing, W. R. (2004). The Motor Cortex and Facial Expression: New Insights From Neuroscience. The Neurologist, 10(5), 235-249.

Porges, S. W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42(2), 123-146.

Porges, S. W. (2006). Emotion: An Evolutionary By‐Product of the Neural Regulation of the Autonomic Nervous System. Annals of the New York Academy of Sciences, 807(1), 62-77.

Pu, J., Schmeichel, B. J., & Demaree, H. A. (2010). Cardiac vagal control predicts spontaneous regulation of negative emotional expression and subsequent cognitive performance. Biological Psychology, 84(3), 531-540.

van Rysewyk, S. (2011). Beyond faces: The relevance of Moebius Syndrome to emotion recognition and empathy. In: A. Freitas-Magalhães (Ed.), ‘Emotional Expression: The Brain and the Face’ (V. III, Second Series), University of Fernando Pessoa Press, Oporto: pp. 75-97.

Williams, A. C. D. C. (2002). Facial expression of pain: an evolutionary account. Behavioral and Brain Sciences, 25(4), 439-455.

First-Person Neuroscience of Pain: Puzzles, Methods and Data

Challenges facing pain reductionism

The official scientific definition of pain was initially formulated in the 1980s by a committee organized by the International Association for the Study of Pain (IASP). This definition and accompanying Note was updated in the 1990s by the IASP to reflect advancements in pain science and has since been widely accepted by the scientific community:

Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause (IASP-Task-Force-On-Taxonomy, 1994: 207-213).

An apparent immediate and inconvenient fact facing pain reductionism is that pain stubbornly resists identification with only the brain. The original pain identity statement proposed by philosopher U.T. Place, ‘Pain = C-fibre activation’ (Place, 1956), neglects two essential features of pain observed in contemporary pain science:
(1) Conscious awareness of wounding is multimodal and is correlated with integrated visual, kinaesthetic, and enteric sensory modalities in addition to noxious signalling (e.g., Chapman et al. 2008);
(2) Wounding is typically part of overall bodily awareness that is correlated with multiple reciprocal nervous, endocrine and immune states (e.g., Chapman et al. 2008; Lyon et al. 2011; van Rysewyk, 2013; Vierck et al. 2010). Convergent lines of evidence demonstrate that wounding followed by pain is strongly correlated with endocrine and immune operations as well as sensory signaling that together exert an extensive non-neural impact. These operations interact and comprise a defensive stress response to wounding [1].

A consideration of the higher structures of the central nervous system (CNS) alone reveals an extraordinarily complex picture of pain. Unimodal functional brain imaging studies of nociceptive transmission, projection and processing show that signals of wounding reach higher CNS levels via the spinothalamic, spinohypothalamic, spinoreticularpathways (i.e., the paleospinothalamic tract) including the locus caeruleus (LC) and the solitary nucleus, spinopontoamygdaloid pathways, the periaqueductal gray (PAG), and the cerebellum (e.g., Burstein et al. 1991; Price, 2000). The thalamus (THA) projects to limbic areas including the insula and anterior cingulate, which have been identified with the integration of the emotional and motivational features of pain (Craig, 2002, 2003a, 2003b). Noradrenergic pathways from the LC project to these and other limbic structures. Accordingly, pain reveals extensive limbic, prefrontal and somatosensory cortical components. A meta-analysis of the literature described brain operations during pain as a complex network involving THA, primary and secondary somatosensory cortices (S1, S2), insula (INS), anterior cingulate (ACC), and prefrontal cortices (Apkarian et al. 2005). Thus, the brain engages in massive, distributed, parallel processing in response to noxious signaling.

The mechanisms of multimodal integration pose a formidable challenge for pain scientists. Hollis et al. (2004) examined how catecholaminergic neurons in the solitary nucleus integrate visceral and somatosensory information when peripheral inflammation is present. Pre-existing fatigue, nausea, intense physiological arousal, and a systemic inflammatory response induced by proinflammatory cytokines (e.g., Anderson, 2005; Eskandari et al. 2003) are all correlated with sensory signalling in the experience of pain. In addition to Craig (2002, 2003a, 2003b), an increasing number of studies have investigated the integration of information from multiple sensory modalities and central operations correlated with emotion and cognition in pain (e.g., Bie et al. 2011; Liu et al. 2011; Neugebauer et al. 2009). The more we are able to delineate the qualia of pain and map these experiences onto specific multimodal physical operations, the closer we come to identifying pain with those operations.

So, why has Place’s (1956) original pain identity statement survived in philosophy of mind? One reason is that the use of ‘C-fibre activation’ by identity philosophers is merely a placeholder for whatever the eventual mechanisms of nervous systems prove to be. We now know that wounding is identical to specific endocrine and immune operations in addition to sensory signaling. These operations interact and in concert comprise a defensive stress response to wounding. However, the purpose of calling it the identity theory of mind is to separate it from philosophical theories that identify mental states with states of immaterial souls or minds (dualism), abstract machine systems (functionalism), or those theories that reject the reality of mental states (eliminativism). It is not to make any substantive assumption about the sensory modality. This is why Place’s (1956) pain identity claim of C-fibre activation has survived, despite being explanatorily incomplete.

[1] In clinical settings, problems of acute and chronic pain do not easily conform to pain-brain type identities. The persistence of chronic pain as a major problem in medicine may indicate that identifying pain with the brain (‘pain in the brain’) has failed to inform clinicians toward curative interventions (e.g., Chapman et al. 2008).

References
Anderson, J. (2005). The inflammatory reflex-introduction. Journal of Internal Medicine, 257(2), 122-125.
Apkarian, A. V., Bushnell, M. C., Treede, R. D., & Zubieta, J. K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. European Journal of Pain, 9(4), 463-463.
Bie, B., Brown, D. L., & Naguib, M. (2011). Synaptic plasticity and pain aversion. European Journal of Pharmacology, 667(1), 26-31.
Burstein, R., Dado, R. J., Cliffer, K. D., & Giesler, G. J. (1991). Physiological characterization of spinohypothalamic tract neurons in the lumbar enlargement of rats. Journal of Neurophysiology, 66(1), 261-284.
Chapman, C. R., Tuckett, R. P., & Song, C. W. (2008). Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. The Journal of Pain, 9(2), 122-145.
Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature Reviews Neuroscience, 3(8), 655-666.
Craig, A. D. (2003a). A new view of pain as a homeostatic emotion. Trends in Neurosciences, 26(6), 303-307.
Craig, A. D. (2003b). Pain mechanisms: labeled lines versus convergence in central processing. Annual Review of Neuroscience, 26, 1-30.
Eskandari, F., Webster, J. I., & Sternberg, E. M. (2003). Neural immune pathways and their connection to inflammatory diseases. Arthritis Research and Therapy, 5(6), 251-265.
IASP-Task-Force-On-Taxonomy (1994). IASP Pain Terminology. In H. Merskey & N. Bogduk (Eds.), Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms (pp. 209-214). Seattle: IASP Press.
Liu, C. C., Shi, C. Q., Franaszczuk, P. J., Crone, N. E., Schretlen, D., Ohara, S., & Lenz, F. A. (2011). Painful laser stimuli induce directed functional interactions within and between the human amygdala and hippocampus. Neuroscience, 178, 208-217.
Lyon, P., Cohen, M., & Quintner, J. (2011). An Evolutionary Stress‐Response Hypothesis for Chronic Widespread Pain (Fibromyalgia Syndrome). Pain Medicine, 12(8), 1167-1178.
Neugebauer, V., Galhardo, V., Maione, S., & Mackey, S. C. (2009). Forebrain pain mechanisms. Brain Research Reviews, 60(1), 226.
Place, U. T. (1956). Is consciousness a brain process? British Journal of Psychology, 47, 44-50.
Price, D. D. (2000). Psychological and neural mechanisms of the affective dimension of pain. Science, 288(5472), 1769-1772.
van Rysewyk, S. (2013). Pain is Mechanism. Doctoral Dissertation, University of Tasmania.
Vierck, C. J., Green, M., & Yezierski, R. P. (2010). Pain as a stressor: effects of prior nociceptive stimulation on escape responding of rats to thermal stimulation. European Journal of Pain, 14(1), 11-16.

Self and World: the case of Pain

The International Association for the Study of Pain (IASP) defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (Merskey & Bogduk, 1994). The IASP definition of pain is unique in that it explicitly recognizes that pain is an experience that can be understood in itself, in an internal way, in contrast to prior definitions (Sternbach, 1968; Mountcastle, 1974) that defined pain in terms of external causal stimuli that are correlated in some way with pain feelings and sensations.

External characterizations of pain based on neuroscientific findings remain influential in the pain literature. For example, according to a leading theory, pain feelings and sensations are externally related to a brain image of the ‘afferent representation of the physiological condition of the body’ (Craig, 2003). Interpreted philosophically, this view of pain is analogous to the traditional rational-metaphysical presupposition that feelings are but ‘sensations or emotions of the soul which are related especially to it,’ as Descartes put it, and thus are features only of the self and not of the world.

But pain is not only a personal feeling adhering to the self but that through my pain I am connected to a felt reality of the world. This world is not a world of causal reasons but a world that tonally flows in a certain direction and manner (Smith, 1986). When a sharp object is painfully cutting me, I experience a feeling of wincing back and away from the object, and in correlation with this feeling-flow the sharp object is felt to have a tonal-flow of flowing forwards, towards and into me in a piercing manner. When pain makes me fearful, I experience a feeling-flow of retreating backwards and away from the existent that is threatening me. The feeling flows backwards in a shrinking and cringing manner; I have the sensation of ‘shrinking and cringing back from’ the threatening existent. When my pain presents the quality of anxiety, my experience does not flow backwards as a ‘retreat from’, but has the directional sense of being suspended over an inner bottomlessness. The feeling flow of anxiety during pain is a flow that hovers before the possibility of flowing in a downward direction. When pain presents angry retaliation, I feel an angry ‘striking back’ towards the pain-affected body-part, and as such flows forwards, towards the limb at which I am angry. It flows forwards in a violently attacking manner. By virtue of correlated tonal and painful flows, the world and I are joined together in an extrarational and sensuously appreciative way.

Instead of only describing the external things to which pain is externally related, it is also possible to describe pain internally by noting other internal determinations of the feelings and sensations with which it is united. Joint internal-external characterizations of pain very roughly map onto neuroscientific evidence showing that our cutaneous nociceptive system differentiates into interoceptive and exteroceptive causal features, such that our interoceptive nociceptive system signals tissue disorders that are inescapable, and causes homeostatic responses, and our exteroceptive nociceptive system extracts meaningful information about events in the world in order to effect behaviors that protect the organism from external threats (Price et al. 2003).

References
Craig AD (2003). A new view of pain as a homeostatic emotion. Trends in neurosciences 26(6): 303–307.

Merskey H, Bogduk N (Eds) (1994). Classification of Chronic Pain (Second Ed.). IASP Press: Seattle, pp 209–214.

Mountcastle VB (1974). Pain and temperature sensibilities. Medical Physiology 13(1): 348–391.

Price DD, Greenspan JD, Dubner R (2003). Neurons involved in the exteroceptive function of pain. Pain, 106(3), 215–219.

Smith Q (1986).The felt meanings of the world: A metaphysics of feeling. Purdue University Press.

Sternbach RA (1968). Pain: A psychophysiological analysis. Academic Press: New York.

Robot Pain by Pentti Haikonen

Pentti Haikonen

‘The Observer is the Observed: Towards Integrating Pain Phenomenology with Third-Person Scientific Methods in the Study of Pain’

Arguing pain-brain relationships in the fetus

How does the physical growth of the fetal brain relate to pain function? Addressing this question is not just of research interest, but has profound consequences in guiding clinical use of analgesic and anesthetic intervention for in utero surgery. Adult brains appear structurally and functionally specialized for types of pain; for example, acute pain preferentially engages medial prefrontal cortical and subcortical limbic regions [1,2]. However, the question of the relationship between such specializations and pain is still controversial in the debate concerning fetal pain [3, for review]. One ‘maturational’ perspective is that brain growth and pain function co-develop through innate genetic and molecular mechanisms, and that postnatal experience merely has a role in the final ‘fine tuning’ [4,5,6,7]. Evidence concerning the differential neuroanatomical development of brain regions is used to determine a lower gestational age when particular regions likely become functional for pain. Several authors claim that maturation within subcortical brain regions enables pain function as early as 20 weeks gestation [6,7], others claim expansion of thalamocortical regions at 24 weeks is necessary and sufficient. An alternative ‘expertise’ view is that brain development and pain function involve a prolonged process of co-specialization that is shaped by postnatal experience [3,8,9,10]. Based on this approach, some authors argue that the fetal brain is not functional for pain at any gestational stage because skills such as sense of self and mind-reading learnt in postnatal life are necessary for pain [3,8,9,10].

Maturational views of functional brain development assume that brain growth and the appearance of functions are equivalent or the same thing, in the way that water and H2O are equivalent or the same thing, which implies that concerning the question of fetal pain, the sequential coming ‘on-line’ of specific brain regions during fetal development is identical with the appearance of pain function. That is, pain function numerically shares all its properties or qualities with the brain. Things with qualitative identity share properties, so things can be more or less qualitatively identical. Apples and oranges are qualitatively identical because they share the quality of being a fruit, but two apples have greater qualitative identity. Maturational views of fetal pain demand more than this, however, since they imply numerical identity. Numerical identity implies total qualitative identity, and can only hold between a thing and itself. This means that a maturational view of fetal pain makes a very strong demand about pain capacity: specific brain regions and pain function co-develop in the fetus because they are numerically identical, one and the very same thing. Pain is in the brain.

Expertise views of fetal pain challenge the core maturational commitment of brain-pain numerical identity and present philosophical arguments and data which claim instead to show the non-identity of brain-pain relationships in the fetus and the necessity of postnatal experience and learning [3,8,9,10]. A representative philosophical argument driving expertise views of fetal pain is the following: All pains are personal experiences and therefore entirely subjective; All brains are physical objects and therefore entirely objective; There is a fundamental divergence between pain and the brain. Therefore, pain cannot be numerically identical to the brain. Thus, the argument:

1. Pains are subjective.

2. Brains are objective.

Therefore, since pains and brains fundamentally diverge,

3. Pain is not numerically identical to the brain.

I will now critically examine and discuss this argument. Take the first premise: ‘pains are subjective.’ On a reasonable interpretation of its meaning, to say that ‘pains are subjective’ is to say that pains are knowable by direct personal experience. However, since brain events such as brain growth are not knowable by direct personal experience, pains cannot be one and the same thing as brain events. Here is the argument:

1. Pains are knowable to me by direct personal experience.

2. Brain events are not knowable to me by direct personal experience.

Therefore, since pains and brains fundamentally diverge,

3. My pain is not numerically identical to my brain.

Once the argument is represented in this form, it is clear that it is fallacious. This can be observed if we compare the argument with the following example:

1. Ibuprofen is known by me to relieve pain.

2. Iso-butyl-propanoic-phenolic acid is not known by me to relieve pain.

Therefore, since ibuprofen and iso-butyl-propanoic-phenolic acid fundamentally diverge,

3. Ibuprofen cannot be identical to iso-butyl-propanoic-phenolic acid.

The premises in the example are true, but the conclusion is known to be false. The argument is fallacious because its core assumption – ‘fundamental divergence’ – is mistaken: it mistakenly assumes that a thing must be known by somebody somewhere. But the property ‘being known by somebody’ is not a necessary feature of anything, much less a property that might establish its identity or non-identity with something otherwise known. The truth of the premises may be due to nothing else but my ignorance of what turns out to be identical with what. This point entails that ‘being known by somebody’ is not a necessary feature of pain that might explain its identity or non-identity with the brain. The non-identity of fetal brain development and pain function cannot be established by this argument.

The argument needs to produce independent evidence for the idea of ‘fundamental divergence’, since it is not self-evident. To illustrate this point, consider the argument for pain-brain numerical identity that personal pain would have no influence on mammalian behaviour were it not numerically identical with brain events [11]. This apparently simple argument wasn’t established until fairly recently because a crucial premise was not available. This is the premise that physical effects like pain are determined by prior physical causes. This is an empirical premise, and one which scientific theories of pain didn’t take to be fully evidenced until the middle and late twentieth century [12, for review]. It is this evidential shift, and not the apparently obvious, which is responsible for the argument’s persuasive power. It remains to be seen if stronger evidence for pain-brain identity in the fetus is forthcoming.

Of course, the failure of this particular argument to establish its conclusion does not thereby abolish the expertise perspective and self-guarantee its opposite, the maturational perspective, or even prove that the two perspectives are mutually exclusive. Rather, what the failure of the argument shows is that apparently obvious logic is sometimes a poor guide to reality. Whether pain-brain identity is true or false is impossible to tell simply by arguing personal appearances.

References

[1] Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011; 152(3 Suppl): S49–S64.

[2] Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E. An fMRI-based neurologic signature of physical pain. New England Journal of Medicine 2013; 368(15): 1388–1397.

[3] Derbyshire SWG, Raja A. On the development of painful experience. Journal of Consciousness Studies 2011; 18: 9–10.

[4] Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. New England Journal of Medicine 1987; 317(21): 1321–1329.

[5] Anand KJ. Consciousness, cortical function, and pain perception in nonverbal humans. Behavioral and Brain Sciences 2007; 30(1): 82–83.

[6] Lowery CL, Hardman MP, Manning N, Clancy B, Whit Hall R, Anand KJS. Neurodevelopmental changes of fetal pain. Seminars in Perinatology 2007; 31(5): 275–282.

[7] Brusseau RR, Mashour GA. Subcortical consciousness: Implications for fetal anesthesia and analgesia. Behavioral and Brain Sciences 2007; 30(01): 86–87.

[8] Derbyshire SWG. Controversy: Can fetuses feel pain? BMJ: British Medical Journal 2006; 332(7546): 909–912.

[9] Derbyshire SWG. Fetal analgesia: where are we now? Future Neurology 2012; 7(4): 367–369.

[10] Szawarski Z. Do fetuses feel pain? Probably no pain in the absence of “self”. BMJ: British Medical Journal 1996; 313(7060): 796–797.

[11] Papineau D. Thinking about consciousness. Oxford: Oxford University Press; 2002.

[12] Perl ER. Pain mechanisms: a commentary on concepts and issues. Progress in Neurobiology 2011; 94(1): 20–38.

whim-wham

Home is not the house you happen to live in, but your most intimate relationships.

You can’t install democracy like computer software. It has to be grown.

Consciousness is one boundless edge. It has no fixed center. The brain, since it is a network, also has no center: it is one massively complex edge. The edge of the brain is the center of activity.

Brain hardware: billions of dumb interconnected neurons.
Brain software: the neural network economy.

Communication is the economy of the brain.

No one connected neuron is as smart as all interconnected neurons.

Neuroscience peers into the mind and sees the brain. Not quite right. Neuroscience peers into the mind and relates what it sees to the brain. It is true that science never just ‘sees’ its object of study: science always alters it. ‘A seeing that transforms’.

Nature continues on in her merry way, oblivious to us humans, and blind to itself. Science transforms our habitual ways of understanding reality which we subsequently take as transforming reality itself. Reality itself is not altered by science.

Science softens up mystery in preparation for discovery.

Success still needs to be managed.

‘Robot Pain’

Abstract. Functionalism of robot pain claims that what is definitive of robot pain is functional role, defined as the causal relations pain has to noxious stimuli, behavior and other subjective states. Here, I propose that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. I argue that what makes a state pain for a neuro-robot at a time is the functional role it has in the robot at the time, and this state is type identical to a specific circuit state. Support from an experimental study shows that if the neural network that controls a robot includes a specific ’emotion circuit’, physical damage to the robot will cause the disposition to avoid movement, thereby enhancing fitness, compared to robots without the circuit. Thus, pain for a robot at a time is type identical to a specific circuit state.

Here.

whim-wham

A living human being is an intelligent mover.

Unlike plants, we go to to the universe, the universe does not come to us. Human beings are not sessile.

Acute pain is a very effective way of selecting the next input.

Don’t ask yourself what you hope to be doing in the future as the source of personal meaning, but how you hope to be feeling. 

Tania Lombrozo, ‘The Mind is Just the Brain’

UC Berkeley psychologist Tania Lombrozo has responded to the Annual Edge Question for 2014, ‘What scientific idea is ready for retirement?’, with a piece entitled ‘The Mind is Just the Brain’, in which she argues for the rejection (‘retirement’) of mind-brain identity theory.

Using a baking analogy to illustrate her case against reductionism, she writes:

But a theory of baking wouldn’t be very useful if it were formulated in terms of molecules and atoms. As bakers, we want to understand the relationship between—for example—mixing and texture, not between kinetic energy and protein hydration. The relationships between the variables we can tweak and the outcomes that we care about happen to be mediated by chemistry and physics, but it would be a mistake to adopt “cake reductionism” and replace the study of baking with the study of physical and chemical interactions among cake components.

But if you are interested in the project of explaining, predicting, and controlling the quality of your baked goods, then you’ll need something like a baking theory to work with.

Rejecting the mind in an effort to achieve scientific legitimacy—a trend we’ve seen with both behaviorism and some popular manifestations of neuroscience—is unnecessary and unresponsive to the aims of scientific psychology. 

In these passages, Lombrozo makes a common anti-reductionistic mistake of thinking that mind-brain identity makes mental experiences somehow unreal or even disappear. Her reasoning implies that a correct explanation of mental phenomena cannot involve scientific reduction of mental phenomenon to neurobiological mechanism. This misunderstanding trades on a peculiar view of reduction, where it is expected that in neuroscience, mind-brain identities eliminate mental experiences. I think this expectation is incorrect.

Temperature was ontologically reduced to mean molecular kinetic energy, but no person expects that temperature therefore ceased to be real or became scientifically disrespectable or redundant. Visible light was ontologically reduced to electromagnetic radiation, but light did not disappear. Instead, scientists understand more about the real nature of light than they did before 1873. Light is real, no doubt; and so is temperature. Some expectations about the nature of temperature and light did change, and scientific progress does occasionally require rethinking what was believed about phenomenon. In certain instances, previously respectable states and substances sometimes did prove to be unreal. The caloric theory of heat did not survive rigorous experimental testing; caloric fluid thus proved to be unreal. A successful mind-brain identity of mental phenomenon such as pain means only that there is an explanation of pain. It is a reduction. Scientific explanations of phenomenon do not typically make them disappear [1,2,3].

It is critical to clear-up a further common misconception about mind-brain identity theory. This is the misconception that mind-brain identity theory is equivalent to reductionism. The truth is that whereas identity theory is compatible with a wide range of reductionistic philosophies, it is not equivalent to all of them. Here are some illustrative examples [4]:

1) Identity theory is reductionistic in the sense that it denies minds are ontologically independent of brains and uniquely self-guaranteeing, in line with functionalist and realization (physicalist) philosophies of mind. But functionalism and realization physicalism are not equivalent to the identity theory, so identity theory is not uniquely reductionist in the sense of (1).

2) Identity theory is reductionistic in the minimal sense that it claims, in line with functionalist and realization (physicalist) philosophies, that mind is ‘nothing over and above’ the brain, but since identity theory and functionalist and realization philosophies are not equivalent, identity theory is not equivalent to reductionism. A philosopher could be a reductionist without being an identity theorist.

3) Identity theory is not reductionistic in the sense that it asserts ‘micro-reductionism’. Mental phenomena might be identified with innate genetic or molecular mechanisms (John Bickle), but this is optional, not required. The core metaphysical commitment of identity theory is that mental states are numerically identical to brain states. Nothing is expected in this core claim about the precise mechanistic nature of brain states, which is a scientific question, anyway.

4) Identity theory is not reductionistic in the sense that it asserts that (e.g.) psychology reduces to neuroscience, cognitive neuroscience reduces to molecular neuroscience, or philosophy of mind reduces to quantum mechanics. One can assert identity theory without asserting epistemic reductionism.

Positively, I entirely agree with Lombrozo when she says:

But if we want to know—for instance—how to influence minds to achieve particular behaviors, it would be a mistake to look for explanations solely at the level of the brain.

Understanding the mind isn’t the same as understanding the brain.

Understanding the mind requires first-person descriptions of mental states and experiences, and third-person scientific descriptions of associated brain states, and a method to integrate them, such as the experiential-phenomenological method [5]. So, Lombrozo is right: ‘Understanding the mind isn’t the same as understanding the brain.’ More precisely, I argue that her correct thesis implies that the subject matter of psychology is brain mechanism as related to mental phenomena. For example, the subject of pain science is brain mechanism as related to pain phenomena (e.g., acute pain, chronic pain, fetal pain, empathy for pain, dreamed pain, near-death pain, and so on). Pain research aims to discover the brain mechanisms subserving conscious pain experiences accessible only through introspection, which means that pain research is entirely reliant on the first-person point of view and on using first-person investigative methods. This necessarily includes introspection together with third-person methods (e.g., neuroimaging). Since pain research aims to know which experience types are generated by which brain mechanism, researchers must naturally know when specific pain experiences occur and what their personal qualities are.

The history of scientific pain research shows that introspection has been extensively used. For example, pain psychophysics typically uses subject pain verbal-report or non-verbal behavior (e.g., facial expressions) to infer the presence of pain. That is, pain psychophysics is committed to subject introspection. It is also important to remember that the validity of pain-related neuroimaging was established by the correlation of brain images with self-report of pain [6]. Pain psychophysics, like psychology, preserves an epistemological dualism in its subject matter while rejecting metaphysical dualism.

How then is mind-brain identity theory positioned relative to the indispensability of introspection in mind science? Personal introspection is a direct way of coming to know about personal experiences and their qualities. It is epistemological. Still, despite appearances to the contrary, what introspection reveals to us may be utterly mechanistic. It may be that what scientists study through third-person methods is numerically identical with what is personally experienced through introspection, that is, brain mechanisms of the appropriate type. There is only one type of activity in question: the brain mechanism with all and only physical properties. Thus, mind-brain identity theory is preserved in the study of the mind.

References

[1] Churchland PM (2007). Neurophilosophy at work. Cambridge, UK: Cambridge University Press.

[2] Churchland PS (1989). Neurophilosophy: Toward a unified science of the mind-brain. Cambridge, Mass.: The MIT Press.

[3] van Rysewyk S (2013). Pain is Mechanism. PhD Dissertation, University of Tasmania.

[4] Polger TW (2009). Identity Theories. Philosophy Compass4(5), 822-834.

[5] Price DD, Aydede M (2006). The Experimental Use of Introspection in the Scientific Study of Pain and its Integration with Third-Person Methodologies: The Experiential-Phenomenological Approach. In M Aydede (ed.), Pain: New Essays on Its Nature and the Methodology of Its Study, pp. 243-275. Cambridge, Mass.: MIT Press.

[6] Coghill RC, McHaffie JG, Yen YF (2003). Neural correlates of interindividual differences in the subjective experience of pain. Proceedings of the National Academy of Science USA, 100, 8538-8542.

An approach to understanding fetal pain and consciousness

The trend in the literature on fetal pain is to approach the question of consciousness in the fetus in terms of conscious states of pain. That is, first define what makes a pain a conscious mental state, and then determine being a conscious fetus in terms of having such a state. Thus, the possibility of a conscious fetus is thought to rely on theories of conscious pain states. Call this the state approach to fetal pain. 

Two state approaches to fetal pain are present in the literature. One approach looks at the brain structure(s), pathways and circuits necessary for conscious pain states and then seeks to establish whether this substrate is present and functional in the fetus. There is broad agreement among researchers that the minimal necessary neural pathways for pain are in the human fetus by 24 weeks gestation [1, for review]. Some researchers argue that the fetus can feel pain earlier than 24 weeks because pain is enabled by subcortical brain structures [4,5,6].

Another phenomenal approach is to consider the subjective content of a conscious experience of pain, and to ask whether that content might be available to the fetus [1,2,3]. Based on this approach, some researchers argue that the fetus cannot feel pain at any stage because it lacks developmental abilities and concepts such as sense of self necessary for pain [1,2,3].

Although both state approaches are presented as opposites in the literature, they share the determination of fetal pain based on specific levels or degrees of complexity, whether of the brain structures and the relationship they have to the conscious state of pain, or of the subjective contents that constitute that state.

An alternate approach to understanding fetal consciousness that has not been explored in the literature on fetal pain is the extent to which pain is based on the arrangement of certain brain structures (or experiential contents), rather than a result of maturation or increase in complexity achieved by growth of the brain substrate which below a certain size does not enable consciousness [7,8]. Thus, whether the fetus is excluded in this regard is not due to its simplicity, but because its lack of certain brain arrangements necessary to enable consciousness.

According to this alternate view of fetal pain, a living creature’s subjective contents may differ greatly in complexity. To convey the range of conscious possibilities, consider the Indian ‘scale of sentience’ (cited in [8]):

‘This.’
‘This is so.’
‘I am affected by this which is so.’
‘So this is I who am affected by this which is so.’

The possibilities in this consciousness scale range from simply experienced sensation (‘This’; ‘This is so’) to self-consciousness (‘I am affected by this which is so’; ‘So this is I who am affected by this which is so’). Each stage in this scale presupposes consciousness. Any experience, whatever its degree of complexity, is conscious. It follows that to see, to hear, and to feel is to be conscious, irrespective of whether in addition a creature is self-conscious that it is seeing, hearing, and feeling [7]. To feel pain is to be conscious of that experience regardless of whether in addition one is self-conscious of being in pain. Self-consciousness is just one of many contents of consciousness available to big-brained living creatures with complex capacities: it is not definitive of consciousness [7,8]. The point of saying this is that it circumvents the logical mistake of misidentifying attributes unique to a specialized form of consciousness (e.g., self-consciousness) as general features of consciousness itself.

With this alternate view of consciousness now sketched in, we should determine where the fetus and where pain fall in the Indian scale of sentience. The possibilities in the scale extend from mere sensation to self-consciousness–where does the fetus fall in?

References

[1] Derbyshire S, Raja A. (2011). On the development of painful experience.Journal of Consciousness Studies18, 9–10.

[2] Derbyshire SW. (2006). Controversy: Can fetuses feel pain?. BMJ: British Medical Journal332(7546), 909.

[3] Szawarski Z. (1996). Do fetuses feel pain? Probably no pain in the absence of “self”. BMJ: British Medical Journal313(7060), 796–797.

[4] Anand KJ, Hickey PR. (1987). Pain and its effects in the human neonate and fetus. New England Journal of Medicine317(21), 1321–1329.

[5] Anand KJ. (2007). Consciousness, cortical function, and pain perception in nonverbal humans. Behavioral and Brain Sciences30(01), 82–83.

[6] Lowery CL, Hardman MP, Manning N, Clancy B, Whit Hall R, Anand KJS. (2007). Neurodevelopmental changes of fetal pain. In Seminars in perinatology (Vol. 31, No. 5, pp. 275–282).

[7] Merker B. (1997). The common denominator of conscious states: Implications for the biology of consciousness. Available at: http://cogprints.soton.ac.uk.

[8] Merker B. (2007). Consciousness without a cerebral cortex, a challenge
for neuroscience and medicine. Target article with peer commentary and author’s response. Behavioral and Brain Sciences, 30, 63–134.

The University of Tokyo Center for Philosophy, 3rd International Conference ‘Phenomenology of Pain’, Jan 4, 2014

The University of Tokyo Center for Philosophy, Uehiro Research Division,
Philosophy of Disability & Co-existence Project (UTCP/PhDC):

3rd International Conference ‘Phenomenology of Pain’

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Critique of Max Velmans on mind-brain identity theory and consciousness – part I

In this first post of a series, I describe and challenge several criticisms of reductive materialism, or mind-brain identity theory [5,6,7,8,9,10], made by psychologist Max Velmans. My focus in this post concerns Velmans’s arguments against mind-brain identity theory as presented in ‘What non-eliminative materialism needs to show’ in Appendix I of [4]. Future posts will address his other arguments against mind-brain identity theory as presented in the same work. My intention here is not simply negative, but also positive: using the first-person third-person distinction Velmans appeals to, I propose that the first-person point of view (introspection) and first-person methods are necessary to consciousness science. In developing this view, I focus mostly on pain.

Velmans is a long-time critic of materialist theories of phenomenal consciousness [1,2,3,4]. Following philosopher CD Broad, Velmans distinguishes three versions of materialism: radical, reductive and emergent. He writes [4]:

Radical materialism claims that the term “consciousness” does not refer to anything real (in contemporary philosophy this position is usually called “eliminativism”). Reductive materialism accepts that consciousness does refer to something real, but science will discover that real thing to be nothing more than a state (or function) of the brain. Emergentism also accepts the reality of consciousness but claims it to be a higher-order property of brains; it supervenes on neural activity, but cannot be reduced to it. [4,20]

Velmans begins his argument against mind-body identity theory:

Let us assume that, in some sense, our conscious experiences are real. To each and every one of us, our conscious experiences are observable phenomena (psychological data) which we can describe with varying degrees of accuracy in ordinary language. Other people’s experiences might be hypothetical constructs, as we cannot observe their experiences in the direct way that we can observe our own, but that does not make our own experiences similarly hypothetical. Nor are our own conscious experiences “theories” or “folk psychologies.” We may have everyday theories about what we experience, and with deeper insight, we might be able to improve them, but this would not replace, or necessarily improve the experiences themselves. [4,20-21]

In this passage, Velmans denies that our conscious experiences are ‘theories’ or ‘folk psychologies.’ However, since that is a central claim made by radical materialism (‘eliminativism’) [5,6], not reductive materialism (mind-brain identity theory), Velmans is in error to attribute it to the latter. Like mind-brain identity theory, eliminativism accepts the claim that conscious states are ‘nothing over and above’ brain states (minimal reductionism), but it rejects type identity. This is because eliminativism denies that conscious states are real, and do not exist [10]. By contrast, mind-brain identity theory is realist about mental states and experiences [10]. Mind-brain identity theory is not equivalent to eliminativism [10] (1).

The final sentence in the quote above reads: ‘We may have everyday theories about what we experience, and with deeper insight, we might be able to improve them, but this would not replace, or necessarily improve the experiences themselves.'[my italics] Critics of mind-brain identity theory, like Velmans, believe that a successful scientific reduction of consciousness would make all conscious experiences somehow unreal or even disappear [e.g., 17,18]. Using this conception of reduction, it is then reasoned that because it is observably obvious that a conscious experience like pain is real, it cannot be reduced by science to neurobiological mechanism. This misunderstanding trades on a peculiar view of reduction, where it is expected that in science, type identity claims make conscious experiences disappear. I think this expectation is incorrect.

Temperature was ontologically reduced to mean molecular kinetic energy, but no person expects that temperature therefore ceased to be real or became scientifically disrespectable or redundant. Visible light was ontologically reduced to electromagnetic radiation, but light did not disappear. Instead, scientists understand more about the real nature of light than they did before 1873. Light is real, no doubt; and so is temperature. Some expectations about the nature of temperature and light did change, and scientific progress does occasionally require rethinking what was believed about phenomenon. In certain instances, previously respectable states and substances sometimes did prove to be unreal. The caloric theory of heat did not survive rigorous experimental testing; caloric fluid thus proved to be unreal. Thus, a successful type identity of pain with mechanism means only that there is an explanation of pain. It is a reduction. But, scientific explanations of phenomenon do not typically make them disappear [5,6,10].

Velmans continues his argument:

In essence then, the claim that conscious experiences are nothing more than brain states is a claim about one set of phenomena (first-person experiences of love, hate, the smell of mown grass, the colour of a sunset, etc.) being nothing more than another set of phenomena (brain states, viewed from the perspective of an external observer). Given the extensive, apparent differences between conscious experiences and brain states this is a tall order. [4,21]

By characterizing mind-brain identity theory as a ‘tall order’, Velmans is in danger of begging the question. It is possible that science will never understand how brain structures such as neurons and protein channels produce pains, emotions and thoughts. The reality of the brain may be forever closed to us. Still, that the problem of consciousness is scientifically tractable or intractable, solvable or insolvable, is impossible to tell simply by noting appearances, since problems do not rank level of difficulty on their sleeves. Why should the problem of consciousness be any different?

Besides, things change. Over time, the nature of a problem may alter shape as new knowledge and understanding arrive. A problem may come to be viewed in novel ways as a result of reciprocal developments in technology, scientific methods and theory. For example, the composition of stars was regarded by scientists as an intractable problem. The problem was that it was impossible to get close enough to collect a star sample without burning up. However, with the unexpected discovery of spectral analysis, this problem proved tractable. The elements of stars were found to produce a type of fingerprint when heated to incandescence, easily observed when light produced from a source is passed through a prism.

In the early twentieth century, the copying problem in molecular genetics was thought to be intractable. This problem, however, was solved in the decades following Watson and Crick’s 1953 publication that DNA is a double helix. By contrast, the problem of how protein molecules fold into their 3D shape once made, believed by many scientists to be solvable in the mid-twentieth century, remains entirely unsolved today despite many decades of effort. Moreover, contributing solutions to twenty-first century problems can come from surprising and novel sources that may challenge conventional thinking. What seems apparently true or observably obvious during immediate experience or armchair reflection is sometimes a poor guide to reality.

Velmans again:

Instances where phenomena viewed from one perspective turned out to be one and the same as seemingly different phenomena viewed from another perspective do occur in the history of science. A classical example is the way the “morning star” and the “evening star” turned out to be identical (they were both found to be the planet Venus). But viewing consciousness from a first- versus a third-person perspective is very different to seeing the same planet in the morning or the evening. From a third-person (external observer’s) perspective one has no direct access to a subject’s conscious experience. Consequently, one has no third-person data (about the experience itself) which can be compared to or contrasted with the subject’s first-person data. [4,21]

It is unclear what Velmans means by ‘From a third-person (external observer’s) perspective one has no direct access to a subject’s conscious experience.’ I presume he intends that what I experience during a conscious episode cannot be available to you or indeed any one else in the way it is directly available to me. I occupy a uniquely privileged position concerning my experience that no one else can occupy. But if so, then he is intuitively characterizing the problem of consciousness in terms of method of access, and in terms of a privileged mode of access at that, namely, ‘direct’ personal introspection, which is question-begging.

This intuitive take on the problem of consciousness also results in a misrepresentation of what science is really up to, since the scientific enterprise relies on the intersubjective availability of its subject matter, in that no one is privileged with regard to collecting evidence about the object of the study. This means that no one has any special epistemic authority over evidence that others cannot in principle understand. In principle, must a successful reduction of pain produce a scientific explanation and pain? Obviously, no – scientific pain research aims to explain pain; it is not in the business of spontaneously concocting the phenomenon in question. To think otherwise is to misrepresent the limits and possibilities of science [5,6,10].

Now, there is a positive characterization of Velmans’s appeal to the first-person and third-person distinction I wish to show. Velmans’s description of the consciousness landscape should be taken to imply that the subject matter of consciousness research is brain mechanism as related to conscious phenomena. For example, the subject of pain science is brain mechanism as related to pain phenomena (e.g., acute pain, chronic pain, fetal pain, empathy for pain, dreamed pain, near-death pain, and so on). Consciousness research aims to discover the brain mechanisms subserving conscious experiences accessible only through introspection, which means that consciousness research is entirely reliant on the first-person point of view and on using first-person investigative methods. Contrary to Velmans’s view, this necessarily includes introspection together with third-person methods (e.g., neuroimaging). Since consciousness research aims to know which experience types are generated by which brain mechanism, researchers must naturally know when specific conscious experiences occur and what their personal qualities are. Which means that introspection is indispensable to consciousness research.

The history of scientific pain research clearly shows that introspection has been extensively used. For example, pain psychophysics typically uses subject pain verbal-report or non-verbal behavior (e.g., facial expressions) to infer the presence of pain. That is, pain psychophysics is committed to subject introspection. It is also important to remember that the validity of pain-related neuroimaging was established by the correlation of brain images with self-report of pain [19].

Finally, Velmans:

Neurophysiological investigations are limited, in principle, to isolating the neural correlates or antecedent causes of given experiences. This would be a major scientific advance. But what would it tell us about the nature of consciousness itself? [4,21]

I will respond to Velmans’s question with my own: how is mind-brain identity theory positioned relative to the indispensability of introspection to consciousness research? As Velmans notes, introspection is a direct way of coming to know about personal experiences and their qualities. It is an epistemological activity. Still, despite appearances to the contrary or personal conviction, what introspection reveals to us may be utterly mechanistic. It may be that what neuroscientists study through third-person methods is type identical with what is personally experienced through introspection, that is, brain mechanisms of the appropriate type. There is only one type of activity in question: the brain mechanism with all and only physical properties.

Mind-brain identity theory follows a long line of identifications that have marked progress in knowledge: water is H2O, light is electromagnetic energy, lightning is electrical discharge, influenza is a viral infection, and so on. Each of these identities is part of a larger theory that was accepted because it provided a better explanation of the evidence than rival theories. To illustrate this claim, take the conventional example of the type identity of fire and rapid oxidation. Why is this type identification descriptive (i.e., informative)? The first step is to conduct a qualitative investigation of fire. The flame is the visible part of fire, it releases heat and light, is normally sustained by a continuous supply of fuel, and so on. Some qualitative facts about fire are easily observed and others take further investigation, for instance, facts about the reactions that make fire explode. This provides a provisional description of fire. These qualitative descriptions (facts) about fire are then matched with qualitative descriptions (facts) about the operation of rapid oxidation, which is the sequence of chemical reactions between a fuel and an oxidant, such as oxygen or fluorine gas. These facts are harder to describe but essential. When sufficient information is at hand concerning the parts and operations of fire and the parts and operations of specific chemical reactions (rapid oxidation), we can describe how the structure of fire delineates its qualitative chemical properties. The multilevel mechanistic description of fire type identifies it with a specific mechanism type, rapid oxidation, and describes its behavior in terms of the behavior and composition of this mechanical operation. Fire is rapid oxidation.

The type identification of fire and rapid oxidation is only enabled if other substances are also type identified with other molecules, and if elements are type identified with chemical types, and so on. That is, the type identity of fire and rapid oxidation works because it is framed in the broader descriptive context of chemistry and physics. Those general framework theories imply the type identifications. Of course, the type identification of fire and rapid oxidation might be faulted as an incorrect description, perhaps because the physical operations involve activity in a broader range of physical processes. But that criticism merely asserts a different type identity description, and does not challenge type identity claims per se. It is conceivable to ponder whether fire is correctly type identified with rapid oxidation rather than with some other operation; but within the framework of chemistry and physics as they are understood, it is not reasonable to ponder whether fire might fail to be any type of mechanical operation at all.

In the same way, mind-brain identity theory is part of a rich theory that aims to explain conscious and unconscious mental phenomena such as perception, memory, reasoning, addiction, and disease. The personal experience of pain is multidimensional and involves specific sensory, emotional and cognitive features. I think there is a well established multilevel view of the physiological mechanisms that best describes pain qualities. This mechanistic description is framed within the context of advancing theories of the nervous, endocrine and immune systems and their complex functional interdependencies. There are also complex adaptive system-based descriptions of pain experience. Taken together, these descriptions reveal how pain is type identified with mechanism [10].

Although empirical progress in the understanding of pain is typically gradual and piecemeal, the type identification of pain with brain mechanism does not proceed in an additive manner. Pain scientists do not discover one pain type identity at a time and then add them together. Rather, what justifies claims to have type identified the mechanisms of pain is the way the entire multilevel mechanistic package coheres [10].

Endnotes

1. Briefly, the central argument for eliminativism is the idea that we use a theoretical framework to explain and predict human behavior [11], usually called the theory-theory (TT). TT views folk psychology (FP) as comprising specific theoretical claims and generalizations (and laws), described by our everyday common-sense psychological (i.e., mental) words such as ‘belief’, ‘desire’, ‘recognition’, ‘fear’, ‘anticipate’, ‘memory’ or ‘pain’. FP generalizations are thought to describe the diverse causal regularities and relations of FP claims.

TT claims that FP generalizations and claims operate in FP much like the generalizations and laws of scientific theories. However, the laws of FP are acquired more informally than scientific theories, as part of normal human development [e.g., 12,13,14,15]. For example, children who observe their parents showing fear and behavioral avoidance to back-stressing tasks, such as lifting heavy objects, may adjust their understanding of that situation (‘back-stressing tasks are dangerous and can cause pain’) and the behavioral effects (‘avoidance of back-stressing tasks generally reduces pain’) based on the generalization ‘Since back-stressing tasks can cause pain, and avoidance of these tasks generally reduces pain, it is best to avoid such tasks’ [16].

References

[1] Velmans, M. (2000). Understanding Consciousness. London: Routledge/Psychology Press.

[2] Velmans M. (2001a). A natural account of phenomenal consciousness. Consciousness and Communication, 34(1&2), 39-59.

[3] Velmans M. (2001b). Heterophenomenology versus critical phenomenology: A dialogue with Dan Dennett. http://cogprints.soton.ac.uk/documents/disk0/00/00/17/95/index.html.

[4] Velmans M. (2002). How Could Conscious Experiences Affect Brains? Journal of Consciousness Studies 9(11), 3-29.

[5] Churchland PM. (2007). Neurophilosophy at work. Cambridge, UK: Cambridge University Press.

[6] Churchland PS. (1989). Neurophilosophy: Toward a unified science of the mind-brain. Cambridge, Mass.: The MIT Press.

[7] Place UT. (1956). Is Consciousness a Brain Process? British Journal of Psychology47, 44-50.

[8] Polger TW. (2004). Natural minds. Cambridge, Mass.: The MIT Press.

[9] Smart JJC. (1959).  Sensations and Brain Processes. Philosophical Review68, 141-156.

[10] van Rysewyk S. (2013). Pain is Mechanism. PhD Dissertation, University of Tasmania.

[11] Sellars W. (1956). Empiricism and the Philosophy of Mind. Minnesota Studies in Philosophy of Science, 1, 253-329.

[12] Churchland PM. (1981). Eliminative Materialism and the Propositional Attitudes. Journal of Philosophy, 78, 67-90.

[13] Hardcastle VG. (1999). The Myth of Pain. Cambridge, Mass.: MIT Press.

[14] Roth M. (2012). Folk psychology as science. Synthese, 189(4), 1-12.

[15] Stich S. (1983). From Folk Psychology to Cognitive Science. Cambridge Mass.: MIT Press.

[16] Goubert L, Vlaeyen JW, Crombez G, & Craig KD. (2011). Learning about pain from others: an observational learning account. The Journal of Pain, 12(2), 167-174.

[17] Chalmers D. (1996). The Conscious Mind. Oxford: Oxford University Press.

[18] Searle JR. (1992). The Rediscovery of Mind. Cambridge, Mass.: MIT Press.

[19] Coghill RC, McHaffie JG, Yen YF. (2003). Neural correlates of interindividual differences in the subjective experience of pain. Proceedings of the National Academy of Science USA, 100, 8538-8542.

Pain in the brain? The question of fetal pain

There is broad agreement among researchers that the minimal necessary neural pathways for pain are in the human fetus by 24 weeks gestation [1, for review]. However, some argue that the fetus can feel pain earlier than 24 weeks because pain can be enabled by subcortical brain structures [2,3,4,5]. Other researchers argue that the fetus cannot feel pain at any stage of gestation because the fetus is sustained in a state of unconsciousness [6]. Finally, others argue that the fetus cannot feel pain at any stage because the fetus lacks the conceptual postnatal development necessary for pain [7,8,9]. If a behavioral and neural reaction to a noxious stimulus is considered sufficient for pain then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. According to [1], much of the disagreement concerning fetal pain rests on the understanding of key terms such as ‘wakefulness’, ‘conscious’ and ‘pain’.

A motivation for thinking conceptual subjectivity is necessary for pain is the idea that subjective experiences such as pain cannot be reduced to or identified with the objective features of the brain [7,8,9]. All pains are personal experiences and therefore entirely subjective; all brain states are physical events and therefore entirely objective. There is a fundamental divergence between pain and the brain. Thus, pain cannot be in the brain. The basic argument:

1. Pain experiences are subjective.

2. Brain events are objective.

Therefore, since pain experiences and brain events fundamentally diverge,

3. Pain experiences are not identical to brain events.

Is this a good argument? Let’s examine its first premise – ‘pain experiences are subjective.’ On a reasonable interpretation of its meaning, to state that ‘pain experiences are subjective’ is to state that pain experiences are knowable by introspection. However, since brain events are not knowable by introspection, pain experiences cannot be identical to brain events. Here is the argument:

1. Pain experiences are knowable to me by introspection.

2. Brain events are not knowable to me by introspection.

Therefore, since pain experiences and brain events fundamentally diverge,

3. My pain experiences are not identical to any of my brain events.

Once the argument is represented in this form, it is clear that it is fallacious. This can be clearly observed if we compare the argument with the following example:

1. Ibuprofen is known to me to relieve pain.

2. Iso-butyl-propanoic-phenolic acid is not known by me to relieve pain.

Therefore, since ibuprofen and iso-butyl-propanoic-phenolic acid fundamentally diverge,

3. Ibuprofen cannot be identical to iso-butyl-propanoic-phenolic acid.

The premises in the example are true, but the conclusion is known to be false. The argument is fallacious because the core idea of the argument – ‘fundamental divergence’ – makes an erroneous assumption; namely, it assumes that a thing must be known by somebody. But the property ‘being known by somebody’ is not a necessary feature of any thing, much less a property that might establish its identity or non-identity with some thing otherwise known. The truth of the premises may be due to nothing else but my ignorance of what turns out to be identical with what. These considerations challenge the assumed epistemology in the conceptual subjectivity view of pain.

They also challenge the related claim made by proponents of conceptual subjectivity that any description of a pain given in objective scientific terms will necessarily always exclude the personal experience of that pain [7,8,9]. The argument made here is by now familiar: since descriptions of pain in personal subjective terms are different from scientific descriptions of pain, it follows that a pain and its private subjectivity cannot be identical with a brain event and its public objectivity. Only persons can feel pain – brain cells and protein channels can’t. Clearly, the argument begs the issue in question: whether or not the subjective features of a pain I personally experience are identical with some objective features of my brain that might be discovered by neuroscience is precisely the question at issue [10,11].

Besides, in order to understand a scientific explanation of pain, neuroscience does not require of a person that he both understands the explanation and feels pain as a condition of understanding. Neuroscience aims to explain pain, that is its main purpose. Too much is demanded of neuroscience if, in addition to formulating an explanation of pain, it is meant to re-create pain in somebody as a requirement of understanding [10,11]. This expectation is therefore much too strong.

References

[1] Derbyshire SWG, Raja A. (2011). On the development of painful experience.Journal of Consciousness Studies18, 9–10.

[2] Anand KJ, Hickey PR. (1987). Pain and its effects in the human neonate and fetus. New England Journal of Medicine, 317(21), 1321–1329.

[3] Anand KJ. (2007). Consciousness, cortical function, and pain perception in nonverbal humans. Behavioral and Brain Sciences30(1), 82–83.

[4] Lowery CL, Hardman MP, Manning N, Clancy B, Whit Hall R, Anand KJS. (2007). Neurodevelopmental changes of fetal pain. In Seminars in perinatology, 31(5), 275–282.

[5] Merker B. (2007). Consciousness without a cerebral cortex, a challenge
for neuroscience and medicine. Target article with peer commentary and author’s response. Behavioral and Brain Sciences, 30, 63–134.

[6] Mellor DJ, Diesch TJ, Gunn AJ, Bennet L. (2005). The importance of ‘awareness’ for understanding fetal pain. Brain research reviews49(3), 455-471.

[7] Derbyshire SWG. (2012). Fetal analgesia: where are we now? Future Neurology7(4), 367-369.

[8] Derbyshire SWG. (2006). Controversy: Can fetuses feel pain? BMJ: British Medical Journal332(7546), 909.

[9] Szawarski Z. (1996). Do fetuses feel pain? Probably no pain in the absence of “self”. BMJ: British Medical Journal313(7060), 796–797. 

[10] Churchland PS. (2002). Brain-wise: V: Studies in Neurophilosophy. MIT press.

[11] van Rysewyk S. (2013). Pain is Mechanism. PhD Dissertation, University of Tasmania.

Pain experience and the self

Conscious pain is always personal. It is experienced from the view of oneself, and is not real or meaningful apart from this perspective.

All pains cluster around one’s personal aperture as around a single point or origin from which they are all perceived, irrespective of where in the body pain is felt. The sensation of a pain in a hand is sensed as located in the hand, but that pain sensation in the hand is not felt from the hand, but from about the same spatial location from which that hand is personally seen, even if pain is felt in complete darkness or in a dream. It is the ‘here’ with regard to which any pain is ‘there.’

It may intuitively feel that this single experiential point is located at the mid-point between the centers of rotation of the two eyes. Mach’s drawing above shows a monocular view of this point given in peripheral vision. In fact, the empirically determined location of the point is deeper inside the head, in the midsagittal plane, roughly 4–5 cm behind the bridge of the nose. Initially developed by Herring (1879/1942), this determination identifies the intersection of a few lines of sight obtained by fixating certain locations in the environment and aligning pins with them along each of the lines of sight or attention.

The self thus located is the origin of all lines of sight/attention and so cannot be any kind of self-representation (Merker, 2007, 2013). It defines the view point from which any and all representations of sensory experience are perceived, including personal pain. It is the point from which attention is directed and relative to which percepts are located in the space whose origin it defines (Merker, 2007, 2013).

To think that self must involve a kind of self-representation is to transfer sensory experience from the sensory state to one of its sub-domains (the self), which I think motivates viewing the self as a kind of cartesian homunculus. On this cartesian view, pain is interpreted in presence of the self. To my mind, it seems the other way round: the self in pain finds itself in the presence of pain (the ‘content’ of pain). The self of any conscious pain is not inherently conscious. Pain is intruder, not self. That is why pain is an aversion.

From this single experiential point we look out upon the world along straight and uninterrupted lines of sight. This orientation is dramatically reversed in the experience of pain. During pain, attentional focus is rapidly and involuntarily moved backwards along these same lines toward their most proximal origin. I believe this reverse direction helps to characterize the meaning of conscious pain as intrusion or threat to oneself.

References

Hering, E. (1879/1942). Spatial Sense and Movements of the Eye. Trans. C. A. Radde. Baltimore, MD: American Academy of Optometry (Original work published in 1879).

Mach, E. (1897). Contributions to the Analysis of the Sensations. La Salle, IL: Open Court.

Merker, B. (2007). Consciousness without a cerebral cortex, a challenge
for neuroscience and medicine. Target article with peer commentary and author’s response. Behavioral and Brain Sciences, 30, 63–134.

Merker, B. (2013). The efference cascade, consciousness, and its self: naturalizing the first person pivot of action control. Frontiers in Psychology, doi:10.3389/fpsyg.2013.00501.

whim-wham

No philosophy of mind is trouble-free.

Is sexual orientation a life choice? This is often asserted in connection with homosexuality, bisexuality and transsexuality, but never in connection with heterosexuality.

Can a child choose his or her own sexual orientation? For example, can a child decide to be transsexual? For that matter, did you choose your own sexual orientation? Of course not.

Understanding one’s own sexual orientation is not at all like choosing items to add to one’s own shopping list. You can’t shop for sexual orientation; you’re born into it.

Someone who comes ‘out of the closet’ to others is not choosing his or her sexuality, but declaring it.

If neuroscience identifies a brain signature of Beethoven’s Fifth Symphony, does the signature thereby replace Beethoven’s Fifth with a scientific explanation, as though Beethoven’s Fifth had never even existed? Of course not! The reduction explains the personal experience of listening to Beethoven’s Fifth by reducing it to the level of a brain activation pattern. It is not a denial of the existence of the particular experience. Now, is it possible for neuroscience to actually produce a neural signature of the Fifth? In the future – maybe.

whim-wham

Pain is part of the story of humankind.

Pain is affirmative of life, not destructive of it. Think of the scream of pain.

Pain is a vital molecule in a great, flowing river. Nothing moves in a stagnant pool, and you will not find pain there, only leering scum.

Pain is identical to brain activity. Pain is not one thing and brain activity another. It is one unitary movement. One pattern.

Whenever pain is separated from brain activity, a new philosophy results.

whim-wham

A scientific reduction does change reality, for it changes us. It changes our understanding of things.

But a scientific reduction doesn’t change a thing into something else. Nothing in reality must disappear, except ideas or ways of looking at reality that no longer mesh with established evidence and theory.

Neuroscience is contributing to the gathering wisdom of who and what we are.

Pain in the brain is like a melody in music

A flash of lightning produces a single sound. Pain in the brain is not like that. Neurons in the brain can excite or inhibit many other neurons, to which they are connected. Pain is not controlled by a single neuron.

A flash of lightning has no intended direction. But pain in the brain is not like that. The synaptic connections between neurons enable coordinated patterns of activation between millions of interconnected neurons. A type of pain is just a type of activation pattern.

Pain in the brain is not conducted like a symphony orchestra by a single individual. It is more like a free-jazz ensemble whose music is produced by loose and coordinated effort among the ensemble members.

‘Do you try to find the real artichoke by stripping it of its leaves?’ Wittgenstein once said. The same can be said of pain in the brain.

The brain is a causal mechanism to convey pain as a sensation. Pain also conveys to us itself. Pain in the brain is like a melody in music. When we feel a pain, the pain doesn’t convey something else that compounds with the activation patterns in the brain. We get the feeling of a pain because pain just is an activation pattern.

In the absence of a general theory of pain or brain function, metaphor and philosophy serve useful placeholder roles.

It is not obvious that experiences of pain are identical to brain activation patterns. In reply, it is not obvious that an ensemble of human beings could produce exciting jazz music, either.

whim-wham

If mind-brain identity theory is correct, it has great potential to unify our theories of human nature and the universe.

Still, it is not obvious that mental states are identical to brain states. It is difficult to believe that they are one and the same thing.

Reductionism in identity theory causes hard feelings in some philosophers because they feel pressured to abandon their wiggle room, the almost imperceptible space between mind and world where philosophical imagination roams free.

whim-wham

My apologies, but I think we should cease the bad habit of thinking that something is real just in case it can’t be proven that it can’t exist! Otherwise, anything you personally dream up but which other people can’t prove can’t exist, must therefore exist! Really, this a bad habit which deserves an honest boot into the abyss.

whim-wham

Pain is one of our great success stories. That we are still around to say so is itself proof of its enduring value.

The self is a unit, but is not unitary, since I may not know what others think of me, nor even facts about myself that I don’t currently know, such as my genome, or my immune profile.

The self is the sum of a creature physically, biologically, culturally, and personally. A developmental theory of self should be able to explain how these dimensions of self become integrated and functional, in normal cases across developmental time, and how, in abnormal cases, how they become disintegrated and dysfunctional.

‘The Libet experiment as a refutation of dualism’ by William Skaggs

William’s reasoning for the title of his excellent article – that dualism inspired by radical skepticism can mystify and confound experimental results – conveys a truth often neglected in a majority of philosophy of mind and consciousness; namely, skepticism is an organ of doubt, but please don’t forget what we already know. Doubt is useful in philosophy; but radical doubt is self-consuming.

whim-wham

I know, human beings are often despicable, but don’t on that account neglect the children.

Why do you fear truthfulness? Because it is so rare? Or do you fear its power to suddenly transform a conversation, to disrupt the social necessity of ‘conversational flow’? Do you fear mindfulness? Or, are you only mindful of imitating others?

Despite the best efforts of government, a deeply conservative society may resist any proposed change to traditional beliefs and values. I am thinking here of Saudi Arabia: fixed gender roles are so deeply embedded in traditional Saudi culture, that recent government-led efforts to modernize Saudi attitudes to women are actively resisted. And what else can the government do when the same cultural attitudes towards gender are mirrored in the institution of Islam itself?

The secret wish of every writer? whim.

A living human being: way and wayfarer.

Radical skepticism, doubt, and uncertainty

Skepticism is healthy, but don’t forget what we do know.

If you always focus on what we don’t know, you may already worship uncertainty.

Doubt is useful; radical doubt is self-consuming.

Radical doubt easily infects others. It is fairly easy to implement: simply find a gap in the scientific evidence on some topic, and use it to initiate a shadow of doubt in the minds of others. Radical doubt takes hold when a shadow of doubt becomes all-encompassing darkness.

Radical skepticism begets more radical skepticism.

Assertions of radical doubt:

“Since evolution could be false, God exists.”

“There is no scientific consensus on general brain function, so there must be a non-physical soul.”

“Neuroscience cannot ever explain consciousness because explaining consciousness is really really hard.”

“I cannot imagine how neuroscience could explain consciousness, so neuroscience cannot ever explain consciousness.”

“I think, therefore I am.” (cogito ergo sum)