The Myth of Pain opens with a series forward, in which the editors state that the aim of the series is both interdisciplinary and uncharted: to offer philosophical examination of mental disorder. Hardcastle provides plenty of empirical information about pain and supposed pain disorders; topics covered include the status of psychogenic pain, the structure of the pain system, self-injurious behavior, and the efficacy of pain treatments. The list of references alone runs to fifty pages, most of it empirical studies of one kind or another. Yet there is rather less in the way of philosophical examination of this material, and what there is is somewhat disappointing. It’s not that Hardcastle shies away from making philosophical pronouncements – she claims to defend an eliminativism about pain talk, together with a materialistic theory of pain and pain inhibition (p. 7) – but these claims aren’t backed up with the desired level of argument.

Why the myth of pain? Hardcastle endorses some form of eliminativism about pain. Unfortunately neither the nature of this eliminativism nor its grounds are particularly perspicuous. Take the nature of Hardcastle’s elimination. On the one hand, she claims that “our folk-theory of pain is woefully inadequate. We might play at revising this theory, but any change that remains faithful to what we know about pain processing is gong to entail that pain [actually: ‘pain’] no longer refers to a simple conscious percept. This sort of change crosses the line from mere revision to outright replacement” (p. 159). Yet Hardcastle remains quite happy to talk about pain and pain sensations. Eliminativism about Xs is normally taken to be the claim that there are no Xs, but Hardcastle seems to think that there are pains. Indeed, in her final chapter she argues that we should do more to treat the pain of children and infants. So the sense in which she is an eliminativist eludes me.

There is also room for confusion regarding the grounds that Hardcastle offers for elimination. Hardcastle claims that although our folk-theory of pain holds that pains are essentially simple sensations, science tells us that (1) “pain is actually a complicated sensory process, and [2] that pain sensations, one tiny component of the entire process, are complex as well.” (p. 193) Perhaps the truth of (1) would be problematic for the folk conception of pain, but I doubt that it is true. (2) is true, but I am not convinced that it creates unbearable problems for the folk-conception of pain. I take these two points in turn.

No doubt pain sensations are only one part of a complicated sensory system. Indeed, much of The Myth of Pain is devoted to exploring the structure of the pain system. Hardcastle argues that there are two pain systems: the pain sensory system (PSS), which functions much like other sensory systems, and the pain inhibiting system (PIS), which is largely top-down. (On p. 122 Hardcastle refers to a pain processing system (PPS), but this seems to be a slip.) All of this material is presented with a wealth of detail, and seems very plausible. But it is far from clear why we should think of pain as the whole process. Pains, many are inclined to say, simply are sensations of a certain kind. Of course, there is a complicated physiological story to be told about the formation and maintenance of these sensations, but the sensations themselves should not be confused with the process by means of which they are constructed. Consider a question that is often asked in philosophy of religion classes: Could God have made a world with creatures that can monitor and respond to bodily damage in the appropriate ways without feeling pain? This seems like a perfectly sensible question, but one is precluded from asking it if one identifies pain with the system that monitors bodily damage.

The second supposed folk-conception of pain that science has refuted is the singularity of pain sensations. Hardcastle seems to think that there are two senses in which pain sensations are complex: (A) pain sensations are essentially connected to non-sensational states; and (B) the sensations themselves are complex. I begin with (A). “Perception, interpretation, judgment and reaction are all tightly bound up with one another. . .Pain is a far cry from the simple sensory event that philosophers assume” (p. 108; cf. 163). Do philosophers really assume that pain sensations are not tightly bound up with perception, interpretation, judgment and reaction? Perhaps some do, but I doubt that this is the majority position. Functionalists, for instance, generally hold that in order for something to be a pain it has to have various relations with beliefs, desires and so on.

I turn now to (B). According to Hardcastle, science tells us that pain sensations themselves have different dimensions, whereas the folk notion of pain requires that a pain is “… a single simple sense datum”. (154) But Hardcastle does not characterize the folk-notion of pain sensations consistently, for she also says that “our commonsense views tie the different aspects of pain sensations into single complex percepts” (p. 151, my emphasis). The latter claim seems to me to be preferable to the former. Consider how researchers uncover the structure of pain sensations. One method that they use is the self-reports such as the McGill Pain Questionnaire (p. 150). This questionnaire records such dimensions as location, affective and somatic qualities, and intensity. In order for participants to be able to complete this questionnaire they have to have some grasp of these various dimensions. In other words, part of our reason for thinking that pain sensations have complex internal structure derives from our ordinary conception of them. Common-sense doesn’t regard the complexity of pain sensations as news.

But Hardcastle has a further point. “The four dimensions of our pain sensations should be kept distinct. They are not like the color and shape of an object or the pitch and loudness of a sound. Our perceptions of objects and sounds are comprised of complex units. We cannot see a shape without also seeing that shape as some color. . .In distinction, pain sensations function quite differently. We quite often get one aspect of pain without the others” (p. 151). This is an interesting argument, but more needs to be said. For one, there appear to be visual pathologies in which the various dimensions of visual percepts – color and shape, for instance – dissociate. Second, even if the dimensions of pain sensations can dissociate in unique ways, it’s not clear why we should say that there are no such things as pain sensations. Indeed, it is not clear what is wrong with saying – as Hardcastle herself does! – that “we quite often get one aspect of pain without the others” (p. 151). I was unconvinced by Hardcastle’s arguments for eliminativism about pain-talk, nor did I have a clear grasp of what exactly it amounts to.

Chapter 5 is perhaps the most philosophical chapter in the book, but it also has its shortcomings. Hardcastle presents a table of possible philosophical positions on pain, but she provides little elucidation of the categories that she includes. (There is also some sloppiness: Gillett appears in the table (p. 95) as an objectivist – with his name misspelled – but in the text (p. 103) he is classed as a subjectivist). Hardcastle takes the view that pain is purely subjective to mean that it is the result of top-down cortical processes (p. 129). Perhaps this is what the physiologists mean when they say that pain is subjective, but I doubt that it is what philosophers tend to mean. One of the things that might be meant by “subjectivism” is that pains are at least partly non-representational, that pain experiences cannot be false or erroneous in the way that beliefs can be. Hardcastle captures this nicely when she says that “… if pain is purely subjective, then there is no way for us to have an illusion of being in pain” (p. 128). But she goes on to say that for the subjectivist, “Phantom pains become just regular pains instead of some special case demanding special consideration and treatment” (p. 128). But this doesn’t follow. All the subjectivist is committed to is the claim that a phantom pain is as much a pain as any other pain – a claim that I imagine most people with phantom pains would endorse! The subjectivist can quite readily accept that phantom pains are special in that they have a special etiology: unlike normal pains, they don’t indicate bodily damage. Hardcastle quite rightly says that pain sensations are akin to visual sensations in that the sensations themselves are not the raison d’être of the pain system (p. 146), but it doesn’t follow from this that we should not use the term “pain” to refer to sensations of a certain type.

Those with an interest in the empirical study of pain will no doubt find much of interest in The Myth of Pain, but those of a more philosophical bent might be somewhat disappointed with the level of treatment that the conceptual issues receive.


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Categories: Philosophical

Tags: Neuroscience and Neuropsychology