## 1. The common-sense conception of pain



There are two main threads in the common-sense conception of pain that
pull in opposite directions. We might call this tension the
*act-object duality* (or *ambiguity*) embedded in our
ordinary concept of pain.


### 1.1 First thread: pain as something in a body part



The first thread treats pains as particulars spatially located in body
regions, or more generally, as particular conditions of body parts
that have spatiotemporal characteristics as well as features such as
intensity (among others). This thread manifests itself in common ways
of attributing pains to bodily locations, such as the following:



> 
> 
> (1) I have a sharp pain in the back of my right hand.
> (2) There is a throbbing pain in my left thigh.
> (3) My right shoulder hurts.
> (4) My wisdom tooth aches.
> 
> 



According to this thread, pains are like physical objects or specific
conditions of physical objects. We also commonly use the verbs
'feel' or 'experience' to describe our
epistemic relation to pains attributed to body parts:



> 
> 
> (5) I feel a sharp pain in the back of my right hand.
> (6) I am experiencing pain in my upper left thigh, etc.
> 
> 



(5) suggests that we stand in some sort of perceptual relation to a
spatiotemporal particular. Without an indefinite article, (6) suggests
that I perceive some quantifiable feature or condition of my thigh.
When we feel pains in bodily locations, our attention and nursing
behavior are directed toward those locations.



Less frequently, we also talk about the same pain returning or lasting
intermittently:



> 
> 
> (7) I have been having the *same pain* in my knee whenever
> I start jogging.
> (8) My headache *returned* the moment we started having the
> same argument again.
> 
> 



So according to this thread when we feel pain in parts of our bodies,
we perceive something or some condition in those parts.  When we
report them by uttering sentences like (1) through (8), we seem to
make *perceptual* reports. These reports seem on a par with
more straightforward perceptual reports such as:



> 
> 
> (9) I see a dark discoloration on the back of my right hand.
> (10) I see the red apple on the table.
> (11) I heard a big explosion.
> (12) I am smelling the sweet odor coming from the rose
> garden.
> (13) I feel the smooth texture of the surface, etc.
> 
> 



Compare, for instance, (5) and (9): they seem to have the same surface
grammar demanding a similar perceptual reading according to which I
stand in some sort of perceptual relation to something.



Thus, this thread in our ordinary conception favors an understanding
of pains as if they were the *objects* of our perceptions. When
this is combined with our standard practice of treating pains as
having spatiotemporal properties along with other similar features
typically attributed to physical objects or quantities, it points to
an understanding of pains according to which pains might plausibly be
identified with physical features or conditions of our body parts,
probably with some sort of (actual or impending) physical damage or
trauma to the tissue. Indeed, when we look at the ways in which we
talk about a pain, we seem to be attributing something bad to a bodily
location by reporting its somatosensory perception there, just as we
report the existence of a rotten apple on the table by reporting its
visual perception.



Nevertheless, the very same common sense, although it points in that
direction, resists *identifying* a pain with any *physical
feature* or condition instantiated in the body. Thus it also seems
to resist identifying *feeling* pain in body regions with
*perceiving* something physical in those regions.



A quick thought experiment should confirm this. Suppose that we do in
fact attribute a *physical* condition, call it *PC*,
when we attribute pain to body parts, and that *PC* is the
perceptual object of such experiences. So, for instance, John's
current excruciating experience (call this *E*) is caused by
and represents a physical condition in his right thigh and our
ordinary concept of pain applies in the first instance to this
condition in his thigh. From this it would follow that



> 
> 
> (a) John would *not* have any pain if he had *E*, but no
> *PC* in his thigh
>   
> 
> (as in the case of, for instance, phantom limb pains and centrally
> generated chronic pains such as sciatica),
> 
> 
> 



and, conversely,



> 
> 
> (b) John would have pain if he had *PC* but no *E*
>   
> 
> (as would be the case, for instance, if he had taken absolutely
> effective painkillers or his thigh had been anesthetized).
> 
> 
> 



But these statements are intuitively incorrect. They appear to clash
with our ordinary or dominant concept of pain, which seems to track
the feeling of pain (experience) rather than the physical condition.
This resistance to identifying pains with localizable physical
conditions comes from the second thread found in the very same
common-sense conception of pain.


### 1.2 Second thread: pain as subjective experience



That pain is a subjective experience seems to be a truism. Given our
common-sense understanding of pain, this seems to be the more dominant
thread: instead of treating pains as objects of perceptual experience,
it treats them as experiences themselves. Indeed it is this thread
that the official scientific definition of 'pain' picks up
and emphasizes, which was first formulated in  1979 by a
committee organized by the International Association for the Study of
Pain (IASP), and has been, since then, widely accepted by the
scientific community and
 clinicians:[1]



> 
> 
> **Pain**: An unpleasant sensory and emotional experience
> associated with actual or potential tissue damage, or described in
> terms of such damage.
> 
> 
> 
> *Note*: ... 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
> 2011 Web Edition, cf. IASP-Task-Force-On-Taxonomy 1994)
> 
> 
> 



Like other experiences as conscious episodes, pains are thought to be
private, subjective, self-intimating, and the source of incorrigible
knowledge. These elements can certainly be found in the IASP
characterization, which also adds that pain experiences are
unpleasant. Indeed, by emphasizing that pain is always a
"psychological state" the note warns against a conception
of pain suggested by the first thread above.



Interestingly, however, when we talk about pains as experiences, we
also, in the same breath, talk about *feeling* them as if these
experiences were also the object of some sort of inner perception,
which suggests introspection. Indeed the discussion of privacy,
subjectivity, self-intimation, and incorrigibility naturally forces us
to talk this way.  These are paradigm features that many have
thought mark the mental phenomena as such.
  





Pains are said to be *private* to their owners in the strong
sense that no one else can epistemically access one's pain in
the way one has access to one's own pain, namely by feeling it
and coming to know one is feeling it on that basis. This sharply
contrasts with the public nature of objects of standard perception,
that is, perception of one's immediate extramental environment
including one's body. Let's call this
*exteroception*, to contrast with *introspection* which
is access to one's intra-mental activity. So, for instance, the
very same apple I see on the table can be seen by others in possibly
the exact same way I see it, so is not private in this sense.



Pains also seem to be *subjective* in the sense that their
existence depends on feeling them. There is an air of paradox when
someone talks about unfelt pains. One is naturally tempted to say that
if a pain is not being felt by its owner then it does not exist. Again
compare the subjectivity of pains to the 'objectivity' of
the objects of standard exteroception. The apple I see does not depend
on my perceiving it in order to exist: (*pace* Berkeley and
phenomenalists) its existence is independent of my, or for that matter
anyone else's, seeing it.



Not only do people seem to have a special epistemic access to their
own pains, they also seem to have a very special epistemic
*authority* with respect to their pain: they seem to be
*incorrigible*, or even infallible, about their pains and pain
reports. Necessarily, if I sincerely believe that I am in pain, then I
am in pain. Conversely, if I feel pain, then I know that I am in pain.
This is the *self-intimating* aspect of pain experiences.



In short, there doesn't seem to be any room for a possible gap
between the appearance of pain and being in pain (that is, no
appearance/reality distinction is applicable to pain). As Kripke
famously put it:



> 
> 
> To be in the same epistemic situation that would obtain if one had a
> pain *is* to have a pain; to be in the same epistemic situation
> that would obtain in the absence of pain *is* not to have a
> pain.... Pain ... is not picked out by one of its accidental
> properties; rather it is picked out by its immediate phenomenological
> quality.... If any phenomenon is picked out in exactly the same
> way that we pick out pain, then that phenomenon *is* pain.
> (Kripke 1980, pp. 152-53)
> 
> 
> 



If there is no appearance/reality distinction applicable to pain, then
it seems that one cannot be mistaken about one's beliefs about
one's pain formed on the basis of feeling pain in the way one
can be mistaken about the existence and properties of the apple one
sees. In the latter case, appearances can be misleading precisely
because the perceptual appearance of an apple might not correspond to
what the apple is like in reality. In apparent contrast to pain,
normal exteroception always involves the possibility of misperception,
and thus miscategorization (that is, misapplication of concepts to the
objects of exteroception).  Even with a healthy dose of
skepticism about whether pain experiences (or, sensations in general)
always exhibit these features, it is clear that the strong and robust
(almost definitional) association of these features with pain
experiences suffice to make pains puzzling and problematic -- as
we will see shortly.
  




### 1.3 The tension between the two threads



Now that the two threads in our ordinary conception of pain are in
full view, we can better appreciate why they are in tension.
Experiences are in the head, if they are anywhere. Indeed, for most
physicalists, they are in the head by being realized in the brain or
in the central nervous system. So we can't be locating pains
*qua* experiences (or *qua* sensations, for that matter)
in body parts when we correctly utter sentences such as (1) through
(6) -- discounting headaches perhaps. But then what are we
locating when we seem to attribute pains to body parts? Recall that,
although the first thread in our common-sense conception treats pains
as spatiotemporally locatable particulars or particular conditions of
body parts, it does not identify pains with them -- it only
exerts pressure towards such an identification in the light of the
fact that there doesn't seem to be any other credible
alternative (but see below). We have already conducted a little
thought-experiment to bring this out in Section 1.1. Comparing the
following two sentences will help us understand the tension
better:



> 
> 
> (5) I feel a sharp pain in the back of my right hand.
>   
> 
> (9) I see a dark discoloration on the back of my right hand.
> 
> 
> 



It is reasonably clear that for (9) to be true, I have to stand in the
seeing (perceiving) relation to a dark discoloration on the back of my
right hand, i.e., to a certain surface region on the back of my hand
marked by a darker shade of the usual color of my skin, a certain
region that can be seen by others possibly in the same way in which I
see it. Note that if I am hallucinating a dark discoloration on the
back of my hand, then (9) is simply false. Also note that although the
truth of (9) doesn't require the possession of any concept by me
expressed by the words making up the sentence, my uttering of (9) to
*make a report* typically does -- if we take such
utterances as expressions of one's thoughts and take thoughts to
be composed of concepts. So my seeing would typically induce me to
conceptually identify something on the back of my hand *as* a
dark discoloration. This is a typical case of categorization of
something extramental under a concept induced by an exteroceptive
experience. Of course, my uttering of (9) does more than attribute a
physical property to a bodily region: it also reports that I am seeing
it.



What has to be the case for (5) to be true? Whatever the complete
analysis of sentences like (5) turns out to be, one thing seems
reasonably clear: the truth-conditions of (5) put no constraints
whatsoever on how things *physically* are with my hand. Anyone
who has a sufficient mastery of our ordinary concept of pain has no
difficulty in understanding how (5) could still be true even though
there is nothing physically wrong with my hand, which is typically the
case in centrally caused chronic pain
 syndromes.[2]



So we standardly use sentences like (5) to make correct statements
about a pain felt in a bodily location even when there may be nothing
wrong with that location. In other words, when we make claims about
where it hurts (attribute pain to bodily locations), strictly speaking
we in fact refrain from logically committing ourselves to there being
anything physically wrong in those locations -- even though we
normally expect to find some physical disorder in them. Compare this
to my uttering (9) on the basis of my having a very vivid visual
hallucination of a discoloration on the back of my hand. In such a
case, my utterance would be incorrect, because in uttering (9) I
commit myself to finding some physical condition (namely, a dark
discoloration) on the back of my hand. If and when I realize that I
have hallucinated, then I correct myself and revert to introspective
mode by saying things like "I seemed to see a discoloration on
the back of my hand" or "it appeared to me that there was
a discoloration," etc. Nothing of this sort happens when I
realize or am told that there is nothing physically wrong with my
hand: I still *correctly* continue to report the pain I feel
there by uttering the very same sentence, (5), or its equivalents. I
don't need to make any correction in my pain report. This shows
that despite the pressure exerted by the first thread, it is the
second thread that seems to capture the dominant common-sense
conception of pain -- as indeed the IASP definition above
indicates.



Still the puzzle remains: what is it that I am doing when I appear to
be attributing something to the back of my hand by correctly uttering
(5) -- if, as agreed, I am not attributing a mental experience or
a physical condition there? It is not clear whether there is a
common-sense answer to this question. Just as the scientific
definition doesn't touch on the issue of our common practice of
*correctly* locating pains in healthy body parts, the common
sense would probably draw a blank if the problem were articulated
explicitly and the question is pressed really hard.



Or maybe not. Intuitively and somewhat naively, what common sense
would drive us to say when pressed hard *might* be something
like the
 following.[3]
 Granted, by uttering (5) I am not attributing any sort of physical
thing or condition to the back of my hand, nor am I locating a mental
experience there -- experiences and sensations are strictly
speaking in the head if they are anywhere. But when I attend to my
hand with my mind's inner eye, so to speak, I clearly feel
something *there*. I can introspectively examine different
qualities of that thing such as its sharpness, volume, intensity,
unpleasantness, burning quality, etc. I can in real time follow the
changes in it: it is now somewhat less intense and unpleasant, now
more; it is getting duller now, it was sharper and brighter a moment
ago; it seems to be moving toward my fingers, etc. Clearly, I seem to
be confronted or acquainted with spatially located *something*
that I can introspectively examine carefully in real time and report
on its various qualities. It is this thing, the object of my inner
attention, which is located in the back of my hand, which seems
essentially private, subjective, and about which I can't be
wrong.



If this is what one might like to say intuitively and naively, one
should be prepared to swallow its strange consequences: this
*object* of my inner attention is both located in public space
and logically private, that is, only I can have epistemic access to it
despite its being spatiotemporally located. Also, the existence of
this object seems to literally depend on my epistemic access to it: it
seems to go out of existence when I cease to *feel* it
(perceive it). In addition, if it is the object *of* my
attention (separate from my attention), how could it be the case that
I cannot be wrong about it? And importantly, if this object is not
physical, what sort of thing could it be? A ghostly mental particular
that I can introspectively attend to which is nevertheless
spatiotemporally located beyond my head?



The act-object duality embedded in our ordinary concept of pain yields
strange results when followed intuitively and naively to its logical
end. But perhaps this duality is a robust symptom of a deeper truth
underlying all perception and introspection. Perhaps pain is simply
the most paradigmatic example of a broad range of perceptual
experiences where this deep underlying iceberg shows its tip most
prominently and revealingly -- albeit confusedly. Indeed this is
exactly the case according to so-called sense-datum theories.


## 2. Sense-datum theories


### 2.1 Introduction



Standard perception (exteroception) can be analyzed as involving the
perception (act) of a public object. The perceptual act on the part of
the perceiving subject, in turn, is analyzed as involving an
experience which typically induces conceptual categorization, i.e.,
application of concepts to the object of perception and its qualities
-- not to the experience. Thus perceptual experiences seem
transparent to the perceiver, who may be said to perceive the
extramental reality directly, without first perceiving or somehow
being aware of the experience itself or its qualities. This view is
supported by common sense and is typically called *naive or direct
realism*.



According to the *in*direct realists, this directness is an
illusion; we are in fact directly aware of experiential
intermediaries, and we perceive the extramental world only indirectly,
in virtue of being directly aware of these intermediaries. Most early
indirect realists (e.g., Moore 1903, 1939; Russell 1912; Price 1950)
thought of these intermediaries as phenomenal or mental particulars,
typically called
 sense-data.
 Consider a hallucination of a red apple. Intuitively, the person
having the hallucination seems to see something. This something is
not, of course, an apple. But it is an object, according to
sense-datum theorists, which is shaped like an apple and is really
red. It is a sense-datum, a phenomenal (mental) individual which
really has the qualities that it visually appears to have. Sense-data,
however, are no ordinary objects: they are private, subjective,
self-intimating, and the source of incorrigible knowledge. According
to sense-datum theorists, sense-data are internal to one's
consciousness: they are not before one's sense-organs. These
theories claim that there is a hidden act-object structure in the
perceptual awareness itself. Every perceptual awareness involves the
act of being aware of phenomenal objects and their qualities that
phenomenally determine this perceptual awareness, whether or not this
awareness is a hallucination or a veridical perception of external
objects.



On sense-datum theories, one perceives external objects and their
qualities indirectly by directly perceiving (being aware of, or
acquainted with) sense-data internal to one's consciousness that
resemble in various degrees the physical objects that cause them.
According to sense-datum theorists, however, we are rarely, if ever,
aware of this indirection in ordinary (veridical) exteroception. It is
only critical philosophical reflection on features of perceptual
awareness that reveals that the indirection must occur. The importance
of pain and other (intransitive) bodily sensations lies in the fact
that the indirection seems to be easily revealed introspectively as is
shown by our unwillingness to identify the pain we attribute to body
parts with anything physical in those parts.



Whatever advantages or disadvantages sense-datum theories might have
with respect to genuine perception (exteroception) and misperception
in general, its attraction seems undeniable when it comes to its
treatment of pains and other "intransitive" bodily
sensations like itches, tickles, tingles,
 etc.[4]
 According to many sense-datum theorists, pains are paradigm examples
of phenomenal individuals, mental objects with phenomenal qualities
whose existence depends on their being sensed or felt, and thus are
logically private to their owners who feel them. This position
presumably explains why we have the act-object duality or ambiguity in
pain talk that we discussed earlier: pains qua localizable objects
cannot exist without the corresponding acts, i.e., without
someone's acts of experiencing them (Broad
 1959).[5]
 In other words, the concept of pain plausibly applies to both the
*object* part of the act-object pair and to the *act* of
being directly aware of these objects.



The puzzle of locating pains in body parts can be treated in more than
one way within this framework. The most straightforward way is simply
to take the phenomena at face value and say that pains as mental
objects or sense-data are literally located where they seem to be
located in body parts or even in empty space where one's limb
would have been, say, before the amputation. That pains are mental
particulars and depend for their existence on being sensed apparently
does not logically preclude their being capable of having, literally,
a spatial location (see Jackson 1976, 1977 for this
 line).[6]



A second and more popular way of handling the location problem is to
say that even though pains cannot literally be located in
*physical* space, they can have location in a
*phenomenal* space or field that is somehow isomorphic or
systematically related to their counterparts (say, tissue damage) in
physical space. In fact, this move would also work for visual
sense-data that require some spatiotemporal framework. In the case of
bodily sensations, this phenomenal space is sometimes called
one's somatic field by analogy to a visual field that maps onto
physical space (Price
 1950).[7]


### 2.2 Problems for sense-datum theories



The most important strength of sense-datum theories is that they are
tailor-made for the peculiarities of pain experiences as well as other
intransitive bodily sensations that we have discussed above. Indeed,
these theories seem to take the naive, perhaps somewhat confused but
intuitive understanding of pain embedded in common sense and turn it
into a full-fledged philosophical theory supported on a general and
independent platform about what perception involves. In other words,
these theories seem to vindicate the act-object duality embedded in
common-sense conception of pain.



There is irony in this. The irony is that sense-datum theories find
their most natural home in intransitive bodily sensations like pain
that have been traditionally and historically *contrasted* with
standard exteroceptual experiences rather than *co-classified*
with them (for many, feeling pain is not a perceptual affair at all).
This is ironic for two reasons. First, the main proponents of
sense-datum theories advanced these theories mainly as theories of
exteroception, that is, perception of external physical reality.
Second, when applied to standard exteroception, sense-datum theories
don't seem to support the perceptual direct (naive) realism of
common sense at all. Indeed, according to common sense, when I see a
red apple on the table, I am directly seeing the apple (at least its
surface facing me) and its qualities like its redness. In short,
although sense-datum theories that are explicitly advanced as theories
of perception (exteroception) in general don't generate much
conviction, they seem to be more convincing when applied to
intransitive bodily sensations like pains that have *not* been
usually thought to be perceptual.



Despite the clash with common sense, various philosophers have
advanced powerful arguments *for* sense-datum theories about
what perception in general involves (Moore 1903, 1939; Russell 1912;
Price 1950; Broad 1959; Jackson 1977, among others). There are also
powerful arguments *against* sense-datum theories. Both sorts
of arguments tend to be general arguments not directly related to
pain, so we won't cover them here (but see the entry on
 sense-data).
 Whatever the fate of sense-datum theories might be as general
theories of exteroception, their appeal as a model for understanding
pains and other intransitive bodily sensations is very strong. Indeed,
as noted before, introspection seems to be the right mode of access
involved in pain. So even if one finds the anti-sense-datum arguments
convincing and rejects indirect realism of this kind for standard
exteroception, there may still be room for adopting a sense-datum
theory for intransitive bodily sensations and for pain in
particular.



Nevertheless, it is plausible to argue that this apparent strength of
sense-datum theories of pain is also one of their main weaknesses, in
that their function seems to merely codify the conceptual
peculiarities of pain into a theory rather than explain them. After we
are told how the sense-datum theories treat pains and other bodily
sensations, our understanding of these sensations don't seem to
be deepened or advanced significantly. Whatever puzzles we had at the
start with only the common-sense conception of pain at hand, they seem
to be transformed into puzzles about what the theories themselves say
or imply.



For instance, the question about what it is that we seem to attribute
to or locate in our body parts when we claim to have pains in just
those parts is answered, on one version of the theory, by saying that
we literally locate mental objects with phenomenal qualities in those
parts. But pains, even by the standards of sense-datum theories, are
mind-dependent objects, and many have taken this to imply that pains
are *internal* to one's consciousness or experience, and
are epistemically transparent to their owners partly because of this
(Perkins 1983,
 2006).[8]
 If they were literally in physical space, does this mean that
one's mind spatially extends or overlaps with one's body?
Alternatively, shouldn't it be possible for others, at least in
principle, to "come across" these pains, that is, access
and interact with them physically? It is one thing to say that there
is no logical inconsistency about pains literally being in physical
space, but it is another to make the view plausible. The latter
requires giving positive arguments showing why our intuitions to the
contrary might mislead us here.



On the other version of the theory, we are told that even though we
seem to locate something in public space, appearances are misleading;
rather, we are locating private mental objects in a private phenomenal
space, which is conceived to be a kind of space, not merely a
representation of real space.  So, on this version, pains are
not, after all, located in body parts, ordinarily understood. But it
is not clear how these two spaces are supposed to relate to or
interact with each other. Phenomenal space is not physical space, nor
is it a subregion of that space. Thus the question of how they can
*causally* interact becomes an issue for two reasons. First,
there is the standard worry about how a physical event can influence
or be influenced by a non-physical event in a non-physical space.
Second, these two spaces need to be systematically correlated with
each other, but it is not clear whether a principled mapping function
can be defined for the correlation especially in the absence of
causation. At any rate, these constitute significant challenges for
the defenders of this view.



Apart from their strange consequences, sense-datum theories seem to
commit their defenders to anti-physicalism. A naturalist who is trying
to understand pain phenomena within a physicalist framework could
hardly admit the existence of phenomenal objects (Lycan 1987a, 1987b).
If there are sense-data, physicalism seems just false. A physicalist
cannot admit actual objects, which are, say, literally colored,
shaped, moving and so on, that one is directly aware of but are not
identical to the extramental objects of perception. So understood,
there seem to be no sense-data to be found in the physical world.


## 3. Perceptual theories



Because sense-datum theories are most plausible when applied to
intransitive bodily sensations, many philosophers, who believe that a
naturalist account of ordinary perception can be given without
introducing sense-data, have attempted to understand pains and other
bodily sensations as species of ordinary perception (exteroception).
The so-called perceptual theories of pain are advanced and defended on
the hope that pains and other intransitive bodily sensations, contrary
to first appearances, are species of information gathering which work
on the same principles that govern other sensory modalities for which
a successful direct realist account can be given.


### 3.1 Introduction



The core commitment of any perceptual view of pain, put as broadly as
possible, is that normally, in having or feeling pain, one is
perceiving something *extramental*. In other words, feeling
pain normally *involves* perceiving something in the same sense
in which one perceives a red apple when one sees it in good light. It
involves exteroception. Sometimes, in ordinary parlance, the term
'perception' is used in conjunction with
'pain' as in 'pain perception' to mean
awareness of pain, or just feeling/experiencing pain. This is the
*introspective* use of 'perception' and should be
sharply distinguished from what the perceptual theorists mean when
they claim that feeling pain involves perceiving something. They have
exteroception in mind, and we'll use the term always in this
sense.



According to perceptual theorists, when one feels, say, a sharp pain
in the back of one's hand, one perceives some physical feature
or condition of one's hand. The proper modality for this
perception is somatosensory, similar to the sensory modality of touch
or proprioception (the sensory modality internal to one's body
that informs one about the position and movement of one's body
and body parts). Most perceptual theorists identify this feature with
tissue damage or some condition of the tissue that would likely result
in damage if sustained in that condition. More abstractly, it is some
sort of physical disorder due to some tissue trauma, irritation,
inflammation, or some such pathological condition, or a condition
close to such. It is also possible to identify the object of
perception in pain with the activation of nociceptors innervating the
damaged or irritated tissue. (Nociceptors are peripheral nerve endings
relatively specialized to respond to potentially damaging stimuli,
i.e., to noxious stimuli). Let's use 'tissue damage'
as a stand-in for whatever physical disorderly condition of bodily
tissue is said to be perceived in feeling pain according to perceptual
theorists. Normally, when we talk about the location of a pain, we are
talking about the location of this perceptual object, i.e., the
location where the tissue damage is occurring or about to occur.



Perceptual theories of pain as alternatives to sense-datum theories
were first explicitly stated and philosophically developed in the
1960s. The most influential and prominent defenders were Armstrong
(1962; 1968) and Pitcher (1970; 1971). There were others, but in terms
of setting the tone and philosophical agenda for the subsequent
discussion for decades to come, it is fair to say that no one has
surpassed their enormous
 influence.[9]
 At the time, the dominant view was that pains and other intransitive
bodily sensations are not perceptual at all: they were conceived to be
sensations or experiences (a la sense-datum theories) that are
reliably caused by (actual or impending) injury or damage to body
tissue or internal organs. They were thus thought to be useful warning
signals, but they didn't have much in common with standard ways
of perceiving extramental world. This view has still many defenders
today. Although the conception of pains as sense-data has been largely
abandoned, those who are not sympathetic to perceptual theories still
hold what might be called the "sensation or qualia view of
pain", according to which pain is not a phenomenal
*object* but a phenomenal *quality* of one's
experience, or alternatively, it is a subjective experience with
certain qualia or qualitative character that one is directly
acquainted with when one is in pain. (Conee 1984 defends a qualia view
of pain. But he draws a distinction between the state of being in pain
and this state's qualitative content, qualia. He claims that we
use 'pain' for both, depending on the context. Aydede 2019
develops a modern version of qualia theories that is adverbialist and
weak representationalist with completely physicalist credentials and
claimed to be free of the problems that plagued the older qualia
theories.)


### 3.2 The appearance/reality problem



The main source of resistance to a perceptual view of pain comes from
the common-sense conception of pain according to which pains are
sensations with essential privacy, subjectivity, self-intimation, and
incorrigibility. These apparently essential features of pains pose
difficulties for any perceptual theory. Indeed, they can be used in
advancing anti-perceptualist arguments whose general form can be put
in the following way. Genuine perception always involves the
possibility of misperceiving the perceptual object that is not
essentially private and subjective. In other words, there is always an
appearance/reality distinction applicable to the objects of genuine
perception which gives rise to the possibility that the perceptual
appearance of this object misleads us about what the object is like in
reality. The main reason for this is that these objects have a reality
beyond their appearances. They are thus public objects and capable of
existing on their own without anyone's perception of them. But
feeling pain has none of these features. Therefore, it cannot be
genuine perception.



So, how do the perceptual theorists handle this objection, which lies
behind the intuitive resistance to treating pain as a form of
perception? Given the core commitment of perceptual views (namely,
that feeling pain involves perceiving something extramental), one
might think that perceptual theorists identify pain with tissue
damage. Indeed, if one takes this view, the above objection seems
almost decisive against it. But relatively few defenders actually take
this route -- among the most notable are Newton (1989), Stephens
and Graham (1987), and Hill (2004, 2006). Most others, including
Armstrong and Pitcher, bowed to common-sense understanding of pain and
identified pains with pain experiences or sensations, understood in a
direct realist fashion. If pains are identified with experiences, not
with their causes (i.e., tissue damage), then the above objection
seems to disappear (but see below).



It is primarily for this reason that most perceptual theorists
identify feeling pain with having an experience in the first place
-- just as the pain scientists and clinicians do (see IASP
definition above) following the second thread in our ordinary
conception of pain. But this is the experience mediating or involved
in the *perception* of tissue damage. In other words, they
grant that the (dominant) concept of pain is the concept of a
subjective experience, but they insist that this experience is
essentially perceptual: it constitutes our perception of tissue
damage. Compare the situation with seeing. In seeing a red apple in
good light, I am having a visual experience which is perceptual: it
constitutes my seeing the red apple. The difference lies not in the
flow of information, but in the locus of our spontaneous interest and
conceptual identification directly induced by the perceptual
experience. According to most perceptual theorists, we apply the
concept of pain, PAIN, primarily to the perceptual experience we are
having, not to the object of this experience, i.e., tissue damage
(even though, as discussed above, common sense also uses confusingly
the same word 'pain' to indicate where the tissue damage
might be occurring by applying it to a bodily location -- more on
this
 shortly).[10
 In other words, 'pain' names a subjective experience. In
vision, however, the locus of conceptual identification is different:
normally it is the object of our visual experience we are interested
in, say, a red apple seen in good light and identified as such. Thus,
we both perceptually and conceptually focus on it and its visible
properties such as its redness, roundness, etc., by applying our
concepts, RED, ROUND, APPLE, to it on the basis of our visual
experience. Of course, we are sometimes interested in and can focus
and report on our visual experiences too, but this happens usually
when we are not sure about what we are seeing.



There is thus an asymmetry in our spontaneous reaction to incoming
stimuli in seeing and having pain; that is, our spontaneous interest
and focus directly resulting from the perceptual experiences is
different in each case. We can represent this asymmetry with a
schematic (**Figure 1**).



> 
> ![Figure 1](asymmetry.png)
>   
> 
> **Figure 1:** There is asymmetry in concept application
> even when it is assumed that the structure of information flow may be
> symmetrical in the contrast cases.
> 



Thus the incorrigibility mentioned before reduces to one's
incorrigibility about one's occurrent experiences. To the extent
to which we are incorrigible in discriminating and conceptually
identifying our own experiences, to that extent we cannot be wrong
about our own pains. Hence the locus of concept application is the
pain experiences, even though it might seem to us as if we were
applying the concept of pain to bodily locations (see below). It
follows that hallucinations or illusions are possible, in one sense,
not about feeling/experiencing pain, but about whether these
experiences' correctly represent some tissue damage, that is,
the object of perception in feeling pain.



The privacy and subjectivity of pains are explained similarly. If
pains are experiences, they cannot exist without being the state of
someone's mind. In other words, they exist insofar as one has
them: they are mental states or processes, hence essentially
mind-dependent. The privacy of pains again reduces to the privacy of
experiences. There may be philosophical problems about how privacy,
subjectivity and incorrigibility are possible in a completely physical
world, but if there are such problems, they are general problems about
having perceptual experience of any kind, not necessarily pertaining
to pains and other intransitive bodily sensations.


### 3.3 The problem of pain location



The perceptualist identification of pains with experiences is not in
the clear yet: the perceptual theorist has to give an account of the
common practice of attributing pains to bodily locations. For if pains
are perceptual experiences they can't be intelligibly (let alone
correctly) located in body parts (except perhaps in the head).



The most common perceptualist treatment of this problem concedes that
there is no way to analyze sentences attributing pain to body parts,
like (1)-(6), which would do complete justice to all aspects of
our common-sense conception of pain. Nevertheless, the resulting
account, it is claimed, comes pretty close. According to the basic
proposal, when I utter a sentence like



> 
> 
> (5) I feel a sharp pain in the back of my right hand,
> 
> 
> 



I primarily self-attribute a certain kind of experience which has an
intentional content (Armstrong 1962, 1968, pp. 314-316; and
Pitcher 1970, pp. 383-385, 1971 -- see also Dretske 1999,
2006; Tye 1997, 2006a). To say that an experience has an intentional
content is to say that it represents a certain situation or state of
affairs (which may be quite complex), or to say that it has an
intentional content with a non-indicative function like issuing a
command (imperative content -- see below). So for instance, when
I see a red apple on the table, I am having a visual experience which
represents, among other things, a red apple on the table. Some
perceptualists might describe the proper intentional or
representational content of experiences in less objectual terms by not
naming what is represented in terms of ordinary objects like apples
and tables. For these theorists, it is more appropriate to
characterize the representational content of perceptual experiences in
terms of the ways in which the sensible qualities of those objects are
instantiated or distributed in one's perceptual field.
Experiences detect or track these qualities. For instance, they may
say that my visual experience represents the instantiation of redness
with the instantiation of a certain (apple-like) shape quality, etc.
But both ways of characterizing this content are meant to be objective
in the sense that they represent extramental reality (at least, partly
-- it all depends on how one conceives of so-called secondary
qualities). Treating perceptual experiences as having intentional
content is appropriate and in line with the naturalistic motivation
behind developing perceptual accounts in general, for this is how they
serve their primary function of informing their owners about their
immediate extramental environment, including bodily environment.



So the proposal is that, just like other perceptual experiences, pain
experiences also represent. They represent tissue damage as occurring
in a certain region of one's body. The location of pain, then,
is the location of tissue damage as represented by pain experiences.
The location is an intentional location. So (5) should be analyzed as
self-attributing an experience which represents a certain kind of
tissue damage occurring in the back of my hand. In other words, even
though the surface structure of sentences (5) suggests that there is
an attribution of pain to a bodily location (more strictly, that I
stand in the feeling relation to a pain which is located in a part of
my body), the proposed analysis says that this is *not* what is
going on. What I do when I utter (5) is an attribution of a different
sort: I attribute to *myself* a *feeling state* (an
experience) which has an intentional content to the effect that a
certain region of my body is in a physical condition of a certain
sort.



On this view, there is thus a confusion in common-sense ways of
talking, due to the fact that the pain is not in my hand; the pain,
being a state of feeling or experience, is "in my mind."
It is the physical disturbance that is in my hand which my feeling
state represents (in a confused and indistinct way, as Descartes would
put it). Upon reflection, however, we may realize that in uttering (5)
I actually attribute an intentional feeling *state* to
*myself* which in turn attributes a physical disturbance to my
hand. The colloquial ways of speaking just jumble the pain with the
disturbance, and thus confuse and mislead us. Pains, on this view, are
experiences, not objects of our experiences. Moreover, since these
experiences have representational content, they have accuracy
conditions: they can be correct or incorrect; they can veridically
represent or misrepresent. But even when they misrepresent, these
experiences are pain experiences. So I can be in genuine pain, even
though there is nothing physically wrong with my hand.



Note that according to this analysis, there are, in a sense, two kinds
of property attribution going on: an attribution of an experience and
an attribution of tissue damage to a body part. But in uttering (5)
*I* do only the former attribution, not the latter. The latter
attribution is done not by me but by my experience, so to speak, by
representing it as happening in my hand. This is why *I* am not
logically committed to *finding* tissue damage in my hand in
truly uttering (5) -- even though this is what I normally
*expect* to find there. Indeed, as observed in the first
section, if it turns out that there is nothing physically wrong with
my hand, *I* am not wrong. (5) is still true. But my experience
is now wrong: it misrepresents the back of my hand as having something
physically wrong with it, as if some tissue damage were occurring
there. I am having an illusion about my hand but I am still in genuine
pain. Illusory or hallucinatory pain experiences are still genuine
pains.



Armstrong's and Pitcher's perceptual accounts of pain
location have been very influential. Treating pain location as the
intentional location of tissue damage as represented in the pain
experience, in one form or another, seems to dominate the thinking in
this area. Nevertheless, there is a sizable philosophical literature
on the problem of pain location or the spatiality of pain in
 general.[11



### 3.4 Direct and indirect perceptual theories



The perceptual view of pain as presented so far is a view even an
indirect realist can subscribe to, although, as a matter of historical
fact, very few indirect realists have done so (Perkins 1983, 2006;
Maund 2003, 2006). A sense-datum theorist is someone who thinks that
all perception of extramental reality is indirect, mediated by a
direct perception of sense-data that stand in certain systematic
relations to extramental objects in the world in virtue of which
sense-data contingently come to represent them. So it is entirely
possible, in fact reasonable, to hold that pain sense-data are also
representational. In other worlds, direct awareness of pain sense-data
could constitute the indirect perception of tissue damage in bodily
regions which typically and systematically cause these sense-data.



The reason why this line was not pursued by indirect realists has
probably something to do with the intuitive resistance against any
perceptual view of pain already embedded in our ordinary conception
that we discussed
 above.[12]
 Indirect realists like sense-datum theorists, as we have already
seen, have the theoretical resources to accommodate the intuitive
understanding of pain without forcing it into a perceptualist mold.
Without any qualms, they can say that we are directly and immediately
aware of pain *qua* a mental object or quality, whether or not
this represents or signals tissue damage. This is to say that they
already have a locus of concept application in their theory for the
concept of pain: PAIN directly applies to the experience or to its
*internal* direct object, i.e., to either a sense-datum or to
its direct awareness. This seems to accommodate all the intuitions
embedded in common sense; why go further? Furthermore, if one is not a
perceptualist, one doesn't have an obligation to deal with what
we'll call below the *problem of focus*, the problem of
explaining why there is an asymmetry in conceptual focus between pain
and standard exteroception if both are genuinely perceptual.



In practice, however, almost all defenders of perceptual view of pains
are direct realists. If one wants to run a direct realist version of
the perceptual theory, however, one immediately runs into the
difficulty of finding an appropriate locus for direct perceptual
awareness, and for that matter, a locus for immediate concept
application; that is, one runs into the difficulty of finding an
object, state, or event to which we spontaneously apply PAIN, ITCH,
TICKLE, etc., when we are introspectively aware of our pains, itches,
tickles, etc., and report them on this basis. This difficulty arises
because the mark of any (early) direct realism in the theory of
perception is the repudiation of consciously available perceptual
intermediaries that mediate standard exteroception: when I see a red
apple on the table, there is no object or quality distinct from the
apple and its redness such that I see the apple in virtue of seeing
*it* (or more generally, in virtue of directly perceiving or
being aware of *it*). On the direct realist view, when I see an
apple, I directly perceive, or am directly acquainted with, the apple
and its qualities such as its redness. This view works well in
veridical perception: the locus of concept application is always the
public object of perception, like the apple and its properties. It
also explains why the spontaneous concept application is the way it is
even when one hallucinates or has illusions. Even when one
hallucinates a red apple, one is naturally disposed to apply the
concept RED APPLE to what one either takes or is tempted to take to be
the public object of one's epistemic efforts and its publicly
available features, and rarely, if ever, to what one believes to be a
private mental object or quality.



But how is the repudiation of consciously available perceptual
intermediaries to be reconciled with the admission that the concept of
pain is the concept of a subjective sensation/experience of a certain
sort? Recall that most perceptual theorists admit that introspective
reports of pain in body regions are reports of *experiences*
that represent physical disorder of some sort in those regions. This
is just to say that when one is in pain one is directly aware of a
sensation or experience, i.e., pain. This in turn means that the
concepts we are spontaneously prompted to apply in having pains and
other intransitive bodily sensations directly apply to the prompting
sensations/experiences in the first place -- appearances to the
contrary. So how to understand the direct realist's talk of
conscious sensations or experiences?


### 3.5 Adverbialist perceptual theories



Direct realists reject the act-object analysis of perceptual
experiences advanced by sense-datum theorists and other indirect
realists. According to most early direct realists (e.g., Ducasse 1952,
Sellars 1975), even when visually hallucinating a red apple on the
table, one does not directly see a private mental particular or a
constellation of mental qualities; rather one is having a visual
experience that is like an experience which is normally brought about
when one actually sees a real red apple on the table. Direct realists,
in other words, typically insist that such cases should *not*
be analyzed in terms of a perceiver standing in a certain perceptual
relation to a private mental object or quality. Rather the analysis
involves only one particular, the perceiver herself, and her being in
certain sorts of (perceptual, experiential) states or conditions that
are typically brought about under certain circumstances in which one
genuinely perceives something. In standard cases, when one is having a
veridical perception, the experiential state of the perceiver is
brought about by the actual object of her perception, and the
perceiver's state is qualitatively differentiated by the causal
influences of the sensible properties of the public object. In
nonstandard cases like in hallucinations and illusions,
phenomenologically the same kinds of states are brought about by
different causal routes, and the qualitative differentiation of
one's experiential state in such non-veridical cases is the
result of deviant causal influences. (Pitcher 1970, p. 384)



This sort of analysis of experiences is sometimes known as
adverbialism in the literature because in perceiving a red object one
is said to be in a state of perceiving something "red-ly."
The theoretical import of this way of talking is that perceiving
something that is red is a *manner* of perceiving that object
that would be distinct from the manner of perceiving it if the object
were blue, in which case one would be perceiving it
"blue-ly." Similarly when one hallucinates a red object,
there is only one object, the perceiver who is sensing in a certain
manner, namely, red-ly. In other words, 'red' is said to
qualify not a private object but rather a state or activity of a
person, that state being a manner of perceiving or sensing physical
objects that are
 red.[13]
 For our purposes, keeping up with the general naturalistic motivation
behind developing direct realist views, we can take adverbialism as an
attempt to get rid of mysterious mental objects or qualities in favor
of metaphysically less costly states or activities of persons or
manners of perceiving that qualify persons qua subjects of experience.
So a pain experience, for a direct realist, is a specific manner in
which tissue damage is (somatosensorially) perceived in a bodily
region. When we report pain, we report the occurrence of experiences
understood this way -- adverbially.



Adverbialism of this sort can be effectively combined with
intentionalism or representationalism about experience (for more on
the connection between adverbialism and representationalism, see Kraut
1982, and Lycan 1987a, 1987b). An adverbialist has to somehow
characterize these ways or manners of sensing/perceiving for
distinguishing between them, and a natural way to do that is by
appealing to the standard or canonical conditions under which those
perceptual events are brought about (recall how direct realists want
to handle a visual hallucination: one is having a visual experience
that is like an experience which is normally brought about when one
actually sees a real red apple on the table). Thus it may be
reasonable to argue that those canonical conditions are what the
specific perceptual events or activities of the persons
*represent*. For instance, it is plausible to claim that a
specific perceptual activity constitutes the perception of red (= the
perceptual event representing the instantiation of red) because it is
the kind of psychological event regularly (canonically) caused by red
surfaces -- indeed one might expect that the psychophysics of
sensory modalities would detail these canonical or standard conditions
in objective terms. Although this maneuver is open to direct realists,
it is optional. When one takes this option the result is pretty much a
strong form of representationalism -- for which see next
section.



There are various technical difficulties with adverbialism, especially
when dealing with phenomenologically complex overall experiences such
as having three pains of different qualitative character
simultaneously occurring in three different locations in one's
body. It is not clear whether adverbialist approaches can successfully
tie the appropriate manners corresponding to different qualities with
the right pains or tissue damage on different locations. (See Jackson
1975, 1977 for a detailed criticism of this sort; Tye 1996a, pp.
74-77, contains a useful summary.) Furthermore, even when one
might successfully get rid of mysterious mental objects like
sense-data with this adverbialist move, it is not clear whether
adverbialism might still lead to a form of property dualism according
to which one is directly aware of certain (non-physical)
phenomenological qualities instantiated by experiences realized by
brain states. These qualities seem to be required to explain how the
manners of different perceptual activities of a perceiver can be
differentiated. 



There are other sources of resistance to direct perceptual theories of
pain and other intransitive bodily sensations. Some objections stem
from considerations about whether direct perceptual theories can give
adequate accounts of perception in general, so are not specific to
their treatment of pain. One of the most frequently discussed worries
about direct perceptual theories in general is whether they can do
justice to the internalist intuition that perceptual experience is
phenomenally rich and peculiar in a way that cannot be pushed back to
the extramental world. In the case of early direct realists like
Armstrong and Pitcher, this worry is even more pressing since they
were cognitivist about perceptual experience in general; that is, they
attempted to explain perception in terms of belief acquisition (or, in
terms of acquisition of belief-like cognitive states). But beliefs
don't seem to have the right kind of phenomenology associated
with perceptual experiences and bodily sensations (see Everitt 1988
and Grahek 1991 for this kind of criticism). As pointed out earlier,
early direct realists played down the importance of experiential
phenomenology and sometimes even denied its existence fearing that
acknowledging it will lead to the introduction of sense-data or
"irreducibly psychic"
 qualia.[14]
 But this concern about qualia or phenomenology in general drove many
away from the early direct perceptual theories (especially those who
were not much worried about skepticism and epistemology in general)
with the conviction that these theories are not adequate after all for
capturing the rich and robust phenomenology of perceptual
experiences.


## 4. Representationalist theories



Confronted with such difficulties and many others, it is tempting to
adopt a strong form of representationalism that openly admits the
existence of phenomenologically rich experiences, while preserving the
basic intuition and naturalistic motivation behind direct realism.
Indeed, many have yielded to this temptation.


### 4.1 Introduction



Representationalism about pain is the view that the entire
phenomenology of a pain experience is strictly identical to its
representational or intentional content. In other words, the
phenomenal and representational contents of pain are one and the same
thing, thus they cannot come apart. Among the defenders of pain
representationalism understood this way are Harman (1990), Dretske
(1995, 1999, 2003), Tye (1996, 1997, 2006a, 2006b), Byrne (2001),
Seager (2002), Bain (2003, 2007, 2013, 2017), and Cutter & Tye
(2011), Cutter
 (2017).[15]



Most early direct realist accounts of perception, as mentioned before,
were shy about acknowledging a robust phenomenology for experiences.
This was primarily because experiential phenomenology was associated
with indirect realism and sense-data theories in particular. Many
early direct realists embraced adverbialism because adverbialism
promised a way of being *realist* about experiences while
avoiding an act-object view of them. Because most direct realists
identified pains with sensory experiences rather than their objects,
the direct perceptual theorists about pain needed a robust (realist)
notion of experience. Adverbialism gave way to a strong form of
representationalism by suggesting ways in which intentional content
could be naturalized on the basis of those canonical conditions that
causally/lawfully control the occurrence of perceptual experiences in
virtue of which they represent those bodily conditions. This opened up
the possibility of defending direct realism about a robust
experiential phenomenology with completely naturalistic credentials.
The result was strong representationalism about all experiential
phenomenology, according to which the entire phenomenal (qualitative)
character or qualities of any experience is metaphysically constituted
without remainder by its (wide) representational content (=phenomenal
content)



Hence, representationalism about experience in this context needs to
be understood in a reductionist sense. As we have seen, indirect
realist theories, especially in the form of sense-datum theories, were
also advanced as representational theories (perhaps excluding the
intransitive bodily sensations). Indeed, the old name for indirect
realism was "representative realism." On these theories,
in having a perceptual experience we are directly acquainted with
qualia, understood either as intrinsic qualities of experiences or as
properties of phenomenal individuals like sense-data. But, at least in
standard exteroception, these qualities *contingently*
represent objective sensible properties of public objects in virtue of
either resembling them or by being regularly caused by their
instantiations -- or both. In other words, on an indirect realist
approach, they are distinct existences: qualia or sense-data *come
to* represent public objects and their sensible properties in
virtue of some *contingent* relations holding between them
(resemblance or causation).



However, in her acknowledgment of phenomenology, the reductionist
direct realist cannot have such phenomenal objects somehow internal to
one's mind or experience, nor can she endorse the existence of
qualities *intrinsic* to experiences that we can become
directly aware of in introspection -- the basic direct
perceptualist intuition, recall, is that our experiences are
transparent to us in that they present us the world directly and
immediately (this external relation is primary). So if qualia are to
be retained in one's direct realist picture of perception, these
qualia need to be reduced to representational content of perceptual
states. We will sometimes use 'strong representationalism'
to distinguish this view from "representative realism"
(see Block 2006 -- Block uses 'representationism' to
mark the same distinction).



Like earlier direct realists, strong representationalists tend to be
naturalists or physicalists. Therefore these theories usually come
with a naturalist account of how these states (thought of as realized
in the central nervous system) acquire their representational content.
The most common account is either an ideal causal co-variation theory
(informational semantics -- see Dretske 1981, Fodor 1987, Aydede
and Guzeldere 2005) or a teleological psychosemantics (see
Millikan 1984, Papineau 1987) or both (Dretske 1988, 1995; Tye 1996a).
These are externalist
 theories.[16]



To recap, strong representationalism is the modern day's direct
realism about perception, where adverbialism is replaced by
representationalism run on a naturalistic story about how perceptual
experiences acquire their (analog) representational content that in
turn constitutes their phenomenology. So, according to strong
representationalism, pain experiences feel the way they do in virtue
of their representational content, and nothing else. They represent
various disorderly conditions of bodily tissue. The way they represent
these conditions is analogous to the way our visual system represents
colors. If colors are (at least, partly) objective features of
surfaces like their surface spectral reflectances, our visual
experiences don't represent colors as such, so we cannot come to
conceptualize colors as spectral reflectances on the basis of their
"grainless" visual presentations. So it is no objection to
representationalism that our pain experiences don't represent
tissue damage as such, which is to say that we cannot necessarily
conceptualize what pain experiences represent as tissue damage solely
on the basis of these experiences.



It is sometimes said that perceptual experiences represent what they
do *nonconceptually*, which is often times equated with
*analog* content (realized in picture-like continuous
representations). In this context we can take this as a claim about
the way experiences are representationally structured: they are not
structured out of concepts (discrete representations) as thoughts are
usually thought to be. Every sensory modality has a range of
proprietary qualities that they can detect. Pain experiences seem no
different, although they may be less rich in terms of their
informational content compared to vision for instance. Nevertheless,
it is reasonable to argue that qualitative differences in pain
experiences are due to their representing different bodily conditions.
Tye lists a number of candidates:



> 
> ... a twinge of pain represents a mild, brief case of damage. A
> throbbing pain represents a rapidly pulsing disorder. Aches represent
> regions of damage inside the body rather than on the surface. These
> regions are represented as having volume, as gradually beginning and
> ending, as increasing in severity, as slowly fading away. The volumes
> so represented are not represented as precise or sharply bounded. This
> is why aches are not felt to have precise locations, unlike pricking
> pains, for example. A stabbing pain is one that represents sudden
> damage over a particular well-defined bodily region. This region is
> represented as having volume (rather than being two-dimensional), as
> being the shape of something sharp-edged and pointed (like that of a
> dagger). In the case of a pricking pain, the relevant damage is
> represented as having a sudden beginning and ending on the surface or
> just below, and as covering a very tiny area. A racking pain is one
> that represents that the damage involves the stretching of internal
> body parts (e.g., muscles). (Tye 1997, p. 333; cf. Tye 1996, 2006a)
> 



The problem of pain location is handled in the same way that the early
perceptual theories handled them: the location of pain is the location
that the pain experiences represent as where the tissue damage is
occurring. This sort of account becomes more attractive in light of
the fact that we now have a much more robust and realist notion of
experience whose phenomenological-cum-representational-content is a
direct guide to the location of tissue damage. The phenomenology of
pain experiences now directly (transparently) presents tissue damage
to the sufferer in virtue of its identity with its representational
content (Tye 2006a, 2006b).


### 4.2 The problem of focus



One of the central difficulties for any perceptual/representational
view of pain is to explain why, if feeling pain is genuinely
perceiving tissue damage in a body part, we report its experience
rather than the tissue damage (see Pitcher 1970, pp. 379-80;
Armstrong 1962, p. 125; and Aydede 2009, 2017b for the statement of
the
 difficulty).[17]
 We may call this difficulty the problem of focus for perceptual
theories in general (including strong representationalist views).
According to the common sense conception of pain (and following it,
most perceptual theories) we are, epistemologically and
psychologically, more interested in the experience than its object,
tissue damage. Our spontaneous conceptual reaction also follows this
pattern: there is a marked difference in the locus of concept
application or conceptual identification between standard
exteroception and pain. As depicted in Figure 1 above, there is an
obvious asymmetry between the two. If feeling pain is nothing but
perceiving tissue damage in a bodily region on a par with seeing a red
apple, then one would naturally expect that when we report pain in
body parts, we are reporting a perceptual relation that obtains
between the perceiver and an extramental condition perceived.



But this is not what we find. Instead, what we find is a report of an
experience of a certain sort whose informational/representational
etiology makes no difference to its own conceptual classification. A
pain report is a report of an experience whose representational
accuracy is of no relevance to whether the report itself is accurate.
Recall that, on most perceptual theories, when I utter a sentence like
(5), I am saying something like "I am having an experience which
tells me that there is some sort of physical disorder in the back of
my hand." In other words, I simply report an experience that
tells me something. Whether or not I come to believe what it tells me
is a matter of factors that ought not to be read into the analysis of
what the truth-conditions of (5) are. In fact, this sort of analysis
proposed by perceptual theorists seems initially plausible given the
ordinary conception of pain, and thus can be taken as an argument in
favor of such theories. But this is precisely where the problem lies
for perceptual theories. Why is a pain report a report of an
experience in the first instance if the experience is genuinely
perceptual (exteroceptual)? Isn't this strange? Nothing of this
sort happens in genuine perception. In fact, this asymmetry can be
transformed into a compelling argument against perceptual (as well as
strong representationalist) theories in the following way.



Every genuine case of perception invites reporting an instance of
perception in the relevant modality by sentences similar to (9)-(13),
where the perceptual verb is used dominantly as a success verb. For
instance:



> 
> 
> (10) I see a red apple on the table.
> 
> 
> 



This is for good reason: perception essentially is an activity whereby
one gathers information about one's (extramental) environment in
real time (including one's internal bodily environment of
course). So it is not surprising that the dominant form of reporting
is in the form of a relation between the perceiver and the perceived
where the latter are extramental objects or conditions of one's
environment. It is also not surprising that perception typically
yields conceptual categorization of the perceived object or condition
in the first instance: the typical result of a perceptual process is
bringing the perceived object under a perceptual concept. Genuine
perception thus puts the premium in the perceived object, not in the
perceptual activity itself or in the perceptual experience whereby one
is typically brought into epistemic contact with one's
extramental environment. Hence the typical result of perception is the
acquisition of beliefs with contents expressible by sentences like
(9)-(13). If sentences reporting pain in body parts don't
follow this pattern, i.e., if they are not to be construed as reports
of perceptual relations between the perceiver and the perceived, then
pain reports are *prima facie* not perceptual reports, reports
to the effect that one stands in a perceptual relation to something
extramental. But pain reports report feeling pain. Thus feeling pain
is a not a form of genuine perception. Let us call this the
*argument from focus* against perceptual theories.



There is an obvious sense in which the perceptual theorist is bound to
concede that reporting pain is not a case of reporting the obtaining
of a perceptual relation between the perceiver and the extramental
perceived object. For to the extent to which reporting pain is
reporting a conscious experience and only that, to that extent it is
an introspective report, a report of *intramental* activity.
Nevertheless, a perceptual theorist would insist that this reported
experience is a perceptual experience. But why report the experience,
the messenger, rather than its object, the message? Why are we fixated
on the messenger here?



A natural explanation that a perceptual theorist might give is that
unlike other perceptual modalities, the acts of sensing tissue damage
involved in feeling pain (i.e., the experience) have a very pronounced
negative affective quality: pains are unpleasant, awful, hurtful,
painful (see Pitcher 1970, p. 379ff; and Armstrong 1962, p. 125ff;
1968, p. 310ff). It is this negative affect that explains why we are
fixated on the experience itself, rather than what it is a perception
of, i.e., traumatized body parts. In other words, it is this negative
quality that turns the recognitional focus onto itself, and with it,
onto the experience it attaches to. If this is correct, then, of
course, pains are equally unpleasant even when they misrepresent. This
is why we pick out our acts of sensing (i.e., the experiences
themselves) rather than their external objects irrespective of their
informational etiology: whether or not they are veridical, they
equally hurt.



This seems to be a plausible explanation on a first pass. Indeed, a
perceptual theorist can even give, plausibly, an evolutionary story
about why these perceptual experiences should feel unpleasant: they
represent or signal a property of body parts that tends to hinder
survival. However, can the same sort of explanation be given for other
intransitive bodily sensations like itches, tickles, tingles, and
orgasms? Perhaps it can be done for experiencing orgasms, which are
usually intensely pleasurable and has obvious evolutionary benefits
(Block 1996, Tye 1996b, Aydede 2019). But what about others? Itches
have an unpleasant quality to them which normally makes one want to
scratch the spot where one itches. But tickles and tingles can be
pleasant at times and unpleasant at others, as well as affectively
neutral at still other times. Still, the concept of a tickle or tingle
is like the concept of a pain in that they apply to the acts of
sensing or experiencing, rather than to what external conditions these
acts may be representing -- if they represent
 anything.[18]
 Further, gustatory and olfactory experiences can be pleasant,
unpleasant or affectively neutral, yet the acts of sensing involved in
the exercise of these sensory modalities seem to be largely
transparent in that we apply the relevant concepts like SWEET, BITTER,
etc. to the external objects of these experiences in the first
instance, and only derivatively or incidentally to the acts of sensing
or to the experiences themselves.



These observations cast doubt on the plausibility of the explanation
offered by the perceptual theorist for the asymmetry in focus.
However, the perceptual theorist can still claim that whatever the
explanation might be in the case of other intransitive bodily
sensations, the explanation offered for pain is essentially correct,
and such a theorist may thus conclude that she has discharged the
burden of proof in claiming that experiencing pain is engaging in
genuine exteroception. This reply has some initial plausibility since
pain experiences have almost always a pronounced negative affect.
Nevertheless, if one suspects -- as one should -- that the
intransitivity of certain kinds of bodily sensations as a whole must
have a unified explanation, one would be wise to conclude that the
offered explanation is probably not the whole story, and thus might
not be adequate all by itself.



There is also quite substantial scientific evidence that there are
abnormal pain phenomena where the sensory and affective aspects of
pain experiences are dissociated from each other -- see Section
6.1 below for references and for further discussion. The most typical
case is known as the pain asymbolia syndrome, where people who suffer
from it have pain experiences without the negative affect.
Interestingly, these people still identify their experience as pain,
but show no bodily, emotional, and behavioral signs typically
associated with the unpleasant aspect of pains. They are feeling a
pain that doesn't hurt! If pains are not necessarily unpleasant,
as this syndrome seems to show, it is an interesting and open question
whether feeling pains without its negative affect would still retain
its intransitive nature.



But the real problem for this response that appeals to negative affect
is that even if the provided explanation were correct, it would not
save a perceptual theory. The explanandum (namely, that the semantic
focus of spontaneous concept application in reporting pains is the
experience rather than the extramental object of this experience) can
plausibly be interpreted as admission that feeling pain in a body part
is not perceiving something extramental there. What justifies this
interpretation is a reasonable condition on genuine perception: an
experience kind is genuinely perceptual only if it generally gives
rise to proprietary concept applications whose semantic focus is the
proper object of this kind of experience. In other words, some
cognitive uptake of a certain sort is necessary for a sensory process
to become genuinely perceptual. Generally, concepts of secondary
qualities are taken to be proprietary for each sensory modality.
Indeed these concepts primarily apply to objects of experiences
typically generated by these modalities, rather than to the
experiences themselves (or if they do, only derivatively). But in the
case of pain, we don't seem to semantically apply PAIN, or
'pain' for that matter, to tissue damage. Again this is
evidenced by the truth-conditions of pain attributing sentences, as
we've seen before. So the explanans may be correct, but it seems
to miss its target, the explanandum: it turns out to be an explanation
of why feeling pain is not genuinely perceptual.



Another kind of response to the problem of focus might be to treat it
as a pseudo problem that stems from our linguistic practices without
affecting the phenomena. It might be argued in the following way
(Chalmers in correspondence; cf. Hill 2006, 2009, 2017). We can invent
a term 'see2' such that one can see2
even when the perceptual object is not present (so
'see2' applies to the visual experience, unlike
the ordinary 'see1'). We can also invent a term
'feel1' such that feeling1 requires
the presence of the perceptual object, tissue damage (so
'feel1' is unlike the ordinary
'feel2'). As it happens, in our language
'see' expresses "see1" and
'feel' expresses "feel2", but
that's just terminology. At the level of phenomena, the two
cases are on a par.



But the problem won't go away with this maneuver. For one thing,
it doesn't really address the anti-perceptualist argument from
focus given above. For another, the question isn't whether we
can or cannot invent new terms or form new concepts so that the two
phenomena turn out to be type-identical. Linguistic practices reflect
our conceptual practices, how we think and conceptually respond to
incoming perceptual information. As a matter of fact, our conceptual
practices treat seeing and other standard exteroception differently
from the way they treat feeling pain, despite the fact that the types
of information flow seem identical in both cases. The question is why?
For these practices are shaped by our epistemic needs and
psychological preferences that show up in our behavior. They are not
arbitrary. If perception is a psychological process by which we gather
information about the extramental world and align our conceptual and
behavioral responses on this basis in a certain way, it is a fair
question to ask whether a psychological process that deviates from
this is perception, especially when the deviation seems to reflect
that our epistemic needs and psychological preferences are markedly
different than those involved in exteroception. The question of
whether feeling pain is perception is not a purely metaphysical or
philosophical question, but it is also partly and importantly an
empirical (psychological) question.


### 4.3 The problem of affective phenomenology



Pains are not only sensory or perceptual experiences, they are also
affective-motivational experiences, or at least they seem to have an
affective aspect. Feeling pain is normally having an awful, hurtful,
'painful,' experience. So we may say that pains have a
negative hedonic valence or affective value.



Strong representationalists are committed to claiming that all aspects
of phenomenology are representational. So if this negative affective
aspect of pain (i.e., the hurting, painful quality of pains) is a
proper part of pain's overall qualitative phenomenology, then it
must also be representational. But what does it represent? Pain
phenomenology seems complex in that it seems to consist of at least
two dimensions, affective-motivational and sensory-discriminative.
Representationalists, along with earlier perceptual theorists, claim
that the sensory aspect of pain is representational: it represents
tissue damage. But what does the affective aspect represent? There
doesn't seem to be a plausible candidate.



The early perceptual theorists, especially direct realists, were
*cognitivist* about pain's negative affect. They claimed,
roughly, that it consists of the experiencer's spontaneous
cognitive/conative reactions to their own pain experiences. These
reactions were conceived as forming *conative or evaluative
propositional attitudes*. In other words, the painfulness of pains
was constituted by their power to immediately "evoke in [one]
the peremptory desire that the [pain] perception should cease"
(Armstrong 1968, pp. 314-16). (See also, Stephens and Graham
1985, 1987; Nelkin 1986, 1994; Hall 1989. Cf. Parfit 1984. According
to Chisholm's 1987 presentation, Brentano also held that pains
and pleasures are partly conative reactions to sensory elements.)



Even though theoretically cognitivism is an option for
representationalism, adopting it would seem to violate the spirit of
strong representationalism. It all depends on how one would like to
develop the cognitivist line. One option is to say that the affective
aspect of pain is not qualitative or phenomenological. We are under
the illusion that it is because we are hard-wired to cognitively and
behaviorally react to the sensory content of pain in a certain way.
This option has the advantage of preserving strong
representationalism: if affect is not qualitative, there is no
pressure to treat it as representational -- cf. Tye (1996, pp.
111-16 and 134-36; 1997, p. 332-3). But if it is
admitted that affective aspect of pain is as qualitative as its
sensory content, then cognitivism comes as a compromise for strong
representationalist because it admits that not all phenomenal
character is representational. This latter option may lead to
representational-cum-functionalist approaches to pains and other
affectively non-neutral experiences in that the sensory content of an
experience may be given a purely representational account while its
affective dimension may be a matter of functionally processing this
content for setting motivational parameters (on the assumption that
cognitive attitudes can be captured functionally).



The problem with cognitivism in general is that it suffers from
intuitive implausibility: it certainly doesn't appear that the
hurting aspect of pain experiences is just a matter of our
*cognitive reactions* to them as *ordinarily*
understood. Cognitive reactions in the form of propositional attitudes
don't seem to have much qualitative phenomenology peculiar to
them. But more importantly, this move appears to mislocate the
problem. The question is: in what does the painfulness, the hurting
quality, of pains consist? The answer offered seems to be: in our
cognitive/conative reaction to the experience, something like having a
desire for it to stop, for instance. But one would like to think that
it is because the experience is painful that one desires it to stop,
not the other way round.



The most straightforward way to deal with affective phenomenology for
a representationalist is to say that it too is representational, just
like the sensory phenomenology. Tye seems to propose such a view:



> 
> 
> People in pain try to get rid of it or to diminish it. Why? The answer
> surely is because pain *feels* unpleasant or bad, because it is
> *experienced* as such. But what exactly is experienced as
> unpleasant? One's attention, when one feels pain, goes to a
> place different from the one in which the experience of pain is
> located. The qualities that are experienced as unpleasant are located
> in the bodily location to which one attends (in normal circumstances).
> People whose pains lack the affective dimension undergo purely
> sensory, non-evaluative representations of tissue damage of one sort
> or another in a localized bodily region. Those whose pains are normal
> experience the same qualities, but now those qualities are experienced
> by them as unpleasant. It is precisely *because* the qualities
> are experienced as unpleasant or bad that people have the cognitive
> reactions to them they do, reactions such as desiring to stop the
> pain. To experience tissue damage as bad is to undergo an experience
> which represents that damage as bad. Accordingly, in my view, the
> affective dimension of pain is as much a part of the representational
> content of pain as the sensory dimension is. (Tye 2006a: 107)
> 
> 
> 



So the experience I undergo when I feel a sharp pain in the back of my
hand feels the way it does because it represents tissue damage in my
hand and it represents it as bad. In other words, it represents tissue
damage as having the quality of being bad. (See also O'Sullivan
& Schroer 2012; Bain 2013, 2017.)



Of course, normally having one's tissue damaged is bad. We also
normally think/judge that it is bad. Not only that, experiencing
tissue damage (i.e., feeling pain) is bad. We think/judge so too. But
it doesn't follow from these truisms (without additional
premises) that the experience *represents* the damage *as
bad*. These truisms should not be confused with this last claim,
which is a substantive metaphysical claim. But what does it mean for
one's experience to represent tissue damage as bad?



This is a non-trivial question for a strong representationalist who
aspires to be a naturalist. Recall that strong representationalism
usually comes with a naturalistic story about how experiences acquire
their representational content. So it is important that representing
tissue damage as bad can be cashed out in terms of whatever
naturalistic story a representationalist has in his disposal. Many
representationalists including Tye defend (or at least start with) an
informational theory. But what is the natural property of the tissue
damage itself that is detected or tracked by the experience so that we
can say the experience carries information about *it*? The
property of being bad doesn't seem to be the kind of property
that can be informationally detected or transduced. Arguably, an
information-theoretic version of representationalism seems not quite
appropriate for affective phenomenology (but see Tye 2006b for a
response -- for different options and critical discussion, see
Bain 2017, Cutter & Tye 2014, and Corns 2018).



But perhaps a functional role semantics might work better for cashing
out what it means for pain experiences to represent tissue damage as
bad. The idea is that pain experiences play a certain
functional/causal role in the behavioral and mental economy of their
owners. In particular, given that they normally signal injury, such
experiences are typically causally associated with a certain battery
of cognitive and behavioral effects. It might be claimed that this
causal or functional profile as a whole (rather than a mere
informational link) is what makes pain experiences *represent*
tissue damage as bad.



It is not clear, however, whether representationalism is doing any
work in this proposal once an appeal to functionalism is made. For one
thing, it transforms strong representationalism into a partly
internalist theory. For another, why not simply say that the
functional role itself *constitutes* pain's affective
phenomenology? Indeed, functionalism (or better: psychofunctionalism)
in the philosophy of mind has always treated pains as paradigmatic
examples of qualitative mental states whose phenomenology can
plausibly be captured by functionalist proposals. What made this prima
facie plausible was pain's affective phenomenology (as opposed
to its sensory phenomenology), which is essentially connected with
pain's being an inherent motivator. But once functionalism is
allowed, we don't need to make a detour via representationalism.
In fact, it is hard to see how an experience's representing
something as bad can be an inherent motivator all by itself. To
explain how, a representationalist has to advert to additional
(learning?) mechanisms to connect representational content with drive
and motivation. (See Aydede & Fulkerson 2014, 2019 for an
elaboration of a psychofunctionalist account of pain affect as well as
further criticisms of representationalism from a functionalist
perspective. See Corns 2014 for criticism.)


## 5. Evaluative and motivational theories



Although a functionalist treatment of affective phenomenology seems
problematic for pure strong representationalists, it may be welcomed
by perceptual theorists in general who are seeking to give a
naturalistic account of pain as a perception. All they need to do to
accommodate pain's affective phenomenology is to say that
feeling pain involves perception although perception doesn't
exhaust its nature: feeling pain is also an affective/emotional
experience that can be explained by invoking other factors, say, the
functional role of pain's sensory/representational content (see,
for example, Lycan 1987a, pp. 60-61 and Clark 2006, Aydede &
Fulkerson 2019 for proposals roughly along this line) or the
evaluative representation of what the sensory-discriminative component
of pain represents (e.g., the badness of tissue damage) -- see
below. Including the affective phenomenology, as we may recall, is
what the IASP definition of pain seems to recommend. It seems also
embedded in the common-sense conception of pain: pains are
unpleasant.



Indeed a number of theorists embraced this sort of approach that may
be usefully called 'mixed theories of pain'. These come in
a variety of forms, sometimes motivated by different sets of concerns,
and accordingly, emphasizing different aspects of pain. But the basic
idea is that the nature of pain is complex consisting of at least two
mental elements. Generally one element is characterized by using one
or more of the following group of terms: sensory, perceptual,
representational, discriminating, descriptive, or informational. The
other is characterized by one or more of the following: affective,
emotional, motivational, evaluative, directive, or imperative. So far
we have been focusing on those theories that have emphasized the
former aspect. Indeed this has been the overwhelmingly dominant style
of theorizing -- at least in the philosophical tradition. But in
the last 10 years or so, there has been an increasing recognition of
the fact that pain has an affective and motivational aspect which
seems at least prima facie distinct from its sensory or perceptual
aspect (see next section for some scientific evidence). As observed,
most perceptual theorists and weak representationalists could, and as
a matter of historical fact, *did* accommodate the affective
aspect of pain to various degrees of success -- mostly, by going
cognitivist as described above. 



Nevertheless, in recent years, a number of theorists have focused more
on the affective aspect of pain experiences rather than on their
sensory/perceptual aspect, perhaps feeling that it is this aspect that
makes pain experiences and other similar bodily sensations unique and
distinctive. There are historical precedents to this kind of approach
(e.g., Marshall 1892, 1894a, 1894b; Duncker 1941), but I will focus on
contemporary developments of the view. (Corns 2013 contains a
criticism of unitary views of pain, and recommends a multi-dimensional
view. In this vein, see also Borg et al., forthcoming, for a polyeidic
model of folk conception of pain.)



A good example is Nelkin 1994. Nelkin calls his theory, the
'evaluative theory of pain', according to which pain
consists of two components, one of which is an occurrent phenomenal
state representing various troubles in body parts. The second
component is a simultaneous and non-inferential evaluation of this
phenomenal state. Nelkin conceives of this evaluation as a form of
spontaneous *de re* judgment about the phenomenal state as
representing harm to the body. He thinks that both elements are
necessary for pain experience. Surprisingly, however, Nelkin claims
that the evaluative component should not be equated with affect and
motivation involved in experiencing pain. According to Nelkin, these
two are only contingently related to pain experiences. (A similar view
is presented in Hall 1989.) 



Another evaluative theory is offered by Helm (2002) who develops the
view in a more integrated fashion. According to Helm, bodily pains and
pleasures are just felt evaluations, spontaneous evaluations of what
is happening in one's body as good or bad. According to Helm,
these evaluations aren't judgments understood ordinarily.
Nevertheless, they have intentional contents rationally responsive to
a broader range of background conative and cognitive states of the
experiencer. Thus as felt evaluations they inherently motivate and
rationalize behavior typically associated with pain and pleasure.
Therefore, they are not a separate or separable component of pain.
Pains and pleasure just *are* felt evaluations. Helm's
account is nuanced in many ways as it depends on his theory of
emotions (Helm 2001). 



Perhaps the two most prominent proponents of a mixed evaluative view
of pain, in recent years, are Michael Tye (2006a,b, Cutter & Tye
2011) and David Bain (2003, 2013, 2017). Both defend strong
representationalism for both the sensory and affective components of
pains. Bain labels the position *evaluativism* and states it
succinctly: 



> 
> 
> A subject's being in unpleasant pain consists in his (i)
> undergoing an experience (the pain) that represents a disturbance of a
> certain sort, and (ii) that same experience additionally representing
> the disturbance as bad for him in the bodily sense. (Bain, 2013:
> S82)
> 
> 
> 



Tye (2006a,b) and Cutter & Tye (2011) take the badness of physical
disorder to be an evolutionarily significant objective property of the
disturbance (such as aptness to harm), whereas Bain seems
non-committal about what the badness might eventually come to (but see
his 2017). (For recent criticisms of evaluativism, see Aydede &
Fulkerson 2019; Jacobson 2013, 2018; see Cutter & Tye 2014 for a
response to Jacobson 2013. Jacobson 2018 additionally develops an
attitudinal first-order anti-damage desire account of pain
affect.)



Hall (2008), Martinez (2011), and Klein (2007) offer accounts of pain
that belong to the class of *motivational* theories. They call
their views 'imperative' theories (or,
*imperativism* as the views have come to be known), according
to which pains are experiences with purely intentional content:
according to Hall and Martinez, pains have mixed intentional contents
partly consisting of descriptive content, and partly of imperative
content. On these views, pain experiences both *represent*
actual or potential damage in body parts and *command* certain
actions involving those parts such as: "Stop! Stop doing what
you're doing with this bodily part" (Hall 2008: 534), or
<See to it that this bodily damage is no more!> (Martinez
2011).



Klein (2007, 2015) further develops this imperative account of pain in
a more radical way: he proposes that pain experiences are exhausted by
their imperative content alone. He claims that they have no
descriptive (in his words, representational) content at all. He
intends his account in the same metaphysical spirit in which strong
representationalists present their account: the difference being in
the kind of intentional content pains have. According to strong
representationalists (in Klein's terminology, intentionalists),
this content is purely descriptive. According to Klein, it is purely
imperative: a proscription against acting with bodily parts where pain
is felt. In his 2015, Klein takes this imperative content to be a
protective command issued by the body to the agent: <protect
*that* body part in *this* way!>. Klein offers his
imperativism as an account of the *essential* nature of pains
which he takes to consist only in pains' sensory-discriminative
component. The affective, unpleasantness, aspect is only contingently
related to pains, according to Klein, and consists of second-order
agential level commands directed at the pain's imperative
content. (For criticisms, see Bain 2011, Aydede [2017, in Other
Internet Resources].)



Gustafson (2006) develops an extended and multi-stage argument against
understanding pain as a sensory experience. On his view, pains are
essentially emotions. 



When the naturalistic underpinnings of these evaluative and
motivational theories are explored, functionalist or
psychofunctionalist reductions of the affective/evaluative dimension
of pain might turn out to be the most natural option for these
theorists. (For general critical reviews of the class of recent
evaluative and motivational accounts of pain, and in particular the
affective aspect of pains, see Corns 2018, and Aydede & Fulkerson
2019, the latter develop a psychofunctionalist and a first-order
experiential anti-damage desire account of sensory affect, including
pain affect.)


## 6. Eliminativism about pain


### 6.1 The argument from reactive dissociation for eliminating pain



Daniel Dennett, in his influential article, "Why You Can't
Make a Computer that Feels Pain" (1978), argued that the
ordinary concept of pain is irremediably incoherent and should be
abandoned. His argument relied on some clinical pain syndromes which
he dubbed the "reactive dissociation" of pain affect from
its sensory aspect.



It has been well known that certain surgical procedures, some drugs
and certain pathological conditions reduce or remove the
unpleasantness of pain while preserving its sensory-discriminative
aspect. These data typically come from patients who have undergone
prefrontal lobotomy (Freeman et al. 1942; Freeman and Wattz 1946,
1950; Hardy et al. 1952; Barber 1959; Bouckoms 1994) or cingulotomy
(Foltz and White 1962a, 1962b; White and Sweet 1969) as a last resort
for their intractable chronic pain (as frequently involved in phantom
limb pain, neuralgia, causalgia, severe psychogenic and cancer pains),
from patients under the effects of hypnotic suggestion (Barber 1964;
Rainville et al. 1997, 1999), nitrous oxide (laughing gas), and some
opium derivatives like morphine (Barber 1959). These patients by and
large claim that they are in pain, and they can recognize and identify
their pain as such, but do not feel or seem bothered or distressed in
ways characteristic to having pain experiences.



Although it is usually not recognized in the literature, there are
important differences among the phenomena afflicting these patients,
which are manifested in patients' reports and behavior. For
instance, pain asymbolia also typically produces a kind of
dissociation -- a rather strong kind -- sometimes similar to
cingulotomy patients' but interestingly different from lobotomy
patients' (Rubins and Friedman 1948; Hurt and Ballantyne 1974;
Berthier et al. 1988, 1990; Devinsky et al. 1995; Weinstein et al.
1995). In fact, there is evidence that pain asymbolia may be the only
form of genuine dissociation (Grahek 2007). These patients, for
instance, don't react even to momentary pains like pinpricks,
small cuts, or burns. Experimental pain stimuli fail to produce any
recognizable affective reactions. Nevertheless, the patients insist
that the stimuli cause pain -- they identify their experiences as
pain (Rubins and Friedman 1948; Berthier et al. 1988, 1990; Dong et
al. 1994; Weinstein et al. 1995). The lobotomy and morphine patients,
on the other hand, do show the usual affective reactions and symptoms
when they are stimulated momentarily by normally painful stimuli. But
they don't seem to care or be bothered by their standing
persistent or chronic pains. Probably, they still feel the negative
affect but don't mind it, whereas the pain asymbolia patients
don't even seem to feel the momentary negative affect.



These two cases also need to be distinguished from so-called
congenital insensitivity to pain, a condition where the patients
don't even report any pain experience upon various kinds of
noxious stimuli -- unfortunately these patients don't live
long (McMurray 1955, 1975; Baxter and Olszewski 1960; Sternbach 1963;
Brand and Yancey
 1993).[19]



In his paper, Dennett primarily relies on the kind of dissociation
involved in lobotomy and morphine cases and treats them as if they
involved the same kind of strong dissociation involved in pain
asymbolia. He also presents certain aspects of the gate-control theory
of pain transmission developed by Melzack and Wall which had already
started to revolutionize the scientific pain research (Melzack and
Wall 1965; Melzack 1973). Inspired by this theory, he then presents a
speculative subpersonal functional theory of pain processing,
according to which pain processing occurs in many functionally (even
anatomically) different components of the central nervous system,
mostly in parallel, such that some of them can be selectively
impaired. This kind of selective impairment, he says, can produce not
only dissociation of the kind we are familiar with, but many more
bizarre phenomena we can expect to find and imagine happening. His
insight is that our ordinary notion of pain with its essentialist
intuitions cannot withstand the implications of such scientific
developments in pain research.



According to the common-sense concept of pain, Dennett argues,



> 
> 
> (14) pain experiences are *essentially* painful, awful,
> abhorrent, so that it is a logical impossibility to have an
> affectively neutral pain experience.
> 
> 
> 



But it is also part of common sense that



> 
> 
> (15) a subject's access to her pain experiences is essentially
> "privileged or infallible or incorrigible" (1978, p.
> 226).
> 
> 
> 



In the case of reactive dissociation (RD) patients, these two main
pillars of our ordinary concept of pain come into irremediable
conflict according to Dennett. A totally alert and conceptually
competent RD patient sincerely believes that (a) she is having a pain
experience, and that (b) her pain experience is not painful at all.
Given (14) and (a), we, as well as the patient, may conclude that she
is having a painful pain experience. But this contradicts her belief
(b) that is guaranteed to be true given (15). So we have a
contradictory concept of pain, which means that nothing can be a pain
-- an object or event with essentially contradictory properties
cannot exist. Dennett also argues that the ordinary notion of pain
will not survive giving up either (14) or (15). So pains, as
ordinarily understood, do not exist. This is Dennett's
eliminativism about pain.



One way to respond to Dennett's challenge is to say that if the
common-sense conception of pain did indeed require (14) and (15), then
it was simply wrong (Kaufman 1985). So strictly speaking nothing
corresponds to the ordinary notion of pain. But given that pain
experiences are almost always unpleasant (in fact, always unpleasant
in non-pathological cases), we can easily replace the faulty
conception with a new one which is close enough not to cause alarm by
its being empty -- read (14) with 'normally' instead
of 'essentially.' A similar line can be run for (15).



Alternatively, one can argue against Dennett that (14) and (15) are
not really part of the common sense concept of pain (Conee 1984,
Kaufman 1985, Guirguis 1998). Indeed when we are told the complete
details of what is going on in RD cases, there is no tendency to
conclude that pains turn out not to exist. Rather, in such cases we
realize that pain phenomenology may be complex: what appears to be a
simple and homogenous phenomenology in casual introspection turns out
to have a complex structure in close and trained inspection
(challenging a strict reading of (15)). Then what the RD cases show is
that the affective aspect is not essential for an experience to be
classified as pain. Indeed such a conclusion was urged by early
introspectionist psychologists long before the discovery of reactive
dissociation. So we learn that the identity of pain goes with its
sensory aspect rather than its affective aspect (as, indeed,
Ploner's 1999 case study seems to show). Surprising, yes, but
nothing like a major conceptual confusion. But part of Dennett's
overall point should be granted in any case: the limit of what can be
conceptually revised or abandoned as a result of scientific
developments may be much closer to home than we ordinarily tend to
think.


### 6.2 Other arguments for eliminativism



In her book, *The Myth of Pain* (1999), Valerie Hardcastle also
argued for eliminating the commonsense understanding of pain and much
of the ordinary pain talk. She argues that the commonsense notion of
pain conceives of pains as simple subjective sensations devoid of any
complexity. According to Hardcastle, pain is a complex phenomenon
consisting of many dissociable dimensions. To the two components
(sensory-discriminative and affective-motivational) we discussed
above, she adds, following Melzack and Wall (1988) and others, a
cognitive component (involving judgments, beliefs, memories,
perception of environment and patient's own history). Hardcastle
claims that to the extent to which these components are ignored by the
commonsense conception of pain, to that extent it's inadequate.
Moreover, on her view, it is a fatal mistake to take this subjective
sensation of pain as the nature of pain because she thinks that a
biologically more realistic objective understanding of pain involving
the various systems processing nociceptive information will serve our
scientific purposes much better and the commonsense understanding of
pain should follow that.



Jennifer Corns (2015) critically discusses both Dennett's and
Hardcastle's eliminativism about pain, and argues that we need
to make a distinction between scientific eliminativism and traditional
eliminativism (about folk concepts). She argues that even if a case
may be made for scientific eliminativism about pain as a natural kind
(see her 2012), nothing follows about eliminating the folk concept of
pain in so far as the latter serves a variety of useful functions in
ordinary life.



There are other ways of being eliminativist about pains having to do
with the nature of qualia or the alleged existence of apparent
phenomenal objects. Some philosophers, feeling that qualia or
phenomenal objects cannot be accommodated by an emerging scientific
naturalism, tend to conclude that they simply don't exist as we
philosophically conceive of them (Dennett 1988, Rey 1997). This is a
particularly vivid worry for intransitive bodily sensations in general
and for pain in particular, because they seem to impress upon us as if
in having them we were literally confronted with phenomenal objects
that cannot be part of the natural world order. If one comes to the
conclusion that none of the theories offered has any chance of
succeeding in helping us understand how a purely physical world could
contain pains, tickles, itches, orgasms, etc., then one way to go is
to say that they don't exist -- rather than giving up on
naturalism or physicalism. But the issues here are more general,
pertaining to broader concerns in the philosophy of mind.


## 7. Conclusion



When we look at the science of pain, especially at what has happened
since the publications of Melzack and Wall's (1965) and Melzack
and Casey's (1968), which revolutionized the scientific research
on pain, we see that the science of pain has increasingly conceived of
pain as less like perception of an objective reality and more like
emotions (affective states) by first drawing the sensory/affective
distinction and then emphasizing more and more its affective aspect.
(For a review see Price 1999. See Gustafson 2006 for a sustained
argument that pain is primarily an emotion. A.D. Craig 2003 claims on
scientific grounds that pains are homeostatic emotions. See also
Chapman & Nakamura 1999 as well as Vogt 2005 for scientific
grounds linking pain to emotion.) As we have seen, the trend in
philosophy, until very recently, had been in the other direction: as
naturalism has started to become an orthodoxy in the second part of
the 20th century, philosophers have increasingly sought for ways in
which they could assimilate pain to ordinary perception like vision,
audition, etc.



One of the main motivations behind the perceptual/representational
views of pain in philosophy is the belief (or hope) that perception as
a species of information gathering can be accounted for entirely in
physicalistic terms. Of course, this is a controversial claim. There
are many who think that perception involving as it does conscious
phenomenal experience cannot be a purely physical
 phenomenon.[20]
 However, even these theorists may agree that it is a plausible
theoretical strategy to pursue an understanding of pain and other
intransitive bodily sensations in perceptual/representational terms.
This strategy, if it works, minimizes the diversity of mental
phenomena, and thus potentially offers the prospects of a more unified
theory of mind. If this theory turns out to be in harmony with the
rest of our sciences and their fundamental metaphysical and
methodological assumptions, so much the better. Indeed, it was the
plausibility of this strategy and the belief that we will eventually
succeed in understanding perception in purely naturalistic terms that
have prompted many philosophers to advance perceptual/representational
theories of pain. Many in fact believe that philosophy has made some
progress in the second half of the last century in developing the
conceptual tools for a better and more naturalistic understanding of
perception and the mind in general -- e.g., the notion of a
mental representation and its (broadly) computational processing.



But does the scientific trend towards understanding pain as a
subjective experience less like a perception and more like an emotion
with quite a variable link to injurious stimuli undermine the
philosophical project? There is no simple answer. We may say,
"yes it does," if we take the perceptual/representational
theories as making the strong claim that pain is strictly nothing but
a perception just like other standard perceptions. We may say,
"no it doesn't" if we take their claim in a weaker
sense to the effect that pain *involves* some form of
perception understood in a certain way (on the assumption that the
perceptualists can answer other arguments against their views, such as
the argument from focus). Nothing in the scientific understanding of
pain by itself seems to show that pain involves no sensory perception
at all. On the contrary, as the science of pain has unearthed in the
last fifty years or so, there are relatively specialized systems that
process noxious stimuli from the moment they affect peripheral
receptors to the central processing of these signals in the spinal
cord and the brain.



If we take the weaker claim to the effect that feeling pain involves
sensory perception but that this doesn't exhaust its nature
mostly due to its affective dimension, we may still preserve a
naturalistic view of pain by giving a functionalist (or,
psychofunctionalist) account of its affective aspect. According to
this proposal, even though the sensory-discriminative aspect of pain
can *perhaps* be handled
 representationally,[21]
 the affective aspect reduces to the way in which the
sensory-discriminative information is processed, not for analysis to
extract information about the proximal or distal properties of the
stimuli, but rather for its significance for learning as well as the
effector or motor systems, to set learning and motivational parameters
for action on the basis of stimuli's informational content.
There is in fact strong supporting evidence for such a thesis in the
evolutionary stories of different organisms at different developmental
hierarchies. The neuroscientific evidence about the affective brain
seems also to support this idea in
 general.[22]



This is a view that treats pain as both a weakly representational and
a functional state. Such a view still needs to provide a good answer
to the problem of focus that we have seen afflicts all
perceptual/representationalist views. Why is there an asymmetry in
concept application, or in the focus of conceptual categorization?
Pointing out that pain has a deeply pronounced negative affect seems
not entirely adequate even when we have an adequate account of what
this affect consists in.



These are the major questions that an adequate perceptual account of
pain ought to give satisfactory answers to. Thus, despite significant
advances in our philosophical and scientific understanding of pain in
the last fifty years or so, there is still a lot of work to be done to
develop a fully satisfactory account of pain.



There are other philosophical as well as scientific questions about
pain. Do animals feel pain? If they do, is it comparable to the way we
feel pain? What are the social, economical, ethical and religious
implications of affirmative answers to these questions? How can animal
pain be scientifically studied? What should be the methodology of
scientific research on animals in general and of animal pain in
particular? How can we project the results obtained by pain research
on animals onto humans (or vice versa)? Parallel or similar questions
arise in the case of fetuses and young infants that are even more
pressing and urgent for obvious reasons. What is the relationship
between pain and pleasure, or pain and emotions in general? What are
the ethical and religious significance and implications of pain? These
and many other questions remain to be the focus of many researchers in
the field. (The literature addressing these questions is huge and
still growing; consult the bibliography of publications on pain cited
in the Other Internet Resources section below for representative
works.)