Is There an Appearance/Reality Distinction for Pain?

In a recent article, philosopher Kevin Reuter has provided an interesting example of experimental philosophy that challenges a widely held view.

The background is that many philosophers (including me) hold that there is no appearance/reality distinction for pain. Pain is nothing but a feeling, so if you have a painful feeling there is no question but that you have a pain. You can be fooled about what is causing you to have the pain; for example, you might think you’ve got a tumor when it’s just a cyst. But you can’t be fooled about whether you are suffering. (Another author in the same journal humorously imagines lack of success for a doctor who would refuse to prescribe painkillers, explaining that the patient is only having an appearance of pain, not a real one.)

There are parallels for our “outer” senses. You can, for example, be fooled about what color a thing is, because you might be looking at it in bad lighting. But you can’t be fooled about the way it *looks*. You might inadvertently pick the wrong word for the color a thing looks to you, but hardly makes sense to say that a thing might seem to look to you other than the way it does look to you. The way a thing looks just is its appearance, and while things in your kitchen can appear other than they really are, appearances themselves can do no such thing.

Many leading views say that the same thing holds for pain. There is simply no difference between feeling a pain, or having something appear to you as a pain, and actually having a pain.

Many leading philosophers also believe that this view – “There is no appearance/reality distinction for pains” – is not a philosophical theory. They are not claiming to say what people *ought* to believe about pains and they are not claiming to have made a philosophical discovery. They regard themselves as merely making explicit what is already implicit in the way people in general speak about their pains.

It is this attribution to the general public of the “No appearance/reality distinction for pains” view that Reuter directly challenges.

The key ground for the challenge is something one does not often see in a philosophy paper. It is a statistical analysis of remarks by non-philosophers – in this case, remarks found on health-related internet sites. Reuter gives details about his methods of search and analysis, but I will just summarize the key results, which I think his evidence clearly supports.

To wit: (1) People use both “I feel a pain” and “I have a pain” (and grammatical variants) in reporting both mild pains and severe pains. However, (2) “feel” is used about as often as “have” when mild pains are referred to, whereas “have” is used far more often than “feel” when the reported pain is severe (about 6 times as often on average, ranging from equally often to 14 times as often, depending on exactly what word — e.g., “major” , “severe”, “bad” — is used).

Result (2) is then combined with another observation: When people use variants of “seems” (e.g., “feels” “looks”, “sounds like”, etc.) in the case of senses such as touch, vision, or audition, they are making an appearance/reality distinction, and they are indicating lower confidence in their judgment. For example, if you speak of a blue tie, or say a tie is blue, you are confidently committing yourself to the claim that the tie is blue. But if you say it looks blue, you are leaving open the possibility that it might not really be blue, and that the way it looks – its appearance – is misleading as to how it really is.

The conclusion is then drawn that the difference in frequency of use of “feel” versus “have” that correlates with mildness versus severity of pain indicates that, at least for mild pains, people – users of health-related internet sites – are making an appearance/reality distinction.

Of course, this conclusion depends on supposing that there is not a better explanation of the correlation between “feel”/”have” and mild/severe. Reuter considers several more or less plausible alternative explanations, and adequately rebuts them. The most plausible of these is that “I have a pain” is, implicitly, a request for help. If the pain is mild, there may be no need for help, so the person reduces the help-seeking implication by using “feel” instead of “have”.

Reuter’s point about this suggestion is that more direct means of seeking aid are easily available, so it is unlikely that pain reports have the function of indirectly asking for help.

There is, however, a variant of this alternative that Reuter does not consider. People know that others are likely to empathize with a reporter of pain. So, if the pain is mild, the person who reports it may want to convey something like “Don’t worry, don’t feel bad for me, it’s only a little pain”. Perhaps using “feel” is a way of indicating this lack of need for empathy.

Of course, it’s unlikely that anyone thinks explicitly that this is what they are doing. So, we might wonder whether such an unconscious adjustment of language is too subtle to be plausible. I do not think so. Consider the shades of politeness in the following list:

Shut the door.

Shut the door, ok?

Would you shut the door?

Please shut the door.

Would you shut the door, please?

If you’ll shut the door, we’ll be less likely to be interrupted.

Which of these we use depends on how we are related to the person we’re addressing, and on circumstances. We do use different degrees of politeness, and we may sometimes pay careful attention to how to put a request. But on many occasions, we tailor what we say to relationships and circumstances without reflecting on or attending to our choice of phrasing, or even realizing that we are adjusting our words to relationships and circumstances. So, perhaps we are sometimes engaging in a similar, unreflective shading of politeness when we say that we “feel a pain” instead of that we “have a pain”.

Whether or not that is a good explanation, we should not forget result (1): People sometimes use “feel” even for severe pains that they cannot plausibly be taken to regard as unreal.

[Kevin Reuter (2011) “Distinguishing the Appearance from the Reality of Pain” _Journal of Consciousness Studies_ 18(9-10):94-109.]

6 Responses to Is There an Appearance/Reality Distinction for Pain?

  1. Kevin Reuter says:

    Thanks Bill for your counter-response. I think we are getting somewhere here.

    There is a certain question-begging language that we both use. When you say, “it is not intuitive for me at all that one could be unconfident about one’s feelings”, then you have not attacked my position, because I do not regard pains as feelings. I do not say that we are unconfident about feelings but unconfident about pains which I take to be conditions of body parts. Take the analogy with colour. Colours and pains I take to be out there in the world, and vision and nociception allow us to perceive these properties. My study reveals certain parallels between how we speak about colours and how we speak about pains, and my hypothesis is that the reason for this parallel language use lies in the unconfidence regarding the property that is talked about.
    Now you might object that I beg the question myself by assuming that pains are not feelings. That’s why we should better just talk about pain simpliciter, and at least for our debate leave it open what pains really are.

    Now, feelings are certainly mental states, and my objection against your account questioned the plausibility of thinking that people associate less empathy with ‘feelings’ of pain then with ‘havings’ of pain. To me it seems that whereas ‘having pain’ has more of a fact-stating purpose, ‘feeling pain’ involves to a greater extent the person who utters the statement. That’s why I find your view counterintuitive.

    I guess you will object that your counterresponse holds equally for pains even if they are not desribed as feelings. Consider following exchange between two conjoined twins which I take to be very plausible, and would demonstrate the possibility to be unconfident about one’s pain.

    Tim: It feels as if there is a pain in our knee.
    Tom: Well, the pain is actually further up in our thigh, and the knee just feels a little numb.
    Tim: Yes, you are right. Now that I pay more attention, I realize that the knee does not feel painful.

    To me, this exchange does not highlight a problem of how to describe pain but rather of identifying the condition of the body part.



    • wsrob says:

      Dear Kevin,

      It had not occurred to me that you might think that pains are not feelings. To the best of my belief, they’re generally regarded as paradigm examples of bodily sensations; more specifically as sensations that one has when some part of one’s body is damaged (or almost damaged) by injury, tumor, infection, etc. (I’ll use “corrupted” as a generic term for such conditions.) If “pain” standardly referred to corrupted conditions of body parts, the sentence (a) “if you have a corrupted condition in a body part you’ll have a pain sensation” would be tantamount to (b) “If you have a corrupted condition in a body part, you’ll have a corrupted condition in a body part”. But I don’t think (a) has that tautologous character.

      So, you’re right about the kind of responses you suspect I’d want to make. But now, for the remainder of this response, I will do my best to set all that aside and, as you suggest, just talk of pains.

      This brings us to the conjoined twins; and my response to that case is that I don’t agree that the conversation as it stands is plausible. There are two parts to my doubt about its plausibility.

      First, Tim’s opening formulation by itself does suggest unconfidence about his pain. But that’s because of the “as if” construction. I’m inclined to think that people do not actually talk about their pains in that way. I agree, however, that that’s an empirical matter. I’m not sure what corpus might reveal whether it occurs in ordinary speech, but perhaps you’ll be able to think of one that you can subject to statistical analysis.

      Second, Tim’s response to Tom is just a flat retraction, and I don’t find that plausible. I think any real person would try to explain the discrepancy. For example, Tim might say “Well, ok, if you want to be exact, but I don’t have a word for the part of the leg just above the knee, and “knee” seemed close enough to call attention to the pain I meant”. Or he might say “The pain was in our knee when I spoke, but you’re right, now it has moved up a bit”.

      Best regards,


      • Kevin Reuter says:

        Dear Bill,

        You express doubts about my conjoined twin scenario. Whereas I agree that people do not regularly speak like that, I am very certain that when people go to the doctor, they often express unconfidence about their pains in quite the way I have depicted.

        More importantly, the fact that normally only one person is connected to one body, has enormous effects on how we express ourselves, e.g. it makes statements like ‘No, you don’t have a pain in your knee’ ungrounded. But this is just a contingent matter which the conjoined twin case nullifies.

        I have indeed conducted a small-scale experiment in which I wanted to investigate whether pains are subjective or not. I presented my students with following vignette:

        Bobby and Tim are conjoined twins (Siamese twins) that are joined at the chest. While they are distinct people, each with their own beliefs and desires, they share their body from the chest downward. One day they eat poisoned food, and Bobby and Tim have a stomach ache. Bobby is then given a pain killer, whereas Tim receives no treatment.

        After the pain killer takes effect, Bobby no longer feels the pain. Which of the following claims would he rather endorse:
        (1) The upset stomach causes Tim to feel a pain.
        (2) The pain is still in the stomach, and Tim feels it.

        The number of answers were almost evenly split between (1) and (2). Nine students found it more plausible to think that Bobby would regard Tim’s feeling of pain to be caused by an upset stomach, whereas eight students claimed that it makes sense for Bobby to hold that the pain is still in the stomach although he cannot feel it. The reliability of these results is of course limited due to the low number of students tested. Nonetheless, this study demonstrates that we should not take the subjectivity of pains for granted but the putative subjectivity may be an artefact of the privileged access we have to our own bodies, and not to our own minds.

        If pains are indeed not subjective, then we have every reason to believe that people who share a body will discuss the intensity, location and character of their pain.

        Best, Kevin

      • wsrob says:

        Dear Kevin,

        That’s a very interesting experiment, but I think the results are open to more than one interpretation.

        I think Bobby would endorse both (1) and (2) (and that your students would think he would). For (1), he thinks Tim is still suffering, and has reason to think Tim wouldn’t be suffering if there were not some kind of corrupted state in their stomach. For (2), he thinks that there is still a pain (he believes Tim when the latter says it still hurts), and he thinks Tim feels it (i.e., he does not likely hold the view that Tim is reporting a pain that he does not feel).

        It looks like the question was presented as a forced choice. If that’s right, and both choices are ones that Bobby would be likely to endorse, then we should expect the roughly even split that you report.

        As far as I can see, on your “objective” view, Bobby should also endorse both (1) and (2) (and, again, that your students would think he would). So, I’m not suggesting that the experiment supports my view of how people think about pains. Instead, it seems to me not to offer evidence for either view as opposed to the other.

        Best regards,


  2. Kevin Reuter says:

    Dear William,

    Some very interesting ideas on my paper that you present in your blog. Thanks for your thoughts.

    I would like to make a few comments:

    1. Your alternative explanation for the correlation of using the phrase ‘feeling pain’ when people have mild pains, and ‘having pain’ with severe pains, is a plausible one – certainly more plausible than the help-seeking explanation. I wonder whether you believe that your alternative explanation (i.e. indicating a lack of need for empathy when using ‘feel’) rules out my own one (i.e. being less confident when using ‘feel’)? It seems to me that I can grant you your point to a certain extent but still insist that people use the ‘feeling pain’ phrase when being less confident about their pains. I could say that it is a consequence of being less confident that people do not want empathy, but not the actual reason for choosing ‘feel’ – language.

    2. We might be able to test your hypothesis experimentally, e.g. maybe people often say “I feel a pain in my neck, but …” whereas they hardly restrict the importance of the utterance when using the ‘having pain’ phrase. What I did was to check whether people are more inclined to say “Do you feel a pain …?” or say “Do you have a pain … ?” It turns out that it is more likely that people say “Do you have a pain?” which suggests that if you are right, people are quite empathetic. In any case yours is an interesting suggestion which merits further investigation

    3. However, I do find your explanation slightly counterintuitive: Is it not the case that we associate greater empathy with the word ‘feel’ than with the word ‘have’, when I think about it consciously? In contrast, most people who I have discussed this article with, agree that it is at least possible that ‘feeling pain’ compared to ‘having pain’ manifests a difference in confidence, even though they have never thought about it.

    4. Your penultimate paragraph: I don’t think that it matters that sometimes people say ‘I feel a severe pain’. After all, (1) language is quite fuzzy, (2) people often say that ‘the tie is blue’ even though they perceive the tie in bad lighting conditions, and are not very confident about it.

    Best wishes,


    • wsrob says:

      Dear Kevin,
      I’m grateful for these comments, and I regret that I have only an intuition to offer in response. Namely, it is not intuitive for me at all that one could be unconfident about one’s feelings. If others are phenomenologically like me, they too would not be expressing unconfidence about their feelings.

      Such likeness is a significant assumption, but I don’t think there’s a reasonable alternative to making it in general, and then setting limits on it only when one has particular evidence for particular limitations. For me, the case under discussion pits the foregoing intuition against the assumption of my general likeness to others.

      I do think that one can be unconfident about how to describe one’s feelings. For example, there might be irritations that are so mild that one is not sure whether they quite rise to *pain*. (Think, e.g., of a muscle that’s been exercised in an unaccustomed way. It’s sore, it’s a source of discomfort. But does what you feel when you stretch it quite qualify as “pain”??) But I’d regard such cases as not involving ambiguity about how one feels, or unconfidence about whether one feels the way one thinks one feels. They would just be cases of uncertainty about what words would be right for conveying the actual level of discomfort.

      If lack of confidence were the only way to account for your data, that’s the view we should accept. But if there’s a plausible alternative account, I think it has a better claim on our credence, so long as it doesn’t contradict other data, or lead to something that’s at least as counterintuitive as being in doubt whether one really has a feeling that one thinks one has.

      Best regards,


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