Is There an Appearance/Reality Distinction for Pain?

January 23, 2012

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.]

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