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Pain's Evils

Published online by Cambridge University Press:  01 June 2009

ADAM SWENSON
ADAM SWENSON*
Affiliation:
California State University, [email protected]
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Abstract

The traditional accounts of pain's intrinsic badness assume a false view of what pains are. Insofar as they are normatively significant, pains are not just painful sensations. A pain is a composite of a painful sensation and a set of beliefs, desires, emotions and other mental states. A pain's intrinsic properties can include inter alia depression, anxiety, fear, desires, feelings of helplessness and the pain's meaning. This undermines the traditional accounts of pain's intrinsic badness. Pain is intrinsically bad in two distinct and historically unnoticed ways. First, most writers hold that pain's intrinsic badness lies either in its unpleasantness or in its being disliked. Given my wider conception of pain, I believe it is both. Pain's first intrinsic evil lies in a conjunction of all the traditional candidates for its source. Pain's second intrinsic evil lies in the way it necessarily undermines the self-control necessary for intrinsic goods like autonomy.

Type
Research Article
Information
Utilitas , Volume 21 , Issue 2 , June 2009 , pp. 197 - 216
Copyright
Copyright © Cambridge University Press 2009

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References

1 There are at least two other candidates. Some hold that pain is intrinsically bad because of the way it moves us to act. For example, Nagel, Thomas, The View from Nowhere (New York, 1986), ch. 8Google Scholar; and Korsgaard, Christine, The Sources of Normativity (Cambridge, 1996), lecture 4CrossRefGoogle Scholar. Others hold that pain is intrinsically bad because it represents bodily damage or the threat of bodily damage. For example, Nelkin, Norton, ‘Reconsidering Pain’, Philosophical Psychology 7 (1994), pp. 325–43CrossRefGoogle Scholar; and George Pitcher, ‘Pain Perception’, The Philosophical Review July (1970). I shall concentrate on the dislike theory herein. Parallel arguments will establish the same conclusions for the other views.

2 I shall assume that if x is intrinsically bad, x's badness must depend solely upon its intrinsic properties. I shall set aside discussion of this and other issues concerning the nature of intrinsic value.

3 Pain is of course instrumentally good in its contribution to self-preservation. The horrific fates of those congenitally insensitive to pain leaves no doubt. See Nagasako, Elna M., Oaklander, Anne L., and Dworkin, Robert H., ‘Congenital Insensitivity to Pain: An Update’, Pain 101 (2003), pp. 213–19CrossRefGoogle ScholarPubMed.

4 Alternatively, we can imagine that she is given a heat-resistant lip balm. This removes the chance that the flavor, aroma and warmth have been altered.

5 For example, St Teresa of Avila, The Collected Works of St. Teresa of Avila, vol. 1 (Washington, D.C., 1976–85); and St Catherine of Siena, The Dialogue, trans. Suzanne Noffke (New York, 1980).

6 Margaret Temkin pointed out that several of these cases involve a kind a ritualistic activity; that they may involve a kind of addiction. Since the association between the enjoyment of the activity and the pain is very tight, we might worry that Kylie and company fail to discriminate between the two in their evaluations. We can imagine parallel cases with one-off or first-time evaluations to circumvent this concern about the soundness of their judgments.

7 There is an important issue here about whether these cases establish that some pains are intrinsically good or that not everything which hurts is a pain. One fruit of section 3's account will be the conclusion that the latter is correct. Nonetheless, both readings undermine the kernel view.

8 There is a great deal of literature on this. For a survey see, for example, Price, Donald D., Psychological Mechanisms of Pain and Analgesia (Seattle, 1999), ch. 2Google Scholar. For more particular aspects, see, Price, Donald D., Mao, Jianren and Mayer, Emeran A., ‘The Psychophysical Attributes of Heat-Induced Pain and Their Relationships to Neural Mechanisms’, Journal of Cognitive Neuroscience 4 (1992), pp. 1–13CrossRefGoogle ScholarPubMed; Rainville, P., Feine, J. S. and Bushnell, C., ‘A Psychophysical Comparison of Sensory and Affective Responses to Four Modalities of Experimental Pain’, Somatosens Motor Res 9 (1992), pp. 265–77CrossRefGoogle ScholarPubMed; Rainville, P., Duncan, G. H., Price, D. D., Carrier, B. and Bushnell, C., ‘Pain Affect Encoded in Human Anterior Cingulate but Not Somatosensory Cortex’, Science 277 (1997), pp. 968–71CrossRefGoogle Scholar; and, especially, Rainville, P., Carrier, B. and Hofbauer, P. K., ‘Dissociation of Sensory and Affective Dimensions of Pain Using Hypnotic Modulation’, Pain 82 (1999), pp. 159–71CrossRefGoogle ScholarPubMed. These relationships are also examined throughout Skevington, Suzanne, Psychology of Pain (New York, 1995)Google Scholar.

9 Korsgaard, Sources of Normativity, p. 147. Italics added.

10 Hare, R. M., ‘Pain and Evil’, Essays on the Moral Concepts (London, 1972), p. 80CrossRefGoogle Scholar.

11 The empirical literature on these factors is huge. Here are just a few examples: Kallai, I., Barke, A. and Voss, U., ‘The Effects of Experimenter Characteristics on Pain Reports in Women and Men’, Pain 112 (2004), pp. 142–7CrossRefGoogle ScholarPubMed; Skevington, Psychology of Pain, chs. 4–5; Beecher, H. K., ‘Relationship of the Significance of Wound to the Pain Experienced’, Journal of the American Medical Association 161 (1956), pp. 1603–13CrossRefGoogle ScholarPubMed; and Vallerand, April, ‘Gender Differences in Pain’, Image: Journal of Nursing Scholarship 27 (1995), pp. 235–7Google ScholarPubMed. There are two possible relationships between the context and the reaction. The causation version holds that the elements of the context – including my dispositions – cause the particular reaction. On the reasons version, the elements of the context are (or provide) reasons for reacting in a particular way to the sensation. I shall not discuss these herein, and will assume the causation version in what follows.

12 It may seem conceptually awkward to claim that one can fear something that is present – fear may be a diachronic attitude like regret. But I need not legislate on this. Being terrified is an essentially affective state. However, it can still be an attitude toward something. Thus, if necessary, we can substitute ‘is terrified of x’ when I say ‘fears x’ herein.

13 There is a complication here. It may seem that the state of disliking x is not bad per se, instead it's only x that's bad. That seems disanalogous to fear, which is itself bad. This raises some larger issues about the bearers of intrinsic value which I cannot address here.

14 Cf. Scanlon's treatment of desire which imbues normatively significant desires with rationally assessable features. That makes dislike more plausibly akin to fear, and less something special and basic in our conceptions of value. See Scanlon, T. M., What We Owe to Each Other (Cambridge, 1998), chs. 1–2Google Scholar.

15 The view I shall now set out is compatible with any answer to Q2 on the composite view – not just the aversion theory. It only requires that the phenomenology of the reaction is part of the pain. I set out this form of intrinsic badness and my conception of user control in much more detail in Adam Swenson ‘Pain and Value’ (PhD dissertation, Rutgers, 2006).

16 User control is not limited to rational beings. Most creatures with minds – my cat Sanuk but probably not Frankfurt's benighted spider – exercise user control in their lives. I shall only discuss humans here.

17 I suspect that the possession of certain kinds of user control is a necessary condition of there being anything valuable for a person. For example, I suspect that if a person does not have certain forms of user control over a desire, the satisfaction of that desire cannot be good for her. For simplicity, I shall focus solely on autonomy as the intrinsic value undermined by pain. Generally speaking, the more central a form of user control is to the fundamental values in life, the worse it is to lose that form. These forms of user control tend to be the most pervasive and the most difficult to lose. Thus the most valuable objects of user control include the ability to direct one's movements and the capacity for directed thought. We share these abilities with many animals, they underlie all physical and mental acts, and they are considerably difficult to lose. These are not the capacities of concentration and movement required for ratiocination or athletic excellence. Even drunken stumbles and blabbering involve one directing her movements and thoughts; the execution is impaired but the capacity is retained. The most important capacities are thus narrower than the most minimal set necessary for any morally significant type of autonomy. A life with only control of thought and movement is unlikely to be a good life. But without control over these things, nothing in life has any value.

18 Cf. the playwright Antonin Artaud's claim that ‘pain as it intensifies and deepens, multiplies its resources and means of access at every level of the sensibility’. Artaud, Antonin, The Theatre and its Double, trans. Richards, Mary C. (New York, 1958)Google Scholar.

19 disassociation may be satisfied by non-pains. For example, if your numb arm falls onto your chest when you awaken from a position restricting its blood-flow, it feels like that of a corpse. The eerie experience that the arm is yours but totally senseless and unmovable may satisfy disassociation. NB, it may not satisfy alien nature.

20 Here's a crude analogy: the difference between alien nature and disassociation is like the difference between a pebble in your shoe (alien nature) and a blister (disassociation) on your foot when you know that one is a blister and the other a pebble.

21 disassociation is also bound up with passivity. Again, I suspect they are logically distinct, but little turns on the issue. To reflect the passivity implicit in disassociation, I shall say ‘A is disassociated from x’ rather than ‘A disassociates from x’. Elsewhere I use ‘detachment’ to refer to the way one may actively dis-identify herself with a pain. Detachment is an effective means in combating pain; disassociation is part of the pain.

22 Certain injuries and pains are reliably accompanied by characteristic contortions. Once, an emergency room doctor took one look as I hobbled in the door – right elbow tightly tucked against ribs, arm across chest, and body leaning 45 degrees – and asked how I broke my collarbone.

23 Scarry, Elaine, The Body in Pain (Oxford, 1985), p. 47Google Scholar. The body ‘being in rebellion’ or having ‘turned against her’ is part of passivity.

24 Scarry, The Body in Pain, p. 53.

25 That requires the hefty metaphysical assumption that the diminution of the intrinsically good is intrinsically bad.

26 My view is thus, in a sense, a privation view of pain's evil. On traditional privation views, pain is bad because it is the loss of the good. Traditional privation views are completely wrong. As I argue elsewhere, the role of user control in my view immunizes it from the problems which beset them.

27 Larry Temkin has suggested to me that most of us wouldn't welcome this temporary ecstasy if it was forced upon us or if we didn't know its source. For example, if while sitting on the couch watching television you were suddenly and mysteriously overcome with this ecstasy, the feeling would be invasive and unwelcome. I have my doubts. I agree that the initial onset of the sensation might be quite disconcerting or even terrifying. But after a moment or two, the way that intense pleasure tends to obliterate thought, and our natural tendency to identify with it will take over. The reason Frances does not give herself over to the pleasure and welcome it is based in her deepest convictions about herself and what's valuable. Thus I suspect that the cases where pleasure is a usurper are rare. Nonetheless, if Temkin is right, these pleasures may be more common than I suspect.

28 I am indebted to Larry Temkin, Ruth Chang, James Griffin and Derek Parfit for their comments.