This paper disputes the theoretical assumptions of mainstream approaches in philosophy of pain, representationalism and imperativism, and advances an enactive approach as an alternative. It begins by identifying three shared assumptions in the mainstream approaches: the internalist assumption, the brain-body assumption, and the semantic assumption. It then articulates an alternative, enactive approach that considers pain as an embodied response to the situation. This approach entails the hypothesis of the sociocultural embeddedness of pain, which states against the brain-body assumption that the intentional character of pain depends on the agent’s sociocultural background. The paper then proceeds to consider two objections. The first questions the empirical basis of this hypothesis. It is argued based on neuroscientific evidence, however, that there is no empirical reason to suppose that the first-order experience of pain is immune to sociocultural influences. The second objection argues that the mainstream approaches can account for sociocultural influences on pain by drawing on the conceptual distinction between narrow and wide content. In response, the semantic conception of pain underpinning the proposal is challenged. Pain experience can occur in pre-reflective, affectively reflective, or cognitively reflective forms, but the semantic conception at most only applies to the last form. The paper concludes that the enactive approach offers a promising alternative framework in philosophy of pain.
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Tye also writes: “In my view, pains are patterns of active cells occurring in topographically structured 3-D arrays to which sentences are attached” (Tye 1995a, 232). Similarly, Dretske holds that pain experiences are “exactly in the same category” (1999, 117) as perceptual experiences, which in his account are “identified with internal states having properties (e.g., ) that make them awareness, experiences, of the properties (e.g., P) that external objects have” (1999, 115). Imperativists tend to be less explicit on this issue, but that they have no issue with internalism is fairly clear from their writings. For example, Klein explicitly develops imperativism to defend intentionalism about pain, that is, the thesis that the phenomenology of pain is fully explained by the intentional content of mental representations (Klein 2007, 2015).
I primarily discuss the cultural embeddedness of pain in the following, but I would like to use the term “sociocultural” to make it clear that the human environment in which we are embedded is not fully captured by the concept of culture. For instance, there are structures of our environment that can only be described by using social, economical, or political terms.
Determining which aspects of the two cultures account for the difference is a tricky issue. Brena et al. (1990) speculates that Japanese patients might be responding to low back pains the way they do because of “the traditional stoicism” characteristic of oriental societies or because of the quantity of “psychosocial support for a chronic pain patient” available in the society (123). Such question can only be resolved empirically, and hence the current proposal is not committed to any specific answer.
It has been suggested by one of the reviewers that proponents of the mainstream approaches might draw on the notion of “cognitive penetration” to account for sociocultural effects on pain experience. To my knowledge, no one has attempted so far to develop representationalist or imperativist accounts of pain in this direction, but I believe this will be a fruitful enterprise for the proponents of this view. In the end, however, I am not convinced that this will allow them to accommodate the sociocultural embeddedness of pain. A full treatment of the issue lies beyond the scope of this paper, but briefly, the reason for this doubt has to do with the nature of sociocultural backgrounds. On a standard definition, ‘cognitive penetration’ is a phenomenon in which cognitive states (such as beliefs, desires, and intentions) affect the content of perceptual experience (Macpherson 2012; Stokes 2013). But an individual’s sociocultural background is not exhausted by a network of cognitive states (Searle 1983; Dreyfus 2012). Accordingly, I find it unlikely for the effect of the sociocultural background on pain to be fully explained in terms of cognitive penetration.
For more discussion, see Geniusas (2017).
Ongaro and Ward (2017) advances an enactive account of placebo effects, which is congruent with the enactive approach to pain advanced in this paper. On their account, placebo treatments can induce changes both in attentional and (even surprisingly) in somatic states, or they “afford healing” (522), because of “the meaning we perceive them to have in virtue of our history of enculturated embodied interaction, and the fact that being intentionally directed towards a meaningful structure in the environment is a bodily and affective relation that entrains specific somatic and attentional patterns” (527).
See also Sartre (2003) who discusses this idea of pain prior to reflective act illustrating it with the famous example of the sore eye (331–9).
For more discussion, see Miyahara “Coping with pain and obeying commands” (under review).
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An earlier version of this paper was presented at the conference “Enactivism: Theory and Performance” at University of Memphis. I thank the audience for the helpful feedbacks on the presentation. I also thank Hayden Kee for reading and commenting on the manuscript. This work was funded by the ARC DP project “Minds in Skilled Performance: Explanatory Framework and Comparative Study” (DP170102987).
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Miyahara, K. Enactive pain and its sociocultural embeddedness. Phenom Cogn Sci (2019). https://doi.org/10.1007/s11097-019-09630-9
- Cultural permeation