ABRAHAM OLIVIER

WHEN PAINS ARE MENTAL OBJECTS

ABSTRACT. In Why pains are not mental objects (1998) Guy Douglas rightly argues that pains are modes rather than objects of perceptions or sensations. In this paper I try to go a step further and argue that there are circumstances when pains can become objects even while they remain modes of experience. By analysing cases of extreme pain as presented by Scarry, Sartre, Wiesel, Grahek and Wall, I attempt to show that intense physical pain may evolve into a force that, like imagination, can make our most intense state of experience become a mental object. I shall finally argue that, though extreme pains cannot serve as paradigm cases, they do show the general importance of taking pain states to be objects.

In Why pains are not mental objects (1998) Guy Douglas rightly argues that pains are modes rather than objects of perceptions or sensations. In this paper I try to go a step further and argue that there are circumstances when pains can become objects even while they remain modes of experience. Intense physical pain as experienced in cases of torture, in the atrocities of the Holocaust as well as in situations of emergency, may evolve into a force that, like imagination, can make our most intense state of experience become a mental object. I shall finally argue that, though extreme pains cannot serve as paradigm cases, they do show the general importance of taking pain states to be objects. In the following I start with a discussion of Douglas’ arguments against Langsam, Nelkin and Grahek that pain is a mode, not an object. Then I analyse biographical cases presented by Scarry, Sartre and Wiesel in order to show that under certain circumstances, while remaining modes, pains can become mental objects. The next part informs and supplements these analyses by means of a discussion of actual experimental data. In the final part I try to show why it is important to go further and argue that while pains are modes of experience they can also become mental objects.

Philosophical Studies 115: 33–53, 2003. © 2003 Kluwer Academic Publishers. Printed in the Netherlands.

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I

In his reaction to Robert Langsam [Why pains are mental objects (1995)] Douglas [Why pains are not mental objects (1998)] criticises Langsam for mistaking pain sensations for objects of sensations. Douglas summarises Langsam’s point of departure as follows: “So Langsam distinguishes objects of perceptual experiences, from the objects of sensations, by the fact that objects of our perceptual experiences are objects that exist when we are not perceiving them, whereas ‘objects’ of our sensations, such as pains, do not exist when we are not perceiving them.”1 Douglas spells out his criticism in terms of a grammatical analysis. He takes two sentences for illustration: (1) I feel a sharp pain and (2) I feel a sharp knife. In the two sentences “pain” and “knife” are two different kinds of accusatives. The knife is an alien accusative and refers to the object of the sentence. A pain on the other hand is a connate accusative and qualifies the verb “feel” rather than the object (Douglas, 1998, pp. 128–129). In this sentence pain does not pertain to what I feel, but to the way I feel. Douglas mentions some other examples to elaborate on this distinction. One is the difference between “I fight a war”, with war as the connate accusative, describing the fight, thus being cognate to fighting, and “I fight a man”, with man as the alien accusative, qualifying the object rather than the verb (1998, pp. 129–130). “Pain” in “I feel a pain” is like “war” in “I fight a war” cognate to the feeling; as such pain is an adverbial description that belongs to the feeling like war belongs to the fight. Another example, making a further dimension clear, is the distinction between tasting tea and tasting bitterness. The bitterness is the way the tea tastes, while the tea is the thing that we taste. In the same way pain qualifies the activity of feeling and not the thing felt. In the case of the knife that I feel, so Douglas concludes, the feeling is a sensory process related to an alien accusative or object. But the pain that I feel is as a connate accusative part of the quality of feeling rather than a sensory object. In Douglas’ opinion Langsam confuses the connate and the alien accusative insofar as he sees pains as objects of sensations (which are only privately experienced and do not exist when we do not perceive them2 ) instead of as qualities of our sensations. Mistaking a pain for an object is like mistaking a war for a kind of opponent,

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or a move for a kind of creation, or a hurry for a kind of getaway vehicle (1998, p. 131). Feeling an object like a knife pertains to what I am conscious of, but feeling pain describes the character of that conscious process. Hence it is advisable not to speak of feeling a pain, or even having a feeling of pain, but to say rather that one feels pain or feels pained (1998, p. 136). Douglas adds a formal argument to his notion of the feeling of pain referring to the problem of the regress of feeling (1998, p. 134). If feeling is reified as an object, the feeling itself becomes something to be felt; this feeling in turn becomes something to be felt and so the process of reification continues ad infinitum. For the sake of the argument one can object by noting that the pain that I feel is a sensory stimulus that can be objectively localised. This could be done in terms of the still most widely accepted pain theory, the gate-control theory,3 as, for instance, adapted by Gillet (1991). Gillet proposes a two-fold neurological system. One subsystem conveys activity in fibres ascending from the body’s periphery (bottom-up sensory input). Gillet refers to these activities as spatio-temporal properties of pain events, which do not capture the affective qualities of pain. The other subsystem (processes information descending from higher centres in the central nervous system) (top-down cortical processes), which might exacerbate or inhibit the activity in fibres ascending from the body’s periphery. This subsystem mediates reactions to pain, providing input for the conscious appreciation of the abhorrent effect of pain, but without carrying data geared for detailed analysis like other sensory modalities (vision, hearing) (1991, p. 194). In the former case (spatio-temporal) pain is not merely a feeling, but becomes a measurable property of the body, suitable for detailed objective analyses.4 Douglas uses Locke to argue against such a kind of objection. Just as “redness” is not a property of a physical object, pain is not a property of physical injured tissue, but a feature of our experience of an injury like a cut or a boil (1998, p. 134). Pain is not the injury itself, but the way we sense the injury. Douglas uses some examples to illustrate this argument. One example is the way physical training, aimed to overcome pain, changes the experience of pain. In such a case the cause of pain occurs, but is not necessarily experienced as

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painful anymore. Placebo effects,5 hypnosis, esoteric practices like lying on a bed of nails, or the popular management courses in firewalking, are other well-known examples that support the notion of the priority of the perception of pain over the sensation of pain. After criticising Langsam for mistaking the feeling of pain for a sensory object, Douglas subsequently accuses Nelkin [Pains and pain sensations (1986)] of confusing pain sensation with a perceptual object.6 Nelkin concedes that pain is not a sensation, but an attitudinal response to sensations. That sensations are painful is the result of an affective response to it. Nelkin interprets some experiments done on several cultural groups as a proof of the argument that, though people have similar (sensations, they respond differently to them. Between the “beetle in the box” (the) sensations) and the pain itself, there appears to be a loose connection (Nelkin, 1986, 136ff). Douglas criticises Nelkin for the same formal reason that he has criticised Langsam: Nelkin takes a sensation of pain for an alien accusative, making it something we respond to rather than to be part of the way we respond (Douglas, 1998, p. 144). According to Douglas, we do not have an affective response to sensations, but to external stimuli. The affective response is part of what is involved in sensing something (Douglas, 1998, p. 143). Nelkin makes a mistake similar to Langsam: though Nelkin thinks pain to be a response to rather than an object of sensations, the sensations of pain themselves are reified as in Langsam’s account. Reifying sensations can be avoided only if the affective response is seen as a part of the way we sense pains. Thus we should rather argue: the affective response characterises the way we feel about things; but sensations are a way we feel about things, rather than things we feel; therefore affective responses must coincide with physical sensations. Ergo: the way we feel about things is both physical and affective. Douglas criticises Nelkin on the same basis that he criticises Grahek [The sensory dimension of pain (1995)], who in turn critically responds to Nelkin. To Nelkin’s observation that certain cultural groups experience the same sensations of stimuli, but exhibit different affective reactions to stimuli, Grahek counters that the sensation threshold of such groups may be the same, but that this does not mean that the groups have the same sensations (Grahek, 1995, p. 176). Grahek extensively reacts to Nelkin’s interpreta-

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tion of the mentioned experiments on cultural groups. Her point of departure is that, what is essential to pain, is the sensation of a particular quality or character. These sensations differ, causing people to have different experiences of pain. One person experiences jabbing painful and another person heat sensations. The experience of pain lies in the difference between the sensations themselves and need not be seen in terms of different perceptions. Douglas contends that Grahek too, makes the mistake of assuming that the attitudinal and emotional part of pain is not part of its sensory quality. In Grahek’s interpretation pains are sensory qualities to which we give affective responses. This is just another way of mistaking the feeling of pain for the thing felt. One can imagine what it is to feel a pain without actually experiencing it, so Douglas admits. In this sense one can scientifically objectify and measure the sensation of pain. But to objectify the feeling is not to feel what it is like to be in pain (1998, p. 147). Douglas rightly identifies a critical limit to objectifying pain as either a subjective perception or an objective sensation. This limit consists in transforming an actual pain experience either into a mental concept or a sensory object. Pain is more than a psychological object of perception; it is a mode of perceiving. And pain is also more than a physical object of sensation; it is a process of sensing. Yet there are cases of extreme pain, which surpass the limit that Douglas sets. As the following analysis of extreme pains shows, there can be cases when pains become alien objects even though they are modes of experience. I shall demonstrate this thesis by analysing biographical cases of extreme pain presented by Scarry, Sartre and Wiesel as well as experimental cases examined by Grahek and Wall. As will become clear this analysis is no simple reproduction of the cases as presented by the authors; instead I use these cases to demonstrate my own thesis that we can take pains to be objects.

II

In her well-known analysis of torture and war, The body in pain, Elaine Scarry describes pain, as in the case of physical torture, as a destructive power “unmaking” the world. Scarry mainly points out two intertwined levels of pain unmaking the world: firstly pain

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bereaves us of language and secondly pain obliterates our bodily existence as beings in the world. Why does pain bereave us of language? Scarry starts with a philosophical answer before moving on to her analysis of torture and war. Pain, so Scarry contends, unlike other interior states of consciousness, for instance fear or love, has no external reference (Scarry, 1985, p. 5). Pains might pertain to injuries, for instance. Yet, like Douglas, she rightly argues that a pain is no injury itself, but a reaction to the injury. Pain is a state that cannot be objectified like injured tissue.7 Scarry goes a step further: pains, unlike other interior states do not “take” objects they refer to. That pain does not “take” any object means for Scarry that, unlike interior states (i.e., love or fear), pain resists expression in terms of external references. We have love of somebody or fear for someone, in which case our love or fear refers to “objects” denoting these states. But pain, unlike any other state of consciousness, has no referential content. Pain is not of or for anything or anyone. Pain cannot be an object and does not “take” any object. For Scarry objects are “extensions” of states (p. 162). The night, for instance, expresses fear like flowers are “extensions” of love. But nothing expresses pain itself. It is this objectlessness that almost prevents pain from being articulated in language (p. 162). More than any state, pain resists expression in language (p. 5). Hence, so Scarry quotes Virginia Wolf, (the English) language can express the thoughts of Hamlet and the tragedy of Lear, but has no words for the shiver or the headache (p. 4). Pain resists language. Severe pain only makes us scream and cry or call for words. But the closest we get is to say analogicaly: “it feels as if”, “it is as though . . . a nail is sticking in the bottom of my foot” (p. 15). One might grant that pain does not refer to, or like Scarry says, “take” an object like love does. But the fact that love does refer to an object, does not mean that this object necessarily is a direct, unequivocal expression – or extension (sic!) – of love itself. It seems to be more appropriate to ascribe an analogical structure to expressions of love. The objects that love “takes”, as much conveys analogically what it is like to love than what it is to analogically refer to pain. No matter what the reference is or is not, we can feel “inexpressible” love as much as “unspeakable” pain. Whatever object “love-of”

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takes, why should this not be as much an analogical expression of an elusive phenomenon than the analogies by means of which we describe our pains?8 The reason why pain bereaves us of language may to some extent be the fact that pains resist expression in language – as could be the case with love. Yet, the more decisive reason discussed by Scarry in the first part of her book is that pain not only resists language, but destroys language as such. Scarry offers an extensive analysis of torture and warfare, based on research material like Amnesty International Reports, to demonstrate this destructive power of pain. It suffices to briefly refer to some aspects of the pain of torture. “Torture consists of a primary physical act, the infliction of pain, and a primary verbal act, the interrogation” (p. 28). According to Scarry, the infliction of physical pain inter alia aims at the obliteration of psychological content (p. 34). That the prisoner speaks, is a sign of self-betrayal; his speech means the destruction of that which the prisoner identifies with (p. 29). In this sense the prisoner’s act of speaking (confessing) is actually an act of destroying his own voice; as far as speech expresses identity, his confession is an act of mental self-elimination. Hence, when torture is used to force a prisoner to speak, bodily pain is used to shatter speech. The prisoner who spoke has lost his speech and is left with his physical pain only. Therefore Scarry concludes that for the tortured the body becomes present the more it is crushed while the voice inversely becomes absent (p. 49). Torture evokes screams, grunts, incomprehensible laughter, exclamations, jeers, that revert to sounds prior to language, sounds that people cannot ascribe to their own voices anymore (pp. 42/43). Even when language is retained and confessions or information are given, the voice sounds detached and alienated; the tortured do not believe to hear themselves speaking (p. 49). The tortured body literally seems to drive out voice and invade all reality. This leads to the second aspect of pain unmaking reality. Torture does not only “unmake” the voice, but also destroys the body. To the extent which the body obliterates speech, the world we live in turns into a destructive, “soulless” space. Scarry (p. 31) gives an example of this obliteration by referring to Sartre’s descriptions in the short story, The Wall. The prisoner, Ibbieta, after his death sentence is announced, experiences his body as full of “pains like a crowd

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of tiny scars”. His body becomes its pains, its scars, it becomes thick and forgetful, unmindful of its hurt, unmindful of anything, mute and insensate. Ibbieta experiences his body as an “enormous vermin” to which he is tied, a collossus to which he is bound but with which he feels no kinship. “In its huge heavy presence, the rest of the world grows light, as though all else has been upended and emptied of its contents” (p. 31). Sartre’s Ibbieta experiences what Scarry calls the “enlargement” of the body, obliterating consciousness (p. 38). To the extent that the body expands, the rest of the world contracts. Scarry gives an impressive account of the tortured body invading space until the whole world is reduced to a single place.9 Finally torture, which is realised through the infliction of pain, makes the body expand to absorb the whole world, which in its turn changes into a weapon that crushes the body. In the end pain also destroys the very body, which occupies our reality. Like Douglas, Scarry argues that pain cannot be seen as an object. For Scarry pain is not only no object, but also does not take any object. Pain as inflicted during torture, destroys the language used to objectify (to make it an object or to refer to it in terms of objects) it. In this sense pain reduces reality to a mere “body in pain”. In the second part of her book, Scarry contends that whereas pain unmakes reality, it is imagination that makes the unreal. But as will be shown in the following parts, in Scarry’s analysis of torture there is an underlying premise that she does not explore: pain unmaking the real subsequently becomes unreal itself. Extreme pain serves as an instance of pain eventually evolving to a force that, like imagination, makes a most intense state becoming an unreal object.

III

How can pain, being so destructive, be associated with the unreal? Scarry associates the unreal with imagination and sees imagination and pain as the two most opposite extremes of experience: the real and unreal (161ff). For Scarry, like I pointed out above, pain pertains to a pure state that “takes” no objects. Imagination on the contrary entails a state that purely is its objects (p. 162). The only evidence that one is imagining, so she argues, is that imaginary objects appear

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in the mind. The object that is imagined, may appear in a nearly palpable or tactile proximity, but is never experiencable in a form of sentience. The imagined Pierre, so Scarry argues on the basis of Sartre’s analysis,10 might be much more vibrantly present than the absent Pierre, but is shadowy, dry, and barely present compared to the real Pierre (p. 163). “Imagination is an intentional object”, so Scarry concludes, but without an intentional state that can be experienced (p. 164). Pain, on the contrary, is an intentional state, but without an intentional object. The more we are in pain, so her argument is explained above, the less we are capable of making objects of our pain; our pain becomes absorbing, it destroys our objectifying capability – for instance in terms of language. This argument is turned around now: the more we imagine, the less are we bound to sentient states. Imagination entails an act of making objects that deviates from the sentient experience of these objects. Imagination therefore pertains to the realm of the sensory unreal. We cannot really have a sensory experience of what we imagine to see. And when we are in pain, we cannot really imagine to free ourselves from our sensory experience; the body in pain occupies us entirely. Therefore Scarry concludes: imagination makes the unreal, pain unmakes the real. Against Scarry’s own intention, her notion of pain intrinsically contains the perspective of pain as a state in which the unreal is experienced. Her brief analysis of Sartre’s The Wall, conveys that pain oscillates between the experience of bodily suffering and mental obliteration. But Scarry understands this obliteration in terms of unmaking the real instead of entering an unreal state. In Sartre’s story however the body not only unmakes, but “makes” us experience an unreal state. The body creates an enormous vermin, tying us to itself, swallowing the entire world. Ibietta’s body gradually invades his whole existence. Sartre meticulously scrutinises a subtle progression of this invasion. On the one hand Ibietta experienced mere bodily suffering. His body was trembling and sweating and stinging with many pains. But the more the night progressed, the more this physical suffering gave way to indifference (Sartre, 1957, 229ff). Ibietta gradually reported pains in his neck and head, which he could not call “real pains”, but something even worse (Sartre, 1957, p. 231). His suffering body was progressively giving way to

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pain, which made all sensory experience unreal. He described this state as a horrible calm: “my body, I saw with its eyes, I heard with its ears, but it was no longer me; it sweated and trembled by itself and I didn’t recognise it anymore. I had to touch it and look at it to find out what was happening, as if it were the body of somebody else” (p. 235). Ibietta’s body became the focal centre of his attention. His body was his entire object. But in a peculiar way this object remained a state. He was feeling his body, but as an object. Unlike Scarry’s Ibietta, Sartre’s Ibietta was indeed in a state of pain, which became its imaginative object. Pain made his body a figure of fantasy, an imaginative object, a vermin, which he was tied to. In Douglas’ vocabulary, Ibietta’s bodily pain became an alien object even though it remained a state of experience. He felt his body like one feels a sharp knife. His pain was an alien accusative, and yet it remained a mode of feeling, a connate accusative, cognate to the feeling. In Sartre’s vocabulary the body was an object of his imagination, but as his most extreme state of pain. Sartre in fact describes pain becoming imagination. Finally, facing his immediate execution, Ibietta’s world became so light, his body so heavy, that he found the surrounding seriousness of the jail and the wards nothing but funny. Contrary to Sartre’s own analysis of imagination, Ibietta was experiencing an unreal state, he was imagining a state that was his utmost reality. Pain made him experience a sensory unreal state.

IV

We find an even stronger and more self-evident account of what “pain making the unreal” amounts to in Elie Wiesel’s experience in Nazi concentration camps as described in his disturbing report, Night.11 A central part of Wiesel’s report deals with the prisoners’ final march and trip in the train to Buchenwald. It was a non-stop march through the night. They marched for over forty-two miles (an ultra marathon of about seventy kilometres), without food or water, in icy wind and snow. Those who stopped were shot, those who fell down were trampled by the thousands who followed. A major part of this description of the march deals extensively with the ever-changing

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tension between physical pain and mental absence. On the one hand Wiesel had to drag with him his body. His body was a skeleton, but had an unbearable weight. At the same time he moved mechanically as if in a dreaming state. For ever longer intervals he grew absent-minded. He experienced himself as two entities – his body and himself (p. 81). Just before the march began, Wiesel had a foot operation. He escaped from hospital because he was afraid to be selected. He ran with a bleeding foot. During the march he became entirely absorbed with thinking of his painful foot. Moreover there was the constant fear that his foot would let him down, which made him think of death incessantly. But then the fear for death gradually turned into fascination for the idea of not being, not feeling the horrible pains in his foot, not feeling anything, not weariness, nor cold (p. 82). This rather disturbing report contains a stunning analysis. Very striking is that Wiesel’s absorbing focus on his physical pain itself made him absently look on the very body that experienced the pain. First he was afraid that this body would make him die. But then he became fascinated by the possibility to get rid of this body as if it was an impeding object. He wished to die. His indifference became destructive. He became absent-minded enough, not only not to care for or even feel his body, but to turn against his body. His body became an invading enemy. First his body occupied his entire presence. More than ever he was his body. But this very absorbing presence pushed him into destructive mental absence. Metaphorically speaking, his mind reacted against his invading body. This means, his body was occupying his whole existence in a destructive way, and made him paradoxically defend himself against it. His mental absence consisted of the wish to escape from the invasive bodily presence. One could say that his body literally was mindblowing. And his mind started to take flight from his body. The relation to his present world gradually gave way to the fascination of the escaping mental absent. Wiesel began running without feeling his throbbing foot, without realising that he was running, without being aware that he “owned a body galloping there on the road in the midst of many thousands of others running” (p. 82). It was not as if he tried to ignore his body. It made him think of it incessantly. But thinking of his suffering body, thinking of it as an entity that he

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had to bear, a disease that was making him die, the very thinking of the pain most strangely removed him from it. The physical burden became too huge and made his mind try to escape. But it was only a kind of pass-out, for he did not lose his consciousness. He entered what he himself calls a dreaming state. Later on he was simply walking in his sleep. He managed to close his eyes and to run like that while asleep. “All I had to do was to close my eyes for a second to see a whole world passing by, to dream a whole lifetime” (p. 83). The pain always recurred to interrupt the dreaming. On the one hand the pain was like a rupture reminding the dreaming mind of its aching body. Their limbs were numb with cold despite the running, their throats parched, famished, breathless (p. 83). On the other hand the pain was like a joint that conveyed the suffering body to an absent mental state where it could forget its pain. The bodily pain attached to being in the world, yet the imagining mind detached from being absorbed by this same reality. The absence was a delusion, a form of escapism, yet as a positivum of existence itself. The absence was not a form of denial of reality, but an overcoming, a sur-passing, of it. “We were masters of nature, masters of the world. We had forgotten everything – death, fatigue, our natural needs. Stronger than cold or hunger, stronger than the shots and desire to die, condemned and wandering, mere numbers, we were the only men on earth.” Wiesel like Ibieta experienced a body in pain making them look on this very body as a detached object. Wiesel’s story is not fiction though, but “unimaginable” reality. In such a state of emergency people look upon their own severe suffering with so much distance, that reality changes to what can only be called the unreal. Yet the unreal was no mere imagined object, but remained a peculiar intensive state. Prisoners suffering together with Wiesel were dealing with a state of immense pain, but treated it as if it was an indifferent object. Physical pain became a mental object, because it was so extremely felt. Prisoners could feel pains and looked at their pains as objects felt. The pains experienced were simultaneously alien objects.

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V

In so far as accounts of extreme pain like those of Scarry, Sartre and Wiesel revolve around biographical detail, still more needs to be said about actual empirical research. Recent research provides significant examples of pains becoming objects. A first example most recently re-examined is the case of pain asymbolia, termed by Grahek (2001, p. 8) as pain without painfulness. Drawing on research of among others Berthier, Starkstein and Leiguarda (1988), Grahek reports that in cases of pain asymbolia people are fully capable of feeling and recognising pain stimuli, yet without perceiving these stimuli as unpleasant or even bothering. Quoting Berthier et al.: “Patients showed normal autonomic reactions (tachycardia, hypertension, sweating, mydriasis) during the painful stimulation, but failed to react with flinch, blink, or adequate emotional responses to threatening gestures presented to both hemispaces” (Grahek, 2001, p. 45). Pain asymbolia patients are said to be feeling pain sensations, but without perceiving them as painful. What is of particular interest is that during experiments such patients act with indifference toward their own pains and are capable to examine them as if they were objects not belonging to themselves. Grahek like others attributes such cases to brain damage, demonstrating that, severed from its affective, cognitive and behavioural components, an injurious sensation does not denote pain anymore (Grahek, 2001, 70ff). As the title of her research indicates, Grahek concludes that pain asymbolia patients feel pain, but without being in pain. Grahek is right to maintain that pain involves both a sensory feeling and the perception of being in pain. She then, however, seems to be inconsistent by concluding that people can feel hurtful responses without being in pain. Though pain symbolia patients may not always respond like we would normally expect from people in pain, they do report that their pain is agonising – as Grahek herself quotes one patient: “In fact it is still agonising, but I don’t mind”.12 As long as such patients recognise stimuli as hurtful, yet without being bothered too much by them, it seems to be inconsistent to say that they are not in pain. I would argue instead that such persons are in pain, but with the difference that they perceive their pain to be less agonising than others would. For whatever reason, they seem to have the peculiar ability to distance themselves from their own pains

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even to the point of observing them as if they were detached objects. Of course there are some extreme cases of pain asymbolia patients who feel stimuli, but do not perceive or learn to perceive them as hurtful. But then one should doubt if it makes sense to say that such people are capable of experiencing any pain at all. Neither does it make sense to conclude from such cases that people can feel hurtful stimuli, but fail to be in pain. As long as people do recognise stimuli as hurtful, though not disturbing, they rather demonstrate that pain states can become detached objects. Another well-known example is Wall and Melzack’s (Wall, 2000, p. 11) examination of pain in emergency room patients. Of the patients who were alert, rational, and coherent, 37 percent did not feel pain at the time of the injury. Of those patients with injuries to their skin 53 percent had a pain-free period and of those patients with deep tissue injuries 28 percent had a pain-free period. The majority of these people reported the onset of pain within an hour, others did not feel pain for many hours. Most of them were embarrassed at appearing careless about their pain. Such patients are well-aware of the meaning of their injuries and the pain-free state is localised precisely to the site of the injury. As Wall adds: “And all victims are eventually in pain” (2000, p. 11). Yet though they are in pain, they are able to localise and objectify the painful site with what appears to be careless indifference. In the biographical cases that Scarry, Sartre and Wiesel present, physical pain becomes a mental object, because it is felt to an extreme extent. In the experimental cases that Grahek and Wall discuss, extreme pain experience is at stake again. Now one can at least say that physical pain becomes a mental object, while it is (more or less extremely) felt. Thus the experimental data serve to inform and supplement the biographical material. In all these cases, however, prisoners like patients feel pains and look at their pains as objects felt. Once again, the pains experienced are simultaneously alien objects. One may reasonably doubt whether extreme pain can be taken as a paradigm case for normal circumstances. The pain suffered by victims like Wiesel eventually appears to be too severe to be real and pain in emergency rooms all but reflects usual experience. At least one cannot compare the pains that everyday life makes us bear

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with the pain that such extreme states cause. And yet an extreme state in its turn casts light on the effect that pain also normally has: it confines people to states of emergency. Even the smallest of pains occupy our entire attention. A mere toothache easily drives somebody to despair; a touch of sadness is enough to be disconcerting; even a brief separation may feel like a grievous loss. Pain is determined to make a difference to my whole existence. It does not take much suffering to make us look at our bodies as strange objects that we wish to get rid of. Also under normal circumstances pain can become a force that makes most intense states become mental objects.

VI

In a sense the discussed cases show that pain becomes an alien object in both Langsam and Nelkin’s terms. In Langsam’s terms the pain is an object of sensation; the pain is felt like a knife, an alien object not cognate to the feeling. In Nelkin’s terms the pain becomes an object of perception; the pain is a physical sensation to which prisoners or patients react indifferently as if it is an object felt. But contrary to Langsam’s and Nelkin’s accounts the pain remains a mode of intense experience even though it is perceived as an alien object. To some extent Douglas is right when criticising Langsam and Nelkin for mistaking pain states for objects of sensations or perceptions. Yet with the cases as analysed above I go further and show that pains can become objects while they remain states. Why is this important? There are two main reasons why it is important to see pains as objects as well as states. 1. The first reason is that, taken for a pure state, pain remains inexpressible. When we consequently view pains as states like Douglas, we end up with Scarry’s version of pain resisting or even obliterating language. Such a position seems to be aporetic. For, if as pure states pains take no objects, our expressions and even our analyses of pain must remain mere references to a phenomenon resisting references. Then we can only talk about pain that actually cannot be talked about. Our references to pain must then be either inapplicable or

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impossible. In that case we either talk about something else but not pain when we talk about pain, or we revert to a position prior to language in which there is no talk and only pain. But how should we know that there is “something” like pain when we cannot talk about it? Even to maintain that pain is inexpressible means that it inevitably becomes “something” we refer to. As such a “something” pain necessarily becomes an object of language. Admittedly, as Scarry maintains, extreme pain can bereave us of language. But such an exceptional state does not give reason enough to generally argue for the inexpressibility of pain. In fact, to say that we suffer inexpressible pain already means to find words like “inexpressible” to refer to such pain. If this seems to be too theoretical an argument, the cases discussed above do show how particularly inexpressible pain can lead to enough detachment to objectify what seems to be an absorbing state. One can still object that pain states de facto remain inexpressible as long as we do not find exact words to express them, with the result that they cannot be really coined as objects of language. Yet, even just by trying to find words for our pains means that we take them under scrutiny as objects of language. Actually, as I have pointed out above, in such a case there seems to be no reason not to refer to pain analogously like we do to love. The McGill-Melzack Questionnaire, which consists of pre-selected adjectives to help people describe their pains, demonstrates how patients express pain by means of analogies like burning, throbbing, shooting, pounding, gnawing. Even though such analogies may not be exact expressions, they do show how pains can be objectified. Moreover, the fact that they have the status of analogies particularly demonstrates that pain remains a state that resists complete objectification. Douglas contends that to objectify the feeling of pain is not to feel what it is like to be in pain. My argument, on the contrary, shows that we can objectify our feeling of pain while simultaneously feeling it. This is important, for if our pains were merely states, the question would be: how can we know that we are in pain if we cannot refer to “something” like pain? Ergo, pain must become an object or must take an object in order to be recognised as a painful state. 2. There is also a second reason why it is important to see pains as both states and objects. This pertains to pain treatment. It is

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well-known that pain entails a signal of damage that demands our attention. If so, then pain cannot be a mere state severed from mental contents such as the ability to pay attention. The above discussed cases demonstrate how pain itself forces us to attentively focus on our own hurtful state of being. Thus pain impels us to take action, for instance, to act sensibly in a state of emergency. Should pain completely absorb our mental capacity, then it would be impossible to attend to it, let alone with rational judgement. This attention requires a certain distance otherwise we would be subjected to a blind and passive state. If we cannot make our own state of pain an object of attention, then at least pain seems to lose its function as a warning signal. Of course extreme pains may have such an effect. But if a pain drives us into blind states, then such states seem to be the effect of the pain, not to be mistaken for the pain itself. Pains not only demand action, but moreover may take us beyond the possibility to act. Wiesel’s report demonstrates how pain itself pushes the body beyond itself to a point of mental distance and even indifference. This distance enabled Wiesel to a great extent to survive the absorbing nature of his pain. The same distance enables many emergency patients to remain calm to a point of indifference for the sake of survival. Such objectification does not itself remove the pain, yet only by objectifying our pain are we in a position to determine a possible treatment. In extreme cases self-objectification leads to such self-alienation that a person can become indifferent to his/her pains as if they were imagined. Imagined states can suspend pain at least temporary for the sake of survival. Yet pain becoming an object must remain a state to be a pain. Though one cannot compare such cases of extreme pain with normal circumstances, as I have pointed out, also everyday pains can make us look at our own bodies as strange objects. At least everyday pains compel us to pay objectifying attention to our own state of being, for example, to take necessary steps toward preventing or treating injuries. Some everyday examples go further and amount in what one can call the objectifying application of pain for other uses. So for instance, in physical training pain is used systematically to develop stamina whereas in masochism pain is calculably inflicted for the sake of pleasure. The underlying claim as in cases of extreme pain is that as hurtful states pains can be objects. Therefore I can

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argue that though extreme pains cannot simply serve as paradigm cases, they do show the general importance of taking pain states to be objects.

VII

As I have argued above Douglas rightly criticises Langsam, Nelkin and Grahek for mistaking pain states for objects of sensations or perceptions. Instead pains denote modes rather than objects of experience. However, I contend that one needs to go further. As my analysis of cases of extreme pains as presented by Scarry, Sartre, Wiesel, Grahek and Wall shows, there can be circumstances when pains become alien objects although they are states of experience. Such extreme cases cannot be simply applied to normal circumstances. But, as I have argued, these cases do show why it is generally important to take pain states to be objects. The first reason is that, taken for a pure state, pain remains inexpressible. As pure states pains could neither be objects of language nor could they take any such objects. Then we could not refer to “something” like pain, and we couldn’t know that we are in pain. Thus pain must become an object or must take an object in order to be recognised as a painful state. The second reason is that as a pure state pain would deprive us of mental contents such as the ability to pay attention to our own hurts and injuries. On the contrary, pain impels us to focus on it as an object of inquiry, for instance, to recognise ourselves as in a state of emergency. If we cannot make our own states of pain objects of attention, pain loses its function as a warning signal demanding treatment. Therefore my contention is that, though extreme pains cannot simply serve as paradigm cases, they do not only show the possibility but also the general importance of taking pain states to be objects.

NOTES ∗

This paper was part of a research project on pain in co-operation with Anton van Niekerk of the Department of Philosophy of the University of Stellenbosch, South Africa. I would like to thank an anonymous referee from this journal for helpful comments and suggestions.

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Douglas (1998, p. 128), Langsam (1995, p. 303). Langsam calls objects of sensations mental objects and somewhat confusingly distinguishes them from perceptual objects, which are not confined to a private realm and which exist even though they are not experienced (Douglas, 1998, p. 137; Langsam, 1995, p. 303). I return to this distinction later. 3 The latest and, in spite of controversy, still most generally accepted neurological theory of pain is called the gate-control theory, founded by Melzack and Wall. Ronald Melzack recently (1998, p. 574) said: “it is apparent that the theory is alive and well despite considerable controversy and conflicting evidence. Although some of the physiological details need revision, the evidence supporting the concept of gating (or input modulation) is stronger than ever.” Patrick Wall, together with Melzack acclaimed as one of the world’s foremost pain researchers, shows no doubt whatsoever when he reintroduces the gate-control theory in his latest book, Pain. The science of suffering (2000). There are numerous variations of the gate-control theory today. Wall himself offers another refined version in his newest book. Neurological theories based on the gate control theory presume to explain how information descending from higher centres in the central nervous system (top-down cortical processes) might exacerbate or inhibit the activity in fibres ascending from the body’s periphery (bottom-up sensory input). This means that there is significant control of pain by the brain activity, which realises cognitive functions, i.e., pain is not merely received but, in part at least, modified by cognition. In fact it is widely accepted that the primary destination of pain processing seems not to be the bottom-up pathway to the cortex, but rather the bottom-down reaction to stimuli. A stimulus is experienced as painful precisely because it is re-cognised as such. The International Association for the Study of Pain (IASP), representing numerous neurological positions, actually defines pain as being always a psychological state. For a critical discussion of the gate-control theory see Hardcastle (1998). 4 See Melzack and Katz (1994, 337ff.). 5 See, for instance, Wall (1994, 1297ff.) for fascinating examples like the anecdote of the surgeon whose abdominal pains were relieved by an injection of saline, which he held to be morphine (p. 1300). 6 An interesting point that remains is the question how far pains are private objects if they only exist when being felt by subjects (Langsam, 1995, p. 303). Besides the fact that pains are not objects for Douglas, he doubts that something that does not sustain when not perceived, can be called an object. Langsam admittedly goes a little further than Douglas presumes. He accepts that pains only belong to subjects privately, but thinks them to be observable by other subjects who don’t experience the pain. The skin of a person being sunburned for instance can be very well observed and the warmth of the skin even be felt, making a conclusion as to her pain possible. Though the pain is not felt by myself and I can leave the person with her pain, other than my own pain which follows me around, it is possible to conclude that the pain may exist when I am not there to experience it. In this sense the pain is only contingently private (Langsam, 1995, p. 107). On this point one must ask, like Douglas does, if Langsam does not confuse 2

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categories, because there is a difference between suffering a pain and observing somebody’s injury. Though Langsam admits that pains are essentially somatic and not observational (1995, p. 309), it is his notion of pains as objects that leads him to such category mistakes as objectively concluding pain experience. 7 See Douglas (1998, 128ff, 142). 8 Indeed there are lots of analogies to describe pain. After all, the well-known McGill-Melzack Questionnaire (p. 7), which consists of pre-selected adjectives to help people describe their pain, says something for the expressibility of pain itself. Moreover, the list of forms of expressions (works of art, political reports, medical questionnaires) that people find to describe their pain, as Scarry mentions in her introduction, very much seems to express how it is to be in pain. 9 Scarry begins with the room of a house in which somebody is tortured. A room, according to Scarry is an extension of the body and a joint to the world. Like the body it keeps us safe and sets boundaries that protect us. Yet the windows and doors of a room like eyes and ears enable contact with and a movement into the world as to make it a place of “homecoming”. The body thus is a miniaturasation of a safeguarding world, of protecting civilisation. Torture consists in barring and sealing rooms. The furniture which originally means “furnir”, to forward, to protect, thereby changes into instruments of agony. In the case of political torture furniture is annihilated as to undo its sheltering and comforting function (pp. 40/41). The rooms and house themselves are extended to the cultural world outside so as to occupy the entire civilised context the prisoner uses to live in. So, for instance, the pain the prisoner experiences will be called familiar technological names (like “the Portuguese submarine”), or linked to cultural events (“tea party”, “hors d’ oeuvres”), or to natural settings (“tiger cage”, the “parrots perch”), but particularly to negate the positive content these names bear (so “the Portugese submarine” for instance refers to electrified water) (p. 44). In this way pain not only enlarges the body to invade, but to destroy the world. 10 See Sartre’s (1961) analysis of the unreal object and unreal behaviour in The Psychology of Imagination (pp. 117–212). 11 One hesitates to analyse such a report. The following analysis takes place with respect for the experience of the author and in consideration of the danger to reduce his strong, self-evident account to cold, impoverishing examination. I have analysed this report in much more detail however in When pain becomes unreal, in Philosophy Today (2002, pp. 113–131). 12 Brand and Nancy (1997, pp. 210–211) quoted by Grahek (2001, p. 33).

REFERENCES Douglas, G. (1998): ‘Why Pains are not Mental Objects’, Philosophical Studies 91(2), 127–148. Gillet, C.R. (1991): ‘The Neurophilosophy of Pain’, Philosophy 66(255), 191– 206.

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Grahek, N. (1995): ‘The Sensory Dimension of Pain’, Philosophical Studies 79, 167–184. Grahek, N. (2001): Feeling Pain and Being in Pain, Oldenburg: Bibliotheks-und Informationssystem der Universität Oldenburg. Hardcastle, V.G. (1997): ‘When a Pain is not’, The Journal of Philosophy XCIV(8), 381–409. Langsam, R. (1995): ‘Why Pains are Mental Objects’, in The Journal of Philosophy XCII(6), 303–313. Melzack, R. (1998): ‘Pain’, in R.L. Gregory (ed.), The Oxford Companion to the Mind (pp. 574–575), Oxford: University Press. Melzack, R. and Katz, J. (1994): ‘Pain Measurement in Persons in Pain’, in P.D. Wall and R. Melzack (eds.), Textbook of Pain (pp. 337–357), Edinburgh: Churchill Livingstone. Nelkin, N. (1986): ‘Pains and Pain Sensations’, The Journal of Philosophy LXXXIII(3), 129–148. Olivier, A. (2002): ‘When Pain Becomes Unreal’, Philosophy Today 2(46), 113– 131. Sartre, J-P. (1957): ‘The Wall’, in W. Kaufman (ed.), Existentialism, London: Meridian Books. Sartre, J-P. (1961): The Psychology of Imagination, New York: Citadel Press. Scarry, E. (1985): The Body in Pain. The Making and Unmaking of the World, New York/Oxford: Oxford University Press. Wall, P.D. (1994): ‘The Placedo and the Placedo Response’, in P.D. Wall and R. Melzack (ed.), Textbook of Pain (pp. 1297–1308), Edinburgh: Churchill Livingstone. Wall, P. (2000): Pain: The Science of suffering, New York: Columbia University Press. Wiesel, E. (1982): Night, New York: Bantam Books.

Department of Philosophy University of Padua Italy