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Reconsidering pain
Norton Nelkin a
a
Department of Philosophy , University of New Orleans , New Orleans, Louisiana, 70148, USA
Published online: 10 Jun 2008.
To cite this article: Norton Nelkin (1994) Reconsidering pain, Philosophical
Psychology, 7:3, 325-343, DOI: 10.1080/09515089408573127

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PHILOSOPHICAL PSYCHOLOGY, VOL. 7, NO. 3, 1994 32 5

Reconsidering pain
 Norton Nelkin
Department of Philosophy, University of New Orleans, New Orleans, Louisiana
70148, USA

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ABSTRACT In 1986,1 argued that pains are essentially not phenomenal states. Using a Wittgen steinian
son of argument, I showed that the same sort of phenomena can be had on different occasions, and on one
occasion persons be in pain, while on another occasion persons not be in pain. I also showed that very
different phenomena could be experienced and, yet, organisms have the same sort of pain. I supported my
arguments with empirical data from both laboratory and clinical studies. There is nothing about this
thesis I would now retract. However, there was a further thesis that
needs to be reconsidered. I argued that phenomenal states are only accompaniments of pains, that pains
are essentially a combination of cognitive, affective and behavioural/motivational states. This thesis I do
now zaish to retract.
I now argue that phenomenal states are necessary for pains, but still not sufficient. There must
also be a cognitive state which involves an evaluation of the phenomenon as something like, 'Harm to the
body'. The evaluation is a kind ofde re belief, regarding the phenomenon as itself representing harm to the
body. Besides admitting that phenomenal states are necessary for pains, I also now claim that other
relevant belief states, affective states, and behavioural/motivational states are not necessary for pain, but
normal consequences of pain.
This revised theory is preferable to the 1986 one because it fits better with empirical facts
(including providing better explanations for anomalous cases), fits better with certain powerful
common-sense intuitions, and fits better with a larger theory of consciousness I have been developing.
Among other things, it turns out that being in pain is a quite peculiar conscious state and considering it as
a paradigm for consciousness is a serious mistake.

Introduction
In this article a theory of pain will be presented [1]. It will be argued that pain sensation
is a complex state, and not simply a phenomenal state (phenomenal states, it will be
argued, are themselves complex) [2]. In part 1, I will argue that pain phenomena do not
form a natural kind. In part 2, the theory will be presented, while in part 3, some of its
explanatory virtues will be illustrated. The theory will, while accepting the conclusions
of part 1, nevertheless maintain that pains are essentially phenomenal states, although
no particular kind of phenomena is necessary for pain, and pains are not phenomenal
states simpliciter [3]. Finally, in part 4, objections to
the theory will be considered and replied to.
As noted in previous literature (for instance, Trigg, 1970; Dennett, 1978;
3 2 6 NORTON NELKIN

Nelkin, 1986), not all common-sense intuitions about pains appear to be correct.
Among these intuitions are that being in pain is being in a transparent mental state such
that people experiencing pains are in the best position to judge if they are really in pain;
that pains are bad; that people cannot be in pain without hurting; and that hurting is tied
up, of necessity, with certain kinds of affects, beliefs, motivational states and behaviour,
such as trying or at least wanting to do something to alleviate the pain, finding it
 uncomfortable, and showing signs of its discomfort—grimacing, groaning and so on
[4]. Moreover, these attitudinal aspects of pain make pains a moral matter, because
pains bother people, and people want them to stop.
Cases of prefrontal lobotomy patients and of patients given morphine prior to
the onset of pain, however, call our common-sense intuitions into question. These
subjects claim to feel pain, yet say it doesn't hurt them. Their remarks are puzzling, to
say the least. Our intuitions concerning pain conflict in these cases: subjects say

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they are in pain and should be the best judges of that; yet they say their pains do not
hurt and subjects show none of the behavioural signs of hurting, nor the usual
motivational signs of wanting the pain to stop. There may be many ways to resolve our
problem here; but, for present purposes, all we need note is that a conflict exists that
requires resolving. If 'pain' is to be a useful concept in a science of human
behaviour—both as an experience to be explained in itself and as a cause of further
behaviours and experiences—then something of the common-sense concept will have
to be surrendered. Yet, since pain is one of those experiences we set out to understand,
it would be well for a science of psychology to preserve as much of the common-sense
concept as reasonably can be done. After all, the common-sense concept does seem to
pick out an important kind of experience—even if common sense only dimly
understands the experience—and science needs to explain that type of experience, not
something else totally unrelated to it. Of course, it could turn out that there is nothing
in reality even close to the common-sense conception; but there is no reason .to assume
that conclusion before we see what, if anything, can, and should be, salvaged.

A traditional view is that being in pain is nothing but experiencing a certain kind of
phenomenal state [5]. This identification, while preserving the transparency of pain,
fails to provide us with any insight into the lobotomy/morphine cases. Such a simple
identification theory is doubtful for other reasons as well: there are reasons to believe
that the same phenomenal state can be involved at one time in pains; yet, at other times,
occur, but fail to be involved in pain states. Moreover, there are reasons to believe that
very different phenomenal states can be involved in pain states, the phenomenal states
being so different from each other that it is difficult to see how they could form a natural
kind. I will briefly present arguments along both these lines (for fuller versions, see
especially 1986, 1987a, 1994b).
Empirical cases are at least compatible with the same phenomenon type's
occurring at a time when pain is experienced, while, at another time, occurring when no
pain is experienced (phenomena will be described as playing a dual role in these
RECONSIDERING PAIN 32 7

occurrences). While these cases do not entail the dualrrole hypothesis, they provide a
reason to take the dual-role hypothesis seriously. After presenting these cases, I will
then proceed to argue in favour of the hypothesis; although, in the end, the best reason
for accepting the dual-role hypothesis will be if the best theory of pain assumes it as
true. Thus, the theory of pain presented in part 2 will itself be an attempt to justify the
conclusion of this section, on which it is built. While sounding somewhat circular, this,
sort of justification of a tenet of the theory by the plausibility of the total theory is itself
 theoretically sound.
Consider the following cases: cultural differences seem to influence when one
feels pain. The intensity threshold at which both Mediterraneans and Nordics
experience shock phenomena of any kind is the same, and both Mediterraneans and
Nordics track increases and decreases of intensity of a shock stimulus equally. But
Mediterraneans describe their phenomena as pains at lower levels of intensity than

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do Nordics. A second fart is that people with chronic pain—causalgia, neuralgia,
phantom-limb pain—often have bouts of pain brought on by tension and worry. A third
interesting case concerns people who were given a light shock when they made
mistakes while being tested with a word list. None of the experimental subjects found
the shocks painful unless the word 'pain' or one of its close relatives was on the list. Yet
another fact is that making people less afraid often lessens their pain. For example,
certain 'preventives' for dental pain, such as a white noise machine was supposed to be,
worked only for dentists who had strong personalities and who had talked to the
patients beforehand, telling them that the machines were very success ful in preventing
pains. With doctors of weaker personality, or with ones who had not talked up the
virtues of the machine prior to the procedure, the machines by and large failed to
prevent pain (these examples are due to Melzack, 1973 and appear there passim; many
of them are reprinted in Melzack & Wall, 1983).
In another study (Glass et al., 1973), volunteer subjects were to push a button as
soon as possible after being given a six-second, somewhat painful shock (this was at a
level that each person had previously identified as painful). Several shocks were
administered in each testing period. The subjects were told that reaction time was
being measured. Afterwards, the subjects were divided into two groups. The control
group was told that the experiment would be the same except that the shocks would
last only three seconds. The experimental group was told instead that the shocks would
be shortened to three seconds if their reaction time was of a sufficient speed. Actually,
both groups received the same number of three-second shocks (speed threshold played
no role).
Following these sessions, both groups were surveyed as to the quality of their pain
experiences. The experimental group reported diminished degrees of pain relative to
their pre-test reports at the same level of shock intensity, although their autonomic
response measurements presented a like profile to that of their counter parts in the
control group, who reported no diminution of pain level. While this judging of pain is
after the fact, it provides at least some evidence that the experimental subjects really
did feel less, or sometimes no, pain [6].
While none of these cases in itself establishes that the same phenomena can be at
one time pain phenomena, at another time non-pain phenomena, each is compat
3 2 8 NORTON NEUON

ible with the dual-role hypothesis. Moreover, they provide evidence that dual roles are
not only possible but actual. Reconsider the Mediterranean/Nordic case. The identical
phenomenal thresholds, the equally accurate descriptions of the intensify ing of
phenomena as the stimulus strength is increased, and the similar neural make-up of the
two groups provide evidence that both Mediterraneans and Nordics experience the
same sort of phenomena even when one of them feels pain and the other does not. If so,
 pain cannot be simply a phenomenon. Wittgenstein (1953, §293, 100) makes exactly
this point in his beetle-in-the-box example. The phenom enon is relatively unimportant.
What is in the box does not matter. That the contents of the Mediterranean's box are the
same as those of the Nordic's does not matter: only the first feels pain.
Or reconsider the Glass ex al. experiment: the autonomic responses of the subjects
being exactly alike provides evidence that the phenomena are alike. Since

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experimental and clinical data suggest that changes in neuroanatomy or neurophys
iology result in phenomenal differences [7], we should also be able to postulate
conversely that when neuro-states are similar, phenomenal experiences are similar. Of
course, whether the relevant neural states are really similar is an empirical matter; but
the known data (for instance, that autonomic response measurements are the same)
provide evidence for their being similar. Also, it is somewhat of a triumph for the dual
role hypothesis if it is agreed to be an empirical question as to whether the phenomena
are the same or different.
Moreover, we have evidence concerning other sorts of phenomenal states that the
same phenomenal state might play different roles in different circumstances. Gregory
(1988) describes his experience of being slowly infused with the anaesthetic Ketamine.
At one stage of the infusion, he began to experience what he described as synaesthesia.
In particular, when his skin was scraped by items like brush bristles, Gregory
experienced what he described as vivid greens and reds, as well as other colour
phenomena—-from touch, not from vision (1988, p. 262). It seems a small step from
this actual case to imagine a race of beings who only experience 'colour' phenomena
with the experience of texture, and employ those phenomena to dis criminate textures,
not colours. These phenomena would be colour phenomena only, so far as I can see, in
an extremely attenuated sense.
While the Gregory case does not itself establish a dual role, even for colour
phenomena, it does provide yet one more piece of evidence that phenomena can play
dual (or even many) roles. If phenomena in general play dual roles, we should not a
priori expect pain phenomena to be different.
Consider two thought experiments, (i) Suppose that someone, neurologically
different from normal people, experiences phenomena like our colour phenomena in the
presence of stimuli like ice water immersion, powerful shocks, burns and so forth, but
has no idea that his or her phenomena are unusual. That is, such a person behaves as we
do, has the same emotional responses we have, shares the same beliefs and desires we
have about cutaneous or visceral damage, can say when a noxious stimulus is
intensified, and so forth. Given the way we learn phenomenal language, such a person
might well come to think—however wrongly—that he or she experi ences our pain
phenomena. Should we say that such a person doesn't really
RECONSIDERING PAIN 329

experience pains? That such a person doesn't really know what the word 'pain' means?
There would be little point in saying either of these things. Perhaps I am going too
quickly. Perhaps such a person couldn't have all the appropriate beliefs, desires and
emotions we have, nor make all the discriminations we make (a burning pain versus a
dull ache, say). At present, we do not know whether such a state of affairs is possible or
not; but it is an empirical, theoretical question whether it is. Supposing it is possible, to
 deny that this person had ever been in pain would seem perverse.
(ii) Next, consider people who deny they feel pain at all. There are such people,
though they tend to die young because of injury or accident, or because of visceral
damage brought about by their failure to change positions, especially while sleeping.
Suppose such a person, in fact, experiences phenomena just like those we experience
when our stomachs ache or when we cut our arms. But the phenomena do not alarm

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this person, or cause the person to look at the arm, or cause worry about the stomach,
or cause a desire for the phenomenal experience to cease. That is, the person has none
of the ordinary attitudes, makes none of the usual evaluations concerning the
phenomenon, but does experience the phenomenon. Is such a person in pain after all,
and are we (including the person in question) just deceived all along? We could say
that, but it is difficult to understand what could reasonably motivate us to do so.
Trigg (1970) seems to hold that this person would be in pain after all, but the
person in the first case, described above, would not be. That is, he identifies pains with
pain phenomena. Trigg sees that some of our intuitions about pains must be
surrendered, but he gives up the wrong ones. He has to give up more of them than I
will have to, he has a much harder time accounting for all the facts, and he cannot fit
those facts into a general theory of sensations. He continually asserts that all pain
phenomena are alike, form a natural kind; but that is just not true [8]. Though
introspection, cannot resolve many of the problems in this area, an appeal to the
reader's introspection on this issue seems entirely legitimate: consider the significant
differences among phenomena we do call pain phenomena (those experienced when
cut, when suffering a toothache, or when having a headache). It is hard to under stand
what feeling they all share in common such that they are all pains. A judgment about
the phenomena (that they are painful) is shared, not a particular sort of phenomenal
feeling.
One might insist that this thought experiment is also too fanciful. Anyone who
really experienced pain phenomena would have to be in pain. But there is no reason to
consider this claim as a priori true; and, empirically, the lobotomy and morphine cases
suggest that it might be false. Thus, in regards to the two thought experiments, the
dual-role hypothesis recommends that we treat the first sort of people, despite their
lack of our pain phenomena, as being in pain, and that we treat this second sort, despite
their experience of our pain phenomena, as not being in pain. Similarly, when one is
deciding whether a particular phenomenon is a pain or a tickle, or a pain or an itch, one
is surely deciding a further categorization of the phenomenon in question rather than
deciding what the phenomenon feels like.
There is nothing obviously alike in all pain phenomena, if we consider only the
3 3 0 NORTON NELKIN

phenomenal states in themselves. They all hurt, of course; but the question is whether the hurt of
these states lies in their phenomenal 'feeling'. Given how different the phenomena are from each
other, it would be pretty remarkable if that were the case.
In the next section, I will assume the dual role of pain phenomena. But it should be emphasized
that I am not denying the existence of pain phenomena. I am denying only that pains are to be
identified with a natural kind of phenomena, even denying that pain phenomena form a natural
kind. Yet I will maintain that phenom ena are essential to being in pain, even so.
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Call the theory of pain to be presented in this section the evaluative theory of pain. In recent years I
have been developing a theory of sensations, consciousness and mind in general; and the evaluative
theory of pain fits in with that broader theory of mind [9]. For the purposes of this paper, only a few
elements of the broader theory need be rehearsed. At this juncture, the most important is the thesis
that 'conscious ness' names three separate, dissociable states, states I call 'sensation consciousness'
(CS), 'propositional-attdtude consciousness' (Cl), and 'introspection consciousness' (C2). Only CS
and C2 need occupy us for the present. CS may be thought to consist of phenomenal states (though
the actual analysis of phenomenal states is more complicated than I have so far indicated—see
below). By 'introspection consciousness' (or, more simply, 'introspection') is meant a second-order
state that has the occurrence of CS and Cl states as its content (for a similar view—though he does
not use the term 'introspection', reserving that term for another purpose— see Rosenthal, 1986).
Introspecting a state does not require attention to it, intro spection is not incorrigible, and
introspection is unlike perceiving (the mode of representation is different, and, among other things,
it is unlikely that anything in introspection plays a role analogous to that of sensory organs in
perception).
In addition, introspection itself has no phenomenology to it (nor does Cl—see especially 1987b,
1989a). In the sense in which there is something it is like for an organism to experience
phenomenal states (Nagel, 1974), there is nothing it is like for an organism to introspect. Since this
claim is controversial, perhaps a little something can be said in its favour (fuller arguments are
presented in 1987b, 1989a, 1993b). Basically, the argument structure resembles that of part 1: to
show that the same introspective thought-type can occur with different phenomena, and the same
phenomenon can occur with different introspective thought-types. In fact, there is reason to think
that introspection does not require phenomena at all.
We can support this conclusion by first considering Cl states, many of which do not require
phenomena either. Consider the thought that tomorrow is Tuesday. That very different phenomenal
states may be experienced when thinking it is obvious. And it is not obvious why a being without
any phenomenal experience might not think it. It is true that we distinguish that thought from the
thought that tomorrow is Wednesday, and distinguish it from the hope that tomorrow is Tuesday.
And our being able to make these distinctions has a basis. But there is no good
RECONSIDERING PAIN 331

reason, other than the fact that sometimes we seem to be able to distinguish
experiences on the basis of phenomena, for thinking that the basis in these cases is
phenomena [10]. And the arguments are analogous for second-order, introspective
thoughts.
Faced with these objections, some philosophers (Searle, 1983; Leon, 1988, for
instance) agree that phenomenal states are unnecessary for such thoughts, but claim
that such thoughts, if not phenomenal, are instead phenomenological—'felt', even if not
felt. My own response to this reply is to deny such phenomenological properties of my
own thoughts—and to deny having the least idea what such properties are. I don't deny
that I have thoughts like these and occasionally introspect them. I deny only that there
is some 'felt' (or felt) quality that provides the basis for either having or recognizing
these thoughts. Moreover, I am bold enough to deny any such qualities of human
 beings in general (though my own case as an exception is enough

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to establish my claims). Phenomenological qualities seem to be a relic of a British
empiricist view that has had its phenomenal rug pulled out from under it.
Moreover, supported by theoretical considerations and by recent laboratory and
clinical findings (Keating, 1979; Stoerig & Cowey, 1989; Stoerig, 1987), I have argued
(1989b, 1993b) that one could be in phenomenal state S while not being
introspectively aware that one was in S. And when one is introspectively aware of S,
the only phenomenality occurring is the phenomenality of S. Introspection adds
nothing phenomenal to S [11]. The cases cited above involve blindsight discrimi nation
of colours. If one believes that colour experience necessarily involves phenomenal
states (as Hardin, 1988 and Boghossian & Velleman, 1991 seem to do), then these
seem to be cases of unintrospected phenomena. And even if one thinks colour
experience does not necessarily involve phenomenal states as denning of colour (I am
in this camp), there are still reasons to think that there are unintro spected phenomenal
states in blindsight experience. But these latter arguments are much too long and
involved to be presented here [12]. All I can say here is that many experiences, both
ordinary and exotic, are made sense of by the notion of unintrospected phenomena.
The dissociations between phenomenal and introspec tive consciousness play an
important role in the discussion to follow.
Let me now sketch the evaluative theory [13]. Earlier, the moral importance of
pain was noted. One reason for its moral importance, I would like to suggest, is that,
like other moral terms, 'pain' is at least partially an evaluative term. When one ascribes
'pain' to oneself, one is not merely describing a condition of oneself. One is also
evaluating that condition [14].
Pains have two components: an occurrent state of the organism and an evalu
ation of that state. An evaluative element is essential because our concept of pain is an
evaluative, as well as a descriptive, concept. Since there seem to be no better candidates
for the occurrent states evaluated, I am willing to concede that phenom enal states are
those states. So I am willing to accept that every occurrence of pain involves an
occurrence of a phenomenal state. However, I believe my earlier arguments to have
shown that (i) no particular phenomenal state is necessary for that role ('pain
phenomena' do not constitute a natural kind); and (ii) the phenom enal state by itself
does not constitute the pain: unevaluated, or evaluated differently,
3 3 2 NORTON NELKIN

there will be no pain, even though the very same phenomenal state occurs. Pains are
bad, but no phenomenal state in and of itself wears that evaluation. Phenomenal states
may have intrinsic qualities 0 think they do), but being a pain is not one of them. To
have a value is, in this case (if not in all), to be evaluated. Such a view comports well
with the cases cited in part 1.
Obviously, the key term in this analysis is 'evaluation'. What is meant by it? More
fully stated, pain involves both a phenomenal state (a CS state) and a spontaneous,
non-inferential evaluation of that state as representing a harm to the body (a C2 state).
Only when the two states occur together does an organism experience pain. However,
neither affects nor motivational states are necessary to being in pain. One can be in
pain, but deny that it bothers one and fail to be motivated to do anything to stop it.
 Pains consist entirely of a phenomenal state and the simultaneous, spontaneous
appraisal of that state as representing a harm to the

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body.
Further clarification is required. When I say that the phenomenal state is evaluated
as representing harm to the body, I do not mean that one represents the CS states as
harmful to the body. CS states, as far as I can tell, are always brain states; and those
brain states are not usually harmful to the body. It would be most peculiar if the result
of evolution were that we always made mistaken evaluations, evaluating as harmful the
brain states themselves. Rather, the evaluation is a second-order representation state (a
C2 state). CS states are themselves representa tional [15]. In the case of those
phenomena we think of as bodily sensations, various states of the body are represented.
In pain, there is also a C2 state that evaluates the state of the body so represented as
being a harm to the body. So the CS state itself is not evaluated, but the state of the
body it represents. The phenomenal state is the occasion of the evaluation, not its
object.
Certain phantom limb cases provide evidence for the representational nature of
phenomenal states in pain. In some cases of phantom limb, brain areas previously
connected to intact areas of the body switch to representing the missing limb. For
instance, there are patients who, when a particular patch of their face is stimulated,
experience these stimulations, including pain stimuli, as occurring in their ampu tated
limb. Moreover, a one-to-one correspondence exists between points of the facial patch
and the missing limb, such that a stimulus at point Ai on the face is felt as at point A2
on the limb; at Bi, as at B2; and so on. More remarkably, the representations are
qualitative as well as spatial: warm water trickling down the facial patch is felt as warm
water trickling down the missing limb, and so on—pains included (see Ramachandran
et al., 1992). The apparent representational nature of phenomenal states involved in
phantom pains makes it plausible that phenomenal states involved in ordinary cases of
pain are also representational.
A second important feature to be stressed is that the judgment component at issue
(the evaluation is a kind of judgment) involves a de re, referring, element. The
judgment is about some actually occurring phenomenal state. So no pain-judgment is
possible without a pain-phenomenon. Both are necessary for, and mutually constitute,
feeling pains.
But what about those other belief states, affective states, and motivational states
RECONSIDERING PAIN 33 3

that are so often involved when one is in pain? Pains are only causally connected to
such states and can occur in their absence. That there exists only a causal connec tion
between pains and these other states, that these other states are not constitutive of pains,
helps explain anomalous cases. We will take a look at some of these anomalies in part
3.

We can use the morphine and prefrontal Iobotomy cases to clarify the evaluative
theory. In both sorts of cases, subjects behave strangely in the face of stimuli normally
 thought to cause pain (shocks, immersion in ice water, and so on). As remarked
previously, when asked about their experiences when so stimulated, subjects say they
feel pain but it doesn't hurt (Melzack, 1973; 1975; Melzack &

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Wall, 1983, pp. 168-9). Are these patients in pain or not in pain?
The evaluative theory maintains that when shocked, or immersed in ice water,
these patients are in pain: they are experiencing a phenomenal state and evaluating it
as harmful to their bodies; but they lack the normal causal connections between their
pains and the usual attitudes. Their remark means just what it appears to mean—where
"hurt' is to be read as expressing an affective state (also expressed by 'I am in pain, but
it doesn't bother me'), which is contingently disconnected from the pain state. It is
notable that, although these subjects say the stimuli do not bother them, if asked
whether they would prefer that the stimuli be stopped, they agree that they should be
stopped. Moreover, we have evidence from other behaviours of Iobotomy patients that
their emotive and affective responses are dulled, while their sensory skills do not, in
general, appear to be dulled.
Masochism, too, is understandable from this model: again, the connections
between pain and the attitudes are severed (or partially severed), or, instead, conflicting
attitude states result. That is, the masochist is in pain, even hurts, but, nevertheless,
desires the pain to continue.
Besides providing an understandable analysis of such anomalous cases, the
evaluative theory also: (1) fits better with available empirical evidence; (2) preserves a
good many of our common-sense intuitions about pain; and (3) fits better with
theoretical claims of a larger theory of mind.
Pain measurement scales, which have proved to be valuable diagnostic tools for
practitioners, all include a series of pain-descriptors that seem to refer to phenom ena:
'sharp', 'dull', and so on; and these descriptors are taken as phenomenal descriptors by
the people who both make up and read these scales (see Melzack, 1975). One might
treat these descriptors, not as phenomenal descriptors, but as affect descriptors (as I
once [1986] did). Such a ^description is probably not fully convincing, though it is not
obviously mistaken either. The evaluative theory allows, on the other hand, that these
terms are phenomenal descriptors. However, an important proviso: the
descriptors—'sharp', 'dull', and so on—are 'names' of properties of common external
causes of such phenomena, not 'names' of the phenomena themselves [16]. No
phenomena are intrinsically pain phenomena. No natural kind, 'pain phenomena',
exists. So the major thesis of part 1 is in no way
334 NORTON NEUON

undercut. 'The pain is sharp' says something like, Th e pain I am now experiencing is a
phenomenal state representing harm to the body and is like the phenomena I feel when I
am poked with a sharp object'. And similarly for descriptors like 'dull', 'stabbing', and so
on. But these phenomena may, in themselves, be different for members of different
species, for different members of the same species, even for oneself at different times.
Despite the use of phenomenal descriptors on pain measurement scales, the
gate-theory (Melzack, 1973; Melzack & Wall, 1983) really treats pain primarily as a
functional state. Nothing is said about the phenomenal qualities per se. And the
evaluative theory explains very nicely why functional analyses of pain can take us so
 far: if a phenomenon is needed to be evaluated as harmful, but which phenomenon
doesn't matter, then the phenomenon is like a place-holder in the theory, a mere X. We
can go a long way toward explaining pains, even while ignoring the actual

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phenomena themselves.
However, at the same time, there is a widely-shared intuition that purely functional
analyses omit something crucial (Block & Fodor, 1981). That intuition is also
understandable on the present analysis. And it could turn out to be the case that human
(or mammalian, or earthly animal) pain phenomena form a restricted class of
phenomena kinds (which would not belie the 'no natural kind' claim) [17]. If so, we will
not understand pain fully unless we go beyond a functional analysis and discover what
this class is and why only its members form the class for us (for mammals, for earthly
animals). But these are empirical issues, and will not be resolved until we know a lot
more about phenomenal states than we currently do.
The present theory allows us to preserve .as true the folk psychological bicondi
tional, 'One is in pain if and only if one believes oneself to be in pain', or, rather, it
allows us to capture something very close to that biconditional. The biconditional is
close to being right in that a kind of judgment is essential to being in pain: one can be
in pain only if one makes the proper evaluative judgment. And if one makes that
judgment, and given that that judgment is a de re judgment, then it is also true that by
making that judgment one is in pain. The present analysis makes sense of why we take
the biconditional to be true. Without such an analysis, it is difficult to see why it would
be thought true.
But it is important to see that merely making the evaluative judgment consti tutes
pain (given the judgment is de re, the phenomenon must also be present). Making the
judgment does not mean that the bodily state represented by the CS state is accurately
C2-evaluated as being harmful to the body. Because a gap exists between making the
evaluative judgment and the evaluative judgment's being correct, we can understand that
someone can be in pain in the absence of physiologi
cal harm. Hypochondriac pain, at least of one kind, fits this description very well.
Hypochondriacs experience bodily sensations that represent states of their bodies; but
their spontaneous, introspective evaluations of these bodily states as harmful are
mistaken. Any of us might be subject to such errors on occasion. It is only because
hypochondriacs present a pattern of such mistaken evaluations that they are
hypochondriacs. So here we have yet another anomalous case, hypochondria, to add
RECONSIDERING PAIN 33 5

to those of the morphine/lobotomy and masochism cases, that becomes quite

understandable on this analysis [18].
The hypochondria cases suggest that, although the evaluations are spontaneous
and non-inferential, we have some measure of control over them. We blame
hypochondriacs for their misevaluations. We believe that not only can we be stoical in
the face of pain, we can even learn not to feel pain under conditions where we once, or
once were likely to have, felt pain. Think of how we teach children exactly this 'skill':
we tell them that the fall didn't really hurt. In addition, we can also understand how
people can be injured, fail to feel pain, see the wound, and only then begin to feel
pain—even though the phenomenal state has not changed. If the theory is right, only
 on seeing the wound does the person spontaneously evaluate the phenomenon as
harmful.

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We also gain insight into how and why pains are located in bodily parts. From
phantom-limb cases (Melzack, 1973, pp. 50-60; Melzack & Wall, 1983, pp. 72-86;
Ramachandran, 1992), we know that pains are sometimes 'located' in non-existent
parts of bodies. So, on few accounts that I know of (Stephens & Graham's 1987
account is an exception), are pains in the leg, say, actually considered to be located in
the leg. Pains in the leg are in the head. Nevertheless, the phenomenal state involved in
a pain in the leg represents a state of the leg. But, of course, the CS representation may
itself be inaccurate (compare the Ramachandran et a/., 1992 cases). Amputees really
do feel pains in their (amputated) legs: both the CS states, which represent their legs,
and the C2 states, which evaluate the CS states as representing states harmful to the
body, really exist. The pain is no illusion. But the CS representation that is evaluated is
itself mistaken, and gives rise to the illusory location of the pain. Referred pain can be
understood in a way similar to phantom limb pain: a pain is felt in the shoulder
because the CS state being evaluated represents a state of the shoulder, even though the
actual bodily harm is a state of one's tooth [19].
Of some interest, and relevant to this analysis, is the evidence that young
children feel pains but do not locate them very well (Leach, 1989, p. 533). Two ways of
understanding this fact mesh with the present account, (i) Children do not experience
pains-in-the-leg, only pains-in-the-body. CS representations grow more refined as we
grow older; and as they get more refined, we feel things we could not feel before. A
corollary is that we adults do not feel a pain and infer it is in the leg, but we, instead,
feel a pain in the leg. No inference is normally involved, (ii) CS represents a state of the
leg from the very beginning, but only minimal information about (or understanding of)
this representation is accessible to introspective con sciousness, such that the C2
evaluation, while about a state of the leg, is cognized at an introspective level only as
regarding some state of the body or other. In this case, the child can be thought of as
having a pain in the leg, feeling it there, but not being introspectively aware that that is a
correct description of its pain. The introspective description of its pain is dependent on
how much information about (or understanding of) the CS representation is available to
C2. The phenomenal feeling is readily available, but the available representational
information of the CS state is minimal. For whatever reasons, as we age, more of this
latter information (or
3 3 6 NORTON NELKIN

a greater understanding of the information) makes its way into introspective

consciousness.
Which of these two ways (if either) of understanding the fact that infants and early
toddlers do not easily locate their pains is correct will be decided by empirical theory.
My own bet, for large-scale theoretical reasons, is the second way.
• Besides fitting better with empirical evidence and preserving a great number of
common-sense intuitions, the evaluative theory has consequences I find quite congenial to a larger view of
the mind. Being in pain requires being conscious in at least two senses: CS and C2. There must be the
second-order awareness of the first-order state. Thus, both forms of consciousness are ascribable to any
organism we correctly ascribe pains to. If we are justified in our ascriptions of pains to non-human animals,
then both forms of consciousness go pretty far 'down' the phylogenetic scale. While many might find this
result unsurprising for CS, it is Downloaded by [McMaster University] at 10:30 02 March 2015
probably more surprising when it comes to C2. But it shouldn't be. Elsewhere
(forthcoming), I argue that C2 is necessary for an organism's coming to conceive of an
external world and of there being objects in it, as well as for the organism's
differentiating itself as a thing in that world. Since I think that animals fairly far 'down'
the phylogenetic scale do conceive of an external world and do distinguish themselves
as different from other objects in that world, I find this result quite pleasing. Also, given
that C2 is essentially involved in so primitive a state as pain, and given the importance
of pain in an organism's life, it becomes more under standable how evolution could give
rise to a greater role for C2 in some organisms than it has in others. All that is required
is taking advantage of a mechanism occurring comparatively early on in evolutionary
history.
Finally, given the tight fit of CS and C2 in pain experience, and given the
importance of pain for our lives and behaviours, it becomes quite understandable how
philosophers (Nagel, 1974, 1986; Searle, 1989, 1990; McGinn, 1988, 1989— among
other recent examples) could take consciousness to be unitary and indivis ible, having
both a phenomenal side and an introspective side. As I briefly argued in part 2, and
more fully argue elsewhere (1987b, 1989a, 1989b, 1993a, 1993b), CS and C2 are
actually dissociable—but, as we now see, not when it comes to pains. Yet pains are
often presented as paradigms of conscious states. In fact, if the present theory is
correct, pains are not paradigms of conscious states, but quite unusual. Pains are one of
a very few kinds of states (along with bodily pleasures) where CS and C2 cannot be
dissociated without the state itself disappearing. Phenomena are dissociable from
introspection. Even the CS state that occurs in a pain-experience is dissociable from its
C2 state. But, as dissociated from the relevant C2 state, it is no longer pain (as is
suggested by the Glass et al., 1973 study). By focusing on pain, an atypical conscious
state, we have been led to draw false conclusions about consciousness itself (or better,
consciousnesses themselves).

While all these reasons weigh in favour of accepting the evaluative theory, there
appears to be a serious difficulty for my accepting the theory. As adverted to in the
RECONSIDERING PAIN 337

previous section, I elsewhere (forthcoming) argue that we learn to distinguish an

external world, objects in it, and ourselves by acting on the world, by distinguishing
acting from being acted on [20]. And among the feedback experiences that allow us to
make this crucial, and foundational, distinction is pain. But if we feel pain before
we have a concept of body, how can we, as infants, evaluate a phenomenon as
representing a harm to the body?
In discussing children's difficulty locating pains, I maintained either that (i) the
CS representation can become more refined, or (ii) various amounts of information (or
of understanding) concerning the CS representation can be available to C2. Either of
these possibilities allows the present question to be answered, (i) The most primitive
form of C2 evaluation in pain is expressible in English (which is not the representation
 system of infant thought) as something like, 'This state of being is harmful!' No more,
no less. This is because the CS representation evaluated is itself

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something like 'this state of being' [21]. Only later do we learn to evaluate a
phenomenon—and, thus, to feel it—as 'Harm to the body', because only later do
phenomena representing states of the body begin to emerge, (ii) Very little infor mation
about (or understanding of) the representational content of the CS state is accessible to
C2. Because the infant does not yet have the concepts BODY and LEG, it cannot
introspectively even think of (describe) the CS representation as representing what it
does represent. At best, it can think of the representation only as 'this state of being'.
On either reading, 'The state here represented is harmful!' is the generalized form of all
pain evaluation.
How are we able to evaluate relevant phenomena in this way without prior
experience of harm? We have evolution to thank. For we must be hard-wired to react in
this way, to make such evaluations, evaluations that are mostly 'correct' (in the sense
that the phenomena so evaluated really do represent harm to ourselves— though we, of
course, have no concept of body, nor of our self). And there is additional evolutionary
'luck' that pains are tied to the affective and motivational responses they normally
evoke. Just as the larger theory of mind maintains that we are aware of being 'in-control'
before we are aware of our self, it maintains that we
similarly represent 'This state of being' before we represent 'This state of body' (or,
instead, introspectively understand our CS representation as 'this state of being' before
we are able to understand it as 'this state of body'—again, either solution is congenial
to the evaluative theory).
A second apparent difficulty for the evaluative theory goes as follows: pains are
said to consist of a CS state and a C2 state. But surely C2 is an evolutionarily
sophisticated state that we human beings possess only because of our large neocor tex.
But many non-human animals possess very little, if any, neocortex, yet feel pain. So
the analysis cannot be right.
I agree that many non-human animals with very little neocortex feel pain. But
I also maintain that pain requires an evaluative state. For reasons presented in part 1,
phenomena alone do not account for pain; and no other analysis makes as much sense
of difficult cases or solves so many problems as the present one. The mistake, then,
must be in thinking that such reflective states are highly sophisticated. I would predict,
instead, that introspection must be, in itself, a fairly primitive state, appear
3 3 8 NORTON NELKIN

ing at least as early as the first creature that felt pain. It may be that C2 is realized by
different brain systems, some of them perhaps non-neocortical altogether, much as
vision seems to be realizable by different systems (see Weiskrantz, 1977, 1986). Again,
as with vision, the ways in which introspection is realized may make it to have a greater
or lesser cognitive range: the states accessible, and the amounts of information made
available, to introspection for us may be much more numerous and greater than those
accessible and available to other animals. That nature could first achieve a minimal
introspective capacity would make it a matter of gradual evolution that such a
mechanism could evolve complexities allowing it to play a greater and greater role in
the lives of some organisms. But just to feel pain, very little sophistication is needed in
 the introspection mechanism. It is interesting, and fits my claims, that there seems to be
a significant neocortical input into our feeling pain, and not just assessing it after it is
felt; and this input is missing in non-primates

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(Stembach, 1968, passim; Melzack, 1973, p. 103; Melzack & Wall, 1983, pp. 167-9).
For us, neocortical realizations of introspection may have replaced earlier midbrain (or
the like) realizations [22]. There is no evidence that the kind of C2 required by the
evaluative theory is too sophisticated for animals 'down' the phylogenetic scale. The
impression that it is too sophisticated comes from thinking about human introspective
capacities.
Actual experiments with non-human animals support the idea that evaluative
introspection plays a role in their pain. When dogs have one of their paws shocked,
they react strongly: pulling the paw away, licking it, running away, yelping and so on.
That is, we have good reason for thinking these dogs are in pain. Yet, Pavlov (Melzack
& Wall, 1983, p. 36) found that if he repeatedly fed a dog immediately after the shock,
the dog's behaviour changed considerably. While the paw might reflexively be pulled
away, the dog showed none of the other characteristic pain behaviour, but instead
displayed the excitement and pleasure of a dog about to eat. When the feeding followed
the shocking of the same paw in each trial but not the shocking of any of the others, the
pleasurable behaviour followed the shocking only of that paw; pain behaviour still
followed the shocking of any of the others. This experiment provides a reason to think
that the dog experienced similar phenomena in the case of each paw, only it sometimes
did not find such phenomena painful. The phenomena did not have the same meaning
for it in each case; and it was the meaning (i.e. the dog's evaluation), not the
phenomena themselves, that determined whether or not the dog was in pain.
Finally, a brief consideration of one more difficulty: one could experience a
phenomenon, evaluate it as harmful to the body, yet label the experience 'a tingling',
say, not 'a pain'. My response is fairly straightforward: the evaluation of a tingling as
harmful to the body is not a simultaneous, spontaneous, non-inferential evaluation as is
the evaluation, 'Harmful to the body', in a pain experience. We have to infer that a tingle
means harm to the body. The evaluation as 'Harmful to the body' is not constitutive of
the experience's being a tingling.
But in the previous discussion of hypochondria it was noted that one could be
taught not to evaluate in a spontaneous, non-inferential way that one's phenomenon
represented a state harmful to the body. Putting this point upside down, couldn't
RECONSIDERING PAIN 33 9

one, after a while, learn to make the previously unspontaneous, inferential evalu ation
of the tingling in a spontaneous, non-inferential manner? [23]. Yes, but, upon
succeeding, the tingle would no longer be merely a tingle. It would be a painful
tingling. Tinglings really are different from pains, and the introspective, evaluative
element is what makes pains distinct. In fact, exactly as distinct, for the phenomenon
experienced could be the same in cases of each [24].
Perhaps a further confusion can be prevented by answering the following
questions: 'Aren't tinglings sometimes introspected, yet one not be in pain? If so, how
could adding introspection to tinglings be pain}' One can be introspectively aware of
tingling without being in pain. But there are all sorts of introspective (C2) states. Only
 when the introspective state involves a de re judgment of a particular kind—a
spontaneous, evaluative representation of the form, 'This state represented by CS is
harmful'—does pain occur. Not all introspected phenomena are pains. Far

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from it. But all pains are introspected phenomena.
One might also claim that a state like nausea, unlike tingling, does involve
essentially the evaluation, 'Harm to the body', and yet nausea is not pain (see Trigg,
1970). But if one considers the great diversity of phenomena experienced in states we
do call pain (a cut, a toothache, a headache, and so forth), it is difficult to see what they
share'in common but which nausea phenomena lack. So the objection is unlikely to be
right. I can only speculate on why nausea isn't considered a pain. It might be that 'pain'
and its synonyms were originally only used for phenomena (evaluated as harmful)
resulting from overt bodily injury. It then, quite naturally, got extended to cover those
resulting from internal states like appendicitis, toothache and headache. So far nausea
has not been included, but only because the circum stances are just different enough
that English speakers have not extended the concept yet again. But no natural kind of
anything would prevent our doing so. And it may be that a scientific account of pain
will treat nausea as a kind of pain. Support for so treating it comes from the fact that
young children do not distinguish pain and nausea, or at least do so only with difficulty
(Leach, 1989, p. 533).

It is now time to sum up the results of this paper. Not only have we seen that there is
evidence that pains are not identical to a certain kind of phenomena, but it is doubtful
that pain phenomena constitute a natural kind.
The evaluative theory of pain builds on this base. According to the theory, pains
do require phenomenal states, but what makes these phenomena pains is their being
spontaneously and non-inferentially evaluated as harmful to the body. Among the
reasons presented in favour of the evaluative theory are, first, pain ascriptions do seem
to involve an evaluative element omitted in all other previous pain theories. Second, the
evaluative theory better fits empirical data, both the practices of pain theorists, as
reflected in their questionnaires, and quite puzzling types of clinical cases, as well.
Third, the evaluative theory preserves many common-sense beliefs about pains. Fourth,
the evaluative theory fits in better with larger theoretical
3 4 0 NORTON NELKIN

considerations. While much of the argument for this larger theory takes place off stage,
as it were, enough has been said to provide at least prima facie plausibility to it, and,
thus to the evaluative theory of pain which comports so well with it.

Acknowledgements
I want to thank Lynn Stephens, Carol Slater, Carolyn Morillo, Sam Rickless and Dana
Nelkin, all of whom read and commented on an earlier version of this paper. I would
especially like to thank Harvey Green, Ed Johnson, George Graham, and an anonymous
 reader for this journal, each of whose comments helped greatly to improve this paper,
both stylistically and philosophically. A Fellowship for College Teachers and
Independent Scholars from the National Endowment

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for the Humanities provided me with time to make the final revisions of this paper.

Notes
[1] Throughout this paper, 'theory of pain' means philosophical theory of pain. Philosophical
theories are not scientific theories, but ways of looking at (a piece of) the world that, if useful,
give rise to scientific theories. Thought of in these ways, philosophical theories are
propaedeutics to scientific theories.
[2] By a phenomenal state, I mean a state characterized by what philosophers call 'qualia'. In
Nagel's (1974) terms, when one experiences a phenomenal state, there is something it is like to
be in that
state, something it is experientially like for the organism whose experience it is. Despite the
possibility of misleading the reader, I will often abbreviate 'phenomenal state' to
'phenomenon' ('phenomenal states' to 'phenomena'). But one should always read the
abbreviating terms as just
that.
[3] Those familiar with my 1986 theory of pain will note that this claim represents a major
departure from that earlier theory.
[4] I will call a cotemporal set of these affective-cognitive-motivational states an attitude.
[5] This is the view of the British empiricists, as well as of a host of twentieth-century philosophers.
[6] The results are more complicated and more numerous than I have presented. I recommend the
full study to the reader. For instance, if the subjects, instead, got six-second-long shocks following
the second set of instructions, subjects who thought they would be in control did worse than those
who did not. The likely interpretation here is that thinking one is in control and then finding out
one is not, or is not able to succeed, is psychologically more damaging than not starting with the
belief in the first place.
[7] For instance (but only as one instance), some people, when injured, become red/green colour
blind. When appropriately tinted lenses are placed in their eyes, several of them can make
colour discriminations that by and large track their previous ones. But these 'recovered'
patients often complain that colours look different to them (Hurvich, 1981, pp. 256-7).
Presumably, they are saying that their phenomenal colour experiences are different—and on
account of changes in their neural states.
[8] By 'pain phenomena', I mean whatever phenomena actually occur in pain experiences—now, in
the past, and in the future.
[9] The evaluative theory represents a departure from my earlier (1986) attitudinal theory, and the
motivation for my reconsideration of pain has two origins: a book' by my colleague, Carolyn
Morillo (in preparation), and my preparing some lectures on pain for a class on Wittgenstein's
RECONSIDERING PAIN 341

Philosophical Investigations. For the broader theory, besides papers previously cited, see. 1987b,
1989a, 1989b, 1990, 1993a, 1993b, 1994a and forthcoming.
[10] This kind of point was long ago made by Descartes (1642/1986, pp. 50-1) in his claim that
thinking about 1000-sided figures is non-phenomenally distinguishable from thinking about
999-sided ones, but seems to have been overlooked by his Empiricist successors—and by many
philosophers since.
[11] This claim marks an important way in which my theory of consciousness differs from that of
Natsoulas (1989, 1990), although, at one time, he also recognized several forms of
consciousness,
including analogues of those I recognize (Natsoulas, 1983). Now Natsoulas wants to add a fourth
state, which he calls 'reflective consciousness', as what consciousness really is. I see no reason to
think such a state exists (see 1993b).
[12] See 1989b for some of the reasons. Also see Rosenthal, 1991 for further arguments.
 [13] Others have argued for a thesis somewhat similar to the present one. Stephens and Graham
(1987) argue for a thesis of this general sort, though in important ways their thesis is closer to
my
earlier (1986) theory. Green (1991) also presents a thesis somewhat similar to the present one;

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but his view is a desire-based, rather than a judgment-based, view.
[14] I think something like this insight led to Wittgenstein's (1953) denying altogether that 'I am in
pain' is a self-descriptive statement. But, if I am right, his insight is somewhat occluded and
his
denial too strong.
[15] More cautiously put, CS states are representations or indicators, where indicators point to
something beyond themselves but do not represent that something. However, the cases
of phantom pain soon to be cited argue for a representational state, not just an indicator
state.
[16] Some of the 'names' may not be related to causes; but, if not, they are, nevertheless, related to
other features and properties of the external world.
[17] Among other things, even if the class of phenomena kinds is restricted, it seems probable that
the members of the class also play a role in non-pain experiences (cf. several of the cases cited
in part
1, such as the Glass et al. shock experiment, 1973).
[18] There may be other states we call 'hypochondria'. For instance, there may be cases where one
feels pain legitimately but infers that its cause, rather than being minor, is some dread disease
like
cancer. Such cases of hypochondria have a different basis from the ones discussed here, and the
evaluative theory does not account for them—but, then again, it is not meant to. I owe an
anonymous reader for this journal thanks for enabling me to see this distinction among cases we
label 'hypochondria'.
[19] Harvey Green, in conversation, helped me get a better handle on these issues.
[20] For a somewhat similar view, see James Russell, 1989. Kant and Piaget are, of course, the real
progenitors of such a view—and I would, pace Piaget, add Descartes to the list.
[21] This way of putting things is misleading in several ways. Of most concern here is that a CS
representation is image-like, not linguistic-like, so trying to capture its content in words is, of
necessity, misleading. The C2 representation is linguistic-like. That is one way C2 representations
differ from CS ones (though not the only way—see 1987b, 1989a, 1989b).
[22] Baars's (1987) 'global-workspace' theory, if correct, provides an alternative account. Baars
hypothesizes that the global workspace (which has much in common with C2) is
instantiated in the reticular-thalamic system, not in the cortex. The cortex, which supplies
the first-order representations an organism can be C2 about, has evolved rapidly from
'lower' organisms to people. But the reticular-thalamic formations have evolved little. Thus,
the difference between 'lower' organisms and us is not that we can introspect and they cannot,
but rather the amount of information and number of kinds of information we can introspect
are much greater than those they can introspect.
[23] Carol Slater presented this objection to me in correspondence.
[24] Compare the Nordic/Mediterranean shock experiments discussed by Melzack (1973, pp. 24-7-
also see Melzack & Wall 1983, pp. 30-3); recall also the Pavlov paw-shocking experiment
(Melzack & Wall 1983, p. 36); also the Glass, et al. shock experiment (1973).
3 4 2 NORTON NELKIN

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