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Affiliation

1 Department of Cell & Molecular Physiology, 5109D Neuroscience Research Building, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7545, USA. erp@med.unc.edu

Affiliation

1 Department of Cell & Molecular Physiology, 5109D Neuroscience Research Building, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7545, USA. erp@med.unc.edu

Abstract

The expression 'painful' can be used to describe both an embarrassing moment and a cut on the finger. An explanation for this dichotomy can be found in the convoluted history of ideas about pain. Whether pain is an independent sensation and the product of dedicated neural mechanisms continues to be a topic of debate. This overview concentrates on the issue of specificity together with other notable information regarding pain that has emerged since 1800.

Retrograde Labeling of Different Distribution Features of DRG P2X2 and P2X3 Receptors in a Neuropathic Pain Rat Model.

Chen L, Leng C, Ru Q, Xiong Q, Zhou M, Wu Y. Chen L, et al. Biomed Res Int. 2020 Jul 22;2020:9861459. doi: 10.1155/2020/9861459. eCollection 2020. Biomed Res Int. 2020. PMID: 32775458 Free PMC article.

Electrical stimulation of cranial nerves in cognition and disease.

Adair D, Truong D, Esmaeilpour Z, Gebodh N, Borges H, Ho L, Bremner JD, Badran BW, Napadow V, Clark VP, Bikson M. Adair D, et al. Brain Stimul. 2020 May-Jun;13(3):717-750. doi: 10.1016/j.brs.2020.02.019. Epub 2020 Feb 23. Brain Stimul. 2020. PMID: 32289703 Free PMC article. Review.

The role of spinal inhibitory neuroreceptors in the antihyperalgesic effect of warm water immersion therapy.

Madeira F, Brito RN, Emer AA, Batisti AP, Turnes BL, Salgado ASI, Cidral-Filho FJ, Mazzardo-Martins L, Martins DF. Madeira F, et al. Braz J Phys Ther. 2021 Jan-Feb;25(1):56-61. doi: 10.1016/j.bjpt.2020.02.001. Epub 2020 Feb 12. Braz J Phys Ther. 2021. PMID: 32070652 Free PMC article.

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national center for biotechnology information

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Ideas about pain, a historical view - PubMed

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The expression 'painful' can be used to describe both an embarrassing moment and a cut on the finger. An explanation for this dichotomy can be found in the convoluted history of ideas about pain. Whether pain is an independent sensation and the product of dedicated neural mechanisms continues to be ...

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Abstract

This essay is an attempt to clarify the construct of unpleasantness in the context of the psychophysics of pain. The first critical point is that one aspect of unpleasantness is tightly coupled to stimulus intensity and is therefore a sensory discrimination. Pain has this quality, but so do other somatic sensations such as itch and dysesthesias that are not recognized as painful by most people. A corollary of this is that pain must have a quality other than unpleasantness that allows it to be unequivocally identified. I use the term algosity for that quality. In addition to stimulus bound (primary) unpleasantness, there is an unpleasant experience that reflects a higher level process which has a highly variable relationship to stimulus intensity and is largely determined by memories and contextual features. I have termed this experience secondary unpleasantness. I suggest that the sensory-discriminative/affective-motivational dichotomy has outlived its usefulness and is currently more of an impediment than a guide to neurobiological explanations of pain. In order to increase our understanding of pain we need psychophysical tools designed specifically to differentiate primary unpleasantness from both algosity and secondary unpleasantness. These tools can then be used to determine the neural mechanisms of pain.

Similar articles

Cortical processing of visceral and somatic stimulation: differentiating pain intensity from unpleasantness.

Dunckley P, Wise RG, Aziz Q, Painter D, Brooks J, Tracey I, Chang L. Dunckley P, et al. Neuroscience. 2005;133(2):533-42. doi: 10.1016/j.neuroscience.2005.02.041. Neuroscience. 2005. PMID: 15896917

The relationship between rectal pain, unpleasantness, and urge to defecate in normal subjects.

Kwan CL, Mikula K, Diamant NE, Davis KD. Kwan CL, et al. Pain. 2002 May;97(1-2):53-63. doi: 10.1016/s0304-3959(01)00490-0. Pain. 2002. PMID: 12031779

A psychophysical comparison of sensory and affective responses to four modalities of experimental pain.

Rainville P, Feine JS, Bushnell MC, Duncan GH. Rainville P, et al. Somatosens Mot Res. 1992;9(4):265-77. doi: 10.3109/08990229209144776. Somatosens Mot Res. 1992. PMID: 1492527

Psychophysics of CNS pain-related activity: binary and analog channels and memory encoding.

Bagley CA, Ohara S, Lawson HC, Lenz FA. Bagley CA, et al. Neuroscientist. 2006 Feb;12(1):29-42. doi: 10.1177/1073858405280553. Neuroscientist. 2006. PMID: 16394191 Review.

Novel inhibitory brainstem neurons with selective projections to spinal lamina I reduce both pain and itch.

Agostinelli LJ, Bassuk AG. Agostinelli LJ, et al. J Comp Neurol. 2021 Jun;529(8):2125-2137. doi: 10.1002/cne.25076. Epub 2020 Dec 4. J Comp Neurol. 2021. PMID: 33247430 Free PMC article.

The α2/α3GABAA receptor modulator TPA023B alleviates not only the sensory but also the tonic affective component of chronic pain in mice.

Neumann E, Küpfer L, Zeilhofer HU. Neumann E, et al. Pain. 2021 Feb 1;162(2):421-431. doi: 10.1097/j.pain.0000000000002030. Pain. 2021. PMID: 32773599 Free PMC article.

References

Apkarian AV, Hodge CJ. Primate spinothalamic terminations of the dorsolateral and ventral spinothalamic pathways. J Comp Neurol 1989;288:493-511.

Barnett EM, Evans GD, Sun N, Perlman S, Cassell MD. Anterograde tracing of trigeminal afferent pathways from the murine tooth pulp to cortex using herpes simplex virus type I. J Neurosci 1995;15:2972-2984.

Berendse HW, Groenewegen HJ. Restricted cortical termination fields of the midline and intralaminar thalamic nuclei in the rat. Neuroscience 1991;42:73-102.

Berkley KJ, Parmer R. Somatosensory cortical involvement in responses to noxious stimulation in the cat. Exp Brain Res 1974;20:363-374.

Casey KL, Minoshima S, Berger KL, Koeppe RA, Morrow TJ, Frey KA. Positron emission tomographic analysis of cerebral structures activated specifically by repetitive noxious heat stimuli. J Neurophys 1994;71:802-806.

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national center for biotechnology information

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This essay is an attempt to clarify the construct of unpleasantness in the context of the psychophysics of pain. The first critical point is that one aspect of unpleasantness is tightly coupled to stimulus intensity and is therefore a sensory discrimination. Pain has this quality, but so do other so ...

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Amanda Williams podcast - evolutionary perspective

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Amanda Williams podcast - evolutionary perspective

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Editor's note: IASP will be celebrating its 50th anniversary in 2024. Even though the anniversary is still a few years away, it already has us thinking about the history of IASP and the evolution of pain research over the past five decades. So, we are providing a series of podcasts that will cover both of those topics, featuring senior leaders in the field who have made major contributions to pain research and care, including those with major roles at IASP.
Our latest such podcast features Amanda C de C Williams, PhD. Dr. Williams is professor of clinical health psychology at University College London, and a consultant clinical psychologist at the Pain Management Centre, University College London Hospital, UK. She also works for the International Centre for Health and Human Rights and is section editor for psychology on the journal PAIN.
After years of full-time clinical work in pain management, during which she completed her PhD, she moved increasingly into research, joining University College London in 2004. Her research interests include evidence-based medicine applied to psychologically based treatments for pain; evolutionary perspectives on pain; behavioral expression of pain and its interpretation by clinicians; better recognition and treatment of pain from torture; and responsive wearable technology to extend healthcare into patients' own environments. She teaches undergraduates and graduate students, and has written more than 300 papers and chapters on pain and psychology; her publications are available here. In the podcast below, Dr. Williams speaks with PRF Correspondent Kai Karos, PhD, a postdoctoral researcher at the Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Belgium, to discuss PRF Correspondent Kai Karos, PhD, is a postdoctoral researcher at the Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Belgium. her path to pain psychology, what she wants people with pain to know, the evolutionary perspective on pain, and much more. The podcast is also available on Spotify here and on Apple Podcasts here. (To listen to other PRF podcasts, visit our podcasts homepage on Spotify here and on Apple Podcasts here).

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Putting Pain Psychology Front and Center: A Podcast With Amanda Williams

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Editor's note: IASP will be celebrating its 50th anniversary in 2024. Even though the anniversary is still a few years away, it already has us thinking about the history of IASP and the evolution of pain research over the past five decades.

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Abstract

A broad range of evidence regarding the functional organization of the vertebrate brain - spanning from comparative neurology to experimental psychology and neurophysiology to clinical data - is reviewed for its bearing on conceptions of the neural organization of consciousness. A novel principle relating target selection, action selection, and motivation to one another, as a means to optimize integration for action in real time, is introduced. With its help, the principal macrosystems of the vertebrate brain can be seen to form a centralized functional design in which an upper brain stem system organized for conscious function performs a penultimate step in action control. This upper brain stem system retained a key role throughout the evolutionary process by which an expanding forebrain - culminating in the cerebral cortex of mammals - came to serve as a medium for the elaboration of conscious contents. This highly conserved upper brainstem system, which extends from the roof of the midbrain to the basal diencephalon, integrates the massively parallel and distributed information capacity of the cerebral hemispheres into the limited-capacity, sequential mode of operation required for coherent behavior. It maintains special connective relations with cortical territories implicated in attentional and conscious functions, but is not rendered nonfunctional in the absence of cortical input. This helps explain the purposive, goal-directed behavior exhibited by mammals after experimental decortication, as well as the evidence that children born without a cortex are conscious. Taken together these circumstances suggest that brainstem mechanisms are integral to the constitution of the conscious state, and that an adequate account of neural mechanisms of conscious function cannot be confined to the thalamocortical complex alone.

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[Acquired drives. The cortical mechanism responsible to the emergence and development of social existence].

József K. József K. Neuropsychopharmacol Hung. 2007 Oct;9(3):151-66. Neuropsychopharmacol Hung. 2007. PMID: 18399034 Review. Hungarian.

[Neurology of consciousness and of consciousness disorders].

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Temporal binding, binocular rivalry, and consciousness.

Engel AK, Fries P, König P, Brecht M, Singer W. Engel AK, et al. Conscious Cogn. 1999 Jun;8(2):128-51. doi: 10.1006/ccog.1999.0389. Conscious Cogn. 1999. PMID: 10447995

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Alcohol use severity and the neural correlates of the effects of sleep disturbance on sustained visual attention.

Li G, Chen Y, Tang X, Li CR. Li G, et al. J Psychiatr Res. 2021 Oct;142:302-311. doi: 10.1016/j.jpsychires.2021.08.018. Epub 2021 Aug 16. J Psychiatr Res. 2021. PMID: 34416549

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national center for biotechnology information

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Consciousness without a cerebral cortex: a challenge for neuroscience and medicine - PubMed

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A broad range of evidence regarding the functional organization of the vertebrate brain - spanning from comparative neurology to experimental psychology and neurophysiology to clinical data - is reviewed for its bearing on conceptions of the neural organization of consciousness. A novel principle re ...

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Education for all is a NNT of 1 Education for All ( EFA) is a UNESCO movement. If it really works then it means that the number needed to treat ( NNT statistic) or number needed to educate (NNE) should be 1; i.e. everyone benefits. This is the goal of the Explain Pain movement.

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Reconsidering fetal pain - Derbyshire & Bockmann

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Reconsidering fetal pain - Derbyshire & Bockmann

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Therapeutic fetal intervention

There have been impressive developments in therapeutic fetal intervention since the first intraperitoneal blood transfusion to a fetus in 1963 and the first successful human fetal surgery in 1981. 5 9 To date, fetal surgery has been successfully implemented for repair of various defects (myelomeningocele, obstructive uropathy, congenital diaphragmatic hernia, congenital heart defects, congenital pulmonary airway malformation), removal of various tumours (chorioangioma, sacrococcygeal teratoma), as well as for specific procedures including twin-to-twin transfusion syndrome and EXIT (ex utero intrapartum treatment) procedures. 10 11 The development of invasive surgical procedures to treat the fetus has been accompanied by specialist development of fetal and maternal analgesia and anaesthesia to support those procedures. 12-14

Up until the late 1980s, surgical procedures with neonates were mostly performed without analgesia or anaesthesia largely because of safety concerns and because it was assumed the neonate was not neurologically sophisticated enough to experience pain. A series of clinical trials clearly demonstrated that anaesthesia and analgesia are safe for neonates and provide for improved postoperative outcome. 4 These important findings led to calls for clinical practice with neonates to be changed and operations with neonates are no longer performed without an anaesthetic and analgesic regimen.

Similar randomised trials with fetal patients might be suggested as an obvious means of demonstrating whether safety concerns can also be minimised for fetal surgery. The rarity and idiosyncratic nature of in utero surgical procedures, however, means that randomised trials are impractical and might be deemed unethical. Consequently, fetal anaesthesia has been developed based on clinical expertise and observation. Most procedures include a general anaesthetic transferred across the placenta often supplemented by an opioid agent and a paralytic agent. 10 Some concerns have been raised that these agents may have harmful effects on cells, may have negative effects on brain development, or may critically interfere with the fetal cardiovascular system. 15-17 To our knowledge, however, all clinicians or surgeons working with fetal patients advocate the use of fetal anaesthesia and analgesia as standard practice. While further studies might be welcome to address the optimal procedures necessary to improve outcomes, there is consensus that the use of fetal anaesthesia and analgesia improves maternal and fetal cardiovascular stability, provides the necessary immobility of the fetus and prevents a dangerous fetal physiologic reaction or "stress response" to the surgery. 12 14

Currently, therefore, we are not aware of any procedures where invasive fetal intervention proceeds without anaesthesia or analgesia, except for abortion. The lack of an evidence base for fetal anaesthesia and analgesia, however, and the need for clinicians to use their professional judgement, means it is theoretically possible that a surgeon or medical team will judge analgesia or anaesthesia as not in the best interest of their fetal patient. In such a (hypothetical) case, the fetus will feel pain if fetal pain is possible. For therapeutic procedures, such pain can be ethically offset. The principle of non-maleficence implies we should first of all do no harm, 18 but pain can be acceptable if the inflicted pain is part of a good faith effort to save or improve the life of the patient. This is the case with therapeutic fetal surgery, and with other invasive procedures, such as blood transfusions and the use of instruments for delivery, aimed at supporting fetal or infant life. Therefore, while surgeons and medical teams might be minded to consider fetal pain (and all the evidence suggests they clearly are), the possibility of fetal pain is not a reason to change current medical practice surrounding fetal surgery or other invasive procedures designed to preserve or enhance fetal life.

Abortion is different for at least two reasons. First, abortion may prevent future suffering that results from being born in a state of painful physical disability, but an abortion is not designed to preserve or enhance ongoing fetal life. In the cases where little or no disability is expected, there is little or no future benefit to the fetus from the pain they might experience. Second, while all the evidence suggests that surgeons performing therapeutic fetal interventions routinely consider pain relief for the fetus, surgeons performing abortions have their focus on the pregnant woman as their patient. 19 Consequently they more rarely consider fetal pain relief during the preparation and execution of abortion. Whether or not the fetus feels pain, therefore, is relevant to current medical practice surrounding abortion and could motivate changes in practice.

Neuroscientific arguments for fetal pain

The most common approach to the possibility of fetal pain is the attempt to align the developing neurology of the fetus to what is considered necessary for pain experience. 20 21 Often it is stated that there is a consensus that pain is not possible before development of the cortex, and before the periphery is connected to the cortex through the spinal cord and thalamus. Those developments are broadly not apparent before 24 weeks' gestation and so many medical bodies and press reports state that pain is not possible before 24 weeks' gestation, which is the point at which most abortions cease to be legal in most parts of the world. 5

Arguably, there never was a consensus that fetal pain is not possible before 24 weeks. Many papers discussing fetal pain have speculated a lower limit for fetal pain under 20 weeks' gestation. 22-25 We note in passing that vote counting and consensus is perhaps not the best way to decide scientific disputes. Regardless of whether there ever was a consensus, however, it is now clear that the consensus is no longer tenable.

Several papers have now been published suggesting that the necessity of the cortex for pain experience may have been overstated. 26-29 One study has, for example, demonstrated continued pain experience in a patient with extensive damage to cortical regions generally believed to be necessary for pain experience. 28 A further study has demonstrated activation of areas generally thought to generate pain in subjects congenitally insensitive to pain but receiving noxious stimuli. 29 While certainly not definitive, those two studies appear to neatly dissociate pain experience from the cortex.

In addition, previous proponents of fetal pain speculated that neural activity in the subplate might support fetal pain experience. 23 At 12 weeks' gestation there are the first projections from the thalamus into the cortical subplate. 30 31 The subplate is a transient developmental structure that forms underneath the cortical plate proper. Neurons destined for the cortical plate first migrate into the subplate where they wait until the cortical plate above is sufficiently mature and then the neurons migrate to their mature position in the cortex. The subplate then gradually withers away and becomes white matter. Recent work with ferrets has demonstrated that auditory stimuli trigger neural activity in the subplate that is topographically highly similar to the activity observed in the more mature auditory cortex. 32 Moreover, the neural activity in the subplate is tonotopically organised and the connectivity and activity of at least some subplate neurons are preserved into adulthood. That is, the thalamocortical projections that are largely considered necessary for mature sensory function are at least in part preserved from the subplate into the cortical plate. Given that the development of all sensory systems follow a similar developmental trajectory and all involve the subplate, it is likely that a bodily mapping of sensory subplate neurons supporting a sensory homunculus will occur, similar to the tonotopic mapping of the subplate supporting auditory processing. Future studies, however, may examine that possibility directly.

In summary, current neuroscientific evidence undermines the necessity of the cortex for pain experience. Even if the cortex is deemed necessary for pain experience, there is now good evidence that thalamic projections into the subplate, which emerge around 12 weeks' gestation, are functional and equivalent to thalamocortical projections that emerge around 24 weeks' gestation. Thus, current neuroscientific evidence supports the possibility of fetal pain before the "consensus" cut-off of 24 weeks.

A difficulty that faces everyone trying to adjudicate on the issue of fetal pain from neuroscientific findings is the intense uncertainty of exactly how the neural activity of the brain translates into the subjective experience of pain. 33 The association of coherent neural activity in brain stem circuits with phenomenal consciousness, such as has been suggested by Merker, 34 has at least a similar validity to the association of coherent neural activity in the cortex with phenomenal consciousness. Coherence and location, in and of themselves, do not provide an explanation for how the underlying nerve impulses, which are inherently unconscious biophysical events, are translated into phenomenological components of experience.

Psychological arguments for fetal pain

A different approach to unravelling whether a fetus feels pain is to focus more closely on what we mean by "pain". Many people take the International Association for the Study of Pain definition as their starting point, which states that pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage... pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life." 35 That definition is often interpreted as meaning that pain is not just phenomenological but also reflective. 36-39 As others have pointed out, such a demanding definition of pain restricts pain almost exclusively to fairly mature human beings. 36 37 To ease that restriction it might be worthwhile to consider a less sophisticated definition, which focuses less on subjective reflection ( knowing that I am in pain) and more on the immediate and unreflective feel of pain ( being in pain).

The possibility of an immediate and unreflective experience of pain gels more clearly with the possibility of pain being based in subcortical, rather than cortical, activity as others have suggested. 23 34 38 An immediate and unreflective, or core, pain experience, however, does lack epistemological clarity as to the exact nature or content of the pain experience. 39 Sense experiences do not occur in isolation and nor are they dissected into immediate features and components that are independent of, or completely walled off from, higher-order consciousness. While we can identify separate features (colours, edges, luminance, and so forth) those separate features are not fragmented from the unity of our conscious self. When we experience red, for example, we experience ourselves as the subject seeing red with the knowledge that we are seeing a particular colour, an experience encompassing memory, understanding, and so on. The red is inescapably about something that is more than any immediate and bounded experience. Red essentially refers to, or is constituent to, a part of a greater scene (a painting, a sunset, a traffic warning, and so on). Red might conjure up an inner state of consciousness relating to fear or concern, desire or excitement, and will afford certain actions and so on. It is difficult for us to withdraw into a fundamental, or "pure" experience of red because we always experience red from our point of view, from the perspective of our lived and ongoing life.

When we experience pain, we experience ourselves as the bearer of pain with the knowledge that we are in pain, an experience encompassing memory, understanding, and so on. The pain is inescapably about something that is more than any immediate and bounded experience. Pain essentially refers to, or is constituent to, a part of the body (an arm, leg, head, and so on). Pain often refers to a stimulus with degrees of threat (a thorn vs a spear or indigestion vs a heart attack), and pain conjures up an inner state of consciousness relating to fear, concern, regret, necessary action and so on. 40 We do not propose that the fetus experiences that; such an all-encompassing conscious experience likely does depend on widespread cortical activity, as discussed elsewhere. 41 Instead, we propose that the fetus experiences a pain that just is and it is because it is, there is no further comprehension of the experience, only an immediate apprehension. The fetus experiences something that is inherent to a certain level of biological activity, and which emerges at an unknown time often speculated to be after 12 weeks' gestation. Our position is quite similar to that of others who have argued that animals might not feel pain at all or feel something that is direct and bodily and not connected to any reflection such that the animal might regard the sensation as unpleasant or, indeed, regard the sensation as anything at all. 42 43 It can be argued that such a pain lacks moral relevance, but we view that position with some suspicion. We may doubt whether the fetus (or an animal) ever feels anything akin to pain, but acting as if we have certainty flirts with a moral recklessness that we are motivated to avoid.

The moral implications of fetal pain

Therapeutic fetal surgery poses certain ethical challenges as discussed elsewhere, 44 but those challenges are not obviously altered or added to by the possibility of fetal pain. Fetal pain does, however, pose a challenge to abortion providers. Concerns about what the fetus might experience or feel have increased, and women considering an abortion express concern about the welfare of the fetus. 19 45 46 Given the evidence that the fetus might be able to experience something like pain during later abortions, it seems reasonable that the clinical team and the pregnant woman are encouraged to consider fetal analgesia. For procedures that involve direct feticide, the possibility of fetal pain is limited to the injection period. The injection provides a nociceptive stimulus that previous studies have associated with a stress response. 46 In the absence of feticide, the trauma of premature birth for medical abortion might result in mechanical pressure that will reach noxious levels, but that pressure is not likely to exceed that produced in a normal delivery at full term. A D&E procedure will deliver repeated nociceptive events that may involve fetal pain before fetal death.

We disagree as to exactly how the "encouragement" to consider fetal analgesia might be implemented for the above procedures. One of us essentially believes that the momentary interests of the fetus as it leaves this life can be accommodated as part of a humane approach to abortion. The clinical team and the pregnant woman can consider whether fetal analgesia makes sense based on the clinical requirements for the abortion, the age of the fetus, and the conscience of the parties involved. The other essentially believes that abortion is inherently violent and may subject the fetus to unnecessary pain and distress after the first trimester. Fetal analgesia and anaesthesia should thus be standard for abortions in the second trimester, especially after 18 weeks when there is good evidence for a functional connection from the periphery and into the brain. 46

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Fetal pain has long been a contentious issue, in large part because fetal pain is often cited as a reason to restrict access to termination of pregnancy or abortion. We have divergent views regarding the morality of abortion, but have come together to address the evidence for fetal pain.

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Sytsma - experimental philosophy of pain

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Sytsma - experimental philosophy of pain

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According to the increasingly popular perceptual/representational accounts of pain (and other bodily sensations such as itches, tickles, orgasms, etc.), feeling pain in a body region is perceiving a non-mental property or some objective condition of that region, typically equated with some sort of (actual or potential) tissue damage. In what follows I argue that given a natural understanding of what sensory perception requires and how it is integrated with (dedicated) conceptual systems, these accounts are mistaken. I will also examine the relationship between perceptual views and two (weak and strong) forms of representationalism about experience. I will argue that pains pose very serious problems for strong representationalism as well.

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Murat Aydede, Is feeling pain the perception of something? - PhilPapers

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According to the increasingly popular perceptual/representational accounts of pain (and other bodily sensations such as itches, tickles, orgasms, etc.), feeling pain in a body region is perceiving a non-mental property or some objective condition of that region, typically equated with some sort of (actual or potential) tissue damage.

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The meaning of pain expressions and pain communication - Borg

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The meaning of pain expressions and pain communication - Borg

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Is the folk concept of pain polyeidic - Borg

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Is the folk concept of pain polyeidic - Borg

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Abstract

Hermeneutic phenomenology and phenomenology have become increasingly popular as research methodologies, yet confusion still exists about the unique aspects of these two methodologies. This article provides a discussion of the essential similarities and differences between hermeneutic phenomenology and phenomenology from historical and methodological perspectives. Consideration is given to the philosophical bases, assumptions, focus of research and research outcomes that differentiate these approaches.

Introduction

" Only when our entire culture for the first time saw itself threatened by radical doubt and critique did hermeneutics become a matter of universal significance."

Gadamer, 1983, p.100

Historically, many areas of academic research have utilized quantitative or empirical methods. In general, the emphasis of this research is on what is observable and accessible, with researchers focusing primarily on those areas and questions that are amenable to the adherence of empirical methods of inquiry ( Gergen, 1985; Valle, King, & Halling, 1989). While researchers continue to place a strong emphasis on these methods, the use of qualitative research methodologies has been growing. Osborne (1994) identifies the early 1980's as a time when greater disenchantment with the limits of logical-empirical research methodologies began. Increasing questions emerged about the focus of inquiry, as well as exploration of methodologies that emphasized discovery, description and meaning rather than prediction, control and measurement. For example, Klein and Westcott (1994) stated that the last 25 years have been a time of growing crisis for mainstream positivistic psychology as both the philosophies and the methodologies used in research are being rethought. Smith (1991) described this as a 'crisis of value' at work that cannot be resolved simply by appealing to traditional forms of logic and authority. In essence, there is a growing recognition of the limitations of addressing many significant questions in the human realm within the requirements of empirical methods and its quest for indubitable truth ( Polkinghorne, 1983).

Out of this milieu, a variety of research methodologies have grown in popularity including phenomenology, ethnography, grounded theory, and hermeneutic phenomenology ( Denzin & Lincoln, 2000). As this has occurred, concern has risen about the use of qualitative methodologies without sufficient understanding of the rigor necessary to ethically utilize them ( Maggs-Rapport, 2001). More specifically, phenomenology and hermeneutic phenomenology are often referred to interchangeably, without questioning any distinction between them. The purpose of this article is to discuss the early philosophical development of selected key issues related to phenomenology and hermeneutic phenomenology and support the position that differences and similarities exist. This exploration will begin with the phenomenology of Husserl and then move to explore heremeneutic phenomenology through Heidegger and Gadamer. Exploration will be given to how these different philosophical perspectives have an impact on the practice of phenomenology and hermeneutic phenomenology as research methodologies.

As final preface, this exploration needs to be framed as a present understanding of these areas. Speigelberg (1960) described the historical roots of phenomenology as a movement rather than a discrete period of time. This distinction is important as it reflects the view that phenomenology and hermeneutic phenomenology, and our understandings of them, are not stationary, but rather dynamic and evolving, even today. The ideas presented herein, therefore, must to be viewed as changing and developing over time, not as static entities.

Phenomenology: Edmund Husserl

Often referred to as the father of phenomenology ( Cohen, 1987; Koch, 1996; Polkinghorne, 1983; Scruton, 1995), Edmund Husserl's (1859-1938) initial work focused on mathematics, with his dissertation exploring the calculus of variations. Despite this emphasis, Jones (1975) reported that Husserl's interest in philosophy influenced his decision to abandon his plans to teach science and to complete his formal education in philosophy, under Franz Brentano. Husserl's work changed over time, moving from attention to mathematics to seeing phenomenology as equally objective and subjective, and finally having subjectivity dominate his pursuits (Cohen; Reeder, 1987) This progression culminated in his interest in 'pure phenomenology' or working to find a universal foundation of philosophy and science (Scruton).

Husserl (1952/1980) criticized psychology as a science that had gone wrong by attempting to apply methods of the natural sciences to human issues. He charged that these pursuits ignored the fact that psychology deals with living subjects who are not simply reacting automatically to external stimuli, but rather are responding to their own perception of what these stimuli mean. Husserl seemed to believe that researchers who attended only to external, physical stimuli that could be isolated and correlated with other isolated responses, not only missed important variables but ignored context and created a highly artificial situation ( Jones, 1975).

Hermeneutic phenomenology: Martin Heidegger

Martin Heidegger (1889-1976) was born in Germany and, like Husserl, began his career in a field other than philosophy. While Husserl's start was in science, Heidegger found his in theology. Jones (1975) reported that the philosophy that Heidegger first committed himself to was Husserlian, yet he was never a formal student of Husserl. While both men taught at Freiberg, Heidegger worked with Husserl, who trained him in the processes of phenomenological intentionality and reduction. Evidently, Heidegger became so proficient in this endeavor that Husserl thought he had found the heir he had been seeking, and he ensured Heidegger succession to his professorship. Once established in Husserl's chair, however, Heidegger disassociated himself from Husserl and his work.

Hermeneutic phenomenology: Hans-Georg Gadamer

Born in 1900, Hans-Georg Gadamer was a student of philosophy at Marburg and Freiburg in the 1920s. It was there that he was influenced by the work of both Husserl and Heidegger and moved to extend Heidegger's work into practical application ( Gadamer, 1976; Polkinghorne, 1983). Gadamer saw the work of hermeneutics not as developing a procedure of understanding, but to clarify further the conditions in which understanding itself takes place: "Hermeneutics must start from the position that a person seeking to understand something has a bond to the subject matter that comes into language through the traditionary text and has, or acquires, a connection with the tradition from which it speaks" (1960/1998, pg. 295)

In agreement with Heidegger's view that language and understanding are inseparable structural aspects of human 'being-in-the world,' Gadamer stated "Language is the universal medium in which understanding occurs. Understanding occurs in interpreting" (1960/1998, p. 389). Gadamer viewed interpretation as a fusion of horizons, a dialectical interaction between the expectation of the interpreter and the meaning of the text ( Polkinghorne, 1983). A 'horizon' is a range of vision that includes everything seen from a particular vantage point. A person with no horizon, in Gadamer's view, does not see far enough and overvalues what is nearest at hand, whereas to have a horizon means being able to see beyond what is close at hand. Questioning, he wrote, is an essential aspect of the interpretive process as it helps make new horizons and understandings possible:

Understanding is always more than merely re-creating someone else's meaning. Questioning opens up possibilities of meaning, and thus what is meaningful passes into one's own thinking on the subject...To reach an understanding in a dialogue is not merely a matter of putting oneself forward and successfully asserting one's own point of view, but being transformed into a communion in which we do not remain what we were. (pg. 375)

Phenomenology/heremeneutic phenomenology: Similarities and differences

The phenomenology of Husserl and the hermeneutic phenomenology of Heidegger and Gadamer share some similar components. Both of these traditions arose out of German philosophy, with their creators having worked with and influenced one another. Moreover, each philosopher sought to uncover the life world or human experience as it is lived. They sought to reclaim what they perceived had been lost through the use of empirical scientific explorations within the human realm. Both Husserl and Heidegger were convinced that the world that scientists believed as the world, based on Cartesian dualism, is simply one life world among many worlds. Both men called for a fresh look at our world and ourselves ( Jones, 1975). Despite shared beginnings and common interest in lived experience from a perspective other than a Cartesian one, differences in direction arise between these two traditions. From my perspective, these differences emerge within ontological, epistemological, and methodological realms.

On the other hand, the interpretivist framework of inquiry supports the ontological perspective of the belief in the existence of not just one reality, but of multiple realities that are constructed and can be altered by the knower. Reality is not something 'out there', but rather something that is local and specifically constructed. Realities are not more or less true, rather they are simply more or less informed ( Denzin & Lincoln, 2000). Polkinghorne (1983) described this paradigm as an attitude about knowledge, not a school of thought. Knowledge is seen as the best understandings we have been able to produce thus far, not a statement of what is ultimately real. Epistemologically, this framework sees a relationship between the knower and the known. The notion of value-free research has been challenged as questionable and it is believed that attempts to attain such a stance have resulted in the loss of certain kinds of knowledge about human experience, such as meaning making ( Cotterill & Letherby, 1993; Jagger, 1989). Polkinghorne viewed research as a human activity in which the researcher as knower is central. Denzin and Lincoln viewed the investigator and the investigated as interactively linked in the creation of findings, with the investigator as a passionate participant. Methodologically, the interpretivist perspective may evolve, for example, in a process of interpretation and interaction between the investigator and research participants. The primary aims are understanding and the reconstruction of experience and knowledge. Issues of reliability and validity or the quality of this type of research have been addressed through the examination of rigor, trustworthiness, credibility, and authenticity ( Beck, 1993; Denzin & Lincoln; Hall & Stevens, 1991).

Ontology and epistemology issues

In a series of many investigations he [Husserl] attempted to throw light on the one-sidedness of the scientific idealization of experience.... To me, however, he still seems dominated by the one-sidedness that he criticizes, for he projects the idealized world of exact scientific experience into the original experience of the world, in that he makes perception, as something directed toward merely external physical appearances, the basis of all other experience. (pg. 347)

At heart, he seemed to have a deep need for certainty that pushed him in the direction of making philosophy a rigorous science. There appeared to be an unresolved conflict at the heart of his thought between phenomenology as describing experience and phenomenology as a quest for certainty ( Jones, 1975; Madison, 1988).

Methodological issues

In comparing phenomenology and hermeneutic phenomenology as research methodologies, similarities and differences exist that arise out of the philosophical bases of these traditions. It is interesting to note that while the focus and outcomes of the research, including data collection, subject selection, and the understanding of the lived experience, may be similar, the position of the researcher, the process of data analysis, and the issues of rigor or credibility can provide striking contrasts between these methodologies. While the methodological issues described herein are presented in a structured or step-by-step fashion, it is important to note that the process itself is more often than not cyclical rather than linear in both phenomenology and hermeneutic phenomenology.

When a decision to engage in research of a particular experience from a hermeneutic or phenomenological perspective is made, the researcher begins a process of self-reflection. For the phenomenologist, this is typically part of the preparatory phase of research and might include the writing down of these reflections for reference during the analysis process ( Colazzi, 1978; Polkinghorne, 1989). The purpose of this reflection is to become aware of one's biases and assumptions in order to bracket them, or set them aside, in order to engage the experience without preconceived notions about what will be found in the investigation. This awareness is seen as a protection from imposing the assumptions or biases of the researcher on the study.

The interview process in both of these traditions works within an environment of safety and trust, that needs to be established at the outset and maintained throughout the project. The interaction in the interview takes place within the context of a relationship, that is central to what is ultimately created ( Polkinghorne, 1983). Marcel (1971) supported the presence of a caring relationship as critical to this type of exploration:

When I say that a being is granted to me as a presence .... this means that I am unable to treat him as if he were merely placed in front of me; between him and me there arises a relationship which surpasses my awareness of him; he is not only before me, he is also with me" (pp. 24-26)

It is within the embodied relationship that the text or data will be generated and interpreted in these types of research.

In contrast, hermeneutic phenomenology might take a somewhat different approach to data analysis. This process involved one of co-construction of the data with the participant as they engage in a hermeneutic circle of understanding. The researcher and participant worked together to bring life to the experience being explored, through the use of imagination, the hermeneutic circle and attention to language and writing. Koch (1995) stated "Hermeneutics invites participants into an ongoing conversation, but does not provide a set methodology. Understanding occurs through a fusion of horizons, which is a dialectic between the pre-understandings of the research process, the interpretive framework and the sources of information." (p. 835)

The result of this process includes the self-interpreted constructions of the researcher and each participant, thus reflecting many constructions or multiple realities. Allen (1995) stressed the importance of reading and writing as core to the production of meaning in hermeneutic strategy. There cannot be a finite set of procedures to structure the interpretive process, because interpretation arises from pre-understandings and a dialectical movement between the parts and the whole of the texts of those involved. What was called for is an obligation to understand the context under which the text or dialogue was being produced and to bring forth interpretations of meaning. These interpretations arose through a fusion of the text and its context, as well, as the participants, the researcher, and their contexts.

Key aspects of the process are the use of imagination, the hermeneutic circle and attention to language and writing processes. Smith (1991) described hermeneutic imagination as asking for what is at work in particular ways of speaking or acting to help facilitate an ever-deepening appreciation of the world or lived experience. This requires an attentiveness to ways in which language is used, an awareness of life as an interpretive experience, and an interest in human meaning and how we make sense of our lives. To see something in a new imaginative way is to see it other than it has been seen before and to integrate it into a new semantic context ( Madison, 1988).

This interpretive process continues until a moment in time where one has reached sensible meanings of the experience, free from inner contradictions ( Kvale, 1996). However, Caputo (1987) cautiously noted that coming to a place of understanding and meaning is tentative and always changing in the hermeneutic endeavor. It is therefore necessary to account for one's position and trace one's movement throughout the research process using a hermeneutic circle.

Finally, reliability and validity can be discussed in these traditions as issues of rigor. In phenomenological research, bracketing, which is incorporated into intentional focusing on the experience, is one factor that is central to the rigor of the study. For a hermeneutic phenomenological project, the multiple stages of interpretation that allow patterns to emerge, the discussion of how interpretations arise from the data, and the interpretive process itself are seen as critical ( Koch, 1995).

When conducting phenomenological or hermeneutic phenomenological studies, researchers need to ensure the credibility of the study. Issues of rigor in interpretive inquiry are confusing to discuss, at times, as there is not an agreed upon language used to describe it or one universal set of criteria used to assess its presence. The rigor concepts presented above may be utilized by researchers in hermeneutic phenomenology or phenomenology or other avenues may be developed which more clearly articulate the quality of the study and ensure its credibility.

Conclusion

A comparison of phenomenology as understood by Husserl and hermeneutic phenomenology as understood by Heidegger and Gadamer has formed the basis of this article. Initial thoughts were given about the increased attention these traditions have received as well as descriptions of the positivist/Cartesian and interpretivist/constructivist paradigms of inquiry. The philosophical underpinnings of these two qualitative traditions, incorporating the assumptions and vocabulary used, were traced and similarities and differences in ontology, epistemology and methodology were highlighted.

Table

References

Lincoln, Y. S., Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. |
Google Scholar Crossref

Wilson, H., Hutchinson, S. (1991). Triangulation of qualitative methods: Heideggerian hermeneutics and grounded theory. Qualitative Health Research, 1, 263-276. |
Google Scholar SAGE Journals

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Hermeneutic Phenomenology and Phenomenology: A Comparison of Historical and Methodological Considerations - Susann M. Laverty, 2003

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Abstract Hermeneutic phenomenology and phenomenology have become increasingly popular as research methodologies, yet confusion still exists about the unique aspects of these two methodologies. This article provides a discussion of the essential similarities and differences between hermeneutic phenomenology and phenomenology from historical and methodological perspectives.

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Painful experience and the constitution of the intersubjective self - Stonier & Miglio

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Painful experience and the constitution of the intersubjective self - Stonier & Miglio

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In this paper, we discuss how phenomenology might cogently express the way painful experiences are layered with complex intersubjective meaning. In particular, we propose a critical conception of pain as an intricate multi-levelled phenomenon, deeply ingrained in the constitution of one's sense of bodily self and emerging from a web of intercorporeal, social, cultural, and political relations. In the first section, we review and critique some conceptual accounts of pain. Then, we explore how pain is involved in complex ways with modalities of pleasure and displeasure, enacted personal meaning, and contexts of empathy or shame. We aim to show why a phenomenology of pain must acknowledge the richness and diversity of peculiar painful experiences. The second section then weaves these critical insights into Husserlian phenomenology of embodiment, sensation, and localisation. We introduce the distinction between Body-Object and Lived-Body to show how pain presents intersubjectively (e.g. from a patient to a clinician). Furthermore, we stress that, while pain seems to take a marginal position in Husserl's whole corpus, its role is central in the transcendental constitution of the Lived-Body, interacting with the personal, interpersonal, and intersubjective levels of experiential constitution. Taking a critical-phenomenological perspective, we then concretely explore how some people may experience structural conditions which may make their experiences more or less painful.

Keywords:

Pain, Husserl, Critical phenomenology, Lived-Body, Intersubjectivity, Normativity

8.1. Introduction

Pain is ordinary and integral to our experiential topography; a 'background texture' of pain characterises our whole lives. I flinch away from a hot pan as it brushes against my arm at the stove. I keep walking briskly, despite the angry blister on my heel. I scratch an itch and the sensation both sooths and prickles my skin. I absent-mindedly rub my shoulder, relieving the dull ache from sitting at my desk too long. If we consider these routine and mundane ways in which pain features in everyday experience, it becomes clear that-far from presenting only through unusual and excruciating events-pain is familiar and, in many ways, vital for navigating the world. Pain draws our attention to our bodies as they pertain to our surroundings. And while everyday pain is often a far cry from the overwhelming agony of extreme injury, it is nonetheless recognisable as pain across these various contexts.

The treatment of pain is a huge global pharmaceutical industry, largely based on a medical conception of pain as a set of quantifiable conditions in the physiological body. Nevertheless, subjective experiences of pain evade reduction to scientific explanation; pain can persist long after physical symptoms are healed or occur without any apparent physical impetus in the first place (e.g. Myalgic Encephalomyelitis). Moreover, it is not only physical hurt that painful experiences can reveal. Social and political contexts produce and sustain subjects in pain, as they are alternately marginalised, disbelieved, prioritised, or cared for; the status of their painful experience garners significance in this relational intersubjective context. The situation of people and their pain is rarely thematised in bioethical discussion of painful experience and health care. Theoretical conceptions of pain as a phenomenon have variously and equivocally presented it as simple sensation, fundamental affect, constituent of suffering, instrument of power, and condition of the lifeworld-seldom is the relational aspect of painful experience drawn out.

By taking a critical-phenomenological approach, this paper seeks to critique and further these conceptions by elucidating the complexities of pain as a phenomenon, and by better accounting for the contextual and intersubjective variation of painful experiences. As such, we articulate how painful experience involves several phenomenological levels-from the hyletic to the intersubjective-which are differentially affected by the subject's social, political, and cultural situation. We suggest that this phenomenological account might be integrated into lifeworld-based approaches to care and treatment of pain, through social and political engagement (e.g. Hemingway 2011; Zahavi and Martiny 2019).

8.2. I: Review and Critique of Conceptual Analyses of Pain

While there are, of course, nuances between the many experiential accounts of pain, there is a certain consensus in the literature regarding the broad characteristics of painful experience. In this section, we contextualise our own analysis by summarising and critiquing some of these influential accounts (Scarry 1985; Leder 1990; Svenaeus 2015). Many authors of these works describe their perspectives as being phenomenological-though they are generally motivated to explicate general structures of pain, rather than seeking to integrate their account into a wider phenomenological tradition. Moreover, while these authors are certainly interested in painful experience, they tend to work through conceptual analysis and therefore do not fully attend to the complexities of painful experiences as they are lived through phenomenologically. We argue that they therefore inadvertently compromise and over-reduce their descriptions of pain, and consequently overlook matters of significant political import. As Disability Studies scholar Alyson Patsavas notes ( 2014), "Even scholarship that directly challenges the biomedical dominance of pain leaves the universally private, individualized, and tragic experience of pain largely intact" (p. 209; cf. Dahl et al. 2019; Käll 2012). It matters how pain comes into experience and by whom it is borne, yet this is not often acknowledged in theoretical accounts of pain. This section will hence demonstrate the necessity of our critical-phenomenological analysis by exploring not only the subjective experience of pain but also its intersubjective constitution.

Aversiveness is frequently assumed to define painfulness. In these cases, pain is unequivocally taken to mean "the very concretization of the unpleasant, the aversive" (Leder 1990, p. 73). It is interpreted as a kind of negation, 'not me,' to be driven out: "[i]f to the person in pain it does not feel averse, and if it does not elicit in that person aversive feelings toward it, it is not in either philosophical discussion or psychological definitions of it called pain" (Scarry 1985, p. 52). In accounts such as these, pain is presented as intrinsically aversive, disruptive, and contrary to 'normal' experience. However, as literary scholar Geoffrey Galt Harpham ( 2001) observes, pain is not homogenous but rather it is "a combination of sensations, dispositions, cultural circumstances, and explanations" (p. 208). Historian Joanna Bourke ( 2014) in turn emphasises that "People do pain in different ways. Pain is practised within relational, environmental contexts. There is no decontextual pain-event" (pp. 7-8). The potentially pleasurable pain of getting a tattoo, running a marathon, or engaging in sexual masochism, for example, differs substantially from the abdominal throb of appendicitis, as do the normative meaning-complexes surrounding each experience respectively (Siorat 2006; Sheppard 2018). At its extreme, the depiction of painful experience as essentially aversive can both problematically reify pain as an agent independent of the person-in-pain and also obscure the fact that pain, under certain conditions and at different constitutive levels, can also be experienced as pleasurable or desirable. Pain here is not always an inconvenience to be borne, later deemed 'worthwhile' according to a logic of calculation, but rather it can be an intrinsically meaningful part of experience as lived-through. Moreover, pain's temporal givenness-its surprising or enduring character-gives form to the experience. Pain is rarely, if ever, a constant, but rather the shape and intensity of pain tends to vary along with embodied activity or circumstance (Leder 1990, p. 72).

To this end, the localisation of pain, in the body itself, can be centred in analysis. Scarry, for example, argues that pain can simultaneously present one's own body as the source of hurt (e.g. the heat and swelling in the finger caused by a splinter) and also be characterised as knifelike, pricking, stabbing, or searing as if an external entity were acting on the body (Scarry 1985, p. 53). Leder ( 1990) highlights a similar notion of 'sensory intensification' where the region of the body in pain "suddenly speaks up," surpassing and overwhelming any prior sense therein (pp. 71-72). These insights draw attention to how pain can present in an instant but, as Svenaeus ( 2015) notes, pain becomes something more problematic "in its more penetrating and chronic forms, [that] develop into something which permeates our entire experience" (p. 111). The duration and character of the pain influence what appears for us in the world through the Lived-Body. In order to differentiate between aversive pain as a reductive (and medicalised) notion of sensation, and aversive experience as a complex subjective manifestation in the lifeworld, Svenaeus ( 2015) appeals to the notion of suffering as "a richer concept than pain" that can explain how "pain changes the everyday experiences and life of a person" (p. 109; cf. Cassell 2004). Svenaeus' distinction helpfully points out that the potential for pain to be aversive depends largely on existential conditions that exceed localised and static bounds of an anonymous body. However, Svenaeus stops short of questioning the structural conditions which disproportionately affect certain people in pain, and does not account for how these conditions affect the very character of the painful experience itself. In this sense, it is not simply that pain is aversive and therefore causes suffering in the lifeworld in a linear sense. As Patsavas ( 2014) notes, "when cultural discourses construct pain as the cause of feelings of devastation, they oversimplify complex cultural, historical, and political phenomena. More than that, they prevent us from examining the structural conditions that make experiences of chronic pain tragic" (p. 204).

This is not to say that pain and suffering are entirely socially constructed, with no basis in the body. Neither is this to deny the importance of analysing suffering and seeking its alleviation in many instances. However, as we later argue in this paper, it is essential to recognise the extent to which cultural beliefs about pain matter phenomenologically and underpin structural conditions in the lifeworld. Pain, suffering, and their associated aversiveness are not simply determined by sensations in the body; popular discourses create entrenched ways of understanding and receiving pain, in turn shaping how we experience pain itself and the meaning it comes to bear (Patsavas 2014, pp. 203-204). We aim to substantiate this somewhat radical phenomenological claim in Section II. Here we simply wish to emphasise that life might be differentially experienced as unlivable for certain social groups, and that simple medical explanations for pain in the body fail to explain whose pain is accepted as more unnatural or abnormal. These vital political insights must be folded into a new phenomenology of pain, running through additional levels of experiential constitution. This will require a thoroughgoing account of the recognition of pain and relationships of care, which feed into the discursive systems described by Patsavas.

Different situations-care and neglect, relative control and precarity-drastically alter the manner in which pain is experienced. I may attempt to explain my pain to someone else, repeatedly, to no avail and without sufficient words to convey the experience (Rodemeyer 2008). At such times, it may be possible to turn one's attention elsewhere and coax the pain to recede into the background of experience, since "the pain quality is dependent upon the way I choose to focus upon things in the world in different activities" (Svenaeus 2015, p. 113). However, a more intense pain might thwart any attempt to gather up the experience into words at all, rendering the subject helpless in "a situation of passivity in relation to feelings that hurt you" (p. 118). This latter disruption perhaps further reveals how pain can obliterate the contents of consciousness, making certain complex thoughts unthinkable (Scarry 1985, p. 54). Leder ( 1990) echoes this notion, describing how 'intentional disruption' brought about by pain "renders unimportant projects that previously seemed crucial" (p. 74). Indeed, in the deepest agony, pain can become a totality and "displaces all else until it seems to become the single broad and omnipresent fact of existence" (Scarry 1985, p. 55). The world disappears as "our horizon of meaningfulness gradually shrinks until nothing but the self-centred pain remains" (Svenaeus 2015, p. 116). Someone experiencing this may feel unreachable and inconsolable, and that their life has been emptied of meaning by the senselessness of their suffering. However, to conclude that this sense of isolation is inevitable, as some of these authors do, is to ignore the intersubjective conditions that may have led to such a crisis (p. 120).

There is a huge stigma attached to many painful experiences. Particularly for those in chronic pain, neoliberal medical discourses individualise and decontextualise factors that make pain unbearable: by interpellating subjects as responsible for their own pain and suffering, framing their decisions on pain management as matters of personal choice and moral failure, gendering and racialising notions of stoicism and compulsory able-bodiedness, and proliferating a sense of being a burden who must overcompensate for care (McRuer 2006, pp. 2-3). In reality, of course, pain is rarely, if ever, experienced in isolation. We might ask, as Patsavas ( 2014) does, how a context in which "interdependence is acknowledged and valued" might transform experiences of pain (p. 209).

This critical perspective is lacking in some conceptual accounts of pain, and can lead to problematic conclusions. Scarry ( 1985) famously argues that pain can "destroy language" (p. 53), and claims that pain "brings with it all the solitude of absolute privacy with none of its safety, all the self-exposure of the utterly public with none of its possibility for camaraderie or shared experience" (p. 53). However, while the radical alterity of the other is preserved in empathy-I feel this pain as yours, not mine-it hardly follows that this is a distinction unique to painful experience, nor that pain is private and impossible to share. Intersubjective encounters are moments for possible shared recognition of pain. Others can turn away from our pain in disbelief and disregard however indisputably real it feels to us, but it does not follow that it is never possible to empathize. Evidence of others' experience is always mediated: their pain, joy, boredom, and ecstasy alike. Different situations can alternately lead people to reveal or conceal their experiences, in turn altering what it is possible for others to recognise and receive-and these situations can be changed.

So while it would be insensitive and wrong to claim that we can fully 'know' another person's experience, it is certainly true that, in empathy, we have our own experience of others' pain (Patsavas 2014, p. 206). In a sense, there is a co-experiencing of the phenomenon-my friends and family will know what it is like to live with my pain in their own way, and their responses will in turn make the experience feel problematic or recognised. The overlapping boundaries between my pain, their pain, and our pain constitute a co-experiencing of pain together, and this can happen at home but also in the clinical encounter. My doctor's incredulity or openness to my experience also alters how I live through my pain (p. 215).

These considerations already demonstrate an interplay between sensation, temporality, intersubjectivity, affectivity, and association already bound up in pain as a phenomenon. It is possible to critically enrich experiential accounts of pain without recourse to Husserlian analysis. However, we suggest that problematic claims to the universal aversiveness of painful experiences, for example, or of its ultimate incommunicability, can be challenged phenomenologically-and this is particularly important when it comes to treatment of pain or pathologisation of behaviour. For this reason, we turn to the rigorous work of Edmund Husserl, as well as the recent work of critical phenomenologists, in order to contribute an account of pain that can attend to these complexities at different levels of experiential constitution.

8.3. IIa: Critical Phenomenology of Pain

We have explored how painful experiences can feel complexly both aversive and pleasurable, how localised pain bears personal meaning, and how different contexts of care can make pain more or less difficult. We can now draw upon the work of critical-phenomenologists to further explicate painful experiences and the constitution of the intersubjective self. Many other academic disciplines concern themselves with the level of intersubjectivity, which is sometimes neglected or bracketed off as separable by phenomenologists-especially with respect to structural and political conditions. The intersubjective level would not merely encompass experiences of other people but also more generally the domain of intersubjective norms, sociality, politics, and collectivity-modes discussed by some scholars in operative terms of social constructivism. It is perhaps one of the merits of the critical-phenomenological approach that it both acknowledges and moves beyond the remit of this framework (Rodemeyer 2017). The importance of structural intersubjective systems is accounted for phenomenologically, but consciousness is not reduced to this level. Particularly when analysing value-constituting sensations like pain, it is problematic that so few phenomenological accounts reflect back at the structural and political situatedness which alters and influences the experiential complex across other levels.

Critical phenomenology is a theoretical attitude that takes up and critiques classical phenomenological conceptions of power relations (see e.g. Beauvoir 1949; Fanon 1952). It also employs the traditional phenomenological 'toolkit' to explore topics usually neglected or overlooked within the phenomenological canon, such as marginalization and oppression. Taking this latter approach, we start our analysis of pain with a rereading of Husserl's reflections on the sensible body as developed in Ideas II.

The body can be perceived and experienced by the subject in at least two different ways: as Body-Object ( Körper) and Lived-Body ( Leib). This is perhaps the most fundamental insight offered by phenomenology. Our bodies are given as objects, with extension in space and time, and are subject to perceptual rules and structures. On the other hand, my living body is the body which I experience-the body I feel and the very nexus of my acting, thinking, and being in the life-world. Sensation is an integral constitutive aspect of this double experiential structure. This is famously explored in §36 and §37 of Ideas II, where Husserl focuses on the concept of Sensings ( Empfindnisse). Here he characterises the body as "the perceptual organ of the experiencing subject" (Husserl 1989, p. 152), and considers how this corporeality is constituted when the Lived-Body comes into contact with itself-for example, when my two hands touch one another. Each hand senses and constitutes these sensations as an object but also as living-namely, the other hand. This combination is not merely the additive result of the physical thing plus the sensations: "it is not that the physical thing is now richer, but instead it becomes Body, it senses" (p. 52).

This case shows that touch between two parts of one's body entails a doubling of the sensations in the two parts of the body engaged in the process. In Husserl's words:

If this happens by means of some other part of one's Body, then the sensation is doubled in the two parts of the Body, since each is then precisely for the other an external thing that is touching and acting upon it, and each is at the same time Body. (p. 153)

Hence, the body is originally constituted as a physical thing with extension, exhibiting perceptible properties such as color, smoothness, hardness, and so on. But more than this, the body senses "on it and in it"; it has "specifically bodily occurrence," which Husserl defines as Empfindnisse-something missing in mere material things, like rocks and tables (p. 153). These localised sensations are defined as "effect-properties": they arise when the Body is touched, pressed, etc., where it is touching and at the time it is touched. In the example of hands touching one another, we witness the unfolding of two sensations, where "each is apprehendable or experienceable in a double way" (p. 154). This distinction between Body-Object and Lived-Body is instructive when applied to the case of pain-since the subject of painful experience is neither a disembodied consciousness nor a mere physiological organism, but rather it is the Lived- Body as experienced by myself and as myself. Pain is experienced by a subject, who has and is their body at the same time (Merleau-Ponty 1945). More precisely, however, pain is experienced as localised in the body-with varying degrees of precision-such that it might be possible to gesture and show 'where it hurts.'

Pain ostensibly occupies a marginal position in Husserl's phenomenology when contrasted with touch more broadly, but it plays an important role in the transcendental constitution of the Lived-Body (Vesey 1961). In Ideas II, Husserl counts pain among the tactile sensations that constitute not only the Leib but also Higher Objectivities. This insight is integral to our thesis that painful experience discloses several interconnected and intertwined levels of constitution. Painful sensations, Husserl says, play a role in acts of valuing "analogous to that played by the primary sensations [...] for the constitution of Objects as spatial things" (Husserl 1989, p. 160). It is not the case, as some have interpreted it, that through "acts of 'taking up,' I transform pure sensations into intentional experiences" or objects (Geniusas 2014, p. 11). Instead, sensations like pain, as they are lived through, arise kinaesthetically through the body and in associative synthesis in ways that affectively move us:

Sensation accounts for the fact that once certain thresholds are reached, we follow the pulsations and organization of the perceptual field. Rather than our actions leading us to the object, rather than our perceptions being 'explicative', these noematic constituents bring the object to us and introduce it to us. (Welton 1977, p. 63)

A sharp pain might awaken me at the level of personal consciousness, and gradually the location of the pain might become constituted and objectivated through a temporal process. I move my body this way and that, I press where it hurts and discover how the pain modulates and worsens. Experience is founded by affective primal sensation ( hyle) prior to this objectivation. These sensations feature in a flow of temporal experience-time-constituting consciousness-within which objectivation through the passive syntheses of temporality and association is possible. Retention, primal impression, and protention play their role here. More than this, habits, inclinations, and associations accrued over time influence what acts and objects of experience appear for me. These are, one might say, conditions of possibility for conscious action such that "the perceptual field is not one which has to be traversed by consciousness but, rather, is a field inhabited by consciousness" (p. 66).

Through the process of objectivation, the pain becomes an intentional object to be investigated, located, imagined, remembered, and so on. The cause of the pain emerges as a naturalistic concern to be reflected upon, as opposed to the pain as it is lived through. In seeking a causal explanation for the painful experience, and thus objectifying the pain, the subject also seeks recognition and legitimation of the pain as some thing. My personal history with painful experiences will come into play-perhaps I have felt like this before, recognise it, and experience personal meaning associated with this kind of pain. I may be able to 'tune out' the sensation of pain as the experience is constituted for me in these various ways; I may distract myself or it may become more normal or habitual for me.

This painful experience will also have garnered intersubjective significance, depending on my circumstances and the care available. I may wonder whether I am likely to be believed if I seek help, for example. Fundamentally, my experience is phenomenologically given to me in a particular way that is inaccessible to the other. However, Husserl notes that this does not preclude the possibility of entering into a mutual understanding or empathetic relation [ Einfühlung], explaining the precise limitations carefully:

[In] a now which, as intersubjective presence, is identical for the different subjects who mutually understand one another, these subjects cannot have the same 'here' (the same intersubjective spatial presence) nor the same appearance. The index of this phenomenological state of affairs is the impenetrability of the different contemporaneous Bodies as such. Two bodies can be Objectively bound into one thing, can 'grow together' into one, but the concrescence into one thing does not create a Body filling the same temporal duration, does not create a here, a space with phenomenal orientation, and an identity of the appearances of things with respect to the world of things surrounding both subjects. (Husserl 1989, p. 216)

Nevertheless, if my experience does not appear as concordant with the experience of others, and does not conform with the norms of the mutual understanding, then it will be received intersubjectively as invalid or indeed pathological (p. 85). While this can emerge between two individuals in a relationship of care, it is heavily influenced by broader political norms and structures. Other questions arise within the painful experience. Do I trust in any healthcare provision to which I have access? How long do I anticipate this pain will continue as a result, and does that anticipation feel bearable? Does this pain feel shameful, and do I feel worthy of care? These aspects of the painful experience may, in fact, problematically intensify or normalise these very pain sensations, depending on the intersubjective social and political context within which I find myself.

8.4. IIb: Pain That Matters

This framework for understanding levels of constitution provides a powerful toolkit for integrating phenomenological accounts with other critical traditions. Norms and normativity garner significance at all these various levels of constitution, and therefore do not so much suffer from equivocation as indicate an irreducible interrelation. A sophisticated social theory ought to account for levels of value-constituting sensory experience. Likewise, a good phenomenological inquiry will account for the intersubjective (social, political, cultural, and inter-corporeal) influences on objectivation and processes of meaning-making. Bringing this perspective to bear on the experience of pain, we might ask: How does our being-in-the-world shape our experiences of pain? How does our social and political situation affect the constitutive levels of experience? Whose pain matters to whom?

We argue that structural conditions may make one's experience more or less painful, bearable, or dangerous. The experience of pain is mediated by a complex web of social and political structures, in ways that parallel experiences such as that of being pregnant, being ill, dying, ageing, breastfeeding, or living through changes in mental health. The common denominator is the intersubjective context, directly influencing the quality and the value of the experience for the subject. Our Lived-Bodies, as both natural and cultural (Merleau-Ponty 1945), are dynamically co-determined in situ by our subjective responses and the intersubjective context and environment (Beauvoir 1949). As explained phenomenologically in Section IIa, personal and clinical histories and idiosyncrasies influence how painful experiences are lived through. In particular, however, structural violations have a crucial role in experiencing pain, in such a way that the intersubjective level affects the most immediate sensory experience of pain. Pain tolerance can become eroded through enduring pain without support, care, or belief from others, for example. It can be especially difficult to make sense of pain without any shared understanding and if not believed by those who might ease our pain, such as health practitioners. And senses of helplessness or shame in pain are more pervasive across certain intersections and positionalities.

Structural violations such as gaslighting (Cohen Shabot 2019) and silencing (Maitra 2009; Caponetto 2017) profoundly affect experiences of pain. For instance, medical practitioners' racist, sexist, classist, ableist, and ageist preconceptions (among others) can and do result in differential pain treatment for patients when their experience is dismissed (Carel and Kidd 2014; Kidd and Carel 2017), further aggravating health and well-being inequalities and limited access to healthcare (Jones 2019). Avenanti et al. ( 2010) have argued that human subjects react empathically to strangers' pain. And yet, these empathetic responses may change according to racial bias and stereotypes. It has also been found that stereotypes about gender, race, and age differences influence people's estimation of others' pain (Wandner et al. 2012). These phenomena do not simply deprive patients of appropriate pain treatment (see e.g. Bonham 2001). Indeed, gendered and racialised biases have been shown to cause inaccuracy in pain assessment and treatment recommendations (Hoffman et al. 2016; LeResche 2011).

Our phenomenological focus is therefore the so-called "quasi-transcendental structures" of painful experience (Guenther 2019). According to Guenther's analysis, there are some structures which are not a priori "in the sense of being absolutely prior to experience and operating in the same way regardless of context", but they otherwise have a key role in the constitution of our experience of ourselves, others, and the world, and "in shaping the meaning and the manner of our experience" (p. 11). Patriarchy, white supremacy, and cisheteronormativity, for instance, are "ways of seeing" that actively inform our natural attitude and shape the quality of our experiences, in turn becoming ways of " making the world" (p. 12). These structures shape our bodily experiences, often in insidious ways, and accounting for these can reveal the power relations and socio-political structures at play (Weiss et al. 2019). While people may not share the same experience of pain strictly in terms of sensation, they may together experience the same structural conditions which make their experience more or less painful. In this sense, while painful experience may feel irreducibly isolating and marginalising, it might be possible to find recognition from others with similar conditions-medical, political, or both-even without words or bodily markers to signify the pain itself.

As discussed in Section I, this aspect of painful experience rarely features in the experiential accounts of pain. We contend that this stressful structural context may, in fact, permeate, affect, and modify sensations of pain and the possibility of its recognition, intensifying the overall painfulness of the experience. As Zeiler ( 2010) points out, "analyses of how the body appears to the subject need to explore the interplay between the subject's experience of injury, disease and/or pain, the social support or lack of support of others, and cultural norms as regards whether and how the subject can express these experiences" (p. 338; cf. Cohen Shabot 2017). The way we make sense of our pain deeply affects our very lived experience.

In this way, the intersubjective level of painful experience-including the management and treatment of pain-directly affects the 'lowest' and most immediate sensory level of the pain. Furthermore, it supports our thesis that, far from exclusively being a primal and pre-reflective experience, pain is complexly co-determined by social, structural, and political features. We believe that acknowledging pain as a constitutive experience of subjectivity may help to shape alternative approaches to healthcare, such as intervening in the passive-active patient-practitioner dynamic; translating practices of care to cultural contexts; challenging the oppressively normative and naturalised notions of 'good' or 'deserving' pain; and extending an understanding of epistemic injustice (Fricker 2007). For these reasons, it may be advisable that medical practitioners and carers not only take a lifeworld-based, person-centred approach to treatment and care-as is often and rightly espoused-but also attend to the specific political and cultural environments integral to both the patient and practitioner's experiences. By attending to these complexities of painful experience and associated suffering, a radically different notion of care may emerge as appropriate for each person beyond unsympathetic and clinical elimination of pain altogether.

8.5. Conclusion

In this paper, we put forth a critical conception of pain as a complex multi-levelled phenomenon, deeply ingrained in the constitution of one's sense of bodily self and emerging from a web of social, cultural, and political relations. In the first section, we reviewed and critiqued some experiential accounts of pain. We explored how pain is involved in complex ways with modalities of pleasure and displeasure, enacted personal meaning, and contexts of empathy or shame. Our primary goal was to show why a phenomenology of pain must acknowledge the richness and diversity of peculiar painful experiences.

The second section interwove these critical insights with Husserlian phenomenology of embodiment, sensation, and localisation. We introduced the distinction between Body-Object and Lived-Body to show how pain presents intersubjectively (e.g. from a patient to a clinician). Furthermore, we stressed that, while pain seems to take a marginal position in Husserl's whole corpus, its role is central in the transcendental constitution of the Lived-Body on multiple levels. We then concretely explored how some people may experience structural conditions which make their experience more or less painful. A stressful structural situation may, in fact, permeate, affect, and modify sensations of pain, intensifying the overall painfulness of the experience and, in some cases, threatening lives.

Painful experiences draw our attention to our bodies as they pertain to our surroundings, not only in their physicality but also in their sociality. Acknowledging pain as a constitutive aspect of subjectivity may help to shape alternative approaches to healthcare, through a reconsideration of the situated experience of the subject, not only in terms of 'personhood' and abstract 'rights' but, also and above all, as embodied and situated.

References

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Bourke, Joanna. 2014. The story of pain: From prayer to painkillers. Oxford: Oxford University Press.

Cassell, E.J. 2004. The nature of suffering and the goals of medicine, 2nd ed. Oxford: Oxford University Press.

Cohen Shabot, S. 2019. 'Amigas, sisters: We are being gaslighted': Obstetric violence and epistemic injustice. In Childbirth, vulnerability and law: Exploring issues of violence and control, ed. C. Pickles and J. Herring. Oxford: Routledge.

Dahl, E., C. Falke, and T.E. Eriksen (eds.). 2019. Phenomenology of the broken body. Oxford: Routledge.

Fanon, F. 1952. Black skin, white masks. trans. R. Philcox. New York: Grove Press.

Fricker, M. 2007. Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.

Guenther, L. 2019. Critical phenomenology. In Fifty concepts for a critical phenomenology, ed. G. Weiss, G. Salamon, and A.V. Murphy. Evanston: Northwestern University Press.

Harpham, G.G. 2001. Elaine Scarry and the dream of pain. Salmagundi, 130/131.

Husserl, E. 1989. Ideas pertaining to a pure phenomenology and to a phenomenological philosophy. Second book: Studies in the phenomenology of constitution, trans. R. Rojcewicz and A. Schuwer. Amsterdam: Kluwer Academic Publishers.

Käll, L.F. (ed.). 2012. Dimensions of pain: Humanities and social science perspectives. Oxford: Routledge.

Leder, D. 1990. The absent body. Chicago: University of Chicago Press.

McRuer, R. 2006. Crip theory: Cultural signs of queerness and disability, vol. 9. NYU press.

Merleau-Ponty, M. 1945. Phénoménologie de la perception [Phenomenology of perception]. Paris: Éditions Gallimard.

Rodemeyer, L. 2017. Lou Sullivan diaries (1970-1980) and theories of sexual embodiment: Making sense of sensing. Cham: Springer International Publishing.

Scarry, E. 1985. The body in pain: The making and unmaking of the world. Oxford: Oxford University Press.

Weiss, G., G. Salamon, and A. Murphy (eds.). 2019. 50 concepts for a critical phenomenology. Evanston: Northwestern University Press.

Welton, D. 1977. Structure and genesis in Husserl's phenomenology. In Husserl: Expositions and appraisals, ed. F.A. Elliston and P. McCormick. Notre Dame: University of Notre Dame Press.

1

Patsavas' cripistemology of pain ( 2014) aims at "tracing the discursive systems that materially produce and structure experiences of pain, laying out a corporeally infused cultural analysis of pain, excavating the felt experiences of cultural discourses, and situating those experiences within a broader cultural politics of ableism" (p. 207).

2

However, as Garland-Thomson ( 2004) reminds us, the "cultural logic of euthanasia" underpinning difficult decisions around worthiness, care, and compulsory cure, often serves to annihilate, rather than support, those in pain.

3

Patsavas ( 2014) explores this point when rereading diary entries by her younger self, where she had written "I need to be punished, for all the pain I can't control. I'm ashamed of that. I'm ashamed of not being able to handle the pain. I'm ashamed of the pain I cause so many people because of it. For that I deserve to hurt" (p. 208).

4

Husserl also, importantly and relatedly, examines the relationship between domains of tactility and visibility. The body is perceived from outside-with all the limits and rules that pertain to the process of visual perception-and some parts which may be perceived by touch cannot be seen: "Touching my left hand, I have touch-appearances, that is to say, I do not just sense, but I perceive and have appearances of a soft, smooth hand, with such a form. The indicational sensations of movement and the representational sensations of touch, which are Objectified as features of the thing 'left hand', belong in fact to my right hand. But when I touch the left hand I also find in it, too, series of touch-sensations, which are 'localized' in it, though these are not constitutive of properties (such as roughness or smoothness of the hand, of this physical thing)" (Husserl 1989, p. 152).

5

Husserl's nuanced conception of pain begins in the Logical Investigations as a response to the debate between Brentano and Stumpf on this matter, where he acknowledges the inherent ambiguity of pain as both an intentional and non-intentional object (Geniusas 2014).

6

"A human being's total consciousness is in a certain sense, by means of its hyletic substrate, bound to the Body, though, to be sure, the intentional lived experiences themselves are no longer directly and properly localized; they no longer form a stratum on the Body" (Husserl 1989, pp. 160-161).

7

Pain has also been conceived not only in relation to corporeality but also as a psychic object, enduring like a melody: see Svenaeus ( 2015), "Pain is not primarily objectified and reflected upon, but rather lived as a melodic style of human experience" (p. 113).

This work was supported by the Wellcome Trust [203109/Z/16/Z]. We are very grateful to colleagues and friends at our respective institutions for their feedback on an early draft of this chapter. We contributed equally as authors to this chapter.

# data[].attributes.attachment_link.title
Painful Experience and Constitution of the Intersubjective Self: A Critical-Phenomenological Analysis

# data[].attributes.attachment_link.description
In this paper, we discuss how phenomenology might cogently express the way painful experiences are layered with complex intersubjective meaning. In particular, we propose a critical conception of pain as an intricate multi-levelled phenomenon, deeply ingrained in the constitution of one's sense of bodily self and emerging from a web of intercorporeal, social, cultural, and political relations.

# data[].attributes.headline
Phenomenology and pain - Nay & Fetherstonhaugh

# data[].attributes.subject
Phenomenology and pain - Nay & Fetherstonhaugh

# data[].attributes.attachment_link.readable_text
doi: 10.1111/j.1748-3743.2012.00329.x.

Affiliation

1 Australian Institute for Primary Care & Ageing, Level 5, Health Sciences 2, La Trobe University, Melbourne, Vic. 3086, Australia. r.nay@latrobe.edu.au

doi: 10.1111/j.1748-3743.2012.00329.x.

Affiliation

1 Australian Institute for Primary Care & Ageing, Level 5, Health Sciences 2, La Trobe University, Melbourne, Vic. 3086, Australia. r.nay@latrobe.edu.au

Abstract

This paper presents four phenomenological accounts of pain which describe: the pain at the time of the experience; the meaning the pain had at the time of the experience (reflection in); and the meaning of the experience looking back on it (reflection upon). Specifically, the accounts describe pain that is emotional, cognitive and physical (acute and chronic). By exploring the essence of pain using very personal accounts, we encourage nurses to reflect on how their own understanding of pain and individual responses to pain can impact on how they in turn recognise, assess and manage pain in older people and especially those living with dementia. Paper 1 highlights the under-assessment of pain in older people with dementia. By confronting readers with this paper's phenomenological approach, it is hoped that they will be challenged to address this situation.

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# data[].attributes.attachment_link.description
This paper presents four phenomenological accounts of pain which describe: the pain at the time of the experience; the meaning the pain had at the time of the experience (reflection in); and the meaning of the experience looking back on it (reflection upon). Specifically, the accounts describe pain ...

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Naïve realism, sense-datum theory and intentionalism

Naïve Realism endorses two main claims, the first ontological and the second phenomenological. The ontological claim is that perception is essentially relational-that is, it fundamentally consists in a relation between a perceiver and one or more objects-and that the objects of perception are mind-independent, such as books, tables and so on. The phenomenological claim is that the phenomenal character of perception derives from this ontological structure.

The phenomenological claim is more difficult to specify, mainly because it relies on a technical notion-that of 'phenomenal character' (from now on 'PC')-that has proved to be particularly hard to handle in the recent literature on the philosophy of mind. One common way to understand it involves the concept of 'what it is like' to be in an experiential state-that is, to how the experience strikes the subject to be 'from the inside'. As such, any conscious experiential state will have a property of 'being like' a specific way. The PC of the experience can be thus variously defined as what captures the 'what-it-is-like properties' of the experience (Martin 1997, p. 93), or to correspond to those properties of the experience that explain how the experience 'seems' to the subject (Nudds 2009, p. 335), or as 'the property of the experience that types it according to what it is like to have it' (Fish 2009, p. 9).

Therefore, the phenomenological claim amounts to the idea that the specific way perception 'seems' to the subject-what it is like to have it-is determined (Martin 1997, p. 94) by the fact that perception consists in a relation with mind-independent objects and their features. According to Naïve Realism, therefore, the PC of perception is a relational property, as the experience could not have it unless its relata-the perceiver and the perceived objects-existed. This is why the Naïve Realists often claim that the PC of perception is at least partially constituted by the perceived (mind-independent) objects, or that these objects 'shape the contours of the subject's conscious experience' (Martin 2004, p. 64).

In principle, the two claims could come apart: one could coherently endorse the ontological claim while rejecting that the PC of perception is determined by its relational structure (for instance, by claiming that perception also involves a representational content and that it is the nature of this content that determines its PC). But since the phenomenological claim arguably constitutes the main motivation to endorse Naïve Realism, and since the main purpose of this paper is to analyse this motivation, I will ignore this possibility in what follows.

Given its commitment to these claims, Naïve Realism is usually conceived as a theory of veridical perceptual experience only. Take, for instance, a situation in which someone is hallucinating an oasis in a desert. This experience obtains in the absence of the suitable object of experience-the oasis. Therefore, the ontological claim-and, hence, also the phenomenological one-appears to be false for cases of hallucination. The fact that Naïve Realism does not account for the nature of misperception is at the basis of the main reason why it has often been considered as a non-starter position in the debate on perception. Consider again the hallucination above. It seems conceivable for that situation to be indiscriminable from a corresponding veridical one-one where the oasis is present in the subject's environment. This has been taken by many philosophers to entail that 'what it is like' to be in the two situations is the same, and hence that they have the same PC. But since the phenomenological claim is false for the hallucinatory case, it seems to follow that also the PC of the veridical case cannot be determined by the experience being genuinely relational. In turn, as I have mentioned above, this seems to undermine the main motivation to endorse the ontological claim as well.

The Sense-Datum Theory and Intentionalism can be seen as alternative ways to exploit the intuition that 'sense-experience'-the term I will use to identify the class of experiences including both veridical and non-veridical cases-should be analysed in terms of a common 'factor'-or a common 'fundamental' kind of mental state-that is allegedly present both in the 'good' and the 'bad' cases. The Naïve Realist's analysis of experience cannot be applied to this alleged common-factor because some of the 'bad' cases do not consist in a relation with the mind-independent objects we take them to present us with. The Sense-Datum Theory deals with this issue by claiming that Naïve Realism is correct when it comes to identifying how the objects of perception are made manifest to the subject-that is, it agrees with Naïve Realism that perception is an essentially relational mental state. But since, according to what we may call the 'common-factor' assumption, this also applies to illusions and hallucinations, it follows that the objects of sense-experience are mind- dependent entities which are usually called 'sense-data'.

On the other hand, Intentionalism agrees with Naïve Realism that the objects of perception are mind-independent, but it disagrees over how these objects are made manifest to the perceiver. According to Intentionalism, sense-experiences are representational states-that is, mental states characterised by the possession of representational content.

This idea is usually elucidated by drawing an analogy with other mental states that are traditionally considered representational, such as belief. Consider a case in which I falsely believe that there is a table right in front of me. In this situation, it would not seem right to claim that the object of my belief is a mind-dependent, or 'mental', object: what I believe to be in front of me is a perfectly physical, mind-independent object. I just happen to be wrong in believing that this table was present in my surrounding environment-that is, the belief was representing my environment inaccurately. Intentionalism construes sense-experience in the same way. Therefore, what individuates it as the kind of mental state it is (including its 'what-it-is-like' properties), is the fact that it possesses an intentional content-a condition that a perceptual state can meet regardless the existence of the represented objects. The difference between veridical and non-veridical cases amounts to whether the intentional content is an accurate representation of the subject's environment or not.

To help us with the transition to the next section, the situation can be outlined as follows. According to Naïve Realism, veridical perceptual experience presents two fundamental features:

1.
Transparency (T) It makes manifest to us mind-independent objects and their features;

2.
Actualism (A) It makes the perceived objects manifest in a way that it cannot be the case that they do not exist and are not perceived.

Due to the mentioned considerations linked with the possibility of misperception, Sense-Datum Theories reject the claim that perception possesses (T) while endorsing (A) for both veridical and non-veridical cases: when it comes to sense-experience, it is true that when the subject senses an object, that object must exist and be sensed, but false that this object is mind-independent. On the contrary, Intentionalism rejects (A) while accepting (T): the sensed objects are mind-independent, but they need not exist for the experience to occur.

The problem is that, according to some philosophers, (A) and (T) are both part of our 'intuitive' conception of perception. It follows that only Naïve Realism articulates such intuitive conception, while the other parties must reject at least one of its two fundamental features. To 'save' our intuitions on the nature of perception, in the last couple of decades some philosophers have denied that 'good' and 'bad' experiential cases should be explained in terms of a common fundamental state-thus embracing a 'disjunctive' account of sense-experience. In this way, it is possible to claim that our intuitive conception of perception is correct at least when it comes to the veridical cases-that veridical perceptual experience possesses both (A) and (T).

Most of the recent debate focusses on whether a disjunctive account of sense-experience is defensible, and on the kind of account Disjunctivism could give of the non-veridical cases. This paper focusses on two more basic questions: what does it mean to say that (A) and (T) are part of our 'intuitive' view of perception? Is it true?

Section 2 focusses on what we should make of the idea that a theory of perception accommodates our 'intuitive' conception of perception, independently from what Naïve Realism takes to be part of such conception. Section 3.1 provides some considerations concerning the two main features of this (allegedly) 'intuitive' conception.

Common-sense and introspective evidence

In this section, I address question (1)-the question concerning what the advocates of Naïve Realism mean when they claim that it best captures our intuitions concerning the nature of perception, independently from the (alleged) specific features of such a conception.

When it comes to this question, there is a widespread oscillation between two at least prima facie different ideas. The first idea is that a naïve conception of perception corresponds to our 'pre-theoretical intuitions concerning perception or, in other words, to the view of the common man' (Fish 2009, p. 5). Martin, for instance, puts things in this way on different occasions: in ( 2002), he claims that subscribing to Naïve Realism allows us to avoid needing 'to posit some kind of error in our naïve or common sense judgments about perception' ( 2002, p. 420); in (2006) that Naïve Realism 'correctly captures the common-sense conception of perception' ( 2006, p. 356) and that it is 'the best philosophical articulation of what we all pre-theoretically accept concerning the nature of our sense-experience' ( 2006, p. 404). Crane expresses the same idea when he mentions that our 'pre-theoretical conception of perception' is that of 'a relation to a mind-independent object' ( 2006, p. 133). In fewer words, according to some commentators, Naïve Realism is the best articulation of our 'common-sensical' or 'pre-theoretical' judgments concerning the nature of perception.

The second idea is sometimes presented in association with the first, while some other times it just replaces it. It is the idea that Naïve Realism best articulates what is evident to us by reflecting on, or introspecting, a veridical perceptual experience. Martin endorses it multiple times, for instance in ( 2001), when he argues that 'reflection on experience gives equal support to both Transparency and Actualism' and that Intentionalism, therefore, denies 'introspective evidence' for (A) ( 2001, p. 219). He then presents it together with the first idea by claiming that Naïve Realism aims to take 'our introspection of experience at face value, thereby avoiding the need to posit some kind of error in our naïve or common sense judgments about perception' ( 2002, p. 420). Finally, he insists that Naïve Realism 'best articulates how sensory experience seems to us to be just through reflection' ( 2006, p. 354). Nudds also pursues this conception of 'naiveness' by arguing that 'when we introspect a visual experiential episode, it seems that we are related to some mind-independent object or feature that is present and is a part, or a constituent, of the experience' ( 2009, p. 334). Crane claims that evidence for the relational view can be found when we 'turn inwards' or 'reflect' on our experience (2005, p. 247).

What is the relationship between these two ideas? Is Naïve Realism 'naïve' in the sense that it articulates our 'common-sense judgments' about perception or our introspective knowledge of it? If we assume them to be different things, one possible interpretation is that Naïve Realism is taken to represent the best articulation of both. This is implausible for at least two reasons: (a) the two ideas are sometimes explicitly presented as connected claims (see, for instance, the passage mentioned above from Martin ( 2002)); (b) none of the authors above provide different sets of features Naïve Realism articulates, one for our pre-theoretical conception of experience and the other for our introspective knowledge of it: in both cases, the features Naïve Realism accommodates are (T) and (A).

It seems plausible, therefore, that by mentioning our pre-theoretical/common-sense judgments on perception and our reflective/introspective knowledge of it, these authors refer to the same thing. One way to accommodate this is to claim that whatever is 'common-sensical' or 'intuitive' to say about perception is exclusively a consequence of what we can know about it through introspection. This could make sense of the idea that Naïve Realism accommodates both, as one would consist in a collection of judgments grounded on our introspective access to perception.

This claim, however, is far from uncontentious. If we imagine asking someone (some 'common' person) about her beliefs concerning the nature of perception, we would probably get an answer along these lines: that perception is a way to obtain information about the external environment through our senses. It is not implausible that some of us could include some rough information about how the external world causes our experience: light being reflected by external objects and captured by the eyes, signals being transmitted by the nervous system to the brain and so on. Could we get to this kind of answer exclusively by introspection? This seems very implausible, but I see no reason why such an answer should not count as 'intuitive' or 'common-sensical'. Of course, one can argue it is not a 'pre-theoretical' conception, as part of it depends on some (albeit vague and, possibly, even incorrect) notions concerning scientific studies on perception. This may be true, but how is it a problem? Common-sense, after all, is shaped by different sources, most importantly including the society in which we live-which, in turn, embeds a whole series of conditionings, also coming from the most diverse areas of knowledge. It is not surprising if common-sense is partially shaped by a sort of vulgarization of highly 'theoretical' acquisitions. Yet, maybe Naïve Realism is supposed to capture precisely what we would say about perception if we were not influenced by this cluster of diverse conditionings. If this is the case, it would become difficult to understand in which sense such a conception would be 'common-sensical'. Moreover, besides the obvious problem of identifying what precisely this 'naïve' conception would amount to, it would become unclear why accommodating it should work as a motivation for Naïve Realism: how does accommodating Tarzan's (alleged) conception of experience constitute a reason to endorse Naïve Realism?

We need to look for a different way of making sense of the connection between the two claims, besides them being simply distinct or one the direct consequence of the other. One option is to give a central role to the second claim rather than the first-that is, to the idea that Naïve Realism is (allegedly) the best way to account for our introspective knowledge of perception. If we focus on this claim, we can more easily connect it with the idea of this account being pre-theoretical: Naïve Realism is, allegedly, the best way to account for what introspection reveals to us about perception when it is not influenced by any further theoretical commitment. The underlying assumption, therefore, is that introspection on perception delivers for everyone, when performed correctly, the same results-so that via introspection we can reach a starting point everyone agrees on.

If this is the case, we have avoided a source of potential confusion: despite being called 'naïve', Naïve Realism does not refer to the conception the 'common person' has of perception. To assess what is naïve about Naïve Realism, therefore, it will be irrelevant to identify what is our 'common-sensical' conception of perception: we rather need to reflect on what appears to us when perceiving and find out whether it is the case that, introspectively, perception seems to possess the two features discussed in Sect. 1.

At this point, one may be tempted to reassign a role to the conception of the 'common person' by claiming that Naïve Realism best articulates what she would answer not to a general question about the nature of perception, but to the corresponding phenomenological one-something on the line of 'what it is like' to perceive. However, there is a widespread acceptance of the idea that phenomenological questions are rather sophisticated ones; questions that are not easy to understand, let alone to answer. One may then legitimately wonder whether there could ever be a 'naïve' response to such a sophisticated question. But even granting that this is not an issue, the main claim of this section would be preserved: Naïve Realism should not be taken to simply articulate our 'common-sense' conception of perception, but rather the conception of experience we gain when we 'pre-theoretically' introspect a veridical perceptual experience. This proposal does not change the fact that the only relevant assessment of the idea that Naïve Realism is 'naïve' is to be gained via reflection or introspection.

Before moving to the next section, I want to point out how this result helps to answer a legitimate question about the motivations for endorsing Naïve Realism. In fact, one may wonder why the idea that only Naïve Realism can take our intuitive conception of perception at face value is supposed to be an advantage of the view. After all, it is even desirable for our advanced investigations on the nature of experience to overtake-or at least to refine-our previously 'naïve' opinions on the matter. Following this line of reasoning, Hawthorne and Kovakovich argue that 'it is still worth wondering why vulgarity is to be celebrated', and that there are reasons to doubt that 'vulgar common sense has seen in advance how to handle various challenges and commitments' ( 2006, p. 180).

If my interpretation is correct, Naïve Realism has little to do with 'vulgar common sense'-as it is 'naïve' in the sense that it takes at face value the phenomenology of veridical perceptual experience. Accommodating the phenomenology of experience is not the only reason to endorse a theory of perception. Other considerations could enter in the picture: one could be attracted by a theory's ability to explain the kind of authority perception has on our empirical beliefs, or to the way it accounts for our knowledge of the external world. However, it is a desirable feature of any theory of perception, and one to which many theories of perception often appeal: as Martin underlines, both Sense-Datum Theory and Intentionalism have appealed to phenomenological evidence to defend their positions against their rivals ( 2001, pp. 216-217).

But if we accept that Naïve Realism is right about how veridical perceptual experience seems to us-that it seems to present both (A) and (T)-then Sense-Datum Theory and Intentionalism must hold that introspection is misleading about the PC of veridical perceptual experience. This is not an easy consequence to digest, because it entails that introspection is not even reliable when it comes to investigating how things seem us to be, which sounds almost paradoxical (Martin 2002, p. 421). Naïve Realism would then be the only account of perception which accommodates the fact that 'what it is like' to perceive involves both (A) and (T), and that this is what explains why it introspectively seems to present them both. If true, this would constitute a far better motivation for endorsing Naïve Realism than the appeal to some vague claims about the opinions of the 'common man'.

Transparency, actualism and phenomenal immediacy

In this section, I complete the clarificatory task of the paper by giving some further details about how we should understand (T) and (A). In this way, it will be possible to provide a conclusive answer to questions (1) and (2)- thus identifying what is supposed to be 'naïve' about Naïve Realism. In the rest of the section, I argue that (A) is not part of our introspective knowledge of perception, and I identify a feature- Immediacy (I)-that is more suitable to capture the intuitions behind (A). I then show that Intentionalism is not committed to rejecting (I), thus challenging the claim that only Naïve Realism can take our intuitive conception of perception at face value.

Clarifying transparency and actualism

Let us first briefly focus on (T), which raises less interpretative issues than (A). Given the conclusion of Sect. 2, the claim that (T) is part of our 'intuitive' view of perception amounts to saying that, when we reflect on a veridical perceptual experience, we find that mind-independent objects and their features are made manifest to us.

As I have mentioned (note 15), the 'transparency thesis' is usually taken to claim that we can describe the PC of perception exclusively in terms of what it makes manifest to us (Harman 1990, p. 39). Under this formulation, 'transparency' has been used to argue against those theories committed to the idea that perception presents some 'intrinsic', non-intentional, features, as there would not be any phenomenological evidence for them.

True or not, this is not how Naïve Realism construes (T) in this context (Hellie 2007, p. 269). Thus formulated, in fact, not even the Sense-Datum Theory would be committed to denying (T), being compatible with the claim that all we are aware of in perception are its objects (construed as sense-data) and their features. (T) rather captures the idea that when we introspect our experience it is not as though the putative mind-independent objects of perception disappear to make way to some other kind of entities:

When my attention is directed out at the world, the lavender bush and its features occupy the centre of the stage [...] when my attention is turned inwards instead to my experience, the bush is not replaced by some other entity belonging to the inner realm of the mind in contrast to the dilapidated street in which I live (Martin 2002, p. 380).

(T) is the claim that our introspective knowledge of perception presents it as directed towards the mind-independent world without intermediaries-that 'the character of one's experience involves in some sense, or is directed on, or of, the mind-independent objects and their features which we take to be around us in our environment' (Martin 2001, p. 217). If this phenomenological remark is correct, as I believe we should concede, Sense-Datum Theories must indeed deny that perception has (T), despite introspective evidence of the contrary.

We can now move to (A). According to (A), perception makes its objects manifest to us in such a way that it cannot be the case that they do not exist and are not perceived. As anticipated, this feature is more difficult to handle than (T), partly because the recent literature oscillates between three different formulations of it.

The first formulation is what I call the modal claim, according to which it introspectively seems to us that we could not be in the same experiential situation in the absence of the suitable objects of perception. This formulation can be found, for instance, in Nudds-who claims that 'your experience seems such that were the bowl of fruit not actually there, you could not be having this particular experience' ( 2013, p. 271)-and Martin-who believes that 'what was distinctive of my situation is that things could not be this way with me and no object be there at all' ( 2001, p. 220).

The second formulation is the constitutive claim, which says that it introspectively seems to one that the perceived mind-independent objects (and their features) are constituents of the experiential state. Nudds, for instance, argues that 'visual experiences seem to have the NR [Naïve Realist] property' ( 2009, p. 335), which he defines as 'the property of having some mind-independent object or feature as a constituent' ( 2009, p. 334), and, more explicitly, that 'our experience [...] seems to have mind-independent objects and features as constituents' ( 2013, p. 271). Martin claims that 'when one introspects one's veridical perception one recognises that this is a situation in which some mind-independent object is present and is a constituent of the experiential episode' ( 2004, p. 65).

Finally, the relational claim is that perception presents itself as a relation to mind-independent objects and their features. Nudds, for instance, claims that 'when we introspect a visual experiential episode, it seems we are related to some mind-independent object or features' ( 2009, p. 334) and that 'our experience seems in this way to involve the mind-independent objects or features that the experience presents, and so our experience seems to be relational' ( 2013, p. 271). Crane also believes that our 'pre-theoretical conception of perceptual experience is that of 'a relation to mind-independent objects' ( 2006, p. 133). Bower claims that when perceiving 'we seem to encounter' ( 2019, p. 215) mind-independent objects, and that 'encountering' should be taken as a metaphor for being related with them ( 2019, p. 215). Finally, Langsam argues that 'reflection on the phenomenal character of experience [...] suggests that an experience is a relation between a subject and an external object' ( 2017, p. 111).

We need to clarify the relationship between these formulations. Although they are obviously interconnected-Nudds, for instance, presents them as alternative ways of pointing out the same essential fact about Naïve Realism ( 2013, p. 271) and Martin does the same at least for the modal and the constitutive claim ( 2004, p. 65)-it is not clear how they are interconnected. Hence, we need to understand under which circumstances the three formulations coincide, and which one best captures what the Naïve Realists believe to be evident by introspection on perception.

To answer this question, my strategy consists in considering the role (A) plays into the debate on perception. As we have seen, accepting that (A) is true for veridical perceptual experience is what marks the difference between Naïve Realism and Intentionalism. Therefore, whatever is (allegedly) evident by introspection must be something that Intentionalism is committed to denying. Although some specific considerations should be devoted to the constitutive claim, if we follow this line of reasoning it seems that the best option for Naïve Realism is to construe our introspective evidence of perception in terms of the modal claim, with the other formulations being different ways of making it intelligible.

First, consider the relational claim. According to the relational claim, perception introspectively seems to be a relation to mind-independent objects and their features. We need to ask under which circumstances this claim would be incompatible with Intentionalism-that is, in which circumstances Intentionalism is committed to denying that perception is relational as it (allegedly) introspectively seems. Intentionalism depicts perceptual experiences (veridical or not) as situations in which some mind-independent objects and their features are represented to a perceiver. This seems to make at least veridical perceptual experience a relational state: something is represented as being in a certain way to someone. Intentionalism is incompatible with a stronger claim-that is, that perception is fundamentally a kind of relation which entails the existence of its relata (Bower 2019, p. 212). This is what some authors try to capture when they rely on the idea that the perceptual relation must be a 'real' (Bower 2019, p. 215) or 'genuine' (Crane 2006, p. 140; Langsam 2017, p. 111) one. Intentionalism must deny that perception is a relational state in this sense because it claims that the same kind of mental state can occur in the absence of the putative objects of perception, which-in some cases of misperception-can have a mere 'intentional' existence. Therefore, if it is introspectively evident that perception is a genuine relation, then it is true that Intentionalism cannot take such evidence at face value. But claiming that perception is a genuine relation amounts to saying that it entails the existence of its relata-that is, that it is a state that could not occur in the absence of the relevant mind-independent objects. Hence, to take seriously the Naïve Realist's contention that Intentionalism cannot take our introspective knowledge of perception at face value, we need to construe (A) in terms of the modal claim.

One may be tempted to apply the same line of reasoning to the constitutive claim. The idea would be roughly the following: according to the constitutive claim, it introspectively seems that the perceived mind-independent objects and their features are constituents of the experiential episode. Intentionalism, however, does accept that the presence of the suitable objects of perception in the subject's environment marks the difference between a veridical perceptual experience and a corresponding hallucination, as this determines the accuracy of the representational content. Therefore, without further specifications on what it means to be a constituent of the perceptual state, it may seem that Intentionalism is not committed to denying that the perceived mind-independent objects are constituents of veridical perceptual experiences. Even in this case, however, Intentionalism cannot claim that these mind-independent objects are essential constituents of the experience-as one could be in the same fundamental kind of mental state regardless of the veridicality of the experience. But if what is introspectively evident of perception is that the perceived objects are essential constituents of the experience, then it is introspectively evident that one could not be in the same mental state unless these objects were present-which is once again the modal claim.

The problem with this line of reasoning is that Intentionalism typically characterizes the connection between perception (taken as a representative state) and the perceived mind-independent objects as a merely causal one. But if the connection is merely causal, then it seems natural to take the suitable mind-independent objects to be distinct from the experience itself and, therefore, not literally constituents of it. This seems to make Intentionalism incompatible with the (alleged) introspective evidence of the constitutive claim-even when it is not understood in terms of the perceived objects being essential constituents of the experience.

In this situation, I believe there is something to grant both in favour of the argument and the objection. On the one hand, Naïve Realists do typically seem to have in mind the idea that mind-independent objects seem to be essential constituents, and not merely constituents, of veridical perceptual experiences. Moreover, construing (A) in terms of the modal claim appears to be the best way to capture the most fundamental line of disagreement between the Naïve Realist's and the Intentionalist's view of the metaphysics of perception-as if the modal claim were introspectively evident, there would be no way for the Intentionalist to take such introspective evidence at face value. This might not be true if the perceived objects were not taken to be essential constituents of perception, as Intentionalism is arguably not committed to the causal picture above.

On the other hand, it seems correct to argue both that this causal picture is not compatible with the constitutive claim and that it is the most natural way to characterize Intentionalism-indeed it seems hard to identify a credible alternative. Therefore, I will proceed as follows: I will develop my argument in Sect. 3.2 against the introspective evidence of (A) by focussing on the modal claim rather than on the constitutive (or the relational) one. I will then show how the same argument can be adapted to argue against the introspective evidence of the constitutive claim as well. This means that, if the argument is successful, it does not matter whether we construe (A) in terms of the constitutive claim rather than (or in addition to) the modal one, as Intentionalism could deny both while still taking our introspective knowledge of perception at face value.

We finally have a satisfactory answer to the question giving the title to this paper: what is so naïve about Naïve Realism? Naïve Realism can take our introspective knowledge of perception at face value. Introspection tells us that the objects of perception are mind-independent, and that perception is such that one could not be in the same experiential situation in the absence of these objects. Naïve Realism claims that perception is exactly how it seems introspectively. Moreover, since Naïve Realism is the only view according to which both (T) and (A) are true about perception, it follows that it is the only account that can take introspective evidence at face value.

In the next section, I will challenge the latter claim by arguing that (A) is a plausible explanation of what is introspectively evident of perception, but that it is not itself introspectively evident.

Immediacy

My strategy to challenge the claim that (A) is part of our introspective knowledge of perception follows two steps. First, I reconstruct how most of the philosophical literature on perception introduces (A)-that is, how the 'intuitive basis' (Crane 2005, p. 247) for (A) is usually identified. I then provide some reasons to take (A) as a possible explanation for this intuitive basis, rather than as being itself part of our introspective knowledge of perception.

Before entering into the details of this line of reasoning, I want to express a general worry connected with the claim that introspection recommends (A) for perception: can modal claims ever be part of our introspective awareness of experience? Introspection does tell one something about how one's experience is-although it is debatable which kind of authority we should grant to such evidence. But is it plausible to claim that introspection also tells us something about how experience could not be? This is what Naïve Realism asks for: that it must be introspectively evident that a certain mental state could not occur in the absence of the relevant mind-independent objects.

A claim that I take to be less contentious is that introspection can play a role in motivating modal claims about experience. To make an example, consider Husserl's method of 'eidetic variation' ( 2012, pp. 157-160)-that is, the method through which one is supposed to identify the essential features of some phenomenon. Roughly put, eidetic variation consists in using imagination to determine what is possible to change in a certain phenomenon, without it ceasing to being the kind of phenomenon it is-thus determining its essential features (and, therefore, the conditions under which such phenomenon could not occur). Such a conclusion is reached by making extensive use of the deliverances of introspection, but it is not reached solely on this basis: other assumptions are at work (first of all, the role played by imagination) and claims about the essential nature of phenomena are the result of all of them. Therefore, although I am not providing here an argument in support of the idea that modal claims about experience are never introspectable, I believe we should be very cautious to move from the claim that introspection is relevant to formulating modal claims about experience to the stronger one that modal claims about experience can be themselves evident by introspection.

But let us forget about this general worry and take a closer look at how some philosophers defend the claim that (A) is part of our introspective knowledge of perception. Some authors move directly from the idea that perception seems to 'involve' mind-independent objects to the claim that they seem to present (A) (Nudds 2009, p. 334). Based on what we have seen above, this move is inadequate: Intentionalism accepts that perception 'involves' mind-independent objects-as it accepts (T)-but disagrees with Naïve Realism over how it involves them. Some other authors, however, make a further effort to explain what is intuitive about (A). Their strategy invariably consists in pointing out the difference between perception and other mental states which also seems to present (T), such as imagination or thought.

Consider a situation in which one is imagining the front door of one's house. The object of the act seems to be mind-independent (and, indeed, it is). However, it would not normally seem to me as though I was perceiving it. The idea, therefore, is that the difference between these mental states constitutes the intuitive basis for (A). Martin explicitly appeals to this line of reasoning, when he states that the difference between perceiving and 'imagining or remembering' is what 'recommends Actualism' to one (2001, p. 219); but we also find similar ideas, for instance, in Crane ( 2005, p. 247) and Bower ( 2019, p. 215).

How should we describe the phenomenological difference between perceiving an object and merely imagining or thinking about it? The philosophical literature on the matter is rich. Sturgeon, for instance, calls 'scene-immediacy' the feature that differentiates perception from other mental states, and he characterises it as follows: 'your visual experience will place a moving rock before the mind in a unique "vivid" way. The phenomenology will be as if the scene is made manifest to you' ( 2000, p. 9). Valberg claims that when perceiving an object 'we are inclined to suppose it exists at the time when it is available' ( 1992, pp. 21-22), which is not true for mere thought ( 1992, p. 20). Crane argues that 'when an object is experienced in perception, it is "there" or "given" or "present to the mind" in a way which is not in other mental states' (2005, p. 247), and then defines this notion of 'perceptual presence' as follows: 'how the actual object of thought is at the moment I am thinking of it does not in any way constrain my thinking of it; but in the case of perception it does' (2005, p. 247). Martin argues that 'sensory states involve a certain immediacy or apparent presence of an object which is simply not required in the case of pure thought' (2002, pp. 387-388), while Millar refers to the same feature with the name of 'object-immediacy' (2014, p. 240). Finally, to take again a step outside the analytic tradition, Husserl attributes to perception the distinctive feature of presenting its objects in 'flesh and blood' ( 1907, pp. 12-13).

Let us call this feature of the phenomenology of perception Immediacy-from now on, (I). It should be already clear how difficult it is to specify (I) in comparison with (T): Sturgeon acknowledges that this feature is 'the most difficult to handle' ( 2000, p. 12); Brewer that it is an idea that is 'extremely difficult' to make precise (2011, p. 2). According to Naïve Realism, we should simply take (I) to correspond to (A)-that is, saying that (I) is introspectively evident is to say that it is introspectively evident that one could not be in the same situation unless the perceived objects were present. This is the claim I am challenging in this section. Now, (A) and (I) are not equivalent, but since the dispute concerns what is introspectively evident to one, this is not a reason to deny that what we mean when we assert that (I) is introspectively evident is just that (A) is evident. This makes it harder to offer proper arguments in favour or against the equivalence, but I will nonetheless try to specify why I find it suspicious.

My line of reasoning is based on identifying an asymmetry in the debate over what counts as taking introspective evidence at face value respectively for (T) and (A)/(I). As we have seen, Naïve Realism and Intentionalism both accept that (T) not only seems true of perception, but that it actually is true of it: the objects of perception really are mind-independent. But this does not mean that Sense-Datum Theories have no potential explanation for the fact that (T) seems true of perception. One possible explanation could be that we are not able to isolate the contribution given by the senses from how it is later 'interpreted'-so that we do not realise we perceive mind- dependent entities which are interpreted as mind-independent at a later stage. The problem is not that Sense-Datum Theories cannot explain why (T) seems to be true about perception, but that the explanations they give do not depend on (T) actually being true of perception.

Let us consider the parallel situation concerning (A). According to Naïve Realism, (A) is equivalent to (I), and it is true about perception because its metaphysical structure is such that one could not be in the same experiential situation unless the perceived objects were also present. If (A) is equivalent to (I), Intentionalism could not accept that it is true for perception, as it construes its metaphysical structure in such a way that one could be in the same situation in the absence of the putative perceived objects.

But let us bracket for a moment our judgment over whether (I) is equivalent to (A). We have said that the objects of perception seem to be 'present' to us in a uniquely 'vivid' way, as if they were 'there' in front of us-differently from what happens for imagination or mere thought. As some philosophers have pointed out (i.e. Martin 2002, pp. 388-389), Intentionalism can provide some plausible explanations for this feature. One possible strategy is to appeal to the idea that perceptual representations are unique kinds of representational relations, different from those that characterize other propositional attitudes. An alternative could be to rely on the presence of a particular kind of content which is (allegedly) only present in perception-such as a non-conceptual content. Another option is to argue that the content of perception includes the representation of a causal connection between the perceived objects and the perceiving subject. To draw the parallel with how Sense-Datum Theories account for the introspective evidence for (T), we need to say that these explanations are such that they explain why it seems that perception has (I) in a way that makes (I) actually false for perception. But this is not the case: the latter explanation, for instance, does intuitively accommodate the distinctive way in which the perceived objects are given, even though it considers both perceptual and imagistic states as representational. Hence, it seems that Intentionalism can account for introspective evidence in a way which would make such evidence actually true for perception, something that does not happen if we just assume that (A) and (I) are equivalent (as the same would not be true if (A) was introspectively evident). This looks to me to be a reason to be sceptical towards the equivalence between (I) and (A): if we test them separately, we find that Intentionalism seems compatible with the former, but not with the latter.

But if (A) and (I) represents different claims about what is introspectively evident about perception, then it seems that the best way to depict their relationship is between an explanandum and its explanans. Crane claims that the 'immediacy' or 'vividness' of perception ' derives from the fact that the perceived objects and their properties are actually given to the perceiver when being perceived, and determine the nature of the experience' (Crane 2005, p. 247. Italics mine). In this case, it seems that the metaphysical structure of perception-construed as making (A) true for perception-is used to explain why experience seems to present (I). But if this is the case, then the claim that only Naïve Realism can take our introspective knowledge of perception at face value is not sustainable. Intentionalism, unlike Sense-Datum Theories, would not be committed to rejecting any 'intuitive' feature of perception, but just one possible explanation of it. In turn, this entails that the real tiebreaker between Naïve Realism and Intentionalism is not whether they are compatible with introspective evidence-because they both are-but on which view can offer the best explanation for (I), which is an issue that remains very much open in the contemporary debate.

Conclusion

It is widely assumed that only Naïve Realism can depict perception in line with our 'intuitive' conception of it. This paper had two aims. The first was to clarify in which sense Naïve Realism is supposed to be 'naïve'. In Sect. 2, I argued that it is because Naïve Realism is supposed to be the only view which takes our introspective knowledge of perception at face value. In Sect. 3.1, I pointed out the two key features of such (alleged) introspective knowledge: that the objects of perception are mind-independent and that one could not be in a perceptual state unless the putative objects of perception existed. The second aim of the paper was to challenge that this latter claim is introspectively evident and to argue that also an Intentional account of perception can take introspection at face value.

This conclusion has relevant consequences for the debate on perception, but also for the philosophy of mind more generally. As a theory of veridical perceptual experience only, Naïve Realism needs to embrace a form of disjunctivism about sense-experience-that is, it must claim that veridical and non-veridical cases are metaphysically different kinds of mental states. Naïve Realism, however, also typically accepts that some kinds of 'bad cases' (such as hallucinations) can be introspectively indistinguishable from corresponding veridical perceptual experiences (Martin 2002, p. 421). Hence, these experiences will also seem to present the distinctive features of perception-(T) and (A)-despite not possibly having them both. In turn, this poses some severe restrictions to our knowledge of our own mental states.

The issue is that if both (A) and (T) are introspectively evident features of perception, Intentionalism and the Sense-Datum Theory are not in a better position-since they respectively reject that (A) and (T) are true for perception. Therefore, both views would have to admit that introspection is systematically misleading about the nature of one's own experience-leaving them in a very weak position to attack Naïve Realism on the limitation it poses to the knowledge of our own mental states (Martin 2004, pp. 84-85). Two conclusions would follow from this: 1) that there is no way to avoid the claim that introspection is systematically misleading about the nature of (at least some kind of) sense-experiences; 2) that Naïve Realism is the only account which can accept introspection gets the nature of some of them right.

If my considerations in Sect. 3.2 are tenable, none of these conclusions are correct. Since perception does not introspectively seem to present (A), Intentionalism does not need to accept that introspection is systematically misleading about the nature of veridical cases-thus being, in this respect, at least at the same level as Naïve Realism. Naïve Realism tries to read too much into our introspective knowledge of perception-which does not speak in favour of any specific account of perception which can accommodate (T) and (I)-misunderstanding evidence for (I) as evidence for a specific way (I) should be accounted for. But since Intentionalism is compatible with a common-factor reading of sense-experience, it also follows it can avoid the conclusion that introspection is systematically misleading about the nature of some 'bad-cases', such as hallucinations. This consequence is, I believe, particularly relevant for phenomenology, which traditionally embraces reflection on our own experience as its core method of investigation (Husserl 2012, p. 174).

This paper does not settle the debate on which is the best metaphysical account of perception: on the one hand, it does not engage with the problem of assessing which one can provide the best account of (I); on the other, it only focusses on the phenomenology of perception, while there are other relevant considerations to be made-such as, for instance, epistemological ones. I hope, however, that it can contribute to reviving attention to some aspects of the debate that, despite their centrality, have been overlooked in recent discussions of perception.

Notes

1.

This view was introduced in the analytical debate through the works of Anscombe ( 1962) and Armstrong ( 1968). A similar account has been arguably the dominant approach in the phenomenological tradition as well (Martin 2003; Bower 2019).

2.

See Martin ( 2004, 2006) and some critiques of his account, such as Siegel ( 2004, 2008), Smith ( 2008) and Sturgeon ( 2008). For some more recent discussions, see Nudds ( 2013) and Moran ( 2019). See Soteriou ( 2016) for a useful overview.

3.

But see Crane ( 2005), Fish ( 2009), and Hellie ( 2007) for some reflections on these matters.

13.

These labels come from Martin ( 2001, pp. 217-218). The second feature is a slightly modified version of Martin's one, which focusses on sense-experience. Many Naïve Realists, however, would not accept (A) for sense-experience, as this would entail that the Sense-Datum Theory is the correct account of hallucinations and (arguably) illusions. This, in turn, generates an issue for Naïve Realism that Martin calls the 'screening-off problem' (Martin 2004). Also, notice that (T) is neutral towards the idea that mind-independent objects are all that we are aware of in perception-that is, it is a weaker claim than the so-called 'Transparency Thesis'. (T) should be read as a claim about what an acceptable answer would be if we were asked to describe our experience: according to (T), mentioning the mind-independent objects we see (and their features) would be a relevant way to address the question-even if, possibly (and this is what marks the difference with the Transparency Thesis), only a partial one. This is how we should read the claim that perception 'makes manifest' to us mind-independent objects and their features. For more on (T) see 3.1 of this paper.

18.

There is some interesting recent empirical research on the topic of determining our 'common' conception of perception, in particular concerning the causal picture mentioned above. For instance, Roberts et al. ( 2016, 2020) have found evidence that this picture is not a 'conceptual truth' about perception ( 2016, p. 729), but rather a 'widely accepted empirical, or more generally theoretical, belief about perception', much like the belief that 'whales are mammals' ( 2016, p. 740). This might point in the same direction as my claim above: that a causal condition would be widely accepted mainly because of external conditionings-thus being something that we learn, just as we learn that whales are mammals-rather than because of some direct phenomenological evidence. Thanks to an anonymous referee for directing me to the relevant literature.

20.

Fish believes, for instance, that the likely answers would be a mixture of 'phenomenological, epistemological and metaphysical considerations [...] lacking any specificity' ( 2009, p. 19). To take a step out of the analytic tradition, consider Husserl's reflections on the relationship between the 'natural' and the 'phenomenological' attitude (i.e., 2012, pp. 52-62). Valberg expresses a similar idea when he describes the attitude of 'being open to experience' as an already philosophical one ( 1992, p. 34).

22.

This does not mean there are no substantive issues in giving a complete account of (T). The most interesting one is that of specifying the relationship between perceiving mind-independent objects and their visible parts. While some philosophers (i.e. Bermudez ( 2000) and Campbell ( 2004)) seem satisfied with the idea that we simply perceive mind-independent objects in virtue of perceiving some of their parts, I believe this strategy eventually ends up being incompatible with (T). However, this issue does not concern the present paper.

23.

That they try to capture the same feature of experience is evident from the fact that they are taken to play the same role-that is, to differentiate Naïve Realism from Intentionalism just as (T) differentiates it from Sense-Datum Theories.

25.

Maybe every relation entails the existence of its relata, as this is part of the definition of the concept of 'relation'. This paragraph does not challenge this claim, but it makes explicit that this is the reason why Intentionalism is incompatible with the relational claim. See Genone ( 2016, p. 6) for a brief discussion of these matters.

29.

See, for instance, Nudds ( 2013, p. 271) and Martin ( 2002, p. 398). Pautz also reconstructs the Naïve Realist 'slogan' as the claim that 'objects are essential constituents of nonhallucinatory experiences' (Pautz 2010, p. 295).

32.

The same consideration applies to the relational claim. Therefore, this discussion on the best characterization of (A) should be taken as an attempt of clarifying the Naïve Realist's position, rather than a way to reduce (A) to a formulation that can be challenged as I will do in Sect. 3.2.

36.

In Sect. 3.1, I have raised the worry that the most typical versions of Intentionalism may not be compatible with (A) even when understood as the claim that the perceived mind-independent objects are merely constituents, and not essential constituents, of perception. It is easy to show how the argument above does not depend on the idea that (A) is best construed in terms of the modal claim, and that it can be adapted to challenge the alleged introspective evidence of the constitutive claim as well. The worry was that Intentionalism construes the metaphysical structure of perception in a way that makes (A) (taken as the constitutive claim) false for perception. Let suppose this is true. If we acknowledge that, on the contrary, Intentionalism is compatible with (I) actually being true of perception, we have a reason to question whether (I) and (A) (taken as the constitutive claim) are equivalent. Even in this case, it seems that taking the metaphysical structure of perception as satisfying the constitutive claim should be considered as a way to explain what is introspectively evident of perception-that is, (I)-rather than as being introspectively evident itself.

37.

On the one hand, see Soteriou ( 2000) for some objections to Searle's (and Millar's) account of (I). On the other hand, Millar ( 2014) argues that the best account Naïve Realism can offer for (I) would be circular (and easily matched by a corresponding Intentionalist one), while Sturgeon argues that it has 'little more than a label for it' ( 2000, p. 14).

38.

This appears even more paradoxical if we consider that Naïve Realism is committed to the claim that the PC of perception is determined by its metaphysical structure. Since this cannot be the case for a hallucination, it follows that such an experience would be misleading also when it comes to 'what-it-is-like' to have it-so that one could be wrong not only about how an experience is, but also about how it merely seems. See Martin ( 2004, 2006) for a discussion of this issue.

Acknowledgments

I would like to thank the participants of Manchester's Mind Reading Group, Emily Caddick Bourne, Wesley Buckwalter and, most of all, Joel Smith for useful discussions and valuable feedback. Also, thanks to an anonymous reviewer for helpful comments and suggestions.

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School of Social Sciences - Philosophy, University of Manchester, Manchester, Greater Manchester, UK

Carlo Raineri

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Correspondence to Carlo Raineri.

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Raineri, C. What's so naïve about naïve realism?. Philos Stud (2021). https://doi.org/10.1007/s11098-021-01618-z
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Keywords

Philosophy of perception

Naïve realism

Intentionalism

Phenomenology

Introspection

# data[].attributes.attachment_link.title
What's so naïve about naïve realism? - Philosophical Studies

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Naïve Realism claims that veridical perceptual experiences essentially consist in genuine relations between perceivers and mind-independent objects and their features. The contemporary debate in the philosophy of perception has devoted little attention to assessing one of the main motivations to endorse Naïve Realism-namely, that it is the only view which articulates our 'intuitive' conception of perception.

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The US supreme court has set a date to hear arguments in a Mississippi case that could overturn Roe v Wade, the near-50-year-old ruling that guarantees a woman's right to abortion.

Oral arguments in Dobbs v Jackson Women's Health Organization will be heard on 1 December. The case concerns a law that bans most abortions after 15 weeks of pregnancy, a direct challenge to Roe v Wade.

News of the court date arrived amid controversy over a Texas law, known as SB8, which effectively bans abortion at six weeks and empowers citizens to sue providers and anyone who helps a woman access their services.

Earlier this month, the supreme court, now dominated by conservatives, allowed the Texas law to stand via an emergency ruling.

In a statement on Monday, the White House said it "strongly supports" a House bill meant to protect access to abortion.

The Texas law, it said, "blatantly violates existing supreme court precedent established under Roe v Wade".

The House is expected to advance legislation designed to stop states from enacting anti-abortion measures like the one in Texas.

But though the bill is expected to pass the Democratic-held House, it will face an uphill battle in the evenly split Senate, where most legislation requires 60 votes. Most Republicans oppose abortion and support calls to overturn Roe v Wade.

The White House statement said: "In the wake of Texas' unprecedented attack, it has never been more important to codify this constitutional right and to strengthen healthcare access for all women, regardless of where they live."

In the Mississippi case, lawyers for Jackson Women's Health Organization, the only licensed abortion facility in the state, have asked the court to reject the state's request to "jettison a half-century of settled precedent" and warned that if the law is upheld, the "fallout would be swift and certain".

The law, known as the Gestational Age Act, was passed in 2018. It allows abortion after 15 weeks in cases involving "medical emergencies or for severe fetal abnormality". Like the Texas law, it contains no exception for rape or incest.

Under the Mississippi law, doctors could have medical licenses suspended or revoked if they perform abortions that do not comply with the law.

Also on Monday, NBC News reported that nearly 900 state legislators from 45 states had filed a brief with the supreme court, asking it to reject the Mississippi law.

Of the 897 state legislators who signed the brief, 895 were Democrats and two independents. The only states that did not provide at least one signatory were Mississippi, North Dakota, Oklahoma, Arkansas and Wyoming.

On Saturday, Cecile Richards, a former head of Planned Parenthood, marked the first anniversary of the death of the liberal supreme court justice Ruth Bader Ginsburg by releasing an open letter emphasising the renewed threat to abortion rights.

Speaking to the Associated Press, she said: "We are in a post-Roe world now. Here in the state of Texas, Roe is no longer in effect ... and all it takes is a Republican governor and a Republican legislature. Your state could be exactly the same."

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US supreme court to hear arguments in Mississippi case that threatens Roe v Wade

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The US supreme court has set a date to hear arguments in a Mississippi case that could overturn Roe v Wade, the near-50-year-old ruling that guarantees a woman's right to abortion. Oral arguments in Dobbs v Jackson Women's Health Organization will be heard on 1 December.

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