Open peer commentary on the article “Kaleidoscope of Pain: What and How Do You See Through It” by Maja Smrdu. Abstract: We agree with Smrdu that pain cannot be reduced to a neurophysiological event and we welcome a (micro-)phenomenological investigation of pain experience. However, we do not think such an investigation can provide sufficient support for either a 5E theory of pain, or (just) an enactive one. A 5E theory of pain would require a clarification of how the 5Es fit together. An enactive account would require a “circulation” between first- and third-person data.

Functional brain imaging studies reveal the complexity of brain activity during pain. The marked explanatory gaps that separate such research from classical neurophysiology and perceptual psychology raise the challenge of integrating knowledge gleaned at multiple levels of investigation into a coherent multidisciplinary account of pain. A conceptual framework from consciousness research, grounded in the concept of self-organization, can address this challenge through nonlinear dynamical systems and related models. We propose a constructivist model that construes pain, not as the passive registration of sensory information that traditional research would presume, but rather an active process of generating and shaping awareness. If pain is a dynamic product of a self-organizing brain, then pain research needs a theoretical framework to address the observations that functional brain imaging yields.

Key words: consciousness, pain, nonlinear dynamical systems, constructivism, functional brain imaging.

In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification.

Context: The cultural worlds that we generate in our living are worlds in which we frequently live in a self-depreciating relational pain. This arises when we feel that we do not deserve to be loved and respected because we think that we are intrinsically incapable of satisfying what we think are legitimate cultural expectations about how we should be. Problem: Can we find an answer to the general question, “How is it that our life is so frequently painful?” Hypothesis: The pain for which a person asks for relational help is always of cultural origin, and arises from some experience in which she has not been loved and has accepted that she deserved not being loved because as a result of that experience she began to feel that she is intrinsically deficient. I propose that that person will come out of her pain – and will recover her self-love and self-respect as she reconnects with her fundamental loving nature as a biological-cultural human being – when she becomes able to realize that she is not intrinsically defective and that the expectations put on her are only arbitrary cultural demands. Results: I show (a) that the recovering of self-love and self-respect occurs as a result of a conversation that opens a relational space for the interplay of the conscious and unconscious reflections in which the person in pain finds that she is an intrinsically loving biological-cultural human being; (b) that this occurs through the reflexive evocation of the inner feelings of self-love and self-respect in the consulting person as she reflexively contemplates her life while she is revealing it to a caring reflective listener in a conversation that flows without expectations, demands or judgment. In such reflective “liberating conversations,” the consulting person finds herself in self-love and self-respect, not through a rational argument but through her spontaneous connection to her unconscious constitutive human inner feelings as a loving being. Implications: We do not need to suppose any reality independent of the operational coherences of our living to explain and understand the different worlds that we generate in the realization of our living.

Key words: love, self-depreciation, reflexive conversation, self-love, languaging, structural determinism, predictability

Open peer commentary on the article “Kaleidoscope of Pain: What and How Do You See Through It” by Maja Smrdu. Abstract: Relational dynamics are the vital cornerstone for a holistic understanding of chronic pain, particularly for a 5E stance. Enactivism and Buddhism prove most expedient to examine such dynamics in a theoretical and practical fashion.

Open peer commentary on the article “Kaleidoscope of Pain: What and How Do You See Through It” by Maja Smrdu. Abstract: Pain remains an unintelligible mystery. Given Smrdu’s efforts to expand the horizons for dealing with chronic pain, I re-present some constructivist ideas regarding communication, including commonly assumed features of communications between patients and clinicians, in particular sharing experience and understanding.

Open peer commentary on the article “Kaleidoscope of Pain: What and How Do You See Through It” by Maja Smrdu. Abstract: I argue that a research method solely focused on subjective experience (phenomenological method) provides scarce scientific evidence to evaluate its support for the 5E theory. Instead, I suggest the experimental phenomenological method, which integrates the scientific study of human subjectivity and research procedures based on experimental psychology.

In this paper we use the theoretical framework of the theory of living systems of Maturana and Varela, which entails a new way of seeing the world and a new way of thinking, a new science of complexity. At the core of the theoretical premise is that we can no longer maintain the division between the observer and observed that is implicit in the atomistic view, but that both observer and observed are interpenetrating aspects of one whole reality. According to Maturana and Varela, we consider cognition as an effective action that involves life in a circular way and where the world is not something that is given to us but something we engage in by living. The paper address the following issues: We consider that every action is embedded in a dynamics of relations that is inextricably part of a systemic dynamics; we put objectivity in parenthesis, so that all views in the multiverse are equally valid and we lose the passion for changing the other; we are responsible for our actions; human beings cannot be controlled in a causal linear way, and there can be no instructive intervention; perception and illusion cannot be distinguished “in the moment of the experience”; we have to listen without prejudice and be aware of the emotions coloring what one is hearing; there are no pathologies in the biological domain and the pain that becomes ing manifest in a therapy is always culturally conditioned.

This paper disputes the theoretical assumptions of mainstream approaches in philosophy of pain, representationalism and imperativism, and advances an enactive approach as an alternative. It begins by identifying three shared assumptions in the mainstream approaches: the internalist assumption, the brain-body assumption, and the semantic assumption. It then articulates an alternative, enactive approach that considers pain as an embodied response to the situation. This approach entails the hypothesis of the sociocultural embeddedness of pain, which states against the brain-body assumption that the intentional character of pain depends on the agent’s sociocultural background. The paper then proceeds to consider two objections. The first questions the empirical basis of this hypothesis. It is argued based on neuroscientific evidence, however, that there is no empirical reason to suppose that the first-order experience of pain is immune to sociocultural influences. The second objection argues that the mainstream approaches can account for sociocultural influences on pain by drawing on the conceptual distinction between narrow and wide content. In response, the semantic conception of pain underpinning the proposal is challenged. Pain experience can occur in pre-reflective, affectively reflective, or cognitively reflective forms, but the semantic conception at most only applies to the last form. The paper concludes that the enactive approach offers a promising alternative framework in philosophy of pain.

Key words: pain. enactivism. intentionality. internalism. cultural permeation

Abstract: Much recent work on cognition is characterized by an augmentation of the role of action coupled with an attenuation of the role of representation. This coupling is no accident. The appeal to action is seen either as a way of explaining representation or explaining it away. This paper argues that the appeal to action as a way of explaining, supplementing, or even supplanting, representation can lead to a serious dilemma. On the one hand, the concept of action to which we appeal cannot, on pain of circularity, be a representational concept. Such an appeal would presuppose representation and therefore can neither explain it nor explain it away. On the other hand, I shall argue, if the concept of action to which we appeal is not a representational one, there is every reason for supposing that it will not be the sort of thing that can explain, or supplement, let alone supplant, representation. The resulting dilemma, I shall argue, is not fatal. But avoiding it requires us to embrace a certain thesis about the nature of action, a thesis whose broad outline this paper delineates. Anyone who wishes to employ action as a way of explaining or explaining away representation should, I shall argue, take this conception of action very seriously indeed. I am going to discuss these issues with respect to a influential recent contribution to this debate: the sensorimotor or enactive model of perception developed by Kevin O’Regan and Alva Noë.

Key words: action, representation, perception, sensorimotor, myth of the giving.