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Acute as opposed to chronic suffering and pain: does anyone talk about their difference? I mean, I think I'm more concerned with extreme pain, and I wondered whether that was a philosophical position, or anything like that.

Perhaps that's confusing! I don't mean oppression, or weakness. Specifically, I mean physical and mental distress, whether anyone talks about if acute examples are what matters. All I know off the top of my head, really, is that Nietzsche is sometimes talked about as rethinking our, or maybe his, relation to pain. Whether or not that's accurate!

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    Well +1 from me. I'm not sure where Nietzsche fits in but I can see the relevance of the distinction to (say) Bentham's 'felicific calculus'. – Geoffrey Thomas Aug 31 '18 at 19:39
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    Please add a citation to Nietzsche, to help readers answer. – Mark Andrews Sep 2 '18 at 5:03
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Moral judgements are sensitive to considerations of suffering - of pain, in the context of your question. Morally we have to take pain into account. The ethical problem I foresee is one of incommensurability. By what metric can we assess the comparative moral importance of a mild pain that is chronic and a severe pain that is brief ?

Some comparative judgements are possible : a mild pain that is brief is, all else equal, of less moral significance than a severe pain that is chronic.

How, from another angle, could one make it a rational choice between (to return to the original example) a mild pain that is chronic and a severe pain that is brief ? (That one doesn't usually have a choice is beside the present point.)

To make a personal example : I have had for several weeks osteoarthritic pain in one leg. It has not been agonising but it has produced sharp discomfort. If I were faced with the choice between this long and sharp discomfort and a brief but intensely severe toothache (say, for two hours), I have no idea what the rational choice would be. Nor, rationality aside, am I sure which option I would actually 'prefer' and go for.

There is contemporary discussion of pain but it tends to find its way into the discussion of grounds for euthanasia, the use of animals in medical experiments, and a general requirement not to cause unnecessary pain. Jeremy Bentham (1748-1832) used pleasure and pain as his sole moral criteria; he would have been fascinated by your question. His An Introduction to the Principles of Morals and Legislation (1780) is online and does have two relevant chapters : Chapter 4: Measuring Pleasure and Pain and Chapter 5: The Kinds of Pleasure and Pain : https://www.earlymoderntexts.com/assets/pdfs/bentham1780.pdf.

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    yeah it is a bit absurd, asking what sort of pain we'd prefer – user34654 Aug 31 '18 at 20:19
  • I suspect most of our health problems are diet related. To try to resolve mine, I am now on Steven Gundry's The Plant Paradox diet. – Frank Hubeny Sep 1 '18 at 3:39
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    @FrankHubeny I tend to agree with you. I was buying supplements and medicines to fix my own bad eating habits. :) Finally it dawned on me that I'd come out cheaper if I left the bad things off my plate. – Gordon Sep 1 '18 at 5:14
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    @Gordon That is Gundry's number one rule. It is what one stops eating that is most important. He identifies lectins as proteins to avoid. Keep the "holobiome" healthy. I suppose there is a philosophical message underlying this if I could only figure out what it is. – Frank Hubeny Sep 1 '18 at 7:23
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When one looks at the science of pain, especially at what has happened since the publications of Melzack and Wall's (1965) and Melzack and Casey's (1968), which revolutionized the scientific research on pain, we see that the science of pain has increasingly conceived of pain as less like perception of an objective reality and more like emotions by first drawing the sensory/affective distinction and then emphasizing more and more its affective aspect.

The trend in philosophy, on the other hand, has been in the other direction: as naturalism has started to become an orthodoxy in the second part of the 20th century, philosophers have increasingly sought for ways in which they could assimilate pain to ordinary perception like vision, audition, etc.

One of the main motivations behind the perceptual/representational views of pain in philosophy is the belief (or hope) that perception as a species of information gathering can be accounted for entirely in physicality terms. Of course, this is a controversial claim.

There are many who think that perception involving as it does conscious phenomenal experience cannot be a purely physical phenomenon.[18] However, even these theorists may agree that it is a plausible theoretical strategy to pursue an understanding of pain and other intransitive bodily sensations in perceptual/representational terms.

This strategy, if it works, minimizes the diversity of mental phenomena, and thus potentially offers the prospects of a more unified theory of mind. If this theory turns out to be in harmony with the rest of our sciences and their fundamental metaphysical and methodological assumptions, so much the better.

Indeed, it was the plausibility of this strategy and the belief that we will eventually succeed in understanding perception in purely naturalistic terms that have prompted many philosophers to advance perceptual/representational theories of pain.

But does the scientific trend towards understanding pain as a subjective experience less like a perception and more like an emotion with quite a variable link to injurious stimuli undermine the philosophical project?

Nothing in the scientific understanding of pain itself seems to show that pain involves no perception at all.

On the contrary, as the science of pain has unearthed in the last forty years or so, there are physiologically specialized systems that process nociceptive stimuli from the moment they effect peripheral receptors to the central processing of these signals in the spinal cord and the brain. This is what happens in all classical five sense modalities, including touch. Indeed, pain may be classified as a submodality of touch.

If we take the weaker claim to the effect that feeling pain involves sensory perception but doesn't exhaust its nature due to its affective dimension, we may still preserve a naturalistic view of pain by giving a functionalist (or, psychofunctionalist) account of its affective aspect. According to this proposal, even though the sensory-discriminative aspect of pain can perhaps be handled representationally,[19] the affective aspect reduces to the way in which the sensory-discriminative information is processed, not for analysis to extract information about the proximal or distal properties of the stimuli, but rather for its significance for the effector or motor systems, to set motivational parameters for action on the basis of stimuli's informational content.

There is in fact strong supporting evidence for such a thesis in the evolutionary stories of different organisms at different developmental hierarchies. The neuroscientific evidence about the affective brain seems also to support this idea in general.[20]

This is a view that treats pain as both a representational and a functional state. Such a view still needs to provide a good answer to the problem of focus that we have seen afflicts all perceptual/representationalist views. Why is there an asymmetry in concept application, or in the focus of conceptual categorization? There are other philosophical as well as scientific questions about pain. Do animals feel pain? If they do, is it comparable to the way we feel pain? What are the social, economical, ethical and religious implications of affirmative answers to these questions? How can animal pain be scientifically studied?

What should be the methodology of scientific research on animals in general and of animal pain in particular? How can we project the results obtained by pain research on animals onto humans? Parallel or similar questions arise in the case of fetuses and young infants that are even more pressing and urgent for obvious reasons. What is the relationship between pain and pleasure, or pain and emotions in general? What are the ethical and religious status and implications of pain? These and many other questions remain to be the focus of many researchers in the field.

ref.

https://plato.stanford.edu/entries/pain/#appearance

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Daniel Kahneman has been working for decades to characterize how we humans make decisions. In Thinking Fast and Slow, he presents many interesting details from these studies, and a not-very-rational 2-part model of our minds.

The book is worth reading in general, but one of his excursions addressed a very similar question -- how we DO, vs. how we SHOULD value pain and discomfort.

He took, as his characteristic question, the pain-time profile of a colonoscopy. He found that people, after the fact, rate pain worse when it occured in the frst or last portions of an experience. And the duration of an experience did not play a large role in retroactive evaluation. And the last portion colored dramatically the remembered evaluation of the pain. So that a short 2 minute pain that his a 10 out of 10 on a pain scale, would be rated equal to a 20 minute procecure mostly at a 6, but spiking to a 10 at the end. And a 20 minute procedure that hit a 10 for a full two minutes midway through, but dropped to a 3 for the last 5 minutes, would be far preferred over the short 2 minute procedure with the same max peak and a shorter max duration.

Kahneman had been getting the pain reports mid-procedure, so they were real experiences. The then extended his two system (like his system 1 vs System 2) model to two other subsets of mind, the experiencing vs. the remembering self. He showed that our decision making is guided by the remembering self, not the actual experiences.

This lead Kahneman to question the morality of letting an irrational remembering self get to decide what the experiencing self has to suffer, when the remembering self keeps putting the experincing self into worse total pain-time circumstances!

Kahneman takes a utilitarian, and "technocrats know best" approach to the question, which grated on my libertarian sensibilities. However, the justifications for libertarianism presume rationality, and his work thoroughly demolishes the presumption of our rational decisionmaking, so his views are justifed by his work.

It is an interesting read, and seems fairly relevant to your question.

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Without delving into Nietzsche or the relevant Philosophic literature on this topic, I can tell you that there is a great deal of discussion about this within the psychology community. My personal experience with this issue and, hence, my answer to your question, stems from my personal experiences with grief (the "mental distress" part of your original question).

My daughter was born with multiple disabilities. These include Severe Cerebral Palsy ("GMFCS Level IV - V"), Septo-optic Dysplasia (a rare congenital malformation syndrome featuring underdevelopment of the optic nerve, pituitary gland dysfunction, and absence of the septum pellucidum (a midline part of the brain)), Diabetes Insipidus ("an uncommon disorder that causes an imbalance of water in the body"), and IQ that is 2 standard deviations below normal, and, to top it off, Level 3 Autism (Severe difficulties in verbal and nonverbal communication. Very limited speech, odd, repetitive behavior; many express their basic needs only and requiring very substantial support).

Now, I'm a pretty smart guy. Not quite Mensa material, but most decidedly above average in intelligence. My wife is also smarter than your average bear. She, unlike me, actually has passed the Mensa practice tests and has a degree in Aeronautical engineering from UC Davis. We both had very high hopes for our child and we both believed (and not without cause I would like to think) that our child would be intelligent, capable, and would have bright prospects for the future. Instead, our child's IQ is 4 standard deviations below ours and she requires almost constant support and supervision.

Anyway, the whole situation reminds me a little of the expanded Kubler-Ross model of grief that I learned about back in college. The major difference being that is that our daughter is not dead. She's alive and well and sitting next to me as I type this. My wife and I continually (chronically you might say) experience the psychological pain of losing a child that never actually existed. Day in and day out we are reminded of what might might have been by what actually is. On week days we exist in a superposition of anger, bargaining, depression and acceptance and on the weekends we collapse into denial.

So, is there a philosophical position on extreme pain? There are many. These days, for the most part, I approach the concept of pain (both chronic and acute) from the functionalist school of thought.

Behaviorists famously held that psychological states are not internal states at all, whether physical or psychical. But, the argument goes, it is easy to imagine two creatures that are behaviorally indistinguishable and that differ in their mental states. This line of reasoning is one of a family of “perfect actor” or “doppelgänger” arguments, which are common fare in philosophy of mind.

In a well-known version of this argument, one imagines that there could be “Super-Spartans” who never exhibit pain behavior (such as flinching, saying “ouch”) or even any dispositions to produce pain behavior (Putnam 1963).

As a result, every time someone complains about how tragic it is that their child is lactose intolerant or has a gluten sensitivity, I want to punch them in the face, but I don't. And that causes me a great deal of chronic mental distress ;-)

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