Just Behavioural: Pain, Psychiatric Patients and Possible Responses to Them (Part Two)

[For Part One click here]

Perhaps more than any of the bad pictures of “pain” Wittgenstein attempts to disentangle people from in the Philosophical Investigations, the above picture assimilates our knowledge of other’s pain to our knowledge of stuff, of features of the external world. Here “pain” is a feature of the world (albeit of that part of the world taken up by someone’s body), one which we can know about with a high degree of certainty, or if we are uncertain about it is simply because we do not yet have enough factual information to hand. (“I’m unsure if she is in pain, I’m still waiting on the results of the scan.”)

Yet it stems from the same kind of unease also leading to those pictures which Wittgenstein does address: the thought that if the question “Are they in pain?” is to have any kind of bite there must be something called “a pain” to exist “somewhere” (whether physically or mentally). The “medical” solution (the one I have discussed above) is a picture which does enable us to know someone elses pain, and yet in doing so robs pain of its phenomenological content (and many of the instances we would refer to as pain.) On the other hand attempts to situate this strange object called a “pain” in the realms of “the mental”, have the unfortunate effect of meaning that we can never know if someone is ever in pain at all. Both pictures, however,  “yoke” knowledge (of another’s pain) to “certainty”: knowing something is being able to gather the appropriate evidence for it,  to be “sure” about it.

However, there are other meanings or usages of the word “know” which don’t define it in the way which leads to these troubling conclusions. Stanley Cavell (in his paper “Knowing and Acknowledging”, MWM 1969) reminds of us of three of these: Firstly statements such as “I know Greta Garbo” where know means to have “become acquainted with”,  Secondly things like “I know I am a nuisance” where to know is to “confess, admit or acknowledge” and thirdly a use of “I know” to “agree or confirm what has been said, or to say I already knew”. It is this second usage which he signals out as key for our knowledge of other’s pain. Here “I know” is not linked to our gathering of facts or evidence about a particular thing, but rather is an attitude we either take or do not take to those facts. That “behaviour is expressive of mind…is not something we know, but a way we treat “behaviour.” (ibid) Because of this suffering and pain are not just further “facts” about a person to be noted, they are things which “make claims upon [us]”.

“It is not enough that I know (am certain) that you suffer” he continues “I must do reveal something (whatever can be done.) In a word, I must acknowledge it, otherwise I do not know what “(your or his) being in pain” means. Is. ..But obviously sympathy may not be forthcoming. So when I say that “We must acknowledge another’s suffering, and we do that by responding to a claim upon our sympathy,” I do not mean that we always in fact have sympathy, nor that we always ought to have it. The claim of suffering may go unanswered. We may feel lots of things- sympathy, Schadenfreude, nothing. If one says that this a failure to acknowledge another’s suffering, surely this would not mean that we fail, in such cases, to know that he is suffering? It may or may not.”

A bad, though hazy, picture of what “knowing someone is in pain” involves, cannot be fully responsible here for our failure to know someone is in pain. This is something I feel those sceptical about the contributions of philosophy to our everyday lives have got right: these abstract, intellectual pictures surely do not have the power to disrupt our practices to such an extent that they by themselves are the reason that a patient almost died from a ruptured appendix because no-one would take her pain seriously**. But what I think they can do is provide a justification for our failure to acknowledge suffering, we’re not refusing to acknowledge their pain because of a deficiency on our part, there simply is no pain to acknowledge. This picture, I feel, is a key reason why often a failure to acknowledge can lead to a failure to know.

As Cavell argues “a “failure to know” might just mean a piece of ignorance, an absence of something, a blank. A “failure to acknowledge” is the presence of something, a confusion, an indifference, a callousness, an exhaustion, a coldness. Spiritual emptiness is not a blank.” Indeed. Perhaps more so with nursing than other things, exhaustion and the kind of callousness that seems to just grow on people who spend their time dealing with pain and suffering, can lead to failures of acknowledgement. It’s much easier to judge someone as “not being in pain” than to be required to go through the time-consuming and emotionally draining comforting that acknowledging their pain would involve. Perhaps we can change this, perhaps not, but at least we could be honest about what is actually going on here.


Psychiatric patients are surely recognized to be more obviously human, their behaviour more obviously expressive of mind, than the artificially created robots or “replicants” from the film “Blade Runner”, and yet much of what Stephen Mulhall says*** in his analysis of the film about the process of coming to recognize them as such, also has bearing here.

“No accumulation of facts or evidence can force someone to acknowledge behavior which fulfills all the criteria of pain-behavior as being the genuine expression of another human being’s pain.  Captain Bryant is not ignorant of “the truth” about the replicants he can see everything that we and Deckard can see; rather, he denies or fails to acknowledge that truth.  Here, however, we should pause to register the inaccuracies of our talk of truth, for truth relates to concepts of evidence and fact; the truth is that replicant behavior fulfills all the criteria for eg pain-behavior, anger-behavior, etc, but that truth does not entail that someone who fails to acknowledge such behavior as genuinely expressive of a heart and mind is denying any of those facts  he is rather adopting one possible attitude towards the facts.”

Likewise, this repeated failure to see the behaviour of psychiatric patients as expressing something (pain or anxiety of terror) tells us very little about them, or what “facts of the matter” are available to us, but rather something rather disturbing about ourselves.




* “Suppose everyone had a box with something in it: we call it a “beetle”. No one can look into anyone else’s box, and everyone says he knows what a beetle is only by looking at his beetle. — Here it would be quite possible for everyone to have something different in his box. One might even imagine such a thing constantly changing. — But suppose the word “beetle” had a use in these people’s language? — If so it would not be used as the name of a thing. The thing in the box has no place in the language-game at all; not even as a something: for the box might even be empty. — No, one can ‘divide through’ by the thing in the box; it cancels out, whatever it is.” (PI 293) As well as the rest of the “Private Language” sections of the Philosophical Investigations.

**  (Of course acknowledgement in the form of comforting would not have saved the patient with appendicitis, she needed urgent medical treatment. However I do think that acknowledging her pain, taking it as real, would have led to her receiving treatment in a more timely manner than denying her behaviour as being expressive of pain and taking it as only a kind of acting or pretence.)

*** http://xroads.virginia.edu/~DRBR2/mulhall.html



One response to “Just Behavioural: Pain, Psychiatric Patients and Possible Responses to Them (Part Two)

  1. Pingback: Just Behavioural: Pain, Psychiatric Patients and Possible Responses to Them. (Part One.) | The Beetle Box

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