Pain and the Dangers of Objectivity

Abstract

There is considerable hope and expectation that objective measures of brain function will soon replace subjective measures as the gold standard of pain measurement. Currently, there is considerable debate as to whether that gold standard will include the cortex or will focus on subcortical structures. This chapter looks beyond that important debate to ask whether any measure of brain function could, in principle, become the gold standard for pain measurement. Perhaps surprisingly, the answer is no, measures of brain function cannot, in principle, replace subjective measures as the gold standard for pain measurement. Essentially, the answer is no because measures of brain function measure objective physical changes, which is the wrong thing to measure if the aim is to capture subjective pain experience. Trying to read pain subjectivity through objective brain measures leads to the attribution of impossible features to physics, such as perspective, time and memory. It also leads to the attribution of implausible features to subjectivity, such as subjectivity having a determined trajectory through time. Part of the trouble arises from treating pain as a private experience when the roots of pain lie in a socially negotiated subjectivity. That socially negotiated subjectivity is lost when experience is reduced to brain function. Doubtless, the brain is necessary for pain, and all subjective experience, but the brain is not sufficient, the social negotiation is also necessary.