Masochism: on how to like pain

Masochism:

On how to like pain

Abraham Sapién Córdoba

Master’s thesis

Cogmaster M2

ENS, EHESS, Paris V

Institut Jean Nicod

4th June 2013

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Originality declaration:

In the present study I propose a new model that gives account of our different

interactions with pain. More importantly, the current study addresses the relationship

between pain and masochism. In comparison to other models, the model here presented

studies pain as part of a wider spectrum that considers our interaction with pleasant and

unpleasant phenomena.

Contribution declaration:

Given the theoretical approach of the present study, the final product is the result of the

collaboration between my advisor, Frédérique de Vignemont, and myself.

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Acknowledgements

From the general to the particular, I would like to thank people in three levels. First, I

would like to thank all the people and institutions that supported and welcomed me to

come study in France. Second, I deeply thank all the people that have discussed with me

about the nature of pain and I would also like to thank the ones who have devoted their

own research to understand pain, without this input not only my project, but research in

general, would be impossible. Third, I would like to particularly thank Frédérique de

Vignemont for her sharp mind and help.

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Introduction

“Whip me”, I begged, “whip me without mercy.”

Wanda swung the whip, and hit me twice. “Are you satisfied now?”

“No.”

“Seriously, no?”

“Whip me, I beg you, it is a joy to me”

Sacher-Masoch, Venus in Furs, (1870).

The main motivation of this research is to have a better understanding of the sensation

of pain, or “physical pain”, by using masochism as a case study. The main characteristic

of masochism is that, in contradiction to the usual behavior in presence of pain,

masochists pursue pain. The standard abhorrent nature of pain has already been

questioned by other medical cases where patients do not present the usual avoidance

behavior in presence of pain. Broadly, in all these cases patients tend to have no

reaction, although they claim that they feel pain. However, the fact that masochists have

the complete opposite behavior arises many questions concerning the nature of pain and

its relationship with pleasure. That is, in order to understand masochism, we need to

understand pain as part of a wider spectrum that also includes our relationship with

pleasant phenomena.

In this research I will address two main issues in relation to pain, one from the medical

sciences and the other concerning the current discussion in philosophy. The first one is

related with medical cases and experimental models, which support that a descriptive

and an evaluative dimension constitute pain; although we usually experience pain as a

whole, there is good evidence that we can experience these two aspects of pain

separately and that they also correspond to different areas of the nervous system. The

second issue is related to the nature of pain. More particularly, one needs to clarify the

notion of unpleasantness in pain and that the intimate relation between the sensation and

avoidance behavior, which is not encountered in other kinds of perception.

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In this sense, in the present research I do not tackle other questions concerning the

physiological or theoretical nature of pain. For instance, I do not carry any sort of

experiments concerning pain or masochism and I do not address the discussion about

the nature of pain in representational terms. The current study proposes a theoretical and

cognitive approach that pursues to shed light on the diverse interactions that we can

have with pain. More precisely, thanks to the medical models of pain and the

philosophical discussion on it, I will propose a model that provides a coherent solution

to masochism and to our general interaction with pleasant and unpleasant sensations.

Finally, if we reconsider our interactions with pain and pleasure, I argue, we are all

masochists, at least to a certain degree.

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Part I.

Do they really like it?

In this first part, I clarify why masochism is an interesting case study for pain. To do so

I proceed in three sections. First, I elucidate on why masochism is usually considered as

a problematic case for pain. Second, I offer a first possible answer in order to show that

masochism is not really problematic; this solution is based on the medical definitions of

both pain and masochism. Third, I will present a second possible answer, which

proposes to explain that, in masochism, pain is merely a means for an end. Finally, I

will show that even if both attempts are useful to get a better understanding about the

nature of pain and our interaction with it, these solutions are insufficient to clarify the

relationship between pain and masochism.

1. Masochist contradiction

1.1. Necessary unpleasantness

The usual contradiction between pain and masochism has the following structure:

1) Pain is unpleasant

2) We dislike unpleasant things

3) Masochists like pain

4) So, masochists like and dislike the same thing!

In other words, what is interesting about masochism is that it seems to be the only

situation where people have a complete opposite behavior in the presence of pain:

masochists seek pain. Since pain is paradigmatically an unpleasant sensation, it seems

contradictory that masochist like pain. So, in order to enter the discussion between pain

and masochism, there are two questions that we have to address: 1) is pain necessarily

unpleasant? And 2) do masochists really like pain?

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We can start by the first question. That is, we usually think masochists cannot like pain

because pain is unpleasant, but are we completely sure that pain is unpleasant? George

Pitcher (1970) concludes that it is. To tackle this question, he develops a dialogue

between two counter parties: on one corner the Affirmativist, who claims that pain is

necessarily unpleasant, and on the other side the Negativist, who argues the opposite.

According to the Negativist, the usual unpleasantness of pain can be dismissed in three

different ways: 1) by special conditioning, e.g., fakirs that have normal pain receptors

but who have trained themselves to stand pain, and pavlovian animals that can be

conditioned to give themselves electric shocks for food; 2) by medical procedures, e.g.,

cases of lobotomy where people affirm that they still have the sensation of pain,

although it is no longer unpleasant; or 3) by unusual desires, such as masochism. In all

these cases, the Negativist argues, people (or animals) are experiencing pain but it is not

unpleasant and, therefore, pain is not necessarily so.

On the contrary, the Affirmativist answers back by saying that these cases do no imply

that pain has lost its unpleasantness. In fact, it can be the case that pain is still in itself

unpleasant; pain may appear surrounded by elements that make the situation less

disagreeable or even pleasant. For the Affirmativist pain in masochism is like olives in

paella: although you may not like olives in themselves, since they are constitutive of

paella, you like them when they are part of the dish. You may not like olives, but you

like paella as a whole, even if it must have olives.

In this way, the Affirmativist could claim that pain is still in itself unpleasant, although

fakirs learn how to control it, lobotomy patients stop minding it, and masochists like it

as part of a whole situation. Following the pain-olive analogy, in the same way that

olives have an intrinsic way they taste, pains have and intrinsic unpleasant way they

feel. In this sense, it is as if the fakir learns how to control his reaction to olives in his

paella, lobotomy patients stop minding the flavor of olives, and masochists desire olives

because they like them as part of the whole paella experience.

Since both the Negativist and the Affirmativist have no further reasons on why one

should interpret the former cases in their way, Pitcher concludes that all the former

cases can be explained with the help of empirical studies. Namely, he claims that if the

Melzack-Wall (1965) Gate Theory is correct, then all the cases can be explained and,

therefore, pain is necessarily unpleasant.

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Nevertheless, there are some problems about Pitcher’s view. For example, Pitcher never

clarifies what he understands by “unpleasant”. In the first two type of cases advanced by

the Negativist, the unpleasantness appears to be reduced to behavior, and in the third it

seems to be described in terms of desires. That is, the fact that fakirs, lobotomy patients,

and pablovian animals do not react as if they were in pain, makes the Negativist

conclude that their chronic pains, the bed of nails, and the electric shocks must not be

hurting them. In addition, this does not fit very well with the third case, where

unpleasantness in masochism can be dissolved by unusual desires.

Moreover, according to Stephen J. Noren and Arlis Davis (1974), Pitcher does not

really have a case against the necessary unpleasantness of pain. They claim that his

argument is fallacious and that empirical studies are irrelevant for the philosophical

problem of whether or not pain is unpleasant. They argue that Pitcher relies importantly

in assuming that the Gate Theory is true. Pitcher assumes such theory and then derives

that, in all the counter examples of unpleasant pain, “the gate of the person or animal is

closed, or nearly closed” (Pitcher, 1970, p. 491).

Noren and Davis point out two problems about Pitcher’s conclusion: 1) it cannot be

simply derived from the fact that there is such gate that, in these particular difficult

cases, the gate is actually closed or nearly closed, further empirical corroboration should

be presented in order to accept it; and 2) the fact that the gate is partially closed does not

imply that there is no pain and that pain is not unpleasant, probably the pain can be

mitigated by an almost-closed gate, but that does not imply that such sensation is not

unpleasant.

In summary, it is very difficult to avoid getting lost in the discussion about the

necessary unpleasant nature of pain, mainly because it is not clear what exactly

“unpleasant” means. The most distinctive feature between masochism and the rest of the

pain cases previously discussed is that, in contrast to pablovian animals, fakirs, or

lobotomy patients, where we are not sure how to determine if their pain is or not

unpleasant, masochism is the only case where we have to determine exactly the

opposite, i.e., if their pain is pleasant.

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2. Medical definitions

2.1 Pain definition

So, if masochists like pain, we can explore what we actually mean by “pain”. The

traditional, and highly problematic, definition of pain is well rephrased by Dennett

(1978). He proposes an intuitive characterization of pain, where pain is constituted of

two properties:

(I) Pain experiences are essentially painful, awful, abhorrent, so that it is a logical

impossibility to have an affectively neutral pain experience

(II) A subject's access to her pain experiences is essentially privileged or infallible or

incorrigible

Dennett (1978) discusses a clinical case called “reactive dissociation” (RD). This is a

peculiar condition where people affirm to have painful experiences that are not

unpleasant. They claim to have the sensation of pain, although they are not bothered by

it. Finally, Dennett claims that there is a contradiction in this conception of pain and

that, given that contradictory terms cannot refer to an on object, we should abandon this

definition and replace it for whatever neurosciences find pain can be.

Following Dennett’s advice, we may take a look at different medical definitions of pain.

One canonical version of pain is the definition proposed by the International

Association for the Study of Pain (IASP), “an unpleasant sensory and emotional

experience associated with actual or potential tissue damage, or described in terms of

such damage”. However, this definition seems to agree quite well with the definition

that Dennett showed to be wrong. That is, in accordance to I), pain is always unpleasant,

and similarly to II), it does not matter what the situation is, if someone says she is in

pain, we take it as true.1

                                                                                                               1 I believe we consider ourselves infallible about our own pain probably because we represent pain in our

bodies, in contrast to other perceptions such visual perception, where we represent shapes and colors “out

there”. That is, our degree of certainty depends on how internal or external the representation is.

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In fact, not only does the IASP definition encounters problems with RD, there are

several medical cases that put into question the unpleasant nature of pain. The common

feature of these cases is that whereas people claim that they feel pain, they also say that

pain does not bother them. Such claims suggest that, in fact, the sensory dimension of

pain can be dissociated from its evaluative-motivational one. It is well know that certain

surgical procedures, pain syndromes, and drugs can “remove” the unpleasantness of

pain. Among these cases, there seems to be different levels of indifference:

First, there are the patients that are not bothered by their pain sometimes; for example,

patients who had undergone prefrontal lobotomy, cingulotomy, or patients treated with

morphine who react normally to momentarily painful stimulation, although they have a

neutral reaction to persistent or chronic pain. Second, there are the patients that are

never bothered by their pain; people with pain asymbolia claim that they can recognize

their experiences as painful, although they do not react in presence of painpricks, small

cuts, or burns. Third, people who do not seem to feel pain at all; people with congenital

insensitivity to pain do not show any responses to usual painful stimuli but, in contrast

to pain asymbolia, they do not report to actually feel the pain sensation.2

In face of these problematic cases of pain, where people claim that their pain is not

unpleasant, various medical models have proposed that there is dissociation between the

sensorial and the affective-motivational aspect of pain. For example, Melzack and Wall

(1965) proposed the Gate Control Theory of Pain. This theory establishes that pain can

be modulated through a gate that impedes the unpleasantness of pain to be processed

and, therefore, leaves the pain sensation intact. In more recent studies Melzack (1996,

1999) proposed that pain is processed in a “neuromatrix”; in this matrix, pain

processing is importantly dependent on psychological aspects that explain the different

interactions that people have with pain. Further, Schnitzler & Ploner (2000) have

studied several brain regions that are associated with pain processing in a “pain matrix”;

this matrix includes the SI and SII somatosensory cortex, the insula, and the anterior

cingulated cortex (ACC), and the last two components are considered to be importantly

involved in the affective-motivational aspect of pain.

                                                                                                               2 For a precise bibliography on these conditions see Aydede (2006), “Introduction: A Crtitical and quasi-

Historical Essay on Theories of Pain”.

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Other example of theories that have proposed that pain has multiple factors is Fields

(1999). He suggested that two levels of processing compose pain: first, “algeosity”,

which refers the way pain feels like, the specific sensation that differentiates it from

other sensations such as tickles; second, “secondary unpleasantness”, that refers to a

higher order process that constitutes the motivational aspect of pain. Also Price (2000)

has made emphasis in the affective subjective dimension of pain. He has conducted

several experiments in order to show that pain is constituted of different levels that are

closely related. According to Price and coll. (2006), pain is constituted of three

dimensions. First, the sensory dimension refers to way pain feels like, which can be

separable from the second level, the immediate affection, which is what Price usually

calls “unpleasantness”, and the third level, the secondary affective, that is associated

with long lasting periods of pain and emotional states such as rumination.

In summary, several models have suggested that two dimensions compose pain. On the

one hand, there is a purely descriptive dimension of pain, which informs about the

presence of tissue damage, from now on I will refer to this as nociception. On the other

hand, there is an evaluative dimension, which is associated with the unpleasantness of

pain and our motivation to avoid such damage,3 from now on I will call this dimension

algeosity.

Now, considering that pain is the combination of these two dimensions, what can we

say about the two former questions in relation to pain and masochism? First, is pain

necessarily unpleasant? The answer is no, if we consider that nociception suffices for

something to be pain. Following this idea, we would admit that RD patients, people

treated with morphine, lobotomy and cingulotomy patients, and pain asymbolia patients

do feel pain because they still have nociception, although their algeosity can be

diminished or even completely absent. On the contrary, the answer is yes, pain is

necessarily unpleasant, if we consider that pain is constituted of nociception and

algeosity. In this sense, if there are people who only have nociception and no algeosity,

then we must conclude that what they feel is not really pain.

Regarding the second question, do masochist really like pain? We could answer, “yes,

masochists like pain”, in the sense that they like their nociception. However, this does

                                                                                                               3 I will address this relation between evaluations and motivation in more detail in Part II.

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not give a straightforward answer of how that could be, i.e., how someone could like

stimuli that is usually considered as negative. Even if we accept the distinction between

the descriptive and the evaluative dimension of pain, this gives neither an explanation of

what constitutes a negative evaluation of pain, nor a solution of how such evaluation

can turn into being positive. In other words, we could try to explain what is happening

to masochistic Tomas by claiming that he has a different interaction with nociception,

i.e., his nociception becomes pleasant. But how can we explain this if we do not know

what we mean by “pleasant” or “unpleasant”? How could we explain that, for

masochists, their pain evaluation is inversed?4

2.2 Masochism definitions

Now, with a clearer understanding of what we mean by pain, i.e., the combination of

nociception and algeosity, we can start to find out what exactly we mean by

“masochism”. I think there is a crucial question in order to understand masochism: do

masochists like every instance of pain or they only like it in very specific

circumstances? The fact that Tomas actually likes pain does not imply that he likes

every instance of it; if Tomas claims to be a masochist, that does not mean he keeps on

pinching himself all day long just for the pleasure of it. If he goes to the doctor because

he has a terrible toothache, then we could argue two things: i) that his pain system is not

so different from others’ because he can have usual nociception and algeosity and ii)

that context may affect on pain.

If pain is unpleasant, it seems contradictory to enjoy pain, yet we can analyze if

masochism is really (or mainly) constituted by the fact that people like their pain. We

can begin by an intuitive version of masochism. For instance, Tomas sincerely believes:

(α) he is having a pain experience and; (β) his pain experience is pleasant. This is

contradictory with conceptions of pain such as Dennett’s (1978) and the IASP definition

of pain. But we could also compare Tomas’ sincere masochist affirmations (α) and (β)

with pain conceived as composed by nociception and algeosity.

                                                                                                               4 Since this is a crucial issue, I will devote an entire section in Part II.

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In this sense, there are various things that can be questioned. Let us start with (α), is

Tomas’ pain experience really composed of nociception and algeosity? Could it be that

he calls his experience “pain” even if there is just nociception? We could imagine that,

since he is not aware of the dissociation between nociception and algeosity, he calls his

experience “pain”, because it feels like it in the descriptive sense, but not because he has

the a negative evaluation of it. Now, what about (β)? What does Tomas mean when he

says his experience is pleasant? Is it pleasant because of they way it feels, because he

wants it, because he seeks for it? That is, we could argue that when Tomas says he likes

pain, what he actually has in mind is that he likes nociception; Tomas does not mean he

likes algeosity, which would be more difficult to make sense.

Similarly to what we did in analyzing different versions of pain, we can also take a look

into the medical definitions of masochism. For example, the American Psychiatric

Association DSM-V (1999) proposes the following criteria for Sexual Masochism:

A. Over a period of at least six months, recurrent, intense sexually arousing

fantasies, sexual urges, or behaviors involving the act of being humiliated,

beaten, bound, or otherwise made to suffer.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress

or impairment in social, occupational, or other important areas of functioning.

C. Specify if: with Asphyxiophilia (Sexually Aroused by Asphyxiation)

Further, we can also consider the ICD-10 Classification of Mental and Behavior

Disorders Diagnostic criteria for research (World Health Organization, 1993) for

Sadomasochism:

A. The general criteria for disorders of sexual preference (F65) must be met.5

B. There is preference for sexual activity, as recipient (masochism) or provider

(sadism), or both, which involves at least6 one of the following:

                                                                                                               5 F65 Disorders of sexual preference: G1. The individual experiences recurrent intense sexual urges and

fantasies involving unusual objects of activities. G2. The individual either acts on the urges or is

markedly distressed by them. G3. The preference has been present for at least 6months. 6 My emphasis.

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(1) pain; (2) humiliation; (3) bondage.

C. The sadomasochistic activity is the most important source of stimulation or is

necessary for sexual gratification.

I believe there are three remarkable things about these medical definitions of

masochism. The first one, these definitions do not necessarily consider that to be a

masochist one must have a preference for pain, i.e., it is sufficient to like humiliation

and/or bondage to be a masochist; if Tomas is a masochist he must have “at least” one

of these three practices. The second one, the unpleasant activities that constitute

masochism are considered to be a problematic and they have to be used for at least six

months; that is, if Tomas uses any of these practices but he is happy about it, or he has

been only doing it less that six months, then he would not be considered to be a

masochist. Third, these definitions do not specify why activities such as being

humiliated, beaten, bound, burned, and so are considered as unpleasant, or why

masochists engage in them if they are so.

What I am trying to point out is that, if we strictly consider these medical definitions of

masochism, then there is no necessary dilemma between pain and masochism. This is

because of two reasons: 1) it could be that Tomas, somehow, actually likes pain, but he

has not being doing it for long time and that does not cause him any problems, then he

would no be considered a masochist or 2) if Tomas likes being humiliated as part of his

sexual practices, this is problematic for him, and it has been happening for a long time,

then Tomas would be considered to be a masochist, although his masochism has

nothing to do with pain.

Nevertheless, the puzzle is still out there. One the one hand, we could try to explain

masochism by claiming that sometimes masochists have a different interaction with

their nociception, but we still have no clue of how that could be. On the other hand, we

could say that according to the medical conception of masochism, being a masochist

does not necessarily entail that you like pain; although this does not solve the matter

because there are instances of masochism where it seems like you could like it.

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3. Pain as a means

3.1 Means vs. Ends

Another alternative to give sense of why masochists undertake pain is to notice that pain

can be the means for something else or it could be an end on its own; so, we could

argue, in masochism pain is a means for something else that is valuable. On the one

hand, there are situations where we accept to feel pain as a means, e.g., if we are very

sick, we may want to get the cure even if we know it is going to be very painful, i.e., our

nociception will be accompanied with a high degree of algeosity. This shows that the

fact that Tomas behaves in favor of receiving pain does not imply that he likes it, what

he actually wants is to stop being ill. On the other hand, if Tomas wants to feel pain just

because he wants to experience it, then this seems problematic. It is more difficult to

explain why someone would like to experience nociception and algeosity for

themselves.

In fact, we could argue that the two medicals definitions of masochism previously

discussed suggest that pain is a means for achieving sexual satisfaction. The DSM-V

claims that masochists have “sexual urges, or behaviors involving the act of being

humiliated, beaten, bound”, but the fact that they have such urges and behaviors does

not imply that they like the pain in itself. Moreover, the ICD-10 classification

establishes that “the sadomasochistic activity […] is necessary for sexual gratification”,

but the activities involving pain, submission, humiliation, etc. are not considered to be

gratifying by themselves. In other words, we could say that masochists need such

unpleasant activities to find sexual satisfaction, which is a valuable end.

In fact, there are people who have taken this position in order to explain masochistic

behavior. According to Goldstein (1983), masochists desire to experience pain because

it represents a way of self-punishment. If we consider that “pain” is equivalent to

“unwanted thing”, it seems absurd that someone wants to experience pain. However, we

can desire pain pains as means, and this does not entail any logical contradiction.

Goldstein considers that “masochists often view their pain as a deserved punishment,

and this is a clue to their thinking” (Goldstein, 1983, p. 221). In other words, masochists

desire to experience pain because they consider that inflicting pain to themselves is the

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means to achieve their punishment. Finally, in Goldstein’s opinion, it is crucial to take

into account that masochism is a perversion, and, at least to a certain extent, the desire

to experience pain as self-punishment is irrational.

Other authors share the view that masochists do not really like pain for itself. For

example, according to Pitcher (1970, p. 485.), masochists mistakenly think they like

pain:

It seems implausible to say that he likes the pains of the whipstrokes and the

cigarette burns. Even if he thinks he does like or want them, it is

overwhelmingly likely that he is the victim of an illusion or of self-deception

or whatever. What he really wants is something quite different —the

humiliation that being whipped or burned entails, or the sexual gratification

that is to follow. Since for the masochist the pain is an essential precondition of

these desirable things, he might naturally be expected to think —wrongly—

that it is the pain he desires. He does not like the pain: he only thinks he does.

Nagel (1986, p. 156-157) also considers that one may pursue pain “as means to some

end or […] backed up by dark reasons like guilt or sexual masochism”. Moreover,

Rachels (2000) argues that masochists cannot like to suffer severe pain; the claim that

masochists pursue pain, may be true, but pursuing pain does not imply that they have “a

favorable emotional attitude towards pain itself, considered merely as a feeling, and

seek its continuation for that reason”. Rachels considers that masochists dislike pain,

but like the pleasure or gratification that accompanies it. Again, what is contradictory is

to have a positive attitude towards pain, by desiring, pursuing, or engaging in painful

activities only because people want to experience pain, which they also consider

unpleasant. So, if pain in masochism is merely a means, then there is no contradiction.

3.2 Painful Rituals

Thanks to this means-and-end distinction, other interesting pain cases can be analyzed.

For example, people undertake some ritual initiations that include pain; we could also

explain that people put themselves in such unpleasant situations because pain has a

mediated value. That is, people submit themselves to processes that imply pain and

humiliation because thanks to them they will obtain, for instance, a new higher social

status.

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There has been research which focuses on torture and pain inflection in ritual initiations.

For example, for Clastres (1973), an important difference between torture and rituals is

that, whereas there seems to be no way in which the victim of torture wants to suffer

pain, in rituals there is a certain acceptance from people who go through the painful

activities. Ritual initiations, although painful and sometimes denigrating, entail other

positive values such as courage, wisdom, manhood, and so. Although pain infliction is

constitutive for torture and initiations rituals, there is a crucial characteristic that makes

them different: whereas the objective of torture is to go beyond the bearable limits of

pain, in ritual initiations suffering intervenes in a way that it is still beneath a tolerable

threshold (Houseman, 1996).

Torture and painful initiations have important divergences and they use pain with a

quite different purpose. Given the general abhorrent nature of pain, it is easier to figure

out why it is used in torture. That is to say, if Tomas is being tortured, it is not because

he wants to be tortured, and the objective of the torturer is to makes Tomas confess or to

make him suffer. In torture there is no valuable thing to be obtained, at least not from

the perspective of the one being tortured. In contrast, in ritual pain, as it also occurs in

masochism, there is certain complicity and acceptance of pain.

For instance, there are initiations where men have to pass through an important amount

of pain in order to obtain the new social status of adulthood. Lemaire (2008) discusses

the initiation process in Côte d’Ivoire. The initiation, broadly, consists in seven years

where men have to perform intense farming and agricultural labors that entail pain.

During their initiation, they also have to be isolated and during the seven first days of

their initiation they have to overcome several painful tests. This is an example, as many

initiation rituals, where part of the challenge is to defeat the difficulties constituted by

painful tasks. Once people have concluded the process, they are inserted in a new higher

social category. Finally, this shows that pain can be conceived as the means: sometimes

for sexual satisfaction, and in other cases for achieving adulthood.

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4. So, do they really like it?

Up until now, there are two ways of answering this question. The first answer is that

masochists do not really like pain. Strictly according to the medical definitions of

masochism, if Tomas only uses humiliation as part of his sexual practices, he can be

considered to be a masochist without claiming to enjoy pain under any circumstance.

Further, we could argue that masochists do not really like pain on itself, what they

really like is something else that they will obtain through pain.

Nevertheless, these answers still leave many things unexplained. For example, the first

one does not tell us anything about the cases where masochists do use pain as part of

their sexual practices, and the second does not exclude the possibility that pain can be

an end. That is to say, even if these answers give us a better understanding of the

different interactions that we may have with pain, they do not explain neither how

masochists could find pleasure in using pain nor why pain could not be something that

we may want to experience as an end.

So, do masochists really like pain? I think they do, and I think so for two reasons:

First, if pain is part of their sexual experience, we cannot clearly differentiate between

time T1 when the unpleasant pain is inflicted and then time T2 when pleasure starts. In

masochism both things are part of the same experience. In contrast to ritual pain, in

masochism we cannot make a clearly distinction between unpleasant means and a

pleasant end because the two things are part of the same experience.

Second, and more importantly, since we usually do not differentiate nociception from

algeosity, we could explain that masochist can interact in different ways with

nociception. We think that masochists cannot like pain because we have in mind that no

one can like algeosity, which is what we usually call “unpleasantness”, but not because

we could not like nociception, which, in principle, we could. The fact both dimensions

of pain are usually experienced as a whole does not imply that it has to be that way. For

example, cases such as pain asymbolia suggests that nociception can be experienced

without algeosity. So, what masochists really like is their nociception, but we still have

to explain how.

  19  

Part II.

How do they like it?

In this second part, I address the relationship between unpleasantness and pain. First, I

tackle the different interpretations of what the unpleasantness of pain stands for, and

how we can explain that, given that pain is unpleasant, we tend to avoid it. Second,

given the different possible interpretations of unpleasantness, I propose a pertinent

equivalent for a theory of pleasure. This is especially important in the case of

masochism since not only do they not experience unpleasantness, but they also

experience pleasantness. Third, I propose a model that recovers the definitions of pain

proposed by the medical studies and includes the philosophical discussion on the nature

of unpleasantness. Finally this model is capable if explaining how masochists may find

pain pleasant.

1. Unpleasantness

1.1 Kinds of algeosity

As we saw in the previous section, it is rather difficult, if not impossible, to work on

pain as a paradigmatic unpleasant sensation without establishing what we mean by

“unpleasant”. In accordance with the previous section, by “unpleasantness” we mean

the evaluative and motivational dimension of pain; so, from now on, I will consider

“unpleasantness” and “algeosity” as interchangeable terms. Similarly, when we consider

something to be “painful”, I believe that what we have in mind is that it is unpleasant,

i.e., that it has algeosity. This, for instance, explains why it does not appear as

particularly shocking to say “painful pain” because we are talking about nociception

with algeosity.

Everyone agrees that pain typically entails algeosity, this is why cases such as

masochism or pain asymbolia are so shocking: they put into question that pain is

necessarily algeostic. But, why do these cases put that in question? One may answer:

because masochists and pain asymbolics do not have the expected behavior to

  20  

nociceptive stimulation. But this does not really explain much since we cannot presume

that algeosity can be reduced to behavior. In addition, if we have the intuition that

algeosity is something you feel, and not something you do, then behavior can only be an

indicator or a result of algeosity, but not constitute it.

Philosophers have offered different theories in order to account for the unpleasantness

of pain, i.e., for the algeostic nociception. One of the more recurrent alternatives is to

think that unpleasantness can be explained in terms of body damage. However, as one

may notice, it is different to say that unpleasantness is the result of body damage and to

say that unpleasantness can be reduced to such damage. For example, if we accept that

unpleasantness is necessarily caused by body damage, then we have to deal with the

difficulty that not every unpleasant thing is caused by a body representation; things such

as boredom or dissapointment are unpleasant yet do not seem to clearly represent any

body damage.

We could also argue that unpleasantness consists in the subject believing the she has

body damage. However, this account also has to face the difficulty that in various

intuitive cases of pain, people do not believe they have an injury in their bodies, they

believe they are in pain. For instance, let us analyze the sentence “I believe I have an

injury in my hand” for a phantom limb patient. Clearly a phantom limb patient does not

believe this: she knows there is no injury in her hand because she knows she has no

hand.

Furthermore, when we think in representational terms about pain, we take pain as a

whole, without noticing that it can be decomposed into subtler layers. If we see a red

apple, we can differentiate its shape from its color, even if we perceive them as one

unity. Similarly, even if we experience pain as one event, we can decompose it into

nociception and algeosity. That is to say, when we say that pain is the representation of

body damage, are we taking about nociception, algeosity, or both? Because, it seems to

me, it is not the same to represent that something is occurring in our body, to represent

that that thing is bad.

Another alternative, leaving the representational issue aside, is to explain

unpleasantness in terms of dislike. For example, for Richard J. Hall (1989) the dislike is

a separate mental state from the sensation, and this can explain that you dislike pain for

two main reasons: either 1) you learn to dislike it based on life-experience associations

  21  

or 2) it is the result of an innate evolutionary adaptation. According to his first

approach, the main reason why we dislike pain is because it is associated with tissue

damage, i.e., nociception seems to be a much more efficient method to know about

body damage that, say, visual perception: whereas you may not see that you have a

wound, you can feel it. Following this idea, the fact our dislike of nociception is part of

an innate mechanism does not imply that we necessarily dislike it. The dislike of

nociception is merely contingent; it is an arbitrary fact that such specific sensation has

been associated with body damage.

If we explain unpleasantness in terms of dislike, we could presume that the degree of

the former depends on the degree of the latter. The algeosity of your nociception

depends on it being disliked and its degree on how much you dislike it. However, it is

not very clear that there is a correlation between these two things. Rachels (2000) offers

the following example: if you expect to be burnt, you close your eyes and, instead of

being burnt, someone puts an ice on your skin, he concludes, you dislike the experience

although it is not necessarily very unpleasant. However, it seems to me that Rachels is

begging the question. Opposite to what he thinks, one could say that actually it was very

unpleasant to feel that ice.

What I believe that the real problem for understanding algeosity in terms of dislike is

that we have two options, we can either think that 1) the dislike is what constitutes

algeosity or think that 2) dislike is a different mental state. If we take the first way, then

the natural question comes: what does it mean to dislike something? And it can be

tempting to give the circular answer: we dislike something because it is unpleasant.

Then, if we take the second way, we are not explaining algeosity; the dislike we usually

have of nociception comes from the fact that it has a certain degree of algeosity, so the

notion of dislike does not shed any light. Again, we dislike things because they are

unpleasant, and not the other way around.

  22  

1.2 Motivating pain

Another possibility to explain algeosity is to define it by our motivation to stop it.

Indeed, one of the interesting things about pain perception is that we tend to evade it.

Even if there are cases that put this into question, there is something about pain that

motivates us to avoid it. If Tomas is cooking and he accidentally touches the pan with

his elbow, he will instantaneously move his elbow back. In contrast to other sorts of

perception such as visual perception, we could explain that the algeosity of pain is

explained by our motivation to stay away from it; whereas pain perception has

algeosity, visual perception does not, and this explain why we do not have a tendency to

avoid colors as we tend to avoid nociceptive stimuli.

In more recent years, a renewed interest on unpleasantness took place. People like Klein

(2007; 2010; 2011), Hall (2008), and Martinez (2010) have defended that the

unpleasantness of pain, at least partially, can be understood as “imperative commands”.

These commands explain our behavior towards pain. Broadly speaking, this view

proposes that whereas the function of general perception, like visual perception, is to

inform us about facts of the world the world, there are other kinds of perception that

command us things. For example, hunger commands us to eat, thirst to drink, and itch

to scratch. In the case of pain, and more precisely, the unpleasantness of pain commands

us to do something. This command is considered to carry the biological function of

maintaining our bodies healthy and intact. So what differentiates pain perception to, say,

visual perception is that whereas the former has an imperative content, the latter has an

indicative one.

Klein (2007) points out that when we think about pain, we usually state it in terms of

“My B hurts” or “I have a pain in my B”, instead of putting in terms of an action such

as “It hurts when I A” or “My B hurts when I A”. Based on this, he proposes that the

painfulness of pain consists of a command that tells us not to do the action that is

hurting us. For instance, if you have an injury in your ankle, the command would tell

you “stop putting height on it!”. This view makes emphasis that pain is not really about

informing about body damage, and there are several reason to think so: 1) pain is not

always caused by body damage, 2) pain is not a reliable source of information about

body damage, and 3) it does not seem like the biological reason of pain is only to

inform us but rather to make us do something about it.

  23  

Bain (2011) argues that this imperative view is insufficient to explain on what consists

the nature of pain and that it does not even clarify why we have the tendency to avoid

pain. The “hedomotive challenge”, according to Bain, is to explain why we react in

order to avoid pain; for the “imperativists”, it is because there is a command that tells us

to do so; for Bain, the notion of command is insufficient for explaining such

hedomotive aspect. Bain offers five different arguments against imperativism:

1. Hedomotive claims: it is not clear exactly what the commands tell us to do, nor that

every single instance of pain shares the same command, e.g. it is difficult to find the

shared command between menstrual cramps and a burned finger. Moreover, if, as Klein

proposes, the commands tell you to stop doing something, this cannot explain situations

when you are in pain but you are not doing anything. Moreover, there are commands

that tell you to do something, e.g., to take a pain killer.

2. Urges: although imperativism proposes that unpleasantness can be understood as a

command, it could be also understood as an urge to do something, which is not

necessarily a command. In other words, not all commands are urges and not all urges

are commands. For example, someone may command you to do sit down, but that does

no imply that you will have the urge do it. Imperativists could argue that, indeed,

commands are urges, but, according to Bain, this seems too ad hockery, and, in this

sense, the extrapolation of the word “command” from a linguistic context does not seem

to illuminate “unpleasantness”.

3. Unpleasantness: it is no very clear why a command constitutes unpleasantness. That

is to say, there are two broad ways in which we can explain unpleasantness through

commands: a) the command constitutes the pain’s unpleasantness, or b) the command is

part of or may cause unpleasantness. Whereas Klein embraces the first option, Hall

seems to take the second weaker version. For Bain, it is straightforward clear that the

constitutive version is wrong, this can be seen in well-known cases such as pain

asymbolia, where people claim to have pain but no particular motivation to stop it.

Grahek (2007) also presents this counter example for imperativism, where people who

suffer such condition are shockingly indifferent to their pain.7

                                                                                                               7  More recently, Klein (2011) proposes a different way to understand pain asymbolia. He considers that

“asymbolics lacked a fundamental capacity to care about the integrity of their body”, and they do it

  24  

4. Reasons: another (apparent) advantage of the imperativist view is that it provides

reasons for avoiding pain; the action of taking your finger away from the flame has a

reason, i.e., there is a command issued by a pain module that “tells” you to take it away.

The module knows best. However, Bain has a counter example for this: imagine that

you know that something will not cause you injury, e.g., the light beam of a lamp on

your hand, but your pain module is malfunctioning and it commands you to avoid the

light because it is extremely unpleasant. According to Bain, this is a case that the pain

command fails to illuminate.

5. Intensity: we can explain that some pains are more intense than other because there is

a stronger command that tells us to stop some behavior. Nonetheless, the imperativists

theory does not clarify what makes a command stronger than other. Further, if a

command is stronger because it prevents you from an even more unpleasant situation,

then the notions becomes circular. That is, we cannot explain unpleasantness by using

the notion of command that presupposes the notion of unpleasantness.

Another possibility would be to explain than a stronger command consists in warning

that there is higher risk of injury, but in this case then commands would not be really

concerned for unpleasantness. One more option could be to say that stronger commands

inform you about how much attention the unpleasantness will grab, but then commands

would be about grabbing instead of unpleasantness.

In summary, there have been various attempts that try to explain the nature of pain,

considering that unpleasantness is in the core of it. An important attempt has been to

explain (or reduce) unpleasantness as the representation on body damage, although this

account fails for two main reasons: 1) it fails to explain why when we experience

unpleasantness in pain, or in other situations, we do not experience it as body damage,

and 2) it fails to illustrate why we usually avoid such unpleasantness. In the face of such

problems, Bain (2012) proposes another alternative: evaluations.

because they suffer a depersonalization syndrome; this, he argues, fits with a “modest version of

motivationalism”, which considers that pains may fail to motivate, but only in situations where the agent

is severely impaired.

  25  

A subjects’s being in unpleasant pain consist in his (i) undergoing an experience (the pain)

that represents a disturbance of a certain sort, and (ii) that same experience additionally

representing the disturbance as bad for him in the bodily sense.

Bain claims that this approach to pain has the advantage that (i) considers a

representational state that can be either true or false, because unpleasant pain represent

that disturbance, and (ii) gives an explanation for the motivational dimension of

unpleasantness: we avoid pain because it represents something that is bad. Evaluations,

constructed as body-directed, Bain argues, can give a reason for behavior. In this view

unpleasantness is bad in itself, because it represents something that is bad for the body.

One of the main features of this view is that the representation is bad in itself, and this is

what motivates us to act and not the other way around. Unpleasant things are not bad

because we avoid them; we avoid them because they are unpleasant. This may seem like

a little difference, but it makes a big difference.

However, Bain’s evaluativist theory does not address the degree issue either.8 He does

not explain why, if unpleasantness depends on a representation of something that is bad

for the body, some body disturbances would be represented as worse than others.

Maybe, if we accept that pain has a biological function of keeping our bodies intact and

safe, as Klein had considered, then this would complement Bain’s proposal. Namely,

this could shed light on why third-degree burns are more unpleasant than superficial

ones, because the former are represented as worse. Although, this still does not explain,

for example, why menstrual cramps can be so painful for some women and very light

for some other, that is, why should in one case menstruation be represented as a worse

body disturbance?

                                                                                                               8 I prefer to use “degree” when it comes to unpleasantness rather than “intensity”. I believe that the

former captures better the qualitative aspect of it.

  26  

2. Pleasant vs. Unpleasant

Most of the theories that focused on the unpleasantness of pain try to address this issue

without an equivalent theory of pleasantness. However, can we really have a theory of

unpleasantness with total lack of a theory of pleasantness? I think there are two reasons

why we cannot:

First, cases like masochism demand a clearer understanding about what we mean by

pleasant and unpleasant. Explaining masochistic behavior based on “masked desires”

that drive masochists to hurt themselves does not really solve the puzzle. Even if

masochists had such desires, we would still have to explain how these desires drive

masochists to seek something pleasant, if pain is just a means for sexual pleasure or

self-punishment, what is the common feature between these two things? Someone may

say, “that they are pleasant”, but that is exactly what these explanations are missing.

Moreover, it is not clear that masochism can be really explained by means and ends, in

contrast to pain in rituals or medical cures, the pleasure and displeasure in masochism

are not two clearly separate experiences.

Second, experiences are categorized in a range that contrasts unpleasantness and

pleasantness. If we simply focus on one side of the spectrum, it seems like we have an

incomplete model. Further, odd cases of pain put into question that the same sensation

is attached to the same degree of unpleasantness or pleasantness. The exact same stimuli

can even be judge in opposite ways depending on the point of reference. For example,

the exact same environmental temperature can be judged as cold or warm depending on

where it is experienced: 20 Celsius degrees can be cold where it is always sunny, but

could also be considered as warm after a long snowy winter.

2.1 Nociception vs. Placiception

Strangely, and I believe this contributes importantly to the confusion about

unpleasantness, we use the word “pain” in ambiguous ways. We use it for bodily

sensations such as headaches, menstrual cramps, sunburns, and broken ankles, but

sometimes we can also use it to refer to emotional suffering, e.g., when we consider that

  27  

disappointment or grief can be painful. Moreover, when we think about the opposite of

pain, “pleasure”, it can also refers to “physical pleasure”, broadly refereeing to pleasure

that we perceive as in our body, such as orgasm and sunbathes or “emotional pleasure”

such as joy or the fulfillment to having accomplished a goal. I believe this ambiguous

use of “pain” is related to the fact that, since nociception is accompanied by algeosity,

then we use “pain” and “unpleasant” indifferently. On the other hand, we use “pleasure”

to generally refer to pleasant things, which can be bodily experiences, like a caress, or

more emotional, such as fulfillment.

In order to avoid these vague uses of “pain” and “pleasure”, from now on I will use

“nociception” and “placiception”. Nociception, as I mentioned before, refers to the

bodily sensory aspect of things such as headaches, burns, cramps, and broken ankles,

and placiception to caress, the warm feeling in the skin when we take sunbathes,

orgasm, and so on. Although, nociception is usually unpleasant, and placiception is

usually pleasant, I consider that this is just a contingent fact about those experiences.

This, in fact, is supported by cases where we consider that nociception is not evidently

unpleasant, like pain asymbolia or masochism, and by people who do not like to be

caressed or touch and who avoid to experience placiception.

In this way, since the sensory aspect of experience can be distinguished from its

evaluative-motivational one, there is no reason why this would not be valid for bodily

sensation that we usually consider pleasurable. On the one hand, cases such as morphine

patients, lobotomy patients, and pain asymbolia, confirm that nociception does not

always have the same degree unpleasantness; and, on the other hand, there are also

situations where our interaction with placiception can be variable, e.g., a caress could be

very pleasant or unpleasant depending on the person from who we receive it, and an

orgasm could be judged as something we should avoid experiencing given our beliefs or

the context where we find ourselves. Furthermore, as Bain (2012) points out, a one-year

orgasm may become quite annoying and unpleasant.

  28  

2.2 Algeosity vs. Hedonisity

Now, in order to get a better grasp of what happens in masochism and in the variety of

sensory experiences, we can try to find an equivalent of algeosity on the other side of

the spectrum. Among the approaches to pain unpleasantness, very few have considered

what the equivalent would be in terms of usually hedonistic sensations. In several of the

medical studies of pain, they seem to consider that behavior and verbal reports are

sufficient for attributing algeosity to nociception. Besides the several issues that a

behaviorist approach entails in order to explain algeosity, we could consider which

would be the behavioral equivalent of hedonisity. From now on I will consider

“pleasantness” and “hedonisity” as interchangeable terms. For example, if we saw that

people try to maintain certain stimuli, and smiled when it is present, we could think that

it is an indicator of hedonisity. However, given all the problems that behaviorism has in

order to explain what constitutes unpleasantness, it may not be a very good option for

explaining pleasantness either.

Another important attempt to explain the unpleasantness of pain is to put it in

representational terms, and we could try to find its equivalent in terms of pleasantness.

So, for example, in the way we try to explain unpleasantness as the representation of

body damage, then pleasantness should be the representation of some body benefit.

Nevertheless this is problematic: sometimes unpleasantness does not represent body

damage, like disappointment, and sometimes pleasantness does not represent body

benefits, like fulfillment.

In order to avoid this kind of problems, we could focus on the unpleasantness of

nociception and the pleasantness of placiception. By doing this, it makes more sense

that such unpleasantness and pleasantness are a representation of something related to

our bodies. For instance, this could explain why burning ourselves is usually unpleasant

because it entails some body damage, whereas a sunbath is something pleasant because

it entails some body benefit. However, this does not solve all instances of body

sensations, e.g., this does not shed much light on why menstrual cramps can be so

unpleasant or orgasms could be so pleasant. That is, menstrual cramps are not clearly

  29  

damaging for women’s body, nor is it obvious than an orgasm entails something good

strictly in terms of our body.9

More importantly, the mere fact that we get a representation of something occurring in

our bodies does not have any answer of why such representations drive us to act, why

do we put our finger away from the flame and why we go out and sit on the grass once

the winter is over? Again, the fact that we perceive something different in our body,

does not entail any clue on why such modification moves us to act. The imperative view

tried to give and answer to this. In Hall’s (2008) words, “if it itches, scratch it!”. If we

accepted the imperative view for algeosity, then, we could try to explain hedonisity in

terms of commands too.

So, if we took this option, we could say that hedonisity is, if not constitutively at least to

some degree, a command to maintain our bodies safe and intact. That is, in contrast to

avoidance-behavior commands for unpleasantness, as Klein (2007) proposes,

pleasantness would be explained in terms of seek-behavior commands. Nevertheless, as

Bain argues, there are many aspects that the imperative view does not explain and, more

importantly, it cannot clarify why such commands would move us to act in order to

avoid unpleasantness and seek pleasantness: the fact that we receive a command does

not imply that we will follow it.

One last option is that algeosity and hedonisity are intrinsic properties of nociception

and placiception. That is, these properties of experience do not depend and are not

reduced in other terms such as behavior, dislike, urges, inclinations, commands, and so.

Rachels (2000), for instance, advocates to this view for unpleasantness, he considers

that it is a property that supervenes on the pain experience. However, if unpleasantness

and pleasantness are mere supervenient properties, then we still have to explain why

they motivate actions. How can those supervinient properties have a causal role? This

way of intrinsically conceiving such properties seem to have problems answering to the

hedomotive challenge, i.e., illuminating why we tend to something in the presence of

nociception and placiception.

                                                                                                               9 Orgasms may be interpreted as benefit at the level of the survival of the species. However, I do not

believe this is a prima facie benefit for your body.

  30  

Following Bain (2012)’s evaluativist theory, we could say that pleasantness and

unpleasantness are, respectively, intrinsically good (or bad) for people who

experiencing them. They are so because they represent something good (or bad) in the

bodily sense and this is what explains that they make us act. We avoid them because

they are bad and we seek them because they are good. If Bain’s proposal manages to

give an account of algeostic nociception, then it could be a suitable baseline for

explaining hedonistic placiception:

A subjects’s being in a hedonistic placiception consists in his (i) undergoing an experience

(the placiception) that represents a disturbance of a certain sort, and (ii) that same

experience additionally representing the disturbance as good for him in the bodily sense.

Following this idea, placiception is hedonistic because it represents something good for

the body. This could explain, for instance, why we find pleasure in eating sugar or why

we like to take long sunbathes; because, in a general sense, they are good for our bodies.

However, we may still have to clarify what exactly constitutes a good disturbance of the

body. For example, in contrast to sugar, it may not be very clear how an orgasm could

be good for the body. Orgasms may be disturbances, but that does not mean they are

good. Maybe they are so in the sense that they allow the transmission of our genes, but

that is not strictly speaking something good for our own bodies, but rather for our

species. Further, as I mentioned before, Bain’s new proposal does not address the

degree of unpleasantness, so, similarly, there is still no explanation for the degree

pleasantness either.

2.3 High vs. low

I believe that there is an important feature about nociception and placiception that has

not be highlighted: we do not always react with the same aversion or acceptance to

similar stimuli. For example, if you accidentally touch hot water, even if you do not get

hurt, your hand immediately moves back as a reflex; in opposition, when people go to

an almost boiling jacuzzi, they enter it and stay there for a long time. In contrast, the

caress of a beloved person can be very nice, whereas if the same stimulus is receive by

someone we dislike or in an inappropriate situation, it could be quite bothersome. How

could we give an account of this? I think it is because algeosity and hedonisity have

different levels of processing.

  31  

In the low level, we could find the stereotypical innate reactions to nociception and

placiception. For example, when we accidentally touch something hot, our body

immediately reacts by putting distance between our bodies and the hot object, or if we

are jumping and we twist our ankle, we immediately stop moving. I believe this kind of

immediate reactions is what the imperativists had in mind when they proposed that there

was a command that made you avoid pain. However, they did not considered that a)

nociception is not always unpleasant and b) that we do not always follow a command.

Nonetheless, it is true that we have typical reactions to typical painful-stimuli. In other

words, we usually avoid nociceptive stimuli because it is usually algeostic.

As Hall first (1989) suggested, those stereotypical reactions could be explained by

either 1) the fact that you learn to react in such way based on life-experience

associations or 2) it is the result of an innate evolutionary adaptation. This also fits with

Pitcher’s (1970) Negativists intuition about fakirs, lobotomy patients, and pavlovian

animals, i.e., that those usual reactions may disappear because, I would say, the low-

level algeosity processing can be altered. It is a contingent fact that boiling water and

broken ankles produce nociception that we find algeostic because, contingently, it is

represented as bad for us. We could imagine that if soft light beams damaged our skin,

we would have learned or evolutionarily adapted to find light beams unpleasant. If, for

example, perceiving red color would be represented as bad for our eyes, then we would

1) learn to avoid it based on life-experience or 2) we would adapt to instantaneously

avoid it.

This low-level immediate reaction, I claim, recovers the intuition of the imperative

view, i.e., that there is a sort of strong impulse to avoid whatever is causing nociception.

However, we do not have to explain such impulse in terms of commands; the reason

why we act in order to avoid unpleasant stimuli is, as Bain (2012) points out, because

we represented it as a disturbance that is bad for our body, and, I would add, we

represent it that way either by learning or by adaptation. Moreover, this can also explain

that not only adult humans are capable of experiencing algeostic nociception, the innate

mechanisms that allow us to detect unpleasantness are probably shared with human

babies and with many animals too, allowing them to be experience unpleasant

nociception, at least in the low-level of it.

  32  

This could also give account of the fact we do not always react in the same way to the

same stimulus, even if we feel the same sensation. For instance, plavovian dogs modify

their low-level algeosity by their training, i.e., they associate the nociception produced

by electrical shocks to food rewarding; further, in pain asymbolia patients, we could

explain that their low-level algeosity processing is importantly, if not completely,

damaged, which explains why they still feel nociception but they do not react in order to

avoid it because they lack low-level algeosity.

Accordingly, we find all sorts of examples of things we do in order to avoid something

that is bad for our bodies, e.g., hunger motivates us to find something to eat, and even if

you try to hold you breath, your respiratory system starts working again even if you do

not want to. In this sense, we could explain that there is a low-level module of algeosity

that avoids harm for you body and, in the case of hedonisity, it seeks things that are

good for it.

Added to this, I propose, there is another is high-level of algeosity and hedonisity. This,

I believe, recovers the intuition of the theories that have tried to put unpleasantness in

terms of desires, beliefs, attention, and so on. In fact, as I will discuss in the next

section, several of these psychological factors seem to importantly influence the

algeosity of our nociception. But we may wonder, how is it possible that higher-level

motivates us to act? My answer is that, broadly and in a similar way that the low-low

level works, when we represent something as bad and therefore unpleasant, this gives us

a reason to have avoidance-behavior; on the contrary, when we represent something as

good, i.e., pleasant, then this motivates seek-behavior. The main difference is that this

higher-level does not have to represent things in bodily terms.

In fact, I believe that this higher-level explains algeostic and hedonistic states that

constantly troubled the previous theories of unpleasantness. For instance, when we

think of disappointment and fulfillment as examples of unpleasant and pleasant

experiences, it is not very clear that they represent any kind of tissue injury. However,

we could explain that they entail something bad and good in psychological terms. That

is to say, when we compare disappointment to broken ankles, we compare them because

they are algeostic, not because both phenomena feel in the same way in bodily terms.

Similarly, the fulfillment of accomplishing our goals and entering a jacuzzi are

hedonistc experiences, even if they clearly do not feel in the same in our skin.

  33  

I presume that this higher psychological level mainly, or at least evidently, belongs to

adult humans. Whereas the lower level explains why we can find more stereotypical

behavior in dogs and cats that in humans, the combinations of both can shed light on the

complexity of our interaction with bodily sensations. For example, this can explain that

whereas the caress of a beloved person is hedonistic in both levels, when an unknown

person touches us, the same stimulus may be represented as something bad; it is bad

because of our associations and by the fact that it is represented as something bad in

terms of beliefs and expectations. That is to say, if you think is going to be bad, then it

is actually worse and if you think it is good for you, then it does feel better.

3. So, how do they like it?

Masochists may pursue pain as an end, but how could we explain that this is possible?

My answer is that if we consider that 1) a descriptive sensory dimension and an

evaluative-motivational one compose pain, and 2) that the latter can be importantly

influenced by our high-level psychological representations, then we can explain that

masochists represent nociception as hedonistic. In other words, people burn or cut

themselves because training or associations can mitigate their low-level of algeosity

and, more importantly, their high-level may be inversed to hedonisity since they

consider that such cuts and burns are good for them.

Similarly, things such as orgasm, which are paradigmatically pleasant, may be

unpleasant. If we conceive an orgasm as something that we should feel guilty about,

although it may be represented with a certain degree of low-level hedonisity, it may

have a high degree of high-level algeosity. Moreover, the fact that these phenomena are

importantly influenced by the high-level explains why we do not see masochistic

behavior or auto-control of sexual impulses in animals.

  34  

Part III.

Can anybody like it?

In this third part, I propose a model that gives an account of masochism, our general

interaction with pain phenomena, and pain modulation. First, I summarize such model, I

explain how it accounts for various pleasant and unpleasant experiences, and precisely

how it sheds light on masochism. Second, I discuss several examples of pain

modulation that can also be explained with this model. Pain modulation supports the

influence of cognition, i.e., high-level processing, on pain perception. Third, I finally

conclude that, given the possible interaction that we may have with pain, anybody could

be, in principle, a masochist.

1. Pain = nociception + low-level algeosity + high-level

algeosity

1.1 Pain model

In summary, I propose that what we usually consider as pain, is actually the

combination three different things. First, there is the descriptive sensory aspect of it,

what I call nociception; this is what we normally recognized as a physical pain, which is

a sensation normally localized in some part of our bodies and that we identify in

experiences such as headaches, stomachaches, broken and twisted ankles, cramps,

burns, cuts, electrical shocks, etc. Second, added to such sensory content, there is the

low-level of algeosity, this is the representation of something bad in bodily terms, the

fact that it is bodily-bad gives us a reason to avoid it, and this is the result of

associations and innate evolutionary mechanisms. Third, there is a high-level algeosity,

which represents something as psychologically bad for us; similarly, the representation

of something being psychologically bad gives us a reason to avoid it, although such

  35  

actions depend on other competing desires and motivations.10 Presumably, this level is

more developed in humans, and also sheds light on unpleasant experiences that do not

clearly represent things in body terms.

In addition, this model is coherent with several medical studies. If we reconsidered the

three dimensions of pain proposed by Price et al. (2006), the sensory dimension, would

be the equivalent to nociception, the immediate affection, would correspond to the low-

level of processing of algeosity, and the secondary affective, would be equivalent to

high-level processing of algeosity. Moreover, regarding Schnitzler & Ploner’s (2000)

studies, I would presume that whereas the SI and SII somatosensory cortex are related

with nociception and probably low-level processing, the insula and the anterior

cingulated cortex may correspond to the higher psychological level of algeosity.

Further, concerning this high-level of processing, Melzack’s neuromatrix (1996, 1999)

considers that there is a very important psychological aspect that explains the

interaction that people have with pain.

One of the important differences between the current model and the medical models of

pain is that it considers an equivalent for pleasurable experiences. What we usually

conceive as a pleasant sensation is composed by three dimensions: placiception, low-

level hedonisity, and high-level hedonisity. Furthermore, the current model

distinguishes evaluations from motivation: the reason why we act is because we

represent stimuli as algeostic or hedonistic. Finally, this model also allows us to

understand experiences that do not represent things in clear body terms. Based on these

distinctions, we can categorize several unpleasant and pleasant phenomena:

                                                                                                               10 This could explain why during depressive states people cannot easily find the motivation to get out of

their negative situation. That is, even if they represent something as bad and they would prefer to stop

felling depressed, there are other competing beliefs and desire that impede them to do something about it.

  36  

For example, many of the situations that we usually consider as painful are included in

usual nociception, i.e., sensations that are commonly accompanied with a certain degree

of low-level and high-level algeosity; such degree may vary depending on our

associations and innate mechanisms, but also in our beliefs and expectations about the

sensation. Accordingly, usual placiception are experiences such as orgasms, the

sensation produced by caresses or warm water that may vary their degree of hedonisity;

such degree also depends on our body responses based on life-experience associations,

innate mechanisms, and in our expectations and beliefs about how good that sensation is

for us.

In addition, this classification also considers that we can have unexpected reactions to a

given stimulation. Namely, since the descriptive dimension is, in principle, independent

to the evaluative dimension, this can explain that people with pain asymbolia appear in

the centre of the diagram, i.e., if the sensorial aspect of being burned is present, they can

identify it, although there is a total lack of motivation because there is no evaluation of

it in any form.

  37  

Lastly, and in contrast to previous models of pain, we can have a place to accommodate

other unpleasant phenomena such as disappointment, unfulfillment, frustration, defeat

or pleasant experiences such as fulfillment, achievement, contentment and so on. These

kind or experiences are not clear body experiences. Even if someone may say that

disappointment is somehow in her chest, it is not comparable to burns or cuts that can be

easily detected in your hand or you feet, e.g., it would be odd to have a disappointed

ear. Similarly, things such as fulfillment cannot be experienced in a very specific part of

our bodies; there is no such thing as fulfilled fingers. For these sort of unpleasant

experiences, we can say that it has an important high-level algeosity, even if it is not

accompanied of a body representation, and for the pleasant ones, we could explain them

as high-level hedonisity with no low-level representation.

So, in conclusion, this model has several advantages: 1) it recovers the intuition from

the medical models concerning different levels of pain processing; 2) it solves the

hedomotive challenge by considering that unpleasantness and pleasantness are

motivating because they represent things as bad or good; 3) it proposes a correspondent

theory of pleasure; 4) it gives an account of the degree of unpleasantness and

pleasantness, since something can be more unpleasant or pleasant if both dimensions are

present; 5) it enters the possibility of explaining unpleasantness and pleasantness for

other situations that are not clear body representations; and 6) it offers an answer not

only for masochism, but also to many other normal and pathological interactions with

pain.

1.2 Masochism: hedonistic nociception

Now, in face of a model of pain that distinguishes nociception from placiception, low-

level and high-level algeosity and hedonisity, what can we say about masochism? Let us

remember that, if Tomas is masochist in a way that is relevant to the discussion about

pain perception, it is because he finds pleasure in the sensation that he identifies as pain.

It is a relevant case of masochism if, say, Tomas likes to spill hot wax in his skin

because he finds pleasure in the sensation produced by such hot wax, al least under

certain circumstances. To explain how Tomas engages in such an unexpected way with

pain, there are three different possible paths of explanation:

  38  

Either a), something different happens regarding his nociception. That is, there is

something in his body that is different from the rest of the people; Tomas’ masochist

nervous system is pre-wired in a way that explains why he has different thresholds and

reactions to pain. There is something about his nociception that does not allow him to

process stimuli properly. For example, recent studies (Pollok, et al., 2010) claim that

masochists, in contrast to controls, have increased pain thresholds and a positive

evaluation of painful laser stimulation.

However, this path cannot lead us to the answer. Let us remember that nociception has

nothing to do with liking or disliking. Even if nociception may work differently in

Tomas, this could only tell us if Tomas is capable of perceiving the raw descriptive

dimension of pain. If Tomas is capable of detecting that there is melting wax on his

skin, then this means that his nociceptors are working correctly. So, since nociception is

not concerned with the fact that Tomas finds his sensation pleasant or unpleasant, then

if something different occurs in masochistic experiences should not be, in principle, at

this dimension of pain processing.

Or could be b), there is something different in Tomas’ low-level processing. That is to

say, the stereotypical innate responses that we have towards pain are different for him,

either by conditioning or by the way his anatomy is organized. I think here lays part of

the answer. As we stayed before, the unpleasantness of pain can be modified by life

experiences, learning, and conditioning, this explain why dogs can be trained to stop

minding electrical shocks. So, similarly, this could also explain Pollok and coll.’s

results. Namely, Tomas has a higher pain threshold; he is less susceptible to algeosity

because he has gotten used to it.

In fact, there are two possibilities about how the low-level of processing could be

different in Tomas. It could be either that 1) he processes nociception as low-level

hedonisity, and therefore, we should expect that he likes and seeks most body damages:

he seeks to be burned constantly by all sort of means and he may even like other

instances of nociception such as broken ankles. The other alternative is to that 2) in

presence of nociception Tomas’ low-level is still algeostic, but it may be slightly

decreased by his habits or his anatomy.

Lastly, it could be that c) there is something different concerning his high-level

processing. I believe here lays the key to explain such unexpected behavior to stimuli

  39  

such as melting wax. That is, Tomas has different beliefs, memories, and expectations

that represent the hot wax as good for him. One of the main features about masochism

is that not only are masochists less bothered by nociception that the rest of the

population, they like that nociception. In contrast to people who seek nociception for

obtaining something else, like a new social status or avoid more suffering, the difficulty

of masochism rests in the fact that they like that nociception. So, my answer is that

Tomas seeks to be burned with hot wax because, at least under certain contexts, because

his nociception is represented with high-level hedonisity.

In this sense, probably his nociception works adequately, so he knows when he

accidentally cuts or burns himself while cooking in the kitchen; his low-level algeosity

might be slightly modified concerning light burns because he has gotten used to them,

so he has a low-level degree of algeosity when he is burned by hot wax; but most

importantly, his beliefs about his nociception related with wax burns are very positive.

This results in a high degree of high-level hedonisity, which explain why he likes it and,

therefore, why he engages in such practices. He actually likes pain sometimes.

  40  

2. Pain Modulation

2. 1 Types of modulation

We can start thinking about a particular pain case mentioned by Valerie Gray

Hardcastle (1999, p. 13). Mathieu Formet-Savoie was a gifted cellist who was

diagnosed with cancer at an early age and had to stop playing music because of this.

The relevant thing about this situation concerning pain is that Mathieu generally refused

any kind of medication to reduce his physical and emotional suffering. He preferred to

deal with it by refocusing his creative energy into writing about his experiences; he

considered himself to be surrounded by a healthy supporting environment, which is

unusual for people who share his medical condition. He died at age thirteen soon after

he published his life’s work Le cancer à 11 ans. What is intriguing about the way he

managed his pain is that it suggests that at least some part of it may depend in our

intellectual capacities to deal with it. Indeed, in recent years several studies have shown

that there are cognitive variables that modulate pain perception. In particular, attention

and emotion play a key role for pain modulation (Villemure and Bushbell, 2002).

For example, several experiments show that attention can influence on pain perception.

Bantick and coll. (2002) gave noxious thermal stimuli to subjects while they had to

perform a stroop task. Interestingly, the authors found that when the task was more

difficult, people reported feeling less pain. Likewise, Pud and Shapir (2006) also

attenuated pain perception by simultaneously giving noxious heat stimulation, auditory

stimulation, and a cognitive task. They found that pain rating was highest when heat

stimulation was presented alone, and that pain rating was attenuated when passive

auditory stimulation was added.

Emotions are also related to pain perception. For example, several studies support that

chronic pain patients are likely to develop depression. However, even if it may seem

more intuitive that long-lasting periods of pain can lead to negative emotional states,

there is also evidence for the reverse causal relationship: being in a negative mood can

also increase pain. For example, Bras et al. (2010) claim that chronic stress disorders

may lead to increase sensibility: patients find unpleasant some stimuli that are not

usually considered as so.

  41  

It has also been shown that pain can also be attenuated by mindfulness, i.e., by having

an “empty mind”. Gard et al. (2009) measured three different variables (pain intensity,

unpleasantness, and anticipatory anxiety) in two groups, one that was trained in

meditation and one that was not. They proportioned noxious stimuli to the subjects

while meditating and in a cognitively neutral situation. In contrast to this neutral setting,

all subjects reported less pain while they were in a state of mindfulness. Further, ratings

were significantly lower for people who were used to meditate.

Another interesting example of pain modulation is hypnosis. Rainville and coll. (1999)

conducted three experiments showing that pain can be modulated by hypnotizing

subjects. During the first experiment, they put subjects under noxious stimuli and after

hypnosis they repeatedly told them that their sensation was of “well-being” and

“surprisingly pleasant”; in the second experiment, they did something similar but told

them that their sensation was of “discomfort” and “surprisingly unpleasant”; in the last

experiment they told subjects that their pain would be more intense and they used words

such as “burning”, “acking”, and “stinging” to emphasize the sensorial aspect of pain.

After the first two tests, they concluded that the degree of unpleasantness could be both

increased and decreased thank to hypnosis; similarly to previously conducted tests

(Rainville and coll., 1992), their results suggest that: 1) as the result of hypnotic

suggestion, people may consider the same intensity of noxious stimuli as more or less

unpleasant, and 2) they can also consider as equally unpleasant different intensities of

noxious stimuli. In addition, based on their in third experiment, what they call “pain

intensity”, could also be modified. Additionally, their results suggest that there is a

correlation between hypnotic susceptibility and pain modulation.

One last example of pain modulation is the placebo and nocebo effects. Nir and coll.

(2011) showed that people’s appreciation of the degree of unpleasantness could be

decreased with a placebo or increased with a nocebo. They administered painful thermal

stimuli to one placebo and nocebo group (and to its correspondent control groups); the

placebo group was told that they would receive a cream that diminished pain and the

nocebo group a cream that, of course, would augment their pain. As expected, people

reported that their pain was less unpleasant with a placebo and more unpleasant with a

nocebo, in comparison to their respective controls. These results point out that pain

  42  

perception is not merely based in the external stimuli and emphasize the relevance of

endogenous analgesia in humans.

In summary, all the previous mentioned authors agree that there is pain modulation. In

most of the cases it seems like such modulation is due to a high-order cognitive skill,

such as performing a stroop task, by having negative emotions and expectations, by

empting our minds, or by changing our beliefs about the nature of the sensation with

hypnosis. However, it is neither clear which is the most effective way to modulate pain,

nor how it is possible that our cognition modifies the unpleasantness of our experiences.

2. 2 Levels of modulation

Among the cultures and individuals people have different reactions towards pain. There

is no conclusive data that show different pain thresholds in different ethnic categories.

Nonetheless, it has been shown that culture modulates how people respond to pain.

Zborowski (1952) described how Americans from different origins (Italian, Jewish,

Irish, and “Old American”) react in different ways in relation to painful stimuli. What

could explain that these different groups have different reactions to the same stimuli? It

could be either that 1) they have different pain receptors so some of them perceive the

same nociceptive stimulation in different ways, or 2) they experience pain in different

ways because of their different cultural background. I believe the latter is the correct

answer. If an ethnic group considers pain as more unpleasant than other is because its

cultural practices lead people to represent nociception as worse in the bodily and/or

psychological sense.

In this way, we can explain the various cases of pain modulation. In the examples where

attention gets modified by focusing on a cognitive task, or by being distracted by

auditory stimulation, algeosity may decrease because the higher-level representation of

pain gets oriented into other stimuli. Further, in the case of mindfulness, the reason why

people who are trained in meditation report less unpleasant pain is because, by “empting

their mind”, they manage to have no high-level representation of their pain. They say

that pain is less unpleasant because their nociception is not represented as bad.

Moreover, they also probably know how to control their low-level algeosity as a result

of their training to rest in uncomfortable positions for long periods of time.

  43  

In addition, this also fits with the fact that negative emotions and chronic stress makes

people more susceptible to pain. That is to say, the fact that we represent nociceptive

stimuli as bad for us, because we are stressed or depressed, can indeed augment the

degree of algeosity that we experience. Similarly, for pain modulation through

hypnosis, we could explain that people find the same stimulus as more or less

unpleasant because they represent it as better or worse, but they represent it as such

because of what they believe. How susceptible they are to change the way they

represent their nociception rests upon how susceptible they are to hypnosis. In other

words, how susceptible they are to modify their high-level representation of such

stimuli as good or bad for them.

Lastly, in the case of the nocebo and placebo effects, we could explain something

similar. This kind of modulation clearly has nothing to do with a modification in the

evaluative low-level. That main difference between taking a placebo and a real

painkiller is that we think that both are going to take our pain away but only one has the

capacity to directly affect our body mechanisms. In the experiments previously

discussed, the fact that people believe that a cream will change their degree of

unpleasantness is what renders their nociception more or less unpleasant.

  44  

3. So, can anybody like it?

Yes, anybody can like pain. However, not everyone likes pain. That is to say, even if we

usually represent nociception as bad, this does not mean that nociception is necessarily

unpleasant. The exact same stimuli can be represented in different ways. There are good

evolutionary reasons why nociception is most of the time represented as bad, which

explains our usual avoidance behavior. Nonetheless, we can change the way we

represent nociception.

Interestingly, the changes in our evaluative representations can work in both directions,

not only can things change their degree of unpleasantness but also of pleasantness.

People, in principle, are capable of representing nociception as good. Pain cognitive

modulation is an example of how changes in our high-level evaluative representations

result in changes in the degree of algeosity. For masochism, this modulation goes

further: people represent their nociception as high-level hedonistic. So, as long as

someone is capable of representing their nociception as hedonistic, that person would

have motivations to seek for it, and would be a masochist.

  45  

Conclusion

The main purpose of this research was to make sense of masochists’ seek for pain.

Since we usually avoid unpleasant things and seek for pleasant ones, and given that pain

is conceived as paradigmatically unpleasant, it seems odd that someone engages in

painful activities just for the pleasure of it. In other words, if pain is unpleasant, it seems

to be nonsense to desire pain as an end. In order to figure out this puzzle I decompose

the discussion into three parts.

In the first part, I clarified why we think that pain is problematic for masochism and

why masochism is different from other controversial pain cases. I analyzed two

different ways in which we could explain that pain is not really a problem for

masochism:

1) Based on the analysis on the medical definitions, pain and masochism are not

necessarily contradictory. On the one hand, according to medical explanations of pain,

we could explain that masochists have the same descriptive experience of pain and a

positive evaluation; however, these theories do no explain how such evaluation may

become positive. On the other hand, strictly according to the medical definitions of

masochism, someone can be a masochist and have a completely normal interaction with

pain; nevertheless, this still leaves unexplained why some masochists could have such

odd interaction with pain.

2) The second possible way to answer is by claiming that pain is only a means for a

valuable end. Namely, pain in masochism is somehow similar to receiving a painful

antidote in order to feel better when we are sick or to be part of a painful ritual initiation

that will give us access to a higher social status. However, in contrast to these situations

in which pain is an unpleasant means for a valuable end, pain in masochism cannot be

clearly dissociated into means and end. Masochism is a situation were people find

pleasure in a sensation that is usually unpleasant. Masochists may pursue pain as an

end.

In the second part, using an evaluativist approach to explain the unpleasantness of pain,

I offered an equivalent theory of pleasantness. This theory broadly postulates that in the

  46  

same way that we avoid pain because we represent it as something bad in the bodily

sense, we tend to seek for pleasant sensations because there are stimuli that we represent

as good in the bodily sense. I propose a model that incorporates i) the medical models of

pain, where pain is understood as composed of different levels of processing, ii) the

philosophical discussion concerning the unpleasant nature of pain and our usual

tendency to avoid it, and iii) a theory of sensations that includes the spectrum varying

from unpleasant to pleasant phenomena. This model proposes that the phenomenology

of sensations is dependent on three dimensions: 1) the purely descriptive sensorial

dimension; 2) a low-level evaluative dimension, which represents stimuli as good or

bad in the bodily sense; and 3) high-level evaluative dimension, which represents

stimuli as good or bad in the psychological sense. Finally, I claim, masochists are able

to find pleasure in pain in the sense that their nociception is represented as positive, and

therefore pleasant, mainly in the high-level evaluative dimension.

Finally, in the third part, I used such model to concretely account for masochism and

give a coherent organization and predictions to several normal and pathological cases of

pain. Cases of masochism in which people seek for pain as an end could be explained

in the following way: 1) their sensorial descriptive level works adequately, which

explains why they can detect cuts and burns normally; 2) their low-level evaluative

dimension represent the stimuli as bad in the bodily sense, although it can be attenuated,

e.g., by conditioning; and 3) their high level evaluative dimension represents the stimuli

as good, which explains masochists’ behavior to seek for cuts and burns. In other

words, masochists may seek pain as an end in the sense that the same descriptive

sensation associated with pain can be, as a whole, evaluated as good and, therefore,

pleasant. In addition, this is coherent with many studies that report that pain can be

modulated by our cognition. That is, the fact that we cognitively represent stimuli as

good or bad does alter how it feels and how we react to it.

  47  

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