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The power of the NYT, the meaning of “pain is an opinion,” and much ado about nothing

 •  • by Paul Ingraham
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.
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Austin Frakt’s NYT article that I was quoted in last week made an impressive splash, like a cannonball in the wading pool of my career. has a large enough audience that I am used to having a dollop of internet “fame” to keep me warm on long Canadian winter nights, but I have always been aware that mainstream media audiences are on another level.

I am in awe of the power of that publication. Even though I was only briefly quoted — and not exactly on the front page — the impact was substantial:

And much of that buzz was an angry buzz, so I’d like to state for the record that I think it was quite a good article (especially relative to other mainstream press coverage of chronic pain). And I want to address two concerns that kept cropping up all week long

“Pain is an opinion” simply does not mean what many readers feared

That phrase was a magnet for misunderstanding. It’s extracted from a longer, famous quote that provides critical context:

Pain is an opinion on the organism’s state of health rather than a mere reflexive response to an injury. There is no direct hotline from pain receptors to ‘pain centers’ in the brain. There is so much interaction between different brain centers, like those concerned with vision and touch, that even the mere visual appearance of an opening fist can actually feed all the way back into the patient’s motor and touch pathways, allowing him to feel the fist opening, thereby killing an illusory pain in a nonexistent hand.

Phantoms in the brain, by VS Ramachandran and Sandra Blakeslee

But even the full quote doesn’t provide enough context on its own. I wrote about it in detail years ago, because it’s an articulate expression of one of the pillars of the science of pain, nuanced and complex.

It is not about malingering and psychosomatic pain. It is not a dismissal of the validity of chronic pain for millions of people. But that is all that a great many readers could see, unfortunately. They saw what they feared. They defensively misintepreted “pain is an opinion” to mean “pain is all in your head,” and the extensive comments on the post are littered with outraged declarations that “my pain is not an ‘opinion’!”

Well, of course it is not. But that’s not what the phrase has ever meant. It does not mean pain is an attitude problem, and it doesn’t mean that you or anyone can “think it away.” I know Austin Frakt doesn’t think that, and I certainly don’t think that. No one reasonable or educated on the topic of chronic pain thinks that.

And, frankly, no one who read the article should be confused about it either! I suspect about half the outrage is based on reading only the title, and the other half on not reading the article carefully enough. You suck, social media!

Austin tells me he doesn’t read comments, ever. Wise man.

Metaphor madness! Brains can’t have opinions!

Naturally brains do not literally have “opinions” about anything. It’s a metaphor. It’s figuratively true, not a factual facty-fact facterton. Opinions are obviously something a person has, something that a mind does… not a 1.5kg neuron pudding.

But a couple of critics expressed bitter philosophical objections to this metaphor. They are ticked off by the idea that a brain can have an “opinion.” They think it’s a terrible mistake, a dire example of the “mereological fallacy,” which is the conflation of a part of something (brain) with the whole (person). Some of their comments were comically overheated. For instance, one of them wrote, “The damage has been done and unless those quoted retract their views, the fallout across the world will be incalculable.”

Now there’s a brain that has too high an opinion of its own opinion. Such hyperbole is a much greater departure from reasonableness than any instance of the mereological fallacy… which is arguably not even a fallacy at all, let alone a serious one. Todd Hargrove saved me the trouble of making that argument myself, explaining that the cries of “mereological fallacy!” are much ado about nothing, and “‘Philosophers do not agree that it is a fallacy to make statements like ‘the brain thinks’ or ‘the brain decides.’”

See also Todd’s excellent article, “The Intentional Stance,” for a deeper dive. It’s basically an argument for writing the way I do about these things, so of course my brain is “in love” with it.

Metaphor and analogy are useful thinking tools, especially in an educational context. It’s not realistic to try to ban them for doing their actual job: reflecting reality imperfectly, but in interesting and informative ways. A reality that, when it comes to pain and neuroscience, we have barely begun to even understand. Schaal concluded much the same in 2005 (writing specifically about the mereological fallacy in neuroscience):

it may be the ability of metaphors and analogies to help researchers accomplish their theoretical goals, and not how well they stand up to connective analysis relative to their conventional counterparts, that is the better basis for approving or disapproving of them.

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