What Pain Asymbolia Really Shows

Pain asymbolics feel pain, but act as if they are indifferent to it. Nikola Grahek argues that such patients present a clear counterexample to motivationalism about pain. I argue that Grahek has mischaracterised pain asymbolia. Properly understood, asymbolics have lost a general capacity to care about their bodily integrity. Asymbolics’ indifference to pain thus does not show something about the intrinsic nature of pain; it shows something about the relationship between pains and subjects, and how that relationship might break down. I explore the consequences of such a view for both motivationalism and the categorisation of pain asymbolia as a syndrome, arguing for a close link between asymbolia and various forms of depersonalisation. 1 Pain and Motivation Pains motivate us. Must they? Motivationalists about pain say yes: motivational force is an intrinsic property of pains. Many disagree. The debate can be shaped by empirical facts. Find someone who is entirely unmoved by pain, and motivationalism is threatened. Fail repeatedly to find such a case, and motivationalism gains credence. In a recent book, Nikola Grahek (2007) presents an apparent counterexample to motivationalism. This is the strange case of pain asymbolia. Pain asymbolia is a rare condition caused by lesions to the posterior insula (Berthier et al. 1988). Asymbolics say that they feel pain, but they are strikingly indifferent to it. In the first reported case, Schilder and Stengel note that: The patient displays a striking behaviour in the presence of pain. She reacts either not at all or insufficiently to being pricked, struck with hard objects, and pinched. She never pulls her arm back energetically or with strength. She never turns the torso away or withdraws with the body as a whole. She never attempts to avoid the investigator. (Schilder and Stengel 1928, p. 147) Quotations from Schilder and Stengel 1928 are the author’s own translation from the original German. Special thanks to Aleks Zarnitsyn and Mae Liou for their help with the translation.