The International Association for the Study of Pain (IASP) Committee for Taxonomy defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. They further state that ‘pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life’ (Merskey, 1994).

This definition states that the employment of the word ‘pain’ needs to be learned through experiences in early life: a child has hurt himself and cries; and then adults talk to him and teach him the use (meaning) of ‘pain’. Wittgenstein (1958b) suggests that the child is trained to substitute its primitive, natural expressive pain-behavior first with exclamations and later with sentences such as ‘I have a stomach-ache’. There are other possibilities. One might point at someone who is manifestly in pain and say, ‘There: that is what it is to be in pain’, or That is pain’ (see Wittgenstein, 1958b, §290). On the other hand, it appears that the perception of pain is an intrinsic feature of life itself, is manifested in all living organisms, and while subject to influence by life experiences, does not require previous experience in the first instance. The first experience of tissue injury is painful, in much the same way that touch, smell, vision, or hearing need not be learned in order to occur in the human being. Infants from 25 weeks gestation show a characteristic pain face consisting of eyes squeezed shut, brows lowered, deepening of the nasolabial furrow, open lips, with mouth stretched vertically and horizontally (Craig et al. 1993; Stevens et al., 1994).

The meaning of these sensations, however, will develop with experience through positive, negative, and contextual associations (Anand & Craig, 1996). In other words, learning cannot be separated from the behaving organism: ‘Only of living human being and what resembles (behaves like) a living human being can one say: it has sensations, it sees, is blind; is deaf; is conscious or unconscious’ (Wittgenstein, 1958, §218). As the person develops, so do its behavioral repertoire and the qualitative features of its subjective experiences. As characteristic features of the behaving organism, learning is incorporated into experience as components of a ‘form of life’ (Sullivan, 2001).

An adult, for example, can pretend to be in pain without saying a word, merely by facial expressions, torso movements, or paralinguistic qualities of speech (Wittgenstein, 1982, §944). But for these apparently simple behaviors to constitute pretence presupposes complex motives, intentions (e.g. the intention to deceive), as well as a complicated play of expressions (i.e. numerous nonverbal actions). Can one imagine a new-born child with the play of facial expressions and expressive-behavior of an adult? A new-born child cannot be insincere, but neither can he be sincere. To dissimulate pain, he must first learn to mimic and to intend to mimic (Wittgenstein, 1958b).

Available empirical evidence suggests that by the age of four children are able to use techniques to dissemble non-painful subjective states. This suggests that they may succeed in misrepresenting expressions of pain (Larochette et al., 2006). Cases of illness falsification have been reported in children as young as 8 years (Libow, 2000). Children report that their most common reason for using deception, especially to conceal physical pain in front of their peers, is a fear of negative consequences, and that controlling facial behavior is the most common method of regulating expressions of emotion (Zeman & Garber, 1996). This suggests that a child learns to dissimulate pain only in the course of learning the complicated interpersonal use of ‘having pain’ (Wittgenstein, 1982). He must learn not only ‘He has a pain’, but also ‘I think (believe) he has a pain’ and ‘He thinks I have a pain’ (Wittgenstein, 1980a).

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