THE BEHAVIORAL AND BRAIN SCIENCES 1985) 8, 43-83

Printed in the United States of America

Pain and behavior

Howard Rachlin
Department of Psychology, Sta.o University of New York at Stony Brook,
Stony Brook, N.Y. 11794

Abstract: There seem to be two kinds of pain: fundamental "sensory" pain, the intensity of which is a direct function of the intensity of
various pain stimuli, and "psychological" pain, the intensity of which is highly modifiable by such factors as hypnotism, placebos, and
the sociocultural setting in which the stimulus occurs.
Physiological, cognitive, and behavioral theories of pain each have their own view of the nature of the two kinds of pain. According
to physiological theory and cognitive theory, "psychological" pain and "sensory" pain are both internal processes, with the former
influencing the latter as central processes influence peripheral processes. According to behavioral theory, "sensory" pain is a reflex (a
respondent) while "psychological" pain is an instrumental act (an operant). Behavioral theory claims that neither kind of pain is an
internal process - that both are overt behaviors.
Although both physiological theory and cognitive theory agree with common sense that pain is internal, they disagree with
commonsense intuitions at other points. They are no better at explaining the subjective experience of pain than is behavioral theory.
They have not generated treatments for pain that are superior to those generated by behavioral theory. There is no basis for the
frequent claim by antibehaviorist philosophers and psychologists that behaviorism, because it cannot explain pain, is less capable of
explaining mental phenomena than physiology or cognition.
Keywords: behavioral psychology; cognitive psychology; mental events; operant psychology; pain; physiological psychology;
psychophysics

The purpose of this paper is to describe three theoretical

approaches to the study of pain - physiological, cognitive
and behavioral - and to evaluate each theoretical approach in terms of its conformity with experimental
observation, the effectiveness of clinical treatment developed from it, and its position in the current philosophical
debate about pain.
Modifiability of pain

One aspect of pain that all theories have to account for is

its modifiability by "psychological" factors. This was
made clear by Beecher's (1956) classic observations of
soldiers' responses to their wounds at Anzio during World
War II. The soldiers were not in severe pain, and most of
them did not request narcotics even though they were
available. Beecher contrasted this behavior with that of
civilian hospital patients who had similar wounds. The
civilians were in severe pain, and most of them did
request narcotics.
The painfulness of a stimulus can be increased or
decreased over wide ranges by such factors as placebos
(McGlashen, Evans & Orne 1969), hypnosis (Hilgard &
Hilgard 1975), acupuncture (Melzack 1973a), and sociocultural factors (Tursky & Sternbach 1967). These
factors are often so strong that they completely override
the presence or absence of normally painful stimuli: "It
can be said with certainty that psychological factors quite
often cause pain and frequently augment its severity.
They may also serve to abate or abolish it even in the
presence of extensive trauma" (Mersky 1968). In the
treatment of severe pain the success of hypnotism (Hilgard & Hilgard 1975) has been as good as or better than
1985 Cambridge University Press

0140-525X185/010043-41 IS06.00

the success of surgery (Melzack 1973b) - and this seems

even more true with respect to lasting than to temporary
success!
While it is clear that pain is highly modifiable by
various "psychological" factors, pain is not normally eliminated by those factors. Beecher's soldiers, for instance,
did not report that their pain had disappeared. Most
soldiers do feel pain, and athletes with injuries often
claim that they play despite pain, not without pain. In
these instances people commonly say that the pain exists
but does not bother them. For instance, Hilgard and
Hilgard (1975) report a "hidden observer" within subjects
hypnotized to be analgesic. One subject said that "while
her hypnotized self had felt no pain, the hidden part had
felt pain of about the same sensory intensity as that
produced by the cold water [her arm had been submerged in ice water] without hypnosis. However, the
covert pain bothered her much less - at this hidden level
within analgesia - than overt pain bothered her in the
normal waking state. " Thus, there seem to be at least two
components of pain: "sensory" pain, which is a response
to a given stimulus and is relieved by the removal of that
stimulus, and "psychological"' pain, which can be modified by external contextual events such as war or an
intense sport. Certain procedures, like hypnotism, seem
able to alter "psychological" pain (the aversiveness) but
leave the underlying pain (the sensation) unaffected. It is
not clear at the present time whether narcotic drugs
(morphine, for instance) affect one component of pain or
another or both.
Reports of the effect on pain of narcotics, biofeedback,
acupuncture, and other treatments often follow this pattern - that the pain is there, is intense, but is not
aversive. Stories of Lawrence of Arabia, G. Gordon
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Kachlin: Pain and behavior

Liddy, Buddhist monks, and others training themselves
to endure pain all seem to emphasize the separation of
pain as a sensation (which remains) and pain as an aversive, terrible thing (which has somehow vanished). Turk,
Meichenbaum, and Genest (1983) quote Freud's description of the cancer in his jaw as "a little island of pain
floating in a sea of indifference."
The word "psychological" is in quotes because "psychological" is used often in opposition to "physiological"
or "behavioral," and no such opposition is intended here.
Each of the three theories of pain to be considered physiological, cognitive, and behavioral - has, in its
modern form, an explanation of both components of pain,
and each explains both components wholly within its own
terms. A physiological theory of pain contains a physiological explanation of both "psychological" pain and "sensory" pain; cognitive theory has a cognitive explanation of
both components of pain, as does behavioral theory.
Another reason for putting "psychological" in quotes is
to deny its opposition to "real." "Psychological" (aversive) pain is no less real and may be much more important
in pain treatment than "sensory" pain. It is by its aversiveness, not by its sensory quality, that pain causes
disability. Development of a treatment by which the
millions of chronic pain sufferers could view their pain as
an island in a sea of indifference would be a vast step in
pain treatment, a step that will be more difficult to take as
long as "psychological" pain is seen as false pain.
Psychophysics of pain
The separation of aversive and sensory pain is reflected in
the words that people use to describe it. The most
commonly used pain assessment technique is the McGill
pain questionnaire developed by Melzack and his coworkers (described in Melzack 1983). A similar questionnaire that uses somewhat more sophisticated measurement techniques (ratio rather than interval scaling) has
been developed by Tursky, Jamner, and Friedman
(1982). They have shown that after identifying the quality
of pain with words such as "stinging," "grinding, "shooting," and "throbbing" there remain two separate sets of
words by which people describe the degree of their pain.
One set of words has to do with the intensity of the pain as
a sensation. In this set there are fourteen words ranging
from "just noticeable" through "mild," "uncomfortable,"
"strong," and "severe" to "excruciating" at the upper
end. Tursky et al. have found that people are capable of
assigning line lengths and numbers to these words that
are consistent from person to person and time to time.
Furthermore, the assignment of numbers, line lengths,
and the words themselves to various intensities of electric
shock is also consistent from person to person and time to
time. Thus a pain-intensity scale that ranges from a score
of 8 units for just noticeable pain to 227 units for excruciating pain has been formed.
The second scale of pain is called a reaction scale by
Tursky et al. The words in this scale range from "bearable" through "uncomfortable," "distressing," "awful,"
and "intolerable" to "agonizing" at the upper end. Numbers are assigned to the words in the reaction scale by the
same methods used with the intensity scale. The numbers of this scale range from 23 units for bearable pain to

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

153 units for agonizing pain. (As with any ratio scale, the
units of the intensity and reaction scales are arbitrary. It is
the ratio of the numbers rather than their absolute values
that provides the test for consistency.) While measures on
the intensity scale seem to remain constant across the
population of speakers of English, reaction measures
vary. For instance.. Blanchard, Andrasik, Arena, and
Teders (n.d.) found that while migraine headache sufferers did not differ from nonsufferers in the numbers
they assigned to words of the intensity scale, they did
differ in the numbers they assigned to words of the
reaction scale, assigning proportionately higher numbers
than normal to the higher words. Similarly, Elmore
(1979) found that biofeedback treatment for pain altered
patients' reaction measures (proportionately reducing the
numbers assigned to the higher words) while leaving
their intensity measures constant. Tursky et al. (1982)
found the same result with a combination of behavioral
and cognitive treatments of chronic pain sufferers. They
also found that morphine altered reaction measures while
leaving intensity measures constant but that aspirin altered both intensity and reaction measures. The intensity
and reaction scales are separable and seem to correspond
to the two components of pain discussed previously. The
intensity scale seems to measure the sensory component
of pain, while the reaction scale seems to measure the
more malleable, aversive, "psychological" component of
pain. Whether this convenient division of words will hold
up under future psychophysical research is still far from
certain, however.
Assuming that Tursky et al.'s division of words into
intensity and reaction scales is valid, the object of clinical
treatment would be to vary the reactive component of
pain under conditions where the intensity component is
difficult or impossible to vary. If the intensity component
is seen as a measure of the pain stimulus itself (the "island
of pain"), then the object becomes to vary the reactive
component (the "sea of indifference"). Each of the three
different theories of pain that we will consider - physiological, cognitive, and behavioral - provides a different
perspective on the nature of the reactive component.

Physiological theory and treatment

Pain does not seem to be a simple sensation. Aristotolc
classified pain, not among the five primary senses, but as
a passion of the soul that resulted from sensation. According to Aristotle, if a pattern of sensation is out of harmony
with a person's psyche it will cause pain, hence the desire
to avoid the source of the sensation. Thus, Arisotle
emphasized the aversive "psychological" component of
pain. The discovery early in this century of various kinds
of sensory receptors in the skin led to considering pain a
simple sensation. Pain is identified as the sensation resulting from patterns of stimulation of the free nerve
endings (Dallenbach 1939).
One problem with this viewpoint is stated by Melzack
and Wall (1970): "To call a receptor a pain receptor . . . is
a psychological assumption: it implies a direct connection
from the receptor to a brain center where pain is felt, so
that stimulation of the receptor must always elicit pain
and only the sensation of pain. The facts of physiological
specialization provide the power of specificity theory

Rachlin: Pain and behavior

[that pain is a specific sensation]; its psychological assumption is its weakness. '
Melzack and Wall (1965) proposed an alternative that
they call a "gate" theory, according to which pain is a
perception rather than a sensation. That is, there exists an
identifiable sensation of pain, but it is rarely, if ever,
purely felt. Rather, it is modified by input from various
other sources. Gate theory and other current physiological theories of pain consist essentially of a hypothetical
mechanism by which the modification occurs. Gate theory says that large and small cutaneous fibers interact at an
early stage in the nervous system, at "gate cells" in the
spinal cord, which in turn regulate the transmission of
pain to both the motivational and the sensory systems.
According to the theory, these gate cells themselves are
influenced by central processes. There is no need to
describe the physiological details of the gate control
theory here because the current consensus seems to be
that, in its physiological details, it is probably incorrect
(Kelly 1981). The theory is nevertheless important because it "reversed the historical research emphasis upon
pain as solely an afferent sensory experience." Kelly adds,
"Pain also disrupts ongoing behavior, demands immediate attention, and serves as a primary negative reinforcer
in a variety of situations. It suppresses behavior when
made contingent upon it and supports a broad repertoire
of avoidance and escape responses. To emphasize only
the sensory features of pain in the study of its neural bases
and to ignore its unique affective and motivational properties is to confront only part of the problem."
The MelzackWall theory, by its postulation of the
interaction of large and small neurons at a relatively
peripheral level, implies that pain can be inhibited at that
level by touch. Stimulation of large-diameter fibers
(touch) can, according to the theory, close the gate. This
feature of gate control theory has provided some physiological support for acupuncture as a clinical technique and
has given rise to some treatments by which cutaneous
electrical stimulation near the site of the pain have successfully inhibited the pain. But the success of acupuncture at sites far removed from the pain and the
success of electrical stimulation on at least one occasion
when a patient forgot to hook up his battery (Kelly 1981)
indicate that pain inhibition by cutaneous stimulation can
also occur at a more central level. How the central process
might work is still unknown.
More recent physiological theory centers around the
action of opiates. Opiate receptors have been discovered
on neurons distributed throughout the brain, including
the midbrain. Chemical stimulation of the latter site with
morphine results in analgesia. It has also been discovered
that certain substances with pharmacological properties
that resemble those of morphine are produced in the
nervous system and that these substances cause analgesia, among other effects, when they are released. Some
of these naturally occurring substances, called endorphins, are much more potent than morphine. This has
given rise to the hope that the administration of endorphins to pain sufferers would alleviate pain without
the problems associated with morphine. "Unfortunately," according to Kelly, "chronic administration of (3endorphin produces progressively weaker analgesic effects (tolerance) and also gives rise to withdrawal signs
comparable to those of morphine (dependence)." 1

The status of surgery in the relief of pain is summarized

by comments of Weisenberg (1975): "No matter what
technique is used, the percentage of failures is significant. . . . Surgery must be done over a large area to
produce longer-lasting pain relief. However, the larger
the area cut, the more other functions, such as bladder
control and strength in walking, tend to be lost. . . .
Frontal lobotomy or leucotomy abolishes the aversive
feelings associated with pain. That is, the patient feels the
pain, but it does not bother him. [But!] The major
problem associated with this type of surgery is the change
in personality - the patient can become an emotional
vegetable."
In summary, physiological theory and treatments
based on it need to address themselves to the strong
"psychological" or, in physiological terms, the strong
"central" influence on pain. "Psychological" pain can
occur with no apparent stimulus whatsoever. The promise of physiology is that when the factors (in the environment) that normally control "psychological" pain are
discovered it may be possible to bypass those factors and
produce analgesia directly, selectively, nonaddictively,
and without side effects.

Cognitive theory and treatment

Before discussing cognitive theories and treatments of
pain it is necessary, because of the current state of flux in
cognitive psychology, to define cognitive theory. We will
consider any theory cognitive that is physiologically noncommittal and postulates functional elements inside the
organism mediating between environment and behavior.
By this definition, Melzack and Wall's (1970) conceptual
model of pain is a cognitive theory. The fact that some
elements of this model are presently reducible to physiological mechanisms and that all elements of the model are
potentially reducible to physiological mechanisms is not
an unusual feature of cognitive theories. 2 Another, much
more complicated, cognitive theory of pain was proposed
(perhaps not seriously) by the philosopher Daniel Dennett (1978).3 In Dennett's model the Melzaek-Wall gate
is just one internal element, interacting with such other
elements as "ratiocination," "belief," "desire, " "reticular
formation," "perceptual analysis," and many more. Unfortunately, except for the physiological research and the
treatment based on the physiological aspects of Melzack
and Wall's theory, these cognitive theories of pain have
not been tested by experiments, nor has any treatment
been devised on their basis.
Both research and treatment, however, have been
based on simpler but unformulated cognitive models.
One simple model assumes that "psychological" pain may
be mediated by imagery so that certain images will
attenuate pain while other images will magnify it (Turk,
Meichenbaum & Genest 1983). Subjects are asked to
practice creating images, for instance, "imagining the
affected area's being numbed with Novocain or seeing
oneself as a television character such as the Six Million
Dollar Man or the Bionic Woman, with mechanical limbs
insensitive to pain." According to the theory, images may
work directly on pain, as with the Bionic Woman technique, or indirectly through a mechanism of attention, as
when the patient is told to imagine a pleasant day at the
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Rachlin: Pain and behavior

beach or attending a party. In either case, pain therapy
based on images has not been successful as a treatment by
itself. Turk et al. (1983), after a careful analysis of extant
laboratory studies, concluded, "The data . . . do not
convincingly establish the efficacy of any cognitive coping
strategy relative to the strategies that subjects bring to
experiments, nor is there sufficient evidence to support
the use of any one strategy compared to any other."
According to Turk et al., results of clinical studies with
imagery have been more positive than results of laboratory studies, but the problem with clinical studies is that in
the clinic treatments based on physiological and behavioral theories are often used in conjunction with cognitive
techniques, so when pain is reduced it is not clear which
treatment or which combination of treatments was
effective.
Even if treatments based on imagery were shown to be
ineffective, imagery and pain may still interact. It may be
that certain images reduce pain but that current techniques of imagery training do not work. A frequently used
method is first to teach subjects relaxation techniques and
then to suggest the images to the relaxed subject, but
there is no evidence that the imagery treatment has any
effect beyond whatever reduction of pain is due to relaxation itself.
Some evidence that cognitions (images or not) play a
role in pain tolerance comes from studies reported by
Turk et al. (1983) in which female subjects immersed
their arms in ice-cold water:
The subjects naturally clustered into two clear groups
according to their tolerance time. In each sample . . .
the distribution tends to be bimodal, with tolerances
generally either less than 100 seconds or approximately
300 seconds (the ceiling employed by the experimenters). . . . Those in the high-tolerance group seemed to
feel that they could use [imagery] strategies to affect
both the pain and their power to persevere despite the
pain, whereas those in the low-tolerance group used
strategies with less conviction of their usefulness and
with less sense of their own ability to influence their
situation other than by removing their hands from the
water.
Another cognitive treatment for pain in common use is
called cognitive restructuring. Cognitive restructuring is
directed not at a person's images but at a person's beliefs.
Beliefs are said to mediate between a painful stimulus and
a response. Turk et al. identify a large proportion of nonpain-tolerant subjects as "catastrophizers. ' Citing the
results of a study in which dental patients described their
feelings, they say:
Catastrophizing took several forms, including negative
self-statements regarding their competence, anxietyarousing thoughts, and extremely aversive images. To
illustrate, one patient stated, "How I hated it. I hate
having injections. I think, 'Oh, no, here we go again.' I
hate it with a passion. Just to see that great big needle
coming down at you, the next thing you know you start
going bananas. I just can't hack it."
On the other hand, one of the pain-tolerant arm-immersion subjects described her thoughts this way:
I sat here and thought, "This isn't happening to me. I'm
somewhere else. It's not my arm; it's just an arm sitting
in the water. I can go on as long as this has to go on.
". . . Every time I was ready to give up I thought, "No,
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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

it's not killing me because it's not my arm. It's just an

arm in the water."
This report, like reports of hypnotized subjects, describes a dissociation between the person and the pain.
Such subjects, one guesses, would describe their pain
with words high on the intensity scale but low on the
reaction scale, for instance, severe (132) but tolerable
(23).
The essence of cognitive theory is that images and
beliefs can be changed directly. Currently there exist no
explicit cognitive methods of instilling images or beliefs
except telling the subject what to imagine or what to
believe. But there is no evidence that telling a person
what to believe will change that person's beliefs. It
therefore behooves the cognitive theorist to develop
methods by which cognitive units may be manipulated.
In other words, more attention must be paid to the input
and output of cognitive mechanisms before the cognitive
units in the middle can be meaningful. There is currently
a wide chasm between cognitive theory of pain and
cognitive therapy for pain.
The current state of cognitive theory with regard to
pain is that images and beliefs are said to mediate between painful stimuli and the aversiveness of pain. The
fact that pain tolerance seems to go along with certain
images and certain beliefs is some evidence for such
mediation. But there is as yet no way to tell whether
images and beliefs mediate between the environment
and pain tolerance, whether they are the result rather
than the cause of pain tolerance, or whether they are the
result of some other set of events that also, independently, causes pain tolerance. What those other events might
be is suggested by the behavioral theory of pain, to which
we turn next.4

Behavioral theory and treatment

The current behavioral model of pain, like the imagerybased and belief-based cognitive models, has arisen from
clinical practice. Wilbert E. Fordyce (1976) has developed a behavioral treatment for chronic pain that, according to Turk et al. s (1983) analysis of outcome studies, is at
least as successful as any other treatment and more
successful than most others. In the effort to explain and
rationalize the treatment he has developed, Fordyce
(1978) presents what is essentially the only extant behavioral theory of pain. It identifies "sensory" pain with
respondent behavior and "psychological" pain with operant behavior. The theory has wide implications for psychology. To understand those implications it is necessary,
first, to distinguish behavioral theories in general from
physiological and cognitive theories; second, to understand the difference between operant and respondent
behavior; and third, to understand the relation between
operants and respondents. We will take up these three
questions as they apply to behavior in general and as they
apply to pain.
The essential difference between modern behavioral
theories and cognitive or physiological theories is that,
according to behavioral theories, whatever actions an
organism takes are actions of the whole organism. For
instance, a rat's bar press is considered to be an action of
the whole rat, not its paw or its nervous system or some

Rachlin: Pain and behavior

functionally defined internal mechanism. Otherwise behavioral theory becomes indistinguishable from physiological or cognitive theory.
Of course, it is still possible to redefine "the whole
organism" as something other than the organs enclosed
within the skin. One might consider an artificial arm as
part of a person, or a diseased tooth or a cancer as a
stimulus to, rather than part of, the person. Whether
such behavioral laws as have been discovered apply
under one or another redefinition is an empirical question; behaviorism is nonetheless distinguishable from
cognitive and physiological theory by its confinement in
theory and practice to overt behavior of whole
organisms.5
Recent criticisms of behaviorism (for instance, Savin
1980) have claimed that this confinement to overt, wholeorganism responses prevents behavioral theory from explaining the very processes of most interest to psychology
- people's mental lives. In philosophical arguments
against behaviorism, "pain" has often been used as an
example of a mental term not amenable to behavioral
analysis. Thus, the explanatory power of Fordyce's theory
and its clinical usefulness are important issues for psychology.
In his discussion of stimulus and response as generic
concepts Skinner (1935) defined a reflex in behavioral as
opposed to physiological terms as a certain relationship
between a set of environmental events and a set of
behavioral events; for instance, the intensity or rate of the
stimulus is related by certain sets of functions to the
intensity or rate of the response. Each set of environmental and behavioral events, related to each other in these
ways, was considered a single reflex, regardless of anatomical connections. A response that was part of a reflex
could be controlled by manipulation of its stimulus.
Pavlov's (1927) classical conditioning could, with more or
less difficulty, describe the alteration of these reflexes.
Unlike Pavlov, however, Skinner (1938) believed that not
all behavior was reflexive in this way. He distinguished
between this kind of reflex, which he called a respondent,
and another kind of reflex, which he called an operant.
Just as it might be said that a given respondent is defined
in terms of the environmental events that precede it, a
given operant is defined in terms of environmental events
that follow it. Like the definition of "respondent," the
definition of "operant" was generic, not anatomical, and it
was behavioral in the sense that an operant was considered to be behavior of the whole organism.
According to Skinner, the environmental events that
define respondents occur just prior to behavior while the
environmental events that define operants occur just
subsequent to behavior. Thus, for Skinner (1938), temporal contiguity was not only important in respondent
and operant conditioning but a crucial element of the
definition of respondents and operants themselves. Current behavioral theory (Baum 1973; Catania 1971; Gibbon, Berryman & Thompson 1974; Herrnstein 1970;
Maier, Seligman & Solomon 1969; Rachlin 1976; 1978;
Rescorla 1967; Staddon 1973; 1980) differs from Skinner
with respect to the role played by temporal contiguity.
While temporal contiguity is unquestionably important
in operant and respondent conditioning, it is not now
generally considered a necessary part of the definition of a
response. Post-Skinnerian behaviorism defines a re-

spondent or operant in terms of temporal correlation

rather than temporal contiguity between environment
and behavior. In this sense current behavioral theory is
more molar than Skinnerian theory. (For a molar behavioral theory, fundamental processes can occur only over
some significant temporal interval.)
Correlated events may be separated in time. At the
extreme, events of a person's early childhood may correlate with or form a part of the same behavioral pattern as
events of that person's adult life. Although indisputably
there are mechanisms in the nervous system that bridge
the earlier and later events - mechanisms that may be
describable in physiological or cognitive terms - modern
(molar) behaviorism is concerned only with the correlations themselves. These correlations are the stuff of
behavioral laws. It is by widening the scope of the search
for correlative relationships among environmental events
and overt behavior further and further back into the past
(rather than deeper and deeper into the person) that
modern behaviorism hopes to explain people's mental
lives. For example, the difference between a person with
self-control and a person without self-control is seen by
behavioral theory, not in terms of the operation of internal physiological or cognitive mechanisms, but in terms of
the temporal extent of the environmental variables that
control behavior. The difference between an overweight
person who accepts a sandwich offered between meals
and an overweight person similarly tempted who refuses
that sandwich is seen by behavioral theory as a difference
between a person whose behavior was controlled, in that
instance, by immediate reward and a person whose behavior was controlled, in that instance, by rewards more
distant in time. 6
Fordyce (1978) considers operant pain to have evolved
from respondent pain. At first pain is correlated with
some antecedent stimulus (a wound, for instance). As
long as the correlation is in effect, the pain is respondent
behavior. But then, according to Fordyce, "If the chronic
pain problem, and the person who has it, exists in an
environment which indeed delivers effective pain contingent reinforcement, a problem of operant pain may
evolve." Here Fordyce is discussing how a particular case
of chronic pain may evolve from a particular case of acute
pain. But this theory of pain evolution may be extended to
pain in general. An infant's crying may at first be entirely
dependent on specific stimuli. For an infant, the specificity theory of pain may be essentially correct. But an
infant's crying almost always has immediate consequences in terms of parental care and attention, and there
is considerable evidence (Etzel & Gewirtz 1967) that
these consequences, in turn, affect the frequency and
nature of an infant's cries. According to Teitelbaum
(1977), the action of the higher levels of the brain involved
in development (and in recovery from brain damage)
accompany the development of operant behavior from
initial respondent behavior. Even the most prototypical
operant response, a pigeon's key peck, has respondent
components, in the sense that the nature of the key peck
depends partly on its antecedents and partly on its consequences. And this is true with regard to both the topography of the individual key peck and the pattern of pecking
over time (Schwartz & Gamzu 1977).
According to Fordyce, instances of pain in adults normally have both respondent and operant components.
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But chronic pain, where physiological causes are apparently absent, is operant pain that has, so to speak, lost its
moorings - has lost its respondent components. Treatment of chronic pain in Fordyce's clinic consists, first, of
discovering the immediate and distant reinforcers contingent on pain, second, either removing those reinforcers or breaking up their dependency on pain, and third,
reinforcing what Fordyce calls "well-behavior," behavior
incompatible with pain.
It is important to emphasize the behavioral rationalization of Fordyce's treatment: A person is exhibiting pain
behavior. We fail to find any stimulus (external or internal) causing this behavior. (We then call this pain "psychological" pain.) Our usual, intuitive supposition in this
situation is that, despite our failure to find a stimulus, an
internal stimulus does exist - the pain itself. Physiological
and cognitive definitions of "psychological" pain are theories about what sort of internal event the pain itself
corresponds to. Fordyce's supposition, suggested by behavioral theory, is that "psychological" pain is operant
behavior and thus there must have existed in the past
events contingent on this behavior that reinforced it. In
accordance with modern behavioristic practice, these
environmental events need not have been contiguous
with pain behavior but may have occurred at times distant
from a given instance of the behavior, so long as they were
correlated with the behavior. When one alters perspective and begins to look outside rather than into the
organism for the causes of "psychological" pain, it turns
out that they are not difficult to discover. The first and
most obvious consequence of pain is access to pain medication, particularly narcotics. Thus, Fordyce removes the
dependency of pain medication on pain behavior and puts
the medication on a strict time schedule; then he gradually reduces its strength. Another consequence of pain is
usually reduction of physical activity; so an exercise
program is instituted. Beyond this, reinforcement is
provided by family and friends in the form of attention
and concern. Often attention and concern habituate, so
that ever-increasing demonstrations of pain are necessary
to keep them going. A vicious circle develops within a
family that Fordyce's treatment endeavors to break. Fordyce also considers whether the dependency of the pain
sufferer on other family members is reinforcing for them
- that is, they may in some sense prefer the pain sufferer
to be in pain than to be well. Pain is also a way (albeit
extreme) to avoid social contact and social obligations.
Pain may be a way to avoid temptation of various kinds,
such as sexual temptation.
Fordyce's treatment (the details of which are given in
Fordyce 1976) sometimes gradually eliminates the reinforcer altogether, as with narcotic medication, but more
often attempts to help the patient obtain the reinforcer by
methods other than pain behavior while simultanously
maintaining and increasing reward contingent on well
behavior. These rewards are likely to differ from patient
to patient, so some sort of behavioral analysis is necessary
to fit the treatment to the patient's needs. The behavioral
analysis is, essentially, a search for the consequences of
pain. For all patients taken on by Fordyce, there has
already been a search for and treatment of the antecedents of the pain, but pain is still present. In other words,
Fordyce does not begin to treat operant pain until respondent pain has been treated.

48

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

The treatment also attempts to make the relation between behavior and its consequences more vivid. Because events correlated with pain behavior are often
temporally distant from the pain behavior itself, they may
support that behavior without the person's awareness
that they are doing so. A person is not usually unaware of
an individual instance of pain behavior but may be unaware of its frequency or intensity as perceived (and
reinforced) by others. Thus, Fordyce's treatment emphasizes record keeping, both of pain behavior itself and of
the rewards contingent on it.
As Turk et al. (1983) indicate, this procedure seems to
work. But, one may ask, what does it accomplish even
when successful? A chronic pain patient, initially disabled, who now works steadily and maintains a normal
social life may be said to do those things despite pain. But
one might consider the degree of normal activity itself the
best possible measure of the aversive, if not the sensory,
component of pain, and it is the aversive component, the
"psychological" component, at which Fordyce's treatment is aimed. It would be instructive to apply a psychophysical scaling procedure that attempts separately to
measure "sensory" and "psychological" aspects of pain in
Fordyce's patients before and after treatment. Unfortunately, this has not yet been done.
In summary, the clinical observation of two components of pain, "sensory" and "psychological," seems to be
captured by the intensity and reaction scales of pain
psychophysics. Any theory of pain (physiological, cognitive, or behavioral) must account in some way for this
dichotomy. Physiological and cognitive theories would
consider both components of pain to be the operation of
internal mechanisms, with sensory pain as a lower-level
or relatively peripheral process and "psychological" pain
a higher-level or relatively central process. Different
physiological and cognitive theories would hypothesize
different kinds of internal interaction between the two
levels of pain. Behavioral theory considers both sensory
and "psychological" pain to be overt behavior, with
sensory pain as respondent behavior and "psychological"
pain as operant behavior. For the physiologist or the
cognitivist (as well as the mentalist) a baby's crying is a
messenger, an ambassador, an indication, or a symptom
of pain. For the behaviorist, the crying (plus the kicking,
the facial expression, and other overt activities) is itself
the pain.

What is behind pain behavior?

Fordyce, quite wisely, ignores the question of the substrates of pain behavior because his main interest is in
treatment, not philosophical dispute; but the question is
worth considering here because it is exactly on this issue
that philosophers have claimed behaviorism to be invalid.
The point was put quite baldly (and personally) by Searle
(1980): "Are there no pains underlying Rachlin's pain
behavior? For my own case I must confess that there
unfortunately often are pains underlying my pain behavior, and I therefore conclude that Rachlin's form of
behaviorism is not generally true." Even Wittgenstein
(1958, p. 102) seems to reject the equation of pain and
behavior: " 'But you will surely admit that there is a
difference between pain-behavior accompanied by pain
and pain-behavior without any pain?' What greater dif-

Rachlin: Pain and behavior

fere nee could there be?" Some philosophers, I fear,
might be tempted to try to refute a behaviorist the way
Johnson supposedly refuted Berkeley - but by kicking
the behaviorist rather than the stone.
One interpretation of this antibehaviorist argument
would make it an antiphysiological and anticognitive
argument as well. According to this interpretation, pains
are fundamental mental events, purely subjective, personal "raw feels" that cannot be reduced to or explained
by anything else. Let us call this the "pure mentalist"
argument. Note that a physiological or cognitive theory
of pain has as much (or as little) trouble with the pure
mentalist argument as a behavioral theory. Searle (1980)
believes all mental events to be identifiable with physiological events in the brain. For him, pain is just a
physiological event. A pure mentalist might say to Searle,
"Are there no pains underlying the neural events in
Searle's cortex?" For my own case I must confess that
there unfortunately often are pains underlying my own
neural events, and I therefore conclude that Searle's form
of physiological reductionism is not generally true. Similarly (as Dennett himself anticipates), a pure mentalist
might say, "Are there no pains behind the operation of
your computer mechanism?"
There is, of course, no way to answer an argument that
asserts its truth as a fundamental axiom except to show
that another axiom might lead to more useful beliefs.
Thus, the best answer to the pure mentalist is the continued development of physiological, cognitive, and behavioral theories of pain.
Yet the pure mentalist cannot just be dismissed, because pure mentalism, at least as regards pain, is part of
the common sense of our time. It would be difficult, it
seems, for any psychological theory to try to alter a
fundamental common belief without showing why that
fundamental belief is so common. Thus, it is up to the
psychological theorist, of whatever orientation, not only
to provide a more useful alternative to pure mentalism
but also to explain why the pure mentalistic view of pain
has become a fundamental belief in the first place. We
leave it for the physiological and cognitive theorist to do
this in terms consistent with physiological and cognitive
theories and only attempt here to explain briefly, in
behavioristic terms, why the pure mentalist theory of
pain is so compelling.
For behavioral theory it is enough to show that a belief
is useful (to explain why it is generally held) and to show
why another theory, if adopted, would be still more
useful (to explain why the generally held theory should be
given up). In what way, then, is the pure mentalist view of
pain a useful one?
Pain functions in society much as a fire alarm does. It
commands instant attention. In a baseball game, a player
who falls, clutching himself, stops the game. Just as
firemen must respond even though there are always a
certain number of false alarms, people continue to respond to expressions of pain even though there may be no
discovered tissue damage. Our expressions themselves
take on standard forms within our society so as to ensure
that response. Pain behavior, whatever else it may be, is a
special kind of communication - like a fire alarm - that
demands a social response first and only allows questions
to be asked later. If a person claims to be in pain, that
person is normally allowed to be right, whether or not

tissue damage is ever found. Because pain as communication works best and quickest when we do not question
each other's pain, society gives each of us the right to
claim to be in pain regardless of any evidence to the
contrary. Thus pain is generally recognized to be a fundamental mental event, a purely subjective, personal "raw
feel" that cannot be reduced to or explained by anything
else. 7
From the behaviorist viewpoint, however, we do not
infer the privacy of another person's pain from the fact
that our own pain is private; we learn simultaneously
about the privacy of our pain and the pain of others. To say
a pain is private is, from this point of view, only to say that
each person in our society has the right to ask for attention
and help without being questioned about it. It is useful for
society to give its members that right, just as it is useful to
respond to fire alarms or to move out of the way of any
vehicle with a siren and a flashing red light. Just as most of
us obey laws even when no one can catch us disobeying
them, so we feel pain even when no one is there. For a
molar behaviorist extreme pain is not an immediate
sensation (deeply felt) but a long-term pattern of behavior, widely performed.
The more convincing we want to be (and the social
object of pain is to be convincing) the less conscious (less
verbal, less deliberate) we must be about what we are
doing, and the wider we have to spread the pain behavior
in time. To be most convincing we have to infuse the
pattern of pain into all our overt behavior, public and
private.
Thus, the pure mentalist view of pain is useful. It
confers a sort of privilege on those organisms (human and
otherwise) who, by their expression of pain, automatically
summon our help or at least our sympathy. The problem
with that view, however, is that the privilege may be
abused. Children abuse it frequently. The story of the
boy who cried wolf in its various forms is an attempt to
instill nonabuse. But the temptation to abuse the privilege is always with all of us. What is wrong with this? Too
many of us are in pain too much of the time. According to
Koenig (1973), the average number of aspirins alone (not
counting other pain medication) swallowed each year by
each American (man, woman, and child) is 225. There are
currently 900 pain clinics in the United States, and the
number is rapidly growing (Turk et al. 1983). A viewpoint
on pain other than the pure mentalist view of current
common sense might help us to better discriminate
"sensory" pain from "psychological" pain and to make
this discrimination of our pain as well as that of others.
Whether the best viewpoint for this purpose is physiological, cognitive, or behavioral remains to be seen.
We turn now to a stronger objection to the behavioral
point of view - one that arises not from commonsense
mentalism alone but from commonsense mentalism in
combination with the physiological and cognitive views.
That objection says that pain, whatever it is, is fundamentally internal. The behavioral viewpoint stands alone
against the others in where it sees pain. For the other
theories pain occurs inside the organism, and pain behavior is only the expression of that internal pain. For a
strictly behavioral theory pain occurs as overt behavior, at
the point of interaction between the organism and the
environment.
It is important to emphasize again that a behavioral
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

49

Rachlin: Pain and behavior

theory cannot internalize its terms and remain a behavioral theory. In their desire to expand their theories to
explain mental terms, the three great behaviorists, Watson, Hull, and Skinner, have postulated the internal
operation of functional entities originally defined as actions of the whole organism. But internal functions, even
internal operants, are physiological or cognitive concepts, not behavioral ones. The question we ask here is
whether a purely behavioral theory of pain makes sense.
A way in which behaviorism may be extended to
account for mental terms and still remain behavioristic is
to consider instances of overt behavior that have occurred
in an organism's past as part of a single pattern of behavior
extending into the present. Even molecular behavioral
theories do this, in miniature, when they consider temporally extended events such as response rates or interresponse times as fundamental behavioral variables.8
Modern molar behavioral theory extends this procedure
to wider intervals, encompassing events that are far in the
past.
In physiological and cognitive theory, by contrast, the
events defining pain occur inside the organism. Although
these events are ordinarily supposed to cause behavior,
through "motor mechanisms," it is within the power of
physiological and cognitive theories to suppose that although the internal events do occur, the behavior is
inhibited. According to those theories, an individual
instance of pain may never be revealed in behavior. If
internal pain does exist in this sense, behaviorism cannot
explain it. It is on the grounds of this restriction that
behaviorism has been most strongly attacked - first with
respect to its failure to explain internal pain, and, by
extension, with respect to its failure to explain other
mental processes.
It is worthwhile, therefore, to discuss this kind of attack
and to attempt to provide a behaviorist answer to it. If this
attempt succeeds, the way will be clear to further develop
a wholly behavioral theory of pain.
The essence of the antibehaviorist argument is that it is
possible to conceive of a person in pain who does not
exhibit pain behavior. The argument has been made most
vividly by Putnam (1980), who asks us to imagine a
community of super-Spartans who are trained from birth
to inhibit all pain behavior except that which is verbal
and, even when they say they are in pain, to say it in a
calm voice. Using our previous terminology, super-Spartans, by virtue of childhood training, have learned to
mold their responses to painful stimuli into a form (the
words "I have a pain in my toe" spoken in a calm voice)
that is useful for functions such as telling a doctor where it
hurts but not useful for functions such as stopping a
baseball game (clutching and falling), warning other people of danger (yelling loudly), or avoiding tissue damage
(pulling ones hand quickly from the fire). In the superSpartan's world, "psychological" pain would not be a
problem (as it is in our world), but they would pay a price
in burned hands for their lack of it.
Super-Spartans calmly say they are in pain but do not
exhibit any other pain behavior. We can certainly conceive of such people and imagine how they might have
been trained. But does that first conception necessarily
entail a second and quite separate conception - that
super-Spartans have pain exactly when they say they do?
Putnam's argument against behaviorism hinges on the
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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

second conception. But there is a good deal of evidence

(reviewed by Nisbett & Wilson 1977) that what people say
about their internal states does not correspond to what
the best available cognitive theories (theories that explain
behavior in a wider context) claim that their internal
states actually are. (And behavioral theories insist even
more forcefully on this distinction. Fordyce (1983b) has
found it necessary, in pain assessment, to distinguish
sharply between what people say about their pain and
what they do.) How should one interpret what superSpartans say? Consider the following instance.
Let us suppose a super-Spartan warrior is struck in the
shoulder by a spear. At that time he neither makes a
sound nor performs any action expressing pain. The next
day, visiting the super-Spartan doctor, he says, in a calm
voice, "I have an excruciating pain in my shoulder, and I
have had it since yesterday when I was struck with a
spear." The doctor may then look for tissue damage.
Suppose a wound is found. Is the doctor then forced to
imagine that the warrior was carrying within him, not
only the wound, but something called "pain" and that the
warrior's current statement is caused, not by the wound,
but by the pain? It does not seem logically necessary for
the doctor to imagine this; nor, more importantly, would
such an image be useful. The doctor (and the superSpartan psychologist) could just imagine that the warrior's statement is a response to his wound. After all, it is
the wound, not the pain, that needs to be treated. But let
us suppose no wound is found. The doctor might then
punish the soldier for reporting pain not confirmed by
tissue damage, suggest changes in the childhood training
of super-Spartans so as to avoid such instances in the
future, or just shrug his shoulders and dismiss his patient.
As a super-Spartan himself he would not show any sympathy to the warrior or give him a day off. What to us seems
cruel would, to a super-Spartan, be the normal behavior,
cruel or not, of his compatriots. Otherwise we would have
to conceive a kind of childhood training that compelled
super-Spartans to inhibit pain behavior even though that
behavior was reinforced in super-Spartan society. If
super-Sparta entails suspension of the normal laws of
human learning as well as normal pain behavior, it becomes harder to conceive of. Within the limitations of
childhood training, as we know it, there is nothing about
super-Spartan behavior that compels abandonment of the
behaviorist viewpoint.
Sensing this, perhaps, Putnam imagines the evolution
of super-Spartans into swper-super-Spartans. The supersuper-Spartans never even say they are in pain, and they
need no childhood training. They act this way from birth.
There are numerous problems in conceiving of supersuper-Spartans. First, there is no way (given Darwinian
evolution) for super-super-Spartans to evolve. While it is
conceivable (however unlikely) that pain behavior should
be so maladaptive that people exhibiting the slightest
trace of it (let us call them "crybabies") would die an early
death, there would be no conceivable way to distinguish
the super-super-Spartans who inhibit all pain behavior
from others who are completely insensitive to pain (let us
call them "numbones"). By hypothesis, neither nature
nor super-Spartan kindergarten teachers could selectively kill off numb ones and still allow super-superSpartan children to survive. But let us put aside this
puzzle and try our best to conceive of super-super-

Rachlin: Pain and behavior

Spartans. (If they could not evolve, perhaps they could be
built.) Suppose that a super-super-Spartan genius discovers the neurological substrate of the pain that the
super-super-Spartans always inhibit. (Putnam says that
super-super-Spartans still have internal physiological
pain.) To be specific, say that Dennett's cognitive theory
of pain is essentially correct and reducible to physiology
but that the connections from the pain mechanism to the
motor apparatus have atrophied in super-super-Spartans.
Suppose that the genius realizes what a great advantage in
terms of tissue-damage avoidance it would be if supersuper-Spartans could communicate to one another when
the pain mechanism (which from his point of view could
only be a more or less accurate internal indicator of tissue
damage) was active. The genius then devises a red light
that can be mounted on people's heads, the intensity of
which reveals the output of this internal mechanism. Let
us say that all super-super-Spartans were fitted with this
red light from birth. Now, a super-super-Spartan baseball
game could stop if a player's red light were lit; supersuper-Spartans would be sympathetic and pay lots of
attention to other super-super-Spartans whose red lights
were frequently shining; super-super-Spartans would
have days off from work when their red light was on; in
severe cases, they would receive narcotics and other
drugs that made them feel good; and so on. How long
would it be, do you suppose, until super-super-Spartans
would have to establish clinics to deal with excessive redlight shining? Put the overt function back in the pain and
the super-super-Spartan world would be our world, with
this difference: that the behavior we call pain, they would
call shining one's red light. Perhaps, eventually, the
super-super-Spartans would learn to inhibit the shining
of the red light on certain occasions even though their
internal mechanism was active. They might then come to
speak of a red light shining within them even though none
was shining outside. But this would be just an illusion.
There might emerge, in super-super-Sparta, two ways of
studying red-light shining: (a) the external factors - the
stimuli, rewards, and punishments that control it - and
(b) the internal physiological-cognitive mechanism discovered by the super-super-Spartan genius plus the other
mechanism (acquired by super-super-Spartans since the
death of the genius) by which the output of the first
mechanism was inhibited or augmented so as to control
the red light. (These correspond to our own external
study of pain behavior and internal study of pain mechanisms). A third discipline, initiated by super-super-Spartan mentalists, the study of internal red-light shining
based on introspective reports, would be pointless. Introspective reports of red-light shining could serve as data
for super-super-Spartan behavioral studies (which might
attempt to discover the reinforcers of such reports) or
for super-super-Spartan physiological-cognitive studies
(which might attempt to discover the internal mechanism
by which such reports were generated), but the content of
the introspective reports, their testimony as to the existence and the nature of the internal red light, is no
evidence whatever either for the existence or for the
nature of an internal red light, which, as we have already
said, would be an illusion - not only according to behavioral theory but according to physiological and cognitive
theories of red-light shining as well.
Returning to our own world, a person who says, "I can

feel pain without behaving," deserves to be heard with no

more (and no less) credence than the person who says,
"The moon is larger when it's on the horizon than when
it's high up in the sky. " Only the mentalist will accept the
latter introspection at face value, and it is only he who can
accept, at face value, the former.
What is pain?
The super-super-Spartans do not prove that behaviorism
is wrong or illogical. But the analogy was worth pursuing
because it highlights what is partly a semantic dispute.
The physiologist and the cognitivist want to speak of real
pain (identified with internal pain mechanisms) on the
one hand and pain behavior on the other. The behaviorist
wants to speak of internal pain mechanisms on the one
hand and real pain (identified with behavior) on the other.
If, for instance, an animal were discovered whose pain
behavior was exactly analogous to ours but whose internal
pain mechanism was entirely different (as a given computer output may be instantiated by different programs),
the physiological cognitivist would say that the animal's
pain was different from ours but its pain behavior was the
same, while the behaviorist would say that its pain was
like ours but its pain mechanism was different.
Putnam's super-Spartan analogy extends the arguments of Geach (1957) and Chisholm (1957) against the
behaviorism of Ryle (1949). According to Geach and
Chisholm, Ryle claimed that a mental state is equivalent
to a disposition to behave in certain ways; that is, when we
attribute a mental state to a person we are saying something about how that person would behave under certain
circumstances. Geach and Chisholm argued that when
we attribute mental states (especially perceptions) to
people we are referring to something that is going on
right then, not what would go on in the future. Since
having a perception corresponds to no immediately observed overt behavior, we must be referring, according to
Geach and Chisholm, to something going on where we
cannot immediately observe it - that is, inside the organism. Hence, they argue, behaviorism is false. The behaviorism I have been defending here, contrary to
Geach, Chisholm, and Putnam's interpretation of Ryle
(although not, perhaps, contrary to Ryle), identifies mental states with overt behavior in the past and present, not
in the future (although behavior in the future may prove
us wrong about a particular identification of a mental
state, as events may prove us wrong about any particular
identification). A rat in a Skinner box may be said to be
responding at a certain rate right now even though the rat
is not at this very moment pressing the lever. Judgment of
the rat's rate is made on the basis of lever presses in the
rat's past (although future lever presses may prove us
wrong). Molar behaviorism extends this mode of analysis
to mental events such as pain. (Lacey & Rachlin 1978
made a similar point about mental events in general.) This
kind of behaviorism has never, to my knowledge, been
acknowledged, let alone refuted, by antibehaviorist philosophers or psychologists.
Is the sense in which a rat is responding at a certain rate
right now (even though not right now pressing the lever)
different from the sense in which a person can be in pain
right now (even though not exhibiting pain behavior right
now)? Geach, Chisholm, Putnam, and other antiTHE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

51

Rachlin: Pain and behavior

behaviorist philosophers would claim that the very meaning of pain demands a distinction between the two cases.
Whether such a distinction is valid will depend on
whether pain is defined as an internal mechanism or as
overt behavior. If pain is defined as an internal mechanism then people in pain right now but not exhibiting
pain behavior right now will be thought of as inhibiting
the output of that mechanism, whereas a rat not pressing
a lever at a given instant is not ordinarily thought to be
inhibiting lever presses at that instant. But if pain is
defined as overt behavior a person could be in pain, even
though not at the moment exhibiting pain behavior,
exactly as the rat is responding at a given rate even though
not at the moment pressing the lever.
The rat possesses internal mechanisms that mediate
between pain stimuli and lever presses just as the person
possesses internal mechanisms that mediate between
stimuli and pain behavior. But lever presses are usually
defined in behavioral terms (as operants) rather than in
terms of those (poorly understood) internal mechanisms.
The concept of a rat pressing a lever at a given rate at a
given moment (even though not, at that very moment,
pressing the lever) has led to a search for correlates of
lever presses in the rat's environment rather than inside
the rat. It has proved to be a very convenient concept for
those of us interested in controlling and (it seems to us)
understanding rats' lever presses.
Just as the behavioral definition of lever presses (despite the existence of internal mediating mechanisms) has
led to control of lever pressing, so a behavioral definition
of pain (despite the existence of internal mediating mechanisms) may lead to control of pain.
It is on empirical work such as that of Fordyce and not
on the conceivability of Putnam's super-super-Spartans
that the behavioral definition of pain must stand or fall. If
you have previously defined pain in terms of internal
physiological or cognitive mechanisms then super-superSpartans will be conceivable to you, and you must believe
behaviorism to be wrong (at least as applied to pain). If
you have previously defined pain in terms of overt behavior then super-super-Spartans will be inconceivable to
you, and you need not believe behaviorism to be wrong.
If you have made no previous commitment to a behavioral
or physiological-cognitive definition of pain then Putnam's super-super-Spartans are irrelevant.
What is gained or lost by a commitment in one direction or another? A point apparently in favor of the physiological-cognitive definition is its correspondence, as regards the internality of pain, with the mentalistic view
resting on introspection and "linguistic intuition." But
this is a double-edged sword because, when used (as it
often is) against the behaviorist definition of pain, it
requires arguments based on introspection and intuitition - the very arguments rejected by physiologists and
cognitivists vis-a-vis the mentalists. It seems inconsistent
to argue on the one hand that pain is an internal event
because our introspections tell us so and on the other
hand that pain is the output of a computerlike mechanism
or a series of neural discharges even though our introspections (and "linguistic intuitions" for that matter) tell
us that pain is a "raw feel."
The best argument for the physiological-cognitive definition of pain would be a truly effective physiologicalcognitive treatment of pain. The best argument for a
52

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

behavioral definition of pain would be a truly effective

behavioral treatment of pain. On this issue, unfortunately, the jury is still out.
ACKNOWLEDGMENTS
I would like to thank George Ainslie, William Bauin, Daniel
Dennett, Marvin Goldfried, George Graham, Stevan Hamad,
Patrick Heelan, Richard Herrnstein, Dennis Kelley, Peter
Killeen, Alexandra Logue, W. Lycan, John Staddon, H. S.
Terrace, and Gerald Zurifffor patiently reading and commenting on previous drafts of this manuscript. Preparation of the
manuscript was supported by a grant from the National Science
Foundation. Reprints may be obtained from the author, Psychology Department, State University of New York, Stony
Brook, N.Y. 11794.
NOTES
1. Placebos may exert their effect through endorphins released
by the central nervous system (Levine, Gordon & Fields 1979).
Thus, ironically, the placebo effect may be mimicked by drugs.
However, there is some evidence (Siegel, Hinson & Krank
1981) that, as with drugs themselves, people may develop
tolerance to and dependence on placebos.
2. But the functional units of a cognitive theory need not
necessarily be reducible to physiology. Fodor et al. (1974) have
argued that, even in principle, cognitive units need not be so
reducible.
3. Dennett (1978, Chap. 11) was showing that a determined
mentalist will never accept the idea that a machine can be in
pain. He makes the computer more and more complicated so as
to handle each of the mentalists objections in turn. Yet the
mentalist is still not satisfied and, Dennett speculates, never
will be satisfied. From a behaviorist point of view, Dennett is
modifying his computer in the wrong direction. What is wanted
(by the behaviorist) is that the function of pain in humans be
preserved in the machine - that the machine's behavior be a
signal of actual damage which the observer needs to do something about. A behaviorist (and perhaps many other people)
would sooner view a wagon with a squeaky wheel as an example
of a machine in pain than Dennett's computer (with all its
complicated internal machinery). The computer, however
much it might simulate pain, will not be judged as in pain
(according to the behaviorist) unless it compels (by eventually
reinforcing them) the kind of social responses that pain does.
4. Ainslie (in press) presents an as yet untested cognitive
theory of pain that is interesting enough to mention. Ainslie
claims that attention is an internal operant response that is
positively reinforced (also internally) by the painful stimulus.
According to Ainslie, such stimuli provide a very brief reinforcement, strong enough to reinforce attention but not strong
enough (and not long-lasting enough) to reinforce a motor
response. This reinforcement, Ainslie claims, is followed by a
relatively long refractory period during which no reinforcement
is possible. The brief reinforcer plus the refractory period is
worth less on the whole than the absence of both. Thus, a person
with a painful blister, say, is like an addict, constantly tempted
to attend to the blister by the brief reinforcement but constantly
lacking in other forms of reinforcement normally available.
Pain, for Ainslie, is just this lack.
Ainslie's theory is cognitive rather than behavioral in the
sense that the processes governing pain are said to be internal.
The behavioral implication of Ainslie's theory is that the aversiveness of painful stimuli is on a continuum with the aversiveness of tempting stimuli. At one end of the continuum the
cycle of pain, the brief reinforcer (too brief for conscious
awareness) plus the longer refractory period, last only a fraction
of a second. Next come itches with a longer cycle of both
reinforcer and refractory periods. Then come addictions. Finally, at the other end of the continuum, are certain moral deci-

Commentary/Rdch\in:
sions, what Ainslie calls "sell-outs," with reinforcer and refractory period lasting months to years.
5. In the history of behaviorism, when behavioral explanations have run into trouble, they have tended to hide inside the
behaving organism. Thus Watson (1913), who began with stimuli as they affected the whole organism and responses of the
organism as a whole, ended (1924/1970, following Pavlov) by
postulating reflexes wholly interior to the organism. Hull (1943),
who began with a set of axioms regarding stimuli to, and
responses of, the whole organism, ended in reply to Tolman's
(1948) persistent and effective criticism by postulating "fractional-anticipatory-goal-responses " wholly inside the organism
(Hull 1952). Skinner, who began by introducing the operant as a
class of overt activities defined by its function, more recently
speaks of covert stimuli, responses, and reinforcers (see Zuriff
1979 for a discussion of "inner causes" in Skinner's work).
6. It is not inconsistent that molar behaviorism identifies
mental states with events in the past and present rather than the
future but operants arc defined in terms of events that follow
them. Molar behaviorism is a theory of an observer of behavior,
while operants are activities of the observed organism. The
observer may observe a series of acts, perhaps distant in the
past, and consequences of those acts less distant in the past.
Current operant behavior is thought to be a function of past
behavior and its more recent consequences.
7. A good example of the social use of the essential privacy of
pain is the following passage from a recent novel by Hilma
Wolitzer (1983):
"Once . . . Kenny broke his leg in two places, skiing. A few weeks
later, he and Joy had three other couples for dinner. One of the men
said, admiringly, that Kenny's leg must have hurt like a sucker, and Joy
smirked. The other women nodded at her, knowingly, without a word
passing among them. Kenny was amazed and outraged. He said that the
pain had been excruciating, and one of the women actually laughed out
loud. She folded her arms and said, It wasn't anything like labor,
huster, you can bet on that.'
"Kenny said he wouldn't know, but that the bone had literally pierced
the skin. It was whitish yellow, like a huge, emerging tooth. A seasoned
ski pro had fainted when he looked at it.
" H a ! the woman said. Ha, ha, the other women added, even Joy,
who had wept in the ambulance and said, Darling darling darling,' until
they'd put him under for surgery.
"The mildest of the men said, 'We get more heart attacks, more lung
cancer, more sports injuries. I mean, that's statistics.
'My water broke with Steven hours before I began to dilate, Joy
said. It was a dry birth. She ripped ofl a ragged piece of bread and
chewed it.
" Have you ever been shot?' Kenny asked no one in particular. Guys
in Vietnam got it in the guts, in the head.' It was a weak, even a specious
argument, since nobody at the table, including Kenny, had been in
Vietnam. Joy lifted the heavy meat platter with one hand and left the
room.
There was a long troubled silence during which the wine was finished
and crusts of bread were shredded into little hills of crumbs. Then one of
the men said, 'Hemorrhoids! '

8. Integration such as this is to some extent a characteristic of

psychology in general - as when a tone of a certain frequency or
light of a certain wavelength is considered to occur at an instant
even though frequency and wavelength require finite intervals
for their definition.

Open Peer Commentary

Commentaries submitted by the qualified professional readership of
this journal will be considered for publication in a later issue as
Continuing Commentary on this article. Intenrative overviews and
syntheses are especially encouraged.

Pain and behavior

Behavior is what can be reinforced

George Ainslie
Jefferson Medical College at the Coatesville V.A. Medical Center,
Coatesville, Pa. 19320

The difference between prescriptive (normative) laws and descriptive ones is clear and fundamental, yet behaviorism has had
trouble with it from the start. Rachlin's article is a case in point.
He says that behaviorism is distinguished from other schools
by the doctrine that "whatever actions an organism takes are
actions of the whole organism." This is not the kind of doctrine
that can be proven or disproven, and Rachlin acknowledges that
he means it to be accepted or not on the basis of whether the
behaving scientist, foraging, perhaps, for facts, finds it "more
useful" than other doctrines. It loses nothing if put in normative
form: "Do not postulate part-organisms as intervening variables, and avoid introspections as data (since they imply one part
of an organism observing another part).
Constraints on scientists' spontaneous foraging to prevent
their seduction by false doctrines were the original concern of
behaviorism. Watson feared the "medieval" orthodoxy of introspectionism, which was "dominated by a kind of subtle religious
philosophy" (1924, p. 3). He did not deny that thoughts could be
observable processes, but he complained that introspectionists
usually fooled themselves about what they observed: "When
they come to analyze consciousness, naturally they find in it just
what they put into it" (pp. 5-6). Skinner likewise worried that
"the whole weight of habit and tradition" kept "raising the
ghosts of dead systems" (1938, p. 5). He did not specifically say
why behavior had (o be limited to "what [an organism] is
observed by another organism to be doing" (p. 6), but the
context made it clear that this was a self-control measure needed
to keep these ghosts at bay. Later, perhaps believing that he had
laid the ghosts to rest, he conceived a number of controlling
variables that were beyond direct observation by another organism (Zuriff 1979). Rachlin in turn chides Skinner for succumbing to the temptation to "hide inside the behaving organism. '
Rachlin's even stricter behaviorism represents a prescriptioi for
resisting such temptations.
Thus when Searle (1980) asks, "Are there no pains underlying
Rachlin's pain behavior?" one would expect Rachlin's answer to
be, "Perhaps, but I have no trustworthy way of studying them."
Instead, he sets out to show that introspections actually contain
no information beyond what can be observed by another organism. He wants the behaviorist doctrine to be taken not just as
prescriptive but as descriptive as well.
I believe he is making a mistake. It has been thoroughly
argued elsewhere that a rule against introspection can only
partially be obeyed, that even behaviorists must depend on this
process in some cases (Alston 1974). A normative law can live
with violations, but a descriptive one cannot. Furthermore,
Rachlin's position requires me to believe that my perception of
my own pain is different in some essential property from my
perception of the injured baseball player who clutches himself
or of the rat who works to avoid shock. It is hard to think what
that property might be. Different sensory modalities? The
existence of distinct pain tracts is doubtful (Weisenberg 1977). I
probably see the baseball player with the same neurons that
subtend painful brightness. Different replicability? Given the
proper instructions, other people might be able to repeat my
introspection, an accepted method for consensual validation in
Gestalt psychology, linguistics, and bargaining research. Of
course, my perception might be distorted by incentives bearing
on the observation process itself- perhaps my wish for sympathy, perhaps my love of an outworn theoretical system - but this
has been known to happen to observations made upon other
organisms as well, and sometimes even to the replication of
those observations. Perhaps the subjects of my introspections
are not behaviors? That would be to say that my "pain behavior"
is not behavior until someone else has seen it. But that is just to

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53

Commentary/Rachlin: Pain and behavior

restate Rachlin's position, not to supply the property that sets
my introspection apart. There seems to be no distinct quality
that separates internal modalities of observation from external
ones. Introspective information may indeed be suspect for
certain scientific purposes, but it cannot be sharply differentiated from other kinds of information, much less be proved
redundant.
I might seem to be arguing that Rachlin's point and perhaps
the point of behaviorism in general is a narrow procedural one. I
am not. In the course of obeying their prescriptive law about
making observations and explanations on the level of behavior,
Watson's followers cultivated the empirical hunch that most
psychological processes were maintained by differential reinforcement. Stimulus-driven processes like conditioned reflexes
became decreasingly important as the description of verbal
operants, autonomic operants, pain operants, and so forth confirmed this hunch. These were revolutionary findings.
These findings have contributed to the controversy surrounding behaviorism, for in many bargaining situations people find it
advantageous to seem unfree (Schelling 1960); the revelation
that some kinds of process are operants disturbs social and
psychological balances. The extent of the population of operants
is a matter of descriptive law, but it is not generally discussed
separately from the prescriptive law about avoiding introspection. The confounding of these quite separate laws probably
springs from the use of "behaviorism" to name the prescriptive
one. After all, a behavior in ordinary speech is not something
public as opposed to private, but something active as opposed to
passive, something purposive, an operant. Behaviorist doctrines like the statement '"Mental states' are dispositions of
bodies to behave" (Graham 1982) can be read as expressing
either the prescriptive law or the trend of the descriptive
findings, or both indiscriminately. I would argue that the heart
of behaviorism is its hypothesis that "mental states" are operants, not its prescriptive law against introspection.
As a behavioral theory in the descriptive sense, the FordyceRachlin argument does not go far enough. Rachlin marshals
good evidence that human pain behavior often fails to follow a
pain stimulus, but then he agrees with Fordyce that it is a
respondent as long as a pain stimulus is present. Why did the
soldiers at Anzio withhold pain behavior when the stimulus was
present? Why do most of us fail to withhold it? How can
seemingly benign stimuli like a dripping faucet or a very lean VI
(variable-interval) schedule of reinforcement come to be aversive even though they do not condition respondents? Why does
pain seem to reinforce attention but punish other kinds of
behavior? It is possible to deal with such questions by treating
all mental processes as operants (Rachlin reviews my theory
fairly in his note 4), but Rachlin cannot do so, because he would
have to use intervening variables inside the organism. The
prescriptive law may have cleared the way for the descriptive
one, but it also confines it in ways that are not useful.

Behavioral definition of pain:

Necessary but not sufficient
Joseph H. Atkinson, Jr. and Edwin F. Kremer
Department of Psychiatry, School of Medicine, University of California, San
Diego, La Jolla, Calif. 92093

Pain is commonly discussed as if it were a unitary disorder, with

the corollary that a discrete theoretical conceptualization (physiological, cognitive, or behavioral) sufficiently defines the phenomenon. Nevertheless, the term pain, especially chronic
pain, may well subsume a family of disorders rather than a single
entity with a uniform etiology or pathophysiology (Merskey
1983). The failure of diverse treatment approaches (including
behavioral interventions) to consistently alleviate chronic pain
would argue that critical variables important to the predisposi54

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

tion, inception, and maintenance of chronic pain have not been

identified. An important task now is to develop more comprehensive categorization of pain disorders by defining, where
possible, homogeneous subgroups of patients by behavioral and
biological markers. Presumably these relatively homogeneous
subgroups could be investigated for their natural history and
differential responses to treatment. The question, then, is
whether a strictly behavioral approach contributes to this effort.
We believe that it is necessary but insufficient to the task, and
that cognitive and physiological data are required to fully interpret pain behavior.
Among the major contributions of an operant behavioral
definition of pain as outlined by Rachlin are that it (a) identifies
the aversive quality of pain as pathology of goal-seeking and
reward behaviors, and (b) views pain as a response of the
organism, rather than a bothersome symptom of medical or
psychiatric illness. The first allows for quantifiable data other
than self-report of pain intensity for treatment and outcome
criteria, since verbal pain estimates are distorted by many
variables (Kremer, Block & Atkinson 1983). Even so, the task of
pain assessment remains complex. It cannot be assumed that
behavioral indices of pain are uniformly reliable and objective
simply because they are quantifiable and easily scaled. For
example, there is evidence from studies using automated activity monitors that some pain patients underreport activity
levels while accurately reporting social behaviors (Sanders
1980). It is also known that pain chronicity, affective state, and
medications commonly prescribed for pain patients (e.g., benzodiazepines) confound self-assessment and behavioral selfreport (Kleinknecht & Donaldson 1975). As more reliable methods of behavioral assessment are developed, patients may be
better categorized according to levels of physical, social, and
other behaviors.
The second contribution, that of viewing pain as a response of
the whole organism in interaction with its environment, is
essential to a comprehensive model of chronic pain. Disease has
been described as a failure of the organism to adapt to situations
and experiences that are adverse or are perceived as adverse
(Weiner 1977). In this view, no one factor (i.e., social, political,
nutritional, or neurological) is an exclusive cause of disease
itself, and factors may interact to make the adaptive task more
difficult. Organisms may be predisposed to disease, and the
precipitation and perpetuation of disease is a complex process
related to many factors. The more conventional approach to
disease disagrees with the adaptive model; it conceptualizes
disease as the direct result of these factors themselves (Weiner
1977).
Implicit in the adaptive approach is the belief that the brain
regulates adaptive activity and modulates physiological processes via the neuromuscular system, the autonomic nervous
system, and the limbic-hypothalamic-pituitary axis. It is conceivable that pain behaviors, as representative of adaptive
failure, might be reflected internally by neuroendocrine dysregulation. The experimental animal paradigm of avoidance
conditioning is analogous to the more complex human task of
coping or adapting to specific situations, and complex patterns of
neuroendocrine response to avoidance-conditioning experiences are noted in primates (Mason, Brady & Tolliver 1968).
Animal studies more specific to pain indicate important relationships between the hypothalamic-pituitary-adrenal (HPA)
axis and the endogenous opioid system (Millan, Przewlocki &
Herz 1981). For example, stressful situations, which commonly
activate the pituitary, alter the sensory threshold to noxious
stimuli (Bodnar, Kelly, Spiaggia, Ehrenberg & Glusman 1978;
Chesher & Chan 1977); and hypophysectomy blocks stressinduced analgesia to acute and chronic pain (Amir & Amit 1978).
Furthermore, there is evidence that opioid peptides influence
the release of growth hormone, prolactin, ACTH, and other
hypothalamic hormones (Meites, Bruni, Van Vugt & Smith
1979).

Commentary/ Rachlin: Pain and behavior

Although there is considerable variability of hormonal response associated with stress (Mason 1975) and psychiatric
disorders (Winokur, Amsterdam, Caroff, Snyder & Brunswick
1982), it is conceivable that neuroendocrine patterns occur in
pain disorders. If so, it may be possible to distinguish subtypes
of pain patients by neuroendocrine as well as behavioral indices.
Nonsuppression of plasma cortisol after dexamethasone (dexamethasone suppression test, DST) has been reported in patients with so-called psychogenic pain (Blumer, Zorick,
Heilbronn & Roth 1982) as well as in pain patients with major
depression and other psychiatric disorders (Atkinson, Kremer,
Risch, Morgan, Azad, Ehlers & Bloom 1983). In addition we
have noted that in some pain patients prolactin secretion is
relatively unaltered by dexamethasone (Atkinson, Kremer,
Risch & Janowsky 1984) regardless of psychiatric status, whereas healthy volunteers show dexamethasone suppression of prolactin and cortisol, and a percentage of patients with affective
disorder show both cortisol and prolactin nonsuppression after
dexamethasone (Meltzer, Fang, Tricou, Robertson & Piyaka
1982). Finally, differing concentrations of cerebrospinal opioid
peptides are reported in patients with psychogenic and organic
pain (Almay, Johansson, von Knorring, Terenius & Wahlstrom
1978), and reliably greater plasma opioid peptide concentrations have been reported to occur in chronic pain patients than
in psychiatric subjects and volunteers (Atkinson et al. 1983),
indicating that other biological markers may be available. Given
that pain and disorders of mood often appear concurrently and
presumably involve common neurotransmitter systems
(GABAergic, noradrenergic, cholinergic, serotonergic, and
peptidergic), discriminating biological markers of stress, pain,
and affective disorder will be exceedingly complex. Longitudinal studies are needed to assess the behaviors of markers in
various phases of pain syndromes and associated affective states.
If chronic pain is to be understood as a failure of adaptive
mechanisms, then basic research using animal models is required to identify factors which predispose organisms to chronic
pain, as well as to study those which initiate and maintain the
process. Our primary clinical obligation, however, is to try to
alleviate suffering. Affective disorder is one component of suffering in pain syndromes, and here the presently available
neuroendocrine markers might have therapeutic application.
For example, nonsuppression of cortisol after dexamethasone
may help identify pain patients with major depression in whom
tricyclic antidepressants are indicated. In the future it may be
determined that behavior therapies are appropriate to certain
groups of patients identified by specific clinical and laboratory
findings, but less productive in other groups. Indeed, the
necessity for such discrimination was acknowledged in the
initial descriptions of behavioral treatments of chronic pain
(Fordyce, Fowler, Lehman and DeLateur 1968). Rachlin's suggestion that the best argument for a behavioral definition of pain
would be a truly effective behavioral treatment of pain oversimplifies the diversity of pain disability and underestimates the
therapeutic challenge.

Internal events as behavior, not causes

Daniel J. Bernstein
Department of Psychology, University of Nebraska-Lincoln, Lincoln, Neb.
68588

In general I find Rachlin's defense of a behavioral analysis of pain

quite convincing. The parallels between sensory/psychological
pain and respondent/operant behavior are well drawn, and his
account of the likely development of the commonsense (mentalist) approach to pain is a useful component of his position.
Rachlin's restrictive criteria for behavioral analysis are less
convincing, and my commentary will focus on the limitations his
criteria impose on a behavioral account of pain.

Rachlin repeatedly limits a "purely behavioral" account to

actions of the whole organism, specifically excluding any internal events. He justifies his rejection of internal events in any
form by asserting that their inclusion makes a behavioral analysis indistinguishable from a physiological or cognitive account.
This assertion would be true only if the internal event were
identified as a causal agent (real pain) and the overt behavior
identified as a product (symptom) of the internal state. It would
be reasonable to reject physiological reductionism in the pursuit
of causes of behavior, because identification of physiological
mechanisms is an incomplete analysis. The inevitable next step
is identification of the environmental antecedents of the physiological events, an analysis that can be made without reference to
physiology by finding the environmental antecedents of
behavior.
It is less reasonable to reject analysis of internal events that
are under the control of identifiable respondent processes and
operate independently of overt operant behavior. The work of
Bykov (1959) and other investigators in the Soviet Union (cf.
Razran 1961) suggests that many body processes are sensitive to
respondent conditioning procedures. With proper instrumentation for measurement and for delivery of stimuli, control of the
behavior of internal organs is possible, and the causal analysis is
consistent with a behavioral account. It seems unnecessarily
restrictive to eliminate these processes from an account of pain
solely because the behavior under stimulus control can only be
measured inside the skin. The analysis is readily distinguishable
from a physiological account because the controlling variables
can be identified in the environment.
Including the behavior of some internal body parts in a
behavioral analysis can bolster Rachlin's discussion of the pain
"underlying behavior" without embracing mentalism. In responding to Searle's (1980) criticism of a behavioral position,
Rachlin conjures up a pure mentalist who asks Searle to identify
the pain underlying his neural activity. Rachlin considers that
request a mentalist error that all materialists would reject, and
he implies that Searle is making the same error by asking for the
identification of a physiological substrate. This is a weak rejoinder, for all three perspectives (as represented in the target
article) are explicitly materialist, and Searle proposed the identification of entities that are in principle measurable within the
guidelines of natural science. Rachlin might have responded by
noting that respondent behavior inside the organism is the cue
for Searle's verbal report, but his limited range of behavioral
analysis precludes such a response.
A slightly broader behavioral account might argue that the
body is full of organs and muscles that are responsive to interactions with the environment, and that people have learned to
respond verbally and nonverbally to the behavior of these body
parts (cf. Skinner 1945). Instead of merely identifying them as
the source of real pain, a behavioral analysis investigates the
conditions under which these internal organs behave in ways
that are labeled with pain words. The behavior of these body
parts is not a cause of the other operant pain behavior; instead,
this behavior is the pain which Searle labels.
Consider the following analysis of the pain associated with
labor and delivery of a child. For several hours before birth a
woman typically reports pain and makes her body tense (operant
behavior) while her uterus repeatedly contracts and remains
taut for short periods (respondent behavior). Most prepared
childbirth techniques involve muscle relaxation and breathing
exercises as ways of minimizing the aversive nature of the labor
period. The aversiveness decreases greatly if the woman's skeletal muscles remain relaxed and if she responds to trained cues
with patterned breathing instead of responding vocally to the
contractions. This description is consistent with a behavioral
account, because interventions that reduce operant pain behavior produce corresponding reductions in reported aversiveness.
A well-prepared woman might remain calm during contractions
but still report pain when asked. If Searle asked where her pain

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

55

Commentary/'Rachhn: Pain and behavior

was, Rachlin could identify the behavior of the uterus as the pain
without being mentalistic.
Limiting behavioral analysis to the actions of the whole
organism is one way to avoid confusing identification of physiological mechanism with explanation of the causes of behavior. It
is not the internality of events that makes them mentalistic,
however; it is their identification as causal agents of overt
behavior that is challenged by behaviorism. The historical
choice of stopping analysis at the skin may reflect the limited
research technologies of the time and not a necessary dichotomy. If the procedures of behavior analysis can be brought to
bear on internal parts of the organism, then their behavior can
be studied without introducing inappropriate inferences of
causal order. It is possible to avoid mentalism without limiting
our analysis to the whole organism.

Pain is three-dimensional, inner, and

occurrent
Keith Campbell
Department of Traditional and Modern Philosophy, University of Sydney,
Sydney, N.S.W., Australia 2006

1. The dimensions of pain. Rachlin has done philosophy a

service by further publicizing the view that pain is not simple,
despite any apparent intuitions to the contrary. There is complexity not only in the organic processes associated with pain but
also in the responses that constitute the pain experience.
Rachlin treats pain as two-dimensional, identifying a sensory
and an aversive component, which are to be measured on
intensity and reaction scales.
The two scales, for intensity and for reaction, are independent
at least to the extent that for different people, different increases
in the one go with a given increase in the other. The independence of the two scales, and hence of pain's two components,
would be further confirmed if for some people in some circumstances the relationship between the two scales were inverted.
The experiments should be repeated using people with a history
of masochism.
To recognize two dimensions to pain is a step in the right
direction, but it does not go far enough. Tantalizingly, Rachlin
recognizes this point but ignores it. For pains have not only
intensity and aversiveness but also quality. They can be stinging, grinding, shooting, or throbbing pains. The existence of
pains of differing qualities is of high importance to behaviorism
since it provides the basis for those arguments from the possibility of a shift in pain quality without any shift in pain's causes
or behavioral manifestations, to the conclusion that cause and
manifestation do not exhaust the reality of pain. The arguments
have very close formal parallels in the spectrum-shift arguments
against behavioral (and functionalist) accounts of colour vision.
A spectrum-shift argument supposes that two people can have
colour vision in which the experience of each involves a shift
along the spectrum relative to the other. What one person sees
as a bluish-green may look to the other as (what the first would
describe as) more nearly yellow. Especially if the shift is slight,
both may use the same colour descriptions, and both may be
able to make exactly the same colour discriminations (the behavioural manifestations of colour vision may match). In both
cases the stimuli (colour vision's causes) will be the same. The
internal, mental effects, insofar as they are functional/behavioural, may likewise match. Since the colour experiences do
not match, there is more to colour than functional and behavioural accounts allow.
The force of the qualia argument in the pain case is no less
than that for the colours.
Rachlin's neglect of the qualitative aspect of pain derives, I
suspect, from a general orientation concerned above all with

56

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

therapeutic strategy (see the final paragraph of the target article). Such a semipractical approach, which sets aside any theoretical issue not connected to questions of treatment, has its
own justification, of course, but it forfeits any claim to be
comprehensive.
Compare the case of pain with that of a group of organic
diseases, bacterial in origin, with fever, coughing, and a variety
of skin rashes and lesions as symptoms. For medical entities
from this group, suppose no methods aimed at suppressing the
skin rash symptoms have any effect on the course of the disease.
Then there will plainly be a difference between an account of the
disease that deals with the aspects relevant to its treatment and a
description of it in its entirety. The former, but not the latter,
will leave out the matter of skin condition.
To suppose that for pain we can conflate the aspects relevant
to treatment and the complete entity is to beg all the philosophically important questions.
2. The location of pain. Rachlin's second service to philosophy
is his forthright concession-indeed insistence-that a behaviorist account of pain, or any other mental item, is rigorously
confined to outer events. "Behavioral theory cannot internalize
its terms and remain a behavioral theory." Nothing but good can
come from keeping competing theories clearly distinct; it is a
matter, one is tempted to say, of mental hygiene.
For this very insistence on the outer status of pain is precisely
what makes behaviorism so implausible. The two sides of this
implausibility are, of course, the possibility of pain without
behavioral manifestation and its converse, pain behavior without suffering.
For pain without pain behavior, the most striking cases are
not Putnam's super-Spartans, which Rachlin discusses, but the
cases of pseudo-anesthesia, especially under curare, which are
mentioned in the medical texts (Buxton Hopkin 1980; Hutchinson 1960). There seems to be no doubt that all symptoms of pain
can be suppressed for at least a moderate period. And, accordingly, all symptoms can in principle be suppressed, for that
individual at least, over an indefinite period. If we then take
Rachlin's position that "for a molar behaviorist extreme pain is
not an immediate sensation (deeply felt) but a long-term pattern
of behavior, widely performed, it would seem to follow that
according to molar behaviorists, a person maintained in a state of
relaxation over an extended period, especially if the period
begins in infancy, would not be in pain, certainly not in extreme
pain. It is to be hoped that no molar behaviorists become
surgeons, and vice versa.
As for pain behavior without suffering, Rachlin should give us
more on distinguishing real psychological pain from faking. The
distinction is straightforward, metaphysically if not epistemically, for cognitive or physiological theories of pain: In real
pain there is a suitable inner cause for pain behavior, while in
faking there is no such thing, and in consequence, with faking
there is no suffering, no literal pain.
But on the behaviorist theory, the difference must be found
on the outside. Now suppose, not a race of super-super-Spartans, but one of super-super-crybabies. Super-crybabies put on
a pain display in advance of any actual tissue damage or malfunction, thereby averting it. Super-super-crybabies do this as if
from deeply ingrained habit, spontaneously, without deliberation i.. conscious intent. But the "habit" was not formed in the
usual way; it is innate.
It would seem that a super-super-crybaby could pass its whole
life in complete comfort, yet be counted, on the molar behaviorist test of a widely performed behavior pattern, as in perpetual and extreme pain.
Fordyce's (1983a) therapeutic success is compatible with
physiological or cognitivist philosophies of pain; his patients
have formed a habit, but they are not faking. The habit is one of
feeling pain although organic causes have lapsed. And habits of
feeling can respond to treatments directed at their behavioral
manifestations.

Commentary/Rachhn: Pain and behavior

3. Timing the occurrence of pain. In "What is pain?" paragraphs 2-5 Rachlin discusses the situation of someone exhibiting extensive pain behavior but not right now showing any signs
of pain. Is this analogous to the case of a rat currently displaying
a certain rate of bar pressing even though quiescent right now?
He first suggests that a choice of definitions will settle the
question: pain defined as internal mechanism will distinguish
the two cases; pain defined as overt behavior will assimilate
them. But how pain is to be "defined" is not in any interesting
sense a matter of choice or decision. The question is whether the
phenomenon indicated by the normal use of the English word
pain involves more real elements than overt behavior. That is a
question of how the world is, not a matter of semantics.
By paying attention to the phenomenon of pain, we can, I
think, discover that the behaviorist position is mistaken. Thus:
Setting aside anxiety, embarrassment, and other nonpain sources of
discomfort; If I am neither displaying nor inhibiting pain behavior, I
am quite comfortable. If I am quite comfortable 1 am not right now in
pain. But if I am neither bar pressing nor inhibiting bar pressing, I
may still be displaying right now a certain bar-pressing rate.
This line of thought depends on common experience, or intuition, about the incompatibility of comfort and pain. Which
brings me to my last point: We must distinguish relying on
intuition for knowledge that some mental event occurs from
relying on intuition or introspection to inform us of that event's
nature. All developed theories of pain, especially nonmentalistic ones, must abandon the second kind of reliance. But only
behaviorism, whether molar or molecular, backward- or forward-oriented, must repudiate the first type. Therein lies its
weakness.

Whether a patient's perceptual world is in his mind, or in his

behavior, or in his nervous system, or does not exist at all, is less
important to an empiricist than the relationships between inputs and outputs. Behaviorism does not have a monopoly on
objectivity. Even a mentalistie empiricist is quite willing to say,
"I do not know whether morphine really reduced the pain
produced by these calibrated noxious stimuli, but I do know that
discrimination, determined by error rate, between higher and
lower intensities was decreased." Or, "I do not really know
whether the patient felt less pain, but he reduced his intake of
analgesics." For example, calibrated noxious stimuli or somatosensory, pain-intensity, and emotional descriptor words (input)
can be presented to an individual, and various types of judgments (output) can be obtained. These are then analyzed by
mathematical models such as signal detection theory (Clark &
Yang 1983) and multidimensional scaling (Clark 1984) to discover the subject's attitudes and the dimensions underlying the
pain response. Or specific cognitive coping strategies may be
taught and responses such as heart rate, gross behavior, and selfreports measured (Mischel, Fuhr & McDonald 1984). These
models lead to a far richer understanding of the complexities of
pain than does the behavioral approach.
Does pain behavior equal pain? If pain is in the behavior, what
happens when operant pain behavior and respondent pain
behavior are discordant? Hilgard (1969) reports that although
hypnosis succeeds in eliminating the report of pain (operant
behavior), the autonomic responses to noxious stimuli (respondent behavior) continue. Which behavior counts? Is the
subject in pain or not? The report of pain possesses both operant
and respondent characteristics, but behavioral analysis is not
the only means of distinguishing between them. A mentalistie
psychophysical approach may yield more information. For example, a number of studies using signal detection theory have
found that placebos, acupuncture, and suggestion cause
Heuristically, "pain" is mainly in the brain
changes in the location of the criterion for reporting pain.
W. Crawford Clark
However, they generally fail to find any effect on sensory
discriminability, an index of accuracy related to neurosensory
New York State Psychiatric Institute; Department of Psychiatry, Columbia
activity; this makes it unlikely that internal mechanisms mediatUniversity, New York, N.Y. 10032
ing pain have been influenced. Thus, these treatments change
How the purer spirit is united to this clod, is a knot too hardfor fallen the pain report criterion (operant behavior), while neural achumanity to untie. . . . How should a thought lie united to a marble tivity in some "pain center" (respondent behavior) remains
statue, or a sunbeam to a lump of clay! . . . to hang weights on the unchanged. Similarly, while behavioral therapy is an effective
wings of the winde seems far more intelligible.
treatment for certain chronic pain behaviors, the neural activity
in some "pain" center could nevertheless remain unchanged.
JOSEPH GLANVIU., (1636-1680)
Individuals with congenital insensitivity to pain appear to
What and where Is pain? I cannot agree with Rachlin and the present a problem for the behaviorist. From birth, these individuals fail to avoid noxious stimulation and do not experience
neobehaviorists that pain resides only in behavior. Neither
pain. However, with experience (including severe burns, abraphilosophers nor scientists know any more about how (or
sions, and fractures) they eventually learn to distinguish mild
whether) physiological activity is associated with mental images
stimulation from tissue-damaging stimulation and to avoid the
(if they exist), or why they appear to correspond with the
latter. Now that they exhibit pain avoidance behavior, should
physical world most of the time, than did Joseph Glanvill. I
they not also experience pain? Yet the evidence is that they have
agree with Rachlin that imaginary super-Spartans do not disnot learned a new dimension of sensory experience but have
prove behaviorism, that philosophical discussions of what pain is
only improved their ability to make distinctions along an intenlead us nowhere, and that we must therefore view the empirical
sity dimension (Clark 1984).
evidence. However, if pressed for a philosophical view an
What about individuals who exhibit pain behavior in the
empiricist would find Fodor's functionalism (1981a; 1981b), in
absence of any noxious stimulus? Are they in pain? Patients,
which a very complex computer could have thoughts and feel
particularly depressed patients, use the word pain to describe
pain, to be more congenial than a view that places pain in the
discomfort, misery, or anguish. In the laboratory, we find some
behavior of an organism, or in the behavior of a computer for
anxious subjects who report pain to a zero-intensity stimulus. If
that matter. The mentalistie physiological-cognitive model as
such behavior is equivalent to pain, the behaviorist must condescribed and dismissed by Rachlin has proven itself useful; it
clude that experimentally induced pain may occur in the abpromotes fruitful research and advances pain treatment. The
sence of a noxious stimulus. Surely it is more realistic to admit
sensory experience of pain cannot be proven to exist, but neural
that pain behavior may occur in the absence of a painful sensory
and cognitive processes that appear to be related to pain provide
experience.
a valuable heuristic. When research is undertaken or treatment
Finally, a problem is encountered in moving from the animal
is required, it is necessary to investigate all components of
model (where molar behaviorism appears reasonable) to human
behavior, including the physiological. The empirical evidence
behavior. Molar behaviorism defines a respondent or operant in
clearly demonstrates that most pains arc not the behavior of the
terms of correlated events rather than temporal contiguity
whole organism but appear in identifiable physiological
between environment and behavior. These two behaviors are
subsystems.
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

57

Commentary/Rachhn: Pain and behavior

differentiated on the basis of their history. This argument may
be acceptable in the instance of a laboratory animal whose every
bar press has been objectively recorded almost from birth;
however, it encounters difficulty when it is transposed to the
analysis of human pain behavior. Granted, "a rat in a Skinner
box may be said to be responding at a certain rate right now even
though the rat is not pressing the lever," but this is true only if its
entire behavioral history has been objectively recorded. Unfortunately the necessary objective antecedent behavioral measurements are not available in man. Without this detailed
history, recorded at the time it occurred, some form of internal
construct must be relied upon. For the analysis of human pain
behavior the molar behaviorist approach appears to be no better
(or worse) than a cognitive approach.
Can treatment outcome save the day for anyone? Treatment
methods based on various theoretical positions, from incantations to neurosurgery, have each had their share of success.
Thus, treatment outcome can neither prove nor disprove a
theory. Nevertheless, since the issue has been raised, it is
worthwhile to scrutinize the real world of pain treatment. Here
pain is very seldom "behavior of the whole organism." There
can be no doubt that behavioral treatments for intractable
chronic pain, such as those developed by Fordyce (1976), have
been quite successful in decreasing pain behavior and benefiting many patients who have failed with conventional treatment.
However, these cases represent a minuscule proportion of the
patients who are successfully treated for both acute pain and
chronic pain. Direct physiological intervention with respect to a
specific subsystem, rather than the whole organism, is extremely effective. The physician and the dentist treat the stimulus source or various parts of the neurosensory system, and the
pain disappears. A tooth is repaired or extracted, pressure on a
nerve is released, an unguent is rubbed on a burn, surgery
corrects a malformation, codeine relieves an earache, methysergide relieves migraine, aspirin relieves arthritic pain, an
anticonvulsant eases the paroxysmal pain of trigeminal neuralgia, and so on. Treatment is tailored to specific subsystems,
not to the behavior of the entire organism. Few practioners
would offer, or patients accept, behavior therapy for these pains;
indeed, to take a behavioral approach would be unethical in
most instances. When direct intervention fails, cognitive techniques may have more to offer than granted by Rachlin. A
summary by McCaul and Malott (1984) of recent evidence for
the effectiveness of cognitive strategies for coping with pain
concludes that pain behavior can be modified by purely cognitive interventions.
Neither philosophical arguments nor treatment outcome can
settle conceptual disagreements. The neobehaviorist position
results in two types of labeling errors: (1) labeling as not in pain
people who fail to display pain behavior but who have sustained
tissue damage, and (2) labeling as in pain people who display
pain behavior without tissue damage. Physiology and cognition
- as well as behavior - need to be included when studying and
treating the complex phenomenon of pain.
ACKNOWLEDGMENT
1 wish to thank Harriet Nerlove Mischel, Department of Psychology,
Columbia University, for her assistance in formulating and sharpening
this commentary.

On Rachlin's "Pain and behavior": A

lightening of the burden
Wilbert E. Fordyce
Rehabilitation Medicine and Pain Service, University Hospital, Seattle,
Wash. 98195

Rachlin and the neurophysiological and cognitive investigators

he cites seem committed, each in different ways, to presenting a

58

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

unified concept of what they seem to assume is a unified

phenomenon, namely, pain. In my view, pain is not such a
unified entity. What is subsumed under the rubric "pain" is a set
of events. Further, the borders of the "set" arc perhaps not
stable. The unification is in the eyes of the beholder. It is not
clear to me that there is any inherent reason to insist that "pain"
is some one thing.
I shall not attempt to analyze physiological or cognitive
perspectives - or pure mentalistic ones - on the subject of pain.
As a somewhat pragmatic behaviorist who is not above trying to
use cognitive methods clinically, I shall attempt to set forth my
own behavioral perspective on the matter.
Pa' behaviors are overt events that are likely to cause
observers to identify the person as having a "pain problem." No
assumption need be made about there having been, either at the
moment or in the recent history of the person, noxious stimuli
within or on the surface of the organism but peripheral to the
central nervous system that served as antecedent stimuli to the
pain behaviors. Pain behaviors are capable of occurring because
of anticipated consequences, immediate or remote. Those consequences are assumed to have been anticipated on the basis of
prior experience. Thus, conceivably, in a given person at a given
time, pain behaviors could spring forth de novo, in the sense
that no antecedent stimulus in the form of noxious stimulation is
essential to the emergence of pain behaviors.
That pain behaviors may occur de novo does not mean that
they often do, only that they may. There is present in most pain
patients compelling historical information indicating that there
has been at some time in the past an injury leading to thermal or
mechanical energy impinging on free nerve endings that in turn
activated A-delta and C fibers. That peripheral stimulation will
have, in the normal course of events, elicited a sensation that
people, when asked, are likely to identify as "pain." The presumed transmission of the peripheral stimulus to the CNS
provides a basis for concluding that there was - and may still be
- "pain." That "pain," whether measured in intensity or in
reactive terms, constitutes another set of events different from,
though potentially linkable to, pain behaviors. That "pain" is
likely to be followed by pain behaviors. When the pain behaviors do occur and are responded to by the environment, one can
begin to say that the person has a pain problem.
The basis for saying there is a pain problem is the occurrence
of pain behaviors. Pain behaviors occurring de novo, in the
sense described above, still constitute a pain problem. They do
not, however, constitute a pain problem that is linked to noxious
stimulation or, as is commonly stated, to "the organic factor."
In the practical case, a more typical pattern is that an injury
resulting in pain and restricted activity has, in the case of
chronic pain, led to disuse of the body parts involved. Muscle
and tissue fibers shorten and lose bulk, strength, or elasticity.
Attempts to use or move the body part then result in the
experience of "pain." The problem here is that both the suffering person and, all too often, the physician identify this "pain" as
indicating that healing has not occurred and that further immobilization is indicated. Further rest only worsens the problem.
This is basically a problem of failing to realize that hurt and harm
are not the same.
Whether modification of pain behaviors also modifies "pain"
is a moot question. It depends on what "pain" we are talking
about. Moreover, the modification of pain behaviors has merit
in its own right, irrespective of how much or how little pain
behaviors may correlate with some concept of "pain." This point
does not concern the debate about whether there is something
"inside" the person known as "pain." It merely indicates that
persons who undergo a treatment program resulting in reduction of pain behavior also show some other worthwhile changes.
They do more than they did before. They also have lower health
care utilization rates. There is ample basis for inferring that the
reduction of pain behaviors by activation and reduction of
analgesic consumption results in neurophysiological changes

Commentary/RacMin:
that may themselves alter "pain." But it is not necessary to
postulate such an effect. In my view, pain behaviors need not be
seen simply as extensions of "pain"; nor is it necessary to insist
that ncurophysiological or cognitive events assigned the label
"pain" must exist in order for pain behaviors to occur.

Radical behaviorism is a dead end

Jeff Foss
Philosophy Department, University of Victoria, Victoria, British Columbia,
Canada V8W 2Y2

What is Rachlin up to? He evenhandedly dishes out criticism to

all three major theories of pain, but he refuses to explicitly pick a
favorite among them, concluding merely that, as regards the
question "Which theory is best?" the answer is, "The jury is still
out." But if we assume that Rachlin intends more than a
derogatory review of pain theories, and if his behavior is ruled
by his principles, then he is in favor of a radical behavioristie
theory of pain. I will argue briefly that the theory Rachlin
promotes is grossly unrealistic and that the behaviorist fundamentalism it expresses is uncalled for.
Rachlin says, "The question we ask here is whether a purely
behavioral theory of pain makes sense." If by "makes sense" he
means merely "has the logical possibility of being true," then
the answer to his question is yes, though the question is rather
silly. Manifestly false theories, like Ptolemy's or the alchemists',
make sense in this trivial way: since they are not self-contradictory, they at least have a meaning - all consistent theories are
true in some possible world, if not in this one. On the other
hand, if by "makes sense" Rachlin means "has a chance of being
true in the actual world," then the purely behavioral theory he
champions makes no sense at all.
The theory, adumbrated, is that pain is a sort of behavior.
What sort? Pain behavior - we uneasily (if not painfully) await
Rachlin's account of how such behavior is to be noncircularly
defined. A little more fully, "sensory pain is respondent behavior, and "psychological" pain is operant behavior. What about
the person who feels pain but is not now evincing pain behavior?
Well, answers Rachlin, that person, despite appearances, is
pain-behaving in the operant sense, the sense in which, "a rat in
a Skinner box may be said to be responding at a certain rate right
now even though the rat is not at this very moment pressing the
lever." Those pains which never evince behavior, Rachlin is
prepared to dismiss as illusions. By these artifices the fundamentalist behaviorist does not, at least, contradict himself- his
theory makes sense in the weaker of the two ways outlined
above. But it is well known among historians and logicians of
science that an empirical theory can be recast in indefinitely
many forms, some of which secure both internal consistency and
peaceful coexistence with the evidence to date. Joseph Priestley's book The Doctrine of Phlogiston Established, published in
1800, well after rapid oxidation had been accepted by chemists
as the true nature of fire, demonstrates that even very sharp
scientific minds can pronounce a cul-de-sac the broad highway
to truth. The final downfall of a theory is sterility: Lavoisier s
new chemistry went on to new triumphs while phlogistic theory
stagnated. Given that it is obvious that neurophysiological
mechanisms mediate and produce behavior, to abjure and
ignore such mechanisms in pursuit of a "purely behavioral"
theory of consciousness is to purchase ideological purity at the
expense of truth.
A curarized subject undergoing dental work without anesthesia experiences painful sensations. Rachlin could try this for
himself: Since subjects could report the pain after the curare
wore off, they would have experienced "psychological" pain
according to Rachlin s theory. These results are indefinitely
replicablc. Now note that a subject could be kept curarized for

Pain and behavior

life after the dental work, thus never evincing pain behavior.
Only someone with a dull axe to grind would insist, contrary to
all of the evidence available from the replicable eases where the
subjects are finally de-curarized, that the permanently curarized subject feels no pain - yet Rachlin does so insist. He takes
the trouble to accommodate the folk-theoretic belief that one
may be in pain now while not now evincing (respondent) pain
behavior, by using the device of operant behavior: Even while
curarized, the subjects are pain-behaving at a certain rate, given
that they will evince pain behavior when de-curarized. But why
bother to make this accommodation? If he is willing to ride
roughshod over the belief that the permanently eurarized subject (or the one who dies before the curare wears off, etc.) feels
pain, why not simply derogate all pain reports whatever? If
behavior is all there is, why even bother to try to specify some
sort of behavior that corresponds to the folk-psychological notion of pain, especially given that according to such notions pain
is quite distinct from behavior of any sort? Even the consistency
Rachlin purchases is merely logical, as is evidenced by its
uncomfortable fit both with extant theory and with the facts.
What could be Rachlin's motive in this exercise? Hull, Watson, and Skinner promoted behaviorism as a methodological
prophylactic for psychology against the unscientific procedures
used in psychoanalysis and other introspective studies. They did
not, as Rachlin himself notes, deny the reality of the internal
mechanisms and processes that make behavior possible. Rachlin
is concerned to eschew such mechanisms and processes because, as he says, such tilings "are physiological or cognitive
concepts, not behavioral ones. ' So what? The existence of such
internal mechanisms and processes is indubitable. And truth is
preferable to ideological purity.

On kicking the behaviorist; or, Pain is

distressing
Myles Genest
Department of Psychology, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada S7N 0W0

I fear that Rachlin would be well advised to guard his shins. I, of

course, am not a violent person. Nevertheless, the temptation
to kick the behaviorist to which Rachlin refers is born of frustration, and parts of his paper exemplify the stubbornly held views
that non-radical-behaviorists find so trying. These views dominate the second half of the paper; but before pursuing them, I
will briefly address two other points.
First, I concur with Turk & Salovey (commentary in this
issue) that Rachlin has completely misrepresented the cognitive-behavioral approach presented by Turk, Meichenbaum,
and Genest (1983).
Second, Rachlin's division of pain into two types is an oversimplification. Rachlin believes that there are two distinct kinds
of pain. The first he calls "sensory pain, " and he asserts that this
kind of pain by itself includes no distress, no anguish, no
emotion: "In these instances people commonly say that the pain
exists but does not bother them"; and again, "the pain is there, is
intense, but is not aversive." (Notice that he is not referring to
simple sensations in these instances - heat, cold, etc. - but to
"pain.') The "bother" or "aversiveness" Rachlin includes as a
separate kind of pain, which he calls "psychological." The
arguments advanced for this dichotomy are specious and superficial. The two-component model is introduced as following
primarily from anecdotal reports that people can separate pain
from its bothersomeness. Such reports suggest the existence of
an interesting phenomenon, but the readiness of a behaviorist to
take them at face value is puzzling, especially in light of evidence, which Rachlin himself cites, that people are frequently
inaccurate in such introspective accounts (e.g., Nisbett &
Wilson 1977).
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

59

Coinmentan//\{i\ch\m: Pain and behavior

As support for the sensory/psychological dichotomy, Rachlin
describes Tursky, Jamner, and Friedman's (1982) intensity and
reaction scales. He notes that the "intensity and reaction scales
are separable and seem to correspond to the two components of
pain discussed previously. " The mere measurability of two
separable components does not indicate that they mean what
Rachlin suggests they do. If subjects are asked to report separately the "intensity" of pain and their "reaction to it using
scales with intensity-related and aversiveness-related adjectives, respectively, what might their reports on these scales
indicate? Faced with having to report separate components, it
seems plausible that subjects might look to the intensity of the
sensation (e.g., heat, cold, pressure, or whatever is concurrent
with the pain) as a means of providing intensity reports. They
might, in other words, use the "intensity" scale to report the
intensity not of the pain but of the physical stimulus, as reflected
in simple sensation (which pain is not). The "reaction' reports,
on the other hand, might actually be reports of pain intensity
(which is, of course, not the same thing as sensation intensity).
Or the reaction reports could be primarily reports of affect, or a
combination of affect and motivation. There are several possibilities besides Rachlin s sensory and psychological pain dichotomy. The requisite validity information to choose among
them is not available.
The most compelling argument against the use of the sensory/psychological dichotomy is the straightforward issue of definition: "Pain" means an aversive or distressing perception. To
speak of pain without anguish - affeetless pain - is to stop
speaking about pain. Affect, motivation, belief, and other psychological factors play a role in pain. Their role is, however,
integral to all pain, not to one type.
But to get back to kicking the behaviorist, it is the final portion
of Rachlin s paper that is particularly troublesome. Rachlin's
central position here is that pain equals certain overt behaviors
of the whole organism. This position necessitates a rejection of
the integrity of the statement "I can feel pain without behaving. "Behaving" refers to overt behavior here, since Rachlin
repudiates previous behaviorists' inclusion of internal or covert
events in behavioral theories. The point is, according to
Rachlin, that if someone is to claim, credibly, that he is in pain,
he must be evidencing overt, observable pain behaviors.
Rachlin says "I can feel pain without behaving' is analogous to
"the moon is larger when it's on the horizon than when it's high
up in the sky." It appears he is suggesting that the person
"feeling" but not "showing" pain is simply in error. This statement about pain, Rachlin implies, like the moon watcher's
statement about the size of the moon, is mistaken, based on
faulty evidence. Presumably, the rig/it evidence would be only
overt behavior. So that if one wishes to determine accurately
whether he is in pain, he should do something like look in a
mirror to determine whether he is showing behavioral signs of
pain: grimaces, a limp, clutching, and so forth. The absurdity of
this seems patent to me, but since it must not be to Rachlin, let
me go a step further.
Apparently, Raehlin's position denies one's ability to label an
experience such as pain correctly from internal cues. Yet there is
evidence that people can and do use cues unavailable to observers in judging their states. For example, it has been found that
subjects can make extremely accurate judgments about their
level of alcohol-induced impairment when they attend to internal sensations (Mann, Vogel-Sprott & Genest 1983; McCollam,
Burish, Maisto & Sobell 1980). (Subjects in these studies were
unable to distinguish a glass of real alcohol and mix from a
disguised placebo, and therefore could not have been using
amount of alcohol consumed as an external cue.) In a similar
vein, one can use entirely internal cues to make claims about
ones myopia. In these instances, the judgments of individuals
can be verified by objective data concerning alcohol digestion,
or measurements of the eye, respectively. Similarly, pain patients use internal information to rate their pain, and their

60

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

ratings are frequently highly discrepant from those of observers

(Lenburg, Glass & Davitz 1970; Teske, Daut & Gleeland 1983).
Reliable observer judgments account for only 10-16% of the
variance in chronic and acute pain patients' self-reports (Teske
et al. 1983). Is one then to conclude that patients are largely
mistaken about their own pain levels, that trained observers
know better? If one can judge alcohol impairment accurately
from internal information, why should it not be possible to judge
pain similarly? Or is one not really impaired, or not really
myopic, or not really in pain, unless others verify it from
observable, overt behavior?
ACKNOWLEDGMENT
The author thanks John Mills, lor his enthusiastic discussions of these
issues and suggestions concerning a draft of this paper, and Glenn
Pancyr, for his helpful comments.

Pain's composite wheel of woe

George Graham
Department of Philosophy, University of Alabama, Birmingham, Ala. 35294

In his target article Howard Rachlin defines a thesis he calls

"behavioral theory for pain and argues that it is compatible
with alleged counterexamples to the identification of pain with
behavior. He contends that, with some refinement, the following is true:
(R) S is in pain = S pain-behaves.
Rachlin denies that being in pain means that one is pained (or
that there is a pain) in one. In addition to (R), he holds that
(Rl) Pain behavior is overt.

(Rl) can be separated from (R). A behavioral theory for pain

does not have to restrict itself to overt behavior (see Graham
1982). And it shouldn't restrict itself to overt behavior. This is
because pain includes a sensory component that takes place
beneath the skin. It feels like something to be in pain, and such
feelings are neither identical with nor always displayed in overt
behavior.
Rachlin recognizes that pain includes a sensory component,
holds that the component is (respondent) behavior, but, oddly,
does not admit that the sensory component occurs beneath the
skin. The sensory element of pain is not incompatible, he says,
with (Rl).
In certain respects, restricting pain to overt behavior is sound
adaptationist thinking (see Dennett 1983). To an extent, pain is
simply a mechanism for keeping creatures alive, and this requires appropriate injury-avoiding movements of the whole
organism. It requires overt behavior. However, there remains
room for multiple adaptive strategies, and some of these allow
for pain or part of pain to take place beneath the skin. This sort of
point can be made quickly by comparing pain with digestion.
Digestion is adaptive and leads to movements of the whole
organism, but it is not overt. Digestion is not some fifth wheel.
But this does not mean that digestion is some sort of spatial
reorientation of the whole creature.
In general, pain should make a difference in movements of
the whole organism. But this goal can be satisfied by pain's
sensory component occurring beneath the skin.
The idea that the sensory component of pain is overt behavior
is unpersuasive, though motivated by the intelligent desire to
avoid thinking of pain as some sort of fifth wheel. Persuasive or
at least extremely suggestive, however, is Raehlin's additional
thesis that pain contains both respondent and operant components. Philosophers sometimes distinguish between sensory
and aversive components of pain or between pain qualia and
attitudes directed toward pain qualia (Graham & Stephens 1984;
Thomas 1978). Raehlin's hypothesis is that this distinction
should be understood in terms of the distinction between
respondent and operant behavior. This suggests the following

Coimnentary/Rachlin: Pain and behavior

analysis of pain. Pain includes a sensory component that has
quality and magnitude. We are all aware of variations in the
magnitude of our pain. We feel certain pains strongly or mildly,
deeply or slightly. This quality of pain is respondent behavior.
The magnitude or intensity with which a pain will be felt is not
affected by the consequences of the feeling. It also cannot he
brought under voluntary control. According to this view, I will
take my pain to have a certain magnitude even if, for example, I
have been threatened with death for doing so; or even if I have
been punished for feelings of that magnitude.
The aversiveness of pain constitutes a second component of
pain; or in related terms, the desire to avoid or withdraw from a
source of painful stimulation is a second component of pain. This
aversiveness, desire, or tendency to withdraw is operant behavior. The tendency can be manipulated by manipulating its
consequences. We wish to withdraw if we have been reinforced
for doing so. We will not wish to withdraw if we have been
punished for doing so.
There is a widely prevalent view of pain that conflicts with the
view suggested by Rachlin. This is the idea that sensory and
aversive components of pain cannot be distinguished. We cannot measure the magnitude of pain independently of the state's
being more or less aversive. Aversiveness and intensity compose a single dimensional quality. Rachlin plausibly interprets
the studies of Tursky, Jamner, and Friedman (1982) to disconfirm the prevalent view. It is not that, like pleasures, pains are
unaversive; the aversiveness of pain is essential to pain. It is
rather that aversiveness is not all that there is to pain. In
addition to pain's aversiveness, pain feels to us to he more or less
intense, and this feeling and pain's aversiveness do not necessarily covary.
It is worth noting that Rachlin's contrast between respondent
and operant components in pain can be interpreted independently of the idea that they are behaviors. For those unattractcd
to calling the sensory-feeling component "behavior, " Rachlin's
contrast can he read as a contrast between elements of pain with
distinct behavioral properties. Pain's qualia are unmoved by
consequences. Pain's aversiveness is affected by consequences.
Rachlin's contrast is also more general than he makes it
appear. The method of distinguishing between respondent and
operant features of pain promises to capture precisely how much
mixture there is in other bodily sensations as well as certain
emotions. Consider being afraid. Normally we distinguish between the feeling of being afraid (fear) and other responses
involved (such as the tendency to escape). Suppose we reinterpret this distinction as a distinction between respondent and
operant elements of being afraid. The reinterpretation postulates that we should find some elements (e.g., the tendency to
escape) to be susceptible to operant conditioning, and other
elements (e.g., the feeling) to be immune to such conditioning.
Furthermore, we should expect people to report that changes in
the magnitude of the feeling are not (always) matched by
changes in the tendency to escape. (Fans of horror movies
sometimes report having intense feelings of fear hut no desire to
leave the theater. Quite the contrary: keeping one's eyes on the
screen is reinforcing.) Emotions such as fear as well as bodily
sensations (such as those involved in perceptions of heat and
warmth) might have ingredients of this sort. Philosophers have
been attracted to viewing emotions and various sensations as
composites. Rachlin's reference to behavioral properties offers
possible empirical confirmation of these interpretations.
This is not the place to refine Rachlin s contrast among the
various kinds of states to which it may apply. But I should
mention that I may have distorted Rachlin s view of the composite nature of pain to the point at which he would no longer
regard the view as his own. He states his view as a view of
behavior. I state his view as a thesis about pain qualia and
attitudes directed toward those qualia. He also states his view as
having various inspirations in the behavioral literature on pain. I
state his view as having a contribution to make to the philosoph-

ical literature. My view of his view may not be his view of his
view. Yet I have the pervading sense that if his view is to gain
appropriate acceptance it should be the view I attribute to him.
Respondent feelings; operant behavior. It's a powerful idea.

Is pain overt behavior?

Gilbert Harman
Department of Philosophy, Princeton University, Princeton, N.J. 08544

Behavioral theory considers both sensory and "psychological" pain to

he overt behavior. . . .
RACIII.IN, p. 48

Once, when I was a boy, I pretended to have caught my hand in

the crack of a door in order to deflect my parents' attention from
an embarrassing line of questioning. I yelled and jumped
around a bit. In fact, I had not caught my hand in the door and
was in no pain at all. Did I engage in "pain behavior"? If not,
why not? If so, does "behavioral theory" imply, falsely, that I
was in pain?
When I was somewhat older, I occasionally got very severe
headaches which seemed unaffected by aspirin, so I learned just
to wait them out. I do not believe I ever mentioned them to
anyone or behaved differently in any way from how I would have
behaved without a headache. More recently, I have learned that
the headaches are connected with sinus congestion and can be
relieved by taking a decongestent or by inhaling water vapor.
Before I learned this, was there overt "pain behavior" of mine
associated with these headaches? If so, what behavior? If not,
does behavioral theory falsely imply I was not in pain when I had
the headaches?

Sensory pain and conscious pain

Julian Jaynes
Department of Psychology, Princeton University, Princeton, N.J. 08544

It is widely agreed among clinicians treating pain problems that

there are at least two kinds of pain, although what pain phenomena fit into which category is not entirely settled. The
categories are usually referred to as acute and chronic or
nocioceptive and psychological or, as in the present paper,
sensory and operant.
Professor Rachlin has written an exciting and stimulating
paper. It is particularly commendable because he has been able
to spread his argument so as to bring together experimental
psychology and the best of modern philosophical thinking. But
the two main questions, I think, need further exploration.
Is chronic pain an operant? In street language this means that
chronic pain is always fulfilling some purpose of the patient,
either getting sympathy or a pension, avoiding work or war,
reenactinga hurt-child-caring-parent relationship in surrogate,
getting noticed by nurses or family, feeling important with
important-sounding medicines, or, as emphasized in the paper,
obtaining medication, particularly narcotics. It should be pointed out here, of course, that all such explanations in human
patients are interpretations after the fact. There is no experimental evidence that this is the case, although I would agree
with Rachlin that it often seems so.
A recent study should make us worry about oversimplified
interpretations, however. In the burn unit of the Harborview
Medical Center in Seattle, Dr. Alan Dimick has tried a selfadministered morphine procedure. Instead of receiving from
the nurse the standard dose of 2-4 milligrams every 2-4 hours,
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

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CommentarylRaclnUn: Pain and behavior

the patient pushes a button to receive the drug. As Dr. Dimiek
states the results,
We are finding that if the patient is allowed to push the button and get
his own dose of morphine, the patient usually pushes the button lor a
lesser amount of drugs than if the physician orders it or if the nurse
gives it. And this method provides a much better pain control.
(Dimiek as quoted in Driver, 1984)

I think this shows that what the patient is feeling is a combination of sensory pain and anxiety, and what is reduced by selfadministration is the latter. It is well known that feelings of
control over pain diminish it (Bowers 1968). At any rate, it is not
exactly what one would expect on the operant model.
There is also a logical fallacy here. The fact that operant
training, as in the Fordyce therapy, 1 reduces pain is an important and welcome result, but it does not therefore follow that the
pain was an operant in the first place. Because an alternative
behavior can be learned does not mean that the original behavior was learned as well. For example, adaptation to a sensory
stimulus that produces an innate response is indeed a form of
learning, but that doesn't mean that the original response to the
stimulus was learned. What is needed to make the point is a
controlled laboratory experiment in which an introspectively
real pain in a normal subject is learned in order to obtain some
future reinforcement.
Is pain merely pain behavior? The central difficulty for most of
us with Rachlin's courageous position is his insistence that pain
is pain behavior and nothing else. As Rachlin understands it,
most of us wish to say that there is a sensory pain and then our
conscious reaction to it, and that psychological pain is at least an
event that goes on in consciousness (where the word "in" is to be
taken metaphorically). Indeed, if Rachlin wished to incorporate
consciousness (or a theory of private events) in his perception of
the pain problem and agree with me that consciousness was
learned on the basis of language at a particular point in history to
obtain very specific consequences (see Jaynes 1976), then he
could call consciousness an operant (and correctly so), fitting
consciousness into neobehaviorism in a consistent way. In
animals pain is pain behavior, but in humans every sensory pain
has its analogue in consciousness as what can be called conscious
pain. And then he could merge the concepts of operant pain and
conscious pain.
But for this to work out to explain some of the data, the
referents of that cardinal term reinforcement, wide enough as
they already are, would have to include reinforcement by other
conscious analogues, particularly ideas of the conscious self.
Then we could speak of intrinsic reinforcement by emitting an
operant that is consistent with some preconceived notion of who
one is in various senses. So successfully functioning healthy
individuals maintain their good behaviors as such behaviors are
constantly being reinforced by consistencies with good and
reasonable self-images - as consciousness of their own behaviors
tell them, something that can only happen with consciousness.
On the other hand, patients with what most of us might think of
as detrimental behaviors such as pain or neurotic symptoms may
learn or maintain their distressing symptoms when those symptoms are reinforced by some long-learned though perhaps
erroneous self-conception.
Phantom pain. Such a possibility would greatly expand the
pain data that Rachlin could explain. The problem of chronic
pain in amputated limbs or occasionally in breasts after mastectomy and sometimes even in teeth after multiple extractions is
an example. Almost all amputees experience some phantom
limb sensations. Even Lord Nelson when he lost an arm in a
naval engagement at Tenerife wrote back to a friend that he
could still sense his missing arm, and he took this as evidence for
the existence of his eternal soul - a considerable conscious
reinforcement. 2
In recent times, approximately half of amputees have phantom limb pain of some kind and of varying durations. It is more
severe in youth (though absent in infancy) and roughly propor-

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

tional to the duration and intensity of suffering before amputation. Others usually have phantom itching or cramps. To me it
seems clear that this has something to do with consciousness of a
body image, perhaps a denial that anything is missing in the
great wish to be whole again. I recently interviewed such a case,
which I think is of sufficient interest to mention here. 3
Seven years ago, B.W., then 30 years ol age, ol high school
education, was pushing a stalled car on the highway when a following
car crashed into him. He was next conscious of his right foot and ankle
being close to his right eye, and wondered what they were doing
there. His pain then began. Some hours laterat the hospital, surgeons
first tried to save his leg but then had to amputate it just above the
knee. Recovering from the anesthetic and told that his leg had had to
be amputated, he denied that this was so, claiming he could still
wiggle his toes and feel himself doing so in the absent leg. Two months
later, because of complications, he had to have a second amputation
just below the hip. He then made a complete recovery, both physically and psychologically. Presently he is well employed and is an
avid amputee athlete taking part in their Olympics. He also counsels
other amputees during their recovery.
But ever since his own amputation, beginning at the hospital, he
has had phantom pain. This consists of a series of 10 or 15 sharp
jabbing pains in the ankle or sometimes the arch of the amputated leg.
At first such series occurred quite frequently, but now after seven
years he may go for a month without pain, followed by a month when
it happens almost every day. The pain is as severe as originally,
perhaps waking him up at night, or while he's sitting down.
His wife, who is in therapy for anxiety attacks that on the surface do
not seem to be related to her husband's problems, was also interviewed. She stated that during the attacks, "he almost passes out, is in
a cold sweat, sometimes almost jumping off the couch with it. The
wife seemed to exaggerate the pain of her husband while the husband
spoke about it in a matter-of-fact way, not being particularly interested in any therapy for his phantom pain.
A possible operant scenario could be constructed, perhaps, that the
husband's problems with his amputation were keeping the couple
together, that his pain was being reinforced by his wife's concern,
perhaps contributing to her own problems. But on further questioning, he revealed something that neither husband nor wife had
realized before, that his attacks of phantom pain occurred only when
his prosthesis was unattached.

While an operant explanation is possible for this particular

case, it could not be complete without consciousness and the
importance of a whole body image. This then would allow
phantom pain to fit into operant terminology, particularly when
one remembers the denial and the wiggling of toes with which
his recovery began. It is as if having taken off his prosthesis,
B. W. is reminded that he does not have a whole body. And then
occasionally later, as if he were asking himself like an unbelieving child, "Have I really lost my leg?" the phantom pain, as an
emitted response, is proof for a few minutes that the leg is still
there, the momentary consciousness of which is the reinforcement. Thus, through seeing consciousness an operant, these
phenomena could be included in an operant explanation.-4
But when I consider some of the extreme debilitating forms of
chronic pain, such as phantom pain in some paraplegics or after
avulsion of the brachial plexus, I have to part company from
reinforcement ideas. Such pain seems far too severe for an
operant theory to deal with.
An alternative view. I would like to suggest a slightly different
categorization that sorts things out in a way different from acute
versus chronic or sensory versus operant. I would propose the
distinction I have mentioned above between sensory pain and
conscious pain. Animals and early humans had sensory pain. But
with the advent of consciousness around the beginning of the
first millennium B.C. began sensory pain plus its analogue in
consciousness, which complicates all pain with anxieties, depressions, hopelessness, anger, memory flashbacks, and feelings of attack upon the conscious self. And this is complicated by
the evidence that sensory pain can be delayed or even abolished

Commentary/\{a.ch\in: Pain and behavior

by consciousness - evidence that the gate-control theory would
explain in a different way. This new type of pain and pain control
develops in history at the same time as there are large changes in
the nature of emotions (Jaynes 1982). Pain in the conscious
human is thus very different from that in any other species.
Sensory pain never exists alone except in infancy or perhaps
under the influence of morphine when a patient says he has pain
but docs not mind it. Later, in those periods after healing in
which the phenomena usually called chronic pain occur, we
have perhaps a predominance of conscious pain.
Recruitment. But consciousness is not something floating
above and apart from bodily physiology; it is part of it and
constantly interacting with it, although we are not even close to
understanding its neural substrate. One of the phenomena of
consciousness is called recruitment, as when, for example,
someone fantasizing about sexual behavior will thereby occasion
physiological responses in erectile tissues, which then continue
to recruit other physiological responses together with hormonal
changes, the feedback from which keeps cuing the fantasy until
it is difficult to turn conscious attention to other things. The
process is similar in pain. Consciousness of pain, cued by a host
of emotional and situational and hormonal variables, recruits
sensory pain until it is difficult to turn attention away.
A common example is a patient saying that on awaking in the
morning he is free of pain. But as soon as he thinks about getting
out of bed, the pain begins. Then he remembers that he is ill,
that he doesn't feel well the way he used to. And once out of bed
he may experience low-intensity pain until the phone rings, at
which time there is a sudden dramatic increase.
Or a woman who finds a lump in her breast and worries if it is
cancerous. She may. suddenly feel pain in the breast that may
then increase in severity and even spread to the shoulder and
arm over time. Later, if her physician assures her that the lump
is of no consequence, there is usually a sudden total relief from
the pain (Melzack & Wall 1983, p. 247). In this view, the
difference between acute and chronic pain resides in the different ratios of sensory and conscious pain as well as their instigation. Thus the dichotomy could be sensory-instigated for acute
pain and consciousness-instigated for chronic pain. So by changing consciousness through imagery or other means, one should
be able to decrease the latter.
Predictions. If this is the case, then certain dramatic predictions follow. If consciousness was learned sometime after 1000
B.C. (as I argue, Jaynes 1976), there should be no evidence of
conscious pain or chronic pain in texts around or before that
date. Indeed, in ancient Proto-Indo-European (before 2000
B.C.) there is no word for pain or hurt at all, although there are
words for wounds and cuts (American Heritage Dictionary,
Appendix). And in the old part of the Iliad, written down about
850 B.C. hut relayed by oral tradition from earlier times, there
are extremely gory descriptions of bloody woundings and terrible disembowelments, but hardly any notice of discomfort so
caused. Rachlin is right for ancient Troy: Pain is merely pain
behavior. In contrast, one should look at Plato's Philebus of
about 350 B.C. for a quite modern-sounding discussion of pain
and suffering (as well as a remarkable description of itching
beginning at 46D).
Also, neither chronic pain nor phantom limbs should appear
in infants before the age of about three, when consciousness
begins to be learned. There is some evidence that this is true
(Simmel 1962). Also, in subhuman animals there should be no
chronic pain and no phantom limbs: Before the present proliferation of veterinarians, one used to see three-legged dogs
often, but I know of no observations of such a dog turning to lick
or nibble the absent leg, as would a normal dog with a hurt leg.
How does conscious pain generation work? Probably in many
ways. Association and recruitment is the most obvious. Perhaps
language is also a medium of such unfortunate learning. The
patient asks himself, do I still hurt? and back comes the pain
with such immediacy. In fact, I suggest that that is precisely

what it is, Pavlovian conditioning rather than opcrant conditioning. In the period of sensory-instigated pain, sensory pain
produces conscious pain. But sensory pain is being paired with
verbalizations, such as the statement "I hurt." So that later such
a verbalization, even in monitoring form, produces the conscious pain response, which then could be followed by recruitment as well as perhaps being maintained by the opcrant
reinforcements mentioned by Rachlin.
If this is so, we can see why Fordyce, at least in his original
study (Fordyce et al. 1968), did not ask his improving patients
whether they still felt pain, since that is precisely the kind of
question and solicitousness that his opcrant training is trying to
abolish. It is a Heisenbergian situation. And yet that still
remains the question to which most of us wish to know the
answer.
NOTES
1. For a critical review of Fordyce and other operant techniques in
the treatment of pain, (as well as a masterly review of the entire subject)
see Melzack and Wall (1983) 333-37.
2. Nelson also lost an eye but never reported on whether he sensed a
phantom eye. I once knew a gaunt elderly blind man who roamed
around Wiltshire with the help of a young boy. Both eyes had been
enucleated. One morning he leaned over to me, stretching open one of
his empty sockets witli his fingers, and said, "You see - they're growing
again! Just about the size of pearls! I saw them in the mirror this
morning. I suggest this is an instance of phantom anatomy and its
substantiation by "sensation.
3. I met with these patients in my capacity as a consultant with the
Richmond Center of Charlottetown, Canada, directed by William
Lawlor. I am grateful to Dr. Wayne Matheson for discussion on this
problem, as well as to Dr. Frank Wheelock of Boston.
4. I should point out that there is an alternative, more sensory
explanation to the case of B. W. without his prosthesis. This is that the
tactile stimulation around the stump with his prosthesis on could
possibly have eliminated the phantom pain. While there is no evidence
that such mild tactile stimulation can function this way, there is evidence that vigorous vibration (Russell & Spalding 1950), or pounding
the stuinp many times as was done a few decades ago (on the theory that
"the nerves would wear out"), or electrical shock to the stump (Wall &
Sweet 1967) bring relief from phantom limb pain in some cases. Perhaps
such violence provides an insistent reminder to some deep level of
consciousness that the limb stops there. In any case, this phenomenon of
relief of phantom limb pain by a functional prosthesis has not, to my
knowledge, been reported before and should be researched.

Chronic sensory pain

Patricia Kitcher
Department of Philosophy, University of Minnesota, Minneapolis, Minn.
55455

The target article raises four different considerations that might

support a behavioral theory of pain. Rachlin offers a possible
function of pain - the "fire alarm " theory - that would make it
natural to think of pain as overt behavior. He reports some fairly
impressive results from behavioral therapies for long-term pain.
The fact that infants naturally and invariably respond to injury,
hunger, and scary stimuli by crying or whimpering lends credence to the idea that pain involves reflex elements. And there
is a pretty good fit between the properties of sensory pain and
respondents. Like respondents, sensory pain is fairly constant
across subjects and across times.
The function argument. I do not think that Rachlin intends this
loose discussion to bear much weight. My point is that it cannot
bear any weight. The suggestion is that pain has a certain
function as a fire which demands immediate response and only
belated criticism. If this function story is accepted, the identification of pain with behavior seems quite natural. Covert fire
alarms would be an evolutionary mistake. But this kind of
storytelling has no probative value. The data Rachlin explains by
reference to this supposed function admit of obvious alternative
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8 1

63

Commentanj/RacMin: Pain and behavior

explanations; for example, in eases such as the sports injuries
cited by Rachlin, what compels immediate attention is the
presence of an injured player. Pain is not the "fire alarm ; the
injury itself is what compels the aid of observers. (Think of cases
where the player is unconscious.)
The argument from therapy. Rachlin reports that behavioral
therapy has a good success rate with psychological pain. As he
presents this material, however, it does not provide support for
a behavioral theory against its rivals. Physiologists will point out
that morphine docs a very nice job of suppressing pain, so that
should be evidence that pain is some physiological condition.
(That morphine is addictive and progressively less effective
undermines its utility as a long-term solution to chronic pain. It
does not impugn the evidence that pain may be a physiological
condition because it can be affected by chemical intervention.)
A cognitivist will reply that the dramatic changes in surroundings will affect the cognitive economy of the pain sufferer, so that
one does not really know whether changing the contingencies of
reinforcement alters the cognitive structure, which in turn
alleviates the pain. Raehlin's presentation of Fordyee's methods
lends some credence to this move. One of the crucial steps is
record keeping so that the relation between pain behavior and
reinforcement, of which the patient is usually unaware, is made
more "vivid to him.
Infants and respondents. Skinner distinguished respondents
from operants by two criteria, temporal order and the flexibility
of the behavioral response. Respondent behavior is fixed and
"natural." Respondent conditioning is just a matter of .stimulus
substitution. Skinner appealed to these features of respondents
to motivate the need for operants, which are extremely plastic
(Skinner 1953, chaps. 4-6). Unlike psychological pain, sensory
pain does not seem to be very plastic. Infantile responses to
noxious stimuli have a reflexive character. So, separately, these
considerations lend some support to the behaviorist identification of sensory pain with respondent behavior. When conjoined, however, these considerations cut against each other.
Rachlin tries to defend the behaviorist theory of sensory pain
by taking on a favorite philosophical foil, the super-Spartans. I
think he should be more worried about an extraordinary Viennese. Unlike the patients whose recoveries from chronic psychological pain Rachlin describes, Freud's chronic pain was
sensory. So on the behavioral theory, we should be dealing with
a respondent behavior. But Freud's reaction to the pain in his
jaw was nothing like the tearing reflex in the presence of onions,
to use one of Skinner's paradigms. Even if Ernest Jones exaggerates his hero's stoicism, it is probably true that Freud spent
little of his sixteen-year battle against cancer crying and whimpering (Jones 1961, e.g., p. 529). The behaviorist can deal with
this case in one of two ways (or by a combination of the two). The
claim could be that besides crying and whimpering, babies
make other overt responses to injury, hunger, and so on. Then
the claim might be that these respondent elements are present
in the behavior of an adult stoic dealing with painful stimuli. The
other move would be to suggest that, with maturation, one
reflex response to painful stimuli is replaced by another. So,
with infants, the respondent behavior is crying and whimpering;
in adults, the respondent behavior is some more subtle but still
detectable pattern.
Rachlin's discussion implies that he would take the latter
course. This is fine, but now one wants some account of the adult
respondent behavior. Departing from Skinner's molecular behaviorism, Rachlin would claim that Freud might be responding
to a painful stimulus even though he is not doing anything right
this minute. Still, whatever the adult reflex is to painful stimuli,
Freud should have engaged in this behavior with increasing
frequency as his cancer grew worse. What could it be? To match
the characteristics of sensory pain, there should be some uniformity across subjects and across time. This does mean that
everyone must make exactly the same response to painful
stimuli, but something should be constant, perhaps the rate of

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

responding. What I find unpersuasive about Rachlin's presentation of this theory is that there is no attempt to specify what the
respondent is, even though it must be overt behavior. Overt
behavior can still be quite subtle, something like gazing into
middle distance, changing fixation, fidgeting mildly, or engaging in a subtle repetitive motion. Behaviors of these sorts might
well have escaped the notice of Freud's daughter and friends.
Such activities of patients with sensory pain are certainly available for study, however. Could Rachlin and his colleagues show
some solid correlations between the intensity of the painful
stimuli and some parameter of overt behavior, then the case for
identifying sensory pain with that respondent would really have
some force.
Rachlin could reply with a tu quoque: There is no complete
physiological account of pain, and no complete cognitive account of pain either. But physiological processes and cognitive
processes are both inner, hence harder to detect. By contrast,
the behavioral theory identifies pain with something overt.
Hence the lack of substantive theory is more worrisome.

Pain behavior: How to define the operant

Hugh Lacey
Philosophy Department, Swarthmore College, Swarthmore, Pa. 19081

Among psychological research programs committed to comprehensiveness but not necessarily to physiological reductionism,
only cognitive science, many believe, remains viable. Against
this trend Rachlin argues that radical behaviorism, interpreted
as resting upon correlations rather than contiguities between
the environment and behavior, still remains a competitor. I will
criticize an important feature of Rachlin s account of pain, but
the criticism will leave open his contention that behaviorist
theories of pain have greater merit in certain respects than
physiological and cognitive alternatives.
Rachlin maintains that pain has an operant component because Fordyce's (1976) procedures for the treatment of pain
show that there is a class of behaviors, pain behaviors, whose
frequency of occurence is a function of contingencies of reinforcement. It is also implicit in Rachlin's analysis that all behaviors ordinarily taken to be expressions or effects of pain belong to
this class (except for those that are explicable in terms of
respondent conditioning.) It follows that all pain behaviors are
lawful, the relevant laws relating the behaviors only to environmental variables, with no need for recourse to internal variables, whether physiological, cognitive, or phenomenal. This is
in accordance with what Rachlin takes to be a central tenet of
radical behaviorism. Whether or not this would constitute
sufficient grounds for identifying pain with pain behavior, it
would - if certain conditions were fulfilled - be sufficient to
justify a theory ofbehavior eschewing all reference to pain as an
inner cause, unreduced state, mental event, or conscious
sensation.
One of these conditions would be that the class of pain
behaviors should be definable in terms that can be applied
independently of such characterizations as "behavior caused by
pain or "behavior that expresses pain, and hence that members of the class should be identifiable without being parasitic on
ascriptions of pain to the sufferer. According to the usual radical
behaviorist tenet, the terms should presumably also be exclusively physicalist (interpreted broadly to include any terms
ordinarily ascribable to physical objects) and not occur in intensional contexts. (A context is intensional if the truth value of a
sentence within it can vary depending on the expression used to
describe a relevant object. For example, "taking his medication and "drinking a light brown liquid" may both adequately
describe a particular event, but "He went to the kitchen in order
to take his medication ' mav be true and "He went to the kitchen

Commentary /Rachlin: Pain and behavior

in order to drink a light brown liquid" false. Expressions that
involve reference to a person's mental states characteristically
occur in intensional contexts; see also Place 1981.) Fordyce's
treatment procedures might work without this condition being
satisfied, but the dispensability of the "mentalist" idiom of pain
in a behavioral theory requires it.
How is the class of pain behaviors defined? Rachlin does not
say. Clearly the class is large and varied, including an assortment of verbal behaviors. It is unlikely that there is a list of
necessary or sufficient (physicalist) conditions for a behavior to
be a pain behavior. But, it will be argued, in behavior theory,
classification is based on functional, not topographical, considerations. The topographical description of a rat's behavior is not
part of the definition of the operant "bar press." Any behavior of
the rat belongs to this operant provided that it produces the
effect of pressing the bar, and it is upon the production of this
effect that reinforcement is contingent. However, pain behavior
cannot be defined by any common effect since there is no such
relevant effect, and looser formulations (e.g., whatever is reinforced under specific conditions) are always on the edge of
tautology.
I cannot see how the class of pain behaviors can be defined
unless its instances arc characterized as expressions or effects of
pain. Moreover, it seems to me that certain behaviors will be
identifiable as pain behaviors only under intensional description
(a description based on the intention, not the effects, of the
action, e. g., taking medication), and that many verbal behaviors
can be classified together as pain behaviors only in virtue of their
expressing similar meanings or intentions. A similar point about
the classification of verbal behaviors arose when Rachlin and I
attempted to apply a behaviorist theory of choice to contexts
where speech played a role in the generation of choices (Lacey &
Rachlin 1978). This, of course, is not a conclusive refutation of
Rachlin's thesis, but it draws attention to a serious weakness in
the present supporting argument.
The thrust of my critique is not necessarily to advocate
moving toward theories that deal with inner causes. My argument is that the classifications required by radical behaviorism
cannot be made without relying on an intensional idiom. It is not
that the lawfulness of behavior cannot be expressed without
recourse to internal events. Radical behaviorism maintains that
an intelligible order can be found at the molar level, represented in laws correlating behavior and the environment. Cognitive science denies that there is a general intelligible order at
the molar level because the laws of behavior involve internal,
cognitive states as well as environmental variables.
An alternative position is that there is intelligible order to be
found at the molar level, not represented in terms of laws that
express regularities, but in terms of teleological and other
intensional categories. On this alternative, when we say that X is
in pain, we attribute to X a state that makes intelligible a wide
range of behavior; it shows that certain behavior is apt, appropriate, and efficacious in the circumstances, that it is conducive to
certain goals, that X needs to be treated in a certain way, and so
on. The part of pain talk that Rachlin wants to absorb under
operant conditioning then appears as part of intensional and
teleological discourse; perhaps that is why it has been so elusive
to those who have tried to contain it within the quest for laws.
From this perspective, the mistake of radical behaviorism is to
attempt to reduce teleological explanations to lawful correlations between behavior and environment. At the same time, the
perspective is compatible with there being regular correlations
between some behavior (classified on the basis of intensional
descriptions) and the environment. Hence it is compatible with
the success of Fordyce's treatment procedures. This success,
therefore, does not uniquely support the radical behaviorist
account of pain.
ACKNOWLEDGMENT
This commentary was prepared with support from NSF (SES-8308604).

Against dichotomizing pain

John D. Loeser
Department of Neurological Surgery, University of Washington, Seattle,
Wash. 98195

As angels dance on the head of a pin, so psychologists cavort on

the meaning of pain, gyrating about the theoretical machinations of their cultural heritage. The rhythms of Aristotle, Descartes, and Wittgenstein are sure to be invoked, not to overlook
the Melzack-Wall (1965) gate hypothesis, which has become de
rigueur. How have these attempts helped the practitioner? Do
medicine and psychology offer better therapies today than in the
past? If not, why has this area of health care delivery lagged so
far behind treatment of infectious diseases or sanitation?
The answer, I believe, lies in the creation of the problem as
proposed by Rachlin. The dichotomy of pain, whether in the
cognitive, physiological or behavioral model, simply does not
lead the practitioner to rational conclusions; super-super-Spartans are irrelevant. Experimental pain, even that carried out on
human volunteers, looks at only one, often trivial, aspect of the
clinical phenomenon; the relationship between the stimulus as
identified by the experimenter and the response of the subject
defined as relevant by the experimental paradigm. What is so
often omitted is the intervening human being.
There is ample clinical evidence to discriminate between
acute pain and chronic pain due to benign diseases. Chronic
pain due to cancer is really acute pain occurring on a long-term
basis. Modern medicine has dramatically improved the management of acute pain: local, regional, and general anesthesia as
well as narcotics have permitted painless surgery, childbirth,
repair of trauma, and so on. Chronic pain, and the disability
associated with it, appears to have reached epidemic proportions. Has the physiologic or cognitive or behavioral basis of
mankind changed in the industrialized Western world? Why is
chronic pain unknown in nonindustrialized parts of this planet?
Why has chronic pain never been recognized in infrahuman
species? In short, there is increasing evidence that the strategies
mounted by physicians to treat chronic pain, which are based
upon the successful treatment of acute pain, not only do not
alleviate but may actually exacerbate chronic pain.
As Lewis Carroll illustrated, the first step in effective communication is some agreement as to the meaning of words. In a
society that uses the phrase "a pain in the neck," Rachlin's
dichotomy is clearly inadequate. Many patients seek health care
because of chronic "pain"; few have evidence of tissue damage.
Many are depressed, often in part owing to the inappropriate
prescription of medications and inactivity. Like it or not, we can
make a statement about another individual only if that individual does or does not do something. That event is behavior in this case, pain behavior. Our diagnostic question is not the
validity of such an event (which is what underlies almost all
physiological-psychological dichotomies) but what are the factors which may contribute to such behavior. Tissue damage
(nociception) is one, but it is usually operative only in cancer
pain or acute pain. Injury to the nervous system is another:
There is no tissue damage where it hurts. Instead, altered
function in peripheral or central nervous system appears to
generate the behavior (consider phantom limb pain). Suffering
induced by depression, anxiety, fear, or isolation can also
generate pain behaviors. Finally, as Fordyce (1983) has so
clearly shown, once pain behaviors are generated the environment can play a major role in their perpetuation. If the brain is
the organ of behavior, all pain behaviors are real and involve
physicochemical processes. The distinctions between sensory
and psychological, cognitive, physiological, and behavioral are
not conducive to an increase in our understanding of the problem of pain. In fact, they have created our dilemma.

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Commciitary/Raclihn: Pain and behavior

Functional behaviorism: Where the pain is
does not matter
A. W. Logue
Department of Psychology, State University of New York at Stony Brook,
Stony Brook, N.Y. 11794

Rachlin s attempt to answer some of the criticisms that cognitive

psychologists and philosophers have made of behaviorism, particularly with regard to the characteristics of pain, differs in two
ways from traditional behaviorism (see Logue, in press a, in
press b). One of these differences, molar behaviorism, greatly
strengthens the position of the behaviorists, while the other,
identifying pain aversiveness with operant pain behavior, turns
away from the original purpose of behaviorism.
The first change is the formal statement of what Rachlin calls
molar behaviorism. According to molar behaviorism, correlations between stimuli and responses are critical factors in determining what an organism does. Thus, events in the distant past
can be seen as affecting an organism's present behavior. Such a
conceptual scheme is extremely helpful in studying pain behavior, for the events that caused the pain and behavior that signals
the occurrence of those events can be widely separated in time
yet still be described within a behaviorist framework.
Molar behaviorism may be particularly appropriate for
human behavior because, owing to humans' highly sophisticated language, events that are temporally distant, or even
events that have occurred to other people, can easily be communicated and can thereby influence a particular person's behavior
(Catania 1983; Lowe 1983). Like someone's own experience
with regard to the aversiveness of a particular stimulus, covert
language is unobservable, yet both the presence of pain aversiveness and the presence of covert language sometimes appear
to influence the effects that various current environmental
stimuli have on responses. For example, owing to what appears
to be their covert language behavior, humans are sometimes
able to wait for the larger, more delayed reinforcer instead of
choosing the smaller, less delayed reinforcer in a self-control
paradigm (Mischel 1981; Logue, Pena-Correal, Rodriguez, &
Kabela 1984). In the case of pain aversiveness, someone may
complain of a headache although there is no evidence of tissue
damage. Both pain aversiveness and language appear to be
responsible for the frequently observed lack of a precise
equivalence between the current environment and overt behavior.
Yet this lack of precise equivalence between the current
environment and behavior need not result in the abandonment
of behaviorism. Both language and pain aversiveness can be
conceived of as hypothetical constructs that represent the effect
of distant events on behavior, defined as the functions that
express the relationship between the environment and behavior. Psychologists must determine the characteristics of these
functions and the rules that govern them. In this way a scientific
approach can be retained while studying what some may wish to
describe as internal mechanisms.
While Rachlin has expanded the scope of behaviorism by
formalizing molar behaviorism, he has not construed pain aversiveness as a hypothetical construct. He has answered the
repeated queries of the cognitivists and philosophers regarding
the location of pain aversiveness for behaviorists by placing
pain aversiveness squarely in operant pain behavior. This is
his second change in the perspective of traditional behaviorism.
A few summary definitions may be helpful at this point. Pain
in its popular usage refers to the subjective experience of both
the sensory and the aversive, bothering qualities of pain.

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

Rachlin s definition of pain consists of two parts: respondent

behaviors that he identifies with the sensory aspects of pain, and
operant behaviors that he identifies with the aversive, bothering
qualities of pain. Note that Rachlin repeatedly uses the actual
words sensory, aversive, and bother. These words are not given
operational definitions; they are simply "identified with" respondent and operant pain behavior. For Rachlin, someone who
never shows even the smallest amount of operant pain behavior
has no pain aversiveness; pain does not bother that person. This
is not merely a semantic distinction; for Rachlin, operant pain
behavior is synonymous with the subjective experience of aversiveness. However, Rachlin himself states that whether this
assertion is true has not yet been settled. In fact, it is a question
about which philosophers and psychologists could argue at
length without ever reaching resolution. Some of these arguments are detailed in Rachlin's article.
In resolving the issue of the location of pain aversiveness it is
helpful to recall the original purpose of behaviorism; to objectively examine and be able to predict behavior (Watson 1913).
Toward this end Skinner (1979) defined operant behaviors in
terms of their function on the environment. For example, a
lever press was defined as all those behaviors that resulted in the
depression of a lever.
Therefore, in terms of traditional behaviorism, the issue is not
where pain aversiveness actually is or what it acutally is, but how
various behaviors can best be organized to predict future behaviors. Simply because people s statements regarding pain aversiveness are modifiable by contingencies of reinforcement does
not prove that the subjective experience of pain aversiveness is
modifiable behavior or that pain aversiveness consists of behavior that is observable given our present techniques. It is impossible to prove that an unobservable feeling (aversiveness) has
been modified, or of what it consists, or even that it exists. The
original behaviorists, Watson and Skinner, knew that this effort
was scientifically useless. By trying to locate pain aversiveness Rachlin is himself making the error that they sought to
avoid.
To summarize, if someone posed the question of whether a
person who never demonstrated any observable operant pain
behavior was experiencing pain aversiveness, Rachlin would say
no, but a traditional behaviorist would say that the person had
not been behaving in the way that was likely given that tissue
damage had occurred. In other words, the traditional behaviorist would say that the person was not demonstrating the set of
behaviors consistent with the organizing concept, the hypothetical construct, which has been named here pain aversiveness. The traditional behaviorist would not discuss whether
the person was actually experiencing pain aversiveness because
that could not be known. All that can be known is what a person
does and the extent to which those behaviors are usually correlated with actual tissue damage.
It may be helpful to call this version ofbehaviorism functional
behaviorism (see also Roback 1923) because it focuses on:
1. organizing behavior according to its function
2. the variations that occur in the functions relating environmental events to behavior
3. behaviorism as scientific psychology that gets the job
done, that fulfills the function of predicting behavior.
Functional behaviorism retains the scientific character of
behaviorism while encouraging investigation of behaviors
that have been identified with so-called intei ial, unobservable events such as pain aversiveness and covert language. It is therefore likely to succeed in predicting
behavior where other versions of behaviorism are not.

ACKNOWLEDGMENT
Comments by H. Rachlin, M. Rodriguez, and M. Smith on a previous
version of this paper are appreciated.

Conetrt//Rachlin: Pain and behavior

One pain is enough

Wallace I. Matson
Department of Philosophy, University of California, Berkeley, Calif. 94720

Rachlin holds that a pain is really two pains - one the sensory
kind (or component), which is respondent behavior, the other
the "psychological" kind, which is operant behavior. But the
evidence cited suggests that, on the contrary, there is only
sensory pain, to which the sufferer reacts - makes a judgment,
adopts an attitude - in a manner that is not always a linear
function of the intensity of the painful stimulus. This reaction is
operant behavior, no doubt, but it is not another pain or another
component of the pain.
The dual pain theory, Rachlin claims, is supported by the
separability of the intensity and reaction scales: Since subjects
tend to assign the same intensity-scale positions to the same
stimulus but differ about degrees of aversiveness, the scales
must be measuring different pains or pain components. But, of
course, the opposite inference should be drawn. There cannot
be a pain or pain component that is simply severe but neither
bearable, uncomfortable, . . . , nor agonizing; or a pain that is
intolerable but neither just noticeable, mild, . . . , nor excruciating. The intensity and reaction scales are well named;
they measure intensity of and reaction to the same pain, and
they would be unintelligible if they did not.
This kind of distinction has wide application. One's children's
playing of rock music on the stereo varies in intensity, and one's
annoyance thereat has its separate degree scale. One can to a
certain extent decide whether to erupt or to tune it out, which
by no means makes it literally inaudible. And we distinguish
people whose loves and hates are insipid from those who are
passionate but self-controlled.
But what, then, are we to make of Fordyee s successful
treatment of chronic pain? (Here and below "Fordyee" is short
for "Rachlin's report of Fordyee'; I have not checked the
publications referred to.) Fordyee accepts only patients in
whom he fails to find any persisting stimulus (external or internal) causing pain behavior; nevertheless, the pain behavior is
chronic. Granted that the patients are not malingering, and
granted that no stimulus is found because there really isn't any,
does it not follow that the patients are suffering - really suffering
- from purely "psychological" pain, the "operant component"
by itself, which therefore is a second pain after all?
A more conventional and economical hypothesis is available:
The patients are deceiving themselves. They believe - really
believe - that they are in pain, but they aren't; they do not
actually feel any pain. There was a time when they really were in
pain. They adopted an (operant) attitude toward it that was
manifested in typically aversive behavior. The behavior brought
its rewards of narcotics and sympathy. Now the pain is (really)
gone, but in order to continue to qualify (in their own view of
themselves) for the rewards, the patients continue the operant
behavior that brings them. Fordyee s treatment consists in
removing the motivation for the self-deception - in a gradual
and gingerly way avoiding martyrdom.
This hypothesis presupposes the possibility of sincerely believing oneself to be in pain without actually being in pain.
Behaviorists will accordingly reject it because to them believing
that one is in pain, behaving in all respects as if one were in pain,
and being in pain are all the same thing. Many nonbehaviorist
philosophers will reject it on the ground that a sincere report of
pain is incorrigible.
But the ineorrigibility of the pain protocol is a myth. In
suitable circumstances (e.g., fraternity initiations in the bad old
days), nonpainful stimuli (e.g., drawing an icicle across the skin)
may produce shrieks of real anguish. This is the converse of the
soldier who doesn't notice for a while that he is missing an arm.
And the behaviorists respondent/operant distinction - corrected to eliminate the redundant second pain - explains them

both: The stimulus (the pain) is one thing; the attitude we take to
it is another. And the attitude, the set to action, with a view to its
consequences, can continue after the respondent stimulus is
withdrawn.

Pain and parallel processing

Ronald Melzack
Department of Psychology, McGill University, Montreal, Que., Canada H3A
1B1

Dr. Rachlin has critically evaluated a wide literature that encompasses all the major approaches to the problem of pain physiological, psychological, clinical, and behavioral. I agree
with many of his arguments and disagree with some. Since he
usually uses the words "sensory" and "psychological" in quotation marks, it is evident that he does not imply that these
processes exclude each other; rather, they are complementary
to one another. This is the sense in which Kenneth Casey and I
proposed that pain experience comprises a number of dimensions that reflect activities in parallel processing systems
(Melzack & Casey 1968).
Clearly, all theories of pain are ultimately "physiological"
theories. Cognitive theories implicitly assume that the neural
processes that underlie cognitive activities occur in parallel with
sensory transmission and are able to influence it. Similarly,
affective and motivational processes occur in parallel with both
sensory and cognitive activities, so that pain is not simply a
string of sequential events but the product of transactions that
occur among neural processes that go on at multiple levels.
This concept, which I consider to be crucial to understanding
pain, is not presented with sufficient clarity in Rachlin's paper,
although it is evident in several places in the paper that he is
fully in agreement with it. I will therefore not enter into any
needless dispute but rather will amplify a few points that, he
seems to believe, are understood by most investigators in the
field. I have learned, often with astonishment and dismay, that
even seemingly obvious features of pain processes must be
spelled out at virtually every opportunity.
Let us consider the first dichotomy that has led to confusion in
the field: Pain is a sensory experience, and everything else emotion, motivation, thought, evaluation, coping strategy - is
the reaction to the sensory experience. This idea, given the
stamp of approval by Beecher in 1959, has been the favored
haven of many psychologists. However, this approach leads to
confusion. It is the basis of the frequent failure to understand
some of the most basic features of pain - such as the absence of
pain after severe, life-threatening injury. If sensation occurs
inevitably after injury and is in proportion to it, how can we
understand the statement made by about 65% of soldiers who
were wounded in battle, that they felt no pain after their injury
(Beecher 1959)? As Patrick Wall and I (Melzack & Wall 1983)
have pointed out on many occasions, this leads to the paradox of
"painless pain " - obviously a meaningless term. It is much more
reasonable to recognize that neural processing permits cognitive activities to act on inputs - to open or close the "gates " before those inputs give rise to sensory experience.
If we recognize that sensory, motivational, and cognitive
processes occur in parallel rather than in series, we also realize
that we cannot equate the word "sensory" with "intensity" and
all other activities as "reaction." The cognitive-affective-motivational processes interact with sensory input beginning at the
earliest synapses and therefore determine the eventual intensity of an input produced by injury. This is the basis of the
variable link between injury and pain (Melzack & Wall 1983).
The second major dichotomy that has led to confusion - which
Rachlin fully recognizes - is the variable link between experience and behavior. As long as we recognize that pain is not

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Commentanj/RachUn: Pain and behavior

simply a reflex response to injury but that a complex brain
intervenes between input and output, we can realistically face
the problem of the "super-Spartan" discussed in the paper. Our
behavior in the face of injury or pathology ranging from a
kidneystone to cancer depends on the intervening activity of
brain. The brain is the repository of our fears and anxieties, our
understanding of the situation, our concern for the future - not
just our own personal future, but the future of those whose lives
touch on our own. It is for this reason that the link between pain
experience and behavior is so variable. Once we recognize the
neural basis of variability, we can avoid needless dichotomies
and instead look to multiple parallel processing systems as the
basis for the richly complex experience and behavior that characterizes pain.

A mentalistic view of "Pain and behavior"

H. Merskey
University of Western Ontario, Department of Education and Research,
London Psychiatric Hospital, London, Ontario, Canada N6A 4H1

Rachlin's target article reached me soon after I had interviewed

my first patient of the day. This lady, whose English is imperfect, began as follows: "Everybody thinks is my imagination. Is
no my imagination - is my back." She also complained of pain in
the right leg that was worse on walking, some headaches, and a
deterioration in symptoms of her hiatus hernia. She added: "Is
not the worry that makes me pain, is the pain that makes me
worry. Only the stupid people is not worry."
Her views raise the question of whether we can treat her
remarks as "behavior." Some part of them certainly is impressive behavior, such as the vigor with which she spoke. Yet to
see it only as behavior and not as an important subjective
experience seems perverse.
I will deal first with some matters of evidence. No one has
shown a way to split the supposed experience of pain neatly
according to its presumed etiology. Leavitt and Garron (1979)
distinguished between the words used by psychological and
organic groups, but usually it is not possible to tell from clinical
descriptions how pain originates. Psychiatric patients with pain
and no lesion most often describe the same sort of experience as
people who have recognized lesions that are thought to cause
pain. Beecher (1959) argued that pain had both a primary
sensory component and a reaction component that could not be
separated completely from each other. A striking effort to prove
that these elements could be separated came from signal detection analysis. Rollman effectively disposed of this view (Rollman
1977, 1979, 1980; Chapman 1977; Jones 1979, 1980).
Popular methods for the measurement of pain such as verbal
scales, visual analogue scales, signal detection, and pain relief
measures are subjective. Direct behavioral studies are relatively rare, and less efficient. There is no satisfactory scientific
evidence that a strict operant procedure works any better than
any other technique (Sternbach 1983). Other methods have
equal success (Pinsky et al. 1979; Catchlove & Cohen 1982).
Fordyce (1983b) claims that some of these methods, including
psychodynamic approaches, have operant characteristics. But
the operant method does not have unique effects.
The theoretical problem relates to confusion between events
within the body and the mind. The use of the word pain is well
defined by practice and is psychological. Its meaning tends to be
lost to physicians since they are aware of physical events within
the body that form part of the mechanism of production of pain.
Thus doctors make contradictory remarks like, "Severe pains
need not be felt" (Jaspers 1963). Patients with vivid experiences
are told that they do not have pain because a lesion has not been
found. Walters (1963) described this difficulty well as follows:

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

Physical pain is a psychic event and not a physical event. The physical
side is the physiological mechanism. . . .The pain is . . . the perceptual experience of discomfort in a spot in the body. . . . This fact is
often ignored . . . . you will hear yourself or your colleagues say that
"pain travels in the spinothalainic tracts" or that "the end organs pick
up pain and transmit it up the pain pathways." But these impulses
centrally bent to excite further mechanisms . . . are no more the pain
than the visual impulses from the retina are the perceptual fields of
colour and pattern that present to us when our eyes are open.

Szasz (1957) developed an identical view. No one to my knowledge has offered a worthwhile alternative to this position that
pain is a word for a psychological condition and not for specific
physical events.
My original definition of pain (Merskey 1964; Merskey &
Spear 1967) served as the basis for an international definition
(I.A.S.P. 1979). The latter is as follows: "an unpleasant sensory
and emotional experience associated with actual or potential
tissue damage, or described in terms of such damage."
Rachlin neglects this viewpoint, which implies that causal
factors promote or produce pain although they cannot be separated in subjective experience. The causes should be identified,
must be studied, and, at times, can be quantified. Fordyce
incorporates the subjective state in a behavioral statement by
relating the latter to the patient's words and saying that he has
no concern witli what the individual actually feels - merely with
what he does verbally. That still amounts to denying part of the
other persons experience. In a curious fashion, the behaviorist
of today resembles the solipsist of the eighteenth century.
My argument is mentalistic and monistic. As Rachlin recognizes, cognitive theory and the Melzack-Wall approach are
similar. They do not require mysterious interactions between
body and mind. Rather, they say that the events which occur in a
human being are a unity but may be described in different
languages. This approach is correct in theory, and is important
in the direct relationship with the pain patient. Any system like
a pure behavioral one which produces an artificial circumlocution around the topic, neglects experience, or refuses to take it
into consideration is incomplete. It also leads to frequent errors
in management, compounding theoretical mistakes with practical failures.

Behavior, cognition, and physiology: Three

horses or two?
T. R. Miles
Department of Psychology, University College of North Wales, Bangor,
Gwynedd LL57 2DG, Wales, U.K.

This is an important paper. What follows represents not so

much disagreement as an attempt at reformulation. Rachlin's
position as he has stated it is open to a number of theoretical
objections, but these can be removed without any radical
change to the substance of what he has to say.
In the first place the distinction he draws between "sensory"
pain and "psychological" pain is potentially misleading. Actions can have painful psychological consequences if they affect
what people think and believe; these are different from "physical" consequences such as injury or bleeding. By analogy,
therefore, Rachlin seems to be suggesting that what people
think or believe about a situation may affect their reactions to
painful stimuli. But it is not clear that this entitles him to say
that there are two kinds of pain or that there are two components of pain, nor is it self-evident that these two claims are
equivalent. He does indeed call attention to the distinction
researchers have drawn between an "intensity" scale and a
"reaction" scale, but to say that the one measures "sensory"
pain and the other "psychological pain does not seem to add
anything.
Second, he suggests that "'sensory' pain is . . . a re-

Commentary/'Rach\\n: Pain and behavior

spondent while 'psychological' pain is an opcrant. " But there is
something logically very strange here. As Ryle (1949, Chap. 7)
has pointed out, sensation words do not stand for events. If
they did, one could take a peep at an ache or tingle in the same
way as one takes a peep at the things that are going on in ones
neighbor's garden. If a sensation of pain is not an event, however, it makes no sense to classify it either as an operant or as a
respondent. Perhaps what Rachlin might have said is that certain stimuli are invariably followed by feelings of pain but that
the extent to which one is troubled by the pain may be decreased if one interacts with the environment in certain ways.
He is thus (quite properly) commending those research programs which investigate such interactions.
Now no one disputes that there are physiological procedures
by means of which pain can be lessened, for example, the use
of injections or chloroform. In a science of behavior, however,
one is interested in the ways in which expressions of pain are
treated by the community. Rachlin here introduces the very
interesting example of "super-super-Spartans" who do not express their pain either verbally or by wincing but who are fitted
with a red light that flashes when their physiological pain
mechanisms are activated. This is an informative analogy, since
the real-life situation is different only in that instead of a red
light that anyone can see there is a bodily sensation felt by only
a single person. Indeed, the analogy could with advantage have
been exploited further. If the word pain does not stand for an
event then it cannot stand for any of those allegedly private
events that behaviorists are so often accused of ignoring; and
indeed, if it did, it is hard to see how anyone could ever have
learned its meaning. In fact, however, cries, winces, verbal
reports of pain, and so on are behaviors to which the community responds, just as they might in principle have responded to
the flashing of a red light. If a young child says that he can see a
cat it is likely that others will say that they also can see it; but if
he says, "My leg is hurting, " he learns that others do not say
that they can feel the pain too. As Rachlin points out, they
either try to comfort him or, in some circumstances, accuse
him of shamming or of making too much fuss.
In general, then, Rachlin is right in saying that there can be
"external study of pain behavior and internal study of pain
mechanisms." However, in including in the same paper a critique of cognitive psychology it is arguable that he has attempted too much. His discussion under "Cognitive theory
and treatment' calls to mind the words of Bolingbroke in
Shakespeare's Richard the Second:
Oh, who can hold a fire in his hand
By thinking on the frosty Caucasus?
But he implies that the correctness or otherwise of a cognitive
approach to the study of pain is something that can be determined empirically, since the answer depends on whether particular strategies such as imagining numbness at the site of the
pain are effective in reducing discomfort. The objections to a
cognitive approach, however, are in fact conceptual: It is a
category mistake to suppose that words such as image and
belief stand for any kind of entity that could be part of a causal
chain between stimulus and response. As a matter of logic,
therefore, there cannot be a distinctive role for the cognitive
psychologist: either his postulated mechanisms are physiological ones, in which case he is a physiologist, or he is studying
the influence of verbal instructions (such as "Try to imagine. . . ") on behavior, in which case he is a behavioral scientist. Rachlin speaks as though there are three horses contending in this particular race, namely, a physiological horse, a
cognitive one, and a behavioral one. He has said some very
helpful things about the first and third of these horses (which,
indeed, as he would agree, are not so much rivals as partners).
If the above argument is right, however, the "cognitive" horse
does not belong in this race at all and should not have been
admitted to the starting gate.

Is there always a neurochemical link

between pain and behavior?
G. Pepeu
Department of Pharmacology, Florence University, 50134 Florence, Italy

Pharmacologists, aware of the limitations and side effects of drug

therapy for pain control, must favor all attempts to use nonpharmacological means for relieving pain. Rachlin s accurate and
critical review outlines the theoretical basis of a psychological or
behavioral approach to pain control. If a general criticism can be
expressed, some of the examples quoted in the review may be
rather obscure to a European reader. Cultural differences apart,
the impression that a biologist gets from Raehlin's analysis of the
physiological, cognitive, and behavioral theories of pain is that
of a semantic dispute, as the author admits, concerning the two
aspects of pain, the nociceptive stimulus and its perception.
Even in the rat it is possible to recognize a "sensory" and an
"aversive' or "psychological" pain. Electrical stimulation of the
tail according to the method of Paalzow and Paalzow (1973)
elicits a motor response characterized by tail withdrawal and
hindquarter movement, an immediate vocalization response,
and a delayed vocalization response that occurs after the cessation of the nociceptive stimulus. Paalzow and Paalzow call this
last response vocalization afterdiseharge. It involves the rostral
regions of the brain and is considered the affective component of
pain. Morphine and anxiolytics are more effective on the vocalization afterdiseharge than on the two immediate responses
(Morichi & Pepeu 1979).
If we examine the rat's behavior in light of the theories as
described by Rachlin, the motor response and the immediate
vocalization could, according to physiological and cognitive
theories, be considered the "real pain," whereas the vocalization afterdiseharge would be the "pain behavior." On the other
hand, for the behavioral theory the vocalization afterdiseharge
would be the "real pain."
Apparently, only pharmacological or elcctrophysiological
ways can affect the rat's response to nociceptive stimulation. In
man, however, pain can be modified by "psychological" factors,
as Rachlin emphasizes in the beginning of his review. Psychological factors have traditionally been exploited in order to
control pain. An example, for which Rachlin forgot to find a
place within the framework of the pain theories, is offered by the
pain control proposed by religions. The Catholic religion invites
the sufferer to accept physical pain in order to obtain a reward in
the future life after death. Real pain is not obtunded by this
approach; rather, pain behavior is changed. According to the
behavioral theory, however, real pain is reduced.
Perhaps the expectation of a reward after death as a means of
making pain less "painful" is the only truly "psychological" pain
control. Other religious practices such as collective prayers,
singing, and dancing appear to reduce pain perception. As an
example, we may recall the medieval flagellants. However, in
these cases conditions favorable to the release of endogenous
chemicals modulating nociceptive information may occur. The
symposium "Shamans and endorphins" mentioned by Henry
(1982) is an example of the current tendency to explain behaviors in term of neurochemical changes in the central nervous
system. Shamanism is a trancelike state including both euphoria
and analgesia. Papers such as that published by Coid, Allolio,
and Rees (1983) showing that mean plasma metenkephalin
concentration was increased in ten severely disturbed patients
who habitually mutilated themselves offer strong support to the
physiological theory of pain. In Coid et al.'s study, patients
reported that the mutilation was carried out without causing
pain.
It is therefore very tempting to equate changes in pain
perception with alterations of a central mechanism controlling
nociceptive input. In this physiological approach the psycholog-

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Commentary/Rdchlin: Pain and behavior

ical and behavioral theories would find justification, so long as
they offered a way of modifing the central neurochemieal control
mechanism of the nociceptive input.
This assumption is tenable only if it can be experimentally
shown that behavioral procedures or mental attitudes relieving
pain always affect brain neurochemistry. Some conditions inducing analgesia associated with a release of endorphins have
been listed by Rachlin. The best known are stress and acupuncture. Long-distance running and sexual activity are mentioned by Henry (1982). Fear conditioning increases enkephalin-mediated analgesia in rats (DeVries, Chance, Payne &
Rosencrans 1979). Can cognitions, as in Rachlin's example
("Cognitive theory and treatment," paragraph 5), do the same in
man? Endorphins need not be the only neuroregulator
involved.
However, chronic pain increases metenkephalin in the spinal
cord segment receiving a direct projection from the painful area
(Faccini, Uzumaki, Covoni, Missalc, Spano, Covelli &Trabucchi 1984). It has been shown that chronic pain induces a
hypoalgesia to acute nociceptive stimulation (Colpaert 1979).
Could the metenkephalin increase in the spinal cord be modulated by nonnociceptive peripheral stimuli, for instance, by
reinforcing the well behavior of Fordyce?
It must be stated that all this has a slight flavor of Aristotelian
humoral theory. Nevertheless, many other circumstantial data
could be marshaled to support the contention that there is a
relationship between pain perception (aversive pain) and brain
neurochemistry. These appear to give a neurochemieal foundation to the gate control theory of Melzack and Wall (1965).
According to this theory, "pain," a state of perception in which
the organism as a whole reacts to apparent injury, is triggered if
the initial gate and subsequent stages of the transmission pathway are favorably set for the exhibition of this state (Wall 1979).
The concept of "favorably set again leaves unanswered the
main question of what it is that makes pain felt, the question
around which the theories examined by Rachlin are built.
Nevertheless the gate control theory has through the years
exerted a strong heuristic influence in stimulating experimental
and clinical investigations that have also led to applications.

Semicovert behavior and the concept of pain

Ullin T. Place
Department of Philosophy, University of Leeds, Leeds LS2 9JT, England

If I have understood him correctly, pain, according to Rachlin,

consists of three elements, a pain stimulus, and two forms of
overt pain behavior: the "respondent" behavior, which occurs
as a reflex response to the pain stimulus and the "operant'
behavior, which is reinforced insofar as its emission by the
organism is followed by an alleviation or termination of the pain
stimulus.
I take it that although he doesn't use the term in this paper, it
is part of Rachlin's view that pain stimuli are normally "aversive"
in the sense that they constitute "an establishing condition," to
use Michael's (1982) term, whereby any operant that is followed
by the alleviation or termination of the aversive stimulus is
thereby reinforced. Rachlin then suggests, following Fordyce
(1978), that the distinction between what he calls "sensory" and
"psychological" pain can be accounted for in terms of the
distinction between respondent and operant pain behavior.
For the purposes of this discussion I shall assume that the
distinction Rachlin has in mind when he distinguishes between
"sensory" and "psychological" pain is the same distinction as
that which is drawn in commonsense terms between what is
sometimes called "physical pain," where pain is a bodily sensation that is usually extremely unpleasant and distressing, and
pain in the sense of the emotional reaction of acute distress when

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

that reaction is evoked, not by pain qua bodily sensation, but

rather by a thought, such as the thought that this pain is perhaps
a symptom of some fatal illness.
If I am right in thinking that this is the distinction Rachlin has
in mind, then it is difficult to resist the conclusion that his
behaviorist theory of pain simply does not contain sufficient
conceptual resources to enable him to do justice to the full
complexity of the commonsense distinction.
I suggest that in order to do that, in addition to the pain
stimulus and the overt and predominantly operant pain behavior which, as we ordinarily understand the matter, is an effect or
"expression" of the pain, rather than part of it, we need to
recognize the existence of three distinct varieties of behavior
each of which is predominantly but not exclusively covert and
predominantly but, with one exception, not exclusively respondent. These three varieties of semicovert behavior, as we
may call them, are (1) attending behavior, (2) emotional reactions, and (3) self-directed verbal behavior or thinking.
Behaviorists of Rachlin's persuasion have traditionally been
reluctant to acknowledge the occurrence of these types of
semicovert behavior. This, I presume, is because the so-called
introspective reports of human subjects, of which behaviorists
have always been suspicious, deal for the most part with the
covert and, hence, otherwise inaccessible aspects of such behavior. It seems to me that this reluctance is misplaced for two
reasons.
In the first place, since this behavior is only partly covert, it
follows that there are many occasions on which it consists partly,
if not wholly, in publicly observable overt molar behavior whose
occurrence even the most hardened behaviorist must acknowledge. Thus visual attending behavior normally consists in a
complex pattern of head and eye movements, such as tracking,
accommodation, and convergence, whose effect is to keep the
retinal image of the object attended to in focus. Similarly,
auditory attending behavior may consist in controlling the noise
one might otherwise make oneself so as not to obscure the sound
one is trying to catch. Olfactory attending frequently consists in
sniffing, gustatory attending in savoring movements of the lips
and tongue, and tactile attending in moving one's fingers over
the surface of the object of attention.
The occurrence of an emotional reaction, in contrast to the
overt operant behavior, like pain behavior, for which the emotional reaction creates the establishing condition, is much less
easily detected at the level of molar observation than is attending behavior. Nevertheless, blushing in shame and embarrassment, weeping in joy and sadness, and the enlargement of the
pupils in excitement and interest are overt, publicly observable
aspects of such reactions.
In the case of thinking, most thoughts are uttered privately to
oneself, without any actual movement of the voice musculature.
People nevertheless often think out loud, not only on occasions
when thinkers intend to share their thoughts svith others, but
also when the thought is entirely self-directed.
The second point that needs making in this connection is that,
even in those cases where the occurrence of the behavior is an
entirely covert event, taking place presumably within the central nervous system, it is usually possible to determine objectively that a covert response has occurred by observing the
change that has thereby come about in the establishing and
other conditions controlling subsequent operant behavior.
Thus the effect of attending behavior is to increase what we
may call the "salience of the stimulus or stimuli to which
attention is paid and hence the vigor and accuracy of the
discriminative control exercised by those stimuli over the subsequent operant behavior. The effect of an emotional reaction, like
the distress involved in both senses of the word pain, is to set up
an establishing condition whereby the alleviation or disappearance of the stimulus or state of affairs that evokes it acts as a
reinforcer witli respect to any behavior that is followed by it.
The effect of thought on subsequent operant behavior is much

Commentary/Rachlin: Pain and behavior

less easy to pin down than is that of attending behavior and
emotional reactions. However, recent work on the contrast
between human and animal responding on fixed-interval schedules of reinforcement (Lippman & Meyer 1967; Lowe 1979;
1983) is beginning to throw some empirical light on the difference between what Skinner (1969) calls "contingency
shaped" and "rule (i.e., thought) governed" behavior.
If we try to relate these three types of semicovert behavior to
Skinner's (1938) "respondent" and "operant" distinction, it
appears that emotional reactions, as contrasted with the operants that "express" the emotion thereby generated, are invariably respondents. Attending behavior and thinking on the other
hand both function in part as operants obeying the Law of
Effect. However, both these forms of behavior appear to be
subject to what we may call "a respondent override mechanism"
that ensures that attention and thought are directed as much
toward stimuli that are highly aversive as they are toward stimuli
that are reinforcing with respect to operant behavior. Without
such a respondent override mechanism the operation of the Law
of Effect would have the maladaptive consequences predicted
by the now long discredited theory of "perceptual defense,"
whereby the organism would systematically ignore aversive
stimuli such as pain, as well as those discriminative stimuli
which act as danger signals with respect to such aversive
contingencies.

Pain without behavior: Inhibition of reactions

to sensation
Kelly G. Shaver and Jana J. Herrman
Department of Psychology, College of William and Mary, Williamsburg, Va.
23185

The fundamental difference between a behaviorist approach to

pain - or to any other psychological phenomenon - and that of
cognitive theory is not that one examines actions of the whole
organism while the other limits its inquiry to a fraction of the
organism. The difference lies rather in what adherents of the
two approaches are willing to infer on the basis of the behavior
they both observe. Can there be emotions, or are there merely
emotional displays? Can there be thought, or is there merely
verbal behavior? Can there be pain, or is there only pain
behavior? True to the behaviorist tradition, Rachlin takes the
latter position, but there are both logical and empirical reasons
to question his argument.
Let us begin with Rachlin's closing assertion that the "best
argument for a behavioral definition of pain would be a truly
effective behavioral treatment of pain." Were a truly effective
behavioral treatment for pain to be discovered, even one that
changed only the individual's overt expression of pain, the force
of Rachlin's paper suggests that his final claims would not be
nearly so modest as the closing assertion would lead us to
believe. On the contrary, despite the present limits to the
evidence, Rachlin concludes from Fordyce's (1976) successful
behavioral treatments of individuals suffering from chronic pain
for which no concomitant tissue damage can be found that all
pain is nothing more than "pain behavior." Ignoring for the
moment that chronic pain may not be the same as acute pain,
and that pain without apparent tissue damage may not be the
same as pain with tissue damage, all that can logically be
concluded from a successful behavioral treatment of pain is that
the method provides control over the disruptive manifestations
of pain. No psychologist familiar with social desirability constraints and demand characteristics (Orne 1962) should accept at
face value the idea that a change in a verbal report is isomorphic
to a change simultaneously occurring in an internal state (unless,
of course, one has defined the internal states out of existence).
Similarly, no psychologist familiar with a falsificationist view of

scientific discovery (Popper 1959) should erroneously infer that

because one theoretical viewpoint has been confirmed all competing formulations have necessarily been ruled out. Demonstrating that effective behavioral therapy can provide control
does not conclusively demonstrate that behavior theory provides sufficient explanation.
Rachlin's inclination to overstate the theoretical import of
Fordyce's (1976) therapeutic success is abetted by his extreme
characterizat'on of the cognitive alternative as "mentalism,"
roughly the psychological equivalent of "alchemy." The argument can be stated more constructively by pointing out that a
cognitive interpretation of pain need only suggest that a conscious process might intervene between the sensation of pain
produced by identifiable tissue damage and the reaction to that
sensation that would be obvious to an external observer. Although Rachlin describes the psychophysical measurement procedures that Tursky, Jamner, and Friedman (1982) have developed to distinguish the intensity of the sensation of pain from the
reaction to the pain, he does not seem aware of the problems
that this distinction presents for a behaviorist theory. If pain
were nothing more than "pain behavior, " then an effective
behavioral treatment that produced a diminution in the reaction
scale would of necessity produce a corresponding reduction in
the intensity scale. Only if one supposes that some conscious
process can intervene between sensation and reaction is it
possible to imagine a therapy (like hypnotherapy) that could
alter how bearable pain might be without also changing (to
exactly the same degree) the felt intensity of pain.
In his discussion "What is pain?" Rachlin compares a person
"in pain . . . though not evincing pain behavior" to a rat pressing a bar at a certain rate although not pressing the bar "right
now." What distinguishes the two cases may well be something
about the very meaning of pain (we would agree with the
"antibehaviorist philosophers" who would argue for the possibility of inhibiting an overt response to a sensation of pain). But
in a larger sense this argument about the meaning of pain is
merely the most recent skirmish in a metatheoretical controversy that predates the emergence of psychology as a separate
discipline. At this broader level the question has to do with a
particular resolution of the classical dilemma of determinism:
The conscious volition required to inhibit the overt expression
of pain is in principle no different from the conscious volition
required to refrain from "immoral" though immediately rewarding behavior. It may be possible for behaviorists to exclude
conscious processes from the expression of pain more successfully than they have been able to exclude them from morality.
But the research Rachlin reviews should give them pause, not
comfort.

Molar behaviorism, positivism, and pain

Charles P. Shimp
Department of Psychology, University of Utah, Salt Lake City, Utah 84112

Rachlin's paper is another effort by a radical behaviorist to show

how a purely behavioral analysis can adequately deal with
private events, in this case, pain. My comments focus on two of
Rachlin's assumptions. I wish merely to point out that there are
alternatives to these assumptions. The alternatives may lead to
importantly different views on the nature of behaviorism and
therefore on behavioral interpretations of private events such as
pain.
Rachlin assumes there are two kinds of pain. One is "fundamental," is "sensory" in nature, and is correlated with an
antecedent stimulus such as a wound. The second is derived
from thefirstand is correlated with the way various pain-related
behaviors are controlled by their reinforcing consequences.
This distinction might be called a "foundationist" approach to
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

71

Commentary/RachWn: Pain and behavior

the analysis of the conceptual status of pain. This distinction
between two kinds of pain, one sensory and fundamental and
the other derived, closely parallels more general, positivistie,
analyses of the nature of seeing and the nature of knowledge.
Such analyses hold that there is a fundamental, sensory knowledge that provides the bedrock or foundation for scientific
knowledge and that this fundamental knowledge is separable
from other, derived, kinds of knowledge.
This "foundationist" position that discovers empirical bedrock in perceptual metaphors has not gone unchallenged (Hanson 1969; Rorty 1979; Ryle 1949; Wittgenstein 1958). Oddly,
one of the works Rachlin cites, that by Ryle (1949), gives a good
analysis of conceptual problems inherent in the foundationist
epistemology. Rachlin references Ryle for various behavioral
ideas that, taken out of context, resemble those of radical
behaviorism. But he does not comment on the complex relation
Ryle assumes between knowing and seeing, and as a result
Rachlin seems to adopt a relatively unsophisticated position on
the nature of scientific observation. As a result, he places greater
faith in the fundamental scientific status of overt behavior than is
justified. Rachlin, like Skinner (1950) and many other radical
behaviorists, seems to feel that by dealing with overt behavior
he can deal with something that provides a privileged, fundamental kind of knowledge.
A related, positivistie claim appears at the end of the section
"Behavioral theory and treatment" and elsewhere. It is said
there that pain is behavior. This kind of operationism seems to
omit much of the grammar of the concept of pain: It does not
adequately take into account the relations among the individual
behaviors (crying, kicking, etc.) said to define pain and especially the way their meanings depend on ordinary language.
This contextual material is very much part of the meaning of the
concept of pain, but it does not seem to appear anywhere in
Rachlin s analysis. This omission is characteristic of positivistie
approaches in general. The idea that there are little knowledge
units, in Rachlin's case deriving from Pavlovian and operant
conditioning, that together adequately redefine a concept such
as pain, is today an anachronism; it resembles Watsonian behaviorism and in some ways the logical atomism of the early
Wittgenstein (1922). It seems not to take into account contemporary thinking in epistemology, the philosophy of science, or
cognitive psychology.
Rachlin seems fully to appreciate that if a theory of pain is to
be confined to overt behaviors, one needs to know something
about how to deal scientifically with overt behavior. Rachlin
offers "molar behaviorism" as the solution to the problems of
what behavior is and of how to deal with it scientifically. He
asserts that this kind of behaviorism has never to his knowledge
been refuted. The defining exemplar of molar behaviorism is the
generalized matching law (for example, see Baum, 1973). Longterm readers of the Journal of the Experimental Analysis of
Behavior will recall that Rachlin (1971) published an article
called "On the tautology of the matching law," the point of
which was that the matching law, being a fundamental causal
law, cannot be refuted. Data that might on the surface appear
inconsistent with it simply indicate the presence of some inappropriately scaled variable or some methodological flaw. Thus,
we have Rachlin asserting here that molar behaviorism has
never been refuted and asserting previously that its defining
exemplar in principle cannot be refuted. Yet molar behaviorism
might not be as frighteningly impregnable as this awesome logicsuggests, and there may yet be a possibility for a molecular
analysis. Thus, of the eight or so examples of molar "current
behavioral theory listed in the sixth paragraph of "Behavioral
theory and treatment, at least half were developed by theorists
who subsequently have gone on to develop more molecular
approaches.
Here is not the place even to list the reasons why a molecular
approach to behavioral analysis is continuing to prove fruitful.
Suffice it to sav that the extremelv radical version of molar

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8.1

behaviorism that Rachlin advocates confronts an evergrowing

list of conceptual issues and empirical phenomena that apparently are beyond its capacity to deal with successfully (Peele,
Casey & Silberberg 1984; Platt 1979; Shimp 1975; 1976; Hinson
& Staddon 1983). Thus, it seems doubtful that molar behaviorism can support the kind of philosophical burden Rachlin is
here placing on it.
If behaviorism is to provide a satisfactory philosophy of
private events in general, and of pain in particular, behavioral
accounts will have to abandon their commitment to a classic
positivistie position on the relation between observation and
knowledge. And if molar theory is to provide a comprehensive
behavioral theory, it will have to find some means of assimilating
molecular phenomena.

The reign of pain falls mainly in the brain

Dennis C. Turk and Peter Salovey
Department of Psychology, Yale University, New Haven, Conn. 06520

At times it is difficult to understand the relationship between

the two parts of Rachlin's target article, the overview of current
pain research and the behavioral theory that relies heavily on
the analogy of the "super-Spartan." We will focus on the first
part of the paper since, in our opinion, the available evidence
does not support the model presented. First, Rachlin suggests
that there is a "cognitive theory" of pain that can be contrasted
with a distinct "behavioral theory" of pain. He cites Turk,
Meichenbaum, and Genest (1983) to show that cognitive coping
strategies have not proven to be effective in enhancing pain
tolerance. He then infers that the data do not support a cognitive
theory of pain. The leap from a conclusion regarding the efficacy
of various cognitive coping strategies (e.g., imaging that you are
on the beach in Hawaii) to the efficacy of "cognitive" treatment
for chronic pain is specious.
The cited quotation from Turk et al. (1983) does not support
the conclusion that cognitive strategies are ineffective. Rather,
laboratory subjects have already developed some coping strategies, and they do not suffer from a coping skills deficiency.
Teaching new coping techniques to subjects who have existing
coping repertoires will not necessarily lead to any improvement. Furthermore, Rachlin fails to consider the literature on
acute clinical pain that supports the efficacy of both cognitive
and behavioral coping strategies (e.g., Langer, Janis & Wolfer
1975).
Few consider a purely cognitive treatment to be a satisfactory
approach to chronic intractable pain (we will return to this point
shortly). Yet Rachlin fails to cite the one study that most closely
resembles a "cognitive" treatment, that of Rybstein-Blinchik
(1979), who demonstrated the efficacy of an approach employing
rational restructuring and relabeling. She reported that this
treatment resulted in a reduction in both self-reports of pain anil
pain behaviors observed by the nursing staff.
The application of what we call a cognitive-behavioral approach to the treatment of pain involves a wide range of treatment strategies. Cognitive-behavioral interventions are active,
time-limited, structured treatments designed to help patients
identify, reality test, and correct maladaptive beliefs concerning
their problems. Patients are encouraged to monitor the impact
that negative pain-engendering thoughts and feelings play in
the exacerbation and maintenance of maladaptive behaviors. In
addition, patients are taught to recognize the connections
among cognitions, affect, physiology, and behavior. The therapist is concerned with both the role that patients cognitions play
in contributing to the disorder and the nature and adequacy ol
patients behavioral repertoire.
We have already noted that there is a body of literature that
supports the efficacy of cognitive approaches with acute pain.

Response/Rachhn: Pain and behavior

There is also some evidence supporting the efficacy of cognitive
and cognitive-behavioral approaches to chronic recurrent pain.
For example, Holroyd, Andrasik, and Westbrook (1977) and
Bakal, Demjen, and Kaganov (1981) have reported on the
effectiveness of stress-management techniques for tension
headaches and vascular headaches, respectively. In fact,
Mitchell and White (1977) reported that the greatest amount of
improvement in migraine headaches was demonstrated following the addition of cognitive strategies to more behavioral ones.
It is possible that Rachlin did not review these studies because
the operant theory has given these types of pain little attention.
Even in the treatment of chronic intractable benign pain,
there is a growing body of evidence supporting the utility of a
cognitive-behavioral approach. For example, Turner (1982) reported on the efficacy of a cognitive-behavioral treatment versus
relaxation with low-back patients. She noted that the former
resulted in significant pain reduction and increased activity
levels. These results were maintained from one and one-half to
two years following the intervention. Several related studies
have supported the importance of cognitive factors in the effective use of biofeedback with chronic-back-pain patients (e.g.,
Flor, Haag, Turk & Koehler 1983; Nouwen & Solinger 1979).
We are not suggesting that the efficacy of cognitive or cognitive-behavioral approaches has been demonstrated unequivocally. In fact, we agree with Rachlin s conclusion that the jury is
still out. We believe, however, that there are a large number of
studies that should be considered before one subscribes to a
purely behavioral theory of pain.
Rachlin contends that there are two psychological theories of
pain with two distinct treatment protocols. However, as we
have suggested, there is actually no "cognitive" treatment
(Rybstein-Blinchik, 1979, notwithstanding). Rather, most treatment studies have adopted a cognitive perspective that acknowledges the importance of patients' processing information
about treatment and their plight and employ some behavioral
strategies to bring about cognitive ami behavioral changes.
We would suggest that even those who adopt an operant
approach incorporate important cognitive components in treatment. Fordyce (1976) spends a good deal of time attempting to
change patients views of their problem as part of an operant
treatment. He provides them with an alternative conceptualization of pain that needs to be interpreted, appraised, and accepted if his treatment is likely to have any beneficial effects.
Rachlin has failed to consider data that are relevant to his
thesis. He has misrepresented the cognitive-behavioral model
as being a purely cognitive one, and, moreover, he has presented the operant model as if it were exclusively behavioral. Pain is
a perception, not a sensation, and thus, the experience is
comprised of cognitive, affective, and sensory as well as environmental factors. Although we agree that behavior is an important
component of the experience of pain, it cannot be viewed as
synonymous with it.

Not "pain and behavior" but pain in

behavior
Patrick D. Wall
Cerebral Functions Group, Department of Anatomy, University College
London, London WC1E 6BT, England

This paper perpetuates a Cartesian dualism by its subdivision of

pain into "sensory" and "psychological." This is an intellectual
artifice invented to preserve a concept of divided brain and
mind. Rachlin proposes a two-stage process. First, a mindless
mechanism reports to the brain the state of the periphery as best
it can. Second, cognitive processes get to work to decide what to
make of the news. Attractive as this sequential process may be to
the classical intuitive philosopher, there is not a scrap of physio-

logical or psychological data to support the dualism (Mel/ack &

Wall 1982; Wall 1979, 1984; Wall & McMahon 1984). What is
observed in others and felt in oneself is an integrated whole
organism which is on occasions in a state of sensory-psychological pain.

Author's Response
Ghostbusting
Howard Rachlin
Department of Psychology, State University of New York at Stony Brook,
Stony Brook, N.Y. 11794

First, I will deal with some common objections to the

target article under various specific topics. Then I will
discuss each commentary individually. This organization
necessarily involves some repetition but will prove convenient for the reader interested only in certain topics or
in certain commentaries.
Specific topics
Introspection. Psychological theories (like those of other
sciences) may be evaluated by standards of coherence,
parsimony, experimental success, and meaningful application to practical concerns. They cannot be evaluated,
I claim, by agreement with our intuitions or introspections any more than a theory in physics can be so evaluated. If a psychological theory that is found to be best by
the above standards goes against our intuitions and introspections, then our intuitions and introspections must be
illusions. The moon illusion is an illusion because it
contradicts accepted physical theory. It is conceivable,
however unlikely, that a theory of physics that sees the
moon to be shrinking as it moves from the horizon to the
zenith will someday be generally accepted. In that event
the moon illusion will not be an illusion but a veridical
perception.
The reasons for accepting or rejecting a physical theory
have nothing to do with perceptions of the subject matter
and everything to do with the other standards mentioned
above (which may constitute a perception of the theories
themselves). As Skinner (1953), Kantor (1963), and other
behaviorists have argued, psychological theories should
be judged by the same standards as other scientific
theories.
Introspection was never rejected by Watson or any
other behaviorist as an object of study - as behavior like
any other. Introspection was rejected rather as a privileged sort of behavior - as a substitute for the scientific
study of behavior itself. Faced with the choice of regarding our mental states as given by introspections or as
determined by whatever is the best theory we currently
have, it is always tempting to rely on introspections. The
rewards for elevating them into scientific truth are immediate. Introspection requires little work and little intelligence. And no one may contradict us. Ainslic believes
that these benefits enable us to trust what introspection
tells us as the truth. But the penalty for so doing, although
THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8.1

73

Response/RacMin: Pain and behavior

delayed, may be severe. It is the possibility of sacrificing
coherence, parsimony, experimental success, and meaningful application - all the criteria of a scientific theory
other than introspection. So we ourselves in our theorizing, like the pigeons in Ainslie's own experiments on selfcontrol (Ainslie 1975), are faced with a choice between a
small immediate gain (a temptation) and a much larger
but delayed gain. We do not succumb to temptation when
we introspect. We succumb to temptation when we
substitute introspection for scientific reasoning.
Theory and application. Most of my colleagues will probably agree with me that psychology, relative to some other
sciences, is far from ready to apply theory directly to the
problems of everyday life. The best we seem able to do at
present is to develop theory and practice in parallel.
Psychological theory can (all too easily) explain post hoc
why certain techniques work and why others fail. Any
theory may act as a heuristic, guiding practice in a vague
way, but none is precise enough to predict in advance
which techniques will work and which will fail. At present, in psychology, theory can benefit much more by a
study of practice than practice by a study of theory. (Until
recently physics was only slightly better off. The development of steam engines probably contributed more to
physical theory than vice versa.) This is why the target
article so strongly emphasized the importance of clinical
techniques in the study of pain.
As several of the commentators pointed out, the radical
behavioristic definition of pain is, given current intuitions, counterintuitive. I do not argue that all the evidence is in. I do not ask the reader to accept behavioral
theory and reject all others. I do claim, however, that the
behavioral theory of pain is no less viable (however
counterintuitive it may be) than any other current theory.
Thus, contrary to the assertions of Clark and Shaver &
Herrman, it is significant that behavioral techniques
(techniques vaguely guided by behavioral theory and
easily describable in its terms) are no worse than others in
controlling pain.
Psychophysics and behavior. In beginning the target
article with the separation in psychophysics between
intensity and reaction scales I meant to illustrate that
people recognize two aspects of pain. I then went on to
identify those two aspects as operant and respondent
behavior. Some commentators, however, seem to have
been so beguiled by my initial reference to the psychophysical results that they did not read what I said afterward. Genest, Wall, and Loeser all (to a degree) make the
same criticisms of current views of pain as I do. But they
erroneously attribute those views to me. As Melzack
indicates, the fault is mine for not emphasizing strongly
enough that I disagree with the linear view of pain
implied by the dichotomy between "intensity" and "reaction." In part, then, Genest, Wall, and Loeser criticize,
not my view, but the linear pain theory as put forth in all
its oversimplicity by Matson.
Words and pain. Where do the words that people use to
describe their pain come from - and why do they use
those words when they do? A behavioral theory (contrary
to traditional psychophysics) assumes that these words
are not descriptions of internal states but rather are
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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

designed (like what Place calls "establishing conditions")

to produce certain actions in listeners which the speaker
or the general environment eventually reinforce. This
notion requires a common understanding between speaker and listener. When migraine headache sufferers describe their pain, are they attempting to produce certain
behavior in the listener or just reporting on an internal
state accessible only to them? Jamner and I (unpublished)
asked a group of non-migraine sufferers to fill out the
McGill pain questionnaire (Melzack 1983) pretending
they were suffering from migraine. We found no difference between the words they used to describe their
imaginary pain and the words used by a group of actual
migraine sufferers. This constitutes some evidence (of
course, not proof) that pain descriptions are social acts
accessible to all people with a common culture rather
than reports of the quality of inherently private states (as
Genest would claim).
Cognitive behavior modification. We should not even
consider cognitive theory as applied to pain, Miles believes. Between a good behavioral theory and a good
physiological theory there would indeed seem to be no
room for a cognitive theory. To slightly alter Miles's
metaphor: with two mature, healthy horses pulling the
wagon we would not need a third. But are physiological
and behavioral psychology mature or healthy? I don't
think so. Theories labeled "cognitive" are, therefore,
worth considering, because they aid in description and
generalization of effective clinical practice.
The problem in applying cognitive theory to clinical
practice, however, is that there seems to be no relation at
all between the work of clinicians who call themselves
"cognitive behavior modifiers" and experimental cognitive psychology (Rachlin 1977a; 1977b). It would be too
much to ask for direct application of theory to practice.
But in this case we do not even have post hoc explanation;
there is simply no relation between theory and practice.
Whatever elegance, symmetry, or experimental precision is contained in current cognitive theory is lost in
cognitive behavior modification. All that remains in common is the name "cognition" and a vague sense that
"thoughts" are being dealt with.
But what about laboratory and clinical techniques developed by the cognitive behavior modifiers? A little
success in practice would compensate for a lot of failure in
theoretical elegance. Turk & Salovey make the remarkable claim that we cannot look for success in laboratory
studies of cognitive behavior modification since laboratory subjects "do not suffer from a coping skills deficiency."
The claim is remarkable because the only decent evidence we have that self-description is related in any way
to pain control comes from the study of laboratory subjects by Turk, Meichenbaum, and Genest (1983) mentioned in the target article. In that study some subjects
(with low pain thresholds) "catastrophized." If that study
is now to be repudiated we are left with only clinical
studies for evidence of the effectiveness of cogntive behavior modification. As indicated in the target article,
clinical studies are difficult to conduct and, almost necessarily, difficult to interpret. That is why I made no special
claims for Fordyce's results. I said his methods were no
worse than any others. Cognitive behavior modifiers
cannot be satisfied with this. They must claim that their

Respou.se/Rachlin: Pain and behavior

cognitive-behavioral techniques are better than purely
behavioral techniques. Otherwise why use cognitive
treatments at all? Why not just stick to behavioral
treatments?
In support of the clinical efficacy of cognitive additions
to behavioral techniques Turk & Salovey cite a study by
Rybstein-Blinchik (1979). In that study 11 chronic pain
patients were told to use "milder" words to describe their
pain and were given examples of mild words: "I feel
numbness" or "I feel itching" instead of "I feel pain."
Then they were given practice in using these words by a
therapist familiar with the purposes of the study, and they
were told that their pain would be helped if they persisted
in using these mild words to describe it. It is not surprising, therefore, that patients in this group obeyed instructions and actually did describe their pain with mild
words, giving their pain lower ("milder") ratings than
patients in control groups. They did also show less overt
pain behavior when it was measured by an experimenter
who they knew was involved with the study. I do not
intend to belittle these results, but Turk & Salovey
succumb to wishful thinking when they say that this
treatment resulted in reduction of "pain behaviors observed by the nursing staff." Rybstein-Blinchik reports
that the nurses observed no differences in pain behavior
between the treated patients and others.
Respondents and operants. The target article does not
adequately distinguish between respondents and operants. Since a behavioral theory of pain depends on it, this
distinction needs to be clarified. I beg the reader's indulgence, therefore, while I briefly discuss laboratory experiments with animals where operants and respondents
have been most extensively analyzed.
According to Skinner's (1938) original distinction, a
respondent is an act controlled by its antecedents and
alterable by classical (Pavlovian) conditioning, while an
operant is an act controlled by its consequences and
alterable by operant (instrumental) conditioning. Skinner
speculated that certain acts might be naturally and wholly
respondents (perhaps those mediated by the autonomic
nervous system), while other acts might be naturally and
wholly operants (perhaps those mediated by the skeletal
nervous system). Dogs' salivation is a prototypical example of the former, and pigeons' key pecking is a prototypical example of the latter.
But it was soon shown that no act is wholly respondent
or wholly operant. Salivation may be controlled by its
consquences and key pecking by its antecedents. The
latter process, known as "autoshaping," is so reliable and
"law-abiding" that it has become one of the two or three
standard methods in the United States for studying classical conditioning itself (see, for example, Locurto, Terrace
& Gibbon 1981; Rescorla 1984). It is currently agreed that
no act can be a "pure" operant. According to Teitelbaum
(1977), all operant behavior evolves in some way from
respondent behavior no matter how different it may
appear to "be in its final form. Teitelbaum's notion of
operants developing from respondents corresponds nicely to Melzack's notion of parallel processing in the physiology of pain. Teitelbaum has shown that the development of eating patterns as a rat's (or a human's) brain
matures corresponds to changes in eating patterns as that
animal recovers from brain operations. At first eating is

stereotypic, reflexive, and relatively unmodifiable by its

consequences. As the higher centers of the brain develop, eating becomes more idiosyncratic, relatively unreflexive (not reliably elicitable by a given stimulus), and
highly modifiable by its consequences. In other words,
eating in rats and humans starts out as mostly respondent
and evolves into an operant. Yet buried within that
operant, so to speak, the respondent still lurks. At times
of stress or extreme deprivation, respondent eating may
take the place of operant eating in adults. (See Breland &
Breland, 1961, for an example of such "instinctive drift"
in pigs.)
In the case of eating by mammals such as rats, pigs, and
humans, normal respondent and normal operant behavior seem to have different (but overlapping) topographies.
But in the case of pecking (hence eating) by pigeons,
normal respondent and normal operant behavior have
almost identical topographies (although there have been
some attempts to tease them apart; see Schwartz &
Gamzu, 1977, for an example). The best way to tell the
difference between a respondent and an operant pigeon
peck is to do experiments to discover which of its aspects
are controlled by its antecedents and which by its consequences. As patterns of pecking become more complicated, the patterns themselves are more likely to be
controlled by their common consequences (the patterns
are operants), while the elements, the individual key
pecks, are controlled by their antecedents (the pecks are
respondents). Thus, respondent and operant behavior
are intertwined.
Returning to the subject at hand, pain, if it is indeed
overt behavior, would seem to be at least as complex as a
pigeon's key peck. To what extent pain is like mammalian
eating (and differs in topography in its respondent and
operant manifestations) or like avian eating (and is similar
in topography in its respondent and operant manifestations, differing only in complexity of pattern achievable)
has yet to be explored.
I agree with Clark, Logue, and Matson that tissue
damage is the fundamental and most common cause of
pain. But tissue damage is still only the unconditioned
stimulus for respondent pain. Beyond direct elicitation
there may be classical conditioning of (respondent) pain
and operant conditioning of pain. I should have said in the
target article, not that there are two kinds of pain, but that
there are two causes of pain and therefore two ways of
controlling pain. If pain is indeed overt behavior, then it
must be controlled by the same methods used to control
other kinds of overt behavior - namely, respondent and
operant conditioning. If I had said this I would have
avoided the criticisms of those commentators who claimed that I had gotten the number of kinds of pain wrong.
(Campbell, Fordyce, and Genest say there are more than
two kinds. Loeser, Logue, and Matson say there is only
one kind.) But this is a pointless argument, and it is my
fault for allowing it to arise.
Whole and part. Four commentators (Bernstein,
Graham, Logue, and Place) disagree with my objection
(based on molar behaviorism) to a behaviorism of the
inner organism; one (Shimp) objects to molar behaviorism in general; and one (Logue) explicitly supports it.
The issue is too complicated to debate fully here. (See
special issue on the canonical papers of B. F. Skinner,
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75

Pain and behavior

BBS 7(4) 1984, and my commentary on Skinner's "The
Operational Analysis of Psychological Terms" for a discussion.) I will merely say that, to me, the expectation that
parts of an animal will be found to function like the animal
as a whole (which is the essential assumption of innerorganism behaviorism) is like the expectation that the
carburetor of an automobile will function like an automobile. Furthermore, it seems impossible to explain
mental states such as pain with a molecular behavioristic
theory unless that theory is extended to the inner
organism.
When asked for an explanation of mental states unaccompanied by current overt behavior, molar behaviorists
point to a pattern of past overt behavior and identify that
pattern with the current mental state. But molecular
behaviorists do not have this option, because for them
patterns are not units. This forces (or at least encourages)
them, when asked to explain mental states, to point inside
the organism. Then mentalists would have behaviorists
just where they want them. The behaviorists internal
mythology is no better than that of the mentalist.
Curare. Two commentators, Campbell and Foss, cite the
"fact" that curarized subjects feel pain even though they
cannot behave. (Significantly, both Campbell and Foss
are philosophers. None of the several commentators who
are physicians or physiologists or even clinical psychologists cited this "fact.") Both Campbell and Foss fully
realize that, even if it were true, the "fact" would not
constitute evidence against the behavioral theory of pain
as I presented it. Both commentators therefore ask us to
imagine a person curarized from birth to death. Would
that poor person feel pain? That, of course, is a meaningless question unless one already has a behavioral
theory of pain, in which case the answer is no.
Let us now return to the "fact" that curarized subjects
can feel pain. Foss cites no references. Perhaps his
dentist told it to him, since he refers to curarized dental
patients. But it is unusual for dental patients to be given
curare. Campbell cites two sources for the failure of
curare as an anesthetic. I could find only one (Hutchinson
1960). In that study 700 patients were interviewed after
operations to discover whether they remembered anything about the operation. The question was put in terms
of whether they remembered anything that had happened or whether they had dreamt anything during the
operation. Nine patients reported dreams. Of these, one
dream was rejected because it was unconvincing. Of the
other eight subjects, six reported discomfort in their
dream, and of these only three reported pain. Two said
they had not been dreaming but claimed to have been
awake during the operation. Since most of the patients
were anesthetized with a combination of several agents
(including curarelike relaxants), this study might seem at
best irrelevant to Campbell's and Foss's point. But,
fortunately, 216 of the patients were anesthetized by the
Liverpool "pure" technique (uncommon in the United
States) which consists only of a mixture of nitrous oxide
and oxygen (which dentists do sometimes give) plus a
curarelike relaxant. Of those 216 patients, 6 claimed later
to have had dreams. Of these, not more than 3 (possibly 2)
claimed to have had a pain in the dream, and only 2
(possibly only 1) described events that had actually occurred in the operating room. About these recollections

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8 1

the author says, "There is very little proof that the

experiences described by the patients really occurred
during the operation." Those two "memories" (or that
one "memory") could have been due to unusually light
anesthesia, to something that occurred as the anesthetic
was wearing off or before it took effect, to what the
surgeon might have told the patient before the operation,
or to other unknown factors.
It is easy to understand why an anesthetist would be
reluctant to take a chance that even one out of a hundred
patients will feel pain during an operation. My question
to Campbell and Foss is, what about those 210 patients
who not only felt no pain, not only felt no discomfort, but
did not remember what happened during the operation?
It may well be that, as opposed to dental doses of nitrous
oxide plus oxygen, surgical doses are effective anesthetics
and do, by themselves, cause loss of consciousness. In
that case the Hutchinson study is irrelevant to the argument. On the other hand, if the doses of nitrous oxide plus
oxygen used on the patients in this study would not have
been enough by themselves to cause complete anesthesia
and loss of consciousness, the study constitutes strong
evidence, not only/or a behavioral theory of pain but also
for a behavioral theo-v of consciousness (see response to
Jaynes).
Super-Spartans and pain actors. Happily, not a single
commentator specifically defended Putnam's super-Spartan refutation of behaviorism. This is surprising, since I
have heard Putnam's argument referred to as "proof" of
the falsity of behaviorism. However, Campbell did ask for
more discussion of "crybabies" (Putnam's perfect actors),
and Harman illustrates the super-Spartan and the perfect-actor argument with homely incidents from his childhood. The problem we have in relinquishing these arguments is our desire to retain the incorrigibility of pain
reports at all costs. But if you see pain as I do - as a
widespread pattern of behavior - it must be possible for
you to be wrong about a specific instance of pain behavior.
A simple act may prove not to be pain behavior even
though it seems to be so at the time; or an act may prove to
be pain behavior even though it does not seem to be so at
the time. It depends on how the pattern develops. To use
a familiar Gestalt example, one or two notes may seem to
be part of one melody but prove later to have been part of
another. What is particularly hard to accept is that this
applies to our own behavior as well as to that of other
people.
As I indicated before, insistence on the incorrigibility
of introspection in this regard is a temptation that we
should train ourselves to resist (as pilots must train
themselves to resist the temptation to fly by the seats of
their pants and instead to rely on instruments). Such a
temptation exists in physics as well as in psychology (in
our intuition that the world is as we immediately perceive
it to be). But the temptation is particularly strong (because the need for immediate solutions is so great) in
psychology. Because we know that the temptation will be
so strong, we should be still more on our guard against it.
The long-term reward for not trusting to the seats of our
pants with regard to our own pains could be the effective
control of chronic pain. It is particularly disappointing to
note that philosophers, who should be the first, are
actually the last to give up their reliance on introspection.

Response/Rach\in: Pain and behavior

Psychologists are not for ahead of them. If we do not give
up this self-indulgence we will truly deserve the wrath of
people such as Loeser, who seems to blame us for the
very existence of chronic pain.
Individual commentaries
In this response I go from abstract to concrete: philosophers first, then psychologists, then physicians and physiologists. Within each division responses are alphabetically organized. I apologize for any misclassifications.
To save space, I emphasize disagreements (of which there
are a sufficiency).
Philosophers. It is quite rightly pointed out by Campbell
that if pains could change in quality while remaining the
same in all their behavioral manifestations, behaviorists
could not account for all there is to pain. But a behavioral
theory does not see the words by which the quality of pain
is usually described (stinging, grinding, shooting, throbbing) as qualities of pain although, as the names imply,
they may be qualities of stimuli that cause pain (see prior
section "Words and pain"). A person who describes a pain
as "stinging" could be describing a stimulus, not the pain
itself. The qualities of pain itself would be topographies of
overt behavior (twisting, writhing, grimacing, yelling,
crying, and patterns thereof). Campbell was (understandably) misled by my initial discussion of psychophysical
research (see section "Psychophysics and behavior"). The
proper categories of pain qua behavior are respondent
and operant, not sensory and aversive (see "Respondents
and operants"). Of course, within these categories, behavior varies in topography.
Campbell, after presenting the curare example (see
"Curare"), asks for more discussion of fake pain. Let us
therefore consider a great actor in a play. Let us say he is
so convincing in portraying pain that everyone believes
him to be actually in pain. Is he really in pain? If, before
and after the play, he acts normally, then people would
say he was faking during the play. If before and after the
play he acts as if in pain, then people would say he was not
faking. They could be wrong. Being a great actor, he
could be acting pain-free outside the theater (say, he has
cancer and wants to reassure his friends) but really in
pain. Then we might have to observe his behavior over
still wider periods of time to discover the truth. But at no
point could we settle the question by asking him or
peering inside him. Mis response to our questions would
just go along with his other behavior; no instrument for
examining his brain exists whereby a doctor could discover that he was in pain even while he convincingly
denied it. Yet his immediate verbal denials could be
contradicted by the pattern of other overt actions.
Campbell claims that a person can be in "comfort"
even while "pretending" from birth to death to be in
excruciating pain. That person would be like the man who
claims on his deathbed to have loved his wife "deep
down" even though he was consistently unfaithful to her
and beat her. "Deep down," in these cases, means
"seldom." Comfort is just as much overt behavior as pain
is. Campbell's super-super-crybabies are as inconceivable as Putnam's super-super-Spartans, and for the same
reason. They are self-contradictory conceptions.
Foss admits that behaviorism has the logical possibility

of being true. Given this, and his apparent rejection of

behaviorism, you would then expect him to cite the
empirical evidence against it. But aside from the curare
example (see "Curare"), Foss provides us only with his
own intuitions and the argument that, because physiological mechanisms underlie behavior, behaviorism must be
false. He must then also believe that, because physical
and chemical mechanisms underlie neural behavior,
physiology is false.
Graham agrees with me that the respondent-operant
distinction applies to pain. But he conceives the stimulus
for the respondent to be inside the organism. What is the
difference, then, between an operant and such a respondent? It cannot be that the operant is modifiable by
its consequences while the respondent is not. Respondents may also be modifiable by their consequences
(see "Respondents and operants"). Thus, given internal
stimuli, the operant-respondent distinction, the distinction that gives meaning to a behavioral theory of pain, is
lost.
Graham compares pain to an internal process like
digestion. He claims that digestion leads to movements of
the whole organism. But it does so only as it interacts with
other internal processes. Those movements are best
explained not in terms of internal antecedents like digestion but in terms of deprivation and overt environmentbehavior interactions. Digestion per se can be defined
functionally wholly within the organism. This is not true
of pain.
Harman, when he was a child, faked having pain in
order to distract his parents. He claims now that he was
not really in pain then. His parents probably had more
sense than he gives them credit for. He might have fooled
them once or twice. But had they consistently reinforced
Harman's fakery he might well be a chronic pain patient
now and (looking back with some insight) might trace his
pain to those events.
Harman also claims to have had headaches and to have
learned to wait them out. He says he never mentioned
them to anyone else and never acted any differently. If so
(unless they have read the commentary), his parents, his
doctor, his closest friends, and his spouse and children (if
any) must, to this day, still not know about those headaches. Does anyone want to bet?
Kitcher rejects my pain as "fire-alarm" theory. She
says that it is the player's injury, not the pain, that stops a
baseball game. To carry the metaphor a step further, the
injury is like the fire and the pain is like the fire alarm.
Kitcher would say that people make way for fire trucks,
not because of the fire alarm, but because of the fire. All
right, but that still leaves the fire alarm with an important
function, analogous to the function of pain.
Next, she points out that behavior therapy for pain
could be explained by cognitive theory too. I agree. It is
always possible to imagine cognitive mediation of behavioral events (just as one can imagine the hand of God
behind physical laws). But it is behavioral theory that
encourages a concentration on the overt consequences of
pain behavior, and that concentration, I argue, is responsible for its success.
Finally, Kitcher makes an attempt to provide a behavioral account of Freud's response to his cancer. She
assumes that operants and respondents must have rigidly
different topographies (see "Respondents and operants").
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Res/jonse/Rachlin: Pain and behavior

But Freud's response to his cancer must be partly respondent and partly operant, the latter having been
shaped from the former.
The single point on which Lacey and I disagree is
whether a behavioral definition of pain depends on physical description of pain behavior. He says it does and
points to the physical description of a lever press. But a
pain is not like a single lever press; it is like a pattern of
lever presses. With patterns of presses (say fixed-interval
scallops) there is no agreed-upon physical definition
(Schneider 1969). Yet surely such patterns are behavior
and not internal states. Similarly, a gymnastic or iceskating performance or a dive is an overt and not an
internal act. Yet there are no accepted physical criteria for
such behavior. That is why we need panels of human
judges to evaluate them.
For responses to Matson's commentary see Melzack's
and Wall's commentary.
Place's concept of "semicovert" behavior solves none
of the problems involved in the concept of covert behavior (see "Whole and part" and response to Graham).
Place points out that a blush is not all there is to shame. I
agree. We disagree about where the rest of shame is to be
found. He looks for it in covert behavior. I look for it in
other overt behavior, which, with the blush, forms the
pattern we call shame.
Psychologists. The argument of Bernstein for a behaviorism of organs rather than organisms is really an argument for physiology. I do not favor abandoning physiology. I just want to abandon physiological mythology as
an explanation of behavior of whole organisms (see
"Whole and part," response to Graham, and response to
Place).
Glark reports on signal-detection studies of pain. The
signal-detection model was intended to distinguish between a subject's ability to make discriminations and the
subject's criteria for reporting those discriminations. This
is the linear process condemned by Melzack and by Wall.
First a stimulus comes (tissue damage), then an "internal
physiological mechanism" is activated. (What or where
that mechanism is is completely unknown to Clark, but it
is exactly there that he locates pains.) Then one decides
whether to tell the world about the pain. If one's criterion
(i.e., threshold) is low relative to the pain itself, one
reports pain. If it is high, one does not. This picture is
exactly what Wall says "there is not a scrap of physiological or psychological data to support. " Even ignoring the
considerable problems of interpretation of the signaldetection model, Clark's redundant claim that "empirical
evidence' supports his assertions is gratuitous.
Clark and I agree that if a diseased tooth causes pain,
getting rid of the diseased tooth generally gets rid of the
pain. But for him that is the extent of pain treatment. Pain
without a diseased tooth or tissue damage of some kind is
beyond his comprehension. He would not label "as in
pain people who display pain behavior without tissue
damage." That to him is a "labeling error." Let him tell
this to a person with a migraine headache.
Fordyce's commentary provides a definition of pain
behavior that he equates with those behaviors that observers identify as constituting a pain problem. They may
follow a given stimulus (in which case they are respondents) or occur without any clear-cut stimulus (in which

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THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

case they are operants). I identify those behaviors with

pain. Fordyce prefers to reserve the word "pain" for
internal events to which those behaviors are a response;
then he claims to be indifferent about whether the "pain"
is really gone when the pain behaviors are gone. That
tactic seems to me to be a waste of a perfectly good word
and a needless concession to his critics. Fordyce claims to
care about people's pain behavior; why should he deny
that he cares about their real pain? That denial too easily
allows his significant contributions to the treatment of
pain to be dismissed as "mere " behavioral manipulations
by moralists of the inner man like Shaver & Herrman.
And it encourages his identification as a "solipsist of the
eighteenth century" by mentalists like Merskey with
eighteenth-century models of the mind.
Much of my response to Genest is contained in the
section "Cognitive Behavior Modification." I would add,
first, that Genest misses the point that pain is a pattern of
behavior extended over time, not an individual act. I
agree with him that a person might be in pain now
without evincing pain behavior now. But I disagree with
him that a person can be in pain now without evincing
pain behavior ever (see "Super-Spartans and pain
actors").
A second point raised by Genest is quite important. He
finds it absurd that mental events may not be private
events (see "Introspection"). This attitude must affect his
behavior as a clinician. It must sometimes encourage him
(contrary to the recommendation of Turk & Salovey) to
use cognitive techniques, not as harmless additions to
behavioral ones, but instead of behavioral ones. He
thinks it is ridiculous to look in the mirror to determine
whether you are in pain. Instead, he seems to accept
Locke's metaphor of an internal mirror in which mental
states are reflected. As Rorty (1979) has convincingly
argued, the metaphor of the internal mirror is not viable.
The behaviorist view suggests that the mirror by which
we see our own bodies is outside of ourselves, in the
environment, particularly that part of the environment
sensitive to our behavior. This is one reason that behaviorists stress the importance of what they call "feedback
functions" (Baum 1973). Feedback functions (including
schedules of reinforcement) are, for the behaviorist, the
true mirrors of the mind.
Genest cites a study in which alcoholics reported accurately on their own impairment without knowing exactly
how much they had drunk. My question is, were they
allowed to move? Would they have done still better if
they could have tried to walk a straight line or look in a
mirror? What does Genest think he is doing when he tells
his clients to record their own behaviors and gives them
feedback? Who does he think can judge better whether a
man is an alcoholic - the man or his family? Finally,
Genest says that he can use "entirely internal cues" to
make claims about his myopia. This implies that he can
make such claims with his eyes closed!
Jaynes makes several interesting points that can only
be dealt with schematically here. First, I do not say that
because chronic pain can be controlled by operant methods it logically follows that pain is behavior (see "Theory
and application"). But if chronic pain could be controlled
by operant methods, the burden of proof would be shifted
to other conceptions of pain. They would have to show
their superiority in terms of explanatory power, experi-

Response/ Rachlin: Pain and behavior

mental validity, parsimony, elegance, and so on despite
the success in application of behavioral theory. I claim
that introspections are invalid alongside these other criteria (see "Introspection").
Second, it is not feelings of control but actual control
over pain stimuli that diminishes pain in the self-administered morphine procedure. This fact is entirely consistent
with molar behaviorism, which sees behavior as a function of a relationship between behavior and the environment. A schedule of reinforcement is just an example of
such a relationship. It is a mode of control.
Third, phantom limbs are a fascinating and complicated subject that I do not wish to oversimplify. But a
behaviorist would put phantom limb pain in the same
category as phantom limb walking. Walking and pain are
both highly practiced behaviors with respondent and
operant components. Without restraint, recent amputees
must often forget they have only a single leg, get out of
bed, and begin to walk. Such phantom walking would be
quickly punished by falling and might be expected to
disappear. Phantom pain remains unpunished and, as
Jaynes points out, is perhaps even rewarded.
Finally, the notion of body consciousness is a useful
way to summarize phantom limb phenomena, especially
the tendency of phantom limb pain to disappear with the
attachment of a prosthesis. Rewards obtainable from pain
behavior might be insignificant compared to rewards
obtainable by acting as a whole person. Then the substitution of one set of rewards for the other would be easily
made. But there could be cases where the reverse might
be true. I would guess that when an amputee is not
quickly fitted with a prosthesis and instead adjusts to life
without it, rewards might be more evenly balanced and
the coming and going of pain not regulated so well by the
going and coming of the prosthesis.
Jaynes (1976) is convincing that something significant,
which can be characterized as the emergence of consciousness, happened in the first millennium B.C. I agree
that consciousness may be considered an operant (see
"Curare"), but as such, I insist, it is a pattern of overt
behavior. What happened at that time might have had
more to do with social relations than anatomy.
Logue agrees with me that molar behaviorism is a good
idea but disagrees about how it should deal with mental
events. For her, mental events are "hypothetical constructs" to be verified (presumably at some time in the
future) by direct observation. In this respect, her commentary belongs with those of Bernstein, Graham, and
Place. Skinner (1984) also rejects a behaviorism based on
wholly overt behavior. Since covert behaviorism is such a
common way of dealing with mental events (dating from
Watson, 1924) let me try to spell out its assumptions and
why I object to it. In the case of operant conditioning we
know that when a response is reinforced, other responses
are also strengthened. For instance, if a key peck with a
force of 10 grams is reinforced, key pecks somewhat
greater and less than 10 grams will also be emitted at
higher rates than before. Why (these theorists argue)
should key pecks of zero grams - internal, covert key
pecks - not also be strengthened? And, if covert key
pecks can be reinforced, why not covert behavior of all
kinds? Response generalization, however, has meaning
only in terms of observable behavior. The conception of
covert generalization leans heavily on the potential un-

covering of these covert responses. How are they to be

uncovered? As behaviorists, Bernstein, Graham, Place,
Logue, and Skinner would, I assume, rule out introspection. Another possibility is myographic measurement of
minute muscular movements. This route has been taken
in the past and been found inadequate. Minute movements are conditionable (Hefferline & Keenan 1963) but
seem to have little to do with the mental events that they
were originally supposed to explain. There is the hope
that Logue's "hypothetical constructs" will eventually be
uncovered by physiological investigation, but as long as
the hypothetical construct is phrased in behavioral rather
than physiological terms the hope seems to me a vain one.
A "hypothetical construct" of hormonal secretion or nervous discharge might eventually be confirmed by physiology. A hypothetical construct that amounts to a conditionable homunculus seems unlikely to be found by
physiologists. What Logue fails to realize is that the molar
behaviorism that she endorses can explain mental events
without such homunculi.
Melzack, a great hero in the study of pain, has more
faith than I do in the future of physiological investigation
of fear and anxiety as these states reside in the brain.
Otherwise, we agree.
Miles rightly points out that a sensation is not an event.
But that does not mean a sensation cannot be an operant
or a respondent. Operants (and even respondents), like
sensations, may be patterns of events. (See "Cognitive
behavior modification" for a further discussion of Miles's
commentary.)
Shaver & Herrman reveal their prejudices by contrasting "mere emotional displays" with "emotions." I
cannot speak for them, but there has been nothing
"mere" about some of the emotional displays I have
witnessed. If I could have been exposed to the fullfledged emotion without the "mere display" I would have
liked it better, I think. Other criticisms raised by Shaver
& Herrman have been dealt with in "Theory and application," "Respondents and operants," and, with more authority than I command, in the commentaries of Melzack
and of Wall. Shaver & Herrman's final antibehaviorist
point is that it takes "conscious volition . . . to refrain
from 'immoral' though immediately rewarding behavior." What do they say about the feet that pigeons can be
trained to refrain from immediately rewarding behavior
(Mazur & Logue 1978)?
Shimp classifies me as a positivist. Recently, Shimp
(1982) called me a British associationist. I am happy to see
he has moved me up from the nineteenth to the twentieth
century. His identifications of respondents with "foundationist" knowledge and operants with "derived" knowledge is strained and beside the point. He classifies Watson as a logical positivist, but it was Brunswik (1952) who
identified himself with the logical positivists - not Watson, who (perhaps wisely) wanted nothing to do with
philosophers. Aside from this, Shimp defends molecular
behaviorism by arguments from authority and energetic
assertion. But he does not indicate how molecular behaviorism would account for pain.
My response to Turk & Salovey is mostly given in
"Cognitive behavior modification." Their commentary is
a good example of the reasoning prevalent in this field. I
defy the reader to discover from their commentary what
cognition is. Is it a coping skill? Is it verbal behavior? Is it
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79

References/RachUn: Pain and behavior

reflection on sensation or behavior? Is it internal restructuring of the environment? Is it processing information?
Is it perception? Or does it serve as a word to cover
whatever the authors cannot, at the moment, understand?
Physicians and physiologists. My answer to Ainslie's
thoughtful commentary is mostly contained in "Introspection" and "Words and pain." The difference between
us lies in the distinction between person A's direct interaction with the environment and person B's observation of As interaction with the environment. Ainslie and I
disagree about how to classify A's introspection in this
scheme of things. I say that A's introspection belongs in
the class of A's other behavior. It is part of A's interaction
with the world. Ainslie says that A's introspection is
actually an observation - a B-like behavior. In what sense
can a person be A and B at the same time? In other words,
how can you know yourself? Ainslie believes you can
know yourself by focusing inward - by taking B's attitude
toward an A that exists inside yourself - that is, by
introspection. I believe you can know yourself by focusing outward - by taking an observer's attitude toward the
interaction of your whole body with the environment.
This characterizes the difference, not only between
Ainslie and me, but between me and several other commentators, for instance, Genest. It is not ridiculous to
look in the mirror to discover your mental state. One
function of a therapist, I believe, is to serve as a sort of
selective mirror and, in so doing, to give a person knowledge of his own mental state.
Atkinson & Kremer cite evidence that different behavioral indices of pain are often reliably accompanied by
specific physiological and neurochemical events. The
behavior that constitutes a given kind of pain may be
difficult to observe because it may extend over wide
temporal intervals. The physiology that accompanies a
given kind of pain is difficult to observe because it is
almost always inaccessible. Nevertheless, there may
come a day when instruments will be developed to
measure these internal events easily. If that occurs it is
likely that we will all define pain (as we now define fever)
in terms of these measurements rather than in terms of
the still-difficult-to-observe overt behavior. Then a doctor will truly be able in the face of contrary behavioral
evidence to tell a person that he is in pain. Until that day
conies, however, we had better define pain behaviorally.
Loeser has a simple way to cut through all the nonsense
about pain. Pain must be caused by something. Get rid of
the causes and you get rid of the pain. What are the
causes? Tissue damage and injury to the nervous system
are mentioned first. Other causes are "suffering induced
by depression, anxiety, fear, or isolation." Now all we
have to do is figure out how to get rid of suffering,
depression, anxiety, fear, and isolation and we'll be all
set.
For Merskey, pain is a "unity [that] may be described
in different languages" - cognitive and physiological.
This is a sort of double-aspect theory. But as with all such
theories, one is tempted to ask: aspects of what? For
Merskey they are two aspects of mind. This conception
helps him personally to empathize with his patients, but
he has no way of knowing whether it helps or hinders or
has any effect at all on their pain.

80

THE BEHAVIORAL AND BRAIN SCIENCES (1985) 8:1

Pepeu's commentary is similar to that of Atkinson &

Kremer, and my response is the same. One point raised
by Pepeu with which I would quibble is his statement that
while a person's response to painful stimuli can be affected by "psychological" factors, the response of rats to
painful stimulation can be affected only by pharmacological or electrophysical manipulation. But we know that
simply signalling an electric shock will strongly affect a
rat's response to it (Badia, Culbertson & Harsh 1973).
[See also Dinsmoor: "Observing and Conditioned Reinforcement" BBS 6(4) 1983.]
I agree with Wall's criticism, but it is not a criticism of
my position. The fault is mine for not having stated it
clearly enough.
NOTE
J. R. Kantor (1888-1984) has recently died. Yet he lives, as
behaviorism lives. This article is dedicated to him.

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