50 shades of touch: the relationship between pleasure and pain

Pain is usually such a negative experience that we rarely think about it in terms of just another sensory modality let alone consider the potential of positive aspects to it. Because of that, this post will be a bit unconventional, especially for a BiM blog. My post, somehow inspired by the controversial novel and movie, “50 shades of Grey”, is precisely about those infrequently considered aspects; my post will be about the relationship between touch, pleasure and pain.

Disgusting or delighting, exciting or boring, sensual or expected, no matter what you think about it, “50 shades of Grey” is certainly not a movie about which people are ambivalent. Based on E.l. James’ novel (honestly, somehow more breathtaking than the movie), it tells the story of the complicated relationship between the assertive multi-millionaire Christian Grey, and the just graduated, inexperienced, and shy Ana Steele. Christian leads Ana (although it is somehow unclear who really does take the lead) towards his sensuous and deviant world, made of ropes, pain, riding crops, chains and strict rules. I could not help but think about the relationship between the sense of touch and pain, two of the main objects of my scientific research into the neurocognitive mechanisms of human perception, emotions and desires, while I first read the book and saw the movie. Well, maybe to be honest, I didn’t make the connection from the very first time, given that it’s easy to be distracted by the sensual events described in the novel, but certainly I was quickly drawn into thinking about my research in the context of the novel. . After all, isn’t the novel about the sensual power of touch and its relationship with pain? How arousing can a light touch on the shoulder be? A kiss on the hair? And what about the tightness of a rope around your wrists or ankles? I was reflecting on where this incredible power of touch comes from and here my research provides some answers. We now know that human bodies have a privileged path to pleasure, one that passes through the sense of touch: CT fibers. These neural fibers innervate the non-glabrous areas of the body and are activated by a caress like stimulus. They must signal comfort and pleasure to our brain, which reacts accordingly. This system is probably inherited from our monkey-like ancestors, social animals that used to groom one another, and also used as a way to set their reciprocal status (dominance) within the group. However, touch is much more than that, it also contributes to the release of hormones, Oxytocin in particular, the bonding (or cuddle, as popularly defined) hormone. Touch actually strongly influences the pace of a relationship, the more touch, the more oxytocin, the stronger a relationship becomes (See Gallace & Spence, 2014; Caressing the skin: The social side of touch).

The two main characters in “50 Shades of Grey” seem to be reciprocally attracted by a magnetic force that pushes their bodies towards unexplored limits. Another important function of touch is actually to set the limits of our body, to define what is ‘us’ and what is not (See Gallace & Spence, 2014; Outside the boundaries of our bodies: The relationship between touch and the representation of the body in our mind). Not surprisingly, in the last few years the discussion about the neural substrates of ‘body ownership’ has become very popular among cognitive neuroscientists. That is, how our brain defines what belongs to it and what does not? I often say to my students at University “Where our touch begins, we are and when someone touches us, we lose a bit of this definition; we become part of the other person.”, Yes, the novel is definitely about touch, the desire to touch and be touched in 50 (and more) different ways.

Some would say that the novel is also about the relationship between dominance and submission, about the question of who is really in charge. But what does truly determine this? Isn’t the sense of touch actually the real leader in this situation? Who touches? When? How? Where? We can watch and hear, but we cannot touch someone without her or his consent. In the second novel by the same author (“50 shades darker”), the ‘untouchable’ Christian asks Ana to use a red lipstick to draw on his chest a map of body areas that she is allowed to touch and areas that are off-limits (areas where touch becomes painful, ‘allodynia’, as we would scientifically refer to it). And still I wonder, can touch be really that powerful? Once again, scientific research provides a positive answer to this question. Touch has been shown to affect a person’s compliance towards a request, their willingness to give more, and their desire to please someone. A number of researchers show that people are much more willing to say yes to a request if they are touched first!

Finally, what about pain? The novel is also about the boundaries between pleasure and pain. Many people would probably wonder about the reason that some individuals are willing to receive corporal punishments from someone they love (and even take pleasure from it). More generally, how can a ‘spank’ be perceived as pleasant? The answer to these questions has certainly much to do with the ‘reward neural circuits’, buried in some of the deepest and evolutionarily oldest parts of our brain. Few would perceive pain as pleasant, but context may make a big difference here! Just as other sensations, pain is a creation of the brain. Lorimer Moseley, the editor in chief of this blog, and one of the major experts in pain worldwide, has often said: “no brain no pain”. I do agree. Many areas of the brain interact to determine the output ofpain, and touch certainly has an important role in this modulation of sensations. Sensual touch is a strong reward, and the brain can lead you anywhere in order to get its reward (See Gallace & Spence, 2014; Touch in the bedroom: The role of touch in sexual behavior). Pain within the context of sensual touch changes its meaning and it is possible that it becomespleasant and rewarding.

I really wonder how the same novel would look with less reference to touch. And even more importantly, how might our life be without tactile sensations? How might our relationships be? How arousing? Here, I have a specific movie scene in mind, the one where Christian uses an ice cube to arouse Ana’s body (admittedly a very often-adopted image in fictional erotic scenes). The effect is strong and its visual impact intuitive, immediate and direct. How do we begin to explore the mechanisms behind something like that? The sensation of wetness on your skin is certainly a very complex one, from a neuroscientific point of view, it requires the activation of at least two classes of receptors, one for temperature, the other for movement over the skin. Without this perfect mixture of neural signals (and the brain’s interpretation of them) we can’t create such sensation, just as we do not feel our body wet while lying completely still in a bathtub full of hot water. Thinking about another object of my research, human machine interfaces (See Gallace & Spence, 2014; Technologies of touch), I really wonder if such sensations will be reproduced artificially one day? Every time I think about these aspects, I can’t help but think about what a huge challenge this is. Will we ever be able to get even close to that? Will touch through interfaces become possible when two people separated by miles? Will these ‘mediated tactile sensations’ be able to ease our pain (such as when we offer our hand or hug to someone in pain)? I want to be positive, but in order to get there more research into the powerful and still somehow mysterious sense of touch in all its 50 (and more) shades is needed.

As a neuroscientist, and as a man who is somehow hypnotized by the magic behind human senses, I am definitely thrilled about what we will learn in the future regarding the brain mechanisms responsible for body sensations, be they pain or pleasure!

About Alberto Gallace

Dr Albert GallaceDr. Alberto Gallace, section editor of this blog, is a cognitive neuroscientist with a special interest in the study of the mechanisms responsible for body-related sensations, pain and touch in particular. He teaches at university of Milano-Bicocca, Psychobiology of human behaviour at both graduate and undergraduate level, and Neuropsychology of Pain at post-graduate level. He is also adjunct professor of Consumer Neuroscience, at commercial university Luigi Bocconi in Milan. His work underpins the very first model of tactile awareness and he is among the few researchers who have scientifically approached both the hedonic (e.g., pleasant) and painful aspects of body sensations. Together with Lorimer Moseley and Charles Spence, he developed and started to test a neurocognitive model of body representation that has set the way towards new approaches to the understanding of pain and more in general of the relationship between mind and body, namely the ‘body matrix’ (Moseley, Gallace, and Spence, 2013). Recently he co-authored with Charles Spence, a book on the theoretical and applied aspects of touch (Gallace A and Spence, C, 2014; see below).


Gallace A and Spence, C (2014). In Touch With the Future: The Sense of Touch from Cognitive Neuroscience to Virtual reality. Oxford, UK: Oxford University Press.


  1. John Quintner says:

    Some of these fascinating issues (e.g. sexual touch) are also addressed by neuroscientist David J Linden in his book – Touch: the Science of Hand, Heart and Mind (2015).

    Alberto Gallace Reply:

    Thanks a lot John. This is certainly another interesting book on touch indeed. It is also nice to see that there are now more and more people that have begun to be interested in touch! I hope that there will be also more people doing scientific research on this topic in the future.

  2. Gerry Daly says:

    Interesting observations, almost adopting a symbiotic intonation in sympathy with the aura of the novel. My view tends to be…..we could go into the detail of each individual ‘perceived transgression’ as described, or we could try and identify the mindset altering ability which seems to allow for a neutralising of otherwise reliable defensive mechanisms. The way I tend to see it is this…’If we perceive consciousness as being predicated on threat detection and defence responses, what is it about a willful negation of those purposes which might create a sensation of ‘pleasures unknown’ ?. Something to do with a voluntary lapse of protective responsibilities, which feeds into a subjective highly sensitized expectation , which, due to there being no defense, offers up the option of a perceived threat becoming a possible pleasure.

    Same might be true for any ‘hands on’ scenario….although it probably has greater potential for added excitement if it’s already known that the perpetrator of the intrusion might have a ‘warped’ agenda. I think the normally overworked protective umbrella we impose on ourselves, is always attracted to a challenging of its abilities, as a means of evaluation of its effectiveness against future threats. And, any pleasure sensations forthcoming are probably only a reflection of the relief experienced whenever we relinquish the protective responsibilities. Add that to the potential for sexual satisfaction, and we’ve got a winning formula !

  3. Gerry Daly says:


    Also, with regards to any similarities to operator manipulations, I think the moment of willing consent by the patient is all important. Besides the relaxing of a protective stance, as described above, there’s also the possibility that a potential for a placebo effect is created. Perhaps that’s where all placebos originate from ? However, I’m also inclined to think that any benefits only work on the ‘conscious’ level. The autonomic response systems still retain their defence mechanisms, and carry on regardless of any mindset alteration. Same might apply to any manipulations conducted whilst the patient is conscious…..there’s an autonomic resistence to anything perceived as a threat, including the manipulations, which might only result in a conflict of responses. That , of course, questions the efficacy of any therapies applied whilst the patient is awake. Those conscious and autonomic resistant responses are, of course, relaxed when we sleep….. and that looks like a much more interesting area to explore to me, because defenses are neutralised, and healing progresses uninterrupted. Sleep might well be the default unconflicted healing state, where the autonomic systems relax their overworked protective status, and put all their energy into healing processes. Speculative, obviously !

  4. Very interesting post here. I guess that with the popularity of 50 Shades of Grey, this is as good a time as any to have conversations like this. It is important to distinguish what’s going on there. Thanks for your insight on this.

  5. Alberto, I have become more familiar with C tactile fibres after reading David J Linden’s book – fascinating! Based on this post, is allodynia environment dependent? If allodynia was dependent on context (patient – clinician interaction and other factors) how would you define a threshold for decision making? Light touch with a defined purpose for the patient might be better tolerated than just determining their sensitivity to touch. I realize decisions are context dependent. Thoughts?

    Alberto Gallace Reply:

    Dear Stu, I totally agree with you, decisions, but also perceptions are always context-dependent, in the sense that our brain never analyses only a single carachteristic of the stimuli. Our central nervous system always considers different aspects of the environment even when we are not aware of them. Pain is not different from other sensations in this respect. Sometime my final decisions might even be triggered by a tiny insignificant aspect of the environment, when in the right context. That detail might create success within a given therapy, or be totally irrelevant within another. In my book, I often say that the perhipheral aspects of touch (e.g., thresholds), are relevant but if you stop there, you don’t know anything about tactile sensations. Sensations, are always multisensory in nature in my opinion. Pain and touch are perfect examples of that!

  6. Alberto, appreciate the insight – the long-held view of allodynia from Wolff’s animal models was infiltration of A beta fibres into vacated areas (dieback) of C fibres in lamina 2. I think this is still taught as explanation. With C tactile fibres in primates, is the interaction of various C fibre inputs (C tactile fibres included) plus all the changes in modulation based on the degree of threat more accurate? I realize there is multi sensory integration at a brainstem level (with superior and inferior colliculus) and upwards and outwards including polysensory neurones in pre central gyrus and posterior parietal cortex that respond to various inputs – could you provide some clarity on protection of the space around the body? I am looking at an integrated framework for understanding. Thanks for your work.

  7. Alberto, sorry for last comment, perhaps off topic – I’ll read your book. It seems that expectations dictate response (‘expectation as aetiology’ in some cases). Context and meaning are strong predictors. Having some control over environment one is in is helpful. Boundaries important – being in drivers seat or at least a willing passenger is key. I haven’t read 50 shades of any colour but perhaps if there was constant uncertainty about the level of control and boundaries, it might be a different story, especially with ongoing nociceptive input. Any comment?

    Alberto Gallace Reply:

    Dear Stu, do not worry, your comment was perfectly related to the topic, I only had no time to reply with all the information needed.
    I am now thinking about the role of expectation. As you say, that is a very relevant point. If you have control over pain or any variable of the environment your experiences are totally different than when you have no control over them. However, thinking about the main theme of the novel 50 shades of Gray, makes me wonder about the possibility that also giving away control over pain can be relevant. In that case, trust between two people is established and after that the lack of control over pain and pleasure is perceived as a positive aspect. I wonder about how this can be translated into a doctor/patient relationship. Also in this case the patient gives away some control on the basis of trust, however the expectation is kind of different, in 50 shades is mainly based on sexual pleasure, while in healthcare is based on the relief from pain. Both things are key motivators of human behavior. This is an interesting and intriguing issue indeed.

    John Quintner Reply:

    Alberto, can you please explain what you mean by “control” over pain. This would seem to me to qualify as a Fallacy of Reification (or Misplaced Concreteness). But I may be missing your point, for which I apologise in advance.

    Alberto Gallace Reply:

    John, I intend control regarding the possibility to experience or not to experience pain (and the amount of it). That is, think about the condition where you can decide how much of an anesthetic is injected into your blood stream (just as in the studies on epidural anesthesia). In that case you experience less pain with a smaller dose of anesthetic as compared to when the anesthetic is administered by someone else. Is that related to subjective thresholds or to the feeling that you can directly ‘control pain’? In my opinion, that is not different, from any other sensorial experience: I don’t like coffee when someone else put sugar in there for me (and the liquid probably tastes even sweeter than when I can decide)!

  8. Gerry Daly says:

    That is interesting. Perhaps we’re steering a course towards the real question of whether it’s possible for anyone to ‘really’ share the subjective pain experience of another person. Despite the sympathy and empathy which we can express, but which has no real interactive healing potential, I think that we are all, whether patient or operator, consciously defensive against any ‘pain’ sharing understanding which might negatively influence our own positive healing expectations in any circumstances. Seems to be a default natural conscious defense we all have.

    So, instead, we tend towards ‘proxying’ pain experiences, as a lesser vulnerable method of getting to grips with anyone’s pain narrative. That means that we listen to the narrative, and if we haven’t had a similar subjective experience, we try to imagine what the complexities of the narrative might feel like if we did have a similar experience…..we come up short somehow, and then we start proxying the best we can imagine onto the patient. It’s a natural intuitive thing to do……patient’s even do this to each other’s narrative. But the ‘proxying’ allows a licence to manipulate the narrative, and perhaps that’s where a dissonance can enter the encounter.

    Although we are well capable of empathy, it might seem that we are resistent to understanding any pain experiences we have not ourselves experienced subjectively…..and we develop a tendency to substitute that deficiency with a ‘proxied’ overview which satisfies our lack of understanding. Any inclinations of that nature would need to be surmounted before assessing the ‘realism’ of any presented narrative.

    In terms of a patient voluntarily dropping their conscious defences when offered treatments that might otherwise constitute an obvious threat, I think that there might be issues about the obvious lack of a rule book to govern those vulnerable situations. Also, because a patient enters the contract willingly, because they entrust themselves, it offers up transient placebo opportunities which might well be a distraction from the real efficacy of any treatments.

    John Quintner Reply:

    Gerry, what a terrific comment! Could there be 50 (or more) shades of empathy that need to be negotiated during the therapeutic encounter?

  9. Gerry Daly says:

    “Gerry, what a terrific comment! Could there be 50 (or more) shades of empathy that need to be negotiated during the therapeutic encounter?”

    Possibly. But then the encounter becomes an ‘operator narrative’ rather than a ‘patient narrative’, and the question arises ‘What exactly needs treating ?’. There’s no doubt that an unqualified acceptance of the presented narrative would negate the need to have to unravel any operator bias (manipulation of a ‘proxied’ overview). But, because there is already a tendency to inject a ‘subtext of disbelief’ where some chronic conditions can’t be rationalised satisfactorily, there arises the prospect for manipulation of context….perhaps as a means to at least impose a limited understanding on a perplexing presentation.

    The way I see this is…this would never happen with a toothache, because the understanding of the presentation is shared by both operator and patient, and the guidelines are well defined. When it comes to chronic issues, with ill-defined source causation, it’s maybe not just the patient who can get it wrong…..the operator is also vulnerable to creating a limited overview which might exclude relevant observations. What usually occurs is an attempt to define, rather than an attempt to explore further.

    John Quintner Reply:

    Gerry, I agree with you. In a therapeutic engagement, empathy can flow in both directions, between clinician and patient. We have argued that empathy can have a “dark” side, which for convenience we termed “negative empathy” or “negempathy”. It is these “shades” of empathy that need to be explored and negotiated, where possible.

    Reference: Cohen ML, Quintner JL, Buchanan D, Nielsen M, Guy L. Stigmatization of patients with chronic pain: the extinction of empathy. Pain Medicine 2011; 12: 1637-1643.

    Gerry Daly Reply:

    Will look this up. Looks interesting

    Michael Negraeff Reply:

    Interesting. Sorry if this convo is dead now. I have a spinal cord injury and neuropathic pain. So when I treat someone with SCI and they have neuropathic pain there is an understanding. I know what they are talking about. Sometimes it;s like they are describing my experience almost exactly. But when I see someone with fibromyalgia, I have no idea. However….when I see someone with SCI and neuropathic pain, I catch myself thinking, “do I really know?” “How do I know it’s the same as mine?” So maybe we can also “over proxy” our own narrative onto theirs even in the same conditions??

    Gerry Daly Reply:

    Yes. There will always be a tendency for the subjective ‘knowing’ to over-layer the objective observation. I wouldn’t be inclined to call that a ‘bias’ or a ‘proxying’…..maybe more an unavoidable ‘validated conflict of intuitions’. Once there is an awareness of possible ‘proxying’ issues entering the equation, I think that possible lop-siding is neutralised by default, and naturally moves on to a more sensitised ‘conflict of intuitions’, and perhaps, hopefully, resolving eventually with some acceptance of a credence in the presented narrative, despite any conflicted doubts.

    It’s obviously a complicated task for any operator to negotiate without prejudice. The patient only has one narrative, but the operator can choose from variable assumed narratives. Where some chronic conditions are ill-defined in causation and dynamics, I think the obvious investigative route forward is strictly within the context of the presented narrative, no matter how that conflicts with progressions in other known conditions. There’s a validity to continuing the search for solutions in those situations, rather than assuming misbehaviours, or malfunctions, or dysfunctions. We’re really not entitled to assume any of these negative characteristics without first knowing how something is supposed to work in the first place.

    Gerry Daly Reply:


    Here’s something which I’ve always found puzzling which might have some relevance to the ‘do I really know ?’ question. Take a similar stenosis issue, with similar impinged nerve, in both lumbar and cervical spine. Why does it seem that, whereas the lumbar issue can immobilise, with pain at source, the cervical issue will always continue to allow flexibility, with no pain at source, and only manifest by means of referred ‘mimicked’ symptoms. The referred ‘mimicking’ can also occur with the lumbar issue, perhaps with a lesser impingement, but generally speaking, any flexibility will be painful.
    I’m inclined to see that difference in nerve response functionality, given similar circumstances, as pointing to a ‘pre-emptive’ function in nerve responses. The neck must maintain flexibility, even reduced flexibility, because it must also support the other vital functions which rely on that flexibility. Similar flexibility is not required in the lumbar region because no other vital functions require it, and so full immobilisation is allowed….the most ideal circumstances for healing to proceed as best it can.

    All seems to point to a hierarchy of priorities being ‘pre-empted’ before any response is actualised. How difficult can it be for any operator to read these dynamics without experiencing the subjective sensations ? And, conversely, how easy is it for them to impose a ‘lesser’, more familiar, understanding on the presentation.

  10. John Quintner says:

    Alberto, as I see it, the only decision open to people in pain is whether or not they decide to report their experience to another person. When someone else puts sugar in your coffee, you can decide whether or not to tell them of your aversive experience. Of course it always remains your decision as to whether or not you want to add sugar to your own coffee. But can the person in pain really decide whether or not to have the experience? I am not talking about self-inflicted tissue damage.

    Alberto Gallace Reply:

    John, what I am trying to say is that if you feel to be in control of a given stimulus (regardless of whether this is true or not), such stimulus is perceived differently than when you feel to have no control whatsoever on it (similarly the epidural example I made).

    John Quintner Reply:

    Alberto, does your coffee taste any different should you decide to add sugar as compared to the taste when someone else adds it?

    I suggest we are talking about a stimulus that is perceived as threatening being less of a threat when we have some control over its administration.

    Alberto Gallace Reply:

    It might indeed taste sweeter John! ultimately this might be due to my expectation about the amount of sugar that someone else will put in my coffee when I can’t decide about it. So in this view, control is probably related to expectation.

  11. John Quintner says:

    Alberto, I look forward to seeing the results of an N of 1 randomised controlled trial concerning the addition of sugar to your morning coffee.

    Alberto Gallace Reply:

    …. and considering that I never drink coffee but only tea that would be very interesting. Anyway I really believe that our (expectation-related) control over sensations is a topic that deserves further research attention.

    John Quintner Reply:

    Alberto, sorry about the tea/coffee mix-up! I know what you believe but I still say that the control is over the stimulus and does not necessarily extend to the response which, as you say, is subject to so many contextual factors.

  12. Gerry Daly says:

    I think I know where the issue lies here. A chronic pain patient, regardless of whether they choose to relinquish control, or not, in fact has no real control anyway over the variety or detail of offered treatments. So, by voluntarily entering ‘the contract’, there is an unspoken further shift in locus of control whereby a hierarchy for decision making is created….and that’s a hierarchy which the patient has little influence over……excepting in a negative capacity. Compliancy is usually a requirement when hierarchies are not democratic. I suppose the question arises….’Just how ‘included’ is any patient going to feel in such a set up ?’ Also, a negative sense of inclusion might shut the door on placebo opportunities.

    Alberto Gallace Reply:

    Jerry, I think you hit the spot here. How much is the patinet included? I think that the answer also depends on the level of trust between patient and doctor, if you have got gratifications before from your doctor (because he/she was able to reduce your pain), your level of trust would increase, and probably also your feelings of ‘being included’.

  13. Gerry Daly says:

    Just wondering what others feel about this aspect……over the last 40 or so years, but particularly perhaps in the most recent 20 years, there seems to have been a drift in medical circles towards a contract with the science, rather than the old reliable personal contract where the patient felt that the buck stopped with the assumed ‘trust’ of that contract. Especially in circumstances where the science might be inconclusive, as with chronic issues, it might seem that the patient has no focus on where to direct any disagreement with suggested treatments that maybe don’t resonate with their intuitive understanding of their condition. In other words, where events might have the potential to go wrong, the patient is now outnumbered by the questionable science, and by those who advocate it. Considering their assumed vulnerability in entering the contract initially, I would have thought that a ‘hypocratian’ re-assurance of a credence in the presented narrative would be the the more likely method for restoring a balance between equals.

  14. Alberto Gallace says:

    …. and talking about beverage, here below is a study where we show that even the colour of a cup can affect people’s taste of the water inside. I believe that the idea of having control over something is not so different (probably more powerful) from such kind of manipulation.

    Risso, P., Maggioni, E. Olivero, N., & Gallace, A. (2015). The association between the colour of a container and the liquid inside: An experimental study on consumers’ perception, expectations and choices regarding mineral water. Food Quality and Preference 09/2015; 44.

  15. Gerry Daly says:

    The big question….Under what circumstances do we allow delusionary perceptions to interfere with our conscious control abilities ?……and, perhaps more relevant, under what circumstances do we not allow etc.? Delusions can usually be easily negated with a little rational thinking. Not so with chronic pain….it tends to keep insisting ( not ‘persisting’ ! ) despite all the efforts to rationalise its confused existence. We wouldn’t impose a delusionary status on an acute injury, yet there seems to be no shortage of suggestions that same doesn’t apply to chronic pain conditions. Again, that might be more ‘proxying’ rather than ‘observation’.

  16. Gerry Daly says:

    On the cup colour/taste matter, would it be fair to suggest that , where no imminent danger/threat has been detected, there is an assumed licence to manipulate conscious perceptions at will. However, where there might be imminent danger/threat, we have an implied need to rationalise the threat properly, for the obvious reason that we must know the nature of whatever it is that endangers us, so that we can protect against it effectively. Basically, where there is no discernible threat, the mind can wander. So, with ‘hidden’ or unidentifiable chronic issues, the patient is impelled to always try to focus on the threat, something which might seem to be negatively obsessive to anyone who doesn’t sense or recognise the same threat. The patient has no choice in the matter. We would all react instinctively like that if faced with the same ‘unknown’ threat that the chronic patient experiences. If the threat is an ‘imaginary’ construct, we can react with imaginary responses. If the threat is real, although only recognised subjectively, the responses are dictated by inherent protective behaviour….not by some conscious realisation of some imaginary response options.

    Alberto Gallace Reply:

    Gerry, my view is that the distinction between reality and illusion is a very complex matter in neuroscience. Consider that what you generally consider real is just an electrical signal interpreted by your brain. For example, what is the colour white? our brain perceives as ‘white’ the brighter object within the environment, no matter of its ‘real’ colour. A dark grey object is white for everyone in a darker room. Is this an illusion? this is the way our brain works, nothing more than that. From a physical point of view colours are just frequencies of light, our brain perceives different shades of red, green, yellow, blue, white, etc. Physical reality is always different from perception. I think that the interpretation of threat or pain is not different from the interpretation of other stimuli in our brain (see also the post by Lorimer Moseley: ‘No Brain, No Pain’).

    John Quintner Reply:

    Alberto, are you categorising “pain” as a stimulus?

    Alberto Gallace Reply:

    no John, I categorize Pain as a perception (just like white, red, green and blue are).

  17. Gerry Daly says:


    I agree with what you suggest about colour perceptions being vulnerable to perceptive variations, but maybe that’s because the colours lack a realistic threat potential. If that colour was the red on a bull’s horns as it raced towards us, I don’t think we would consciously allow the same licence for misinterpretation….Red = Blood = Imminent Threat. The threat reaction is usually instinctive and immediate. There’s no time, nor conscious inclination, for allowing mindset variations to run through a selection of perception processes. Mindset variations only occur when allowed within a non-threatening framework, and the person usually knows that they have the ability to correct the perception, if needed. Perceptive variations are basically a conscious game, not meant to confuse reactions in times of need.

    Consider a chronic pain patient, perhaps with a ‘hidden’ nerve entrapment and referred symptoms…….they might well have a sense of continuous imminent threat, and so their behaviour must reflect that. The only way to change anything is to relieve the sense of threat, by relieving the threat itself….not by asking them to disbelieve the existence of a threat. That would only make sense if the sense of threat was a consciously manufactured event, and who knows that better than the patient themselves with the subjective experience ?

    There needs to be a line drawn between chronic pain patients with a diagnosed ‘ no healing expectation’ condition…and patients who are susceptible to delusionary self-convincing about such matters. They are two different classes of patient, with no crossovers.

  18. Gerry Daly says:


    Just one thing to say about pain. It differs from other conscious perceptions in the sense that it is not stimulated by the senses as we know them. We can only speculate on what function (disputed) allows the conscious pain perception (not disputed) to appear. But, just like other conscious perceptions, it is very likely to result from the ‘purpose’ of some functionality. Once consciously perceived, it then becomes vulnerable to conscious mindset variables. Those variations are a distractive irrelevance in terms of identifying source.

  19. Alberto and John, I was reading on motor induced suppression; my understanding is that there is dampening of the signal (ex. if you are shouting, there is anticipatory dampening of reception of auditory signal however when auditory signal is unexpected, different story) – something about efference copy? Perhaps this is not relevant to danger signals from the body however I found when doing burn care for years, that for many patients, if it was a collaborative process, it was tolerated better. Thoughts?
    Collaborating on the context of pictures that are acceptable for practice with left/right discrimination and visual imagery also seems relevant. Intensity of practice – ranges vs strict numbers which allow choice – the message is always modulated, is it not?

  20. In terms of social engagement and pain communication (Hadjistavropoulos for review or Mogil’s studies), the ultimate loss of control with torture – results in persistent pain states and PTSD usually. It is also often resistant to treatment. There are less questions about semantics. Stimulus and response. I do think the issue of control, boundaries and expectations are important. Autonomy is a powerful human need. Does the ultimate control over one’s choice in how to respond to a situation (Victor Frankl) become a moot point in some situations? Can one fully understand another’s life experience? No, I realize that just as I have a very narrow understanding of brain function, the same applies to the life experiences of the patients that I see. I try to empathize. I am curious.
    I try to understand. I believe there is still hope. I look for insight. Thanks.