Last updated: Fri, Sep 13, 2024
Other sections point out some key truths about pain that explain why it is easy to find pain cast as a subterfuge in a scheme to cheat:
A consequence of these conditions is that it is presumably easier to feign or exaggerate pain than it is to disprove its existence or to determine its true intensity. (Less often remarked upon, it is also possible to minimize, downplay, or otherwise underestimate one's own pain.)
The private nature of pain also has less-obvious and more-complex consequences. It is quite easy to imagine that we know the quality or force of another person's pain based on our own private experience with pain. Their back is hurt, you have hurt your own back in the past, so you know what a hurt back feels like. (See Mirror Neurons and Empathy for more about how we feel each other's pain.) Nature will never correct such a belief precisely because each person's pain is private. While normally-sighted individuals can pick an external object and agree that it is red or blue, there is no common external referent for pain. There is in fact evidence that people vary in important ways in their pain reactions (Pain-related Variability), but this is scientific evidence, not experiential evidence, and so it is less widely and less forcefully understood.
The potential for cheating exists whenever entitlement to good things is connected to the existence or nature of pain. Those who worry about this (which seems to include many people) are concerned about two classes of "goods". The first is money. The second class is less tangible and more varied, and is often referred to as "secondary gain" from illness. Things of potential value in this second class include nurturance, attention, legitimate abdication of responsiblities, treatment with pain medications, in short, anything that might result from being considered ill that one can conceive of as being valued.
The privileges and exemptions of the sick role may become objects of 'secondary gain' which the patient is positively motivated, usually unconsciously, to secure or retain.1
The question of cheating is not always clear-cut, it is often a question of degree. How bad must pain be to be debilitating and therefore to merit compensation? The legal institutions that make such decisions have procedures and rules that always result in a decision, but their rules and standards are vague and variable. As a matter of public policy, the standards are also a matter for public debate and difference of opinion.
In a 1972 segment on "low back losers," for example, NBC News endorsed the legitimacy of subjective pain and the pain clinic's importance yet also voiced angry frustration about the "losers ... whose learned pain cost the state of California $102 million a year in compensation."2
Some Political History of Pain in the USA summarizes some of the political activity revolving around pain in the second half of the twentieth century.
Reagan insisted that "several billion dollars a year were being spent to support people who were not, in fact, disabled."3
We are angered by deception. Anger is an emotion that motivates aggression, and evolutionary anthropologists, among others, believe that the link between knowledge of deception and anger has been adaptive in our history. “The importance of aggression following knowledge of deception [or perception thereof] is that it may greatly increase the costs of deceptive behavior and the benefits of remaining undetected."4 (See Deception and Self-deception.)