At a meeting of the American Philosophical Association in Washington D.C. on December 28, 2011, Michael McClain, the department’s Director of Communications, presented a paper titled Strange Bedfellows: Ludwig Wittgenstein and the National Institutes of Health On the Language of Pain in which he explored the relationship between the approach to the assessment of pain taken by the PROMIS initiative and the remarks Wittgenstein makes about pain in his Philosophical Investigations.
PROMIS is an acronym for Patient Reported Outcomes Measurement Information System, a multi-site project sponsored by the National Institutes of Health as part of an initiative to chart a roadmap for medical research in the 21st century. Its objective is to develop item banks that measure patient-reported health status in order to standardize clinical research, and ultimately to assist individual practitioners in the clinical assessment of patients.
Ludwig Wittgenstein, an Austrian born philosopher, is primarily known for his work on the foundations of logic and mathematics. In his later years, he assembled materials for his Philosophical Investigations, published posthumously in 1963. It contains a long section on private language in which he argues that words describing pain and other “inner experiences” acquire their meaning though their use in conventional language, not through their association with private sensations.
After a review of the qualitative and quantitative techniques used by the PROMIS researchers, Mr. McClain concluded that their treatment of pain is generally consistent with the approach implied in Wittgenstein’s remarks, primarily because they confine themselves to the publicly observable realm of language use and because they interpret the links between the pain construct and the pain experience not in terms of formal identity, but in terms of reference and relevance to the experiences of people in pain.
Mr. McClain added that Wittgenstein’s remarks about the role of language in the experience of pain might suggest a need to test for differential item functioning among subgroups who may be culturally conditioned to use pain words differently. He also suggested that Wittgenstein’s comments about meaning as use-in-language should alert researchers to the possibility that a shift in use from research to clinical applications might result in a subtle shift in the meaning of terms used in their item banks.
