What is "pain" ?.....What is "vertigo"....???
I cant see how the Tractatus, or indeed Witty's later language-game stuff, tells us anything about biology. Language, logic, and to some extent epistemology, sure, but not biology. Am interested in your viewpoint here though - can you explain?
What is "pain" ?.....What is "vertigo"....?
I am a medical doctor in real life dogjones. I do primarily hospital based work in a big fancy urban tertiary care center. I'll present a real live case here for you dogjones, you can play doctor/philosopher with me, and together we shall explore this very interesting issue.
I am what is called a "nocturnist", a night time hospital specialist. During the often busy evenings at our medical center, it is not uncommon for someone first evaluated in the emergency room(ED or ER) to be found sick enough that hospitalization is required. In such cases, the ER physician calls me and I go down to the emergency department to do my own evaluation, see if I agree with the ER doc's assessment, and assuming I too think the patient needs to come in, I "bring him/her upstairs with me", and we go from there.
One evening last week I was called by the ED doc to come down and evaluate a 61 year old Caucasian woman. She had been out to lunch with some friends and shortly after lunch became exceedingly vertiginous and profoundly nauseated. This, for no apparent reason. She was outside and the world was spinning spinning spinning around her. She was so symptomatic that she had to brace herself, lean up against a wall so that she would not fall down. Paramedics were summoned and she was brought to our emergency department.
The patient was given medication for nausea and also for vertigo per se by the ED staff. She improved. Somewhat surprisingly, according to the ED doc anyway, her symptoms resolved completely. The vertigo and associated nausea were gone by the time I got down to the ED to see what was up.
The ED doc told me he was just about to send the patient home when he noticed that the patient's "troponin level" measurement had a value of 0.17. "Upper normal" of a blood troponin level for our lab is 0.07, so we were looking at 2 and one half times that. Not a huge number as troponin elevations go, but still nothing to ignore. With a big heart attack you can see a troponin of 10 or even higher still. Troponin is a chemical found inside your heart and pretty much only inside your heart. If some troponin has "leaked" into your blood, it means you have had a heart attack. Other things can cause troponin to go up, but heart attack is the big one, the main one, and for the purpose of my real life example and you dogjones, there is no need to consider the alternative explanations for troponin elevation here.
I spoke to the ED physician and he said he couldn't send this patient out with a troponin of 0.17 and wanted me to keep her overnight to be sure this wasn't a heart attack in evolution. The lady had no prior cardiac disease history, and she had no risk factors for a coronary artery disease related problem; family history, diabetes, smoking, hypertension, high cholesterol. She was not viewed as one to likely have a problem in this regard.
If we are assessing someone for a heart attack, we measure their troponin every 6 hours. If the number climbs, regardless of how the patient feels, we have got a problem. In this case, the ED doc said the patient was symptom free now, no vertigo, no nausea, and he only wanted me to keep the patient over night for observation. "What would vertigo have to do with a myocardial infarction anyway?", the ED doc said to me. It was only 3 hours from the time of the patient's blood draw that gave the troponin value of 0.07, but I asked the ER staff to draw the blood again immediately. If the troponin measurement was high on the repeat draw, we would admit the patient even though she was now well, at least per the ED doc. It sounded as though this, the troponin elevation, might have been a lab error, or just one of those things.....The ED doc loved my idea and was expecting the redraw to come back normal. The patient's EKG looked normal with one small, very very very subtle exception.
The troponin redraw came back at 1.98, A HEART ATTACK!!!!! Now it was my turn to speak with the patient.
She was a sweet lady, lived with her sister not far from me. She had a job in a boutique that she just quit because she could not do gift wrapping satisfactorily and this lead to a crazy tension between her and her boss. SHE HAD MARKED ANXIETY OVER THIS PROBLEM AND THAT ANXIETY LEAD TO HER QUITTING. In the context of her difficulties, her gift wrapping anxieties, the patient had noticed for the last 2 months episodes of "indigestion" from time to time, and as a matter of fact, she had experienced the indigestion that very day, the day of the vertigo with the nausea. The indigestion would last minutes to hours and at times be associated with subtle chest pressure/pain as it was that very day. She was describing what doctors call an "anginal equivalent". Heart angina, "pain" due to poor blood flow through the heart, but not typical in its "experiential qualities". We typically do not associate indigestion with angina, so we say "anginal equivalent" dogjones.
Vertigo, nausea, indigestion, chest pain however subtle or profound, ANXIETY, all of these symptoms most would view as PRIVATE OBJECTS. Common sense tells us that these are things we point to inwardly and describe with words of a private language; "vertigo", "nausea", "indigestion", "chest pain", "ANXIETY", in the way that we point to oranges, and chairs and televisions and fish and airplanes in the third person world that we all inhabit/share and name them with the public words; "chairs", "televisions", "fish" and "airplanes".
Is vertigo a private object denoted by the private word "vertigo" in the same way, albeit a first person way, that the word "apple" denotes an instance of that piece of fruit, the apple, which we all know so well as it exists in our shared third person world?
Wittgenstein says there is no such thing as a private language, and he says we most decidedly are NOT NOT NOT referring to private objects with private words as we do refer to third person objects like apples in our third person world at large. It is a logical impossibility and the case he makes is insanely persuasive. But if he is correct, what was that lady talking about? What was my patient telling me? What then is vertigo, nausea, anxiety, indigestion, chest pain????????? I understood this lady perfectly well. Indeed, I made an accurate diagnosis of coronary artery disease based on her history, HER STORY TELLING, HER SYMPTOM TELLING.
I give so much detail to emphasize this is very much NOT crackpot stuff. It is a MEANINGFUL AND IMPORTANT part of our lives, the language of sensation.
So what is vertigo, anxiety, nausea, indigestion, pain and what are we doing with the words "vertigo", "anxiety", "nausea", "indigestion", "pain" in the context of our talking to one another and even talking to ourselves about our sensations whatever they may be? Are we naming private objects, or doing something else entirely? What ever we are doing, it most decidedly has something to do with biology. Nausea, anxiety, pain, they are biological, are they not?
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