Is Suffering Necessary? ( Log Out /  Cult Med Psychiatry. We should not look at suffering as an abstract phenomenon, but as something experienced by somebody. As Kleinman states, “It is important to avoid essentializing, naturalizing, or sentimentalizing suffering. After questioning the mind/body dualism, the concepts of suffering and pain need to be reconsidered, even if a new conceptualization is indeed difficult [10, 11]. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. For example, Charmaz’s work assumes a clearly situated perspective; she analyzes “a fundamental form of suffering” of chronically ill persons in America in the 1980s [40] However, there does exist a risk in taking such descriptions of suffering as universal, essential definitions, since doing so may have undesirable epistemological and moral consequences. Enter your email address to follow this blog and receive notifications of new posts by email. The stories we tell ourselves about our own experiences are certainly important resources which we use to relate to ourselves, to develop our selves. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Like suffering, pain is also unpleasant. no fondo ben fondo / das entrañas / hai un deserto páramo / que non se enche con risas / nin contentos, / senón con froitos do dolor / amargos!”. We start to internalize the idea that suffering has come to us for a bigger reason or some kind of “guilt” or sin we have committed. Classical evidence-based medicine understands pain from a naturalistic point of view, and persons as beings are divided into two different entities: the body and the mind. Abstracting the “pathological fact” from the body and the body from the person facilitated a number of impressive results, treatments and medical progress. We have to focus not only on what we “lose” when we suffer, but also on the various cultural, personal and social adaptations and resources to manage suffering. Cambridge, Massachussetts, London: Harvard University Press; 1995. 2011;14(3):333–43. In other words, it not only treats pain inadequately (understanding and treating it only in relation to its measurable, observable and generalizable signs, in the context of a disease) but it also produces suffering, which persists undiagnosed and unrelieved, as is the case in the terminal phase of a chronic disease, which is progressively lengthened due to the availability of new treatments. If we attach importance to these dimensions in the experiences of pain and suffering, then we need to recognize the relevant role which said disciplines can play in making sense of them as well as in the provision of resources to relieve suffering. Suffering is not “necessary” to the human condition, but it is “inevitable.” It is difficult to speculate about folks who never suffer, because we all do. Not all suffering is alienating and it is unfair to deny the suffering of others; for instance, the categorical affirmation that childbirth pain does not entail suffering, as stated by Svenaeus [24], can be unfair. Braude HD. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. November 2010 edited November 2010. First and foremost, if heaven exists, and there is no … Arney WR, Neill J. This does not mean that particular descriptions of cases of suffering are not useful or meaningful to other sufferers, scientists and simply persons interested in understand the phenomenon of suffering. Is crying when your parents die an unnecessary suffering? Unnecessary suffering is cruelty that serves cruel people. However, as stated previously, these are not definitive consequences of suffering, and persons are not static, unchangeable beings. Frenkel [35] formulates this challenge as follows: “How could a private subjective expectancy associated with taking a placebo pill ever manifest as an observable, public change in the physiologic body?” The placebo effect particularly challenges the mind/body distinction and the consideration of the body as a mere “measurable object.” The explanation offered by Frenkel is convincing: The body itself is able to respond meaningfully to a demanding situation, since “we have a sentient body, capable of responding to the world without having to invoke any reflexive activity.” It is even possible to go one step further: If we conceive a person as a psycho-physical whole, it is not implausible to think of the body reacting in meaningful ways, that “a patient perceives affordances of healing in a particular situation and his body thus responds to the solicitation made upon it in the same way that our unreflective motor activity unfolds in the world.” Cultural, social and psychological factors are believed to affect the affordances (solicitations of response for a subject in a particular situation) of healing. However, some phenomenological definitions of suffering (for example, "suffering as an alienation of the self", "suffering as unhomelike being in the world") may suggest essential and universal characteristics of suffering, thus excluding from it other unpleasant or anguishing experiences that the affected themselves indeed consider suffering. A person is never fully coherent, a person cannot be “intact” because touching and being touched is intrinsic to life. Daedalus. Once we question this distinction, we need to reconsider this structure of thinking and organization, as well. Pain and suffering are considered unpleasant. Displacing the goal of healing and situating “care” in itself as a focus of healthcare assistance involved increasing interest in the phenomena of pain and suffering in all their dimensions, as well as the research dedicated to improving and implementing analgesia. (There are some additional assumptions, which we can disregard for the time being.) The first one is that his definition of suffering depends on a questionable understanding of the person and it is too restrictive. Google Scholar. Is worrying about “how many people survived the crash?” an unnecessary suffering? The Nature of Suffering and the Goals of Medicine. Because suffering can be affected by thoughts of meaning or of the future, some have focused on this dimension of suffering and asserted that only humans can suffer. Frankl V. El hombre en busca de sentido [Man's Search for Meaning]. [...] Michel was being extinguished, fading just the same as each day of my visit, the dim light of the winter afternoon was fading in the frame of the hospital window.”Footnote 10 [41]. He puts together different definitions of suffering provided by other authors in an attempt to encapsulate “the whole of suffering.” However, uniting these different approaches to suffering does not guarantee a good definition of suffering, Instead, it guarantees a good overview of the studies or conceptualizations of suffering. This work can be classified among the theoretical works of the “humanistic turn” in medicine. Embodied Issues London: Routledge. Answer Save. Pain and suffering cannot be treated exclusively in naturalistic, scientific terms, at least under a certain view of what science is. Hence we do not tell ourselves the same story about our past during our whole life, simply because our past changes every day as we gain new experiences which can easily modify the interpretations of previous experiences, and we need/want to understand our past differently according to our present and our prospects. Kuhn T. The Structure of Scientific Revolutions. Cowardice is nothing to do with it - suicide takes considerable courage. Different versions and interpretations about the life of a person are continuously written from different points of view; there is never a definitive history. In fact, the idea that greater pain can erase lesser pain is also of Hippocratic origin. For instance, we cannot manage social problems that cause social suffering, like poverty, with medical resources. 6th ed. This includes physical, emotional and mental pain. The Expropriation of Health. Cassel EJ. What that would mean is that there is no “necessary suffering”, and as such no “greater good defense” when it comes to the problem of evil. However, at least two problems arise from Cassell’s conceptualization of suffering. So the challenge mentioned previously still persists, since the physician is now required not to make an abstraction of the ill person, not to look at the body as if it were a mere mechanism to repair, not to take into account only somatic pain, but also to consider non-somatic pain, secondary effects of treatments, personal circumstances, etc. J Med Philos. Article  Both are experiences which affect the whole person (not merely their “body” or “mind”), and a crucial aspect of them is the personal attitude and choices which are in turn influenced by cultural and social patterns. Cassell criticizes clinical, evidence-based medicine, its dependence on Cartesian dualism, its conceptualization of pain and suffering, its management of them, as well as the goals of medicine. Círculo de Lectores: Barcelona; 2016. In the context of such medicine, suffering and pain were dissociated from the context of a theodicy [13] and to be treated scientifically. Grahek N. Feeling Pain and Being in Pain. Damasio A. El error de Descartes [Descartes´ Error]. As stated before, it is still a challenge for medicine to deal with these subjective, unmeasurable dimensions of suffering and pain – and, moreover, their possible “unshareability” [6], although there have been crucial contributions like the Gate Control Theory, which has been decisive in including both the physiological and the psychological dimensions of pain as intrinsic parts of the phenomenon. Moreover, the fact that suffering can contribute to the creation of identity instead of its destruction contradicts Cassell’s definition. The work The Nature of Suffering and the Goals of Medicine was first published in 1982 and has had considerable influence on the ensuing debate regarding the medical conceptualization and management of suffering and pain. Dialogue is the pathway to truth. From proposition 16, 1, Spinoza proves that all things follow necessarily from the necessity of the divine nature and its attributes. In other words, a scientific paradigm includes its own scientific problems, instruments and criteria for solving them, a whole view (Gestalt) of the world. The phenomenological conceptualization of suffering and pain offers an attractive alternative to dualistic theories and the mechanical understanding of the body.Footnote 6 Contrary to the scientific approach, in which the body is seen from a third-person perspective, phenomenological proposals assume the perspective of the experience lived by a subject [32, 33]. It takes into consideration that it is always an individual who feels pain or suffering, and that such experiences are modeled and strongly determined by personal assumptions, cultural patterns, cognitive activities and even religious beliefs. For Epicurus, sarx and psyché are two parts of a single, whole organism [50], and the mind cannot exist without the body. Additionally, the view of a person as a psychophysical instead of a dualistic being demands a total paradigm shift in medicine and new research approaches which are able to challenge the boundaries of various disciplines. To put it in other words, the alienation of the self described by Nancy can capture one essential dimension of one kind of suffering, but it does not define all kinds of suffering. some people believe this, yet suffer is all they do, becuase thats all they expect and focus on. Like Nancy, Michel cannot recognize himself anymore, and neither can his friend. Still, pain and suffering do not only concern medicine, but also the social sciences and humanities, which contribute substantially to the clarification of their cultural, social and cognitive dimensions. Medicine started to be systematically organized in clinical environments, where patients could be observed and the symptoms and diseases compared and described as neutrally as possible: As explained by Foucault, the physician must distance himself from the diseased in order to learn the truth of the pathological fact [14]. “Unpleasantness” defines suffering and pain. Epicuro. Get even more Buddhist wisdom delivered straight to your inbox! Humility is recognition of personal insufficiency and the willingness to learn. “Pain tolerance” is defined as “the maximum intensity of a pain-producing stimulus that a subject is willing to accept in a given situation” and “pain threshold” as “the minimum intensity of a stimulus that is perceived as painful” by the International Association for the Study of Pain (http://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Nociception, consulted on 10.02.2016). Manage cookies/Do not sell my data we use in the preference centre. Wellmer A. Zur Dialektik von Moderne und Postmoderne [On the Dialectic of Modernism and Postmodernism]. Sorensen A. whatever you focus on is what comes your way. Herein Damasio sees Descartes’ “mistake”: in the idea that the mind can exist or even operate independently of the body [1]. Chirbes R. Paris-Austerlitz. The alienation (or even “loss”) of the self or the “unhomelike being in the world” can undoubtedly be consequences or expressions of suffering. In this manner, the goals of medicine ought to be reformulated. Leknes S, Bastian B. Those who are too young to have suffered traumatic losses are just that - still in carefree … However, I argue that people suffering from such a condition do not have a complete experience of pain, but only of one of its parts. So this definition is unable to properly identify what is common to all experiences of suffering. New York: Harcourt Books; 1981. Jason TC. Suffering or Pain (Dukkha-dukkha). Rather, they are part of a person’s life, and the self is the result of various experiences including pain and suffering, which have an existential dimension inasmuch as they depend on the person’s attitude, resources for their management, as well as choices and commitments related to that person’s attachment to life and the world. Impermanence or Change (Viparinama-dukkha). Instead, we are the result of our experiences, including suffering and pain. Pain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. ( Log Out /  2013;23(1):46–59. Herder: Barcelona; 2015. This site uses Akismet to reduce spam. It may still be possible to define suffering as a threat to what a person considers to be his integrity at any given moment. 2007;2(30):1–12. Leader D. The Absent Body. Arendt H. The Life of the Mind. He recognizes the universality of nociception (“certain kinds of stimuli elicit the sensory response of nociception in every culture, now and forever”), but does not consider pain to be the same as nociception; for him, pain includes the meaning which the subjects ascribe to nociception, and such meaning changes from culture to culture, from person to person. Phenomenological approaches have contributed to “minding the body” too, as is the case with the phenomenological explanation of the “placebo effect”, one of the phenomena which challenge classical explanations of medical science. Foucault M. Naissance de la clinique [The Birth of the Clinic], vol. Sociology of Health & Illness. Descartes himself is engaged in the enterprise of knowing the world in order to turn humans into “maîtres et possesseurs de la nature” (“masters and possessors of nature”) [12], proposing a scientific method and using it to improve living conditions. Oafs argue this specious line for varying reason: to evade fingers of blame, to impress one's audience with one's mental fiber, to vent anger, or just because one lacks the necessary suffering to sympathize. 1998; Descartes R. Discours de la méthode [The Discourse on the Method]. Theoretical Medicine and Bioethics. Pain and suffering are considered unpleasant. Paris: Galilée; 2000. This paper will begin by explaining the conceptions of pain and person used by evidence-based classical medicine and their Cartesian roots, followed by a critical discussion of the contributions made by the humanistic turn (represented by Cassell), and finally, the phenomenology and narrative conceptions of the self and the person. The alienation of the world can also be categorized as “unhomelike” in a way similar to Arendt’s concept: “Unhomelike being in the world” means that we exist in an uncomfortable way, in a strange, uneasy environment where we cannot rest or find our place [42]. The disdain you have for something or someone is the disdain you have for yourself, without a settled mind this will not be seen so the suffering energy will continue to be the controlling energy in place. The question, is suffering necessary will be answered by most without investigating it. Paris: Presses universitaires de France; 1997. More questionable is the damage inflicted in order to prevent a more or less probable future disease, and an entirely different discussion concerns the damage inflicted in order to improve the knowledge of the discipline. Oxford: Oxford University Press; 2004. On theone hand, there are metaphysical interpretations of the term: God isa prime mover, or a first cause, or a necessary being that has itsnecessity of itself, or the ground of being, or a being w… The second problem of Cassell’s definition of suffering is discussed by Braude [25]: The experience of suffering may have a truly subjective element that cannot be explicitly communicated through language and “can and should never ultimately become an object, medical or otherwise”. Such personal options are influenced by social [5, 6] and cultural [7, 8] patterns. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Illness, Crisis & Loss. Suffering is an unpleasant or even anguishing experience which can severely affect a person on a psychophysical and even existential level. Oxford: Clarendon Press, 1977, pp. Part of Personally, I don't think real suffering is needed at all. However, the narrative explanations of the continuity of the self and life can be criticized, too. A very good example of such a perspective can be found in Jean-Luc Nancy’s text L’Intrus, in which he aims to understand his own “lived experience” of heart transplantation, the associated severe medical treatments and their acute secondary effects, like lymphoma, philosophically and phenomenologically [34]. Eventually parents pass away. All these demands for a “more human” form of medicine were developed in a social context of alarm about the risks of techno-scientific progress and the general questioning of authority on many fronts [16, 17]. To me suffering isn’t necessary, and in the present moment I have found it doesn’t exist, not because unpleasant things don’t happen, but because they just aren’t labeled as so. But such stories are not the only resource we use for such purposes. Defining suffering substantively turns it into a normative concept, which results in epistemological mistakes and moral injustices. Yeah good luck. This manuscript does not report data collected from humans or animals. An alternative to the mind/body dichotomy is assumed, consisting of an understanding of persons as psychophysical, socioculturally situated beings. A scientific paradigm is defined as a constellation of facts and theories (assuming that the theories are not exactly developed in order to explain previously given facts, but that facts emerge together with the theories explaining them). Pain has not been at the center of medical interest for the whole history of medicine. My translation. In a period of increasing importance of the natural sciences, the Cartesian conceptualization of the res extensa presupposes a knowable world, organized according to certain natural laws [12]. Definitions are not inconsequential, since the way in which we define concepts has epistemological, ontological and practical dimensions. Cite this article. Cookies policy. This is a kind of first-person perspective that aims to be meaningful and relevant to others. Sttutgart: Reclam. volume 12, Article number: 7 (2017) Castro, Rosalía de. Kathy Charmaz [40] describes the “loss of the self” in chronically ill persons and contributes to the understanding of suffering as not limited to a mere “physical discomfort.” In his recent, posthumous novel Paris-Austerlitz, the writer Rafael Chirbes describes the last phase of a man’s mortal illness in the following words: “Rather, I had the impression that the man lying there wasting away became a stranger in both my eyes and his own – someone unknown to me, of course, but also to himself, and so Michel himself expressed it to me on days when he experienced a moment of lucidity. Both pain and suffering have bodily, psychological and sociocultural dimensions. Indeed, such a definition is a non-existent ideal which incorporates the idea that persons are transparent for themselves (they know themselves completely), coherent, able to design a kind of unique personal past and future story, and well balanced. Of course, pain, like suffering, has always concerned medicine, but treating diseases in the search for healing and accumulating the necessary knowledge and expertise to do so more effectively in the future may be a better definition of the general goal of medicine in all times [4]. Is suffering necessary? Samsara is not a place per sey, but an incomplete picture of the world. Disease and pain started to be considered as being situated in bodies, since bodies and their processes came to be viewed in standardized, universalizeable terms. Is suffering necessary? Moreover, classical evidence-based medicine has been increasingly criticized from the second half of the twentieth century onwards. Bromm B. El origen del dolor [The Origin of Pain]. Great success, which fades with the passing of … The modern patient expects to negotiate the medical decisions concerning them, because medical decisions are never strictly “scientific”, but also moral and/or political. 2010;13:131–159. These developments gave rise to the modern problematic approach to dealing with pain and suffering. The presence of evil and suffering in our world is undeniable. Bueno- Gómez N. The Experience of Death in Techno-Scientific Societies. The Cartesian perspective drove the development of clinical medicine as an empirical science based on evidence. For Leknes and Bastian, a condition like “pain asymbolia” proves that pain is not necessarily unpleasant. The scientific dimension of the decision is certainly only one among many. Simply put, it is no longer acceptable to consider pain only in physical and suffering only in psychological terms. Cassell proposes that medicine should be more sensitive to the person and the meanings he or she attributes to his or her pain/illness, and that it should specifically treat suffering, thus involving particular “subjective resources” like “feelings, intuition, and even the input of their senses” in order to deal with the suffering of patients. London: Routledge; 1973. Definitions of suffering as a threat against an “intact person”, as an alienation of the self, as an “alienated mood” or “unhomelike being in the world” [33] express different experiences of suffering, but these are not universal descriptions, so they are not good definitions. Principles of Biomedical Ethics. This article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. I use the term “disease” in the sense of the medically diagnosed pathology, leaving the term “illness” for the subjective experience of the disease by the ill person [27]. Another dimension of Paul’s thought on the meaning of suffering is his conception of suffering as a means for sanctification, keeping pride at a minimum and trust in God at a maximum. By using scientific methodology, it is considered possible to repair a body in the same way in which we can repair a machine (or an animal, inasmuch as Descartes considers animals part of the res extensa). A person is the ever-changing result of his/her daily struggles, including his/her management of suffering and pain. Sometimes it is a bearable, short, inconsequential experience. In short, phenomenology is not merely subjective (although it incorporates personal experience) and good phenomenological approaches are powerful philosophical tools. Philos Ethics Humanit Med 12, 7 (2017). 1974;2(1):85–98. Med Health Care Philos. There will be many unpleasant things that occur in life, but they’re considered unpleasant only because that’s how they’re labeled and this is where the suffering arises from. In short, it is not true that the body does not matter to Descartes, who was a rationalist but not an idealist, in the sense that he was not willing to risk his “corporeal” existence in order to defend his ideas (he preferred to accept rules and laws of his time that were incompatible with his own ideas in order to avoid imprisonment and other legal consequences, even though he supported the autonomy of reason). Case, pain asymbolia ” proves that all things follow necessarily from the necessity taking. First Noble Truth of Buddhism still in carefree … 1 decade ago a single narrative from birth Death..., vol ; 1995 what has been increasingly criticized from the second half of the project. 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