Suffering

The word suffering is sometimes used in the narrow sense of physical pain, but more often it refers to mental or emotional pain, or more often yet to pain in the broad sense, i.e. to any unpleasant feeling, emotion or sensation. The word pain usually refers to physical pain, but it is also a common synonym of suffering. The words pain and suffering are often used both together in different ways. For instance, they may be used as interchangeable synonyms. Or they may be used in 'contradistinction' to one another, as in "pain is physical, suffering is mental", or "pain is inevitable, suffering is optional". Or they may be used to define each other, as in "pain is physical suffering", or "suffering is severe physical or mental pain".

Qualifiers, such as mental, emotional, psychological, and spiritual, are often used for referring to certain types of pain or suffering. In particular, mental pain (or suffering) may be used in relationship with physical pain (or suffering) for distinguishing between two wide categories of pain or suffering. A first caveat concerning such a distinction is that it uses physical pain in a sense that normally includes not only the 'typical sensory experience of physical pain' but also other unpleasant bodily experiences such as itching or nausea. A second caveat is that the terms physical or mental should not be taken too literally: physical pain or suffering, as a matter of fact, happens through conscious minds and involves emotional aspects, while mental pain or suffering happens through physical brains and, being an emotion, involves important physiological aspects.

Unpleasantness is another synonym of suffering or pain in the broad sense. More technically, the term is used in physical pain science for referring to the basic affective dimension of pain (its suffering aspect per se), usually in contrast with the sensory dimension, as for instance in this sentence from Professor Donald Price: “Pain-unpleasantness is often, though not always, closely linked to both the intensity and unique qualities of the painful sensation.”^[4] Words that are roughly synonymic with suffering, in addition to pain and unpleasantness, include distress, sorrow, unhappiness, misery, affliction, woe, ill, discomfort, displeasure, disagreeableness.

Hedonism, as an ethical theory, claims that good and bad consist ultimately in pleasure and pain. Many hedonists, in accordance with Epicurus, emphasize avoiding suffering over pursuing pleasure, because they find that the greatest happiness lies in a tranquil state (ataraxia) free from pain and from the worrisome pursuit or unwelcome consequences of pleasure. For Stoicism, the greatest good lies in reason and virtue, but the soul best reaches it through a kind of indifference (apatheia) to pleasure and pain: as a consequence, this doctrine has become identified with stern self-control in regard to suffering.

Jeremy Bentham developed hedonistic utilitarianism, a popular doctrine in ethics, politics, and economics. Bentham argued that the right act or policy was that which would cause "the greatest happiness of the greatest number". He suggested a procedure called hedonic or felicific calculus, for determining how much pleasure and pain would result from any action. John Stuart Mill improved and promoted the doctrine of hedonistic utilitarianism. Karl Popper, in The Open Society and Its Enemies, proposed a negative utilitarianism, which prioritizes the reduction of suffering over the enhancement of happiness when speaking of utility: "I believe that there is, from the ethical point of view, no symmetry between suffering and happiness, or between pain and pleasure. (…) human suffering makes a direct moral appeal for help, while there is no similar call to increase the happiness of a man who is doing well anyway." David Pearce, for his part, advocates an utilitarianism that aims straightforwardly at the abolition of suffering through the use of biotechnology (see more details below in section Biology, neurology, psychology). Another aspect worthy of mention here is that many utilitarians since Bentham hold that the moral status of a being comes from its ability to feel pleasure and pain: therefore, moral agents should consider not only the interests of human beings but also those of (other) animals. Richard Ryder developed such a view in his concepts of 'speciesism' and 'painism'. Peter Singer's writings, especially the book Animal Liberation, represent the leading edge of this kind of utilitarianism for animals as well as for people.

Another doctrine related to the relief of suffering is humanitarianism (see also humanitarian principles, humanitarian aid, and humane society). "Where humanitarian efforts seek a positive addition to the happiness of sentient beings, it is to make the unhappy happy rather than the happy happier. (...) [Humanitarianism] is an ingredient in many social attitudes; in the modern world it has so penetrated into diverse movements (...) that it can hardly be said to exist in itself."^[5]

Pessimism holds this world to be the worst possible, plagued with worsening and unstoppable suffering. Arthur Schopenhauer recommends us to take refuge in things like art, philosophy, loss of the will to live, and tolerance toward 'fellow-sufferers'. Friedrich Nietzsche, first influenced by Schopenhauer, developed afterward quite another attitude, exalting the will to power, despising weak compassion or pity, and recommending us to embrace willfully the 'eternal return' of the greatest sufferings. Philosophy of pain is a philosophical specialty that focuses on physical pain as a sensation. Through that topic, it may also pertain to suffering in general.

Suffering plays an important role in most religions, regarding matters such as the following: consolation or relief; moral conduct (do no harm, help the afflicted, show compassion); spiritual advancement through life hardships or through self-imposed trials (mortification of the flesh, penance, ascetism); ultimate destiny (salvation, damnation, hell). Theodicy deals with the problem of evil, which is the difficulty of reconciling an omnipotent and benevolent god with evil. People often believe that the worst form of evil is extreme suffering, especially in innocent children or in beings created ultimately for being tormented without end (see problem of hell).

The Four Noble Truths of Buddhism are about dukkha, a term usually translated as suffering. The Four Noble Truths state (1) the nature of suffering, (2) its cause, (3) its cessation, and (4) the way leading to its cessation (which is the Noble Eightfold Path). Buddhism considers liberation from suffering and the practice of compassion (karuna) as basic for leading a holy life and attaining nirvana.

Hinduism holds that suffering follows naturally from personal negative behaviors in one’s current life or in a past life (see karma in Hinduism).^[6] One must accept suffering as a just consequence and as an opportunity for spiritual progress. Thus the soul or true self, which is eternally free of any suffering, may come to manifest itself in the person, who then achieves liberation (moksha). Abstinence from causing pain or harm to other beings (ahimsa) is a central tenet of Hinduism.

The Bible's Book of Job reflects on the nature and meaning of suffering. Pope John Paul II wrote "On the Christian Meaning of Human Suffering".^[7] This meaning revolves around the notion of redemptive suffering.

Artistic and literary works often engage with suffering, sometimes at great cost to their creators or performers. The Literature, Arts, and Medicine Database offers a list of such works under the categories art, film, literature, and theater. Be it in the tragic, comic or other genres, art and literature offer means to alleviate (and perhaps also exacerbate) suffering, as argued for instance in Harold Schweizer's Suffering and the remedy of art.^[8]

Landscape with the Fall of Icarus

This Breughel's painting is among those that inspired W.H. Auden's poem Musée des Beaux Arts :

About suffering they were never wrong,
The Old Masters; how well, they understood
Its human position; how it takes place
While someone else is eating or opening a window or just walking dully along;
(...)
In Breughel's Icarus, for instance: how everything turns away
Quite leisurely from the disaster; (...) ^[9]

Social suffering, according to Arthur Kleinman and others, describes "collective and individual human suffering associated with life conditions shaped by powerful social forces."^[10] Such suffering is an increasing concern in medical anthropology, ethnography, mass media analysis, and Holocaust studies, says Iain Wilkinson,^[11] who is developing a sociology of suffering.

The Encyclopedia of World Problems and Human Potential is a work by the Union of International Associations. Its main databases are about world problems (56,564 profiles), global strategies and solutions (32,547 profiles), human values (3,257 profiles), and human development (4,817 profiles). It states that "the most fundamental entry common to the core parts is that of pain (or suffering)" and "common to the core parts is the learning dimension of new understanding or insight in response to suffering."^[12]

Ralph G.H. Siu, an American author, urged in 1988 the "creation of a new and vigorous academic discipline, called panetics, to be devoted to the study of the infliction of suffering."^[13] The International Society for Panetics was founded in 1991 to study and develop ways to reduce the infliction of human suffering by individuals acting through professions, corporations, governments, and other social groups.^[14]

In economics, the following notions relate not only to the matters suggested by their positive appellations, but to the matter of suffering as well: Well-being or Quality of life, Welfare economics, Happiness economics, Gross National Happiness, Genuine Progress Indicator.

In law, "Pain and suffering" is a legal term that refers to the mental anguish or physical pain endured by a plaintiff as a result of injury for which the plaintiff seeks redress.

Pain and pleasure, in the broad sense of these words, are respectively the negative and positive affects, or hedonic tones, or valences that psychologists often identify as basic in our emotional lives.^[15] The evolutionary role of physical and mental suffering, through natural selection, is primordial: it warns of threats, motivates coping (fight or flight, escapism), and reinforces negatively certain behaviors (see punishment, aversives). Despite its initial disrupting nature, suffering contributes to the organization of meaning in an individual's world and psyche. In turn, meaning determines how individuals or societies experience and deal with suffering.

Neuroimaging sheds light on the seat of suffering

Many brain structures and physiological processes take part in the occurrence of suffering. Various hypotheses try to account for the experience of unpleasantness. One of these, the pain overlap theory^[16] takes note, thanks to neuroimaging studies, that the cingulate cortex fires up when the brain feels unpleasantness from experimentally induced social distress or physical pain as well. The theory proposes therefore that physical pain and social pain (i.e. two radically differing kinds of suffering) share a common phenomenological and neurological basis.

According to David Pearce’s online manifesto The Hedonistic Imperative, suffering is the avoidable result of Darwinian genetic design. BLTC Research and the Abolitionist Society,^[17] following Pearce's abolitionism, promote replacing the pain/pleasure axis with a robot-like response to noxious stimuli^[18] or with gradients of bliss,^[19] through genetic engineering and other technical scientific advances.

Hedonistic psychology,^[20] affective science, and affective neuroscience are some of the emerging scientific fields that could in the coming years focus their attention on the phenomenon of suffering.

Disease and injury cause suffering in humans and animals. Health care addresses this suffering in many ways, in medicine, clinical psychology, psychotherapy, alternative medicine, hygiene, public health, and through various health care providers.

Health care approaches to suffering, however, remain problematic, according to Eric Cassell, the most cited author on that subject. Cassell writes: "The obligation of physicians to relieve human suffering stretches back to antiquity. Despite this fact, little attention is explicitly given to the problem of suffering in medical education, research or practice." Cassell defines suffering as "the state of severe distress associated with events that threaten the intactness of the person."^[21] Medicine makes a strong distinction between physical pain and suffering, and most attention goes to the treatment of pain. Nevertheless, physical pain itself still lacks adequate attention from the medical community, according to numerous reports.^[22] Besides, some medical fields like palliative care, pain management (or pain medicine), oncology, or psychiatry, does somewhat address suffering 'as such'. In palliative care, for instance, pioneer Cicely Saunders created the concept of 'total pain' ('total suffering' say now the textbooks^[23]), which encompasses the whole set of physical and mental distress, discomfort, symptoms, problems, or needs that a patient may experience hurtfully.

Since suffering is such a universal motivating experience, people, when asked, can relate their activities to its relief and prevention. Farmers, for instance, may claim that they prevent famine, artists may say that they take our minds off our worries, and teachers may hold that they hand down tools for coping with life hazards. In certain aspects of collective life, however, suffering is more readily an explicit concern by itself. Such aspects may include public health, human rights, humanitarian aid, disaster relief, philanthropy, economic aid, social services, insurance, and animal welfare. To these can be added the aspects of security and safety, which relate to precautionary measures taken by individuals or families, to interventions by the military, the police, the firefighters, and to notions or fields like social security, environmental security, and human security.

Philosopher Leonard Katz wrote: "But Nature, as we now know, regards ultimately only fitness and not our happiness (...), and does not scruple to use hate, fear, punishment and even war alongside affection in ordering social groups and selecting among them, just as she uses pain as well as pleasure to get us to feed, water and protect our bodies and also in forging our social bonds".^[24]

People make use of suffering for specific social or personal purposes in many areas of human life, as can be seen in the following instances.

• In arts, literature, or entertainment, people may use suffering for creation, for performance, or for enjoyment. Entertainment particularly makes use of suffering in blood sports, violence in the media, or violent video games.

• In business and various organizations, suffering may be used for constraining humans or animals into required behaviors.

• In a criminal context, people may use suffering for coercion, revenge, or pleasure.

• In interpersonal relationships, especially in places like families, schools, or workplaces, suffering is used for various motives, particularly under the form of abuse and punishment. In another fashion related to interpersonal relationships, the sick, or victims, or malingerers, may use suffering more or less voluntarily to get primary, secondary, or tertiary gain.

• In law, suffering is used for punishment (see penal law ); victims may refer to what legal texts call "pain and suffering" to get compensation; lawyers may use a victim's suffering as an argument against the accused; an accused's or defendant's suffering may be an argument in their favor.

• In the news media, suffering is often the raw material.^[25]

• In personal conduct, people may use suffering for themselves, in a positive way.^[26] Personal suffering may lead, if bitterness, depression, or spitefulness is avoided, to character-building, spiritual growth, or moral achievement;^[27] realizing the extent or gravity of suffering in the world may motivate one to relieve it and may give an inspiring direction to one's life. Alternatively, people may make self-detrimental use of suffering. Some may be caught in compulsive reenactment of painful feelings in order to protect them from seeing that those feelings have their origin in unmentionable past experiences; some may addictively indulge in disagreeable emotions like fear, anger, or jealousy, in order to enjoy pleasant feelings of arousal or release that often accompany these emotions; some may engage in acts of self-harm aimed at relieving otherwise unbearable states of mind.

• In politics, there is purposeful infliction of suffering in war, torture, and terrorism; people may use nonphysical suffering against competitors in nonviolent power struggles; people who argue for a policy may put forward the need to relieve, prevent or avenge suffering; individuals or groups may use past suffering as a political lever in their favor.

• In religion, suffering is used especially to grow spiritually, to expiate, to inspire compassion and help, to frighten, to punish.

• In rites of passage (see also hazing, ragging), rituals that make use of suffering are frequent.

• In science, humans and animals are subjected on purpose to unpleasant experiences for the study of suffering or other phenomena.

• In sex, individuals may use suffering in a context of sadism and masochism or BDSM.

• In sports, suffering may be used to outperform competitors or oneself; see sports injury, and no pain, no gain; see also blood sport and violence in sport as instances of pain-based entertainment.

• Joseph A. Amato. Victims and Values: A History and a Theory of Suffering. New York: Praeger, 1990. ISBN 0-275-93690-2
• Cynthia Halpern. Suffering, Politics, Power : A Genealogy in Modern Political Theory. Albany: State University of New York Press, 2002. ISBN 0-7914-5103-8
• Jamie Mayerfeld. Suffering and Moral Responsibility. New York: Oxford University Press, 2005. ISBN 0-19-515495-9
• David B. Morris. The Culture of Pain. Berkley: University of California, 2002. ISBN 0-520-08276-1
• Elaine Scarry. The Body in Pain: The Making and Unmaking of the World. New York: Oxford University Press, 1987. ISBN 0-19-504996-9