Arguments concerning the nature of natural evil vary in their conclusions depending on the particular approach with which they commence inquiry; one of the most contested conclusions regards evil as privation, sourcing its justification primarily from Aquinas’ metaphysical conception of good as being and evil as non-being. It should be of no surprise, then, that the dismissal of natural evil’s privative nature comes about when the understanding of natural evil favours a phenomenological approach rather than a metaphysical one. Proponents of said dismissal generally centre their claims around the notion of pain and suffering as substantially contentful – as in, non-privative – experiences of evil. On the other hand, theorists espousing the privation account generally argue that characterisations of pain and suffering as necessarily evil do not consider the context of orientation towards individual wellbeing within which pain/suffering experiences naturally function. Furthermore, some of the arguments for the privation account’s dismissal seem to disregard completely the Thomistic sense of the form and hierarchy of the good, which ends up straw-manning the privation account to a point where it can no longer reconcile the awfulness of experienced pain and suffering with these experiences not being necessarily evil. The importance of understanding this Thomistic sense is further emphasised in its capacity to explain why a divine and fully good Creator would involve the world with such evil. Thus, this paper first considers the account of evil given in question one of Aquinas’ De malo, along with contemporary arguments for the nature and purpose of evil as privation; second, these are then used as resources to help make sense of, one, the general nature of pain and suffering, and two, some of their specific expressions as found in disease and depression, and throughout evolutionary history.