BackgroundThis article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them are critically discussed with such purpose.MethodsA philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are (...) found as better definitions of suffering and pain.ResultsPain 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. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. 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. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one’s own attachment to the world. An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person’s life, and the self is the ever-changing sum of these experiences.ConclusionsThe provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain. (shrink)

This article develops a phenomenology of suffering with an emphasis on matters relevant to medical practice and bioethics. An attempt is made to explain how suffering can involve many different things—bodily pains, inability to carry out everyday actions, and failure to realize core life values—and yet be a distinct phenomenon. Proceeding from and expanding upon analyses found in the works of Eric Cassell and Elaine Scarry, suffering is found to be a potentially alienating mood overcoming the person and engaging her (...) in a struggle to remain at home in the face of loss of meaning and purpose in life. Suffering involves painful experiences at different levels that are connected through the suffering-mood but are nevertheless distinguishable by being primarily about my embodiment, my engagements in the world together with others, and my core life values. Suffering is in essence a feeling , but as such, it has implications for and involves the person’s entire life: how she acts in the world, communicates with others, and understands and looks upon her priorities and goals in life. Suffering-moods are typically intense and painful in nature, but they may also display a rather subconscious quality in presenting things in the world and my life as a whole in an alienating way. In such situations, we are not focused directly upon the suffering-mood—as in the cases of pain and other bodily ailments—but rather, upon the things that the mood presents to us: not only our bodies, but also other things in the world that prevent us from having a good life and being the persons we want to be. Such suffering may in many cases be transformed or at least mitigated by a person’s identifying and changing her core life values and in such a manner reinterpreting her life story to become an easier and more rewarding one to live under the present circumstances. (shrink)

Western thinkers have usually falsified our experience of suffering in trying to make sense of it. In a postmodern age, their accounts seem implausible. We need a way of making sense of suffering while admitting its horror.

In recent years a large empirical literature has appeared on suffering at the end of life. In this literature it is recognized that suffering has existential and social dimensions in addition to physical and psychological ones. The non-physical aspects of suffering, however, are still understood as pathological symptoms, to be reduced by therapeutical interventions as much as possible. But suffering itself and the negative emotional states it consists of are intentional states of mind which, as such, make cognitive claims: they (...) are more or less appropriate responses to the actual circumstances of the patient. These circumstances often are such that it would rather be a pathological symptom not to be sad and not to suffer. Suffering, therefore, is sometimes and to some extent a condition to be respected. Although I do not dispute that the alleviation of suffering is the main aim of palliative care, in pursuing that aim we should acknowledge a constraint of realism. (shrink)