On the Suffering of Compassion

Compassion is often described in terms of suffering. This paper investigates the nature of this suffering. It is argued that compassion involves suffering of a particular kind. To begin with a case is made for the negative claim that compassion does not involve an ordinary, or afflictive, suffering over something. Secondly, it is argued that the suffering of compassion is a suffering for someone else’s sake: If you feel compassion for another person, P, then you suffer over P:s suffering for P:s sake, and if that is all you do, then you are not affected with an afflictive suffering over something. The final section identifies and addresses a problem concerning self-pity, and a suggestion is made on how to specify the proposed account so as to cover both self-directed and other-directed compassion.     

Suffering, meaning, and bioethics.

Suffering evokes moral and metaphysical reflection, the bioethics of suffering concerns the proper ethos of living with suffering. Because empirical and philosophical explorations of suffering are imprisoned in the world of immanent experience, they cannot reach to a transcendent meaning. Even if religious and other narratives concerning the meaning of suffering have no transcendent import, they can have aesthetic and moral significance. This understanding of narratives of suffering and of their custodians has substantial ecumenical implications: chaplains can function as general custodians of narratives and sustainers of a generic religious meaning. This understanding is contrary to traditional Christianity, which discloses a transcendent significance of human suffering found in a very particular history involving particular persons: Christ as the second Adam through the submission of the second Eve has taken on our nature so that we can be united with God. Human suffering is tied to human sin, not simply as a punishment for sin, much less as an opportunity to discharge a supposed temporal punishment due to sin. Human suffering is the result of our rebellious free choices. It provides an opportunity for humility and submission, so that, united to the cross of Christ, sin can be forgiven and suffering set aside in the Resurrection. Knowledge of this framing context for all human suffering is accessible not through rational argument. It is a knowledge garnered through repentance, purification of the heart, illumination by God's grace, and unification with God. Christian bioethics is embedded in the narrative of suffering, which is part of the history of salvation and which encompasses and places all of medicine in its terms.     

The myth of the control of suffering

Is it true that the suffering associated with chronic illness can be controlled in all but a few intractable cases? The bio-ethical literature gives the impression that suffering is primarily pain and that a competent physician should be able to control suffering. This perception jibes neither with my forty years of clinical experience nor with suffering as depicted in novels. Using Kenaz' novel,The Way to the Cats as a starting point, I argue that, with regard to suffering and illness, fiction is closer to reality than professional literature, and suffering is far more than pain. I content that the control of suffering is a modern myth. This argument applies equally well to the control of non-insulin dependent diabetes. Patient selection, duration of follow-up, remembering what we want to remember, bias, self-fulfilled prophecy, and asking the wrong questions are offered as partial explanation for the gap between perception and reality. The complexity of suffering and the elusiveness of its control should be honestly recognized.     

The paradox of healing pain

Pain may be seen as a problem to be healed or as a means for healing. The secular biomedical view of pain is that it is to be avoided and alleviated; its only meaning is as a symptom of underlying disease. In contrast, there have been throughout history other views of suffering—as redemptive or as transformative, for example. This paper considers the disparity between these perspectives, examining the role of the emotions and the underlying neurobiological processes though which pain and suffering come to be experienced as meaningful, then analyzes interview material exploring how religion and religious beliefs help people cope with suffering or with pain. The experience of pain is subjective, enculturated experience; the meaning that pain or suffering holds within a given cultural context affects the experience of pain and suffering. In a context where pain and suffering are understood to be valuable, those experiences can be used for spiritual transformation and integrated within a meaningful identity. In contrast, in a context where pain and suffering are not understood to have value, that attitude can create more suffering, even in conditions meant to alleviate suffering, such as in biomedical situations.     

The paradox of healing pain

Pain may be seen as a problem to be healed or as a means for healing. The secular biomedical view of pain is that it is to be avoided and alleviated; its only meaning is as a symptom of underlying disease. In contrast, there have been throughout history other views of sufferingdas redemptive or as transformative, for example. This paper considers the disparity between these perspectives, examining the role of the emotions and the underlying neurobiological processes though which pain and suffering come to be experienced as meaningful, then analyzes interview material exploring how religion and religious beliefs help people cope with suffering or with pain. The experience of pain is subjective, enculturated experience; the meaning that pain or suffering holds within a given cultural context affects the experience of pain and suffering. In a context where pain and suffering are understood to be valuable, those experiences can be used for spiritual transformation and integrated within a meaningful identity. In contrast, in a context where pain and suffering are not understood to have value, that attitude can create more suffering, even in conditions meant to alleviate suffering, such as in biomedical situations.     

My <Emphasis Type="Italic">Ishvara</Emphasis> is Dead: Spiritual Care on the Fringes

Human suffering speaks differently to different lived contexts. In this paper, I have taken a metaphoric representation of suffering, Ishvara, from the lived context of a Hindu immigrant woman to show that suffering is experienced and expressed within one’s lived context. Further, a dominant narrative from her world is presented to show that the same lived context can be a resource for spiritual care that could reconstruct her world that has fallen apart with a suffering experience. Having argued that suffering is experienced and expressed within one’s lived context, and that lived context could be a resource, in this paper I present that spiritual care is an intervention into the predicaments of human suffering and its mandate is to facilitate certain direction and a meaningful order through which experiences and expectations are rejoined. Finally, I observe that spiritual care is an engagement between the lived context where suffering is experienced and the spiritual experience and orientation of the caregiver.     

Proportionality,Terminal Suffering and the Restorative Goals of Medicine

Recent years have witnessed a growing concern that terminally ill patients are needlessly suffering in the dying process. This has led to demands that physicians become more attentive in the assessment of suffering and that they treat their patients as 'whole persons.' For the most part, these demands have not fallen on deaf ears. It is now widely accepted that the relief of suffering is one of the fundamental goals of medicine. Without question this is a positive development. However, while the importance of treating suffering has generally been acknowledged, insufficient attention has been paid to the question of whether different types of terminal suffering require different responses from health care professionals. In this paper we introduce a distinction between two types of suffering likely to be present at the end of life, and we argue that physicians must distinguish between these types if they are to respond appropriately to the suffering of their terminally ill patients. After introducing this distinction and explaining its basis, we further argue that the distinction informs a (novel) principle of proportionality, one that should guide physicians in balancing their competing obligations in responding to terminal suffering. As we explain, this principle is justified by reference to the interests terminally ill patients have in restoration, as well as in the relief of suffering, at the end of life.     

Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

The 2004 Indian Ocean Tsunami Catastrophe,its Survivors,Job and the Universal Features of Suffering: A Theoretical Study

The purpose of this theoretical article is to discuss the existential and universal feature of suffering—as illustrated by Job’s suffering in the Book of Job in the Bible and by the survivors of the 2004 Asian tsunami catastrophe—and to highlight its significance for health care. Further, the study is aiming at contributing to health professionals’ understanding of patients’ suffering. The sources are narratives, comprising Job’s book, TV interviews 1 year after the tsunami catastrophe and the survivors’ autobiographies. The methodological approach is a philosophical analysis. The existential, universal, ontological and epistemological aspects of suffering are carefully scrutinized to unveil the universal and existential versus culture-specific features of suffering. Based on the results, the authors’ recommendations are (1) a holistic concept of the patient and health care has to seriously consider suffering in all its complexity because when a person is in pain, it is not his/her body but the whole person as a unity of body, psyche and spirit that suffers and (2) suffering should be seen as the most central concept of health care, which should provide treatment for physical pain and all dimensions of suffering: physical, social, mental and spiritual aspects.     

Levinas on suffering and compassion

This paper provides an analysis of suffering and compassion in the work of Emmanuel Levinas. Levinas describes compassion as ‘the nexus of human subjectivity’ and the ‘supreme ethical principle’. In his early texts, suffering discloses the burden of being, the limits of the self, and thus the approach of alterity. Levinas’s later phenomenology of suffering as passive, meaningless, and evil, functions as a refutation of rational explanations of suffering. I argue that Levinasian substitution, the traumatic election to an excessive responsibility, is the compassionate suffering that Levinas terms the nexus of human subjectivity. For Levinas, ethics is the compassionate response to the vulnerable, suffering Other.     

Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.     

Suffering for Justice in Anne Conway and Maria W. Stewart

Anne Conway and Maria W. Stewart are quietly revolutionary philosophers who provide valuable insights into the nature of suffering and its relation to justice. Conway scholars have claimed that she offers a theodicy, trying to reconcile suffering with the existence of a just God. However, this does not make sense of her arguments or audience. Instead, we should see her as a theoretician of the role of suffering in a person's life. Moving beyond the personal, Stewart's emphasis on social sources of suffering leads her to posit a vision for bringing about a more just society in the near term that is absent in Conway. Both philosophers provide fascinating insight into how to theorize suffering and justice, including the role of unity in a just society.     

Gender, Religion, and the Experience of Suffering: A Case Study

This article explores how gender and religious belief come together in an elderly woman’s experience of suffering. It is based on qualitative research that explored experiences of suffering in a group of community-dwelling elders (80+) living in a North American city. We use the case study method to introduce themes that show suffering’s uniqueness to the individual whose narrative we report, as well as similarity to themes that emerged in other participants’ narratives. In this case, an elderly woman’s gender and religious identities merge in her stories of suffering, which include the memory of a childhood disability and an incident of clergy abuse that occurred 70 years previously. A key finding in this paper is that key themes in her story of suffering, which are disablement and clergy abuse, resonate to the general themes of suffering found in our study, which are (1) threats to personal identity; (2) loss of a valued item, quality, or relationship; and (3) a lack of control over self or the circumstances of life.     

Negative Theology and Meaningless Suffering

This article attempts an exploration of the limits of our capacity to weave suffering into patterns of meaning. I try to show that something like an apophatic moment in our response to some kinds of suffering is both necessary and difficult to sustain. From this emerges a question about the relationship between this ‘something like apophasis’ before suffering, on the one hand, and unknowing in face of the mystery of God, on the other. I argue against a tendency in some modern theology to elide one into the other – against a tendency to absorb the ‘mystery of suffering’ into the ‘mystery of God.’ The article concludes with the suggestion that in order to avoid such an elision, and other forms of false reconciliation with suffering, Christian theology needs to maintain a commitment to a future-oriented eschatology, a real – if unimaginable – eschatological hope.     

“I Desire to Suffer,Lord, because Thou didst Suffer”: Teresa of Avila on Suffering

Teresa of Avila's desire for suffering cannot be interpreted as the mere passive assumption of a feminine sacrificial role. On the contrary, Teresa was able to transform her suffering into the incarnated performance of her relationship with God: By desiring suffering and by understanding it and her ability to confront it as proof of divine love, she was able to reinforce her self‐confidence and strength. This article discusses Teresa of Avila's experience and interpretation of suffering in the context of the female ascetic‐mystic Christian tradition. It criticizes Teresa's positive conceptualization of suffering but examines in depth the potential of her ability to actively manage and control it. Although Teresa was able to affirm her personality through ascetic practices such as self‐humiliation and mortification, the general applicability of such practices to the management of suffering is fraught since they leave the suffering individual in a vulnerable position. Although Teresa of Avila finds fulfillment and, paradoxically, self‐actualization through self‐denial and the surrender of her will, such practices entail the substantial risk of total self‐annihilation.     

Suffering and Transcendence

This essay explores the experience of suffering in order to see to what extent it can be understood within the context of the human condition without diverting the reality of suffering or denying the meaning of human existence and divine reality. Particular attention is given to describing and interpreting what I call the transcendent dimensions of suffering with the intent of showing that in the experience of suffereing persons come up against the limits of what can be accounted for in ordinary terms and point towards transcendent reality. In religious faith the transcendent dimensions of suffering may be understood to come together with other transcendent dimensions of experience in a more distinctive or focused encounter with transcendent reality. The conception of God that is suggested by the transcendent dimensions of suffering, however, differs from the model of God in western theism as an absolutely transcendent, all powerful, immutable and impassible being.     

Recognition,ideology, and the case of “invisible suffering”

The purpose of this paper is to expose, and provide a possible solution to, an internal inconsistency in Axel Honneth's critical theory of recognition. 1 Honneth requires a way of making his claim that misrecognition causes subjective suffering, with the potential to cognitively disclose injustice, consistent with his account of ideological recognition as a form of misrecognition that engenders compliance with an oppressive social order. Only by reconciling these claims—that is, by showing how ideological recognition can engender an acceptance of domination whilst at the same time causing subjective suffering—can Honneth's theory of recognition retain the kind of critical capacities he desires. As a means of achieving this reconciliation, I propose the notion of “invisible suffering.” In the case of ideological recognition, I suggest that the suffering caused by misrecognition has its disclosive power blocked by the faux‐affirmation that the ideology discursively accords, and this renders the experience of suffering, qua painful indicator of social injustice, invisible to the subject. Drawing on insights from medical sociology, I show how the need to supplement Honneth's theory of recognition with the idea of invisible suffering is revelatory of the kind of critical theoretical stance demanded by his ontological commitments.     

Nietzsche and the dilemma of suffering

In this paper, we attempt to view a long-held assumption in nursing as mistaken. That is, that patient suffering is something to be overcome. Utilizing Nietzsche's statements on Amor Fati, we carefully examine the cultural assumptions behind our denigration of suffering, look at specific nursing examples of this situation, and attempt the beginnings of a discourse on what it would take for nurses to overcome their own predetermined views of suffering in order to better help their patients "own" their own suffering.