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American Pain Society
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Mark Sullivan, MD PhD, Department Editor
Michael Nutkiewicz, PhD
Department Editor’s Note: Below you will find a reply to Jamie Mayerfeld’s “The Moral Significance of Suffering: An Argument Against Redemptive Pain,” (APS Bulletin, November/December 2001). Michael Nutkiewicz, executive director of the Program for Torture Victims in Los Angeles, describes an “ethic of suffering” and contrasts it with the “metaphysic of suffering” provided by Mayerfeld. Nutkiewicz refers herein to the Jewish ethical tradition, adding to our previous discussions of the value of pain from Christian and Buddhist traditions. This “ethic of suffering” sees pain always within a social context. Pain invites us to honor the covenant we share with all other humans who may suffer. In this respect, it is neither wholly evil nor without redemptive value.
In his article, Jamie Mayerfeld (2001) argues “suffering is intrinsically evil for the individual who experiences it—evil in itself” (p. 4). For Mayerfeld, it is self-evident suffering is evil. Whatever remedial or redemptive function we impose on the experience does not negate the bare fact that suffering is evil. Using phrases like “per se,” “in itself,” and “intrinsically evil,” Mayerfeld casts the existence of suffering in philosophical-metaphysical terms, and turns suffering into an abstract ontological entity rather than a human experience.
I want to present a contrasting understanding of suffering, one in which the experience can never be understood outside a social context. My claim is suffering is the acid test of our ability to exhibit concern, compassion, and healing and, therefore, is always about relationships. In this view, suffering cannot be intrinsically evil because it can never be plucked from a social context. Even torture—an extreme example of fortuitous suffering—is evil, not for the pain it inflicts but for its attempt to undermine the victim’s belief in relationships. In contrast to Mayerfeld’s metaphysic of suffering, I present an ethic of suffering, and illustrate this approach by looking at traditional Judaism’s prescriptive laws of bikkur holim, visiting the sick (the terms metaphysic and ethic of suffering are taken from the late Rabbi Joseph B. Soloveitchik). Before developing the ethic of suffering, let us first look at Mayerfeld’s claim and the consequences that follow.
Mayerfeld admits he has no (logical) argument for his claim. Apparently, it depends upon the observation that suffering is usually accompanied by physical and psychological distress. Mayerfeld, however, does not distinguish suffering from pain, illness, or psychological anguish. This muddles his discussion because many people would argue suffering is the meaning or interpretation we impose on pain or illness. Beliefs, ideologies, upbringing, and personality, among other factors, inform and shape meaning. Suffering is one of many ways in which pain, illness, and psychological distress are interpreted and expressed.
Mayerfeld claims we “denature and falsify” suffering because we are unable or unwilling to truly grasp the nature of suffering. He writes, “True suffering is simply too horrible for us to acknowledge; but a false and pleasing simulacrum of it will be gladly admitted into our consciousness” (p. 6). He points to popular films and literature that sentimentalize pain and tragedy as examples of our inability to face up to suffering. But Mayerfeld fails to see narratives of suffering couched in sentiment are among the many ways in which we socially mediate pain.
Recent work on pain and illness narratives, pioneered by Frank (1995) and others, reinforces the idea that suffering is not some kind of Platonic abstraction called evil, but is imbedded and understood through the various ways in which the sufferer engages with self, physician, family, friends, and community. For example, Frank identified three archetypical narratives: restitution, chaos, and quest. Others have suggested narrative is in the “black box” of even the most traumatized brain. Waitzkin and Magana (1997) argue some trauma, like torture, is such a totally unacceptable narrative that it can be “spoken” or uttered only as a physical symptom with no apparent organic source. Whatever their form, pain and illness narratives reflect the various interpersonal and socially mediated ways in which people grapple with traumatic experiences.
Besides sentimentalizing pain, Mayerfeld believes we shield ourselves from the perception of other people’s suffering because we fear facing our own suffering. Our fear compels us to deny the existence of evil in the world. Affirming the existence of an objective, external evil, however, raises epistemological questions. If all suffering is evil, then every instance of suffering, from the pain that alerts me to remove my hand from the fire to the psychological anguish I feel upon my divorce, is in the class of objects to which the term “evil” may be applied. Some people, for example, apply the terms “suffering” and “sufferer” to the natural environment. Consequently, we have no criterion for deciding for any given instance of suffering whether it falls within the extension of the term “evil” or not. Evil becomes a universal that is difficult to analyze and define.
I am sure were we able to reify and face evil, we would be terror-stricken. The problem, however, is reified evil makes suffering a wholly external static—something human beings confront rather than experience. Illness narratives remind us suffering is a dynamic of response. When illness or tragedy strikes, we respond with panic, chaos, confusion, and anger. This state of mind, however, generally does not remain, and the ill person sooner or later seeks to understand his or her condition. This is not, as Mayerfeld would have it, an attempt to justify or mitigate pain, but a part of the natural course of the experience. By reifying suffering, Mayerfeld creates a world in which the person and their suffering stand in relationship of one object to another. In effect, he widens the gulf between the sufferer and the nonsufferer by calling for “an accurate intellectual understanding of what suffering is ” (p. 7). Mayerfeld gives us the metaphysic of suffering, but we still do not have an ethic of suffering. We still do not know how to behave in the face of suffering. The covenantal idea in traditional Judaism offers an ethic that is based on a shared set of expected relationships. Unlike contracts, which are private acts that do not necessarily have a moral aspect, covenants have both public purposes and moral dimensions.
How does one know, however, what is expected? Underlying the covenant’s ethico-legal demand is the doctrine of imitatio dei: human beings are created in the image of God and therefore must behave like God. Imitatio dei is the conceptual key to many normative religious obligations in Jewish life. For example, the obligation to visit the sick found in the biblical verse, “On the day Abraham circumcised himself...God appeared to him in the oaks of Mamre; he sat in the entrance of the tent in the heat of the day” (Genesis 17-18). The 11th century French commentator, Rabbi Shlomo Yitzchaki (“Rashi”) refers to an ancient midrash (homiletic tale) that directs us to both an attitude and an action: “Rabbi Huma, the son of Hanina, said: It was the third day after his circumcision and the Holy One, blessed be He, came and inquired after the state of his health.” (Herczeg, 1995, p. 174)
Rashi’s midrash, however, suggests another and larger point, namely, that illness or pain offers the possibility of relationship, of human beings helping one another. “Despite the divine nature of Abraham’s recovery from circumcision,” writes Weinberg (1999), “The laws covering medical care—human therapeutic interference—are centered precisely and prominently within the Talmudic chapter delineating circumcision” (p. 72). For a discussion on the obligation to alleviate pain, see “Palliation of Pain” by J. David Bleich (2002). The doctor who heals, the nurse who wipes the brow of the ill, the volunteer who holds the patient’s hand, the visitors who simply make known their presence, all assume relationships mean something. In fact, to the person in pain, to the one who suffers, relationships are everything.
In this worldview, suffering is not a metaphysical entity, but an interpersonal or relational experience. Medicine is deeply symbiotic and relational. By contrast, suffering without at least the hope for, and belief in, relationships is “evil,” not because of the suffering per se, but because a human being is experiencing it alone.
If medicine is symbiotic, torture is deeply alienating. Although torture is an extreme example of suffering (still practiced in more than 90 countries around the world), it reveals the connection between pain and relationships. Torture is the purest example of the use of pain to undermine the belief in relationships. The torturer is distant and impersonal. He controls the human being and attempts to make him over as he wishes. “I’ll take you to the verge of death as many times as I want to,”(Krog, 1998, p. 97) said South African police captain Jeff Benzien to his victim.
Politically motivated torture often attempts to turn victims into informers, breaking and reorienting relationships. The torturer inflicts pain to make the victim believe he is alone and there will be no help, comfort, or compassion from the outside. The torturer does not so much undermine the victim’s sense of self as make the victim think he is abandoned and alone. Survivors emerge from the torture experience hypervigilant, fearful, and mistrustful. They are emotionally numb and feel estranged from people. Mainly, they talk about feeling alone. “Where I come from, they don’t like me; where I am, they don’t know me. It’s like the world is just you,” explains an Angolan torture survivor (personal communication, September 23, 2002). If a survivor cannot rebuild trust and relationships, he is condemned to live alone in the anguish of his inner wilderness. The torture survivor challenges us to think about how relationships contribute to rehabilitation and healing.
The rehabilitation of torture survivors is a subject that goes beyond the scope of this article. But there seems no better way of illustrating the ethic of suffering than to return to the question: according to convenental Judaism, what obligation does suffering impose upon man?
As we saw, Mayerfeld believes we will be more successful in fulfilling our moral obligation to alleviate suffering when we reach “an accurate intellectual understanding of what suffering is” (p. 7). The unbridgeable gap between the sufferer and the nonsufferer, however, makes this task impossible, and Mayerfeld is correct that inevitably well-meaning people will avoid the sufferer or lose interest (a type of kindness fatigue). In an ethic of suffering, by contrast, the care for my fellow human being does not depend upon an accurate intellectual understanding of suffering; nor does it depend upon the overflow of feeling aroused when a sensitive soul sees the sufferer. Jewish law has formulated concrete actions—routines and standard rituals—that have the force of obligation rooted in a covenantal relationship with God. These behaviors put public purposes ahead of private ends. The poor must be fed and clothed, the dead must be buried, the struggling farmer must receive cash loans, and so forth. The laws of visiting the sick are detailed, and include rules on how to comport oneself before the sufferer. Although an ethic of suffering establishes a framework to act out of love and compassion, correct behavior is not motivated by these subjective feelings. The sufferer does not remain alone just because I do not feel love and compassion on a given day. An ethic of suffering neither ponders the reality of evil, nor the value of suffering. It simply responds to the needs of a fellow human being.
Herczeg, Y. (Ed.). (1995). Bereishis/Genesis. Brooklyn, NY: Mesorah Publications.
Frank, A. (1995). The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Press.
Krog, A. (1998). Country of my skull: Guilt, sorrow, and the limits of forgiveness in the new South Africa. New York: Three Rivers Press.
Mayerfeld, J. (2001). The moral significance of suffering: An argument against redemptive pain, APS Bulletin, 11(6), 4, 6-7.
Waitzkin, H. & Magana, H. (1997). The black box in somatization: Narrative, culture, and unexplained physical symptoms. Social Science and Medicine 45, 811-825.
Weinberg, M. (1999). FrameWorks Genesis. Boston: Foundation for Jewish Publications.
Bleich, J.D. (Spring 2002). Palliation of pain. Tradition 36, No 1, 89–114.
Sontag, S. Illness as Metaphor. 1988. New York: Farrar Straus & Giroux.
Michael Nutkiewicz received his MA in philosophy from USC, and a PhD in history from UCLA. He is the executive director of the Program for Torture Victims in Los Angeles, an agency that provides medical, psychological, and case management services to survivors of torture. Nutkiewicz is the oral history consultant to an interdisciplinary study at the UCLA Pediatric Clinic. He can be reached at nutkiewicz@ptvla.org.
