Suffering

Overview
Suffering, or pain in this sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm.

Suffering may be called physical, as in a back ache, or mental, as in a grief. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of intensity. Suffering is also often characterized by how much it is considered, for instance, avoidable or unavoidable, useful or useless, deserved or undeserved.

All sentient beings suffer during their lives, in diverse manners, and often dramatically. No field of human activity deals with the whole subject of suffering, but many are concerned with its nature and processes, its origin and causes, its meaning and significance, its related personal, social, and cultural behaviors, its remedies, management, and uses.

Clarification on the use of certain terms related to suffering

 * The word Suffering is sometimes used in the specific narrow sense of physical pain, but more often it refers to mental pain, or more often yet to pain in the broad sense. Other terms that are more or less synonymic with suffering may include distress, sorrow, unhappiness, affliction, woe, discomfort, displeasure, disagreeableness, unpleasantness.


 * More often than not, the word pain refers to physical pain, but it may also refer to pain in the broad sense, i.e. suffering. In the latter sense, pain includes physical and mental pain, or any unpleasant feeling, sensation, and emotion. Care should be taken to make the appropriate distinction when required between the two meanings. For instance, philosophy of pain is essentially about physical pain, while a philosophical outlook on pain is rather about pain in the broad sense. Or, as another quite different instance, nausea or itch are not 'physical pains', but they are unpleasant sensory or bodily experience, and a person 'suffering' from severe or prolonged nausea or itch may be said 'in pain'.


 * The terms pain and suffering are often used together, in different senses which can become confusing, for example:
 * being used as synonyms;
 * being used in 'contradistinction' to one another: e.g. "pain is inevitable, suffering is optional", or "pain is physical, suffering is mental";
 * being used to define each other: e.g. "pain is physical suffering", or "suffering is severe physical or mental pain".


 * Qualifyers, such as mental, emotional, psychological, and spiritual, are often used for referring to more specific 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 experience such as itch 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, it involves important bodily physiological aspects.


 * The term unpleasant or unpleasantness commonly means painful or painfulness in a broad sense. They are also used in (physical) pain science for referring to the affective, that is to say 'suffering-like', dimension of pain, usually in contrast with the sensory dimension. For instance: “Pain-unpleasantness is often, though not always, closely linked to both the intensity and unique qualities of the painful sensation.”

To avoid confusion: this article is about suffering in the sense of any unpleasant feeling, emotion or sensation. This includes suffering in the specific narrow sense of physical pain, which is covered in detail by the article Pain.

Philosophical, ethical perspectives
Hedonism, as an ethical theory, claims that good and bad consist ultimately in pleasure and pain. Many hedonists, such as 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 self-control in front of even the worst sufferings.

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's utilitarianism asks straightforwardly for the abolition of suffering (see here under section called 'Biological, neurological, psychological aspects'). Many utilitarians, since Bentham, hold that the moral status of a being comes from its ability to feel pleasure and pain: moral agents should therefore consider not only the interests of human beings but also those of 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 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."

Pessimism, as Arthur Schopenhauer famously describes, holds this world to be the worst possible, plagued with worsening and unstoppable suffering. Schopenhauer recommends 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 to embrace wilfully the 'eternal return' of the greatest sufferings.

Philosophy of pain focuses on pain as a sensation, but much of its content concerns also suffering in general.

Religious perspectives
Suffering plays an important role in most religions, regarding matters like consolation or relief, moral conduct (do no harm, help the afflicted), spiritual advancement (penance, ascetism), and 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 consider that the worst form of evil consists in 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 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). 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". This meaning revolves around the notion of redemptive suffering.

Arts and literature perspectives
Artistic and literary works often engage with suffering, sometimes at great cost to their creators or performers. The Literature, Arts, and Medicine Databaseoffers a list of such works under the categories art, film, literature, and theater.

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

The Encyclopedia of World Problems and Human Potential is a monumental work by the Union of International Associations. It has three core parts: World Problems (30,000 items), Human Potential: Transformation and Values (7,000 items), Strategies - Actions – Solutions (35,000 items). As it says in its Notes and Commentaries: “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”.

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." 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.

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.

"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.

Biological, neurological, psychological aspects
Suffering and pleasure, the former being called negative and the latter positive, are the two affects, or hedonic tones, or valences that psychologists often identify as basic in our emotional life. The evolutionary role of physical and mental suffering, through natural selection, is primordial: it warns of threats, it motivates coping (fight or flight, escapism), and as a punishment it reinforces certain behaviors. Despite its initial disrupting nature, suffering contributes to organize meaning in an individual's world and psyche. In turn, meaning determines how individuals or societies experience and deal with suffering. Thus, in the end, persons or cultures differ in their affectivity and behavior, for instance from the most oversensitive to the most insensitive.

Many brain structures and physiological processes take part in the occurrence of suffering: (list to come). Various hypotheses try to account for unpleasant experiences. One of these, the pain overlap theory 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. It therefore proposes that physical pain and social pain (i.e., two radically differing kinds of suffering) share a common phenomenological and neural 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, following Pearce's abolitionism, promote replacing the pain/pleasure axis with robot-like response to noxious stimuli or with gradients of bliss, through genetic engineering and other technical scientific advances.

Hedonistic psychology, 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.

Health care approaches
Disease and injury cause suffering in humans and animals. Health care addresses such 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 remain highly problematic, according to Eric Cassell, the most cited author on that subject: "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."

Some medical fields nevertheless, like palliative care, pain management, oncology or psychiatry, give more importance to suffering 'as such'. In palliative care, for instance, pioneer Cicely Saunders created the concept of 'total pain' ('total suffering' say now the textbooks ), which encompasses the whole set of physical and mental distress, discomfort, symptoms, problems, or needs that a patient painfully experiences.

Relief and prevention in collective life
Since suffering is such a universal motivating experience, people, when asked, can relate easily their activities to its relief and prevention: farmers, for instance, may claim that they prevent famine, artists that they take our minds off our worries, and teachers that they hand down tools for coping with life hazards. However, in aspects of collective life such as those below, suffering by itself comes often as a forefront concern.
 * Security and safety: these concepts relate to precautionary measures taken by individuals or families, to interventions by the military, the police, the firefighters, and to notions like social security, environmental security, and human security.
 * Public health
 * Human rights
 * Humanitarian aid
 * Disaster relief
 * Philanthropy
 * Economic aid
 * Social services
 * Insurance
 * Animal welfare

Uses of suffering
"But Nature, as we now know, regards ultimately only fitness and not our happiness (Darwin, 1871, p. 298), 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" writes philosopher Leonard D. Katz.

People make use of suffering for specific social or personal purposes in many areas of human life:
 * Politics: there is infliction of suffering in war, torture, and terrorism; people may use nonphysical suffering against competitors in nonviolent power struggles; also, people point to relieving, preventing, or avenging a suffering when they want to discuss or justify a course of action.
 * Crime: criminals may use suffering for coercion, revenge, or pleasure.
 * Law: penal law uses suffering for punishment; compensation is asked for pain and suffering; a victim's suffering can be used as an argument against the accused; an accused's or defensor's suffering may be an argument in their favor.
 * News media: suffering is often their raw material.
 * Religion: see section above.
 * Business: abusive demands are made on people or animals for profit.
 * Interpersonal relationships: there are various kinds of uses and abuses of suffering, including punishment, in family, school, or workplace.
 * Personal conduct: in various ways, people find meaning in their lives by striving against suffering; suffering may lead to bitterness, depression, or spitefulness, but also to character-building, spiritual growth, or moral achievement; realizing the extent or gravity of suffering in the world may motivate to relieve it and give an inspiring direction to one's life; alternatively, people make self-detrimental use of suffering; compulsive reenactment of painful feelings occurs in order to protect oneself from seeing their origin in unmentionable past experiences; people may addictively indulge in a disagreeable emotion like fear, anger, or jealousy, in order to enjoy the feeling of release when the emotion ceases.
 * Sex: see for instance sadism and masochism.
 * Sports: a lot of suffering occurs for the sake of performance, see for instance no pain no gain.
 * Arts and literature: see section above.
 * Entertainment: see for instance violent video games, blood sport.
 * Rites of passage make use of suffering.
 * For the sick, or victims, or malingerers, suffering may facilitate primary, secondary, tertiary gain.

Selected bibliography

 * 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