On the Human Condition and the Nature of Suffering
Suffering, while painful, can also serve as a catalyst for growth and transformation.
Introduction
The human condition is defined by its complexities. It is an intricate web of emotions, experiences, and existential challenges. Among the most defining challenges is suffering. Pain and suffering have shaped human lives since time immemorial, compelling individuals to seek meaning, purpose, and resilience in the face of adversity. In exploring the nature of suffering, it is crucial to differentiate between the physical experience of pain and the broader concept of suffering, which encompasses psychological, social, and spiritual dimensions. Through the work of scholars such as Cassell and Bueno-Gómez, this article delves into the human experience of suffering, its impact on personal identity, and the limitations of traditional models. This insight seeks to enhance our understanding of suffering in all its depth. Exploring the concept of suffering is not just a matter of intellectual curiosity; it is vital for developing strategies that enable us to find meaning and build resilience in the face of fate and life's inevitable challenges.
Defining pain and suffering
Discussing resilience without first understanding pain and suffering is often a risky endeavor. These two fundamental human experiences shape our pursuit of meaning and the inevitable journey toward resilience. How we cope, flourish, and eventually recover from suffering hinges on our understanding of life events, our perception of fate, and our response to adversity. Many frequently confuse pain and suffering, using them interchangeably, yet they are distinct concepts. Bueno-Gómez (2017) cautions against this conflation, defining pain as a specific physical, sensory experience, while suffering encompasses a broader spectrum of physical, psychological, social, and spiritual elements. According to her, suffering can include personal difficulties such as loneliness, anxiety, and discrimination. I, therefore, define suffering as a psychosocial and spiritual experience, where it is primarily a spiritual phenomenon—a solitary struggle in the wilderness of existence.
Suffering threatens the intactness of an individual.
One book that has become a near-canonical reference on pain and suffering within the medical and public health sectors over the past four decades is Eric J. Cassell’s The Nature of Suffering and the Goals of Medicine. Cassell’s paradigmatic model has been an essential resource for medical professionals who challenge the depersonalization of patients in clinical settings (McKenny, 1997). In this influential work, Cassell (1986/1991/1994) defines suffering as "the state of severe distress associated with events that threaten the intactness of the person.” In other words, Cassell posits that suffering undermines the integrity of an individual’s intactness, suggesting that a person is an autonomous, rational, coherent, and well-adjusted entity.
Cassell laments the medical profession's limited understanding of suffering. He asserts that doctors are trained to anatomize the human body, focusing only on specific, isolated parts of the whole person. While this method may help interpret physical pain, breathing difficulties, and other bodily afflictions, it falls short of capturing the complexity of suffering (Cassell, 1981). According to Cassell, suffering stems from the complex web of factors that make up an individual, including their history, aspirations, responsibilities, relationships, and the broader societal and political context in which they live. Pain, shame, diagnostic uncertainty, a bleak outlook on the future, and even the actions of medical professionals can all contribute to suffering, particularly when they threaten a person's sense of wholeness (Cassell, 1986). Cassell argues that suffering is an inherently personal and subjective experience, regardless of its cause. His integrated model for understanding suffering is highly regarded for its holistic approach, yet it has faced some criticisms over the years; one of Cassell’s critics is Bueno- Gómez.
Suffering can help construct an individual’s identity rather than destroy it.
Historically, classical evidence-based medicine has relied on a naturalistic approach rooted in the Cartesian mind/body dichotomy (Bueno-Gómez, 2017). This perspective views the body as a machine operating through processes that can be universally understood and manipulated. Bueno-Gómez critiques this Cartesian approach and suggests that it reduces pain and suffering to mere mechanical functions, often neglecting their profound impact on the lives of suffering individuals. Although Cassell's "humanistic turn" in medicine has encouraged a more encompassing view of pain and suffering, Bueno-Gómez argues that medicine continues to treat different parts of the body in isolation, overlooking the personal and existential dimensions of suffering—particularly in cases of chronic pain, non-somatic pain, and severe distress. This failure to consider the full scope of suffering can lead individuals to spiral into despair and, in some cases, even resort to suicide (Bueno-Gómez, 2017).
Bueno-Gómez offers a more holistic approach to understanding suffering than many existing models. While she acknowledges Cassell's critique that modern medicine neglects the symbolic, subjective, and meaningful dimensions of suffering, she also highlights a missing link in his framework—the existential dimension of the human condition. Various studies now show that existential challenges can profoundly shape an individual’s ability to endure suffering. Bueno-Gómez contends, "Suffering is not reducible to pain, but rather includes a complex array of psychological, social, and existential dimensions" (Bueno-Gómez, 2017). Her criticism of Cassell’s model presents a broader understanding of pain and suffering.
I find Cassell’s model of pain and suffering to be a significant innovation in the medical field. It transcends the dominant mind-body dualistic narrative when he first published The Nature of Suffering and The Goals of Medicine. However, I do endorse Bueno-Gomez's objection to this notion of wholeness, arguing that it contradicts much of the existing research in sociology, psychology, and philosophy. For instance, it is a socio-historical fact that narratives have always been integral to an individual’s identity. Throughout history and across cultures, narratives have been used to construct personal identity and our understanding of human life, including the lives of others (Bueno-Gómez, 2017).
Nevertheless, while narratives or life stories have always shaped the self, Bueno-Gómez points out that these life stories are “always partial, fragmentary, and never definitive.” Thus, narrative theories of human identity do not align with Cassell’s concept of wholeness or intactness. Moreover, she highlights that Cassell’s view—that suffering undermines an individual's integrity—contradicts research showing that pain and suffering can, in fact, help construct a person’s identity rather than destroy it.
As revolutionary as Cassell's model stands, both Bueno-Gómez (2017) and Tate & Pearlman (2019) criticize it for failing to adequately account for the severe afflictions that some individuals are either unable to describe or are unaware of. Two illustrative cases come to mind: some suffering individuals struggle to understand why they are suffering, having temporarily lost their sense of self—such as the biblical figure Job. Others may simply be unaware of their fate. This disconnection between suffering and self-perception strengthens Bueno-Gómez's call for a more holistic approach to suffering. In response to this challenge, philosophers like Arthur Schopenhauer (1974) and scholars such as Tate & Pearlman (2019) have proposed conceptual models that place an emphasis on the individual's sense of self and the existential dimensions of suffering. These models consider suffering as a phenomenon intertwined with time-consciousness, self-worth, spiritual crisis, and personal loss. In essence, suffering is not merely a physical or psychological experience but a spiritual journey—an isolated struggle in the wilderness of human existence.
Conclusion
Suffering is an inescapable phenomenon in the human experience, but it should not define or diminish us. By exploring the intricate connections between pain, suffering, and identity, we can begin to shift our understanding of how suffering shapes and transforms us. Cassell’s model, though revolutionary in many respects, falls short of capturing the full existential dimension of suffering. Bueno-Gómez’s holistic approach offers a more comprehensive view that accounts for the psychological, social, and existential elements of the human condition. As we navigate the complexities of suffering, we have come to realize that our response to adversity ultimately shapes our identity and ability to recover. The key takeaway is that suffering, while painful, can also serve as a catalyst for growth and transformation—paving the way for resilience, personal insight, and a deeper sense of purpose.
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References
Bueno-Gómez, N. (2017). Conceptualizing suffering and pain. *Philosophy, Ethics, and Humanities in Medicine*, 12(1), 7. https://doi.org/10.1186/s13010-017-0049-5.
Cassell, E. J. (1991). *The Nature of Suffering and the Goals of Medicine* (Rev. ed.). Oxford University Press.
Cassell, E. J. (1986). The nature of suffering: Physical, psychological, social, and existential aspects. The New England Journal of Medicine, 314(25), 1378-1384.
McKenny, G. P. (1997). *To Relieve the Human Condition: Bioethics, Technology, and the Body*. SUNY Press.
Schopenhauer, A. (1974). The World as Will and Representation. Dover Publications.
Tate, R., & Pearlman, R. (2019). Suffering, Identity, and Self-Worth: Reflections on Cassell’s Model. Journal of Medical Humanities, 40(2), 285–297.