Abstract
This paper has four tasks. First, based on a phenomenology of personhood, it argues that the subject of chronic pain is not the body, conceived neurophysiologically, but the person, conceived phenomenologically. Secondly, it demonstrates that the processes of de-personalization and re-personalization make up the essential temporal structures of chronic pain experience. Thirdly, it offers an answer to one of the central objections raised against phenomenology of illness and pain, which suggests that phenomenology offers a solipsistic account of pain experience, which does not facilitate but impedes empathy and understanding. Fourthly, the paper maintains that the recognition of the de-personalizing and re-personalizing dimensions of chronic pain experience compel one to rethink some of the central distinctions entrenched in phenomenology of medicine, such as the distinction between organic and psychogenic pain, illness and disease or healing and curing. The paper concludes by addressing the therapeutic significance of dialogue.
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Notes
- 1.
Here I rely on the essential principles of Husserl’s phenomenology, and especially on how they are presented in Husserl (1983), §2–§4.
- 2.
I do not claim that chronic pain is the only kind of de-personalizing and re-personalizing experience. Rather, to put the matter in those terms that Husserl employs in §3 of his Ideas I, chronic pain is a “particularization” (i.e., an instance) of a group of experiences (a group that also includes other experiences, such as depression and melancholia), whose Eidos consists of de-personalization and re-personalization.
- 3.
In this regard, see especially Scarry (1985). According to Scarry’s central claim, while physical pain is inexpressible and “unmakes the world,” the creation of verbal and material artifacts, which ultimately relies upon the powers of imagining, remakes the world.
- 4.
Besides Vrancken’s study, see Szasz (1975). Both provide a telling account of the reasons that motivate physicians to suggest to their patients that they visit psychiatrists. As a rule, these reasons derive from the physician’s failure to discover an organic cause of pain. Realizing this, patients commonly interpret such referrals as signs of the physician’s disbelief that they are in pain (Szasz 1975, p. 92). This view is further corroborated by Arthur Kleinman as well as RA Hilbert, who suggest that “pain patients feel biomedical practitioners routinely delegitimize the experience of their illness, pressing them to believe that it is not real or, at least, not as serious as they fear it to be” (Kleinman 1994, p. 170).
- 5.
In phenomenological literature, James and Kevin Aho have recently emphasized this point: “in medical science the corporeal body is both de-contextualized and de-animated. Medical science does not treat persons as such; it deals with human organisms” (Aho and Aho 2009, p. 77). This point is further echoed by Alfred I. Tauber: “…we recognize that as the body is reduced to just so many materialistic parameters of measurement, the person inhabiting that body may be de-personalized, if not lost altogether” (Tauber 2002, p. 9).
- 6.
See Szasz (1975), pp. 93–99.
- 7.
While extra-Bodily things are only moveable mechanically, the lived-body is “the one and only Object which, for the will of my pure Ego, is moveable immediately and spontaneously” (Husserl 1989, p. 159).
- 8.
In this regard, with a reference to Heidegger’s analysis of Zuhandenheit, one could liken the experience of pain to the lived-body’s unreadiness-to-hand: just as a piece of equipment becomes noticeable when it no longer functions properly, so the lived-body becomes thematic when it is no longer an obedient servant of the will.
- 9.
Or as Brian—Byron J. Good’s interviewee—puts it, “and then it goes back into my conflict about my body. Is it my body? Is it my thinking process that activates physical stresses? Or … is it the other way around?” (Good 1994b, p. 35) Consider also Gordon Stuart’s, a thirty-three-year-old writer’s, who is dying from cancer, observations: “The feeling there is something not me in me, an ‘it, eating its way through the body. I am the creator of my own destruction. These cancer cells are me and yet not me. I am invaded by a killer…. Cancer makes us think of a lingering torture, a being eaten away from inside. And that is what it’s been like for me” (Kleinman 1988, p. 148).
- 10.
See Sartre (1956), and especially the section “The Body as Being-For-Itself: Facticity” (pp. 404–445) and “The Third Ontological Dimension of the Body” (pp. 460–471).
- 11.
These references to A. Kleinman’s J. Jackson’s and B. Good’s studies are meant to illustrate the philosophical fruitfulness of anthropological studies of pain. It is highly regrettable that to this day, neither the phenomenologically oriented anthropologists, nor the phenomenologically minded philosophers have shown interest in each other’s works. In this regard, Katherine J. Morris’ recent study (Morris 2013) is a noteworthy exception. This work reconstructs the main reasons that have led medical anthropology to consider phenomenologically relevant themes. This study also spells out the main phenomenologically resonant themes that have emerged from anthropological studies of pain.
- 12.
I readily admit that these four kinds of disturbance are not unique to the experience of pain; they also aptly characterize other forms of affliction, such as illness. Yet chronic pain does not affect the body the way illness does. While illness affects the whole body (and thus we would never say that our head, or our lower back is ill), chronic pain is always located within the body (and thus it is always our head or our lower back that is in pain). Due to its localizability, chronic pain marks the relation between the self and the body as profoundly and irreducibly paradoxical. One the one hand, the body in pain could be characterized as both subject and object. On the other hand, the body in pain could be further said to be both subservient and insubordinate to the self.
- 13.
See Gergel (2012, pp. 1102–1109).
- 14.
See Fuchs (2008, pp. 65–81).
- 15.
See Fuchs (2008).
- 16.
See Kleinman and Kleinman (2007, pp. 468–474).
- 17.
See Scheper-Hughes (2007, pp. 459–467).
- 18.
See Cassell (2001, p. 382).
- 19.
- 20.
See Scheler (1973, pp. 328–344).
- 21.
See Scarry (1985, pp. 3–11).
- 22.
No one else has maintained as strongly as E. Scarry that pain, unlike other feelings, resists verbal objectification: “Thus Sophocles’s agonized Philoctetes utters a cascade of changing cries and shrieks that in the original Greek are accommodated by an array of formal words (some of them twelve syllables long), but that at least one translator found could only be rendered in English by the uniform syllable ‘Ah’ followed by variations in punctuation (Ah! Ah!!!!)” (Scarry 1985, p. 5).
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Geniusas, S. (2016). Phenomenology of Chronic Pain: De-Personalization and Re-Personalization. In: van Rysewyk, S. (eds) Meanings of Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-49022-9_9
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