Читать книгу The Phenomenology of Pain - Saulius Geniusas - Страница 9

INTRODUCTION

PAIN AS EXPERIENCE

We can say about pain what Augustine (2006, 242) has said about time: “What is pain? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know.” Concessions of this kind are common in pain research. For instance, Thomas Lewis begins his Pain with the following admission: “I am so far from being able satisfactorily to define pain . . . that the attempt could serve no useful purpose” (1942, v). So also, Johannes J. Degenaar remarks: “I thought I knew what pain was until I was asked to say what the word ‘pain’ means. Then . . . I realized my ignorance” (1979, 281).

Such statements might take one by surprise, especially in light of the overabundance of literature on pain that we come across in various sciences. The available literature, however, consists largely of empirical research on various neurological mechanisms as well as other factors that elicit a painful reaction on the part of some organisms. We are flooded with intricate and fascinating details about pain mechanisms, although we know little about the nature of pain experience.

In the phenomenology of medicine, it is common to draw a distinction between illness and disease and to maintain that while the nature of the disease is determined neurophysiologically, the nature of illness must be fixed phenomenologically (see, for instance, Toombs 1993). We come across no analogous distinction in pain research. Should we take this to mean that the concept of pain is equivocal, that insofar as we think of pain as a biological mechanism, it must be determined neurophysiologically, while insofar as we think of it as experience, it must be determined by some other means? We would avoid much confusion if we conceded that pain as such is not neurophysiological in any sense of the term. At its best, pain biology can clarify the neurophysiological causes that give rise to pain as well as provide effective means to minimize pain or even eliminate it. Pain biology, if successful, can shed light on the neurophysiological mechanisms that, presumably, accompany pain experience. However, irrespective of its practical utility, pain biology cannot clarify the nature of pain experience.

Pain biology presupposes that we know from experience what pain as experience is. Presumably, what we do not know are the causes that trigger it or the influences that shape it. It thus appears that we are in need of knowledge about matters that lie beyond the boundaries of experience. It seems that we are in need of pain biology, not what one might call “pain phenomenology.” How legitimate is such a view? To be sure, experience by itself tells us little about the neurological mechanisms that trigger pain experience. For this reason alone, there can be no question about pain phenomenology replacing pain biology. Yet what exactly do we know about pain as experience from experience? As soon as we try to articulate what is entailed in this implicit understanding, we come to the realization that we are dupes of our own ignorance. What is pain as experience? For this, we appear to lack words.¹

In 1979, with the aim of determining the concept of pain with precision and thereby resolving various ambiguities that have arisen in the science of pain, the International Association for the Study of Pain (IASP) offered the following definition of pain, which continues to be the guiding definition to this day: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey and Bogduk 1994, 209). Thus, according to the nowadays-dominant definition, pain is an experience.² Yet what kind of experience? To qualify it as unpleasant is hardly sufficient to grasp its nature, for, clearly, such a determination is too broad and does not serve to distinguish pain from various forms of psychological suffering. The further stipulation that pain is not just an emotional but also a sensory experience does not resolve the problem, since nausea, vertigo, heartburn, the sensations of excessive heat and cold, of hunger and thirst, even itches and pressure can also be qualified as “unpleasant sensory and emotional experiences.” The IASP definition qualifies pain as experience, yet it does not clarify what kind of experience it is. This definition places pain in the genus of sensory and emotional experience, yet it does not provide us with the differentia.³

Although it is undeniable that at its core, pain is an experience, our current knowledge of pain is marked by the failure to understand pain as experience. This failure is not accidental. The dominant methodological standpoints in pain research do not provide us with a suitable methodological framework to conceptualize pain as experience. Broadly speaking, naturalism and social constructionism constitute the two dominant methodological standpoints in pain research (see Geniusas 2013). While the naturalist focuses on the specific neurological mechanisms that trigger pain experience, the social constructionist traces the social, cultural, and historical influences that shape the experience of pain. In different ways, both the naturalist and the social constructionist conceptualize pain experience as a psychological effect that is activated by different kinds of mechanisms. What both methodological standpoints are interested in is not pain experience as such (they both presuppose that we already know what pain as experience is), but the various neurological mechanisms that trigger it and the particular sociocultural influences that shape it. Yet clearly, if one claims that pain is triggered by these mechanisms and shaped by these influences, then one must have some kind of understanding of what pain as such is. We are thus forced to ask: What can we say about pain as experience, considered independently from the mechanisms that trigger it and the influences that shape it? Contemporary pain research does not have the methodological basis to answer this question.

THE PHENOMENOLOGICAL APPROACH

In light of these circumstances, the following study contends that phenomenology is indispensable for pain research. Neither pain biology nor pain sociology can clarify the nature of pain experience, and, therefore, they must be supplemented with pain phenomenology. In a general and preliminary way, we can conceive of phenomenology as a method designed to study experience and the different ways in which phenomena manifest themselves in experience. Thus, the often-cited phenomenological refrain, “Zurück zu den Sachen selbst” (Back to the things themselves), must be understood as a solicitation to return to the field of experience, conceived of as the fundamental field within which phenomena manifest themselves and their multifaceted meanings originate. According to one of the central phenomenological claims, in the natural course of life, as well as in the sciences, we misconstrue phenomena by transforming them into what they are not, and we do so precisely because we misunderstand how they manifest themselves in experience. Phenomenology’s chief ambition is to liberate us from falsifications, which consciousness itself gives rise to in virtue of its absorption in the world of things and its inherent self-forgetfulness, which manifests itself through its tendency to misunderstand itself as a thing among other things. The goal of phenomenology is to liberate consciousness from its self-opacity, to clarify the fundamental structures of experience and recover the lost world of concrete life. Phenomenology proves to be indispensable for pain research because it offers a highly useful methodology to determine the nature of pain experience, irrespective of the specific natural causes that might trigger it and the specific cultural influences that might shape it.⁴

Phenomenology is neither the first nor the only philosophical tradition to be qualified as a philosophy of experience. Various brands of empiricism and pragmatism also merit the same qualification. Are there any reasons to privilege phenomenology over these other philosophical traditions, as far as the philosophy of pain is concerned? Arguably, the reasons are methodological. First and foremost, the phenomenological method is designed to study experience from the first-person point of view. In this regard, it is exceptionally well-suited for pain research, since pain itself is conceivable only as firsthand experience (a pain that is not experienced could be qualified as a painless pain—an expression that is no less self-contradictory than a square triangle). The science of pain is thus in need of phenomenology, for with its help it can inquire into the compatibility in the findings obtained using the first-person and the third-person methodologies (see Price and Aydede 2005). Still, one might object that such a clarification does not fully answer the question, since it leaves the possibility open that introspectionist psychology might fit the bill. In this regard, one should stress that not any description of phenomena from the first-person point of view is to be qualified as phenomenological. There is no phenomenology without the epoché and the phenomenological reduction, conceived of as the two complementary methods designed to provide the researcher with access to experience that is purified of naturalistic misconceptions. These sophisticated methods, unique as they are to phenomenology, are designed to suspend the natural way of considering phenomena so as to let them appear without any bias, distortions, or manipulations. As far as pain research is concerned, these methods prove indispensable for any attempt to conceive of pain as pure experience, by which we are to understand the experience of pain, considered independently from pain biology and pain sociology.

In light of my foregoing remarks, one cannot help but be surprised by the scarcity of phenomenologically oriented book-length studies of pain. All in all, one can single out just two studies. Christian Grüny’s Zerstörte Erfahrung: Eine Phänomenologie des Schmerzes was published in 2004. Abraham Olivier’s Being in Pain appeared in print a few years later, in 2007. Besides Olivier’s and Grüny’s studies, there are no other book-length investigations that have exclusively focused on the phenomenology of pain.⁵ Strangely, a philosophical tradition that prides itself on being attentive to lived-experience, on returning to the things themselves and thereby taking distance from meaningless abstractions that it finds at the heart of many other traditions of thought—this tradition has been remarkably silent as far as the nature of such embodied feelings as pain is concerned. It has certainly contributed less to our understanding of pain than other philosophical traditions, which never claimed that they were striving to offer a reliable account of the nature of experience.

The central ambition of the following study is to break this regrettable silence and to show that phenomenology has an important contribution to make in the framework of pain research in general, and the philosophy of pain in particular. With this in mind, the following investigation will present a philosophical study of pain, which relies upon the phenomenological method. Besides delimiting a phenomenological approach to pain, this study also aims to open a dialogue between the phenomenology of pain and other types of pain research, which we come across in such fields as the analytically oriented philosophy of pain, cognitive science, cultural anthropology, cultural psychopathology, and psychoanalysis. Such a methodological commitment and dialogical orientation carries the demand to situate oneself within the phenomenological tradition, while at the same time being attentive to the developments in other fields of research.

The fundamental goal of this study is thereby delineated: this study aims to demonstrate why phenomenology is indispensable for pain research. Admittedly, there are different kinds of phenomenology, and the complex relation between them continues to raise doubts about the unity and coherence of the phenomenological movement. In the framework of this study, it is not my goal to provide a detailed analysis of the reasons why, despite far-reaching disagreements, the phenomenological tradition as a whole retains its overarching unity.⁶ My goal, rather, is to focus on one particular phenomenological tradition, namely, the Husserlian tradition, and to demonstrate why it is of great importance for the philosophy of pain. In such a way, I will aim to complement Olivier’s and Grüny’s above-mentioned studies, which rely mainly on the resources of Martin Heidegger’s and Maurice Merleau-Ponty’s phenomenologies. Unless otherwise stated, in this study the concept of phenomenology will be employed as synonymous with Husserlian phenomenology.

Some readers might wonder, Would it not be more appropriate to proceed on a different phenomenological basis and rely on more existentially and less epistemologically oriented phenomenological resources? One of my goals is to show that such stereotypical rejections of Husserlian phenomenology are far from convincing. Appearances to the contrary notwithstanding, Husserlian phenomenology provides a remarkably solid methodological basis for the philosophy of pain. One can single out eight fundamental reasons that make Husserlian phenomenology highly fitting for pain research. Only in Husserlian phenomenology do we encounter the full configuration of these reasons, although, admittedly, some of them can be also found in other philosophical frameworks:

1. Phenomenology is a philosophy of experience, whose fundamental ambition is to clarify phenomena as configurations of meaning that are constituted in experience. As we will see, the methods employed in phenomenology are highly useful to study the nature of pain, conceived not only as a configuration of meaning but also as lived-experience.

2. In contrast to other philosophies of experience, phenomenology provides the methodological basis to study the experience of pain by setting aside naturalistic preconceptions, including all the available theoretical accomplishments, which, for the reasons that will have to be clarified in due course, tacitly reconfigure the nature of experience. Here I am referring to the phenomenological methods of the epoché and the reduction, which enable phenomenology to conceptualize pain in the absence of naturalistic bias and manipulation.

3. Phenomenology primarily relies upon a descriptive method, which is also of great importance for pain research: to this day, the phenomenal nature of pain remains unexplored and it can be surveyed only descriptively.

4. Phenomenological descriptions are not focused on the idiosyncratic characteristics of personal experience. Rather, by virtue of the method of eidetic variation, phenomenology strives to offer accounts of the essence of pain experience. In this regard, too, phenomenology promises to fill a serious gap in pain research.

5. Phenomenology has been celebrated for a long time for overcoming the subject/object dichotomy and for disclosing the centrality of the body in thinking, acting, and feeling. In this regard, too, it proves to be remarkably apt for pain research, since pain in its essence is a bodily phenomenon.

6. Phenomenology provides us with some of the richest—if not the richest—analyses of the temporal nature of experience. In this regard, also, it promises to be of great significance for pain research in that it provides the means needed to clarify the temporal structures of pain experience.

7. The groundbreaking distinction in phenomenology between the naturalistic and the personalistic attitudes is of fundamental importance, since pain as experience can be grasped only from the personalistic, and not from a naturalistic, standpoint.

8. Finally, the phenomenological analyses of the life-world are also highly relevant for the philosophy of pain, since these analyses enable us to philosophically conceptualize different ways in which the experience of pain is rooted in cultural worlds.

THE STRUCTURE OF THE FOLLOWING INVESTIGATION

This study will be concerned with three fundamental tasks: it will aim to (1) clarify the fundamental methodological principles that must underlie phenomenologically oriented pain research; (2) develop a new conception of pain on the basis of such methodological principles; and (3) clarify what contribution the phenomenology of pain can make to philosophical anthropology. It is highly important to carry out all these tasks, and for various reasons. As far as the first task is concerned, let us not overlook that in pain research we come across various studies that call themselves phenomenological, even though the exact meaning of this qualification remains unqualified. Various autobiographies, “pain narratives,” and empirically oriented studies, as well as introspectionist accounts, are passed off as though they are phenomenological studies of pain. So as to counteract this tendency and the deep confusions it gives rise to, one must stress that phenomenology is first and foremost a method, which means that only insofar as one subscribes to the distinctly phenomenological methodology can one qualify one’s study as phenomenological (in the above-mentioned sense).

In chapter 1, my goal will be to lay out those methodological principles that are indispensable for any study that wishes to identify itself as phenomenological in the Husserlian sense of the term. I will contend that the methods of the epoché, the phenomenological reduction, and eidetic variation are the fundamental and indispensable principles of the phenomenological method. Besides clarifying the meaning of these principles, I will further argue that especially in the framework of pain research, these three fundamental methods call for a further twofold supplementation. First, the method of eidetic variation must be supplemented with a method of factual variation, conceived not so much as an independent method, but rather as an important extension of the method of eidetic variation. Second, static methodology in general must be supplemented with what in Husserlian phenomenology is identified as genetic methodology. Taking such a methodological orientation into account, I will maintain that phenomenology is not concerned with the idiosyncratic nature of any particular experience, and in this regard, it should be distinguished from the anthropologically and sociologically oriented pain research that we come across in the literature. In contrast to all empirical research on pain, phenomenology is concerned with essential structures of experience, that is, those structures without which experience as such could not be qualified as painful.⁷

Having clarified the fundamental methodological principles of phenomenological research, we will proceed to the second fundamental task. Our guiding question runs as follows: What is pain, when conceived of as experience and when considered from the phenomenological point of view? Building on the basis of phenomenological descriptions, this manuscript will propose the following answer to this fundamental question: pain is an aversive bodily feeling with a distinct experiential quality, which can be given only in original firsthand experience, either as a feeling-sensation or as an emotion.

I should stress that this conception of pain does not rely either on pain biology or on pain sociology. It does not subscribe to the fundamental methodological commitments of either naturalism or social constructionism. All the qualifications entailed in this definition rely upon phenomenologically oriented reflections on pain experience. This conception is meant to articulate the eidetic features of pain experience. I will maintain that the conception of pain proposed here captures the phenomenological essence of pain experience.

To corroborate such a view, the following study will take seven major steps and answer seven central questions. What does it mean to claim (1) that pain is a bodily feeling; (2) that this feeling is aversive; (3) that it has a distinct experiential quality; (4) that it is an original experience; (5) that it can be given only in firsthand experience; (6) that it is originally lived through as a nonintentional feeling-sensation; and, finally (7), that it can also be given as an intentional feeling? Chapters 2–5 of this study deal with these questions explicitly. Chapter 2 conceptualizes pain both as a nonintentional feeling-sensation and as an emotion; it further shows what it means to claim that pain can be given only in firsthand experience. Chapter 3 supplements this conception by showing that pain must be conceived of as a fundamentally aversive feeling that has a unique experiential quality. Chapter 4 supplements the foregoing analysis with an investigation into what it means to qualify the experience of pain as an original experience. Finally, in chapter 5, I will bring this analysis to its end by inquiring into the fundamentally embodied nature of pain experience. By the end of chapter 5, it will have become clear what it means to claim that pain is an embodied and emotionally stamped bodily feeling, whose fundamentally aversive nature is of a distinct experiential quality.

Phenomenology’s relevance for pain research is not reducible to the conceptual clarification of the nature of pain experience, no matter how important such a task might be. This will bring us to the third fundamental task of this study, which concerns the contribution that the phenomenology of pain could make to philosophical anthropology.⁸ What can the phenomenology of pain contribute to our philosophical understanding of human existence? This is the central question, to which the final two chapters of this study will aim to offer an answer. Put phenomenologically, what is at stake here are those essential features that make up the core of pain experience, conceived personalistically and not naturalistically. In this regard, it will prove necessary to clarify in detail what it means to claim that the phenomenological category of the person depicts the subject of pain and that the phenomenological concept of the life-world designates the fundamental horizon within which human pain is lived. The last two chapters will address these issues while focusing on chronic pain. Chapter 6 will focus on pain as a depersonalizing and a repersonalizing experience. Chapter 7 will supplement this investigation with a further analysis of the role that somatization and psychologization play in pain experience.