© Borgis - New Medicine 2/2010, s. 63-65
Giampiero Camurati, *Fabio Gabrielli, Matteo Ianno, Franco Mauro
Patterns of suffering: an anthropological reading
Interfaculty Department for Scientific Research (D.I.R.S.) – L.U.de.S. University, Lugano, Switzerland
L.U.de.S. University, Switzerland
Head: Prof. Rodolfo Paoletti
Pain as laceration of the original Unit, and "feeling of nostalgia for the Centre”, becomes suffering when it reflects on itself, on its sense or non-sense.
In other words, pain as an ontic event, with biographical signs, refers to ontological pain, and, for a perfect interpretation, to the metahistorical laceration of the original Unit, to the "feeling of nostalgia for the Centre”, for the Beginning, for the lost Eden (to exemplify, from Orphism to Gnosticism to Christianity).
Their symbology has been employed ever since and unceasingly in man's existence and cultural productions, marking our biographies obsessively, from erotism to metaphysics. Medicine is really adult when it draws close to suffering – as structural, original data, that become daily suffering corporeity – from a humanological perspective. In this way it concerns not only the disease but also the illness and the sickness, i.e. the unrepeatable experience of the suffering subject and the social impact of the disease. Here we can see the centrality of the person, per se unum, an unrepeatable unit, different from any other one, and its correlated therapeutic intimacy, in the perspective of a humanological medicine, able to consider disease as a relational wound. This wound refers to bodily and everyday life violation, whose anguished experiences require empathy, discretion and attention.
In this context, philosophy, anthropology and human sciences in general may really contribute to medicine in order for it to become more and more attentive to people and their existential dynamics.
The experience of living pain as laceration of the original Unit
In one of Nietzsche's most significant pages of The Gay Science (1), it is emphasized how the experience of pain causes a substantial gestaltic re-orientation to those struck by suffering and to their relationships – such a radical fracture, such a deep dig destroying order, restructuring ethical and existential dynamics, regaining or losing the visions of the world. This is the point, in the sign of an unavoidable recovery of sense: "Only great pain is a liberator of the spirit [...] Only great pain, that long, slow pain that takes its time and in which we are burned, as it were, over green wood, forces us philosophers to descend into our ultimate depths and put aside all trust, everything good-natured, veiling, mild, average – things in which formerly we may have found our humanity. I doubt that such pain makes us 'better' – but I know that it makes us deeper.”
Pain as experience, as biological data, acquires an existential sense when it reflects on itself, namely it becomes suffering. Suffering has an axiological primacy on pain, insofar as it involves the whole man in attributing values and sense – that may also be the sense of a non-sense – to the specific feeling of living and living as such ( in der Welt sein).
Suffering is a privileged place for human integration. This means that enigma and fundamental mysteries always refer to the person as a unit of being, as harmonic co-existence of levels, as an interaction among biology, environment, ideas and values (2). To summarize, when pain opens a gash in one's life, and suffering gives origin to questions of sense embodying pain in a deep, mutual integration of nature and culture, the subject addresses the human spiritual productions: from religion to philosophy and myth, in order to look up to the often unspeakable abyss of suffering.
In other words, ontic pain, which arises hic et nunc with biographical signs, refers to ontological pain, and, for a perfect interpretation, to the metahistorical laceration of the original Unit, to the "feeling of nostalgia for the Centre”, for the Beginning, for the lost Eden (to exemplify, from Orphism to Gnosticism to Christianity). Their symbology has been employed ever since and unceasingly in man's cultural productions, marking our biographies obsessively, from erotism to metaphysics: "At the most fundamental levels there are transitions from continuous to discontinuous or from discontinuous to continuous. We are discontinuous beings, individuals who perish in isolation in the midst of an incomprehensible adventure, but we yearn for our lost continuity. We find the state of affairs that binds us to our random and ephemeral individuality hard to bear. Along with our tormenting desire that this evanescent thing should last, there stands our obsession with a primal continuity liking us with everything that is” (3).
Medical humanology as a real person's recognition
Medicine can be named as such insofar as it assumes the form of a qualitative synthesis of technophilia, "loving what is art”, and philanthropia, "loving what is human”: from ancient philanthropy to medical humanology.
Medical humanology consists in the acknowled-gement of an excess, of a transcendence of all that is deep, the person ( per se unum, an unrepeatable unit, irreducible to any other one) as a total reality compared to what is considered a phenomenon, mere sensibility: I cannot explore a person by turning around him or her as if it were an armchair. I would perform an inadequate action from an ontological point of view (4).
The depths of the ens sofferens is not just referable to the word "disease”, namely pathology, but also, and overall, to "illness” – an experience, a subjective way of living the disease – and "sickness” – social relations referred to the disease. In short, the disease finds a sense in suffering that is a restless reflection on pain: an inevitable and nevertheless unexpected event.
However, when faced with the ens sofferens, a technical report is not enough. A personal knowledge is necessary (5-20), i.e. a knowledge implying understanding of the sufferer, but also self-knowledge as a doctor. This is a rather different concept if compared to a simple therapeutic report (21). All this means that explanation should be incorporated into understanding. Medicine should not be reduced to a naturalistic sphere but should be inserted into a more comprehensive, ontological-existential context. University education should always take into consideration philosophy courses for doctors, in order to get them used to complexity and wondering about sense, psychology (in order for them to learn to grasp deep personal relational dynamics), poetry and art (in order to develop affective intelligence and care for the detail, an essential aspect in their profession).
Medical care should become an intimate closeness to the suffering person through a hetero-centred pact on homo patiens. This does not mean just a " pro-tension ” on the other through a nevertheless empathic, medical survey, but, as far as it is possible, an ad-tenzione, i.e. look at the eyes of the suffering person in order to grasp inner nuances and the feeling of living the disease through analogies and between shadows and lights. This is the heart of intimacy.
Intimacy between doctor and patient
If pain is just restricted to a sociological survey or laboratory operations, cold clinical or statistical data are the results, without considering feelings and emotional nuances, i.e. dismay, anguish, but also discretion due to the shame caused by despair and progressive disintegration of one's identity (22). It is therefore necessary to give one more sense to the experience of suffering, because "pain is felt and tries out, it ties and binds but, at the same time, it allows attention and intelligence to shift the focus from worry to care”. The doctor starts a relationship with a subject who considers pain the limitation or the end of any possibility, of an existential project marked by loneliness and structural difficulty in communicating such a personal experience. Pain is felt like an anticipation of death and it becomes an exposition of the "nothing” (23), of an oppressive precariousness of life, of our own contingency.
It is then clear that a medicine that does not just concern the disease dimension, but that can grasp the intimacy of the suffering person, may guarantee, if not salvation against the myth of healing (24, 25, 26, 27), at least the dignity of care as a deep ethical and existential relationship.
Intimacy as a concept having a double meaning – i.e. on one side the patient in a trustful abandonment and on the other side the doctor having a warm responsibility – concerns Care (essential meanings of life) and not Worry (intra-worldly relations). This is because the experience of disease is a relational wound that destructures the subject's existential narration (28):
1. Wound in relation to the own body because, as Thomas Mann said in "The Magic Mountain”, " disease makes man more bodily, makes it body ”. On one side man wants to keep away from it because it is a synonym of precariousness of existence. On the other side, man wants to take possession of it – as it never happens in a healthy life – because the anguished feeling of dispossession, not only carnal death but also medical visibility (anguish at the reification of medical survey), lets us feel the whole weight of our vulnerability;
2. Relational wound toward daily life. Its narrative laceration causes dismay at first, then a progressive eclipse toward an undetermined elsewhere and therefore full of anguish, inhospitable, requiring not only a simple clinical look, but an intimate one that, as an abyssal expression of empathy (29, 30, 31, 32, 33) takes the shape of discretion, a kept back word, a lived gesture, total attention to the suffering face in a mutual exchange of meanings.
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