Pain and Suffering: korper und leib, and the telos of Pain Care

摘要

Hillel Braude offers a thoughtful paper that explores the nature of suffering, with particular relation to-and distinction from-pain, as regards the work of Eric Cassell, and in reflection of the perspectives of Karl Jaspers and Emmanuel Levinas. To be sure, establishing distinction(s) between pain and suffering is not an easy task. As Yuri Maricich and I have noted, pain and suffering are often used synonymously, even in medical conversation(s). Yet, we have urged that such colloquialisms should be rectified, particularly in clinical contexts, because they can, and often do, foster ambiguities regarding the nature of these experiences, meanings to patient and clinician, and attendant trajectories and responsibilities for care (Maricich and Giordano 2009). Toward such a goal, one might seek to employ a number of viable definitions and discriminations of pain and suffering that have appeared in the literature. As Braude recognizes, Peter Moskovitz has recently provided a conceptual and neurobiological approach that seeks to explicate the activities of various somato-central (i.e., 'bottom-up') and centro-somatic (i.e., 'top-down') neural networks, describe the 'states' of pain and suffering and thereby frame the relation(s) and distinction(s) of these concepts (Moskovitz 2006, 2010). Pain can be a symptom of some insult or trauma, a disorder in and of itself (e.g., neuropathic pain), and manifest illness (i.e., maldynia). Each and all of these can evoke suffering.