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Philosophy

A Tapestry of Pain

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by Chuanfei Chin

Caravaggio's 'Boy Bitten By a Lizard' (Florence); source: Wikimedia Commons (copyright expired).

‘Without pain our life is unthinkable. With it, life is hardly to be endured’ (7). Most of us share the capacity to feel pain. We accept that having this general capacity is part of being human, yet we avoid specific experiences of pain. This is the first of our seemingly paradoxical attitudes to pain, with which Arne Johan Vetlesen, professor of philosophy at the University of Oslo, opens his book. Secondly, we fear pain and condemn those who wantonly inflict it, though its forms and meanings fascinate us. It has a ‘Janus face’. Thirdly, we alone must endure the pain in our own bodies. Yet we readily observe pain in others and expect that they suffer from it as we do. What is privately suffered is assumed to be potentially shared. Such attitudes alert Vetlesen to the possibility that pain ‘contains something inherently desirable’. He is ‘prepared to be a spokesman for such an opposite view’ (10) – to decry a western culture that has developed ‘the most negative ever’ view of pain (8).

If his opening stance impresses, it has to be conceded that his defence of pain’s desirability disappoints. So far as I can tell, this is summed up later in an aside: Being susceptible to pain means being ‘sensitive’ and so ‘able to experience what is good’. It also makes us ‘want to enrich and expand ourselves through contact with the good’ and motivates us ‘to protect everything that is good’ (92). These ideas – that the capacity for suffering is constitutively and causally related to goodness – have been explored by many who wrestle with the problem of evil. Vetlesen echoes the ideas without responding to the challenges that have been posed to them.

What he offers, more intriguingly, is an eclectic study of pain. There are 12 chapters, mixing philosophical and cultural analysis. I divide them roughly into three overlapping parts. These make sense of pain as an isolating experience, a shared aspect of the human condition, and a cultural phenomenon. Part I (Chapters 1-3) probes the pain which results from torture, chronic illness, and psychological trauma. Through these, Vetlesen provides a conceptual analysis of how pain changes our normal connections to the world, including to other humans. Part II (Chapters 4-7) is a phenomenological description of how pain is experienced. From it, he draws existentialist conclusions about our responsibility and vulnerability in the world. Part III (Chapters 8-12) develops a model of how pain circulates within society and how culture transforms this pain. He uses it to interpret two aspects of western culture: its violence and valorisation of choice.

As my outline shows, Vetlesen’s concerns in this short book are varied – too varied, I believe, for him to be a natural ‘spokesman’ for any cause. He acts more like a solitary weaver. In this short book, he weaves together insights from a small but scattered group of philosophers, psychologists, psychiatrists and cultural critics. This can be frustrating to look at. When the weaving is too loose, it distorts the views of others and depends on careless generalisations. But, if we are alert to these dangers, we can find in Vetlesen’s tapestry some promising new patterns.

I. CONCEPTUAL ANALYSIS

In Part I, Vetlesen studies three intense forms of pain. Each ‘sheds light’ on ‘concealed’ aspects of pain (15). I find this method most illuminating in the first study on torture, where he shows a grasp of concrete and unusual details. There are fewer surprises in the studies on chronic illness and psychological trauma, where his conceptual analysis relies more on generalities.

Chapter 1 begins with some concepts about pain and torture from Elaine Scarry’s The Body in Pain (1985). As reported by Vetlesen: Pain perception is different from other psychological states because it is not ‘about’ or ‘for’ something in the world. Pain marks an ‘absolute division’ between persons because my pain ‘absolutely cannot be doubted’ while others’ pain ‘absolutely can be doubted’ (16). During torture, the victim’s pain ‘is the end, not the means’. The torturer only seeks information so as to recast his victim as an active betrayer of others, rather than a passive sufferer of pain. These conceptual claims about pain are too unnuanced to convince; it is rarely helpful to speak of the ‘absolute’ without saying what the relative would be. The claim about the torturer’s ‘pretended motive’ is implausible. Why need the torturer go to such lengths when the victim is often already cast as an agent of ideology or conspiracy – as ‘one of them’ (25)?

Vetlesen’s analysis is more compelling when he focuses on the victim and torturer’s experiences. To the victim in intense pain, the ‘world outside the body ceases to feel real’ (20). His body becomes his ‘worst enemy’ and his torturer’s ‘most effective tool’. On the other hand, the torturer is caught in a double bind. He must recognise pain in the victim, for he wants to use it against him. Yet he must deny its moral significance – part of the ‘human reality’ of pain (22). This leads to two conceptual insights. Firstly, pain undermines our ‘outward orientation’ onto the world and our unreflective control over our own bodies. Both enable us, in normal situations, to act in the world with ‘intentionality and agency’ (21). Secondly, in normal situations, we recognise pain in others automatically and respond to it sympathetically. Contra Scarry, there is often no room for doubt that others are in pain.

In Chapter 2, Vetlesen reinforces that last point. He re-interprets Scarry’s ‘absolute difference’ – between my pain and your pain – as something that is produced ‘under special conditions’ (27). For instance, during chronic illness, a patient’s intense and prolonged suffering can consume his life and diminish his solidarity with others. He will feel ‘cast out into a kind of aloneness’ and withdrawn ‘from a common human universe’ (28). Abruptly, Vetlesen infers: We are united by our common exposure to pain, but divided by our experiences of pain. ‘The pain that strikes always strikes in the form of a particular event in a particular person’s life’ (31). He also implies that this ‘experienced reality’ of pain is ‘overlooked’ by medicine and science, which assume only that similar bodies are ‘exposed to pain in a similar way’.

This analysis over-reaches in two ways. Firstly, Vetlesen neglects those painful experiences that are shared. These can bond us more tightly together: Ask anyone who has undergone tough sport or military training with others. Secondly, neither medicine nor science are as crude as he suggests. Here and elsewhere, he generalises about both with hardly a reference to the medical or scientific literature. In fact, some doctors and scientists worry when they compare painful experiences between individuals from different ethnicities and culture (Morris 2001; Lasch 2002). Others wonder about boundary cases such as human foetuses and persistently vegetative patients (Lee et al. 2005; Anand 2006; Demertzi et al. 2009): How far must their bodies be similar to ours to share painful experiences?

In Chapter 3, Vetlesen challenges a ‘classical division’ between psychic and physical pain. It does ‘more harm than good’ in understanding and treating pain (32), though it is ‘so ingrained’ that even he cannot avoid using it (50). Unfortunately, his analysis conflates two kinds of pain that are commonly labelled ‘psychological’. The first are psychosomatic pains, which do not have an obvious physical source. They are sensations that do not seem to lead from bodily injury or illness. The second are painful emotions, which need not have an obvious physical site. Fears or sorrows need not be felt in a part of the body, though they are normally expressed in sensations that are. Vetlesen protests that psychosomatic pains are sometimes dismissed as ‘second-rate’ and less than ‘real’ (32). I would add that neither psychosomatic pains nor painful emotions lack a physical basis – in this sense, they are as physical as pains which are easily sourced or sited. But these are reasons for clarifying, not abandoning, our conceptual distinctions. Such distinctions help us to study and treat different pains in their own right.

Vetlesen then makes a ‘detour to psychoanalytic thinking’ (34). He describes clearly how Anna O., a patient of Freud’s colleague, was diagnosed with psychological trauma, which she had displaced into muteness. Her case shows that the proximate cause of ‘mental sufferings’ need not be an actual event, but one fantasised by the sufferer. However, Vetlesen’s other conclusions from the case are confusing – it is not reassuring when he has to interrupt himself to say, ‘Do not let me make this more cryptic than it is’ (38). He starts with an implausibly strong metaphysical claim about our ‘primary reality’: ‘Only that which is mentally real for an individual is actually real’ (38). This is gradually weakened to: It plays the ‘decisive role’ in our lives (39). A human is ‘dependent on meaning’, as dependent on it for life as on food (42). He ends with two causal claims about suffering. One seems to me a banal comparison: that psychic pain ‘can be just as fatal’ as physical pain (43). The other draws an unsupported contrast: that the cause of psychic pain is ‘far more complex’ and involves personality and history to a ‘far greater extent’ than physical pain.

II. PHENOMENOLOGICAL ANALYSIS

Part II contains a critique of Sartre’s ‘existentialist view’ of emotions (especially painful ones), followed by an abstract account of painful experiences from Vetlesen’s ‘phenomenological perspective’. The former is based on a misreading, while the latter is misleading in parts; nevertheless, Vetlesen highlights some aspects of pain that are missing from Part I. At the end, he uses ‘existentialist philosophy’ to draw two lessons from painful experiences.

'Horror and Agony': Figure 21 from Charles Darwin's The Expression of the Emotions in Man and Animals. Source: Wikimedia Commons (copyright expired).

Chapter 4 introduces his criticisms of Sartre, though they are elaborated throughout Part II. Sartre is a ‘so-called existentialist’ philosopher, whose ‘striking individualism’ is ‘in tune with the spirit of the age’ (44). He believes that an individual’s mental reality is ‘completely’ his ‘own responsibility’. In particular, ‘feelings – like moods and mental states – are chosen and willed by the individual’. They have an intentional relation to the world and a meaning that is ‘created and maintained by the subject’ (46).

According to Vetlesen, this general theory of emotions faces two problems. Firstly, it neglects their affective dimension. Painful emotions such as shame and fear include ‘a quality of being moved, shaken, hit, touched’ (46); they are not chosen, ‘unlike some possible object for my thoughts and my will’ (47). Sartre’s theory fails to capture this ‘gut firstness of the feeling’. Secondly, it lacks a ‘clinical and therapeutic’ perspective (49). From this perspective, an advanced ability or desire to ‘lay aside’ and ‘go in and out’ of our own emotions may be a symptom of mental illness. It is a ‘warning sign’ of inauthenticity – rather than an ‘innocent theoretical point about what it means to feel something (as Sartre believes)’.

I believe that neither problem arises for Sartre, when he is properly read. In Being and Nothingness, Sartre describes cases in which we seem to deploy our own painful emotions. For instance, if I ‘adopt’ the attitudes appropriate to sadness, then I am able to put this sadness aside when a visitor comes. I ‘promise it an appointment for later’ after he leaves (1958, 61). This ability suggests, to Sartre, that my sadness ‘is itself a conduct’ – a ‘magical recourse’ used by my consciousness to avoid the ‘too urgent’ realities of my situation. Vetlesen recounts this case, then inflates it into a general ‘theory’ of emotions: ‘As with other emotions, “being sad means first making oneself sad”; sadness itself is a kind of behaviour that I choose’ (42 with my italics; 66). But here is what Sartre says: ‘And in this case even, should we not say that being sad means first to make oneself sad?’ (1958, 61). He offers his diagnosis as specific to some unusual cases. He explicitly adds that deploying an emotion is not the same as having it. ‘If I make myself sad, it is because I am not sad – the being of the sadness escapes me by and in the very act by which I affect myself with it.’

For Sartre, there is nothing ‘innocent’ about such cases. He presents them as examples of ‘bad faith’, which Vetlesen acknowledges (44). Later, Vetlesen points to the ‘internal and pre-reflective’ relation to one’s own feelings (66). In particular, a painful experience is marked ‘by its lack of distance, by its directness’: ‘my pain fills me’ (73). This is offered ‘in stark contrast to Sartre’s analysis’ – for he has Sartre proposing that ‘I as a subject, as consciousness, completely decide the meaning of pain’ (72). Sartre, it seems, has missed something obvious about ‘the reality of pain in human existence’. Yet, from a chapter on ‘The Body’, here are Sartre’s descriptions of how his eyes hurt when he is reading:

Pain is not considered from a reflective point of view; it is not referred back to a body-for-others. It is the eyes-as-pain or vision-as-pain…but it is not named in consciousness, for it is not known. (1958, 332-333)
The pain is neither absent nor unconscious; it simply forms a part of that distance-less existence of positional consciousness for itself. (334)

It takes reflection before we can ‘transcend the pure quality of consciousness in pain’ and treat the pain as an ‘object’ (335). And even then: ‘The facticity of a pain-consciousness…is a facticity discovered in perpetual flight’ (387). Thus Vetlesen agrees more with Sartre than he thinks.

In Chapter 5, he draws on Merleau-Ponty’s ideas about the body to offer an account of how pain is experienced. Two features of his account stand out. Firstly, it is highly abstract. Vetlesen begins by connecting, ‘at a basic level’, pain and feeling: ‘to be exposed to pain is the same as being able to feel pain’ (50). This connection applies to both painful sensations and emotions. Next, Vetlesen claims that the feeling of pain ‘cannot be separated from conscious understanding’ (51). He is ambiguous in specifying this cognitive dimension: ‘the principle characteristic…is precisely the feeling of something causing pain’ (51), though ‘hurting is what the feeling is quintessentially about’ (52).

Sometimes Vetlesen uses metaphors to amplify his abstract claims. Pain is an ‘uninvited guest’ or ‘intruder’, who ‘does not go away even though I might wish for it’ (52). It has an ‘utterly sovereign’ power that ‘heaves the ego down from the pedestal’ by challenging our power over everything in life. Pain turns into a ‘magnet’ that attracts all attention or a ‘tyrant’ who mercilessly dictates all meaning (56). Such metaphors can be provocative. At their best, they highlight aspects of some painful experiences which are theoretically neglected – in this case, a patient’s loss of power.

Secondly, his account is highly general. ‘Generally speaking, pain is what makes the body a particularly important concern for the individual’ (54). To support this claim, he cites Merleau-Ponty’s insight that we normally act with our bodies. The body is the ‘self-evident, unreflected and unnoticed centre’ of experiences. So, ‘it is because of pain (illness, injury, dysfunction) that I become aware of my body at all.’ Vetlesen is careful to note exceptions to this rule, such as our heightened awareness during sexual experiences. But he does not address the risk that he is conflating significantly different phenomena. ‘Injury, illness, dysfunction’: his account does not distinguish how these, in different ways, bring awareness to our bodies.

Instead he offers a rhapsody:

Pain steals the focus. Pain commands my total attention, it drains me of energy….Pain is voracious: it wants to consume me, have all of me, not share my consciousness….Pain is intensely jealous: it eliminates all rivals of my attention and energies as soon as they emerge, so that finally all that is left is pain, as the all-consuming and all-penetrating centre of my life. I am pain, the pain is me, there is nothing else, nothing outside. (54-55)

Earlier Vetlesen contrasts his phenomenological perspective with other more ‘theoretical’ ones: it is ‘pain as something experienced that interests us’ (52). But his analysis shows us that phenomenology can also be too theoretical – too effortlessly afloat the concrete detail of ‘something experienced’. As long as it remains at an abstract and general level, there are limits to what he can discover about complex experiences of pain.

In Chapter 6, Vetlesen does narrow his focus to ‘Anxiety and Depression’. This title is misleading since he does not seriously discuss either as medical problems. Instead, he discusses Angst – a state of anxiety which has no ‘particular object in the world’ and where the ‘cause is unknown to the person’ (58). Vetlesen compares this anxiety to ‘my enemy, the stranger in my midst who knocks me down, who springs up without my being able to prevent or control it’ (60). For the sufferer, it drains the outside world of meaning and paralyses him from acting in it. But Vetlesen, following Heidegger, believes that this anxiety has a ‘positive nature’ (61). It can ‘rouse’ an individual to take ‘responsibility for his own life and own choices’, and to abandon ‘conformist or rigid ways’ (65). It is thus ‘a springboard for existentialist choices’ (67).

Chapter 7 qualifies this existentialist interpretation. Although painful experiences can motivate us to confront choices, they also point us towards ‘the given’­ – those aspects of life which are not governed by choice. Our susceptibility to pain is one such ‘non-choosable’, ‘unalterable’ and ‘fundamental’ condition of existence (69). Vetlesen lists a few others: ‘Dependence, vulnerability, mortality, the fragility of relations and existential loneliness’. Our choices are made within a ‘framework’ of these fundamental conditions (70). What happens when we forget this framework? At the end of the next Part, Vetlesen identifies a danger for those who fail to acknowledge the vulnerability that limits our responsibility.

III. CULTURAL ANALYSIS

Part III takes up more than half of Vetlesen’s book. He creates a model to describe, abstractly, the circulation of pain in society. Then, in two long chapters, he uses it to analyse two cultural phenomena: ‘Violence in Culture’ and ‘Compulsive Choice in a Multi-option Society’. Vetlesen’s model is based on theoretical ideas from a few psychologists and psychiatrists, while his analysis includes a range of hit-and-miss cultural references. The connections between these ideas and references are not always clear; in what follows, I reconstruct some of them after having reread the chapters several times.

According to his model, pain creates psychic pressure on an individual – a ‘pressure that seeks release’ (88). This release comes via two social processes: pain is either transported from that individual to another or transformed through their culture. Chapter 8 focuses on transportation. Pain is relieved by shifting it onto others: ‘You bear it instead of my doing so’ (75). This may be a ‘primitive, even infantile’ attitude, but it is ‘fundamental for all of us’. It is most salient in psychopaths. Vetlesen cites research by the psychiatrist Otto Kernberg and the psychologist Alice Miller. Kernberg argues that some psychopaths hurt others because they are themselves hurt. Their pain stems from a sense of vulnerability; for them, ‘to be vulnerable is to be hurt’ (76). Miller makes a broader generalisation from her case studies: ‘Every abuser has once been a victim of abuse’ (80).

Vetlesen concedes that the latter claim is a ‘considerable exaggeration’. There are exceptions, such as ‘first movers’ who abuse others without having been abused (80). Moreover, some abused youngsters turn into empathetic adults who take on the ‘self-effacing giver role’ (81), thereby breaking the ‘evil circle’. Nonetheless, Vetlesen proposes that most of us share the impulse to transport pain. He seeks our acknowledgement of this: ‘What we see fully developed in the psychopath are traits all of us can…recognize in ourselves’ (77).

If this impulse is ‘universally human’, then it risks being explanatorily idle. So how is it significant? Firstly, I think it draws a surprising theoretical connection between some psychological forces. They are all vehicles for transporting pain. Vetlesen mentions at least three in Chapters 8 and 10: envy when another person embodies ‘what it pains me most that I lack’ (84), which makes me punish him; projection of my own ‘inner conflicts’ onto others, so that they can be attacked there (82, 96); and sadism which tries to ‘create and control’ suffering in others, so as to avoid experiencing it myself (100, 102). Secondly, for Vetlesen, this impulse is part of the ‘interpersonal dynamics’ which causes pain (77). Such dynamics are neglected when the ‘public health sector and ‘public debate’ focus on ‘biological and genetic causes’. He implies that this may collude with those who would blame the suffering victim (78).

Chapter 9 describes a more ‘mature’ and ‘non-destructive’ way to relieve pain: its transformation through culture. Culture provides ‘symbolic forms’, which we can use to ‘convert and process’ our painful experiences (88). Vetlesen cites Edvard Munch’s paintings as examples. Their depiction of pain expands the ‘symbolic space’ in which we can ‘open up to the pain we carry around with us’ (90). He concedes that this may seem a ‘highly banal’ interpretation of Munch’s art, though he clarifies that his ‘humanist’ interpretation does not exclude other artistic meanings and effects. In Chapter 10, Vetlesen compares these transformational products of culture with transitional objects in psychotherapy. He borrows a concept developed by the psychoanalyst Donald Winnicott: A teddy bear is a ‘transitional object’ when it acts as a ‘stand-in’ for the mother (106). An angry child might bash the bear instead of his mother – the ‘real object’ of his rage. Similarly, cultural products can be ‘symbolic substitutes’ that reduce our need to ‘force pain out onto others’.

Assessing his overall model, Vetlesen cites its ‘advantage’ in highlighting some ‘dynamic processes’ that cause pain (92). What about its disadvantages? I shall briefly mention three limitations in its ‘social perspective’ on pain. Firstly, the model focuses on pain’s circulation, rather than its creation or distribution. Vetlesen does not discuss how different societies create different kinds of suffering, and how unjust arrangements distribute suffering unfairly. Instead, his model assumes that society begins with a fixed distribution of pain, which is then transported or transformed. This assumption is reinforced when he abruptly switches from talking about ‘experienced pain’ to ‘existential pain’ (89-90). The latter is defined, variously, as the pain of ‘being human’ – of ‘not being perfect’ (100) and ‘still being vulnerable to the reality of pain’ (159). It is common to all humans and, thus, not dependent on their arrangements.

Secondly, the model is centred on individuals, rather than institutions. It explains pain’s circulation by appealing to individuals’ impulses and interactions. For Vetlesen, the ‘most violent’ sources are ‘inside us’: we are ‘driven’ by ‘inner forces we have not chosen to be there’ (97). His model does not include the social structures that surround these ‘inner forces’. Culture appears only as the ‘symbolic resources society places at the disposal of its members’ (89). Not surprisingly, his solution to suffering stresses individual responsibility. There is ‘a task for each and every one of us’ – to transform pain, to use the symbolic resources to heal our ‘wounds’ of suffering (93).

Thirdly, the model focuses on the substitution effects of transformation. Vetlesen is concerned with how cultural products can substitute for human targets. He does not describe their different meanings. What matters, to his model, is that low culture can be ‘existentially just as resilient, just as symbolically saturated’ as high culture (126). Thus he offers only a few criteria for evaluating their potential to transform pain. Cultural products cannot be ‘too concrete’ in representing ‘aggression and destructiveness’; the hurtful needs to be portrayed in an ‘abstract and thereby processed’ form (94). Engaging with ‘richer and more elastic’ images of destructiveness will reduce the urge to destroy ‘real people’. Symbols trap this urge ‘within a world of fantasy and imagination’ (96). So the ‘more impoverished’ a set of symbols, the shorter ‘the path to bodily action’.

Such weak criteria contributes little that is new to cultural criticism. In Chapter 11, Vetlesen applies the criteria to analyse the products of popular culture. Full of violence, these products are ‘too similar to the hurtful and evil’. Their images and stories are ‘too little abstract’. So they cannot fulfil their ‘alleviative and stand-in functions’ to transform an audience’s pain (108). He mentions three of the usual suspects: violent films that end up ‘quite simply as user manuals’ (109); reality television with a ‘vulgar-Darwinist premise’ that weeds out the weakest; and computer games that prize killing, which make aggression seem like the ‘natural’ reaction to frustration (112). His criticisms are too familiar. They draw no surprising connections between these phenomena.

Moreover, they are undermined when he mischaracterises some of the phenomena. Two examples: The vampire is not – as Vetlesen claims – the ‘image of evil’ in popular culture (108). He is not always an ‘evil misdoer’ who discourages us from showing ‘vulnerability and dependency’ (109); in books and films, he is now often the romantic and tormented anti-hero. Reality television is not ‘without mediation’ (111). Far from being ‘directly transmitted directness’, it is full of manipulated scenarios and exaggerated reactions. These are put on screen by producers and participants to boost ratings.

Despite these problems, Vetlesen’s model leads to two insights when he adds a social dimension to his cultural criticism. Firstly, when a society suffers from ‘symbolic impoverishment’, its members stop processing their pain on the ‘inside’. Instead, they transport it automatically to the ‘outside’. Violence towards others becomes the ‘favoured answer’ to pain: it is ‘handed down from generation to generation’ as a social norm (115). The result, as observed by others, is a wider ‘culture of callousness’ (117). Secondly, it is not enough for a society to produce ‘good symbolic resources’ which can be used to transform pain. These resources must be distributed to reach those ‘groups’ which need them ‘most of all’ (125).

But, as I noted above, his model remains too centred on individuals to account for social structures which support this ‘symbolic impoverishment’. It fails to explain how these structures contribute to social norms about violence and how they ought to distribute symbolic resources. To be fair, Vetlesen does not ignore these issues. He mentions: too few ‘opportunities for development’ in young people (121); too much permissibility and individualism, which urge ‘one’s own satisfaction at any price’ (122); too many challenges to both the parental authority to ‘pass on moral values’ and the adult responsibility to ‘communicate standards of right and wrong to other people’s children’ (122); and too much ‘relativism’ with its ‘plurality of life-views and lifestyles’ (123). These criticisms are, again, familiar from some conservative critiques of modernity. Vetlesen casts no new light on them, for they are not related systematically to his model.

I suspect that Vetlesen is aware of his model’s limitations. Chapter 12 – the longest in the book – breaks out from these limitations to describe the creation of some painful pathologies and their connection to our social structures. He diagnoses the ‘pathologies’ of surviving in a ‘multi-option’ society. In western society, choice has become ‘compulsory’ because we see it as the mark of freedom (128). To choose is to express our ‘creativity and individuality’. This extends even to our identities: we claim ‘a newly won “freedom” to constantly recreate’ ourselves (129). At the same time, choice has become more difficult. Modern culture has a ‘radical openness’. It offers more options than ‘answers and yardsticks’. There are ‘fewer sheet anchors, less clarity, less unambiguity and objectivity’ (134). What results from being compelled to choose in this culture?

Vetlesen interprets various pathologies – burn-out, action paralysis, anxiety and depression – as ‘unintentional consequences’ of these ‘social conditions’ (128). A sample of his diagnoses: The increasing freedom to choose develops into a ‘fear of taking a wrong turning’ (145). Firstly, this fear makes one constantly ‘assess and re-assess’ choices. Life becomes an ‘uninterrupted exam’, creating stress and exhaustion (149-150). Secondly, one is more easily ‘paralysed by possibilities and unable to act’ (146). This paralysis can build into depression. Vetlesen quotes the French psychiatrist Alain Ehrenberg, who believes that depression is ‘melancholy in a society where everyone is equal and free’. So far, so familiar: the link between excessive choice, paralysis and depression has been explored by other critics of free-market liberalism (Lane 2001; Schwartz 1994, 2004).

What is new in Vetlesen’s analysis arises elsewhere. He reminds us that ‘neo-liberal’ ideology often conflicts with reality. It prizes freedom in the form of choice and individuality, but both are compromised in a modern economy. Some choices are open only to individuals with ‘material resources’. Yet these resources ‘tend to be distributed along lines of class’ (130). In an era of individualism, ‘conformism…is tightening its grip’ (138). As workers, individuals must make themselves ‘flexible’ and ‘adaptable’ to suit corporate needs. As consumers, ‘all needs, all aims, all fantasies’ are shaped by markets so that they can be satisfied by commodities (139). The fashion industry, for instance, claims to value individuality, but relies on ‘iconic figures’ and celebrities to influence consumer tastes (153).

Amidst these conflicts, Vetlesen uncovers two new forms of pain. Firstly, individuals suffer from shame when they cannot realise the freedom promoted by neo-liberalism. Their shame is ‘fuelled by a sense of sub-optimal performance’ – of ‘not realising enough of one’s presumed potential’ (135). It leads to self-disgust, which encourages the individual to enforce ‘strict self-control regimes’ (135). For Vetlesen, this becomes a common cause behind three separate phenomena: eating disorders; sadomasochistic sex; piercing and other forms of self-injury. He adds a provocative parallel between the self-injuring teenager with the businessman ‘who walks slightly faster, almost breaks into a run, checks his watch for the umpteenth time’ (140). Both are ‘exploiting themselves’ and ‘pushing themselves’ to ‘withstand more and more’.

Secondly, individuals suffer from pain that has been shaped by ‘pressure from the market’ (152). Vetlesen brings up the industries in cosmetic surgery, pharmaceuticals and fashion. Each thrives by ‘putting pressure on people’s self-esteem’, ‘making us detest our bodies and dissatisfied with our looks’ (153). Their products change our standards of physical beauty and psychological orderliness. As more customers use the products, others face increasing ‘social pressure’ to meet those standards. A vicious cycle of pain may result, in which efforts to ‘master pain’ create so much stress that life ‘becomes more painful’ (155). Vetlesen connects this possibility to our failure at acknowledging human limits. Believing that every limit can be transformed into a choice – a choice to transcend that limit with technology: this is a modern ‘hubris’ (154). It is another way to overlook those aspects of life which are not open to choice. Here his cultural and phenomenological analyses reinforce each other. Both Parts II and III end by highlighting the unchosen vulnerability that underlies our freedom to choose.

Let me conclude by considering Vetlesen’s title, A Philosophy of Pain. This may be a translator’s gift – the original in Norwegian is more simply, perhaps more ambitiously, Pain. What are this book’s weaknesses and strengths as ‘a philosophy’? Its first weakness: Vetlesen neglects a substantial philosophical literature on pain. Since the 1960s, analytic philosophers have built perceptual and representational models of pain (Aydede ed. 2006). These offer conceptual resources which could help him to contest Scarry’s reported claim that pain is not ‘about’ the world. Other philosophical writings – such as Wittgenstein (1953) and Ryle (1968)challenge her ‘absolute division’ between my pain and others’ pain. I see them as missed opportunities for a dialogue, since the analytic models could also gain from his phenomenological insights. Secondly, when he mentions other philosophers and their views, he can be careless. I have spelled out how he sets up a straw-Sartre. Elsewhere, without warrant, he states that ‘all of moral philosophy rests’ on the claim that ‘human beings naturally…strive for what they regard as good, or what seems to promise pleasure’. Then he proposes that the ‘connection’ in this descriptive truism ‘can be expressed most directly’ by the normative – and far from common – claim that ‘something is good because we connect it with pleasure’ (10).

There are two main strengths. Firstly, Vetlesen combines three approaches to illuminate different aspects of pain. I have shown, for instance, that his conceptual analysis of how pain changes a person’s relationship to the world is broadened by his phenomenological attention to the experience of pain. His existentialist interpretation of what pain says about life supports his cultural diagnosis of new forms of pain. Secondly, Vetlesen’s cultural analysis leads us to new patterns in pain-related phenomena. Some of his arguments are avowedly selective and provocative; they depend on the risky interpretation of ‘signs’ (132) and ‘warning signals’ (142). But, through them, we can weave our way to some unexpected meanings of pain.

Arne Johan Vetlesen: A Philosophy of Pain
Translated by John Irons.
Reaktion Books, London 2009.
ISBN-13: 978-1-86189-5417.
Softcover, 167 pages, US$27.95

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Chuanfei Chin is  doctoral candidate in Philosophy at the University of Oxford and Senior Tutor in the Department of Philosophy, National University of Singapore. 

Acknowledgments: The author wishes to thank Alexandra Serrenti and Gavin Maughfling for discussion.

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