The Phenomenology of Pain
Series in Continental Thought, № 53
Ohio University Press · Swallow Press
2020
Hardback $95.00
264
Reviewed by: Fredrik Svenaeus (Södertörn University, Sweden)
In his recently published study The Phenomenology of Pain Saulius Geniusas sets himself the task of developing precisely that – a phenomenology of pain – on the basis of Edmund Husserl’s philosophy. According to Geniusas, in Husserl’s work (including the posthumously published manuscripts) we find all the resources needed to develop such a phenomenology. Husserl took the first steps himself in developing a phenomenology of pain and by following in his footsteps, proceeding by way of the phenomenological method and concepts he developed, we can achieve this important goal. Why is it important to develop a phenomenology of pain? Apart from the general impetus of exploring all phenomena relevant to human life, we may in this case also point towards the mission of helping those who suffer from severe and chronic forms of bodily pain. Pain is from the experiential point of view generally something bad to have, even though it may guide our actions and call for changes of life style that are in some cases beneficial for us in the long run.
The definition that Geniusas develops in his book and defends in comparison with other suggestions and conceptions of what pain consists in is the following: “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” (8). The strategy of his investigation is the following. In the first chapter he presents Husserl’s phenomenology and method, he then in the second chapter turns to the way pain was viewed by Husserl and some other (proto) phenomenologists in the beginning of the 20th century, primarily Franz Brentano, Carl Stumpf and Max Scheler. With the exception of Jean-Paul Sartre, other major phenomenologists that have dealt with pain, such as Martin Heidegger, Maurice Merleau-Ponty, and Paul Ricoeur, are scarcely mentioned, even less brought into the analysis. In chapter three Geniusas tests his Husserlian theory by confronting it with rare disorders, which have been reported in the medical literature and have been elaborated upon by (mostly) analytical philosophers, in which pain is not perceived in standard ways. In chapter four he turns to the temporality of pain on the basis of Husserl’s theory of internal time consciousness. In a sense this is the high peak of the analysis where Geniusas enters the terrain of the transcendental stream of consciousness and the constitution of the ego. In chapter five, the author moves downwards from the transcendental peak exploring more mundane topics such as the lived body, which is obviously an important subject for a phenomenologist of pain. Chapter six introduces the notion of personhood and the idea of a personalistic in contrast to naturalistic view on pain. In this and the following chapter seven, dealing with pain and the life world, Geniusas aims to show how his Husserlian alternative can improve upon the philosophical anthropology at work in fields such as medical humanities, cultural psychopathology, psychoanalysis and psychosomatic medicine when it comes to pain. The main concepts he makes use of in the last two chapters, in addition to the ones found in his definition of pain, are depersonalization, re-personalization, somatization and psychologization.
In general I think the strategy of first developing a phenomenological point of view on a subject and/or in a field of research and/or practice (in this case pain research and treatment of pain patients) and then try show how this phenomenological angle can enlighten the researchers and practitioners in the field(s) is a good one. I am convinced that pain needs a phenomenological analysis to be fully understood as the personal experience it truly is. What makes me ambivalent about Geniusas’ book is that I am less convinced that Husserl’s transcendental phenomenology is the best, or, at least, only alternative to work with when it comes to developing a phenomenology of pain, and a bit disappointed that Geniusas does not acknowledge the works on pain that have been carried out in phenomenology of medicine and medical humanities already. The reason he omits, rejects or limits the discussion of such phenomenological efforts to the footnotes is no doubt that they proceed from phenomenological strategies and concepts that are rejected by the author because of deviating from Husserl’s basic set up. I am a bit worried that these two shortcomings (shortcomings at least to my mind) will make this review a bit more negative than I feel the author deserves. Geniusas is a fine philosopher and he certainly makes the most out of the cards that Husserl has dealt him when it comes to understanding pain. Researchers in the field of cognitive science and cultural anthropology will benefit greatly from reading this work and it will also be interesting to Husserl scholars. Phenomenologists of medicine could also learn a great deal from Geniusas’ consistent analysis although I think many of them will have objections similar to my own.
Geniusas distances his own definition of pain from the influential definition put forward by the International Association for the Study of Pain (IASP): “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (2). The reason for this is not only that Geniusas’ alternative is much more precise and comprehensive than IASP’s definition. Actually, the wording of “unpleasant sensory and emotional experience” comes quite close to the stratified phenomenology of pain that Geniusas wants to develop (“an aversive bodily feeling given as a feeling-sensation or emotion”) himself, but it is of vital importance for him to keep the first-person analysis clean of any third-person perspective involving the talk of tissue damage. This is phenomenologically spoken correct, of course, but I cannot help thinking that the cautious account of “actual or potential tissue damage” have been created by the IASP for the reason of prioritizing the point of view of the pain sufferer in comparison with the medical scientist, and I think this should be acknowledged rather than belittling the definition.
Geniusas states that he wants to keep a door open to enrich the phenomenology of pain with other perspectives, but the first impression in reading his book is that he is rather busy closing such doors to ensure that the phenomenology of pain will be “pure” in the sense of not resting on any “pain biology or pain sociology” (4). Many times in the book, the need to stay clear of naturalistic theories of pain is mentioned. At other points in his analysis the author questions the relevance of distinguishing between curing in contrast to healing and disease in contrast illness, distinctions standardly made in the philosophy of medicine (155-56). Geniusas’ reasons for this are no doubt to give privilege to the phenomenological (also called personalistic) perspective in health care in view of the dominance of medical science, but the phenomenological privilege-claim easily begins to sound a bit preposterous in the case of medicine. It is one thing to urge the medics to complement the third-person perspective with a first- (and second-) person perspective – this is greatly needed and called for in health care – but Geniusas appears to come close to a position in which phenomenology should replace other perspectives in the case of pain. This would, of course, be quite absurd in light of what medical science has achieved the last 70 years or so in understanding and treating pain. Most phenomenologists working with themes highlighted by illness and healing (including these two concepts) would be more humble than Geniusas when it comes to positioning their own work in relation to the research done by medical scientists, psychologists, sociologists, etc. Complementing is certainly different from replacing and although the phenomenologists would ultimately privilege the first-person perspective by understanding empirical science as a project originating in the life world, they could learn a lot of value for their own analyses by leaving the arm chair and inform themselves about what is happening not only in the everyday world but also in the world of empirical science, especially when it comes to themes such as pain.
Geniusas tries to keep such a door open to both medical science and the everyday world by the way he sets up and develops his Husserlian method. His elegant and promising idea is that what is known in phenomenology as eidetic variation can be used not only to imagine possible variations of a phenomenon but also to import examples found by way of everyday narratives and empirical science (27). Geniusas goes as far as calling this “dialogical phenomenology” but in order for his book to qualify as dialogical he would, to my mind, have needed to do more when it comes to learning from pain narratives and pain physiology, including brain science and current treatment programs for (especially) chronic pain. As it now stands the dialogue most often consists in showing other researchers of pain that they need to read more Husserlian phenomenology to even understand what they are dealing with. I think the third chapter of the book is indicative of this one-sidedness, this is the chapter in which we should have been taken through at least the basics of contemporary pain research, but what we get instead is a dialogue (or rather attempts to correct) various philosophers in the analytical tradition trying to define pain by taking account of various rare disorders, such as congenital insensitivity to pain, pain asymbolia and what is called pain affect without pain sensation. Do not get me wrong, I do think that these disorders are important to understand what pain truly is and they need to be brought into the analysis, but the way they are presented in this chapter, out of context, not taking into consideration all the interpretational difficulties created by the different historical time points and research traditions in which they have been gathered the last 100 years or so, makes it very hard to follow and critically evaluate the philosophical moves. This goes for phenomenologists, but also, and perhaps more importantly, for all sorts of people experiencing or working with people in pain. Geniusas perhaps succeeds in reaching through to the philosophers working in the field of cognitive science, but my guess is that he does so at the expense of losing many of the phenomenologists and researchers of pain on the way.
Chapter four, dealing with Husserl’s C-Manuscripts on how the living present opens up in and by the stream of consciousness, will probably do the job of scaring away the last remaining empiricist readers. Perhaps I am unfair to Geniusas at this point, after all it is perfectly possible to skip chapter three and four and move directly from the basic introduction of the Husserlian pain-theory outlined in chapter two to the discussions of pain and embodiment (chapter five), personhood (chapter six) and life world (chapter six). But I cannot help feeling there is something absurd about moving to the transcendental heights (or perhaps rather depths) of Husserl’s genetic phenomenology in a book on pain. How could the transcendental ego be in pain? The way I view Husserl’s analysis of transcendental consciousness and its underpinnings is as a methodological point of view for the phenomenologist, not as a piece of ontology per se.
This brings me back to Geniusas’ second chapter on the phenomenological method and what it means for him to do phenomenology. The author claims that for an investigation to qualify as phenomenological it is not enough to proceed from the first-person point of view in contrast to the third-person perspective; the moves performed by the phenomenologist must also include the well-known epoché paired with a phenomenological reduction including eidetic variation (12-20). As Dan Zahavi has recently pointed out, such demands will necessarily be rather off putting and unproductive for empirical researchers wanting to do phenomenology (Zahavi 2019). For a Husserlian – and Zahavi certainly qualifies as a such – it is better to distinguish between philosophers doing transcendental phenomenology – including the epoché and all steps of the phenomenological reduction – and empirical phenomenologists using phenomenological concepts in their research that have been developed by the philosophers (different types of intentionality, lived body, life world, etc.). I have issues with Zahavi concerning the understanding of what it means to perform the epoché – is a researcher not by default performing the epoché at least to some extent when making use of a phenomenological concept? – but when it comes to Husserl’s presentation of the phenomenological reduction I think Zahavi is perfectly right concerning empirically based phenomenologists not having to perform these moves. With Geniusas definition of phenomenology there will be very few remaining phenomenologists in the world except for philosophers like Zahavi, me and himself. From his point of view this may not be a problem, the empirical researchers working with first- and second-person accounts of and attitudes towards pain and persons in pain will just have to rechristen themselves; they can still go on with their work and ideally learn more and more about phenomenology by reading Husserl and Geniusas. At some point they may even become able of doing real phenomenology and earn the badge. To me, however, this sounds like a rather unilateral set up of phenomenology, not deserving the name of dialogical that Geniusas claims.
It is now about time to come back to Geniusas’ definition of pain that is stated early (already in the introduction) and then gradually explained, defended and repeated throughout the book: “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”. The author is commendably clear and pedagogical in the development of his phenomenological theory of pain even though he at some points walks through rather muddy terrains (muddy in the sense of hard to walk through, not in the sense of being obscure). That pain is given only in original firsthand experience is common sense, at least for a phenomenologist. We witness the pain of others and also to some extent feel their pain (it is called empathy and sympathy), but this pain is not a bodily feeling with the same experiential quality that pain in its original form has. That pain is aversive and, at least to some extent, distinct in contrast to other bodily sufferings is also, to my mind, phenomenologically correct. Some of the rather bizarre medical disorders mentioned above question the necessary aversiveness of pain, but I trust there are phenomenological explications of these cases that allow us to keep the aversiveness in the definition.
My quarrel with Geniusas regards the last part of his definition created by a combination of points found in Stumpf, Brentano and Husserl: that pain is given either as a feeling-sensation or as an emotion. The reason for my skepticism is that this appears to come rather close to what in the analytical tradition is known as a perceptual theory of pain (Svenaeus 2020). According to Geniusas, at the most basis level pain is a bodily sensation lacking meaning and content except for its aversively felt quality (Husserl calls these feelings “Empfindnisse”), but pain can also take on an object (the part of the body that hurts) and it then becomes an intentional feeling, what is known as an emotion in the philosophical literature. Inner perception is different from outer perception, Geniusas is quick to point out, but is not this difference an indication that we at this point need a different phenomenological conception of pain altogether? Emotions are standardly looked upon as feelings having objects by being about things in the world (say if you love or hate another person or a thing you have to do). The things emotions can be about admittedly includes one’s body (like when you love or hate your looks or the fact that you are, or are not, capable of running one mile in less than four minutes). But this is different from feeling your foot hurting when you trip on a stone or your chest hurting when you try to force yourself to run faster. Pain, also when it is recognized as “filling up” parts of one’s body, does not carry any cognitive content except the hurting feeling itself. Therefore it is to my mind misleading to call pain an intentional feeling (an emotion) if what is meant by this is merely that the feeling body has been brought to awareness of (parts) of itself. A better alternative is to talk about embodied moods or existential feelings that aside from making you aware of the body also opens up (and close down) various aspects of and possibilities in the surrounding world (Rattcliffe 2008). Geniusas mentions such pain moods (atmospheres) when briefly addressing Merleau-Ponty and Sartre in chapter two (48, 51, 60, 63) but he does not proceed with the concept in his own analysis. The reason for this, I think, is the way he looks upon the relationship between the subject (ego) and the lived body.
In chapter five, Geniusas finally arrives at the well-known phenomenological distinction between “Körper und Leib” introduced by Husserl himself and known in English as the distinction between the physical and the lived body. The lived body is no doubt a key concept for phenomenologists of pain but in Geniusas analysis it is developed in a different way than the standard more or less Merleau-Pontyian version. According to Geniusas, the lived body is not something I am, it is something I have constituted and consequently I exist separately from it (135, 142). This is in accordance with Husserl’s philosophy of transcendental consciousness, but such a position creates many difficulties when trying to give a phenomenological account of pain (and many other mundane matters). Geniusas claims that pain is necessarily “lived at a distance” (137 ff.) but the immediate question to such a position is: where is the conscious ego when it feels this distance between itself and the hurting knee or head (to just mention two examples)? In the head? Hardly. In the rest of the body that does not hurt? Definitely not. In transcendental space-time? Perhaps, but it is hard to even understand what this would mean in this case. Phenomenologists of pain and illness have most often worked with a more radical conception of the lived body according to which I am my own body but yet the this living body is also foreign to me because it has its own ways, which do not always fit with my ambitions and projects (when it hurts is a major example of this). Drew Leder is the most prominent phenomenologist in this tradition, he figures in the footnotes of Geniusas’ book but is never brought into the main analysis (Leder 1984-85, 1990).
In the last two chapters, the author enters into a discussion with philosophers of suffering and illness, such as Eric Cassell and Kay Toombs, and with cultural anthropologists, such as Laurence Kirmayer and Arthur Kleinman. His aim is to introduce the concepts of depersonalization, re-personalization, somatization and psychologization as pertinent for a phenomenology of chronic pain when it comes to understanding and helping patients. The concept of depersonalization is a bit surprising in this context given its standard meaning in psychiatry (a feature of psychotic experiences) but Geniusas aims to give it the meaning of being separated by way of pain from one’s body, one’s world, other people and, finally, one’s own personal being (148 ff.). Pain brings about a series of ruptures in human existence that makes one less of oneself. Having developed such a phenomenology of illness (including pain) since a long time by way of the keywords of bodily alienation and unhomelike being-in-the-world I cannot help feeling a bit hurt of not even being mentioned here (eg. Svenaeus 2000). The same goes for Geniusas’ praise of narratives as a way of better understanding experiences of pain and meeting with pain patients (157-162). What happened with the whole tradition of phenomenological hermeneutics as a way of articulating the understanding established by way of the clinical encounter? Hans-Georg Gadamer is just as absent as Martin Heidegger in this book and this may be perfectly fine concerning the phenomenology of pain – not every type of phenomenology can be made use of – but it is more than strange if you want to consider narratives in medicine and health care as a way of developing self-understanding (for patients) and clinical understanding (for physicians, nurses, psychotherapists and other medical professionals) (Gadamer 1996).
The terminology of somatization and psychologization employed by Geniusas in the last chapter fits nicely into the fields of cultural anthropology, psychosomatic medicine and psychoanalysis that he wants to connect with, but it also carries heavy dualistic cargo. The author is aware of this and assures us that the phenomenological perspective and attitude he is employing by way of his definition prevents us from ending up with any dualism. Nevertheless, I think it is hard to use this terminology without employing some form of at least minimal dualism and that there are better alternatives if you want to address medical professionals (including psychotherapists) trying to help persons suffering from chronic pain.
I want to end on a positive note by saying that even though I do not agree with some of the ideas concerning the basic set up and strategies for developing a phenomenology of pain in this book, I think the author shows admirable consequence and strength in pushing his Husserlian alternative through. Despite dealing with hard matters and making use of a very complex conceptual set up Geniusas is always lucid when arguing and stating his views. I hope the book gets many readers and would recommend skipping chapter three and four if you have any doubts or allergies concerning analytical philosophy of mind or Husserl’s theory of internal time-consciousness. If these are your preferences you will have no difficulties in getting through.
References:
Gadamer, H.-G. 1996. The Enigma of Health: The Art of Healing in a Scientific Age. Trans. J. Gaiger and N. Walker. Stanford, CA: Stanford University Press.
Leder, D. 1984-85. “Toward a Phenomenology of Pain.” Review of Existential Psychology and Psychiatry 19: 255–266.
Leder, D. 1990. The Absent Body. Chicago: University of Chicago Press.
Ratcliffe, M. 2008. Feelings of Being: Phenomenology, Psychiatry and the Sense of Reality. Oxford: Oxford University Press.
Svenaeus, F. 2000. The Hermeneutics of Medicine and the Phenomenology of Health: Steps towards a Philosophy of Medical Practice. Dordrecht: Kluwer.
Svenaeus, F. 2020. “Pain.” In Routledge Handbook of Phenomenology of Emotions, eds. T. Szanto and H. Landweer. London: Routledge, 543-552.
Zahavi, D. 2019. “Applied Phenomenology: Why it is Safe to Ignore the Epoché.” Continental Philosophy Review (published online). DOI: https://doi.org/10.1007/s11007-019-09463-y
