Painful Experience and Constitution of the Intersubjective Self: A Critical-Phenomenological Analysis

Abstract

In this paper, we discuss how phenomenology might cogently express the way painful experiences are layered with complex intersubjective meaning. In particular, we propose a critical conception of pain as an intricate multi-levelled phenomenon, deeply ingrained in the constitution of one’s sense of bodily self and emerging from a web of intercorporeal, social, cultural, and political relations. In the first section, we review and critique some conceptual accounts of pain. Then, we explore how pain is involved in complex ways with modalities of pleasure and displeasure, enacted personal meaning, and contexts of empathy or shame. We aim to show why a phenomenology of pain must acknowledge the richness and diversity of peculiar painful experiences. The second section then weaves these critical insights into Husserlian phenomenology of embodiment, sensation, and localisation. We introduce the distinction between Body-Object and Lived-Body to show how pain presents intersubjectively (e.g. from a patient to a clinician). Furthermore, we stress that, while pain seems to take a marginal position in Husserl’s whole corpus, its role is central in the transcendental constitution of the Lived-Body, interacting with the personal, interpersonal, and intersubjective levels of experiential constitution. Taking a critical-phenomenological perspective, we then concretely explore how some people may experience structural conditions which may make their experiences more or less painful.

Beyond Pain Scales: A Critical Phenomenology of the Expression of Pain

“…It is very much possible—and often vitally important in relations of care—to receive another person's expression of pain, to understand something of its painful nature, and to demonstrate this understanding. We can accept this philosophically without requiring an identity of experience between the person in pain and their companion(s) [( 9 ), p. 206; ( 4 ), p. 106]. We know intuitively when other people “get it”.…”

“…Does this pain feel shameful, and do I feel worthy of care? These aspects of the painful experience may, in fact, problematically intensify or normalize these very pain sensations, depending on the intersubjective social and political context within which I find myself [( 4 ), p. 109].…”

“…However, without a detailed sense of how pain manifests in the lifeworld, medical consultation can feel frustratingly generic and detached for patients [( 19 ), p. 3]. Especially in cases of chronic pain, individual painful circumstances shape and color the lifeworld and, in “attending to these complexities of painful experience and associated suffering, a radically different notion of care may emerge as appropriate for each person beyond unsympathetic and clinical elimination of pain altogether” [( 4 ), p. 111]—it is, after all, not always possible for treatment to offer a straightforward “cure,” and the unique significance of chronic pain for the patient must be taken seriously when exploring alternative treatment avenues. Ideally, treatment would respond specifically to the expression of pain for each individual in their particular situation.…”

“…It is interesting, however, that Scarry extrapolates from the impossibility of linguistic expression to claim that pain “brings with it all the solitude of absolute privacy with none of its safety, all the self-exposure of the utterly public with none of its possibility for camaraderie or shared experience” [( 14 ), p. 53]. Certainly, the urgency and aversiveness of painful experiences can underscore the fundamental separation between first and third person perspectives; it is precisely when we most need someone to understand our pain, to care that it hurts us, and to know how to cure it that others “can turn away in disbelief and disregard,” since the pain is ultimately subjective [( 4 ), p. 106]. To a certain extent, if someone tells you their pain is unbearable then you can but take their word for it (or choose to disbelieve); you cannot verify this claim with firsthand experiential evidence.…”

“…As phenomenologists, we are greatly heartened by how these considerations have enriched contemporary debate in the clinical sphere. Having previously argued that it crucially matters how pain is constituted in experience within an intersubjective (social and political) context, and that this affects the very painfulness of a given experience ( 4 , 5 ) we also greet this discussion concerning the shared dimensions of painful experience with enthusiasm. It is similarly heartening to see the biopsychosocial model of pain gaining traction in research and practice as a means to recognize how intersecting biological, psychological, and social determinants all contribute to the overall experience of pain ( 6 , 7 ) and that none of these determinants taken in isolation will sufficiently capture painful experience in its complexity.…”