Towards a holistic understanding of pain

Manasa Gopakumar


Siby K George and P G Jung, Editors. Cultural ontology of the self in pain. Springer India, 2016. 288 pages (Hardcover) | INR 6989.0 | ISBN 978-81-322-2600-0.

Cultural Ontology of the Self in Pain, an edited volume by Siby K George and P G. Jung, seeks to release one of the most fundamental concepts of human existence—pain—from the clutches of its reductive, physicalist, and mechanistic understanding in modern medicine. This anthology consisting of fourteen papers follows squarely in the tradition of medical humanities, which aims to provide a holistic understanding of pain and suffering through narratives grounded in diverse cultural and social contexts, thereby fostering a more humane and compassionate attitude towards pain. The uniqueness of this volume lies in its contextualisation of this topic in the social and political history of India.

Heavily grounded in phenomenology and existentialism, this volume conceives of the self as being shaped by social, political, historical, religious, and cultural forces. As against the essentialist and substantivist notions of self that underlie modern medicine, this volume endorses an anti-essentialist notion of self, one where the self is seen as the non-substantial way of being or relating meaningfully to the world. Drawing on the pioneering works of Mark Zborowski, Elaine Scarry, and David Morris, this anthology makes several crucial interventions in the emerging literature on pain. Firstly, unlike the previous literature, this volume does not reduce cultural ontology to mere cultural analysis, nor does it emphasise cultural differences in the experience of pain. Rather, the focus is on the non-substantial self which cannot be culturally neutral, and consequently, on pain experiences shaped by cultural and social forces outside of one’s control. Secondly, the volume highlights the ambiguous nature of pain—while pain is traumatic, harrowing, and aversive in its extremes, it is also inescapable, fundamental, and necessary for being human. At once self-destructive and self-formative, pain is absolutely central to, and yet, disruptive of human existence. This line of thought, along with the emphasis on the positive role of pain in human life, has been pursued in a number of essays in this volume, including those by Siby George, John Russon, Shannon Hoff, Kirsten Jacobson, and Roman Meinhold. Thirdly, this volume is enriched by an interdisciplinary and multiparadigmatic approach as it draws from Buddhism (Russon), Gandhian philosophy (Douglas Allen), ancient and modern western philosophy (Jung), phenomenology (George, Jacobson, Hoff), analytic philosophy (Phil Hutchinson), literature (Daniel M Becker, David B Morris), mythology (Meinhold), feminism (Shefali Moitra), sociology (R Umamaheshwari) and politics (Malem Ningthouja, Parinitha Shetty). It features an eclectic collection of papers on subjects ranging from Buddhism to state sponsored torture. At times, the anthology is diverse to the point of lacking in consistency and continuity, which is understandable, given that this is an emerging field of study. However, the editors have beautifully woven these diverse strands into a narrative. The strength of this volume lies in the fact that it is both interdisciplinary and theoretically grounded, which is, in fact, essential in a volume seeking to diversify the narratives of pain while also cementing a new area of research in the process.

The distinctive feature of this volume is its focus on the socio-political context in India and the different kinds of pain that are experienced in a shared manner in such a context. However, this is also one of the major shortcomings of the volume. As the editors duly acknowledge, the question of caste is curiously missing in the volume. The omission is glaring, not only because there are other papers in the volume that discuss the structural silencing of certain kinds of pain in society (Umamaheshwari), but also because there is an existing and emergent body of Dalit literature and scholarship, bringing to light not just repressed narratives of pain, but also theoretical and philosophical insights on the phenomenology of pain among the Dalits. Caste, nevertheless, finds a shadow presence in Umamaheshwari’s paper on marginalised communities and silenced narratives.

While the volume is a critique of modern medicine’s understanding of pain, the tone is more or less amicable, aiming at supplementing or broadening the medical definition of pain, rather than outright dismissal. This is evident in Meinhold’s paper which suggests looking beyond modern medicine, without denying its curative and palliative powers. An exception to this is the paper by David Morris where the critique of western medicine is at its sharpest. Most papers in the volume also avoid the usual unreflective division between mental and physical pain, which is commendable. The editors, in fact, emphasise the inclusion of shame, guilt, anxiety, trauma, and loss in the notion of pain.

Barring a few flaws, this volume is a thoroughly original, important entry in the field of medical humanities, and would be relevant not just to medical ethicists, but also to philosophers, sociologists, literary scholars, and political scientists as it cuts to the very core of human existence.