To Give Suffering a Language

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The resident doctor said, “We are not deep in ideas, imagination or enthusiasm— how can we help you?” I asked, “These days of only poems and depression— what can I do with them? Will they help me to notice what I cannot bear to look at?”

—Robert Lowell, Day by Day ¹

Rational cognition has one critical limit which is its inability to cope with suffering.

—T. W. Adorno, Aesthetic Theory ²

In his book The Illness Narratives, Arthur Kleinman admits that “[c]linical and behavioral science research . . . possess no category to describe suffering, no routine way of recording this most thickly human dimension of patients’ and families’ stories of experiencing illness. Symptom scales and survey questionnaires and behavioral checklists quantify functional impairment and disability, rendering quality of life fungible.” But medical categories, he adds, are woefully insufficient to account for the intimate and inward experience of illness: “[A]bout suffering they are silent. The thinned-out image of patients and families that perforce must emerge from such research is scientifically replicable but ontologically invalid; it has statistical, not epistemological, significance; it is a dangerous distortion.” ³ Unlike the “practitioners who are turned out of medical school as naive realists,” Kleinman’s aim is to delay the naming of the illness, so as to “legitimiz[e] the patient’s illness experience—authorizing that experience, auditing it empathically” (p. 17). What one hears in the patient’s story is “a changing system of meanings” that necessitates at a later stage a disentangling of various narrative strata that comprise “four types of meaning”: “symptom symbols, culturally marked disorder, personal and interpersonal significance, and patient and family explanatory models” (pp. 17, 233).

These layers of meaning in a patient’s narrative are not too different from the complex layers that constitute the “thickness of surface” with “infinitely receding depths” that have been attributed to Sophoclean tragedy. ⁴ In Kleinman’s book, thickness and depth are pervading metaphors to describe the complexity of illness narratives. Their complexity, Kleinman notes, necessitates a fine-tuned reconstruction, analysis, and deconstruction. The clinician-turned-anthropologist, or literary critic, now discovers in the layered textuality of the patient’s illness narrative the four types of meanings mentioned above. Each of these meanings in turn “thickens the account and deepens the clinician’s understanding of the experience of suffering” (p. 233).

Although illness narratives thus evidently have a literary dimension, Kleinman’s pragmatic concerns prohibit the “excessive speculation” of which he accuses psychoanalysts and cultural analysts. Instead, he advocates that “we should be willing to stop at that point where validity is uncertain” (p. 74). If such self-imposed limitations are justified by the urgency of Kleinman’s pragmatism, a literary analysis of illness narratives insists that precisely the point where validity is uncertain should warrant excessive speculation. ⁵ A therapeutic analysis—one that stops where validity is uncertain and forbids excessive speculation—forecloses articulation of just those anonymous bodily processes that constitute the sufferer’s most intimate experience of pain. Concealed in the many-layered linguistic, social, and psychological complexities of illness narratives and their elaborate interpretations lies still, unheard and speechless, the mute materiality of suffering itself.

But if suffering is in the unbearable, silent body rather than in the sharable disembodied language of its narratives, how then can suffering speak? How can one hear the unspeakable? How can one listen without assuming one has understood? Indeed, how can one begin to understand?

What inclines a literary inquiry toward such questions is the very literature it has sought and failed to analyze. ⁶ For literary inquiry attempts to analyze what is lastly irreducible to analysis. And precisely because of this paradox a literary inquiry might help the physician to acknowledge or witness—not to diagnose or to explain—the solitary, secret body in pain. Perhaps the very language of the aesthetic, a language without any meaning other than its own occurrence, might echo the mysterious occurrence of suffering. Perhaps the mystery of art has its origins in the secrecy of suffering, the keeping of which is the purpose of the work of art...