Unraveling the Knot of Suffering: Combining Neurobiological and Hermeneutic Approaches

The title of my paper, “Affecting the Body and Transforming Desire,” (Braude 2012a) is inspired from Plato’s Symposium, where the physician Eryximachus presents a purely neurophysiological discourse on love. James Giordano’s and Gerrit Glas’s commentaries on my paper have the timbre of a contemporary symposium, in this instance to discern the nature of suffering. Thus, I take Giordano’s and Glas’s commentaries to be generally sympathetic to my offering, although providing further critical insights that deepen the multidimensional understanding of suffering and the correct ethical and medical response.

From different perspectives both commentators zone in on one central aspect of my analysis, that is, the importance of hermeneutic approaches in the way that medical practitioners deal with pain and suffering. Giordano cites Karl Jaspers to support the idea that effectively treating pain requires both acknowledging the “facts and realities of pain” and translating these into the “therapeutic and moral agency of the clinician in practice” (Giordano 2012, 280). Giordano has written extensively on the neurobiological mechanisms of pain in relation to clinical practice as a hermeneutic exercise. For Giordano, as for me, neurobiology presents a scientific language that is intelligible to clinicians and that sheds light on the ontological and ethical dimensions of the pain–suffering relation. Giordano demonstrates that neurobiology of pain provides important data for the hermeneutic practice of medicine, helping to accentuate the importance of accounting for the subjective, first-person experience of pain by the pain physician. Glas also emphasizes the importance of clinical medicine as a practice that, through hermeneutic means, tries to deal with the alleviation of suffering as a concept that functions as a beacon “at an ever receding horizon” (Glas 2012, 287).

Glas correctly notes that I navigate between the seemingly opposing theses: (1) that the alleviation of suffering is not the primary aim of medicine and (2) that it is not justifiable for doctors to pay no attention to suffering. I adopt here a nuanced position that is also evidenced in Jaspers. On the one hand, as I have elaborated, Jaspers criticized Von Weizsäcker’s totalizing hermeneutic psychosomatic practice that turns all of disease into subjective entities. Jaspers’ insight contrasts with philosopher of hermeneutics Hans-Georg Gadamer who in applying his philosophical hermeneutics to psychiatry extolled Von Weizsäcker’s central concept of gestaltkreis, yet is oblivious to the social and political dangers involved in medicine becoming a purely hermeneutic enterprise detached from its technological elements (Gadamer 1996). Jaspers insightfully argues that it is not sufficient for medicine to concern itself with horizons of meaning to become truly humanistic. In modeling itself on Aristotelian practical wisdom, or phronesis, medicine requires both praxis and techné (Braude forthcoming [2013]).

On the other hand, Jaspers emphasized the importance of physician empathy as a means to understand first-person experience. Through its transformation into suffering, pain is intrinsically associated with the existential search for meaning and the formation of human values. This does not mean that a physician can understand another person’s experience of pain as self-given. Medical practitioners should, of course, be involved in treating pain and alleviating suffering, but should not assume that medical knowledge incorporating hermeneutic approaches will provide full understanding of the nature of suffering—that the entire subjective experience of suffering can be objectively understood.

Giordano’s development of pain medicine demonstrates how technical understanding combined with sophisticated philosophical reflection may enhance patient care. The complexity of pain requires multidisciplinary pain management. The horizon of holistic healing in response to severe suffering requires the incorporation of different narrative approaches that have a bearing on the well-being of patients (Braude et al. 2008). The imperative to seek healing through circles of interpretation, therefore, reinforces the insight that the synthesis of healing and comprehension is an elusive desire motivating hermeneutic healing practices.

My approach emphasizing the neurobiology of pain to assess suffering gives reason for Glas’ criticism that I maintain the Cartesian split between objective facts and inner states. This claim is prima facie correct in that my analysis does follow...