365betÓéÀÖ

Dr. WARREN MATTHEWS
Old Dominion University, U. S. A.

In recent years there has been a stir in the wide field of philosophy among some philosophers who have been concerned with particular areas of humans making decisions. One of the earlier areas of concern, shared with other disciplines as well, was that of the human experience of death and dying. Developing during the same period, although somewhat later, was the whole field of biomedical ethics. These areas of investigation have taken on a spirit of urgency in as much as new technologies and techniques have been making possible many procedures of initiating, prolonging, or terminating human life which go beyond the possibilities recogniz­ed by traditional laws. The whole field of applied ethics has been stimulated to explore what ought to be done to bring laws and policies up-to-date so that new technical developments can be related properly to new perceptions of human beings about their continued being and well-being.

A third area of concern is beginning to emerge alongside of the first two. It is the area of philosophies of suffering and healing. It arises out of the realization of health professionals and philosophers that suffering and healing are open to more philosophical approaches than might have been commonly employed in this century. The internist, the surgeon, and the psychiatrist each has had a slightly different way of analyzing and understanding suffering and healing. But each has assumed that his way is scientific, opposed to the ancient and medieval attempts which were likely to incorporate a vast amount of unproven authority and even spiritual or mythological concepts. A kind of rigid material­ism has often been seen as the only reliable philosophy to be used in the understanding of pain, suffering, and healing. On the other hand, medical language continues to carry in some of its examples a kind of Cartesian dualism of body and mind. Without disparaging in any way the remarkable progress which has been achieved, I would simply point out that other philosophies of suffering and healing are now being explored, and that through them additional benefits might be extended to humans!

The analytic, function of philosophy has a considerable con­tribution to make in clarifying some of the traditional concepts in suffering and healing. For example, what is pain and what is suffering? Is suffering always present when there is pain or is pain always present in suffering? If pain is not always beneficial, are there conditions where suffering has a positive role to play? My explorations with Dr. Frank Marsh have only scratched the surface, but we have found that the questions are much more complicated than tradition has supposed. It is a field of terms ripe for exploration by philosophers in language analysis.

While the questions of what pain and suffering are and what means are available for healing human suffering remain, there is also a very important question of whether human suffering can be understood. For the question which nearly every human being asks when one suffers is, “Why is this happening to me?� The question may have a clear answer in terms of empirical analysis. The sufferer may hear the answer from the scientifically trained medical professional and still continue to ask a question which the medical professional probably will not venture to answer, at least not as a medical professional. Why must I suffer? What is the purpose of suffering? What have I done to deserve? What is happening to me?

The healing function of medicine, in scientific medicine, has traditionally been separated from spiritual or religious philosophies of life that have been traditionally employed to answer these questions, While retaining the serpentine symbols of Aesculapius, modern health professionals have separated their healing procedures from the ancient temples. And yet, when it comes to providing suffering human beings with the answers they seek as to the meaning of their suffering, answers which patients want in addition to the traditional scientific medical explanation, the health professionals have most often been eager to pass along the problem of answering to the religious professionals. The problem of explaining the meaning of suffering, meaning beyond a materialistic, empirical answer, has been left, even until today, to the various religious philosophies of the world.

In these religious philosophies one finds a wealth of resources. Rather than one answer, one finds a whole spectrum of answers, not only among the several major religions of the world but also among the rich variety of views within each of those religions. These systems of thought have been analysed seriously for centuries, and especially in the last century and a half. Yet, there is an opportunity at this time for a fresh analysis of these spiritual systems to examine the resources they can provide in answering questions pertaining to the ways human suffering can be understood.

In such a brief time it is not possible to do justice to the richness and variety of answers offered by the religious philosophies of the world. But it may be possible to give a few general observations, which, although the, bear a strong stamp of subjectivism, may stimulate other investigations of their possible contributions to this field. It is my purpose in this outline to stimulate appreciation and discussion of what these religious philosophies may have to contribute, and my purpose is not at any time to slight, denigrate, or malign any of them.

Speaking of the tradition with which I am most familiar, that of the Judaa-Christian, it seems to me that one striking feature in the explanation of human suffering is spiritual-moral. In ideal form, separation from God is the underlying explanation of human suffering. But this ideal form is often lost by general practice which explains suffering more in the specific terms of moral offence. To be more clear, the common answer for sufferers is one advanced by the visitors to the classic man of suffering, Job. A person suffers because that person has made a choice of action which violates a law, which carries a penalty. One has exercised one’s power of choice in such a way as to offend God by violating a law which God has made to prescribe or proscribe human con­duct. Of course, in this philosophy, one is responsible for one’s own suffering, even though one may not be sure what offense one has committed. Although I am much less familiar with Hindu philosophy, it appears to me possible for one to see part of the meaning of the law of Karma in this moralistic interpretation what one gets in life is determined by one’s moral choice in this or some prior life. Perhaps this moralistic view of suffering is not entirely absent from any religious philosophy; at least, that is an idea to be explored.

The moral interpretation of suffering is not, however, the only one offered in Judaa-Christian thought. Job, for example, challenged the simple moral explanation of his suffering offered by his visitors. Christians challenged the explanation of the suffer­ing of Jesus as being due to his moral faults, or sin. In both accounts, of Job and of Jesus, other explanations of the meaning of their sufferings are preferred. Job’s answer in the poetry section of the book is that God’s reasons, in his depths of wisdom, are past human discovery on understanding. Human wisdom would seem to lead to the conclusion that suffering is to be borne by human in humility, assuming that although their pains and suffering make no sense to them, their pains and suffering do have a purpose to God’s deeper understanding of his purposes. Early Christians saw the suffering of Jesus as necessary, not due to his moral defect, but in order to bring healing to other sufferers. His suffering helped them because his perfection did not deserve the suffering which he voluntarily took upon himself from other humans.

Two other Christian writings from the earliest centuries present the explanation that suffering, although not desired by human beings, serves to benefit them. The writer of Hebrews argues that suffering is a kina of discipline sent by God to train his children. Far from showing God’s disregard for human welfare, it is the discipline which every father who loves his son will administer. The church father Irenaeus similarly concluded that God’s purpose is not simply to provide a comfortable cage for pets but to educate his children so that they grow in knowledge. Suffering, then, is explained as a part of a discipline in education which prepares the sufferer for the greater things that God has in store for him.

It seems to me that from what I understand about the Buddhist he had an explanation for the meaning of suffering which is somewhat different from the spiritual or moral ones already presented. His view, which is so attractive to man, people of the world, located the explanation of suffering in the desires of the individual. St. Augustine found suffering due to humans making a mistake in what they desire, preferring inferior things to superior things. But Buddha found the explanation in desire itself re­gardless of what is desired. Certainly there is a line of reasoning which deserves careful exploration al one tries to understand the meaning of human suffering.

In terms of personal experience, I am much less familiar with the various kinds of practice today in Confucianism and Taoism. And yet in the general impressions which I have of their early teachers, I find still different philosophies to explain the suffering of human beings.

My impression is that Confucius understood the meaning of human suffering in terms of social relationships. Somehow, if social relationships were kept in proper priority order, much of the suffering which afflicts mankind could be avoided. If subjects were in proper relationship with the ruler, if husbands and wives were properly related, parents and children as well as siblings, all properly related, then human suffering would be reduced consider­ably. Perhaps that understanding can be treated as a kind of spiritualism or a kind of morality, but it seems to me to be a different philosophy, although a priority in relationships is not entirely absent from Judaism or Hinduism. There is much in psychiatry to suggest that disorganization in groups contributes to much suffering, both psychical and physical.

The concern that many peoples of the world have today about the human suffering which is caused by environmental pollution may well increase interest in the early teachings of the philosophy of Taoism. The theme which I find there that is stimulating to pursue is that suffering comes about due to man’s being out of harmony with nature. If the human body were brought into tune, into harmony with nature, then much suffering which is now experienced could be avoided. The renewed enthusiasm today in the practice of holistic health seems to operate on a philosophy of suffering which is akin to this early form of Taoism.

Time does not permit the mention of every existing religious philosophy. Nevertheless, I should like to mention one more which seems to me to offer an insight which ought to be included. One impression I have of Shinto is that it offers, among other views, the one that pain and suffering are not necessarily the greatest evils that can befall a human. Physical suffering is less dreadful, for example, than breaking faith with one’s ancestors, or breaking faith with one’s family or country. Shinto is a reminder that pleasure and pain cannot be labels simply equated with desirable and undesirable.

In this discussion of understanding the meaning of human suffering I have mentioned primarily religious philosophies which offer explanations. In my culture, and perhaps in most others, even the healing professionals with scientific training are usually relieved to delegate to others the explanation of the meaning of suffering, when it comes to trying to comfort a suffering patient.

On the other hand, philosophers who like to operate outside of religion are aware that other philosophies which are essentially non-religious have also come to grips with the meaning of suffering.

Epicurus, 341-270 B. C., I believe, has suffered from a bad press. His own pain with kidney stones gave him adequate reason to develop a philosophy of suffering. He is well-known for his advice to avoid pain and seek pleasure. But he saw pain and suffering in naturalistic terms, aside from any question about the existence of gods. Pain and suffering are conditions which exist in conscious persons. Consciousness goes with a certain configura­tion of atoms falling and swerving in the void. As long as one is conscious, or alive, one tries to live so as to avoid pain. But there is no reason to have great fear or worry about suffering, for it does not continue once the atoms disintegrate and go their separate ways. Pain and suffering are human experiences of conscious persons. Death is the end of that kind of experience, as it is the end of consciousness.

The atom today is no longer considered indivisible. It is not a crude mechanical component that would fit the mechanistic materialism of Descartes, who thought he had to place a ghost or non-physical mind in a body to move the mechanism. My own conversations with physicists about matter gives me the impression that their concept of matter contains dimensions which are closer to the nature of ideas than to the physics of Descartes. In other words, the concepts of physical matter today, although they have a physical side in that an atom of uranium can be “seen� in a microscope, and particles do leave tracings on photographic plates, the nature of parts of atoms functioning in electro-magnetism may be as close to the idealism of Berkeley or of Royce as to the materialism of philosophers who, after the writings of Darwin, rejected metaphysics for empirical inquiries alone.

What I am suggesting is that it is now possible to develop a revised concept of naturalism which incorporates both the world seen by the traditional materialists and by the traditional idealists. The world ofappearances is the empirical world, and the real world is a world of concepts and ideas, not directly empirical, yet ultimately subject to empirical or pragmatic tests for truth.

The revised naturalism would be of considerable help in medicine, for it would allow a metaphysics that would permit the overcoming of separation between physical illnesses and mental illnesses. Illnesses would be human illnesses, in that there is where they are experienced. On the other hand, human beings would be seen as a part of the total environment, not different in basic material from any other materials in the universe.

Pain and suffering would be interpreted in a frame of reference of revised naturalism. Since matter would include those dimensions that traditionally have been considered “mental� or “spiritual� the health professional could legitimately deal with questions on the meaning of suffering. The health professional would not necessarily have to separate physical, mental, or spiritual concerns into isolated compartments but would be able to present them all part of one whole picture bearing on the total health of one whole person in one whole environment.

As one example of the implications of my hypothesis, I would cite the article “A Systems Approach to Suffering and Healing,� by Howard Brody, M. D., Ph. D., of Michigan State University. He argues that the optimum of healing occurs in what Engel has called a biopsychosocial model of medicine rather than in a reductionistic biomedical model. Traditional medicine, he says, asked biomedical questions about symptoms. With behaviour sciences added to their practice, physicians asked patients how they felt about their illnesses. Now one must ask what the patient thinks about his illness. (Here Dr. Brody cites the powerful effects of placebos, dependent upon the patient’s thoughts.) As a part of this system of approach, Dr. Brody sketches a hierarchy from atoms to molecules, cells, organs, the person, family group, organiza­tions, societies, homo sapiens, and the Biosphere. What I have suggested about a new naturalism begins at the lowest step, but it is included at every higher step of the system or hierarchy.

Dr. Brody does not rule out biophysical medicine. Neither do I rule out traditional spiritual or religious answers to the meaning of suffering any more than I would the psychological. I do not imply that the physician, the surgeon, or the psychiatrist or the theologian or nurse is expendable. On the contrary, all of these have a place in a patient’s understanding the meaning of his suffering and, also in his healing. Indeed, family, fellow employees, the community, and the natural environment also have a place.

What I am suggesting is that with a revised materlaism, a revised naturalism, which it seems to me is not out of line with contemporary physics on the nature of the atomic structure of the universe there is a new basis for co-operation, a common understand­ing of the nature of universe. Philosophy and religion are not, then, excluded from scientific medicine, but philosophy, religion, and medicine can pool their insights to help the suffering person understand his suffering, and, perhaps, ultimately overcome it.

[Full text of the lecture delivered at the conference of Neo-Platonism held at Madras in January last under the auspices of the Swadharma Swarajya Sangha.]