gain, again, I apologise for the lack of updates (and for the long ones when they do come!). But herewith the final section of Chapter 1, plus, as an added bonus, the conclusion.  In some sense, Robert, this may to towards answering your questions about Levinas, and about my work. My concern is that, no, I don’t think we do ‘share’ the things that you list in the sense that we could then know the other’s suffering. Hopefully the critique of Frank here will help to make this point clearer. The writing-up, if anyone is interested, is inevitably slower than I would like. If I didn’t have to move house in the middle of all of this, I would probably be doing substantially better than I am! But, nonetheless…

The ethical response, for Levinas, is quite clear: it is com-passion. Compassion may sound deeply problematic: a number of those involved in discussions of best healthcare practice have discussed the similarities and differences between empathy and sympathy (see, for example, Hojat et al 2001). I want to set aside existing discussions of these two for the moment, and instead discuss the distinction we might derive from a Levinasian ethics, between empathy and compassion, based on their etymologies. The word ‘empathy’ comes from the Greek, and is taken from em, which means ‘in’ and pathos, which means ‘suffering’ (or sometimes more loosely ‘feeling’). This evokes, I want to suggest, a subject placing him or herself in the shoes of the suffering other. This is thematising response to the other, which is thus no response at all, because it supposes a form of feeling that involves the subject supposing that he or she knows what the other is experiencing. This suffering-in-the-other, then, involves the subject’s construction of the other as knowable. The response given in such a situation responds, then, not to the radical difference of the other, but rather to the subject’s supposition of what the other is, or, more dangerously still, what the subject supposes the other ought to be.

This is, I want to suggest, precisely the grounds for the limited response that Frank has towards the woman with ugly feet: he can, perhaps, understand the benefits of her surgical modification, but he refuses to sincerely believe her when she claims to be suffering. This claim to know the other is, precisely, the presumptive gesture of unethical empathy. Alterity remains beyond representation, and beyond knowledge; and this, in order to be ethical, is what the subject must respect. Yet although Frank is all too willing to recognise some forms of suffering, which fit within his understanding, others are denied. Worse, the suffering of the woman who believes she has ugly feet is reduced to nothing more than a social indicator, a means to the end of critiquing a particular cultural configuration (technoluxe). For Frank, it is precisely the otherness of this woman’s suffering that is so difficult to understand. This difficulty in understanding is, in some sense, precisely the response the subject must always have to the other, who remains never-fully-graspable. Yet in presuming that there is some underlying commonality between them, or that there ought to be (a position doomed to failure precisely because she is an other) he does violence to her suffering, and indeed, to her.  It is not that Frank is intentionally unethical; far from it, it is, indeed, his awareness of broader political concerns which produces this effect. In his haste to find a guideline for who should be given surgery, he effaces the otherness of the other by forcing a thematisation of suffering.

The danger of responding in this way lies partially in the unethical presumption to know the other, and partially in the danger of engaging in theodicy, in all its dramatic secular forms. Levinas offers the following as expressions of theodicy which regularly go unnoticed as such. He argues that suffering is regularly made to carry a variety of meanings:

the meaning of pain that wins merit and hopes for a reward… Is it not meaningful as a means with an end in view, when it makes itself felt in the effort that goes into the preparation of a work, or in the fatigue resulting from it? [Or playing] the role of an alarm signal manifesting itself for the preservation of life against the cunning dangers that threaten it in illness… [Or again,] suffering appears at the very least as the price of reason and spiritual refinement. It is also thought to temper the individual’s character. It is said to be necessary to the teleology of community life, when social discontent awakens useful attention to the health of the collective body. Perhaps there is a social utility in the suffering necessary to the pedagogic function… [S]uffering, undergone as punishment, regenerates the enemies of society and humankind? This political teleology is founded, to be sure, on the value of existence, on the perseverance in being of society and of the individual, on their health, taken as the supreme and ultimate end (Levinas 1998, 95).

What is held in common between these various forms of theodicy is the attempt to make suffering somehow meaningful. Yet every meaning thus offered is the beginning of a justification, Levinas argues, because in making ‘pain henceforth meaningful, [it is] subordinated in one way or another to the metaphysical finality glimpsed by faith or belief in progress’ (Levinas 1998, 96).  It is precisely such a subordination that permitted the Holocaust to occur; this was ‘the exasperation of a reason become political and detached from all ethics’ (Levinas 1998, 97). It is theodicy which permitted the subordination of the suffering of Jewish people, homosexuals, people with disabilities and many others, to the sought-after ends of Nazism: a pure race.

It may, indeed, seem laughable or offensive (or even both!) to set the suffering of individuals during the Holocaust alongside the suffering of the woman with ugly feet; in many respects, this is ludicrous, if we suppose that suffering is always and everywhere the same, that the two experiences are always straight-forwardly comparable.  Yet suffering is always unique, as Levinas has demonstrated, and the ethical responsibility to the suffering other always absolute. To begin to draw distinctions between “worthy” and “unworthy” suffering is not only to thematise it, but to enter once more into theodicy and the justification of suffering. Levinas argues:

But does not this end of theodicy, which imposes itself in the face of this century’s inordinate trial, at the same time and in a more general way reveal the unjustifiable character of suffering in the other, the outrage it would be for me to justify my neighbour’s suffering?… [T]he justification of the neighbour’s pain is certainly the source of all immorality (Levinas 1998, 99).

What I take Levinas to be indicating here is that entertaining theodicy, in the form of justification for suffering at any point is problematic. The very supposition that suffering can be permissible in any circumstances produces and reproduces suffering as something that can be justified; further, it produces a political setting within which justifications for suffering may be offered. This in turn allows politics and reason to be ‘detached from all ethics,’ rather than being the means by which ethics is sustained and indeed, made possible.

This is the risk of Frank’s positioning of rational, ‘Socratic,’ dialogical ‘form of decision-making we respect’ (Frank 2004, 26) as the sole means by which someone may achieve relief from suffering. Quite aside from the homogenising implication that there is only one form of decision-making which it is possible to respect, the Levinasian question is, what does Frank’s suggestion allow to be justified? The way is opened for two problematic outcomes: on the one hand, such a method may suggest that certain people who claim to be suffering ought not to do so, and thus that their suffering does not deserve the response they seek, clearly contravening the imperative of ethical responsibility that Levinas describes. Second, it does indeed allow a means by which suffering is made justifiable. I have much sympathy with Frank’s concern to ensure the justice of the distribution of medical resources. However, to engage in secular theodicy in order to ensure this justice creates a political imperative which recognises some people not just as undeserving of medical treatment, but as suffering in the first place.  In this respect, politics actively undermines ethics.

Frank’s attempt, here, to provide a framework by which the relief of suffering may be assessed retains, I want to suggest, an implicit allegiance with medicine. Indeed, Frank’s rhetorical question is quite telling: ‘if having unfashionable toes counts as humiliation, in what words can we describe the lives of people living with massive facial deformities?’ (Frank 2004, 22) What Frank is relying upon here is the reader’s implicit agreement that suffering must necessarily follow upon massive facial deformity. I will discuss this issue in some detail in chapter three; however, at this stage, I want to point out that Frank is here deploying a hierarchy of bodies, in which the most normal is expected to suffer least, and the most abnormal is expected to suffer most; when such expectations are foiled, this can result in a denial of suffering. This is because the implicit hierarchy of bodies is constituted, then, in relation to the norm; a norm supposed to have been “discovered” through the objective sciences of statistics and medicine. Thus we are returned us to the issue of subjectivity and objectivity: Frank’s ability to claim that the woman’s humiliation over her ugly feet is merely ‘an inflation in the language of pain’ suggests that there is an objective assessment of her body that counters her claim to subjective suffering.

Medicine thus provides the model by which this woman’s suffering may be diminished or even dismissed. Indeed, this reveals that the subjective/objective distinction in medical techniques of diagnosis is bound up with an unethical presumption to know the other’s suffering. In an echo of Canguilhem and Cassell, then, Levinas provides the means for a critique of medicine from medicine’s supposed origins: ‘[The call constitutes an o]riginal opening toward merciful care, the point at which… the anthropological category of the medical, a category that is primordial, irreducible and ethical, imposes itself’ (Levinas 1998, 93).  In this respect, medicine’s attempt to treat pathology rather than suffering functions not only against its own legitimating claims, but against its own nature. Medicine, then, plays a key and problematic part in the secular theodicy of allowing only the suffering understood “objectively,” or, more accurately, understood common-sensically, to be recognised. It should be noted, however, that some forms of medicine are more willing to take suffering such as that articulated by the woman with ugly toes seriously; after all, she did have surgery. Yet even such forms of medicine attempt to maintain the subjective/objective distinction; as will be discussed in chapter three, this may even involve the “discovery” of a new pathology in order to ‘justify’ suffering. Maintaining the subjective/objective distinction ensures secular theodicy precisely because there is always a means by which suffering and the response it demands may be refused; for example, as Cassell puts it, ‘if no disease is found, physicians may suggest that the patient is “imagining” the pain, that it is “psychological” (in the sense that it is not real), or that he or she is “faking”‘ (Cassell 2004, 35). (Recollect Frank’s ‘inflation in the language of pain’ as an example of this logic at work in lay discussion, too.)

Frank’s framework, however, owes something more than the hierarchy of bodies to medicine: he presumes that medical “cure” as the sole means by which we can ethically respond to suffering. The ethical response is a necessity, but what Frank presumes without even considering it is that medical cure is the only possible answer. The centrality of medicine to this discussion is remarkable, and indicative, I would suggest, of a far more sinister logic. It takes the individual’s suffering as a starting-point, presuming that the individual who suffers simply does so neutrally, naturally, or precisely because of some ‘ontological perversion’ (Levinas 1998, 95) that must be righted. Here is the danger of medicine’s equivalence of suffering with pathology, and of the attempt to making objectively knowable what is not simply subjective but alterity (and thus ungraspable). It leaves uninterrogated the dovetailing between suffering and abnormalcy, which is implicitly what allows Frank’s (against implicit) distinction between suffering worthy of “cure” and suffering that ought not to seek resolution in the first place-that ought not to exist. In all of this, the extraordinary sway that normalcy has in the forms of ethical and political (not to mention medical!) responses made to suffering remains uncritiqued. This will be discussed in more detail throughout this thesis, but at the moment, I simply want to mark that the various forms of medical treatment Frank considers are all normalising. His focus on the suffering individual echoes the position of science in that he treats them, somewhat paradoxically, given his analysis of Bourdieuian “field” and his awareness of the effect one person’s surgery may have on another, as if they occurred ex nihilio. The situatedness of the subject may in fact play into their experience of suffering escapes attention; a situatedness, I would suggest, which is fundamentally bound up with the politics of normalcy. Frank’s conception of justice, then, may be aware of the effect of one person’s modification of their body on those around them, but does not consider either that their suffering may be part of their construction within a context; nor does he explore the possibility of intervening in, rather than simply reiterating or refusing to reiterate, conceptions of normalcy. It becomes ethically questionable, in such a context, to hold an individual responsible for his or her own suffering.

Empathy, then, creates a dangerous assumption that the other is knowable, and even that she or he is like me, which can wind up in theodicy and the problematic of a political system which permits the justification of suffering. Levinas’ counter to such a position is compassion (derived from the Latin com, or “with” and pati “to suffer”) is a suffering-with, rather than a suffering-in. It is a suffering-for-the-suffering-of-the-other.  Levinas describes it thus:

the suffering of suffering, the suffering for the useless suffering of the other, the just suffering in me for the unjustifiable suffering of the other, opens suffering to the ethical perspective of the inter-human. In this perspective there is a radical difference between the suffering in the other, where it is unforgivable to me, solicits me and calls me, and suffering in me, my own experience of suffering, whose constitutional or congenital uselessness can take on a meaning, the only one of which suffering is capable, in becoming a suffering for the suffering… of someone else (Levinas 1998, 94).

In this then, Levinas demonstrates that the ethical response to suffering is suffering. But rather than a suffering which is turned inward and thus causes meaning to drain away, this suffering has a meaning; the pre-originary meaning of being-for-the-other. Compassion is ethical because it does not presume to know the other’s suffering, but responds, affectively, to the call of the other. That is, it must not deny the other’s alterity by attempting to fully know or thematise suffering, particularly by attempting to make it useful. Rather, ‘for pure suffering, which is intrinsically meaningless and condemned to itself with no way out, a beyond appears in the form of the interhuman’ (Levinas 1998, 93); that is, a ‘beyond’ in the relation engendered through the subject’s response. This allows the ethical relation to be opened once more, and thereby sapping suffering of its meaning-destroying power. Indeed, in recommending the form of response to a suffering person, Cassell reiterates Levinas, writing that, ‘the first step in restoring intactness is… to reach out to the suffering person to bring him or her back’ (Cassell 2004, 287). This ‘bringing back’ is the institution of the ethical relation such that the world becomes an assemblage of meaningful, useful data for the other once more. Suffering-with, then, is ‘compassion, not explanation’ (van Hooft 2004, 17): it neither intends nor functions to render the other’s suffering knowable, but simply to suffer alongside the other, in response to him or her, and thereby prise open the isolated passivity of his or her suffering. The subject’s response (arising from responsibility) then, is a suffering-with; to recall, the response to the other is the foundation of their very subjectivity. In compassion, a distance between subject and other is permitted by the ethical non-thematisation of the other such that the ethical relation which allows the other to be other is engendered; in contrast, empathy presumes that this spacing does not exist, and thus closes down the possibility of response, and in turn the possibility of opening the suffering other out to the meaningfulness of the ethical relation is lost.

Conclusion

Suffering, it is clear, holds a deeply contentious place in contemporary society. It demands a response, a response often thought to be provided by medicine and politics. Yet Levinas’ ethics demonstrates that suffering demands a response from the subject before there is any possibility of negotiating, thinking, reasoning our way around, in or out of that responsibility. It is in responsibility that I am brought into the possibility of meaning, even as the other exceeds my capacity to know and to name. In light of this, medicine’s scientific desire to render suffering back up as an objective matter is already unethical, already in denial of the unique experience of the other.  Indeed, this gesture echoed by van Hooft and Edwards, in a perfect demonstration of the extent to which medicine has insinuated itself so thoroughly as the best form of response to suffering: to such a point that the bioethical examination of suffering is performed almost entirely in order to supplement medical intervention, presupposed to offer the best cure. Yet as Cassell points out, the refusal to critique the subjective/objective distinction is what produces medicine as unable to negotiate with the complex weave of different elements at play in suffering (as well as in ‘personhood’), such that medicine fails its stated and legitimising goal: the alleviation of suffering.

Yet as my discussion of Arthur Frank has made clear, there is another problematic aspect of assuming that the other’s suffering can be made knowable. This can be the grounds for what Levinas names as a secular form of theodicy, when some forms of suffering are made justifiable, even politically positive. These forms are presumed to somehow escape the ethical imperative of response, because they are subordinated to political ends. Frank’s response to the woman with ugly toes who claims her humiliation was sufficiently painful that it required cure remains ambivalent: he either believes that she suffers but that she ought not, or that she is indulging in an ‘inflation in the language of pain.’ Either constitutes an attempt to set aside her suffering as a form that need not be responded to, and indeed, ought not to be responded to, because the medical cure (which, it is implied, is the only possible response) might detract from other, worthier forms of suffering. This is a politics which, according to Levinas’ formulation, has lost its way: the inevitable violence of comparing the incomparable has given way to a politics which requires that some suffering remain unrecognised or at any rate not cured, in order that some greater purpose-in Frank’s case, the just distribution of medical resources-may be achieved.

The contextual specificity of suffering has been gestured to by this account, but I have also suggested that Frank fails to fully engage with the thoroughly contextual experience of the subject. I have begun to suggest that making sense of this contextually-derived experience, we need to examine the hierarchisation of bodies through the concept of normalcy, and the effects of this on an individual subject. Indeed, whilst medicine supposes itself most often to be treating the body, a thorough engagement with bodily being has been perhaps somewhat paradoxically absent from the discussions of suffering explored in this chapter. Even granted Cassell’s willingness to challenge the distinction between subjectivity and objectivity, and its homologue in the dichotomy between mind and body (Cassell 2004, 31), he nonetheless fails to fully engage with embodiment. And whilst I do not think that Levinas intends to invoke a disembodied subject, it is nonetheless clear that suffering poses a distinct problem for consciousness, in his discussion, and specifically for consciousness’ meaning-making capacity. Bodily being remains underconsidered; and specifically, the relation between bodily experience and the context within which the subject occurs has not yet been sufficiently considered. In the next chapter, I will begin the task of elaborating a theory of suffering which engages with the subject as embodied, thereby challenging the Cartesian dualism of mind/body, as well as the dichotomy of self/other. Thus, through a consideration of Merleau-Ponty’s phenomenology, I will explore how and why the embodied subject and his or her experience of suffering is produced in and through being with others, and within a context.

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