The phenomenology of pain distinguishes localised pain from existential suffering, discusses lived time and empathy, and defines the difference between pain and suffering: what happens when we feel pain? We discuss it, on the occasion of Pain Awareness Month, with Professor Francesca De Vecchi, Full Professor of Theoretical Philosophy and Chair of the Master's Degree Programme in Philosophy of the Contemporary World, UniSR.
Founded by Edmund Husserl at the start of the twentieth century, phenomenology is a philosophical method that investigates how we experience "things" and the meaning they take on for those who live through them.
The starting point of phenomenology is intentionality. The experiences we live are intentional: we perceive an object, remember an event, fear a possibility, suffer a loss. Every experience puts us in relation with something (objects, situations, people, qualitative saliences of the world in which we live) and possesses its own structure. Insofar as it is intentional, every experience is also a way of taking a position toward that something with which we enter into relation. The intentionality of lived experience is therefore characterised by both relationality and positionality.
This perspective therefore turns to the various forms of experience that characterise our personal life: sensory perception, emotional states, the lived body, temporality, encounters with others. It does not replace medical or neuroscientific explanation, because it poses a different question. A clinical examination can identify the site and cause of an injury; phenomenology examines how that injury is lived by the subject, that is, how it "is given" within their experience. The clinical definition of pain has also moved closer to this phenomenological view: in 2020, the International Association for the Study of Pain revised it for the first time since 1979, explicitly including lived experience alongside tissue damage.
This is exactly what makes pain philosophically relevant. Pain appears in the body and, at the same time, modifies how a person feels, based on how that pain is lived. It can remain circumscribed, or take on greater weight, to the point of affecting the meaning we attribute to what we are living through. It is in pain, then, that the physical body, observable from outside, meets the lived body, which each of us experiences in the first person.
A pain in the hand has a precise location. We can point to the spot and distinguish it from the rest of the body; it is, after all, a physical pain. «For phenomenology, experiences of this kind belong to sensory feelings: they are tied to localised bodily sensations and possess a pinpoint character», says De Vecchi.
Hence the distinction between "hurting somewhere" and "feeling unwell." The first answers the question "where" does it hurt?"; the second describes how a person feels as a whole. One can have a pain in the hand and yet, in general, feel well. An intense or persistent pain, however, can go beyond this localisation and affect the subject's overall state.
This analysis presupposes a stratification of experience. At the most basic level are sensory feelings, tied to localisable bodily sensations: a headache, a toothache, a hand injury (the physical pain just discussed). A further layer holds vital feelings, such as exhaustion or a diffuse malaise that no longer points to one precise spot.
Personal suffering concerns a further layer still: the meaning attributed to one's own experience and, more deeply, to one's own existence as a whole. It does not coincide with a passing unease caused by tiredness: it affects how a person understands and confers meaning on what they happen to live through, managing to find their bearings within their own life. In certain psychopathological conditions, including depression, this very capacity can break down. The world appears devoid of meaning to the person, lived experiences become devoid of sense, and the intentional relation between the intending subject and the world is modified.
Physical pain and personal suffering must be distinguished, yet they can intertwine. The same injury takes on a different weight depending on the person and the situation. A hand injury has particular consequences for a pianist on the eve of a concert, because it touches directly on their profession and their plans. The sensory intensity of the pain alone cannot explain the meaning conferred on that experience.
De Vecchi sums up the point: «the question is the meaning we give to the experience we are living through: the weight, the relevance of what we live through, and how we respond, that is, the position we take toward it». This response does not follow the linear model of a cause producing an effect. What comes into play are what phenomenology calls motivational connections: relations of sense that make it possible to understand how a person responds to what they happen to live through.
Time seems to change when we are in pain. The minutes measured by a clock keep the same duration, but they can feel endless. This is lived time, distinct from quantifiable time: De Vecchi invokes Henri Bergson's durée, the "duration" that indicates a temporality grasped from within, one that cannot be reduced to a sequence of identical units. Pain absorbs the present and narrows the horizon of experience; the wait for it to end can make it feel even more burdensome. Part of this experience is passive: if someone steps on our foot, we cannot choose not to feel pain. «What differs is how the mind returns to that pain, dwells on it, or connects it to other experiences», De Vecchi clarifies. This does not mean the person suffering is responsible for their own suffering; rather, painful temporality depends both on what the body imposes and on the relevance that event takes on in a person's life. It is a different kind of dilation from the one neuroscience describes when studying time perception, yet just as real.
The boundary between my experience and someone else's calls on the subject's capacity for empathy. «One cannot live another person's physical pain in the first person», the Professor points out. Phenomenology distinguishes empathy from identification or emotional fusion. Edith Stein, the philosopher who devoted her first philosophical research to empathy in 1917 (Zum Problem der Einfühlung), understands it as access to another's experience as such, that is, as another's experience: «empathy is grasping the lived experience of another: it is an experience lived in the second person», De Vecchi explains.
I can see a wound, blood or inflammation through sensory perception. I empathise, however, when I grasp that body as a living body, belonging to a subject who feels. Stein holds that a form of empathy is possible even for physical pain, because human bodies share a structure, a "general type" of which each body constitutes an individual exemplification. Max Scheler, another major phenomenologist, takes a different position: to understand another's pain, we would have to reproduce it in the first person, but in doing so we would feel our own pain, the pain we would feel if we were in that situation, not the pain the other person is living through now. Their overall state remains accessible, though, together with the personal meaning their suffering has taken on.
Empathy does not work like a switch that turns on or off. Instead, it is characterised by different degrees of fulfilment, and works best when we grasp the meaningful connection between what a person feels and the situation that motivates that lived experience.
This also holds when we empathise with a character in a novel or a film. That character belongs to a different space and time from our own, but the precision with which a work renders their world can let us grasp the unified sense of their suffering.
Pain calls for treatment, attention and solutions, but a diagnosis does not exhaust everything that happens to the person who suffers. Their relationship with their own body, the time that seems to dilate, and the meaning that experience takes on all still need to be understood. Treating pain is a medical act. Understanding it also draws on psychology and philosophy. That is why the phenomenology of pain does not replace a clinical diagnosis: it completes it.