Notes on a Theology of Suffering

Introduction

To say that the problem of human suffering is one of the most incorrigible difficulties of our lived experience is to trivialize it. The problem of suffering and its close cousin, pain, raises the kind of questions which have kept many a philosopher and theologian awake at night. More profoundly, the experience of suffering and its sometimes attendant pain has wracked the body and soul of mortals since the Adamic fall.

Tackling the problem of suffering is a daunting task. Who is equal to the task of explicating its nature, explaining its causes, and ameliorating its distress? I would like to offer the following discussion as a way of beginning our conversation on this topic. While I do not claim that my discussion is in any way comprehensive, I could hope that it would at least provide a suggestive treatment of the important aspects of a theology of suffering.

The Problem of Pain

Suffering may be painful and pain may cause suffering, but one is not identical with the other. Cornell University Medical College clinical professor Eric Cassell puts it, “Although pain and suffering are closely identified in the minds of most people and in the medical literature, they are phenomenologically distinct.”1 It is difficult, if not impossible, to provide a satisfactory definition of pain.2 Pain is not something we define, it is something we feel, something we point to (“that hurts”), and something we sometimes fear. In her modern classic, The Body in Pain, Elaine Scarry observes:

For the person whose pain it is, it is “effortlessly” grasped (that is, even with the most heroic effort it cannot not be grasped); while for the person outside the sufferer’s body, what is “effortless” is not grasping it (it is easy to remain wholly unaware of its existence; even with effort, one may remain in doubt about its existence or may retain the astonishing freedom of denying its existence; and finally, if with the best effort of sustained attention one successfully apprehends it, the aversiveness of the “it” one apprehends will only be a shadowy fraction of the actual “it”). For the person in pain, so incontestably and unnegotiably present is it that “having pain” may come to be thought of as the most vibrant example of what it is to “have certainty,” while for the other person it is so elusive that “hearing about pain” may exist as the primary model of what it is “to have doubt.” Thus pain comes unsharably into our midst as at once that which cannot be denied and that which cannot be confirmed.3

Pain is an interior state of consciousness. Whether physical or psychical, it hurts, it aches, it burns, it crushes, it throbs, it pounds, it sears, it stabs. Moreover, pain is idiosyncratic. Despite my best efforts, I cannot “feel your pain” or know how your pain feels. I might be able to discuss it by analogy (does it feel like a headache in your leg?). I might be able to approximate its intensity (does it hurt worse than burning your finger on a match?). I might be able to quantify its duration (has it hurt for more than a week?). Nevertheless, pain is a singularly personal, subjective experience, known fully only by the one who is experiencing it.

While the evidence indicates that we are not doing a very good job of controlling pain,4 especially for some sorts of illnesses such as metastatic cancer, pain is almost entirely controllable. According to several studies, in approximately 90 percent of cancer patients, pain can be controlled through relatively simple means.5 Moreover, a consensus statement from the National Cancer Institute Workshop on Cancer Pain concluded that “…every patient with cancer should have the expectation of pain control as an integral aspect of his/her care throughout the course of the disease.”6 In fact, says Edmund Pellegrino, “With the optimum and judicious use of [pain management techniques], there are virtually no patients whose pain cannot be relieved.”7

Yet there is a difference between pain and suffering. Anyone who has ever gotten a paper cut knows that it hurts; but hardly anyone seriously says he or she “suffers” from a paper cut. While childbirth, I’m told, can be immensely painful, few new mothers describe their ordeal as suffering. So, what is our account of the difference between pain and suffering?

The Nature of Suffering

Eric Cassell argues that pain grows closer to suffering when: (1) the pain is so severe that it is virtually overwhelming, (2) the patient does not believe that the pain can be controlled, and (3) the pain continues for a very long time so that it seems that the pain is endless.8 “In sum,” he says, “people in pain frequently report suffering from pain when they feel out of control, when the pain is overwhelming, when the source of the pain is unknown, when the meaning of the pain is dire, or when the pain is apparently without end.”9

As with pain, “The only way to learn whether suffering is present is to ask the sufferer.”10 Suffering may take many forms, from psychological to social and from spiritual to political. What seems to be a defining characteristic of suffering is that it violates one’s integrity as person. The self is fragmented, unraveled, and imploded by suffering. Consider the suffering of Job who laments: “My soul loathes my life; I will give free course to my complaint, I will speak in the bitterness of my soul. I will say to God, ‘Do not condemn me; Show me why You contend with me. Does it seem good to You that you should oppress, That you should despise the work of Your hands, And smile on the counsel of the wicked….Your hands have made me and fashioned me, An intricate unity; Yet You would destroy me. Remember, I pray, that You have made me like clay. And will You turn me into dust again? Did You not pour me out like milk, and curdle me like cheese?’” (Job 10:1-3, 8-11).

Or, hear the anguished voice of the psalmist in Psalm 88: “O Lord, God of my salvation, I have cried out day and night before You Let my prayer come before You; Incline Your ear to my cry For my soul is full of troubles, And my life draws near to the grave I am counted with those who go down to the pit; I am like a man who has no strength. Adrift among the dead, Like the slain who lie in the grave, Whom You remember no more, And who are cut off from Your hand” (Psalm 88: 1-5).

Even when unrelated to illness or disease, suffering may still ravage the person of the sufferer. Recall the nearly inexpressible suffering of C. S. Lewis after the death of his beloved wife, Joy:

No shadows here. Only darkness, and silence, and the pain that cries like a child. It ends, like all affairs of the heart, with exhaustion. Only so much pain is possible. Then, rest.

So it comes about that, when I am quiet, she returns to me. There she is, in my mind, my memory, coming towards me and I love her again as I did before, even though I know I will lose her again, and be hurt again.11

One wonders how Lewis’s masterful theodicy, The Problem of Pain,12 might have been altered had it been written after 1960, the year Joy died, rather than in 1940. Two years after her death, Lewis wrote to his good friend, Sheldon Vanauken, “I am now as convalescent as (apparently) I am ever likely to be. Loneliness increases as health returns. One must have the capacity for happiness in order to be fully aware of its absence.”13 The most severe form of suffering may be deprivation of one’s person from other persons.

Suffering, moreover, does not arise ex nihilo. One always suffers from something. The unraveling is due to some experience, some pathology, some dementia. Thus, it is appropriate to speak of suffering from moral evil, material circumstances, or some combination of the two. Daniel Sulmasy is director of the Center for Clinical Bioethics at Georgetown University. His taxonomy of suffering is a helpful matrix by which to classify types of suffering for the sake of analysis.

Type I

Human beings can suffer as a result of our own moral evil without any intervening material occasion; examples include the pangs of conscience, remorse, and guilt. This is the experience of personal moral finitude. A physician may feel guilty about having abandoned a patient and recognize his or her limited individual capacity for good. In penance, we confess our moral finitude as undermining our intrinsic dignity.

Type II

Human beings can suffer as a result of the moral evil of others without any intervening material occasion; examples include experiences of loneliness, hurt, and alienation. This is the experience of the moral finitude of others. If one were a patient, one might feel hurt by the cold and relatively inattentive manner in which one was treated by one’s physician. No material wound or blow need serve as an intervening occasion of the suffering; the moral failure of the physician is sufficient cause. One recognizes that the world’s love is finite.

Type III

Human beings can suffer as a result of the moral evil of self or of others mediated through material occasions of suffering. The long and horrible list of examples include self-mutilation, torture, assault, rape, poisoning, murder, war, and willful negligence. These are at once experiences of the moral finitude of others and of the material finitude of one’s own person. Records and memories of “experiments” performed on Nazi prisoners provide especially egregious medical examples. More subtly, a physician’s greed may lead to excessive use of medical technologies with attendant physical harm to some patients.

Type IV

There are a myriad of material occasions of human suffering that require no moral evil whatsoever—the central problems of medical suffering. Examples include fractured bones that result from landslides, inherited diseases like cystic fibrosis and hemophilia, and the relentless commonplaces such as arthritis, diabetes, cancer, heart attacks, and strokes. These are personal experiences of material finitude. From the physician’s perspective, they can also represent the physician’s own experience of the finitude of medicine. Medicine does not grant immortality.

Mixed Types

Certainly there can be occasions of suffering that are, in part, directly material and, in part, the result of moral evil. Multiple combinations and permutations are possible. Examples could include a person with lung cancer who had a genetic predisposition but who also started smoking at an early age, in part because greedy tobacco company executives, motivated by a desire for profits, deliberately repressed evidence about the addictive nature of cigarettes and authorized an advertising campaign aimed at teenagers. The bad genes are a contributing factor, but the teenager’s decision to smoke and the business practices of the tobacco company played significant roles also.14

This taxonomy is admittedly artificial. Suffering is, more often than not, impossible to dissect with such precision. Nevertheless, this taxonomy helps us locate suffering within its moral and material matrices.

Making Sense Out of Suffering

A theology of suffering must begin with the assertion that this is not the way things are supposed to be. To make sense out of suffering is, first, to realize that suffering is a result of human sin; it is a consequence of the Adamic fall. Had our first parents obeyed God, there would have been no suffering. Because of the disobedience of our progenitors, humanity was destined to be bruised and bloodied. Because our first parents refused God’s way, a chain of events was set in motion which culminated in a curse. “Cursed is the ground for your sake; In toil you shall eat of it All the days of your life. Both thorns and thistles it shall bring forth for you. And you shall eat the herb of the field. In the sweat of your face you shall eat bread Till you return to the ground, For out of it you were taken; For dust you are, And to dust you shall return” (Genesis 3:17b-19). Peter Kreeft puts it simply but profoundly when he says, “All three evils, sin and death and suffering, are from us, not from God; from our misuse of our free will, from our disobedience. We started it!”15

In light of the fact that human beings are by nature opposed to God and God’s way, the real question to be asked in the face of suffering is not “Why me?” but “Why not me?” The consequences of the fall into sin being what they are, any day without suffering is a day of grace and mercy. This may seem like very thin gruel when the experience of suffering is at its apex, but it is important for us to embrace the reality of post-Adamic suffering as part of the groundwork of our worldview. Sadly, the contemporary theological naivete of Christians and non-Christians alike has left them without an answer to the problem of sickness, suffering, or death in the world. When suffering comes—and for the overwhelming majority of Adam’s race it will come—contemporary individuals have no philosophical category or worldview through which to interpret it. If one begins with the assumption that suffering is endemic to the human condition, then there can be no such thing as “pointless” suffering. This is not to argue that suffering is to be sought, but that suffering is deserved. There is no injustice in a God who allows suffering. In other words, the important question is not “Why do bad things happen to good people, but why do good things happen to bad people?”

A second assumption necessary to make sense out of suffering is the fact that suffering may have redemptive purposes or good ends. This is not the view that suffering is good in and of itself, but that suffering may have good consequences. C. S. Lewis calls suffering “God’s megaphone,” by which he means that it calls us back to the Creator and announces our dependence upon the one who made us. Says Lewis,

Now the proper good of a creature is to surrender itself to its Creator—to enact intellectually, volitionally, and emotionally, that relationship which is given in the mere fact of its being a creature. When it does so, it is good and happy. Lest we should think this is a hardship, this kind of good begins on a level far above the creatures, for God Himself, as Son, from all eternity renders back to God as Father by filial obedience the being which the Father by paternal love eternally generates in the Son. This is the pattern which man was made to imitate—and wherever the will conferred by the Creator is thus perfectly offered back in the delighted and delighting obedience by the creature there, most undoubtedly, is Heaven, and there the Holy Ghost proceeds. In the world as we know it, the problem is how to recover self-surrender. We are not merely imperfect creatures who must be improved: we are, as Newman said, rebels who must lay down our arms. The first answer, then, to the question why our cure should be painful, is that to render back the will which we have so long claimed for our own, is in itself, wherever and however it is done, a grievous pain.16

Suffering, therefore, calls us to surrender our will to God’s. Against the backdrop of our rebellion and its consequences, this must be seen ultimately as a good.

Thirdly, in order to make sense of suffering, we must see it as an important component in the development of our sense of compassion and identification of community. In Stanley Hauerwas’s essay on suffering in his volume Suffering Presence, he observes that “it is our capacity to feel grief and to identify with the misfortune of others which is the basis for our ability to recognize our fellow humanity.”17 Only human beings experience genuine suffering. In a dark but very real sense, suffering unites the human community. Animal pain is real and we ought not unnecessarily harm animals, but they do not suffer in the same sense in which persons suffer. Sulmasy makes this point clear by defining suffering as “the experience of finitude in tension with intrinsic human dignity.”18 Since animals do not share the “intrinsic dignity” of human beings, there is no such tension and, thus, no suffering in this sense. This observation may help us interpret the permission in Genesis 9:1-6 to kill animals for food at the same time premeditated homicide is both strictly forbidden and penalized.

Finally, a theology of suffering must be informed by the reality that this is not the way it will always be. The more one suffers, the more one can identify with the apostle Paul’s hopeful lament (not an oxymoron) in 2 Corinthians 4 and 5: “Even though our outward man is perishing, yet the inward man is being renewed day by day” (4:16). The body is perishing. Sometimes it is perishing so palpably as to call the experience suffering. “In this,” says Paul, “we groan ….” (5:2). Sufferers know groaning. But for those who know the Suffering Savior, we shall not always groan. For, as Paul says, we confidently await the day when “mortality may be swallowed up by life” (5:4).

We may also appeal to the first epistle of Peter in order to understand this point. To a people experiencing terrible suffering and almost unspeakable dislocation, Peter says, “Blessed be the God and Father of our Lord Jesus Christ, who according to His abundant mercy has begotten us again to a living hope through the resurrection of Jesus Christ from the dead, to an inheritance incorruptible and undefiled and that does not fade away, reserved in heaven for you, who are kept by the power of God through faith for salvation ready to be revealed in the last time. In this you greatly rejoice, though now for a little while, if need be, you have been grieved by various trials ….” (I Peter 1:3-7).

Apart from these realities, suffering cannot be interpreted or understood. If we would respond appropriately to suffering, we must renew our affirmation of these verities. Without coming to grips with these truths, we will neither be able to help ourselves nor others.

Relieving Suffering

Suffering becomes unbearable when we are hopeless and alone. Job expresses this morbid fact when, in the darkness of the moment of suffering he cries, “For He is not a man, as I am, That I may answer Him, And that we should go to court together. Nor is there any mediator between us, Who may lay his hand on us both. Let Him take His rod away from me, And do not let dread of Him terrify me. Then I would speak and not fear Him, But it is not so with me” (Job 9:32-35).

I have argued elsewhere that the church holds three offices or functions in the world The church has a prophetic office, a priestly office, and a kingly office. I will suggest in closing that when the church functions obediently with respect to suffering, the church herself can provide a context in which suffering can be experienced in ways that help make sense of that experience.

First, in her prophetic office, the church calls her members to understand and follow the way of the Lord Jesus. In holiness and obedience, the church will affirm the theology of suffering, embracing its reality and anticipating its relief. Second, in her priestly office, the church will engage in comprehensive ministry to those who are suffering. To rescue the perishing and care for the dying will mean that the church will come alongside those who are suffering, provide compassionate ministry to the dying, and point persons to the hope of the Christian’s inheritance. Finally, in her kingly ministry, the church will offer protection against the evils of the age, including the culture of death and its embrace of assisted death. Relief of suffering must not be offered through relieving the sufferer of life itself. It is more than strange, it is a decided evil, to remove what Sulmasy calls “the experience of finitude in tension with intrinsic human dignity” by assaulting that dignity through premeditated homicide.

Edmund Pellegrino insightfully has said,

Seriously ill persons suffer commonly from alienation, guilt, and feelings of unworthiness. They often perceive themselves, and are perceived by others, as economic, social, and emotional burdens. They are exquisitely susceptible to even the most subtle suggestion by physician, nurse, or family member that reinforces their guilt, shame, or sense of unworthiness. It takes as much courage to resist these subliminal confirmations of alienation as to withstand the physical ravages of the disease. Much of the suffering of dying patients comes from being subtly treated as nonpersons. The decision to seek euthanasia is often an indictment against those who treat or care for the patient. If the emotional impediments are removed, and pain is properly relieved, there is evidence that many would not choose euthanasia.19

It may well be the case that in order to halt the assisted death juggernaut, the church will have to reestablish her threefold ministry as prophet, priest, and king. That may mean, among other things, that churches will once again have to found hospitals and fund hospices where dying patients are treated with compassion and dignity, not prematurely dispatched. God help us if we do not rise to the challenge.

This article first appeared in Theology Matters, Vol. 7, No. 1 (Jan/Feb 2001).