This article is about suffering or pain in the broadest sense. For physical pain see Pain. For other uses see The Suffering. Tragic mask on the faade of the Royal Dramatic Theatre in Stockholm

Suffering or pain in a broad sense1 is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical2 or mental.3 It may come in all degrees of intensity from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of intensity. In addition to such factors people's attitudes toward suffering may take into account how much it is in their opinion avoidable or unavoidable useful or useless deserved or undeserved.

Suffering occurs commonly in the lives of sentient beings in diverse manners and often dramatically. As a result many fields of human activity are concerned from their own points of view with some aspects of suffering. These aspects may include the nature of suffering its processes its origin and causes its meaning and significance its related personal social and cultural behaviors its remedies management and uses. Contents 1 Terminology 2 Philosophy 3 Religion 4 Arts and literature 5 Social sciences 6 Biology neurology psychology 7 Health care 8 Relief and prevention in society 9 Uses 10 See also 11 Selected bibliography 12 Notes and references Terminology

The word suffering is sometimes used in the narrow sense of physical pain but more often it refers to mental or emotional pain or more often yet to pain in the broad sense i.e. to any unpleasant feeling emotion or sensation. The word pain usually refers to physical pain but it is also a common synonym of suffering. The words pain and suffering are often used both together in different ways. For instance they may be used as interchangeable synonyms. Or they may be used in 'contradistinction' to one another as in "pain is physical suffering is mental" or "pain is inevitable suffering is optional". Or they may be used to define each other as in "pain is physical suffering" or "suffering is severe physical or mental pain".

Qualifiers such as mental emotional psychological and spiritual are often used for referring to certain types of pain or suffering. In particular mental pain (or suffering) may be used in relationship with physical pain (or suffering) for distinguishing between two wide categories of pain or suffering. A first caveat concerning such a distinction is that it uses physical pain in a sense that normally includes not only the 'typical sensory experience of physical pain' but also other unpleasant bodily experiences such as itching or nausea. A second caveat is that the terms physical or mental should not be taken too literally: physical pain or suffering as a matter of fact happens through conscious minds and involves emotional aspects while mental pain or suffering happens through physical brains and being an emotion involves important physiological aspects.

Unpleasantness is another synonym of suffering or pain in the broad sense. More technically the term is used in physical pain science for referring to the basic affective dimension of pain (its suffering aspect per se) usually in contrast with the sensory dimension as for instance in this sentence from Professor Donald Price: Pain-unpleasantness is often though not always closely linked to both the intensity and unique qualities of the painful sensation.4 Words that are roughly synonymic with suffering in addition to pain and unpleasantness include distress sorrow unhappiness misery affliction woe ill discomfort displeasure disagreeableness. Philosophy

Hedonism as an ethical theory claims that good and bad consist ultimately in pleasure and pain. Many hedonists in accordance with Epicurus emphasize avoiding suffering over pursuing pleasure because they find that the greatest happiness lies in a tranquil state (ataraxia) free from pain and from the worrisome pursuit or unwelcome consequences of pleasure. For Stoicism the greatest good lies in reason and virtue but the soul best reaches it through a kind of indifference (apatheia) to pleasure and pain: as a consequence this doctrine has become identified with stern self-control in regard to suffering. Part of a series on Utilitarianism Predecessors Epicurus David Hume  William Godwin  Francis Hutcheson People Jeremy Bentham  John Stuart Mill Henry Sidgwick  Richard Mervyn Hare  Peter Singer Types of utilitarianism Preference  Rule  Act Two-level  Total  Average Relative  Negative  Hedonism Enlightened self-interest Key concepts Pain  Suffering  Pleasure Utility  Happiness  Eudaimonia Consequentialism  Felicific calculus Problems Mere addition paradox Paradox of hedonism Utility monster Related topics Rational choice theory  Game theory Social choice  Neoclassical economics   Politics portal v d e

Jeremy Bentham developed hedonistic utilitarianism a popular doctrine in ethics politics and economics. Bentham argued that the right act or policy was that which would cause "the greatest happiness of the greatest number". He suggested a procedure called hedonic or felicific calculus for determining how much pleasure and pain would result from any action. John Stuart Mill improved and promoted the doctrine of hedonistic utilitarianism. Karl Popper in The Open Society and Its Enemies proposed a negative utilitarianism which prioritizes the reduction of suffering over the enhancement of happiness when speaking of utility: "I believe that there is from the ethical point of view no symmetry between suffering and happiness or between pain and pleasure. () human suffering makes a direct moral appeal for help while there is no similar call to increase the happiness of a man who is doing well anyway." David Pearce for his part advocates a utilitarianism that aims straightforwardly at the abolition of suffering through the use of biotechnology (see more details below in section Biology neurology psychology). Another aspect worthy of mention here is that many utilitarians since Bentham hold that the moral status of a being comes from its ability to feel pleasure and pain: therefore moral agents should consider not only the interests of human beings but also those of (other) animals. Richard Ryder developed such a view in his concepts of 'speciesism' and 'painism'. Peter Singer's writings especially the book Animal Liberation represent the leading edge of this kind of utilitarianism for animals as well as for people.

Another doctrine related to the relief of suffering is humanitarianism (see also humanitarian principles humanitarian aid and humane society). "Where humanitarian efforts seek a positive addition to the happiness of sentient beings it is to make the unhappy happy rather than the happy happier. (...) Humanitarianism is an ingredient in many social attitudes; in the modern world it has so penetrated into diverse movements (...) that it can hardly be said to exist in itself."5

Pessimism holds this world to be the worst possible plagued with worsening and unstoppable suffering. Arthur Schopenhauer recommends us to take refuge in things like art philosophy loss of the will to live and tolerance toward 'fellow-sufferers'. Friedrich Nietzsche first influenced by Schopenhauer developed afterward quite another attitude exalting the will to power despising weak compassion or pity and recommending us to embrace willfully the 'eternal return' of the greatest sufferings. Philosophy of pain is a philosophical specialty that focuses on physical pain as a sensation. Through that topic it may also pertain to suffering in general. Religion Suffering plays an important role in a number of religions regarding matters such as the following: consolation or relief; moral conduct (do no harm help the afflicted show compassion); spiritual advancement through life hardships or through self-imposed trials (mortification of the flesh penance ascetism); ultimate destiny (salvation damnation hell). Theodicy deals with the problem of evil which is the difficulty of reconciling an omnipotent and benevolent god with evil. People often believe that the worst form of evil is extreme suffering especially in innocent children or in beings created ultimately for being tormented without end (see problem of hell). The 'Four Noble Truths' of Buddhism are about dukkha a term usually translated as suffering. They state (1) the nature of suffering (2) its cause (3) its cessation and (4) the way leading to its cessation (which is the Noble Eightfold Path). Buddhism considers liberation from suffering and the practice of compassion (karuna) as basic for leading a holy life and attaining nirvana. Hinduism holds that suffering follows naturally from personal negative behaviors in ones current life or in a past life (see karma in Hinduism).6 One must accept suffering as a just consequence and as an opportunity for spiritual progress. Thus the soul or true self which is eternally free of any suffering may come to manifest itself in the person who then achieves liberation (moksha). Abstinence from causing pain or harm to other beings (ahimsa) is a central tenet of Hinduism. The Bible's Book of Job reflects on the nature and meaning of suffering. Pope John Paul II wrote "On the Christian Meaning of Human Suffering".7 This meaning revolves around the notion of redemptive suffering. Arts and literature Artistic and literary works often engage with suffering sometimes at great cost to their creators or performers. The Literature Arts and Medicine Database offers a list of such works under the categories art film literature and theater. Be it in the tragic comic or other genres art and literature offer means to alleviate (and perhaps also exacerbate) suffering as argued for instance in Harold Schweizer's Suffering and the remedy of art.8 Landscape with the Fall of Icarus This Breughel's painting is among those that inspired W.H. Auden's poem Muse des Beaux Arts : About suffering they were never wrong The Old Masters; how well they understood Its human position; how it takes place While someone else is eating or opening a window or just walking dully along; (...) In Breughel's Icarus for instance: how everything turns away Quite leisurely from the disaster; (...) 9 Social sciences Social suffering according to Arthur Kleinman and others describes "collective and individual human suffering associated with life conditions shaped by powerful social forces."10 Such suffering is an increasing concern in medical anthropology ethnography mass media analysis and Holocaust studies says Iain Wilkinson11 who is developing a sociology of suffering. The Encyclopedia of World Problems and Human Potential is a work by the Union of International Associations. Its main databases are about world problems (56564 profiles) global strategies and solutions (32547 profiles) human values (3257 profiles) and human development (4817 profiles). It states that "the most fundamental entry common to the core parts is that of pain (or suffering)" and "common to the core parts is the learning dimension of new understanding or insight in response to suffering."12 Ralph G.H. Siu an American author urged in 1988 the "creation of a new and vigorous academic discipline called panetics to be devoted to the study of the infliction of suffering."13 The International Society for Panetics was founded in 1991 to study and develop ways to reduce the infliction of human suffering by individuals acting through professions corporations governments and other social groups.14 In economics the following notions relate not only to the matters suggested by their positive appellations but to the matter of suffering as well: Well-being or Quality of life Welfare economics Happiness economics Gross National Happiness Genuine Progress Indicator. In law "Pain and suffering" is a legal term that refers to the mental anguish or physical pain endured by a plaintiff as a result of injury for which the plaintiff seeks redress. Biology neurology psychology Pain and pleasure in the broad sense of these words are respectively the negative and positive affects or hedonic tones or valences that psychologists often identify as basic in our emotional lives.15 The evolutionary role of physical and mental suffering through natural selection is primordial: it warns of threats motivates coping (fight or flight escapism) and reinforces negatively certain behaviors (see punishment aversives). Despite its initial disrupting nature suffering contributes to the organization of meaning in an individual's world and psyche. In turn meaning determines how individuals or societies experience and deal with suffering. Neuroimaging sheds light on the seat of suffering Many brain structures and physiological processes take part in the occurrence of suffering. Various hypotheses try to account for the experience of unpleasantness. One of these the pain overlap theory16 takes note thanks to neuroimaging studies that the cingulate cortex fires up when the brain feels unpleasantness from experimentally induced social distress or physical pain as well. The theory proposes therefore that physical pain and social pain (i.e. two radically differing kinds of suffering) share a common phenomenological and neurological basis. According to David Pearces online manifesto The Hedonistic Imperative suffering is the avoidable result of Darwinian genetic design. BLTC Research and the Abolitionist Society17 following Pearce's abolitionism promote replacing the pain/pleasure axis with a robot-like response to noxious stimuli18 or with gradients of bliss19 through genetic engineering and other technical scientific advances. Hedonistic psychology20 affective science and affective neuroscience are some of the emerging scientific fields that could in the coming years focus their attention on the phenomenon of suffering. Health care Disease and injury cause suffering in humans and animals. Health care addresses this suffering in many ways in medicine clinical psychology psychotherapy alternative medicine hygiene public health and through various health care providers. Health care approaches to suffering however remain problematic according to Eric Cassell the most cited author on that subject. Cassell writes: "The obligation of physicians to relieve human suffering stretches back to antiquity. Despite this fact little attention is explicitly given to the problem of suffering in medical education research or practice." Cassell defines suffering as "the state of severe distress associated with events that threaten the intactness of the person."21 Medicine makes a strong distinction between physical pain and suffering and most attention goes to the treatment of pain. Nevertheless physical pain itself still lacks adequate attention from the medical community according to numerous reports.22 Besides some medical fields like palliative care pain management (or pain medicine) oncology or psychiatry does somewhat address suffering 'as such'. In palliative care for instance pioneer Cicely Saunders created the concept of 'total pain' ('total suffering' say now the textbooks23) which encompasses the whole set of physical and mental distress discomfort symptoms problems or needs that a patient may experience hurtfully. Relief and prevention in society Since suffering is such a universal motivating experience people when asked can relate their activities to its relief and prevention. Farmers for instance may claim that they prevent famine artists may say that they take our minds off our worries and teachers may hold that they hand down tools for coping with life hazards. In certain aspects of collective life however suffering is more readily an explicit concern by itself. Such aspects may include public health human rights humanitarian aid disaster relief philanthropy economic aid social services insurance and animal welfare. To these can be added the aspects of security and safety which relate to precautionary measures taken by individuals or families to interventions by the military the police the firefighters and to notions or fields like social security environmental security and human security. Uses Philosopher Leonard Katz wrote: "But Nature as we now know regards ultimately only fitness and not our happiness (...) and does not scruple to use hate fear punishment and even war alongside affection in ordering social groups and selecting among them just as she uses pain as well as pleasure to get us to feed water and protect our bodies and also in forging our social bonds".24 People make use of suffering for specific social or personal purposes in many areas of human life as can be seen in the following instances. In arts literature or entertainment people may use suffering for creation for performance or for enjoyment. Entertainment particularly makes use of suffering in blood sports violence in the media or violent video games. A more or less great amount of suffering is involved in body art. The most common forms of body art include tattooing body piercing scarification human branding. Another form of body art is a sub-category of performance art in which for instance the body is mutilated or pushed to its physical limits. In business and various organizations suffering may be used for constraining humans or animals into required behaviors. In a criminal context people may use suffering for coercion revenge or pleasure. In interpersonal relationships especially in places like families schools or workplaces suffering is used for various motives particularly under the form of abuse and punishment. In another fashion related to interpersonal relationships the sick or victims or malingerers may use suffering more or less voluntarily to get primary secondary or tertiary gain. In law suffering is used for punishment (see penal law ); victims may refer to what legal texts call "pain and suffering" to get compensation; lawyers may use a victim's suffering as an argument against the accused; an accused's or defendant's suffering may be an argument in their favor. In the news media suffering is often the raw material.25 In personal conduct people may use suffering for themselves in a positive way.26 Personal suffering may lead if bitterness depression or spitefulness is avoided to character-building spiritual growth or moral achievement;27 realizing the extent or gravity of suffering in the world may motivate one to relieve it and may give an inspiring direction to one's life. Alternatively people may make self-detrimental use of suffering. Some may be caught in compulsive reenactment of painful feelings in order to protect them from seeing that those feelings have their origin in unmentionable past experiences; some may addictively indulge in disagreeable emotions like fear anger or jealousy in order to enjoy pleasant feelings of arousal or release that often accompany these emotions; some may engage in acts of self-harm aimed at relieving otherwise unbearable states of mind. In politics there is purposeful infliction of suffering in war torture and terrorism; people may use nonphysical suffering against competitors in nonviolent power struggles; people who argue for a policy may put forward the need to relieve prevent or avenge suffering; individuals or groups may use past suffering as a political lever in their favor. In religion suffering is used especially to grow spiritually to expiate to inspire compassion and help to frighten to punish. In rites of passage (see also hazing ragging) rituals that make use of suffering are frequent. In science humans and animals are subjected on purpose to unpleasant experiences for the study of suffering or other phenomena. In sex individuals may use suffering in a context of sadism and masochism or BDSM. In sports suffering may be used to outperform competitors or oneself; see sports injury and no pain no gain; see also blood sport and violence in sport as instances of pain-based entertainment. See also Wikimedia Commons has media related to: Human suffering Look up suffering in Wiktionary the free dictionary. Wikiquote has a collection of quotations related to: Suffering Topics related to suffering Physical pain-related topics Pain  Pain (philosophy)  Psychogenic pain  Chronic pain Evil-related topics Evil  Problem of evil  Hell  Good and evil: welfarist theories Compassion-related topics Compassion  Compassion fatigue  Pity  Mercy  Sympathy  Empathy Cruelty-related topics Cruelty  Schadenfreude  Sadistic personality disorder  Violence  Abuse  Physical abuse  Psychological or emotional abuse  Self-harm  Cruelty to animals Death-related topics Euthanasia  Animal euthanasia  Suicide Other related topics Dukkha  Weltschmerz  Amor fati  Dystopia  Victimology  Penology  Theory of relative suffering  Pleasure  Happiness Selected bibliography Joseph A. Amato. Victims and Values: A History and a Theory of Suffering. New York: Praeger 1990. ISBN 0-275-93690-2 Cynthia Halpern. Suffering Politics Power : A Genealogy in Modern Political Theory. Albany: State University of New York Press 2002. ISBN 0-7914-5103-8 Jamie Mayerfeld. Suffering and Moral Responsibility. New York: Oxford University Press 2005. ISBN 0-19-515495-9 David B. Morris. The Culture of Pain. Berkley: University of California 2002. ISBN 0-520-08276-1 Elaine Scarry. The Body in Pain: The Making and Unmaking of the World. New York: Oxford University Press 1987. ISBN 0-19-504996-9 Notes and references See here above the section 'Terminology'. See also the entry 'Pleasure' in Stanford Encyclopedia of Philosophy which begins with this paragraph: "Pleasure in the inclusive usages most important in moral psychology ethical theory and the studies of mind includes all joy and gladness all our feeling good or happy. It is often contrasted with similarly inclusive pain or suffering which is similarly thought of as including all our feeling bad." It should be mentioned that most encyclopedias like the one mentioned above or like Britannica do not have an article about suffering and deal with pain in the physical sense only. Examples of physical suffering: pain certain kinds of itching tickling tingling or numbness certain feelings of hunger or thirst various sickness feelings like nausea shortness of breath weakness mouth dryness 12. Other examples are given by L. W. Sumner on page 103 of Welfare Happiness and Ethics: "Think for a moment of the many physical symptoms which when persistent can make our lives miserable: nausea hiccups sneezing dizziness disorientation loss of balance itching 'pins and needles' 'restless legs' tics twitching fatigue difficulty in breathing and so on." Mental suffering can also be called psychological or emotional (see Psychological pain). Examples of mental suffering: grief sadness depression (mood) disgust irritation anger rage hate contempt jealousy envy craving or yearning frustration heartbreak anguish anxiety angst fear panic horror righteous indignation shame guilt remorse regret resentment repentance embarrassment humiliation boredom apathy confusion disappointment hopelessness doubt emptiness homesickness loneliness rejection pity self-pity. Donald D. Price Central Neural Mechanisms that Interrelate Sensory and Affective Dimensions of Pain Molecular Interventions 2:392-403 (2002). Crane Brinton article Humanitarianism Encyclopaedia of the Social Sciences 1937 Kane P.V. History of the Dharmastras Vol. 4 p. 38 On the Christian Meaning of Human Suffering. Schweizer Harold (1997). Suffering and the remedy of art. Albany N.Y: State University of New York Press. ISBN 0-7914-3264-5.  W.H. Auden Muse des Beaux Arts (1938) in Collected Poems p. 179 (E. Mendelson ed. 1976) Social suffering. Daedalus. Proc Amer Acad Arts Sciences 1996;125(1). Iain Wilkinson Suffering - A Sociological Introduction Polity Press 2005 Encyclopedia of world problems and human potential project - commentaries Union of International Associations (UIA) Ralph G.H. Siu Panetics The Study of the Infliction of Suffering Journal of Humanistic Psychology Vol. 28 No. 3 Summer 1988. See also Ralph G. H. Siu Panetics Trilogy Washington: The International Society for Panetics 1994 ISBN 1-884437-00-1. ISP Giovanna Colombetti Appraising Valence Journal of Consciousness Studies 12 (8-10) pp. 106-129 (2005). Pain Overlap Theory Abolitionist Society See Vanity Fair interview with Pearce See Life in the Far North - An information-theoretic perspective on Heaven Kahneman D. E. Diener and N. Schwartz (eds.) Well-being: The Foundations of Hedonistic Psychology Russell Sage Foundation 1999 Eric J Cassell The Nature of Suffering and the Goals of Medicine 2004. See for instance the National Pain Care Policy Act of 2007 See Existential pain an entity a provocation or a challenge in Journal of Pain Symptom and Management Volume 27 Issue 3 Pages 241-250 (March 2004) Katz Leonard David (2000). Evolutionary origins of morality: cross-disciplinary perspectives. Devon: Imprint Academic. pp. xv. ISBN 0-907845-07-X.  Meiners Erica R.; Ibez-Carrasco J. Francisco (2004). Public acts: disruptive readings on making curriculum public. New York: RoutledgeFalmer. pp. 6. ISBN 0-415-94839-8.  See for instance Viktor Frankl's Man's Search for Meaning Fukuyama Francis (2002). Our posthuman future: consequences of the biotechnology revolution. New York: Farrar Straus and Giroux. ISBN 0-374-23643-7.  v d eEmotions (list)  Emotions Adoration  Affection  Aggravation  Agitation  Agony  Alarm  Alienation  Amazement  Amusement  Anger  Anguish  Annoyance  Anxiety  Apprehension  Arousal  Attraction  Bitterness  Caring  Cheerfulness  Compassion  Contempt  Contentment  Defeat  Dejection  Delight  Depression  Desire  Despair  Disappointment  Disgust  Dislike  Dismay  Displeasure  Distress  Dread  Eagerness  Ecstasy  Elation  Embarrassment  Empathy  Enjoyment  Enthrallment  Enthusiasm  Envy  Euphoria  Exasperation  Excitement  Exhilaration  Fear  Ferocity  Fondness  Fright  Frustration  Fury  Gaiety  Gladness  Glee  Gloom  Grief  Guilt  Happiness  Hatred  Homesickness  Hope  Hopelessness  Horror  Hostility  Humiliation  Hurt  Hysteria  Infatuation  Insecurity  Insult  Irritation  Isolation  Jealousy  Jolliness  Joy  Jubilation  Liking  Loathing  Loneliness  Longing  Love  Lust  Melancholy  Misery  Mortification  Neglect  Nervousness  Optimism  Outrage  Panic  Passion  Pity  Pleasure  Pride  Rage  Rapture  Regret  Rejection  Remorse  Resentment  Revulsion  Sadness  Satisfaction  Scorn  Sentimentality  Shame  Shock  Sorrow  Spite  Suffering  Surprise  Sympathy  Tenderness  Tenseness  Terror  Thrill  Torment  Uneasiness  Unhappiness  Vengefulness  Woe  Worry  Wrath  Zeal  Zest  Worldviews Compatibilism  Existentialism  Fatalism  Incompatibilism  Metaphysics  Nihilism  Optimism  Pessimism  Reclusion  Social justice  Weltschmerz Source: Parrott W. (2001) Emotions in Social Psychology Psychology Press Philadelphia. v d ePain and nociception Head and neck Headache  Neck  Odynophagia (swallowing)  Otalgia (ear)  Toothache Torso Abdomen  Back (Upper Lower)  Chest  Mastodynia (Breast)  Pelvic pain Musculoskeletal Arthralgia (joint)  Bone pain  Myalgia (muscle) Other conditions Delayed onset muscle soreness  Congenital insensitivity to pain  HSAN (Type I II congenital sensory neuropathy III familial dysautonomia IV congenital insensitivity to pain with anhidrosis V congenital insensitivity to pain with partial anhidrosis)  Neuralgia  Pain asymbolia  Pain disorder  Paroxysmal extreme pain disorder  Allodynia  Breakthrough pain  Chronic pain  Hyperalgesia  Hypoalgesia  Hyperpathia  Phantom pain  Referred pain Tests Cold pressor test  Dolorimeter Related concepts Anterolateral system  Pain management (Anesthesia Cordotomy)  Pain scale  Pain threshold  Pain tolerance  Posteromarginal nucleus  Substance P  Suffering  OPQRST   Philosophy of pain M: CNS anat(n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp noco(m/d/e/h/v/s)/cong/tumr sysi/epon injr proc drug(N1A/2AB/C/3/4/7A/B/C/D) M: PNS anat(h r t c b l s)/phys/devp/prot/nttr/nttm/ntrp noco/auto/cong/tumr sysi/epon injr proc drug(N1B)