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Gary B. Madison, On Suffering: Philosophical Reflections on What It Means To Be Human. Hamilton: McMaster Innovation Press/Les Erables, 2013; 464 pages. ISBN: 1926633075.

Review by Paul Fairfield, Queen’s University

On Suffering represents a culmination in the writings of Gary B. Madison, a philosopher in the phenomenological-hermeneutical tradition whose previous writings include contributions to political theory (most notably The Political Economy of Civil Society and Human Rights, The Politics of Postmodernity, and The Logic of Liberty) as well as hermeneutics and phenomenology (notably The Hermeneutics of Postmodernity, Understanding, and The Phenomenology of Merleau-Ponty). This book—his longest to date—finds Madison taking a turn toward more existential themes while continuing his longstanding practices of impressive erudition and passionate prose. On Suffering, in my view, is not only Madison’s best book but is a prime example of what philosophy can still be in the modern world but too seldom is: the pursuit of wisdom in the Greek sense and a concerted endeavor to answer perennial questions about human existence in the tradition of Pascal, Montaigne, Kierkegaard, Nietzsche, Heidegger, and the many other thinkers upon whom this book draws. There is a remarkable boldness about this book, a determination to confront directly questions of the meaning of suffering and what it means to be human in a manner that one used to expect from philosophy but that today is typically shied away from for one reason or another. In being written for a non-specialist audience, it strikes a balance between being accessible to a general (educated) reading public while also containing an original line of argument.

What is immediately notable about the book is the wealth of citations it contains, both ancient and modern and also drawing upon thinkers in both the Western and Eastern traditions. Madison draws seamlessly upon ancient Stoics and contemporary phenomenology, Confucius and Buddhism, William James and Gabriel Marcel, as well as innumerable others in an attempt to situate his argument in “something like a sapientia perennis, … [a] richly variegated ‘wisdom of the ages’” rather than present his reflections as if they lacked historical precedent. By sapientia perennis Madison is referring not to any straightforward doctrinal consensus in the history of thought but to a complex yet discernible commonality of sentiments and recurring themes which he traces throughout this book, particularly in the high points that are ancient Stoicism and (the tradition in which Madison is most at home) modern continental philosophy.

Suffering, he points out, has long been distinguished from the more straightforward matter of pain. The latter concept tends to have a narrower and physical or quasi-physical connotation while the former potentially rises to the level of a spiritual and existential condition. If suffering, as Madison argues, constitutes a “moral-philosophical problem” rather than a strictly “physical-medical” one, this entails the need for a radical reconsideration of a good deal of current medical thinking which tends not only to elide the distinction but to reduce the entire domain of human suffering—a mystery in Marcel’s sense of the word—to a problem which admits of only a narrow range of solutions. Suffering is not merely an issue of pharmaceutical medicine but “is a specifically human phenomenon; bodies can experience pain, but only persons suffer.” (8) As Madison writes, “Precisely because medicine is a dedicated attempt to resist our vulnerability to illness and disability, it can also lead us to ignore the fact that, in order to live a properly human life we must not reject but must learn to accept and live with our innate frailty—and the suffering that necessarily goes along with it.” (8) What the medical model too often overlooks is the myriad ways in which suffering is a complex bearer of humanly significant meaning, one that demands to be faced and thought about in a certain manner without necessarily being solved or remedied.

If suffering is a moral-philosophical problem, it cannot be thought in purely naturalistic terms and calls for a quality of ethical thinking that is not beholden to the empirical. Here Madison draws upon the ancients—not, as one might expect, Plato and Aristotle so much as Cicero, Seneca, Marcus Aurelius, and also Confucius. An ethics of human suffering must be resolutely non-utilitarian, he argues, and capable of understanding the human condition at a deeper level of analysis than one that presupposes a Hobbesian moral psychology and a materialist ontology. The Stoics had a keener sense of human frailty and contingency than modern approaches, and a good part of the book finds Madison appropriating ideas that fly directly in the face of modern scientific-technological views. In his words, “the heart of [Stoicist] ethics is the belief that there are some things that are intrinsically good and worth doing for their own sakes—such as being gracious and showing kindness to another human being or giving thanks for the unmerited gift of life—and not simply on a quid pro quo basis and for the personal benefit one thinks one might get from doing them.” (15) Understanding suffering also requires a sense of the tragic in human existence that again is typically lacking in contemporary worldviews, with the important exceptions of philosophers of a more phenomenological-existential orientation.

Madison writes at length about the consequences of these ideas for the healthcare profession. An especially prominent theme here is the present over-reliance on pharmaceuticals and the narrowly solution-oriented approach to pain and suffering that one finds in much of contemporary medicine. Madison writes, “The manifest dangers posed by the indiscriminate use of pharmaceuticals should challenge physician and patient alike to realize that it is not by fleeing from suffering but only by confronting the reasons for one’s suffering head-on and wrestling with one’s own demons that one can become a better, stronger person.” (318) The argument of the book’s final chapter, “Implications for Health Care,” is of special relevance to medical professionals and is written in a way that is accessible to them. The current reality, he argues, is that many patients themselves now regard pharmaceuticals as consumer goods that hold out the promise of a pain- and trouble-free existence, and it is a habit that medical professionals and drug companies have done much to foster. The first principle of medicine since ancient times has been to do no harm, but when it is forced to compete with a new imperative to eradicate unhappiness in any form this principle is effectively undermined. Not everything in human life is a medical problem, and this includes ordinary forms of pain and suffering that are a part of our condition. When the latter are subsumed without discrimination under the category of depression and the continuum between health and disease, normal and abnormal, all but disappears, we face an existential counterpart of physician-created disease. Sadness, in the vast majority of cases, is not a disorder. Treating it as if it were an inherently medical phenomenon impoverishes human experience and creates impossible expectations about what a good life may be. Such expectations commonly undermine our capacity to cope reflectively with any aspect of our condition that is difficult or unpleasant.

The good life, Madison argues, requires “learning to live with the mystery,” the title of the book’s epilogue. Not everything in our existence, as Marcel would say, is a problem in need of a solution; a good deal of it is a mystery in need of a kind of reflection to which a scientific-technological conceptual scheme, and the medical model of psychology that issues from it, cannot do justice. Understanding suffering in phenomenological and ethical terms demands that we face up to the mystery that is an existence that searches for happiness and meaning while never being far removed from suffering in its myriad forms. There is a tragic sense of life that emerges from this book, but not a pessimistic one. Hope is the theme on which the book concludes. “The struggle to find meaning in life is itself what confers meaning on one’s life” (429), and “[h]ope … is a matter of active willing and is productive of a certain kind of habitus or mode of living. If our reach did not exceed our grasp and we did not strive after greater being, we would not be human.” (437)

On Suffering is published by McMaster Innovation Press/Les Erables rather than a conventional academic publisher and has not been peer-reviewed. This should not raise eyebrows. As readers of Madison’s previous books will expect, the scholarship is of the highest quality and the book is well edited. If it raises questions at all, it may be about the future of academic publishing and the value of peer-review. Now that technology has made it possible to self-publish without the drawbacks associated with conventional presses—waiting times, marketability/profitability, etc.—one wonders how many philosophers and other academics will begin opting for publishers like Amazon, Barnes and Noble, and so on, or simply publishing books directly on our own websites. I have no prediction here, and as of yet I have not gone this route myself, but apart from professional advancement I can think of no good reason not to. The advantages are many, including that a book can be brought out quickly and at a low price. It may also help to foster the kind of bold thinking that this book exemplifies. Perhaps self-publishing brings less prestige, and perhaps this value tends to be over-prized.