Robert Kugelmann (Book Review of: "The Palliative Society: Pain Today" by Byung-Chul Han, translated by Daniel Steuer, Polity Press, 2021, 76 pp, $59.95, hardback ISBN: 13-978-5095-4723-4
The Palliative Society is one of many books by the philosopher and cultural critic Byung-Chul Han, whose other titles include The Burnout Society (2010/2015) and Capitalism and the Death Drive (2019/2021). Eleven brief chapters constitute the book, examining pain from various perspectives, including its meaninglessness, its cunning, as a mode of truth, as a revelation of being, and our fear of it, our algophobia, throughout. The Palliative Society is the critique of modernity, signaled by the opening quotation from Ernst Jünger: “Tell me your relation to pain, and I will tell you who you are” (Jünger, 1934/2008, p. 32, quoted on p. 1). This slim volume, written aphoristically, explores the philosophical complexities of pain in societies marked by an extreme aversion to pain and discomfort. For Han, pain is not simply a sensation or feeling of displeasure; rather it constitutes important ways of what it means to be human. Indeed, for Han we are so much the worse for our penchant to flee it. Pain is an opening via negation to otherness, and without it we are lost “in the hell of the same” (p. 6, emphasis in original). What Han calls “the neoliberal dispositif of happiness” (p. 13) distorts happiness, which “is not at one’s disposal. Inherent in it is a certain negativity” (p. 13). “Dispositif,” a term of Foucault, designated “discursive and nondiscursive elements, … [that are] historical and culturally bound to a certain area or civilization, and … are answers to certain greater problems in a particular society” (Peltonen, 2004, p. 216). This neoliberal dispositif is palliative, seeking happiness by eliminating pain and discomfort without addressing the issues that, if attended to, might lead to radical social change: “Instead of revolution we thus get depression” (p. 12, emphasis in original). The neoliberal imperative, “be happy” (p. 11), draws upon our desire for “self-improvement and self-optimization” (p. 11), so that we discipline ourselves to conform to requirements for productivity, fully believing we are free in our self-subjugation.
Central to Han’s critique is that our palliative society has made health its supreme value. Health, however, is described in a specific way, as the functioning of the body defined exclusively in anatomical and physiological terms: “Life is reduced to a biological process that must be optimized. It loses any meta-physical dimension” (p. 16). Ours is a society of “survival,” “a society of the undead” (p. 17), as we have no concept of what a “good life” might mean. We are like Paul Valéry’s Monsieur Teste, who cannot narrate his pain, as it is meaningless, “outside the symbolic order” (p. 19). Life that is “reduced to a biological process” (p. 22) has no story, no “meaningful horizon” (p. 22).
Pain will have its way, nevertheless, with Jünger speaking of the “cunning of pain” (cited, p. 26). Where does pain insinuate itself in a palliative society? Han refers to the spread of chronic pain, of “cutting” (p. 28) and other forms of self-harm. We are beset with loneliness and isolation, and “narcissism and egotism are intensifying” (p. 28), echoing Christopher Lasch’s (1991) diagnosis. Cultural anesthesia leads to a need for “increasingly stronger stimuli … to provide people in an anesthetic society with any sense of being alive” (Illich, 1976, p. 152, quoted on p. 33).
Pain is a way of knowing, and it is essential to experience (German Erfahrung), as “a painful process of transformation that contains an element of suffering, of undergoing something” (p. 39). An experience in this sense, as Gadamer (1960/1989) wrote, “thwarts an expectation” (p. 356), and one undergoes a reversal, which is painful, a “learning through suffering” (p. 356), as in the catharsis of tragedy. Indeed, drawing on Heidegger’s notion of mood (Stimmung), Han writes that “pain is the fundamental mood of human finitude” (p. 45), thinking of “that area of being ‘in which pain and death and love belong together’” (Heidegger, 1950/2002, p. 205, quoted on p. 45). This mood attunes us to the “non-available” (p. 45), making pain Orphic: Orpheus loves Eurydice and descends into the underworld to rescue her from death with the enchantment of his music, only to lose her again by turning around to see her, to keep her present and to possess her—to keep her visible, thus losing her as other. Essential to pain as mood, then, is a desire that would overcome death, a love that cannot negate death, a longing for the face of the other. Han cites Heidegger again, who proposed that “the spirit [muot] which answers to pain, the spirit attuned by pain and to pain, is melancholy [Schwermut]” (Heidegger, 1950/2002, p. 153, quoted on p. 46). Melancholy, the disease of the philosopher according to an ancient text, attuning us to the saturnine, the flaws, cracks, and limits of human life, is a way of negation that gets at essences. Melancholy, which draws its significance from pain as a fundamental mood, recognizes that “a crucial part of taking care … is the experience of unavailability … otherness and strangeness” (p. 47). Like the melancholy angel in Dürer’s woodcut, Melencolia I of 1514, our eyes are on what is beyond us, on otherness, when we do not flee pain.
Han’s ultimate remedy is not heroic endurance of pain. It is, with Levinas, “a sensibility for the other [that] presupposes an ‘exposure’ that ‘offer[s] itself even in suffering” (Levinas, 1974/1991, p. 15, quoted on p. 52). This is primal pain: “pain toward the other,” “meta-physical pain” (p. 52), openness to the suffering of others, cracking the complacency and pursuit of the comfortable that defines our palliative society. Han closes on a somber note: because we cherish comfort more than freedom, we face a “transhuman” future, without pain and always happy, which is “not a human life” (p. 60). The undead will inherit the earth.
Much of the book is a dialogue with Ernst Jünger, whom Han quotes extensively. Jünger was a prominent and controversial German thinker of the twentieth century, a fierce critic of bourgeois society for its desire for comfort and security and its rejection of heroic virtues of endurance and courage. As an example of what Jünger meant by heroic virtue, to amplify Han’s account, consider the story of the Roman soldier, Gaius Mucius Cordus Scaevola, who held his arm over a flame without flinching to show his enemy his contempt for his own body and pain. Han does not follow Jünger in a celebration of militaristic derring-do, submission to authority, and a willingness to endure pain and self-sacrifice. He is, however, clear that our algophobia—morbid fear of pain—is leading us down a primrose path to a loss of individual freedom, autonomy, and authenticity (see Taylor, 1991), virtues that modernity at its best strives to cultivate. We seem to have a predilection, according to Han, to what I would call an Esau complex, a willingness to surrender our birthright for a mess of porridge.
Han writes that “every critique of society must … provide a hermeneutics of pain” (p. 1). Pain is too important to be left to medicine, where it primarily resides today. This medicalization of pain progressively destroys any meaning that pain might have, as it is something to avoid, eliminate, or conceal (the word “palliative” comes from the Latin palliare, “conceal”). Neither Jünger nor Han have been the first to make the charge that algophobia is one of modernity’s besetting flaws. For Jünger, “the bourgeois individual typically dwells in a ‘zone of sensitivity,’ where ‘security,’ ‘ease,’ and ‘comfort’—and ultimately ‘the body’ itself—become the essential core of life. Here, one seeks to avoid pain at all cost” (Durst, 2008, section 2). Jünger thus captured societal “algophobia.”
The charge that we moderns are more sensitive to pain than people in the premodern world has been made repeatedly (Kugelmann, 2017). In the nineteenth century, commentators tied increased sensitivity to pain to the upper classes and to the “civilized” races of Europe: “In the ideology of the [American] slave owners, it was a commonplace that slaves were relatively insensitive to pain” (Armstrong, 2012, p. 146). Weir Mitchell (1892), an important nineteenth-century neurologist, found an increasing sensitivity to pain taking place in the United States. An article in The Living Age (“The Meaning of Pain,” 1906) stated that “it is a well-established conclusion of science that the higher we rise in the scale of nervous organization the greater the possibilities of pain,” with “civilized races” feeling pain more exquisitely than “savages,” and men more than women (p. 699). Indeed, among the civilized and the men, “brain workers” feel pain more acutely than do manual laborers, which accounted for the more frequent occurrence of neurasthenia among these privileged groups, a view shared by the prominent psychologist and anthropologist, W. H. R. Rivers (1920). Such views, connecting intellect, level of civilization, and increased sensitivity to pain, were shared by Schopenhauer and Nietzsche (De Moulin, p. 541, n. 4).
Well before these accounts of algophobia, Alexis de Tocqueville (1835/1966), in Democracy in America, based on his journey to the United States in 1831–1832, noted that Americans continuously seek “improvement” in all spheres of life, especially material improvement, and that Americans have a great “taste for physical comfort” (p. 503), unlike European aristocrats and lower classes, the former because they take comforts for granted, the latter because they take their absence for granted. Only autonomous selves, it would appear, would eliminate all displeasure in the pursuit of happiness.
There is more to the story. In the middle of the nineteenth century came surgical anesthesia, word of which spread around the globe like wildfire and eventually made endurance of surgical pain absurd. It was with good reason that Weir Mitchell (1900), on the fiftieth anniversary in 1896 of the introduction of surgical anesthesia, could read his poem, “The Birth and Death of Pain,” in which we hear: “Whatever triumphs still shall hold the mind,/ Whatever gift shall yet enrich mankind,/ … No hour as sweet as when hope, doubt, and fears,/ ‘Mid deepening stillness, watched one eager brain,/ With Godlike will, decree the Death of Pain” (p. 18). I assume that even modernity’s fiercest critics avail themselves of anesthesia before going under the knife. Anesthesia altered existential possibilities for responding to pain.
Daniël de Moulin (1974) documents that René Leriche, acclaimed author of The Surgery of Pain (1939), found that “modern man is more sensitive to pain than even his immediate ancestors” (De Moulin, p. 542), this sensitivity being for Leriche a consequence of moderns having more methods available to eliminate pain, including anesthetics and analgesics, such as aspirin. The Dutch phenomenologist and physiologist F. J. J. Buytendijk (1943/1961), living in occupied Netherlands, wrote: “Modern man is irritated by things which older generations accepted with equanimity. He is irritated by old age, long illness, and even by death; above all he is irritated by pain. Pain must simply not occur. … The consequence is an immoderate state of algophobia … which is itself an evil and sets a seal of timidity on the whole of life” (pp. 15–16). His colleague, the phenomenological psychiatrist, J. H. van den Berg (1975), repeated the claim that modernity brings increased sensitivity to pain, explaining it through a loss of community and greater individual autonomy. For van den Berg, pain has been disembedded from social relationships, and pain is more painful when we face it alone. Ivan Illich, to whom Han refers on this topic (p. 19), charged that our medicalization of pain results in a cultural shift: “People unlearn the acceptance of suffering as an inevitable part of their conscious coping with reality and learn to interpret every ache as an indicator of their need for padding or pampering” (Illich, 1976, p. 133).
Han has extended “algophobia” to imply that “we live in a society of positivity that tries to extinguish any form of negativity” (p. 2). Power operates today not primarily by repression and overt violence—although that continues, especially in minority communities—but by “self-optimization” (p. 3). We discipline ourselves by striving “to be all that you can be,” as states an advertisement used to attract recruits to the US military (Singer, 2008). Our palliative society is also a “performance society” that, eschewing negation, finds opportunities for increased performance in any situation, such that we speak of “post-traumatic growth” and “resilience” (p. 2) come what may. Drawing on social media, Han also characterizes the palliative society as “the society of the like [Gefällt-mir], increasingly a society characterized by a mania for liking” (p. 3): Nothing should hurt. Han at this juncture introduces his sed contra by asserting that “what has been forgotten is that pain purifies. It has a cathartic effect” (p. 3), a claim echoing Jünger’s contempt for pain-averse middle class couch potatoes.
Han does not make a case for military discipline or for the contempt for life and comfort symbolized by the suicide bomber. No, for Han the palliative society is, to use the phrase of John McKnight (1996), a “careless society,” in the double sense of “not having a care in the world” and “I don’t have to care about you, because experts can handle whatever is ailing you.” What our palliative, performance society of the like faces is a loss of “nakedness of soul, exposure, the pain toward the other” (p. 54). Our algophobia is fundamentally fear of “pain towards the other” (p. 54), and not the quivering of the flesh in the face of discomforts and negativity.
With that Levinasian perspective, space opens between Han’s cultural critique and that of Jünger’s. For Jünger (1934/2008), the bourgeois individual lacks the heroic spirit: “The heroic … world presents an entirely different relation to pain than does the world of sensitivity. While in the latter … it is a matter of marginalizing pain and sheltering life from it, in the former the point is to integrate pain and organize life in such a way that one is always armed against it” (p. 16). For Han, it is not this heroic attitude that ultimately matters. It is pain as a fundamental mood of existence, exposing us to the pain of the other, that matters. Thus, by contrast, Han can write: “Pain is a gift” (p. 49). How do individuals and cultures receive this gift? Han, with Illich, sees the drift toward greater medicalization of pain as rendering people unable to cultivate what Illich (1976) called the “craft of suffering well” (p. 145), to which Han (p. 19) refers, emphasizing how with the atrophy of cultural ways to reckon with pain and suffering, pain becomes a “purely physical agony” (p. 19). In the anesthetic state inculcated by the palliative society, exposure to the pain and suffering of the other vanishes, along with the capacity to tolerate discomfort.
Nevertheless, to some extent, this craft of suffering is still very much with us. For example, professional and not-so-professional athletes learn to bear pain in the course of their training, their askesis. It can be a badge of honor to play through the pain of an injury. The heroic spirit thus endures, even in a palliative society. The historian Esther Cohen (1995) describes earlier forms of this craft, from antiquity to the late Middle Ages. Even though our primary attitude toward pain, she writes, is that of “rejection,” for which “physical suffering is not considered inevitable or unavoidable” (p. 51), Cohen does not see the development of modern pain-killers as causing this rejection of pain: “Many primitive societies are familiar with the analgesic qualities of various plants, yet they do not resort to them in situations in which modern Westerners would automatically demand relief. More important, in many societies the acceptance of pain is a cultural imperative” (p. 51). This observation supports the diagnosis of algophobia in contemporary society. Indeed, probably less common today than formerly, is an art of suffering Cohen calls “impassivity, … to endure without flinching” (p. 51). The Roman soldier who held his arm in the flame demonstrated impassivity. Cultural patterns of enduring pain “stoically” and “keeping a stiff upper lip” are still with us, although they may appear unenlightened with analgesics abounding. “Impassibility” is an attitude that seeks “the capacity of transcending pain completely” (p. 52), through trance and ritual and arduous training. Cohen notes that in the West, such freedom from pain “was a miraculous quality, a gift from heaven granted only occasionally to saints and martyrs” (p. 52). In the later Middle Ages, “philopassianism” developed, the deliberate evocation of pain, an attitude absent earlier in Christian Europe. Cohen explains philopassianism: “The idea of Imitatio Christi, fervently preached throughout the period to clerics and laymen alike, insisted that in order to follow Christ’s footsteps one must carry his cross and feel his pain” (p. 59). Practices such as self-flagellation were a means to feel this pain, ultimately of sin and repentance. Ariel Glucklich (2003) found that such practices break down the boundaries of the self and can open a person up to what is other; hence their use in religious practices throughout the world. Even a mild ascetical practice such as fasting can change one’s attunement in the everyday world, disrupting routine and exposing one to one’s lack. Thus, arts of suffering occur across cultures and history, and endure even among us. These arts keep their practitioners exposed, even potentially to the other. Nevertheless, a palliative society does make such arts more difficult to justify and practice.
The upshot is that Han uncovers the consequences of our pursuit of what we call health; algophobia-is-us. The book also addresses the Covid-19 pandemic, and here we see how the thesis that modernity puts us face to face with meaningless pain has its latest manifestation. The thrust of Han’s claims about the Covid pandemic center around “bare life,” our living defined in biological terms only. Let me extend Han’s critique to sources outside his text: Jeffrey Bishop on the “anticipatory corpse” and Illich on “life” as an idol. To put this into perspective, consider how Jeffrey Bishop (2011) distinguishes between zoē and bios in ancient Greek thought. Zoē is “bare life, the life we have by virtue of being alive” (p. 213). Bios is one’s “biography,” such as the “contemplative life,” the “life of pleasure,” and the “political life” (p. 213). Zoē “belongs to the realm of the oikos, or home, and not the realm of the polis, or city” (p. 214), whereas for us, with what Foucault called “biopolitics,” “the sphere of the polis reaches into the sphere of oikos” (Bishop, p. 214). We are thus confused, and do not know when this bare life begins or ends, and we tend to equate longevity, the continuance of zoē, as in itself a good. Illich (1992) goes further: In “The Institutional Construction of a New Fetish: Human Life,” Illich argued that “‘Human life’ is a recent construct, something which we now take so much for granted that we dare not seriously question it” (p. 219). Moreover, “thinking in terms of ‘a life’ and ‘human life’ vaguely connotes something of extreme importance and tends to abolish all limits that decency and common sense have so far imposed on the exercise of professional tutelage” (pp. 219–220). In his history of “a life,” Illich contended that our “a life” originated in a corruption of the Christian message that Christ was “Life,” such that today “life” is, in religious terms, an idol. While Han does not go that route, it is clear that he, along with Bishop and Illich, sees “bare life” as an impoverished rendering of human living. Bare life is visible in the x-ray and the lab results, in the anatomical text and health statistics. Bare life makes living available to increased biopolitical surveillance.
The pandemic accelerates the shift to “a biopolitical surveillance regime” (Han, p. 18) since the protection of zoē knows no limits. The privacy and autonomy of the modern individual succumbs to the demands for containing the spread of the virus. Thus, “the biopolitical regime of surveillance spells the end of liberalism” (p. 59). Han’s insight into bare life as an idol makes sense of what at first sounded to this reader as a rant against commonsense public health measures during the pandemic. For example: “Because of the pandemic, the society of survival has prohibited church services, even at Easter. Priests, too, practice ‘social distancing’ and wear protective masks. They sacrifice faith entirely to survival. … Virology deprives theology of its power” (p. 15). Finally, “faith degenerates into farce. It is replaced with intensive care units and respirators. The dead are counted daily” (p. 15). Han here engages in some sliding of the signifier as the Lacanians might say, with “distance” shifting from meaning steps taken to avoid infecting other people to meaning indifference and a lack of empathy. Indeed, Han asserts that “‘social distancing’ contributes to the loss of empathy” (p. 52), because we are apart and not near one another. That assertion is an empirical matter, with Pfattheicher et al. (2020) finding social distancing a sign of empathy. The encounter with an other is not measured in feet and inches. Han’s hyperbole in this matter—faith is replaced with intensive care units?—makes sense only if one sees that the idolatry of “bare life” is in play in public health measures, despite the goodwill that promotes them. The sacrifice of faith for survival is better understood in terms of Illich’s contention, surpassing Han’s on this point, that our efforts to preserve bare “life” perverts what it means to be an individual or a person. The palliative society’s valuation of bare life undermines the good that we would do in responding to the pandemic. After all, the road to hell is paved with good intentions.References
Armstrong, T. (2012). The logic of slavery: Debt, technology, and pain in American literature. Cambridge University Press.
Bishop, J. P. (2011). The anticipatory corpse: Medicine, power, and the care of the dying. University of Notre Dame Press.
Buytendijk, F. J. J. (1961). Pain: Its modes and functions (E. O’ Shiel, Trans.). University of Chicago Press. (Originally published 1943)
Cohen, E. (1995). Towards a history of European physical sensibility: Pain in the later Middle Ages. Science in Context, 8(1), 47–74.
De Moulin, D. (1974). A historical-phenomenological study of bodily pain in Western man. Bulletin of the History of Medicine, 48(4), 540–570.
Durst, D. C. (2008). Translator’s introduction. In E. Jünger, On pain. Telos Press.
Gadamer, H.-G. (1989). Truth and method (J. Weinsheimer & D. G. Marshall, Trans.) (2nd ed.). Continuum. (Original work published 1960)
Glucklich, A. (2003). Sacred pain: Hurting the body for the sake of the soul. Oxford University Press.
Han, B.-C. (2015). The burnout society (E. Butler, Trans). Stanford University Press. (Original work published 2010)
Han, B.-C. (2021). Capitalism and the death drive. Polity Press. (Original work published 2019)
Heidegger, M. (2002). Off the beaten track (J. Young & K. Haynes, Eds. & Trans.). Cambridge University Press. (Original work published 1950)
Illich, I. (1976). Medical nemesis: The expropriation of health. Pantheon Books.
Illich, I. (1992). In the mirror of the past: Lectures and addresses 1978–1990. Marion Boyars.
Jünger, E. (2008). On pain (D. C. Durst, Trans.). Telos Press. (Original work published 1934)
Kugelmann, R. (2017). Constructing pain: Historical, psychological, and critical perspectives. Routledge.
Lasch, C. (1991). The culture of narcissism: American life in an age of diminishing expectations. Norton.
Leriche, R. (1939). The surgery of pain (A. Young, Trans.). Williams & Wilkins.
Levinas, E. (1991). Otherwise than being or beyond essence (A. Lingis, Trans.). Kluwer Academic. (Original work published 1974)
McKnight, J. (1996). The careless society: Community and its counterfeits. Basic Books.
Mitchell, S. W. (1892). Characteristics (3rd ed.). Century Co.
Mitchell, S. W. (1900). The wager and other poems. Century.
Peltonen, M. (2004). From discourse to “dispositif”: Michel Foucault’s two histories. Historical Reflections/Réflexions Historiques, 30(2), 205–219.
Pfattheicher, S., Nockur, L., Böhm, R., Sassenrath, C., & Petersen, M. B. (2020). The emotional path to action: Empathy promotes physical distancing and wearing of face masks during the COVID-19 pandemic. Psychological Science, 31(11), 1363–1373. https://doi.org/10.1177/0956797620964422
Rivers. W. H. R. (1920). Instinct and the unconscious: A contribution to a biological theory of the psycho-neuroses. Cambridge University Press.
Singer, P. W. (2008, May 2). How to be all that you can be: A look at the Pentagon’s five step plan for making Iron Man real. Brookings. https://www.brookings.edu/articles/how-to-be-all-that-you-can-be-a-look-at-the-pentagons-five-step-plan-for-making-iron-man-real/
Taylor, C. (1991). The ethics of authenticity. Harvard University Press.
The meaning of pain. (1906, March 17). The Living Age, 7th series, 30(3219), 699–701.
Tocqueville, A. de. (1966). Democracy in America (J. P. Mayer & M. Lerner, Eds.; G. Lawrence, Trans.). Harper & Row. (Original work published 1835)
Van den Berg, J. H. (1975). Divided existence and complex society: An historical approach. Duquesne University Press.