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“Everything That Really Matters”: Social

Suffering, Subjectivity, and the Remaking of
Human Experience in a Disordering World

Arthur Kleinman

Harvard Theological Review / Volume 90 / Issue 03 / July 1997, pp 315 - 336

DOI: 10.1017/S0017816000006374, Published online: 10 June 2011

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Arthur Kleinman (1997). “Everything That Really Matters”: Social Suffering,
Subjectivity, and the Remaking of Human Experience in a Disordering World.
Harvard Theological Review, 90, pp 315-336 doi:10.1017/S0017816000006374

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"Everything That Really Matters":
Social Suffering, Subjectivity, and the
Remaking of Human Experience
in a Disordering World*

Arthur Kleinman
Harvard University

W hen William James launched into the Gifford Lectures of 1901, he

admitted to his Edinburgh audience a certain feeling of trepidation.
Those lectures, which he would later publish as The Varieties of Religious
Experience, evoked in James a sense of consternation because, as he re-
marked on the occasion, he was neither a theologian, nor a historian of
religion, nor an anthropologist. "Psychology is the only branch of learning
in which I am particularly versed," James pleaded.1
While admitting to the same feeling of alarm in addressing a subject that
seems at first so different from my own fields of expertise, I have this one,
and only this one, advantage over William James. Although we both trained
first in medicine, only later turning to psychology (in James's case) and
psychiatry (in mine), I happen also to be an anthropologist. And indeed it
will be through the engagement of anthropology with social medicine and

* This article is a revised version of the William James Lecture on the Varieties of Reli-
gious Experience presented at the Harvard Divinity School, March 1997.
'William James, The Varieties of Religious Experience (1902; reprinted Cambridge, MA:
Harvard University Press, 1985) 11-12.

HTR 90:3 (1997) 3 1 5 - 3 5

316 HARVARD THEOLOGICAL REVIEW

cultural psychiatry that I will take up questions that I hope will prove
pertinent to the varieties of religious experience. That said, I know that I
will soon expose inadequacies in my knowledge of the subject matter at
hand that are much more serious than any my illustrious Harvard academic
ancestor may have exhibited almost a century ago. Nor do I possess the
magic of James's rhetorical style, which in the Varieties is so crucial to his
demonstration that to get at experience we need to remain open to diver-
gent readings that evoke the uncertainty, the exigency, the novelty, and the
multiplicity of what is definingly human.

• Formulation of the Problem

I wish, then, to address that point at which medical anthropology, and
particularly that brand of medical anthropology that I have called the an-
thropology of experience, converges with the study of religion. This par-
ticular point exists, in my opinion, in the experience of suffering.2 For the
choke, anguish, and often desperate hurt of suffering spark fundamental
questions about human conditions that are as central to medicine and to
anthropology as to religion. Those questions, moreover, become only sharper
through the transformative experiences of repair, remoralization, and regen-
eration. Serious illness, death and dying, grief, trauma, and healing, no
matter how great the differences in their cultural elaboration, are the com-
mon stuff of experience that summon inquiry in medical anthropology, as
well as in the study of religion.
Even as medical anthropologists have broadened their theoretical and
empirical framework to follow the blood trail of trauma from individual
episodes of distress and disease to such social disasters as civil conflicts,
structural violence, institutional racism, and the havoc of breakdown in
communities and even entire societies, the experience of suffering remains
their orienting subject. Anthropologists now configure suffering as much
more than the deep subjectivity of the afflicted person, the psychology of
the individual to which William James gave priority in his theory of the
twiceborn. 3 That "moreness"—a term that James favored as a multilevel
signifier of whatever is subconscious, moral, and ultimately religious all at
the same moment—I shall use to examine suffering that includes the indi-
vidual level but also transcends it as cultural representation, as transpersonal

2
On the ethnography of the experience of suffering, see Arthur Kleinman, Writing at the
Margin: Discourse Between Anthropology and Medicine (Berkeley: University of California
Press, 1996); Arthur Kleinman, Veena Das, and Margaret Lock, "Social Suffering," Daedalus
125 (1996) xi-xx; and Veena Das, Critical Events: An Anthropology of India (Delhi: Oxford
University Press, 1996).
3
James, Varieties, 71-78.
 ARTHUR KLEINMAN 317

experience, and as the embodiment of collective memory.4 That is to say,

one can speak of suffering as being social. Social suffering, its relation to
subjectivity, its bodiliness as processes that connect the moral to the medi-
cal, the political to the emotional, and the religious to the physiological,
and the manner in which it (and with it the human experience of transfor-
mation) is being remade in our disordering contemporary world—that is
what I seek to conjure in this essay.
On the side of the study of religion, John Bowker has shown persua-
sively that, the question of suffering is always a central problem for the
world's major religions, although handled in greatly divergent ways.5 For
Max Weber, whose intellectual legacy for our fields is incalculable,
theodicy—in its broadest sense, meaning-making in the face of history's
inevitable tragedies—was the modus operandi for the social science en-
gagement with suffering as a religious question.6 As the underpinning of
capitalism and the social order generally, Weber may actually have had in
mind sociodicy—the legitimation of society in the face of its failures—as
much as the justification of the cultural authority of divinity. Nevertheless,
his agenda for social analysis has oriented several generations of anthro-
pologists of religion, as well as of medicine.7 Those anthropologists have
taken as their framing orientation the concept of meaning (ultimate mean-
ing and the more prosaic varieties). The object of their inquiry is: how
people make, negotiate, and unmake meaning in the greatly divergent con-
texts of human conditions, including, and perhaps even especially, in con-
ditions of breakdown and disruption.
So dominant and abiding has this framework become that one wants to
speak almost of a tyranny of meaning that overvalues coherence and other
intellectualist priorities at the expense of everything else that the Jamesian
imagination (Henry, as much as William) held experience to comprise.8

4
Ibid., 55, 67, 402-3; and John E. Smith, "Introduction," in James, Varieties, xlv.
5
John Bowker, Problems of Suffering in Religions of the World (Cambridge: Cambridge
University Press, 1970).
6
Max Weber, The Sociology of Religion (1922; reprinted Boston: Beacon, 1963) 138-50. On the
broader issue of Weber's view of meaning-making in the face of history's tragic course, see John
Patrick Diggins, Max Weber: Politics and the Spirit of Tragedy (New York: Basic Books, 1996).
7
On the centrality of a Weberian approach to meaning in the anthropology of religion, see
Clifford Geertz "Religion as a Cultural System," in idem, ed., Interpretation of Cultures (New
York: Basic Books, 1973) 87—126. For its influence among medical anthropologists, see Arthur
Kieinman, Patients and Healers in the Context of Culture (Berkeley: University of California
Press, 1980) 71-118; and Byron Good, Medicine, Experience and Rationality (Cambridge:
Cambridge University Press, 1994).
8
James, Varieties, 15, 59, 290, 402-3; for Henry James's view of experience, see his
discussion of consciousness in his preface to The Wings of the Dove (1902; reprinted New
York: Penguin, 1986) 35-51.
318 HARVARD THEOLOGICAL REVIEW

Sensory conditions of sounds, smells, tastes, feel, balance, sight, and more
complex and subtle sensibilities (moral and aesthetic), as well as muscular
agency and action also constitute everyday experience. So do social rela-
tions and social memories; fragmentary, contradictory, changing, unexpressed
and inexpressible, though they often are. The literary imagination's revul-
sion against, and the popular culture's reaction to, the bloody havoc of our
century has challenged the dominion of meaning as inadequate, distorting,
or even inhuman.9 Primo Levi is not alone in finding the most chilling and
ironically inhuman implication of personal experience with the most ex-
treme kinds of social suffering to be that human beings can come to terms
with and indeed justify anything.10 For many survivor authors, making
meaning out of the most extreme and dehumanizing conditions that invert,
betray, or unmake the most basic values and moral interpretations is more
than hypocrisy. It annuls the very project through which meaning illumines
or is illuminated by experience. No meaning can be made out of the enor-
mity of this defeat, as Holocaust scholar Lawrence Langer avers." Only an
intense feeling of alarm emerges from the monstrous calamity of the Shoah.
Accordingly, Elie Wiesel, Paul Celan, Primo Levi, Dan Pagis, and other
survivor writers deny the possibility of theodicy.
Echoing the existentialist writers of four and five decades ago, current
social theorists, like the Indian anthropologist Veena Das or, for that mat-
ter, her historian colleagues who are partisans of the school of subaltern
studies, argue that meaning-making needs to be critically evaluated as a
political tool that reworks experience so that it conforms to the demands of
power.12 On the other hand, these social theorists and historians claim that
fashioning meaning perhaps should be understood as a largely bourgeois
preoccupation, incongruent with the sheer exigency of surviving that is the
destiny of the one-fifth of humankind existing under the grinding depriva-
tions of extreme poverty. The desperately poor, Das shows in her compel-
ling ethnography of political violence in India, have meaning thrust upon
them by legal, medical, welfare, security, and religious institutions, whose

9
KIeinman, Das, and Lock, "Social Suffering." Out of an enormous literature of anguished
response to twentieth century havoc, see also Paul Fussel, The Great War and Modern Memory
(New York: Oxford University Press, 1975); and Carolyn Forche, ed., Against Forgetting
(New York: Norton, 1993).
10
Primo Levi, The Drowned and the Saved (New York: Summit, 1988).
"Lawrence Langer, Holocaust Testimonies: The Ruins of Memory (New Haven: Yale
University Press, 1991); idem, "The Alarmed Vision: Social Suffering and Holocaust Atroc-
ity," Daedalus 125 (1996) 47-66.
l2
Das, Critical Events ; Gyanandra Pandey: "The Colonial Construction of 'Communal-
ism,'" in eadem, ed., Mirrors of Violence: Communities, Riots and Survivors in South Asia
(Delhi: Oxford University Press, 1990) 94-134.
 ARTHUR KLEINMAN 319

purpose too often seems to serve the interests of the state rather than local,
let alone personal, concerns.
Survivors of the Bhopal disaster thus lose their voices as victims to
legal, medical, and still other professionals, whose categories reduce their
pain and suffering to the grievances of plaintiffs, the symptoms of patients,
or the ritual pleas of supplicants. This process of appropriation silences the
collective authenticity of their own voices and denies their agency, while
redefining their needs away from demand for basic reforms or fundamental
rights.13 The poorest poor, not only in India, but as one encounters them in
telling ethnographies by anthropologists in Brazilian slums, Haitian
shantytowns, the killing fields of Sri Lanka and Mozambique, and deterio-
rated inner-cityscapes in North America, often express the idea that they
lack the resources (symbolic and material) to control and to make sense of
what befalls them.14
Students of globalization describe a cacophony of instantaneous images, a
commercialized voyeurism, a prodigality of dismaying pictures that comprise
global communication in a postmodern world of fragmentation, disorienting
unpredictability, bafflement, and dogged demand for the promiscuous arousal
deriving from constant change. The impossibility of engagement with the
real life constraints and contingencies of that which is local has become
operative for global "infotainment," such as one sees with the latest images
of current horrors from afar on the television's nightly news. This creates an
amoral virtual reality: suffering at a distance, and a safe distance at that.15
How can one assess meaning under these circumstances?
Talal Asad, one of the more original anthropologists of religion today,
analogizes the dominant cultural discourse of the global present—namely,
the amalgam of science, technology, political economic policy, and legal
procedure—to the role of Christianity as the determinative discourse of the
medieval period in the West.16 Both have created hegemonies: medieval
Christendom, Asad argues, deployed ultimate meaning to sanction disci-

l3
Das, Critical Events; eadem, "Suffering and Moral Experience," in Lincoln C. Chen,
Norman Ware, and Arthur Kleinman, eds.. Health and Social Change (Cambridge, MA: Har-
vard University Press, 1994).
l4
See, for example, Paul Farmer, AIDS and Accusation (Berkeley: University of California
Press, 1992); Nancy Scheper-Hughes, Death Without Weeping (Berkeley: University of Cali-
fornia Press, 1993); Phillip Bourgeois, In Search of Respect (Princeton: Princeton University
Press, 1996); and Patricia Lawrence, "Violence, Suffering, Amman: Agentive Moments in Sri
Lanka's Eastern War Zone," unpublished manuscript.
l5
Arthur Kleinman and Joan Kleinman, "The Appeal of Experience, the Dismay of Im-
ages: Cultural Appropriations of Suffering in Our Times," Daedalus 125 (1996) 1-25.
l6
Talal Asad, Genealogies of Religion: Discipline and Reasons of Power in Christianity
and Islam (Baltimore: Johns Hopkins University Press, 1993) 1-26.
320 HARVARD THEOLOGICAL REVIEW

pline, command, obedience, and control; the global policy discourse of moder-
nity is one in which moral and religious meaning must operate on the margins
in domestic, semiauthorized, or alternative spheres, driven out of the mainstream
discourse by a technical rationality that makes theodicy beside the point.
Humiliation, states Asad, served the former regime as a means of cre-
ating loving obedience as a virtue that, in turn, created social subjects
appropriate to that particular time and place. Under the global policy re-
gime, no one admires or uses humiliation, but rather classifies it as a
personality pathology. Biomedicine, for example, employs a thoroughly
disenchanted rationality for which the question of ultimate (or really any
human) meaning lacks legitimacy. For biomedicine, disease processes have
no purpose; illness experiences no teleology; and death, no mystery.17
Biomedicine's technological triumphs are its defining image; but the pro-
fession also produces suffering, about which there is an abrogation of
meaning. Even bioethics, astonishingly, seems to gain the requisite legiti-
macy to operate in the high technology settings of the hospital's intensive
care units by disavowing the broad contextual implications of deeply hu-
man experiences of suffering in favor of a narrow technical agenda of
professionally defined principles concerning individual choice. Although
not without importance, these principles frequently overshadow everything
else that matters in the experience of families, patients, and health practi-
tioners. Talk regarding abstract principles of autonomy or informed con-
sent, for example, substitutes for understanding and engaging the
ethnographic contexts of end-of-life care or the unprecedented limits on
patient-doctor interactions under managed care. 18
Thus the absolute primacy of concern with meaning—meaning that is
understood as a cognitive response to the challenge of coherence—would
seem to be dubious. When examined alone in this narrowly cognitivist
frame, meaning as a category provides an inadequate account of medical,
political, moral, or religious experience. It places greater value on "know-
ing the world," as William James put it, than on inhabiting, acting in, or
wrestling with the world. What other ways exist, however, for adequately
speaking of human experience and its changing conditions? To offer an
alternative, one needs to redefine suffering.

• Social Suffering: Cultural Representation, Transpersonal

Experience, and Embodied Subjectivity
Suffering, as I have said, is social. This is true in a number of senses:
(1) it is often a transpersonal engagement with pain and misery in social

l7
Kleinman, Writing at the Margin, 21-40.
l8
Ibid., 41-67.
 ARTHUR KLEINMAN 321

relationships, as in a family tragedy; (2) it is a societal construction that

acts as a cultural model, a moral guide of and for experience, as in tradi-
tional Chinese socialization of children to endure serious hardship with
endurance as an end in itself; (3) it is also a professional discourse that
organizes forms of suffering as bureaucratic categories and objects of tech-
nical intervention, such as the professional conversion of illness experience
into disease pathophysiology, or the making over of poverty by welfare
regulations into legitimate and illegal forms of welfare experience. As this
last sense, indicates, suffering is social, not only because social force breaks
networks and bodies but also because social institutions respond with as-
sistance to certain categories of sufferers (categories that institutions have
constructed as authorized objects for giving help), while denying others or
treating them with bureaucratic indifference.19 Thereby social institutions,
through their policies and programs, frequently deepen certain forms of
social suffering and become obstacles to their alleviation. Structural adjust-
ment policies of the International Monetary Fund and World Bank, which
have deepened poverty in Africa, are a case in point.20
One way of perceiving suffering as cultural representation is through art.
For example, the depiction of Christ, the man of sorrows, in the formalized
religious imagery of the Crucifixion both evokes pathos and shapes its
cultural form.21 Michelangelo's Pieta realizes one of the Western tradition's
prototypes of moral relationships, here cast as the suffering of the other in
response to the sufferer. Bernini's Ecstasy of St. Teresa is yet another
example of an arresting and influential cultural imagination of suffering as
religious passion. More recent examples continue some of the same themes,
but in new forms. When the cultural representation of suffering changes, as
one can see in the images of social memory and cultural authority in Western

"Kleinman, Das, and Lock, "Introduction," xi—xx; Michael Herzfeld, The Social Produc-
tion of "Indifference ": Exploring the Symbolic Roots of Western Bureaucracy (New York:
Berg, 1992).
20
Paul Farmer, et al.. Women, Poverty and AIDS (Monroe, ME: Common Courage Press,
1996).
21
For authoritative religious images of the Crucifixion, I refer to Jane Turner, ed., The
Dictionary of Art (34 vols.; New York: Grove Dictionaries, 1996) 8. 211-15. More recent
cultural representations of the Crucifixion by Picasso and others that demonstrate the trans-
formation of the imagery of this icon of suffering in terms of abstractionism and other move-
ments in modern art appear in Terez Gerszi, Les Plus Beaux Dessins de Vinci a Chagall (Paris:
Belfond, 1988). Analytic accounts of changing depiction of the bodiliness of Christ's suffering
include: Rosemary Coffey, "The Man of Sorrows of Giovanni Bellini" (Ph.D. diss., University
of Wisconsin, 1987); and Sarah Beckwith, Christ's Body: Identity, Culture and Society in Late
Medieval Writings (London: Routledge, 1993); and Andrew Louth, "The Body in Western
Catholic Christianity," in Sarah Coakley, ed., Religion and the Body (Cambridge: Cambridge
University Press, 1997) 111-130.
322 HARVARD THEOLOGICAL REVIEW

art, for example, do collective and subjective experiences change with it?
If so, how? (See fig. 1.)

subjectivity

Fig. 1: The transformation of "experience"—for example, suffering and

responses to it—is depicted here as the reciprocal influence of shifts in cultural
representation, social experience, and subjectivity which are shaped and
reshaped by epochal political, economic, and social structural transformations.

In her book The Suffering Self: Pain and Narrative Representation in the
Early Christian Era, Judith Perkins advances the idea that, in contrast to
the Stoic persona that was a key representation of the self for ancient
Romans (for whom suffering was no great virtue), second-century Christian
discourse fashioned a self that was centered around suffering, both as re-
ligious identification with divinity and as a political alternative.22
This discourse created a new paradigm for understanding suffering-and
death, and, consequently, the experiential world. . . . [T]hings that had
universally been thought bad and contemptible were suddenly seen as
valuable. . . . [T]his empowerment, together with the emphasis on the
resurrected body, display the subversive underpinnings of this discourse.23
The suffering body became the meeting place of the human and the
divine; healing became the material manifestation of Christian power. Chris-

22
Judith Perkins, The Suffering Self: Pain and Narrative Representation in the Early Christian
Era (London: Routledge, 1995) 3, 11, 122-23, 131, 141.
23
Ibid., 122-23.
 ARTHUR KLEINMAN 323

tianity thereby is involved, this author claims, in a transformation of sub-

jectivity. This new subjective self as sufferer took institutional form around
the organized collection of funds, administration of hospitals and poor-
houses, and experiences of religious transformations, so that the entire cluster
of representation, self, and institutions became a vehicle of political power.24
Anthropologists of experience provide other sorts of empirical materials to
confirm the relationship of changes in collective meanings, in transpersonal
experience and in subjectivity to those in historical, political-economic, and
social structures.25 For example, William Christian, in his marvelous account
of peasant visionaries in Ezkoiga in the Basque country during the pre-
Franco 1930s, relates the visionary experience of sightings of Mary and the
saints (which attracted more than a million people to this village) to the
Republic's anticlericalism and the growing political resistance that would
culminate in the Spanish Civil War.26 His description of the transformation
of subjectivities via extraordinary experiences would have delighted William
James, for it is quite in keeping with the Varieties' magnificent chapter on
"Mysticism."27 Christian, however, interprets this change as the correlation
of sensibility and social context—a correlation of a constructed sociosomatic
kind rather than a presumedly natural psychosomatic kind. One can see this
by comparing pictures of transformed subjectivity from Christian's book with
pictures of Charcot's classical psychosomatic interpretation of religious expe-
rience as hysteria, which seeks to make sense of the psychological pathology
of isolated individuals who dissociate into postures of crucifixion in the
acontextual confines of the clinic, without attending to its place in social
experience, as if it were a naturalized entity instead.28

• Somato-Moral Basis of Experience: Suffering and

Transformation
The anthropology of experience understands the moral, the religious,
and the political to be embodied, evoked, realized, or actualized in somatic
processes like habitus, normal physiology, as well as in symptoms of pa-

24
Ibid., 202.
"See books reviewed in Arthur Kleinman, "The New Wave of Ethnographies in Medical
Anthropology," in Writing at the Margin, 193-256.
26
William A. Christian, Jr., Visionaries: The Spanish Republic and the Reign of Christ
(Berkeley: University of California Press, 1996); these visionaries saw the Civil War as the
beginning of the Apocalypse and the coming of the reign of Christ.
"James, Varieties, 301-39.
28
Jean-Martin Charcot, Les Demoniaques dans I'Art (Paris: Adrien Delahaye et Emile
Lecrosnier, Editeurs, 1876-78); Desire Bourneville and Paul Regnard, Iconographie
Photographique de la Salpetriere (Service de M. Charcot) (Paris: Adrien Delahaye et Libraires,
Editeurs, 1876-1878).
324 HARVARD THEOLOGICAL REVIEW

thology. Persons incorporate social memory in the body; cultural rituals

transform bodily processes. Moral categories are directly linked to emo-
tions, as are political affairs, much as the pathbreaking French philosopher
of science and historian of medicine George Canquilhem imagined norms
in society to enfold into normality in the body.29 Meaning is not unimpor-
tant, to be sure, but it is the bridge that it creates between transpersonal and
bodily processes that is most consequential for human experience.
Job, to take a biblical example, refers to his state of suffering as ka'as,
Hebrew for "vexed." 30 He is deeply vexed, shaken by a force outside of
him, a power that threatens to break him, his body, and his personal world.
The emphasis, according to Moshe Greenberg, is on the relationship of
outer force to inner state: religious, moral, and social condition to body-
self reaction. This is different from the current psychogenic emphasis; the
Book of Job expresses inner state somatopsychically (or even somatoso-
cially), with an emphasis on the corporeal body as mediator between soci-
ety and individual. Emotion is one of the body's conditions, not a free
floating independent state. In Job there is no difference between psycho-
logical pain and physical pain. Bruno Snell's great book on the discovery
of the mind in ancient Greece expresses a similar point of view.31 Before
subjectivity deepened the dimensions of the self to craft a thoroughly modern
mode of self-awareness, which has occurred massively over the last several
centuries in the West, and with great intensity in the past few decades at
least among educated urbanites in the non-Western world, the discourse of
sociosomatic or moral-bodily relations was primary.32
In our own age of the dominance of the psychological, it is still startling
to read in William Styron's description of his life-threatening manic depres-
sive disorder that the experience of depression for him was a physical
pain, 33 much as Robert Burton described melancholia in The Anatomy of
Melancholy almost four centuries earlier.34 Without mind-body dualism,

29
George Canquilhem, The Normal and the Pathological (1966; repr. New York: Zone, 1981).
30
Moshe Greenberg, "Job," in Robert Alter and Frank Kermode, eds., The Literary Guide
to the Bible (Cambridge, MA: Harvard University Press, 1987) 283-304.
3l
Bruno Snell, The Discovery of the Mind: The Greek Origins of European Thought (New
York: Harper, 1960) xi, 14, 16, 18-22, 65, 69.
32
See, for example, Arthur Kleinman, Social Origins of Distress and Disease: Neurasthe-
nia, Depression and Pain in Modern China (New Haven: Yale University Press, 1986); Tho-
mas J. Csordas, "Introduction," in idem, ed., Embodiment and Experience (Cambridge: Cambridge
University Press, 1994) 1—26; Robert A. LeVine, Culture, Behavior and Personality (New
York: Aldine, 1973); Robert I. Levy, Tahitians: Mind and Experience in the Society Islands
(Chicago: University of Chicago Press, 1973); and Charles Taylor, Sources of the Self: The
Making of Modern Identity (Cambridge, MA: Harvard University Press, 1990).
"William Styron, Darkness Visible: A Memoir ofMadness (New York: Random House, 1990).
34
Robert Burton, The Anatomy of Melancholy (1621; reprised New York: Vintage, 1977).
 ARTHUR KLEINMAN 325

Burton could speak of the spiritual and emotional aspects of melancholy,

as well as of the soul's physical sensation of it. In seventeenth- and eigh-
teenth-century England, "depression" evolved as a term based on the expe-
rience of deprimere ("to press down") in both a material and emotional
sense, and in the sense of a lowered or falling spirit, something like the
sensibility of the soul's falling downward in the body. 35 The point I seek
to emphasize is that this earlier cultural rhetoric linked the social world, as
well as the invisible world of spirit, directly to the body. It perceived the
subjective self as only one aspect of that interconnectedness and regarded
it as a compound of physical, emotional, and spiritual elements.
In research that my wife, Joan Kleinman, and I conducted in China from
1978 through 1986 with survivors of China's immensely chaotic and de-
structive Cultural Revolution (1966-1976), we found that many who had
been deeply wounded during this political maelstrom also used the term
vexed (Chinese fanzao) and complained primarily of bodily symptoms. 36
Somatic symptoms, complaints of dizziness, pain, and exhaustion, were
their chief problems. While it was possible to argue on a case-by-case basis
whether the local diagnosis of neurasthenia or the global medicalizing cat-
egory of depression was a more appropriate interpretation, on the collective
level there was an entirely different issue to consider. During a time when
political expression of criticism of the Cultural Revolution (and by exten-
sion of the Chinese Communist Party itself) was unacceptable, these shared
complaints of injured habitus were a form of collective memory, of societal
wounds and recrimination. It was possible to express these physical com-
plaints and even for small groups of people to come together around them
as a kind of shared trauma, even if there was a clear limit to their use as
political criticism and resistance. Here the subjective experience of pain
spread metaphorically from the physical body to the social body (namely,
the pain of damaged and damaging social relations). Similarly, the symp-
tom of dizziness established a metaphoric link between the dizzying effects
(personal and interpersonal) of a political campaign gone wild and vertigi-
nous. Exhaustion as lack of bodily vitality merged with the devitalization
of social institutions and networks, the exhaustion of social resources. 37

"The definitions of "depress," "depressed," and "depression" in The Oxford English

Dictionary show the mix of material, energetic, and emotional senses. Stanley Jackson's mag-
isterial treatment (A History of Melancholia and Depression [New Haven: Yale University
Press, 1987]) illumines the interconnections between physical state (melancholy humor), emotional
and energetic condition (depression), and moral-spiritual condition (acedia).
36
Arthur Kleinman and Joan Kleinman, "How Bodies Remember: Social Meaning and the
Bodily Experience of Criticism, Resistance and Delegitimation Following China's Cultural
Revolution," New Literary History 25 (1993) 707-23.
37
Ibid.; Kleinman, Social Origins of Distress and Disease, 143-79.
326 HARVARD THEOLOGICAL REVIEW

Elsewhere I have shown that, in the Chinese tradition, metaphoric connec-

tions between moral categories, such as face (lianmiari) and favor, the moral
quality of relationship (renqing quanxi), and emotional states represented by
loss of face and absence of favor are really two sides of the same sociosomatic
coin. These are not discrete phenomena inhabiting entirely separate spaces
(inner and outer); rather, they are processes that cross the boundaries be-
tween the personal and the transpersonal, the bodily and the cultural.38 Moral-
somatic interconnections indicate, moreover, that the flow of experience is
thoroughly dialectical. In that flow, cultural representation, transpersonal
relations, and embodied subjectivity interact so as to transform experience.
The idea of the spread of experience, like the shifting biphasic states of
wave-particle from social metaphor to corporeal sensibility (and vice versa),
can convey a notion of lived connection (or vital disconnection) among oth-
erwise seemingly distinctive phenomenological domains.
My purpose, then, is to call attention to a form of being-in-the-world
that insists that experience is both within and without the boundary of the
body-self, crossing back and forth as if that boundary were permeable.
Enculturation of persons into society accompanies the socialization of both
their physiologies and their selves. When social ties are severed, as in
bereavement, so too are physiological ones. While I do not have the space
to review the neurological, endocrinological, immunological, or cardiovas-
cular processes that may contribute to the bodily mediation of social expe-
rience, there is a fascinating and rapidly expanding literature on this subject.
It demonstrates that biology is open to the social world to such a degree
that one may speak of local biologies or "cultural biology." 39
In this medical-anthropological orientation, experience is a tidal stream
of transpersonal engagements in a local world: a family, a network, a neigh-
borhood, a community. That flow of practices and forms of life is, as
Bergson, Merleau-Ponty, and many European phenomenologists understood
it to be, a vital medium of socially constructed gestures, somatosensory
communication, actions, reactions, engagements that moves both interper-
sonally and within the person. 40 It is a tide that rises and falls, sometimes

38
Idem, Writing at the Margin, 95-172.
39
See Margaret Lock, Encounters with Aging: Mythologies of Menopause in Japan and
North America (Berkeley: University of California Press, 1993); Arthur Kleinman and Anne
Becker, "Introduction," Psychosomatic Medicine: Special Issue on Sociosomatics 60 (1998),
publ. forthcoming. Anne Harrington, Professor of History of Science at Harvard University,
will be editing a book series entitled "Cultural Neuroscience."
40
Henri Bergson, Les donnes immediates de la conscience (Paris: Alcan, 1889); Maruice
Merleauu-Ponty, Phenomenology of Perception (London: Routledge and Kegan Paul, 1962)
105, 405; Max Scheler, Man's Place in Nature (1928; reprinted New York: Noonday, 1971);
Alfred Schultz, On Phenomenology and Social Relations (Chicago: University of Chicago
Press, 1968).
 ARTHUR KLEINMAN 327

washing in among the objects of inner experience, at other times drawing

back outwardly among the participants in the transpersonal world. The sym-
bolic connections involve transductions between social states and emotional
states. Aesthetic conditions, such as response to music, point to similar trans-
ductions in moral conditions.41 Put more prosaically, in the disenchanted
language of social science and medical research there is a connection among
stressors, supports, coping reactions, and physiological processes, so that, for
instance, gender-related social losses and pressures transduce into the psy-
chobiology of clinical depression.42 As with demoralization and depression,
so with remoralization and healing: societal transductions into physiology
underwrite powerful transformations of experience. The mediators of those
transductions appear to include smells, sounds, words, images, memories,
interactions, ritual performances, and music. Recent ethnographies illustrate
these body-self-society transductions in healing; other kinds of research are
beginning to shed light on how they create their effects.43
Experience (including its sociosomatic interconnections) is innately moral,
because it is in local worlds that the relational elements of social existence
in which people have the greatest stake are played out. These include sur-
vival, status, power, resistance, or loss. I do not mean to posit a banal idea
of universals for the human condition. What is at stake undergoes great,
even extravagant, elaboration through the cultural apparatuses of language
and aesthetics and across divergent social positions of gender, age cohort,
political faction, class, and ethnicity. Yet the fact that some things really
do matter, matter desperately, is what provides local worlds with their
immense power to absorb attention, orient interest, and direct action. More-
over, it is these local worlds that have the power to transform the
transpersonal and subjective poles of experience. 44

41
See, for example, William Flemming, Arts and Ideas (3d ed.; New York: Holt, Rinehart,
and Winston, 1958) 313, 342; Steven Feld and Aaron A. Fox, "Music and Language," Annual
Review of Anthropology 23 (1994) 25-54; Marina Roseman, Healing Seconds from the Ma-
laysian Rainforest: Temiar Music and Medicine (Berkeley: University of California Press,
1991); Haili You, "Defining Rhythm: Aspects of an Anthropology of Rhythm," Culture,
Medicine and Psychiatry 19 (1995) 361-84.
42
George Brown and Tirrel Harris, Social Origins of Depression (New York: Free Press, 1978).
43
See, for ethnographic examples, Thomas Csordas, The Sacred Self: A Cultural Phenom-
enology of Charismatic Healing (Berkeley: University of California Press, 1994); Robert
Desjarlais, Body and Emotions: The Aesthetics of Illness and Healing in the Nepal Himalayas
(Philadelphia: University of Pennsylvania Press, 1992); and Renate Devisch, Weaving the
Threads of Life: The Khita Gyn-ecolo-gical Healing Cult among the Yaka (Chicago: Univer-
sity of Chicago Press, 1993). For examples of studies of how healing is mediated, see Arthur
Kleinman and Anne Becker, "Introduction."
44
For works that describe the moral orientations of local worlds, see the references in
Arthur Kleinman and Joan Kleinman, "Suffering and Its Professional Transformations," Cul-
ture, Medicine and Psychiatry 15 (1991) 275-301.
328 HARVARD THEOLOGICAL REVIEW

Having defined moral worlds and somato-moral processes, let me illus-

trate them with a few statements by people whom I have interviewed in
rather different settings because of their experiences of suffering. These
remarks provide the title of this article: "Everything That Really Matters."
They also will begin, I hope, to suggest how the moral-somatic language
I am building here may help us to get at religious experience and how the
forms of moral and religious experience undergo those great sea changes
that define epochal shifts in social life.
When I think about those really bad times [the Cultural Revolution],
the beatings, the real chaos, the destructiveness, I think of what really
matters ["really is important"]. Family, surviving, keeping principles. . . .
These are so much better times now. We live so much better. We all
do. But that time, that terrible time made it clear, completely clear
about everything that really matters. And now, I'm not so clear. Not
really clear. None of us are. Now what matters is money, things to
buy. Our experience is changing. We are all changing. Then I felt
really vexed, deeply troubled. Now, what do I feel? Can't be certain.
Nothing is clear anymore.
A sixty-year-old Chinese intellectual, 1995

Everything that really matters! Matters to me. Know what I mean? Liv-
ing, dying, going through it all, all those things you do, and need, and
love, and want, and feel. When she [wife of 38 years] died, when she
died I knew, just knew, I had to do what matters. No good suffering,
hurting. Get ready; do what you need to do. No good suffering. Feeling
sorry for yourself. Get over it. The rest, I thought, is meaningless. . . .
But now, three years later, I can't get the handle of it. Really I can't. I'm
not sure, not so sure what counts anymore. Fm floating. There isn't any
firm, really firm ground. It seems all to be shifting. Do I start over
again? Do I stay loyal to my memories? Do I? I feel lost. But I find my
friends are the same way. Everything seems to be changing. Not just us,
the world. What does matter? It just is terribly confusing.

A sixty-two-year-old American executive

Here I'm dying of metastatic cancer, and you ask me, 'Does your reli-
gious belief help?' It does really; it does help. But I think you don't
mean belief. Or I don't mean belief. Well, what is religion, really? Is it
going to church to pray to God to get better? Maybe, for some. But not
for me. For me, well. . . here, it's faith that something more really
matters, counts. Something bigger and beyond you. So death's got to
be seen against. . . against that; and then all of a sudden it looks
different, and feels very different. It is so depressing otherwise, when
 ARTHUR KLEINMAN 329

you consider it from just you. It's a feeling thing. You feel different
and act differently. I'm here so sick and the disease is bad, and yet I
don't feel depressed. For that matter, I don't feel my usual self either.
I'm better than usual in one way. I don't feel so uncertain. I think our
world is one where we are made to feel uncertain, to question every-
thing. In some bizarre way, I don't feel that way now. Something has
changed, for me. . . . I'm even thinking maybe we live in a world
where religion or faith only really counts when you're up against the
end. Then everything is clear. Otherwise it's pulling in all directions.
Our. world doesn't let you. . . doesn't let you. . . well, you just don't
see, maybe can't see, what matters most of the time.
S. R., a sixty-three-year-old American college
teacher in the terminal stages of lung cancer

• The Transformations of Suffering: Moral, Religious, and

Medical Degenerations and Regenerations
"Everything that really matters"? This phrase, or one of its congeners,
runs through these very different interviews almost as a golden thread. In
the first instance, I use these examples to illustrate the fundamental moral
basis of social experience. What really matters may be, and usually is,
distinctive, but the realization that something really matters and that it is
anchored locally, both in a transpersonal and in a subjective sense, gives to
human conditions, I am convinced, their moral edge and depth, their hu-
manness. As I shall try to show in the final section of this paper, the
sensibility that what is at stake is threatened by fundamental changes—
political, economic, cultural—may also be characteristic of moral experi-
ence. But I shall also attempt to describe how the protagonists recorded in
these contemporary interviews, individuals from two very different societ-
ies, associate a certain kind of threat, a type that one humanist scholar has
called the threat of the loss of the human, with the disordering transforma-
tions in moral experience evoked by the current phase of global capitalism.
I now return to the case of S. R., the sixty-three-year-old college teacher
from an East Coast, North American city who is in the terminal stages of
metastatic lung cancer. From a purely technical perspective of cancer treat-
ment outcome, he is about to become part of the still grim statistics on the
deadliness of lung cancer, even in an era of powerful oncological interven-
tions. For the highly malignant tumor with which he was afflicted, five-
year survival rates, even with surgery followed by radiation and
chemotherapy (all of which he had received), are very poor. Most patients
330 HARVARD THEOLOGICAL REVIEW

don't live beyond five years, many don't reach this mark. S. R. lived three-
and-a-half years beyond diagnosis of the tumor.
Medically speaking, the treatments merely slowed the progression of
cancer. Because those treatments also caused significant side effects (pain,
rash, intestinal problems, weakness) that S. R. found initially unpleasant
(and eventually, awful), it is not entirely certain whether overall the bio-
medical treatment contributed to the quality of his life or made it more
problematic. In a broader perspective, however, hospice care in the termi-
nal weeks and months with nurses and doctors visiting his home, enabled
S. R. to die very much as he wished: at home, in the company of family
members, and in sufficient control of pain and other serious end-of-life
symptoms that he remained clearheaded and able to do the things he highly
valued—reading, talking, observing nature—even into the final hours. End-
of-life care for him was successful.
Not only did S. R. not feel depressed during this final period of his life,
he felt, in at least one very important sense, "better than usual." In the
interview, he went on to say that terminality, confronting his own death, let
him determine with greater clarity and certainty "what matters," and it did
that in an epoch and local setting that usually makes such clarity and
certainty unavailable. Rather than having felt defeat, demoralization, or
despair as the end approached; he felt remoralized. This sense of moral
regeneration was so strong that in interviewing him just before he died, I,
myself, caught it and felt uplifted by his spirit. I now relate it to the way
one feels, for example, after listening to the conclusion of Mahler's Third
Symphony or other musical works that stir the emotions and in their finales
lift something deeply human within, leaving a sense of expansion, comple-
tion, even joyousness. I associate similar feelings with prayer in the syna-
gogue when I was a child and a believer. Doubtless others have more
recent familiarity with this lived experience of transfiguration. One must,
then, think of the outcome of illness in moral (or religious) terms, rather
than in medical terms alone.
For many patients with serious, chronic conditions, the lived experience
is one of endurance of severe hardship: suffering is a way of life and
transformations are usually not good. The claims made for high technology
interventions and the growth of our scientific knowledge base—which in-
deed have produced important successes—hide that reality, as do the facile
expectations that psychotherapy and psychopharmacology can relieve re-
sidual pain and suffering. In this respect, the culture of biomedicine, which
does not value the core illness experience at the same level as the diagnosis
and treatment of disease pathology, conspires with the popular culture to
treat death as the enemy. They have great difficulty coming to terms with
 ARTHUR KLEINMAN 331

the limits of treatment and the reality of suffering as a way of life. A good
death in our society is becoming more and more difficult to create.
In the process that I am highlighting, transformation is not moral-reli-
gious (to beg the question of how they differ by hyphenating the term)
because the outcome is transcendence. Suffering itself is a moral-religious
experience. As Clifford Geertz famously put it: "as a religious problem, the
problem of suffering is, paradoxically, not how to avoid suffering, but how
to suffer. . . ."45 In American society in the current era, culture critics
repeatedly affirm that the highest value is still placed on the popular expec-
tation of a good therapeutic outcome, of happy endings. 46 But persistence,
endurance, and progression of suffering or decline are widely shared fates.
This too is a moral-religious condition, even if there is no regeneration.
The lived experience of "everything that really matters" transforms the
ordinary. That is what the words of S. R. and the other interviewees that I
have quoted seem to mean. The bodiliness of moral categories, the meta-
phoric spread of emotional processes through social relationships, the physi-
ology of socially constituted conversion from norms into normality (what the
Book of Jeremiah means when it quotes divinity as saying, "I shall put my
law into their inward parts"), 47 these sociosomatic processes not only connect
society and the body-self, they can transform both poles of experience.
Perhaps this says something more fundamental about suffering, disrup-
tion, healing, or transcendence as bodily mediated transpersonal experi-
ence. Sociosomatic reactions, in this sense, are a source not only of positive
transformation but perhaps even more routinely of negative change. Any-
one who visits the medical intensive care units and wards of any major
hospital would find that a high percentage of the most seriously ill patients
with cancer, heart disease, stroke, end-stage renal or liver disease, and the
like would satisfy the technical criteria for major depressive disorder. Are
they suffering from a psychiatric illness? The neurovegative complaints
that may make one conclude so, can also result from their primary medical
diseases and the treatments they receive. What some interpret as their sad-
ness and depressed mood strikes me as the felt moral-emotional experience
of suffering at the end of life. That there is a moral-religious experience at
the end of life is demonstrated not only by states of regeneration and
remoralization, but by demoralization and despair. Those too seem to be
core aspects of moral-religious phenomenology. Yet, increasingly, our own
society denies this side of suffering, rendering it impossible by the techni-

45
Geertz, "Religion as a Cultural System," 103.
4
'See, for example, Christopher Lasch, The Culture of Narcissism (New York: Norton,
1978) 3-33; and Philip Rieff, The Triumph of the Therapeutic (New York: Harper, 1968).
47
Jer 31:33-34.
332 HARVARD THEOLOGICAL REVIEW

cal rationality and technology of biomedicine, and by the sentimentality

and gratuitous optimism of Hollywood. The difficult reality of embodied
demoralization and the troubling uncertainty over whether to treat it as a
mood disorder or a moral state is the primal scene for many people's deaths
and for considerations of assisted suicide. Perhaps nowhere else at the
margins of the dominant technical discourse that authorizes social experi-
ence in our times and the private, semiofficial, or alternative discourse of
moral-religious life that presses up against that dominating version is there
a more poignantly powerful example of the failure of our society to come
to terms with suffering per se as moral-religious experience.
I'm ready to die; but they won't let me, it seems. It makes sense in my
case: this disease can't be cured. I've had all the treatments. Nothing's
worked. Now its time to let me die on my terms. Oh, I'm not always
convinced another try with yet some other treatment won't give me a
few more days or weeks. And my family is just as uncertain. But
really what's the point. . . . A psychiatrist told me I was depressed. Of
course, I am. Isn't that what suffering is supposed to be? I want to
bring it all to a close. Do I have to go with a smile on my face? That
seems to me ridiculous, and insulting.

A seventy-eight-year-old artist with leukemia in

hospital with fourth exacerbation in six months

Many Americans, together with increasing numbers of people in other af-

fluent societies, seem to regard suffering as something that no one need feel,
that one can and should avoid, that is without any redeeming virtue, and as
something to which society should respond primarily with the high technology
that defines our age. There is also the problem of the misappropriations and
abuses of suffering that I discussed earlier. This points to a transformation in
moral orientation and social practice that is troubling to consider because it
highlights a tragic consequence of history: our globalizing political economy
and popular culture seem to have become a threat to the human—a topic to
which I now will briefly turn as the conclusion to this essay.

• The Threat of the Loss of the Human in a Disordered and

Disordering Epoch
In the "Introduction" to his deeply pessimistic history of the world in the
twentieth century, the distinguished British historian Eric Hobsbawm offers
a devastating warning concerning the passing of the human in our times:
At the end of this century it has for the first time become possible to
see what a world may be like in which the past, including the past in
the present, has lost its role, in which the old maps and charts which
 ARTHUR KLEINMAN 333

guided human beings, singly and collectively, through life no longer

represent the landscape through which we move, the seas on which we
sail. [It has become possible to envision a world] in which we do not
know where our journey is taking us, or even ought to take us. 48

One can find similarly dire warnings and wildly dark prophesies in the
work of other humanists, social scientists, and culture critics. The noted
French cultural historian Philippe Aries, in his magisterial volume on the
history of death in the Western tradition, is yet one other member of this
rueful chorus when he sardonically concludes:
A small elite . . . propose not so much to "evacuate" death as to
humanize it. They acknowledge the necessity of death, but they want it
to be accepted and no longer shameful. . . . They propose to reconcile
death with happiness. Death must simply become the discreet but dig-
nified exit of a peaceful person from a helpful society that is not torn,
not even overly upset by the idea of a biological transition without
significance, without pain or suffering, and ultimately without fear.49

The threat of the loss of the human turns on the idea that if cultural
representation and collective experiences can transmogrify in a fundamen-
tal way in a time of enormous social change, then so too can subjectivity
be transformed.50 That transformation, this line of analysis so ominously
insists, can be of a kind to cancel, nullify, or evacuate the defining human
element in individuals—their moral, aesthetic, and religious experience. It
is a social reconstruction not so much of a category of the person as of a
life trajectory and of experiential existence. The threat could come from the
iron cage of technical rationality that Weber, for example, believed bureau-
cratic society would create to replace tradition, sentiment, and the ad hoc
with efficiency-based institutional controls. Or it might come from the de-
struction of empathy owing to a turn toward inhuman fundamentalisms, to
a blame-it-on-the-victim, narcissistic preoccupation with materialism, or to
commercialization of suffering. Another scenario for this prototypical hu-
man end game expects, as in Hobsbawm's bitter forecast, a loss of collec-
tive memory owing to the bloody havoc of this century that has dislodged
inner values from their traditional cultural moorings, while failing to re-
place them with cultural resources from the programs of modernity that

48
Eric Hobsbawm, The Age of Extremes: A History of the World, 1914-1991 (New York:
Pantheon, 1994) 16.
49
Phillippe Aries, The Hour of Our Death (New York: Alfred Knopf, 1981) 614.
50
I am grateful to Gerald Bruns, Professor of the Humanities at Notre Dame University, for
suggesting the term "threat of the loss of the human," which is the theme of the Roger Allan
Moore Lecture that he will deliver at the Harvard Medical School in the spring semester
ofl998. Also relevant to this essay is Bruns's article, "Loose Talk about Religion from Wil-
liam James," Critical Inquiry 11:2 (1984) 299-316 .
334 HARVARD THEOLOGICAL REVIEW

offer hope of a new or renewed means of authorizing human ends. Touch-

stones in this genre are the apocalyptic visions of the Holocaust, the Cam-
bodian genocide, the Stalinist terror, and the more recent tragedies of societal
breakdown in Afghanistan, Rwanda, and the former Yugoslavia: times and
places of enormous destruction that call into question the very reality of the
moral and religious foundations of humanity. Here society must confront
the desperate, even cynical feeling that maybe nothing really matters any-
way. There is a perspective alive in the humanities and social sciences that
even contributes to this nihilistic conclusion.
Some have claimed that the escalatory rhetoric of loss of the human is
part of millenarian dismay, a contagious sensibility of human decline that
is simply out of keeping with actual human affairs and conditions. The
economists of the World Bank, for instance, insist that things have never
been better in material terms.51
This fear of the loss of the human, although it has picked up intensity
in the 1990s, has been around for a very long time. Discernible also in
earlier periods of vast societal change is the fear that fundamental human
values and the subjectivity of humanity itself could develop in an inhuman
direction.52 Nor is this fear culture-bound to the West, although it seems to
find its most intense and consistent voice there.
Fear of the loss of the human seems to correlate with an awareness of
changing forms of social experience and inner life that are the consequence
of vast historical, political-economic, and cultural transformations. These
major transformations periodically sweep through localities, regions, or, in
the current interdependent world, the entire globe. This recognition is an
apprehension that the existential itself is not fixed, that human nature is
malleable, and perhaps to so great a degree that the term itself is invalid.
Human beings are no longer the same persons in sensibility or other as-
pects of body-self that their ancestors were, or that their descendants will
be. More than just dress, diet, and cultural meanings change.
Collective experience, as well as subjectivity, are distinctive in different
eras and different places.53 Today one senses a fundamental change. The

^Investing in Health (World Development Report; Washington, DC: World Bank, 1993).
52
For a representative sampling of the literature, see Jean Delumeau, Sin and Fear: The
Emergence of a Western Guilt Culture, 13th-lSth Centuries (1983; reprinted New York: St.
Martin's, 1990); Andrew Delbanco, The Death of Satan: How Americans Have Lost the Sense
of Evil (New York: Farrar, Strauss, and Giroux, 1995); Peter Gay, The Naked Heart: The
Bourgeois Experience, Victoria to Freud (New York: Norton, 1995); Christopher Lasch, The
True and Only Heaven: Progress and Its Critics (New York: Norton, 1991); and Keith Tho-
mas, Religion and the Decline of Magic (New York: Scribners, 1971).
53
The literature suggesting this point as it relates to suffering comes from a number of
directions, as I have illustrated above. Other examples include Rebecca Lester, "Embodied
Voices: Women's Food Asceticism and the Negotiation of Identity," Ethos 23 (1995) 187-
 ARTHUR KLEINMAN 335

tendency is to fear that this change is so great that it will threaten what is
at stake for humanity, so that entirely different matters will define the
world of our children's children, while today's world will be so completely
lost that this age will be able to lament with Montaigne, who remarked
ruefully in the Essays that the world he was born into was gone forever.54
What makes this fear especially powerful at present is the disordering
effects of advanced capitalism which, like some universal solvent, appears
to many to dissolve all that really matters. There is a part of me that shares
this fear. Another part, however, rejects its essentializing implications and,
in its place, would conclude: substantial transformation of "everything that
really matters"—in the sense that I have discussed it here as transformation
of what is at stake in local worlds—is always the point of salient historical
change in social experience. Whether one likes it or not, or understands its
shape and direction, or can adjust or not to its speed and ramifications,
today is such a time of change. One can feel and react to its effects: in
personal relationships, in work, in sensibility, and not least in one's "in-
ward parts." This provides the grounds to engage social suffering and to
rethink policy, programs, and moral initiatives for its relief.55

222; Margaret R. Miles, "Voyeurism and Visual Images of Violence," The Christian Cen-
tury 101 (March 21-28, 1984) 303-4; Christopher McKevitt, "To Suffer and Never to Die:
The Concept of Suffering in the Cult of Padre Pio da Pietrelcino," Journal of Mediterranean
Studies 1 (1991) 54-67; and Douglas Hollan and Jane Wellenkamp, Contentment and Suf-
fering: Culture and Experience in Toroja (New York: Columbia University Press, 1994).
For a provocative discussion of changes in collective experience and subjectivity that take
place dramatically in events of political violence, see Stanley J. Tambiah, Leveling Crowds:
Ethnonationalist Conflicts and Collective Violence in South Asia (Berkeley: University of
California Press, 1996).
54
Michael de Montaigne, The Complete Essays (1948; reprinted Stanford: Stanford Uni-
versity Press, 1992) 773.
55
Consider the following instances of policy-oriented analyses that use social suffering
as a platform upon which to erect different scaffoldings for organizing programs and poli-
cies: Robert Desjarlais, et al., eds., World Mental Health: Problems and Prospects in Low-
Income Countries (New York: Oxford University Press, 1995); William Felice, Taking
Suffering Seriously: The Importance of Collective Human Rights (Albany: SUNY Press,
1996); and Timothy Lytton, "Responsibility for Human Suffering: Awareness, Participa-
tion, and the Frontiers of Tort Law," Cornell Law Review 78 (1993) 470-506.
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