It is essential that we keep in mind the distincton between pain and suffering.

Both are certainly influenced by subjective factors--compare the apparent experience of the religious martyr being burned at the stake with that of the individual trapped in a burning vehicle.

Pain, however, as customarily defined, is a result ot stimulation of pain receptors located throughout the body (except in the case of central nervous system disease such as tumors, affecting the central pain centers).

As such, the experience of pain can be measured against a standard stimulus to a group of those peripheral nociceptors, as, for example, in the application of a known amount of heat energy to a measured area of skin, or in the restriction of circulation--and consequently oygen--to the arm, both for a determined period of time. Identical s¹imuli will not be similarly perceived by different people--or even by the same person at different times--because of the multiple synaptic steps between the stimulation of the pain receptor and the conscious perception of the pain, or even a reflexive response to the stimulus, such as withdrawal of a pain-stimulated extremity; a "gating" system, largely controlled by higher centers in the brain, has been identified within the spinal cord itself that controls the progress of the pain impulse, and while not as well defined, sirnilar modulators doubtless exist within the brain.

Suffering, in contast, is purely a mental phenomenon, a product of activity within the central nervous sytem. I know of no way to determine an external referent for it. I find a dangerous, albeit interesting, convergence between medical/ psychological thinking and Buddhist thought on the nature of suffering, in that both see it as a function of the ego. Dangerous because the term, ego, has quite different meanings as used by each; interesting because there is some overlap in the areas each definition encompasses, and it is in just that area of overlap that the issue of suffering centers. In medical/psychological terms, suffering is a consequence of injury to the ego, a result of an event that is unexpected and felt to be undeserved. It ranges from being treated badly-disrespectfully--in an encounter with another, to something untoward happening, whether it be illness or economic deprivation. Individual expectations, largely based on life experience, obviously play a key role here, from how one thinks one "ought" to be treated, to notions of personal invincibility/immortality, to concepts of opportunity and entitlement in a just society. Insofar as a common response to suffering is anger, which for most people is much easier to tolerate, thc conection between rising levels of expectations that are increasingly being frustrated and social unrest, that has received much attention from sociologists and political scientists, becomes obvious. I leave addressing the issue of the ego and suffering in Buddhist terms to those more knowledgeable.

Caring and Response

What might lead othewise sensitive, caring people to not respond to the suffering of others? Here, too, attitudes and expectations, culturally sanctioned, as well as familial and idiosyncratic, play a key role.

James Conant, former president of Harvard, illustrated the cultural sanction when he justified his position on strategic bombing during World War II, and the choice of Hiroshima for the first atomic bomb, despite the civilian suffering it caused, on the principle that in wartime, the rules are different; it is this principle that enables a society to expect that its armed forces will in good conscience suspend the normal rules about killing.

For the individual, two lines of thinking appear to make it possible to ignore the suffering of others, whether a single person, or a group. On the most elemental level, is the response to the question, "Do they deserve it?" The disciplining of children is perhaps the most common arena where this justification is applied. It also may be seen in the contemporary response of many to those suffering with AIDS. Where the sufferer is not "deserving" of the suffering, a slightly more complex reasoning is applied: "Are they 'like me' whether in their capacity to suffer, or in being deserving of our concern for their suffering, or are they 'different'--’like animals' (as some have described young, inner-city, single mothers), or 'gooks' (as was the popular wartime designation)?" Margaret Mead identified this reasoning when she declared its obsolescence in her observation, "You can no longer save your family, your tribe or nation. You can only save the whole world."

As humans, we seem to be "hardwired" to compassionately respond to the image of a suffering human--something that both confidence men and public relations people recognized long before it was scientifically confirmed by the sociologists. This has been attributed to a "sympathetic identification" with the sufferer, a "like me", and "There, but for the grace of God..." reaction. Yet not all respond compassionately. The role of personal experience in influencing this response to suffering is complex and difficult to define. Contrary to what might be expected, the personal experience of suffering does not necessarily lead to greater compassion; suffering may "harden the heart", resulting in indifference to, or even pleasure in the suffering of others. While a variety of theories have been invoked to explain this latter phenomenon, my own view is that how an individual responds to the suffering of others is more a reflection of his or her overall perspective on life than it is of personal experience with suffering.

In oontrast with the compassionate response to the suffering individual, there may be little response to the suffering of faceless masses. Whereas the sympathetic identification with the individual sufferer is immediate, anonymous, aggregate humanity does not evoke a similar response.

Before such a response will be elicited, an intermediate intellectual step is necessary; the observer must translate that faceless mass into recognizably human individuals. Because the experience of compassion contains elements of discomfort ("a reflected suffering"?), and disrupts pre-existing equanimity, many are unprepared or unwilling to take that step.

Sympathetic Identification and Empathy

There is an inauspicious aspect to the reaction of "sympathetic identification" that lies at the root of the not uncommonly observed phenomenon of the reluctance to initiate actions that may cause pain, and perhaps suffering, to another. In the extreme, this was seen in the compassionate student who withdrew from medical school because of an inability to tolerate causing discomfort to a patient even when it was clearly for the patient's benefit, as with a needle-stick for the purpose of drawing blood for necessary diagnostic testing. More commonly, it is seen with parents unable to discipline their children--even without resorting to corporal punishment--because of the suffering they fear they will induce.

Contrasting the concepts (and experiences), of sympathy and empathy can provide a preliminary appreciation of the nature and source of this difficulty.

Unlike "sympathy", in common use since the sixteenth century, "empathy" was introduced into the English language less than 100 years ago; its earliest documented use was in 1904. The word was coined as a technical term by an English writer to discuss a concept of art appreciation elaborated 20 years earlier in a German paper; it is the literal English equivalent of the original German term for the concept, "Einfuhlung", which translates to "feeling into". Both in its original intent, and in its current usage, the word is contrasted with sympathy: Empathy involves sharing the feelings of another as a means of coming to an appreciation of the other; it contains both emotional and cognitive elements. In contrast, sympathy entails simply sharing the feelings of another, without any intellectual element. Szalita draws the distinction with a metaphor: Empathy entails appreciating another through putting oneself in their shoes; syrnpathy entails putting oneself in their shoes and wearing them. As Aring earlier noted, "Appreciation of another's feelings and problems is quite different from joining in them, and in so doing, complicating them beyond resolving."

Aring considered the sustained awareness of one's "separateness" (i. e., "otherness"), the critical element in the ability to avoid that "joining in". More than a millennium ago, the Japanese poet, Fijiwara no Kanesuke, trenchantly identified the difficulty in maintaining this separateness, in his observation, "The heart of a parent goes astray, though not in darkness, for the love of a child."