Vulnerability, Compassion, and Ethical Responsibility: a Buddhist Perspective on the Phenomenology of Illness and Health

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Vulnerability, Compassion, and Ethical Responsibility: a Buddhist Perspective on the Phenomenology of Illness and Health Vulnerability, Compassion, and Ethical Responsibility: A Buddhist Perspective on the Phenomenology of Illness and Health Ellen Y. Zhang Centre for Applied Ethics Hong Kong Baptist University Abstract: The experience of bodily vulnerability and the phenomenology of illness are one of the concerns in recent ethical discourse. This paper will explore the notion of bodily vulnerability and show how illness (both physically and mentally) is perceived, appropriated, and understood from the Buddhist perspective of dukkha (suffering). The discussion includes: (1) the dis-ease of human finitude and the inner experience of bodily vulnerability, (2) the suffering body as an interpretative “text”, (3) the irreducibility of ethical responsibilities for the one who is suffering, and (4) the phenomenology of illness and the healing process. The paper gives an account of various aspects of human vulnerability (viz., contingency, suffering, and mortality), and links it with the Buddhist ideas of karunā (compassion) and ethical responsibility to each other. The paper will also explicate the Buddhist meditative method such as śamatha (tranquility and stillness, 止) and vipaśyanā (insight meditation, 觀) as a way of dealing suffering and vulnerability. Key Words: vulnerability, Buddhism, suffering, compassion, ethical responsibility, phenomenology of illness, meditation I. Introduction Perhaps, no religion like Buddhism speaks explicitly of the human experience of bodily vulnerability. According to the Buddhist tradition, the story of the young prince Siddhartha and his decision of embarking on the journey of enlightenment is closely related to his personal experience of seeing the “four passing signs”, three of which are about the experience of human vulnerability: aging, sickness, and death. First Passing Sign: The young prince, who had been protected by the family from the sights of sounds of human suffering for twenty-nine years of his life, was out in his chariot one day when he saw an older man, who 1 bent like a roof-beam, broken, learning on a stick, tottering, sick, his youth all vanished (Anguttara Nikaya).1 . Deeply disturbed by what he saw, realizing that all humans, including himself, cannot escape from the miserable condition of losing youth and getting old, the young prince wondered, can anyone be able to acknowledge that happiness and comfort like what he is experiencing in the palace is transient and temporary? The suffering of aging lies in wait for every human being. Second Passing Sign: Some days later, the young prince was being driven around the royal park when he encountered a sick man, suffering, very ill, fallen in his own urine and excrement, and some people were picking him up, and others putting him to bed (Anguttara Nikaya). Upon seeing the sick man shivering with fever and being told that poor man may not recover from the illness, the young prince went back to the palace. He thought to himself: I, too, am subject to illness and cannot escape it. If I, who am subject to illness without escape from it, should see another who is ill, and should be oppressed, beset and sickened, it would not be well with me (Anguttara Nikaya). Third Passing Sign: One day when the young prince was being driven around the royal park again, he saw a corpse being carried to the burning ground. Distressed by what he saw, the young prince asked: But am I too then subject to dying, not exempt from dying? … I, too, am subject to death and cannot escape it. If I, who am subject to death without escape from it, should see another who is dead, and should be oppressed, beset and sickened, it would not be well with me (Anguttara Nikaya). After experiencing the above three signs, the young prince encountered a wandering religious beggar on his way to the royal park, which is called the “Fourth Passing Sign”. The young prince was surprised by the beggar’s countenance that is filled with peace and joy, and resolved to become also a wandering beggar… And we all know 1 The account of the story of the four passing signs is found in Digha Nikaya 14.2. Translation by Maurice Walshe in The Long Discourses of the Buddha: A Translation of Digha Nikaya (Boston: Wisdom, 2995), pp. 207-210. 2 the rest of the story. Of course the story of the “four passing signs” should be understood allegorically rather than a faithful account of a historical event. Nevertheless, it tells us that Buddhism begins with specific existential questions engendered by human experience, that is, old age, illness, and death, the important aspects of human sorrow and suffering As a matter of fact, Buddhism not only realizes the physical pains of human beings in terms of old age, illness, and death, it also talks about the mental anguish of human beings in terms of thirst, craving, and desire. The word “suffering” is a translation of the word duhkha (Pali) or dukkha (Sanskrit), which literally means dis-ease or unsatisfactoriness. There is a well-known Buddhist claim, “All this is dukkha.” Suffering is, then, shown as a kind of dis-ease caused by human finitude. Yet suffering is more complicated than a subjective, psychological description or an intentionalist view that the phenomenal character of any experience is entirely constituted by its representational content; instead, it has a wide range of meaning from that experienced and reality itself, although Buddhism does not seem to focus on reality as it is without human experience. The whole business of Buddhist enlightenment as such is about self-reflection on experiential dimension of human life in reality as well as the possible way of releasing human beings from the experience of sufferings caused by “disease”. The central tenet of the Buddhist teaching is called the “four noble truth” which states there is: 1. The truth of what suffering is; 2. The truth of the conditioned cause of suffering; 3. The truth that suffering can be eliminated by eliminating the conditioned cause; 4. The truth of the means to eliminating suffering by following the Middle Way, constituted by the Noble Eight Paths. With regard to the truth of suffering, the Buddhist teaching further explains it as follows: The noble truth if suffering is this: birth is suffering; aging is suffering; sickness is suffering; death is suffering; sorrow and lamentation, pain, grief and despair are suffering; association with the unpleasant is suffering; disassociation from the pleasant is suffering; not to get what one wants is suffering – in brief, the five aggregates (skandhas) of attachment are suffering (Anguttara Nikaya). 3 Since human life is pervaded by suffering, both visible and invisible, what is needed is a remedy to cure the fundamental human illness of suffering. Buddhism, therefore, focuses on meditative insight into dependent-originating, the ever-changing and interrelated nature of existence, which provides means for one to develop an awareness of all kinds of dispositional influxes that produce an illusion of a fixed self, as well as craving, greed and hatred. Vulnerability, according to Buddhism therefore, is not merely a physic-psychological description, pointing to corporeal limits or emotional frangibility, but a total and lived experience of human existence. II. The Suffering Body as an Interpretative “Text” The experience of bodily vulnerability and the phenomenology of illness are one of the major concerns of in recent bioethical discussion. In their work Body Matters: A Phenomenology of Sickness, Disease and Illness, James Aho and Kevin Aho attempt to surmount a new way in which sickness, disease, and illness are socially and historically constructed.2 Following the core principle of phenomenology as a return “to the things themselves” they study the phenomena of bodily afflictions and examine them from three different perspectives: “sicknesses” (a sociological perspective), “disease” (a medical perspective), and “illnesses” (a patient’s perspective). The three perspectives are definitely different from each other yet interrelated at the same time. Moreover, by making a crucial distinction in phenomenology between two senses of the body, namely, the quantifiable, corporeal body (Körper) and the organic living or lived-body (Leib). The study by the Ahos attempts to show us that an understanding of the vulnerable and suffering body is an interpretative process that is more profound and complicated than biomedical notions of disease and illness. Illness then is not simply a phenomenon that is experienced; rather it has the same status as notions such as experience and consciousness, since it signifies the subjectivity from which a particular phenomenon is understood and interpreted. The issue of illness is also connected to the mind/body problem. The notion of the lived-body is a significant one here, indicating a dynamic, transformative, and relational body rather than the body reduced to a mechanic thing. Another related question is our conception of health. It is true that most of us tend to act in the world through the medium of our bodies in an unreflective fashion. When we are in good health, we take our healthy bodies as an ontological state of being, and illness as such is seen as “lack (or absence) of good health.” In other words, illness is 2 See James Aho and Kevin Aho. Body Matters: A Phenomenology of Sickness, Disease and Illness (Lexington Books, 2008). 4 our body’s alienation from its primary state. Traditional bio-medicine in the West hence identifies a healthy, “immune self” with an individual person who defies pains and the suffering other, and at the same time seeks a method to deal with pain caused by illness. In recent years, however, some new terms such as “existential medicine” and “medical humanities” have been used to imply an alternative way of looking at illness and health.3 These new concepts aim to recapture an understanding of biochemical, physiological, and morphological factors in living organisms and their development in time and space, and health and illness.
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