Pathologizing Pathos: Suffering, Technocentrism, and Law in Twentieth-Century American Medicine

In the second half of the twentieth century, concerns about problems in the doctor-patient relationship gave way to a new medical discourse on suffering, owed largely to the work of American physician Eric Cassell. This article tracks the development of his theory of suffering and its global success in transforming tragic medical experiences into diagnosable clinical entities. Beginning with his intellectual development in the 1960s, this article traces Cassell's initial interest in suffering first to his early research on truth-telling and autonomy, followed by his pioneering work in bioethics. Although closely aligned with philosophy, much of the institutional success of bioethics came from American law, which affected Cassell's theorizing. At the same time, doctors experienced a growth in medical malpractice lawsuits, driven in large part by costly "pain and suffering" awards, which the medical community sought to curb by encouraging legislatures to codify informed consent. The success of these efforts mandated that doctors disclose previously withheld bad news capable of causing suffering. The cultural changes that followed these disclosures became Cassell's impetus, while legal pain and suffering supplied much of his theory's language and concepts.