Disease, Pain, & Sacrifice

Bakan, David

Primary Category: Literature / Nonfiction

Genre: Treatise

Annotated by:
Coulehan, Jack
  • Date of entry: May-17-1999


This book is subtitled, "Toward a Psychology of Suffering." In the first chapter, Bakan sketches a theory of disease as telic decentralization. He defines "telos" as that which is "determinant of form." In multicellular organisms, there are multiple, subsidiary tele, as well as an overall telos of the organism. Growth and development can occur only if there is a certain degree of telic decentralization, yet disease can also result from this internal separation or estrangement. Bakan supports this theory with arguments from post-Darwinian evolutionary theory, Selye, and Freud.

In the second chapter, Bakan considers pain as the psychic manifestation of telic decentralization. Suffering is a pain-annihilation complex: the experience of pain external to the ego, associated with an internal fear of annihilation. In the last chapter, the author considers the Book of Job as a literary approach to understanding the meaning of pain, sacrifice, and suffering.


This is an important, yet difficult, book. The psychoanalytic terminology is somewhat dated and the author's use of neologisms like "telic decentralization" requires the reader to put in some effort. Yet Bakan's analysis of pain and suffering as intrinsic to the human condition and his understanding of disease as separation or estrangement are extremely important steps toward a psychology of suffering. His understanding of disease is reminiscent of the Navajo concept of "dysharmony" (Coulehan JL, Navajo medicine: implications for healing, J. Fam. Pract. 1980;10:55-61).

Some of Bakan's insights are developed further, and more clearly, by Eric Cassell in The Nature of Suffering and the Goals of Medicine (see this database). The discussion of the Book of Job is psychoanalytically oriented and focuses on the theme of the infanticidal impulse, showing parallels and differences between the stories of Job and Abraham.


Univ. of Chicago Press

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