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EVERYONE KNOWS THAT SUFFERING EXISTS. The question is how to define it. Given that each person's pain has a degree of reality for him or her that the pain of others can surely never approach, is widespread agreement on the subject possible? Almost all of us would agree that premature and painful illness, torture, and rape constitute extreme suffering. Most would also agree that insidious assaults on dignity, such as institutionalized racism and sexism, also cause great and unjust injury.
Given our consensus on some of the more conspicuous forms of suffering, a number of corollary questions come to the fore. Can we identify those most at risk of great suffering? Among those whose suffering is not mortal, is it possible to identify those most likely to sustain permanent and disabling damage? Are certain "event" assaults, such as torture or rape, more likely to lead to late sequelae than are sustained and insidious suffering, such as the pain born of deep poverty or of racism? Under this latter rubric, are certain forms of discrimination demonstrably more noxious than others?
Anthropologists who take these as research questions study both individual experience and the larger social matrix in which it is embedded in order to see how various large-scale social forces come to be translated into personal distress and disease. By what mechanisms do social forces ranging from poverty to racism become embodied as individual experience? This has been the focus of most of my own research in Haiti, where political and economic forces have structured risk for AIDS, tuberculosis, and, indeed, most other infectious and parasitic diseases. Social forces at work there have also structured risk for most forms of extreme suffering, from hunger to torture and rape.
Working in contemporary Haiti, where in recent years political violence has been added to the worst poverty in the hemisphere, one learns a great deal about suffering. In fact, the country has long constituted a sort of living laboratory for the study of affliction, no matter how it is defined. "Life for the Haitian peasant of today," observed anthropologist Jean Weise some twenty-five years ago, "is abject misery and a rank familiarity with death."l The situation has since worsened. When in 1991 international health and population experts devised...