Considering the preceding outlines, it should already be clear that the depicted phenomena can be described as a struggle for recognition in a more general way that is in line with a trend of the last several years to frame many social conflicts as conflicts of recognition (see Fraser and Honneth 2015: 7; Fraser 2015: 15–27). However, the depicted phenomena can furthermore be transferred or translated in a more specific way as a struggle for recognition that takes up a theoretical framework provided by more recent discussions in social philosophy. As it is neither possible nor necessary here for the argument’s sake to reconstruct those complex academic debates about recognition, a reference to Honneth’s work should suffice as a starting point for further presenting the idea we pursue here.Footnote 10 His work seems most applicable as a starting point, as it not only has an explicit and genuine societal-theoretical point of view, but has already been successfully applied and discussed in various contexts, such as Salminen’s (2020) recent study regarding young people and professionals in social and youth work. But as Honneth has not specifically addressed the topic chronic pain, we will need to make some necessary conceptual adaptations.
In The Struggle for Recognition (Honneth 2005), Honneth combines ideas from Georg Wilhelm Friedrich Hegel’s early work on this topic with the work of George Herbert Mead to reestablish the term recognition. Honneth makes use of this term to describe a fundamental aspect of social life, highlighting the social interdependency of one human being to a counterpart as a constitutive condition for subjectivity and as an enabling condition for a successful life or even a good one. In this manner, he presented recognition quite literally as “a vital human need” (Taylor 1994: 26), because “[i]n order to acquire a successful relation-to-self, one is dependent on the intersubjective recognition of one’s abilities and accomplishments.” (Honneth 2005: 136) Hence recognition is not only conceptualized as something positive, but even further, something necessary for the individual. When understood this way, recognition is not merely cognizing another human being, but rather “the expressive act through which this cognition is conferred with the positive meaning of an affirmation” (Honneth 2001: 115, italics added by the authors).
However, this recognition does not simply exist and “[a]ll types of practical self-relations are fragile in the sense that, once formed, they continue to be vulnerable to the erosive effects of misrecognition.” (Wilhelm 2021: 65) Recognition hence must not only be established, but also maintained via reciprocal, conflictual action, as Honneth’s usage of the term struggle indicates. At the heart of such struggles is the absence, denial or lack of desired recognition. This is labeled as disrespect, which, contrary to everyday language “refers not merely to a failure to show proper deference, but rather to a broad class of cases, including humiliation, degradation, insult, disenfranchisement, and even physical abuse” (Anderson 2005a: iix; see 2005b: xviii). In Honneth’s understanding, this renders the term disrespect quite specifically as “an injustice not simply because it harms subjects or restricts their freedom to act, but because it injures them with regard to the positive understanding of themselves that they have acquired intersubjectively.” (Honneth 2005: 131) In this perspective there is a normative obligation to try to minimize disregard, as it is a condition that people intensely dislike and one that ought not to exist. At the same time, attempts must be made to establish all forms of recognition. In this sense recognition and disrespect are complementary, whereas a denial of recognition leads to disrespect which obstructs the possibility of a good life as it disrupts a person’s process of identity-formation. Overall disrespect “hinders or destroys persons’ successful relationship to their selves.” (Iser 2019).
Applying one overarching perspective that follows yet transforms Hegelian and Meadian thought demonstrates that Honneth (2005: 131–139; see Bedorf 2010: 47–63) is concerned with various forms of normatively substantial disrespect appearing in three different types of social spheres that he distinguishes in bourgeois society. These are: (1) the sphere of primary relationships or sphere of love and friendships, where disrespect prominently takes on forms of physical abuse; (2) the sphere of legal relations, where disrespect appears in forms such as exclusion or denial of rights; and (3) the sphere of solidarity where disrespect takes on forms of denigration or humiliation. For now, this proves to be a rather abstract differentiation that seems to be more of an analytical distinction than a radical one. We highlight subsequently how this can be connected with the specific topic of chronic pain and the affected persons’ social hardships.
The sphere of primary relationships and the withdrawal of attention
In the sphere of primary relationships, one can identify the most fundamental mode of recognition. What Honneth describes here as love refers to a way of caring for one’s basic needs by significant others. In the insinuated sense, love is not restricted to romantic love by spouses, significant others, etc., but is to be understood in a broader sense including all meaningful connections on an emotional level. In this sense one should mistakenly narrow love as it is terminologically coined here to “describe an emotional relation to others that achieves social integration of concrete individuals through acknowledgement of and care for emotional and physical needs and desires.” (Wilhelm 2021: 56) Hence, “[l]ove relationships are to be understood here as referring to primary relationships insofar as they—on the model of friendships, parent–child relationships, as well as erotic relationships between lovers—are constituted by strong emotional attachments among a small number of people.” (Honneth 2005: 95; see Deines 2007: 279) Employing an ontogenetical line of argument (based on the parent–child relationships), these kinds of relationships are fundamental for human beings as they are constitutive for any self-confidence an individual can develop. Additionally, although there are socio-cultural variations, love is an ahistorical precondition for self-confidence (see Honneth 2005: 107, 133). In this sense, the kind of recognition provided in the sphere of primary relations is prior to all other forms and spheres of recognition. Prime examples of disrespect in the sphere of primary relations for Honneth are torture and rape, which combine physical pain, loss of power, being overpowered, abuse, and helplessness. In such cases of “mistreatment, torture and rape the perpetrators do not only intentionally inflict pain and injury on their victims but also deride the agency of the latter.” (Iser 2019) Exploiting and condoning pain or an intention of actively inflicting it is constitutive for this specific kind of disrespect, where the physical integrity of the sufferer is endangered by others and physical as well as psychological well-being might get destroyed (see Deines 2007: 280).Footnote 11
Adapting this for chronic pain creates the need for a particular theoretical alteration,Footnote 12 as the disrespect in this sphere does not inherently connect to the chronic pain. Rather, it is more often an incidental byproduct of the pain condition itself. Here chronic pain patients’ physical integrity has been damaged already. This damage, though, is not necessarilyFootnote 13 a result of a voluntary, abusive act by another person, but due to medical conditions. This makes it different in its genesis than Honneth’s examples. However, it is not uncommon that, family members, friends, coworkers, and peers start to turn away from the chronic pain patients or abandon them completely in the context of the chronic pain patients’ condition.Footnote 14 Thus, the patients’ need for caring companionship is neglected. There are evidently forms of disrespect towards chronic pain patients which fit a Honnethean framework in the primary relationships, although these may be more subtle than in other cases. Situations such as being desperate for a gentle hug, not being lent an ear or being socially absent from their closest surroundings evokes forms of suffering, especially forms of social isolation. Patient P. Andresen (2009, authors’ translation) described it quite simply:
Our environment today is geared to functioning and hence, there is simply no demand for people with pain. And they are no longer nice to have around and then they are alone quickly. [...] Then comes the unfortunate realization: If you are lucky and one person stays there, or two, that is quite a lot then. And you cannot expect that either.Footnote 15
Such a withdrawal of dependable and reliable companionship does not only add another dimension to the pain experience itself. The retraction of significant others, regardless of whether it is a slow process or an abrupt loss, can result in a hurtful isolation for the affected people. They have not been accepted in their condition by the people who are closest to them. Although it is understandable and desirable—even from a non-subjective, normative standpoint—if chronic pain patients could be part of loving relationships, one has to acknowledge that love is something that cannot be imposed or enforced. As Wilhelm (2021: 57) recently put it: “Love as deep affection cannot be expanded at will or to too many individuals” and therefore one cannot simply be asked to love someone.
The sphere of legal relations and conflicts about the enforcing of rights
The second sphere, the one of legal relations, presents itself as distinguished from the sphere of primary relations. This sphere is historically contingent, and in and of itself, a product of history. One attains recognition here explicitly not as a specific individual, but as an equal member of the general public. By institutionalizing rules via legal practices in legislative procedure or organizations like independent courts, the legal relations guarantee a person’s freedom and status as an equal without considering their specific individuality. By being granted legal rights and being able to act according to them, a person is not only able to establish self-respect, but also learns to reciprocally take the point of view of the other and respect the other (see Honneth 2005: 133, 1990: 1049; Deines 2007: 280). Having legal rights is contingent, so controversies arise about the central question, who obtains them and is therefore a person in a moral sense. Depending on how this question is answered and who is included and excluded in the understanding of a person in a moral sense leads to quite a difference in which rights are guaranteed to whom and to what extent. In line with this, the withholding or withdrawal of recognition here “refers to those forms of personal disrespect to which an individual is subjected by being structurally excluded from the possession of certain rights within a society.” (Honneth 2005: 133) This consequently leads to “the feeling of not enjoying the status of a full-fledged partner to interaction, equally endowed with moral rights” (Honneth 2005: 133; see Deines 2007: 281). This damages a person’s self-respect.
One example of such disrespect in the legal relations is the exclusion of people because of their heritage, sexuality, religion, or skin color. In such cases, a person is denied the legal entitlement due to contingent empirical factors and there is a misapplication of rights or a refusal to apply them at all (see Wilhelm 2021: 82). In a similar way, some chronic pain patients seem to feel that they are denied legitimate claims. This conflict, next to the documented “disparities in access to pain care for certain groups” (Edwards et al. 2014: 373; McGee et al. 2011: 1377–1378, 1381–1382) and whether due to financial, geographical or other reasons, can be identified in a disparity in the interpretation of what chronic pain patients are rightfully owed and what they need for an actual improvement of their situation e.g. in forms of payment for medical treatment in rehabilitation programs. In this context, patient I. Meyer (2009, authors’ translation) stated: “And according to the law, it all sounds very different. When I read the statute book now and then I think: well my God, you have actually taken care of it, you will find help everywhere, but in practice it is not so.”Footnote 16 Such a difference between patients’ perception of what they deserve and the institutionalized way of aiding them, as well as the interrelated conflicts can become virulent. Patient I. Meyer demonstrated this when explaining about the complex processes of evaluation and revaluation when it comes to official assignment of care levels: “You have to fight for everything. I had care level two, now I am to be downgraded to one, even though I felt worse. Yes, so then I was informed, care level one, […] then I had to go to battle again, now it is in the works, and afterwards it should then be decided” (Meyer 2009, authors’ translation).Footnote 17 Such an exhausting and bureaucratic task is only one aspect of the conflict, though, as it is often accompanied by stigmatization due to the partial or whole denial of their legal claims.
The sphere of solidarity and the limited capability to contribute to society
The third sphere Honneth addresses is the one of solidarity, which like the sphere of legal relations, is also a historical product. However, there is a central difference. In contrast to the legal relations sphere, in the sphere of solidarity, one does not receive recognition as a result of being a person in a moral sense and hence, on the basis of a generalized concept. Instead, recognition here is based on a shared set of specific values the members of the sphere of solidarity agree on. When a person matches and satisfies those specific values and therefore contributes to common goals, they are recognized as a valuable member in the shared social praxis and can establish self-esteem. As one’s self-esteem relies heavily on contributing to and participating in society in a culturally sanctioned way, a problem for the individuals can arise “[i]f this hierarchy of values is so constituted as to downgrade individual forms of life and manners of belief as inferior or deficient, [because] then it robs the subjects in question of every opportunity to attribute social value to their own abilities” (Honneth 2005: 134; see Deines 2007: 281). This value of one’s specific capabilities can vary as the values themselves are contingent. They are “the result of social and cultural struggles that lack the universality that is distinctive of legal relations” (Anderson 2005b: xvii).
Modern society contains many values, such as legal equality or helping people in need. However, nowadays performance—especially in the work context—seems to have become a main priority, or core value. This has an excluding impact on various groups of society. The elderly comprise one such group because as they age, elderly people can have the feeling that they cannot contribute anything valuable to society when they are no longer part of the economic production system. Many chronic pain patients have the same feeling of being unable to contribute to society, as they cannot fit within the dominant norms of performance, productivity, and efficiency. Their pain condition hinders them from working fully or even working at all and “[s]ome who continued to work found they could no longer perform adequately. Others said they worked in constant pain.” (Jackson 2000: 35) As a result of such limitations, chronic pain patients are often no longer perceived as fellow human beings who, despite their limitations, may be able to contribute something valuable to society. Instead, they are often exclusively viewed as supplicants or claimants, although they actually want to partake, but are simply unable due to their condition.
Patient Klein’s (2009, authors’ translation) statement is a testimony of this kind of social struggle: “And I don't have to throw myself into the job market because nobody would hire me anymore. No, I can kiss that goodbye […] [Y]ou're not that old at all and suddenly the world has no use for you. And then I really don't know what to do. I really do not know. I lack my place in this world.”Footnote 18 Not only do such statements express feelings of despair and uselessness, they also reflect that some of those affected by chronic pain cannot perceive themselves as a valuable contributor to the community and are not given the desired social appreciation. They are structurally excluded by not matching societies’ norms of contributing—especially economically. Often, they are only acknowledged as chronic pain bearers and not as appreciative human beings who are able to partake in society despite their pain-induced restrictions. In this way, chronic pain patients are excluded from societal participation.