Annie James introduces the concept of ‘ontological friction’ to explore the medical and lived complexity of a form of menstrual pain.
Dysmenorrhea, a type of ‘menstrual pain’ involving severe cramping, is a lived illness experience that evades capture, moving fluidly across medical categories and challenging diagnostic boundaries. It is in fact a composite experience that cannot be made into a singular, unitary condition. The ‘messiness’ of dysmenorrhea isn’t a flaw in our understanding of the disease, but rather the very characteristic of it. I argue that this messy reality of menstrual pain/dysmenorrhea is exactly what health and medicine should try to understand.
In this piece, I introduce my concept of ‘ontological friction’ as a gateway to understanding how multiple, conflicting realities of dysmenorrhea come into being, across medicine, the body, and lived experience. Drawing on philosopher Henri Bergson’s ‘differences in kind’ (2023) and anthropologist Annemarie Mol’s ‘ontological multiplicity’ (2023), I argue that dysmenorrhea resists being pinned down as a singular object. To understand this, I believe we must shift our focus from simply describing different illness experiences, to looking at how multiple health realities are made and lived.
Health/medicine broadly considers the nature of disease to be that of a single, stable object that can be categorised and treated. Mol has stated instead that, “no object, no body, no disease is singular. If it is not removed from the practices that sustain it, reality is multiple” (Mol, 2002, 6). It isn’t just a multiplicity of knowing about the disease, Mol argues, but rather a multiplicity of being (an ontological multiplicity). Furthermore, material objects in health and illness, such as platelets, estrogen, and ultrasound instruments are not passive actors. Drawing on philosopher Jane Bennett’s work on new materialism, it is helpful to understand them as having ‘thing-power’: the capacity to act, to animate, to produce (Bennett, 2010, p. 6). Looking at objects in this way, I consider how such material things act to produce multiplicities of disease rather than a singular disease object.
Ontological Multiplicity and Difference in Kind
‘Ontological friction’, as I use it, names what occurs when various realities of illness experience interact and disrupt attempts to make them singular. This means looking past the unitary framing of dysmenorrhea as ‘menstrual pain’ and instead unpicking how it is made in various ways across sites of diagnostic, treatment, physical body (impaired mobility, reduced range of motion), and lived experience. Viewed through the lens of Mol’s concept of ontological multiplicity, dysmenorrhea isn’t a singular condition viewed in different ways. Rather, disease objects-in-practice are multiple: they are enacted in multiplicity by different spaces that don’t always align (Mol 2002, pp. 46-47). Taking an approach which focuses on what materials do in practice, what can be termed a practical materiality approach (Mol 2002, 13), dysmenorrhea has an ontological multiplicity that fights against being simplified into a single, stable form.
In medicine, multiple realities of dysmenorrhea (hormonal, muscular, pharmacological, lived experience) are often coordinated through diagnostic scans and treatment protocols, and made to appear as if they are simply parts of one underlying disease object. Mol shows how different medical practices bring into being different realities of a disease, which are then flattened and stabilised into a single medical category (Mol, 2002): i.e., into ‘dysmenorrhea’. Such flattening is achieved through making invisible certain practices – such as how muscle spasms are classified, how hormone levels are investigated – and only reconsidering them when findings appear unreliable. Such coordination smooths over concerns about how different realities fit together. But in practice, the body with dysmenorrhea resists such flattening, producing what I call ‘ontological friction’, the friction that happens when multiple realities co-exist but are made to unify.
Ontological friction becomes more pronounced when we read Mol’s ontological multiplicity through philosopher Henri Bergson’s (2023) notion of difference in kind. Mol shows us that a disease object is produced differently across practices, but generally, these are treated as differences in degree of the same thing: one person may report mild cramping, another immobility from pain, and both are plotted on the same scale of degrees of pain. Bergson argues that this framing compresses lived reality into quantitative data. Reality, he insists, is not composed of static parts that we can add up, but is ‘duration’: a continuous, indivisible flow of ‘real time’ (Bergson, 2023, p. 27). Treating all lived experiences as quantitative blocks reduces differences in kind – qualitatively distinct realities of pain– as if they were merely mild or severe degrees of the same experience.
Dysmenorrhea as Lived Multiplicity
Mol’s work shows that diseases take different shape depending on the practices involved. This may seem like a reiteration of an oft had debate in the philosophy of medicine over whether disease is a unified ‘real kind’, a product of evaluative judgements, or a hybrid of biological facts and human values (Maung, 2025, p. 1). However, reading Mol through Bergson, we can broaden our understanding of multiplicity— not just as different aspects of lived reality, but as profound qualitative differences rooted in the irreducibility of lived experience.
Consider two aspects of dysmenorrhea. The first is a sharp pain, arriving monthly, managed through nonprescription painkillers. The second is a sharp, immobilising pain radiating through the pelvis, making it difficult to move, think, or speak clearly. In biomedicine, this is treated as a difference in degree and is plotted along a continuum of severity. Drawing on Bergson, we can contend that it is rather a difference in kind: the second experience is not just more severe pain; it transforms the flow of time, distorting thought and bodily orientation. Measuring both on a scale from 1 to 10 quantifies ‘duration’, cutting lived time into separate, static units and missing out on thinking with life itself.
The body here is not simply a passive carrier of symptoms but a participant in the unfolding of multiple ontologies. Dysmenorrhea isn’t a thing that simply happens. Rather, the material objects of muscle spasms or hormones act and produce ontological multiplicity: “no object, no body, no disease is singular” (Mol, 2002, 6). Reality, she writes, is multiple, not just in how it is experienced, but in how it is done. And when medicine plots dysmenorrhea on a continuum of degree of severity, Bergson reveals this as a spatial mistake, erasing lived time. In translating lived experience into measurable units, medicine cuts up duration or lived time—continuous, fluid, and qualitative—into static points on a scale. What is lost is the movement of life itself: the unfolding of dysmenorrhea as continuous and multiple, each qualitatively different, within the flow of life, that cannot be reduced to one.
To think with life itself means attending to multiple realities (ontological multiplicity) as qualitatively distinct (differences in kind). In this, dysmenorrhea is not a problem of degree of severity, but of kind: the distinct realities of pain. Dysmenorrhea isn’t just mild to severe menstrual pain; it’s made up of qualitatively distinct realities. Modernist ontology, singular and appearing to be stable, is inadequate for capturing this. This reading expands Mol’s already radical account of ontological multiplicity from many versions of the same disease object to multiple kinds of reality, not addable, but incommensurable.
Conclusion
Moving away from treating the lived experience of dysmenorrhea as subjective interpretations of a unitary object/subject, this account insists that dysmenorrhea is not one thing. It is many realities, ever becoming. Rather than understanding dysmenorrhea as measurable pain vs. lived experience, Bergson shows that the subject/object natures of dysmenorrhea are their own kinds, each growing out of the generative flow of life itself, not comparing one thing to another.
The medical posthumanities must attend to a lived reality of illness that isn’t singular, but multiple and qualitatively different. Ontological friction offers a conceptual tool for rethinking what health, illness, and lived experience might mean when we take seriously the multiplicity, materiality, and durational qualities of conditions like dysmenorrhea (menstrual pain). It invites us to see that what resists capture, what health/medicine might call messy, is in fact the very stuff of reality. This essay contributes to a growing posthumanities and is part of a resurgence of Bergson’s philosophy, not just critiquing modernist ontology, but reimagining health/medicine as a terrain of fluid material and temporal multiplicities.
About the author
Annie James is a PhD candidate in (health) psychology at Christ University, Bengaluru. Her doctoral research adopts feminist new materialisms and STS (science and technology studies) for qualitative research on women’s reproductive health in South India. Working through ontological questions, she explores how diseases, bodies, and health behaviors materialize within local sociomaterial worlds.
She can be found on Bluesky @arb0re1um.bsky.social
References
Bergson, Henri. 2023. Creative Evolution. Rev. Ed. Translated by Donald Landes. New York: Routledge.
Bennett, Jane. 2010. Vibrant Matter: A Political Ecology of Things. Duke University Press.
Maung, Hane Htut. 2025. “The Disunity of Disease.” Philosophy of Medicine 6 (1). https://doi.org/10.5195/pom.2025.240.
Mol, Annemarie. 2002. The Body Multiple: Ontology in Medical Practice. Duke University Press.
