On Suffering

1. Suffering in Medicine: A New Aspect of an Old Problem

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pp. 13-24

Suffering in contemporary society has many meanings based on religious, legal, cultural, and secular societal belief systems. While it is important to understand the origins of individuals’ beliefs about the nature of suffering, it is not useful to combine suffering and pain as one entity in medical practice. Clinically, it has been observed that some individuals who suffer experience little pain and...

2. Suffering Is Not Pain: The Evidence

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pp. 25-38

Science promised answers to all the mysteries of life, and postmodern society is the recipient of many of the wonders revealed and described by science. Unfortunately, contemporary society seems to have forgotten the revelations achieved through art and intuition. Consequently, in the attempt to conquer disease, many in medicine have forgotten that often it is not the disease that is the patient’s real...

3. The Power of Religious and Spiritual Beliefs

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pp. 39-50

Postmodern medicine has, to a large extent, abandoned its passionate commitment to the whole person to embrace the cold, distant anonymity of the technological age. We have forgotten the wisdom of the words of the poets of the past. The British poet William Wordsworth lamented that “The world is too much with us” and that “we have given our hearts away” (1). In the poignant words inspired by...

4. Suffering and Culture

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pp. 51-64

Cultural traditions have a profound effect not only on individuals’ idea of self but also on the identity of families and the community at large. Cultural traditions may augment not only the experience of suffering but also its expression. Insensitivity to transcultural issues can result in ineffective health care treatment outcomes, increased suffering of individuals, and an escalation of health care...

5. Crises of Suffering across the Life Span

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pp. 65-76

Personhood is defined as those responsibilities and activities of individuals that constitute a life. When considering the experience of suffering, personhood has a further meaning. Personhood, within the context of suffering, also involves an individual’s perception of threat to those developmental psychosocial tasks and behaviours that must be addressed throughout the life span. Failure to...

6. The Language of Suffering

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pp. 77-88

Beneficence, that is, doing good, is the primary goal of all health care providers. The challenge in clinical practice is to do what is considered to be morally good as opposed to performing self-serving acts that one determines are for the “good” of the patient but are really attempts to derive personal prestige and reward. The moral obligations imposed on medical acts of beneficence are...

7. Medical-Legal Disclosure of Suffering

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pp. 89-106

The issue of suffering in contemporary medical practice is of considerable concern. Legally, the law regards pain and suffering as one and the same entity, and proof of suffering is found in the realm of psychological illness. Some clinicians fear that acknowledging suffering as separate from pain will result in insurance adjusters denying legitimate claims for fiscal compensation to those...

8. Power Differentials and Suffering

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pp. 109-127

The need for personal autonomy and the impact that medical and legal discourse can have on personal power indicate that a complete assessment of individuals who suffer requires a comprehensive, objective measurement tool. The Measuring and Assessing Suffering Questionnaire (MASQ) is a clinical measurement tool to aid clinicians in determining those patients who are experiencing...

9. How to Assess Suffering

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pp. 128-147

The aim of contemporary medicine is to provide optimal care to patients based on objective scientific evidence. Raw data, that is, the actual numerical value designated by the patient for a specific item or the mean of a group of subscores in a particular section of the masq, provides an opportunity to clearly identify those areas of greatest importance to patients. The purpose of this chapter is to (a) illustrate...

10. Standards of Care

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pp. 148-163

Normative data are obtained from tests and scales and are used for comparison of results from one group or individual to the means and standard deviations of another group or to individual sets of measures. They delineate that which usually occurs in a specific population at a specific point in time and are an important treatment guide, particularly when specific treatment interventions...

11. Key Components of Suffering in Chronic Illness

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pp. 164-180

The universal characteristics of suffering are a loss of central purpose, unresolved self-conflict, and impaired interpersonal relationships. The differentiation of suffering from pain responses is challenging because patients often talk about pain intensity and suffering at the same time. Research results as discussed in chapter 2 show clearly that suffering and pain are separate entities. Further...

12. The Resolution of Suffering

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pp. 183-196

13. The Roles of Health Care Professionals

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pp. 197-215

The challenges of managing the experience of suffering in modern medicine occur throughout treatment from the acute stage of illness or injury to either complete restoration of health or, in some cases, permanent chronic disability. Initially, the doctor is the first health care professional to encounter the suffering of the patient. Issues of concern that focus on the impact of the disorder on the...

14. Habilitation and Rehabilitation

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pp. 216-230

The first health care professionals involved with patients are usually the physician, nurse, and sometimes the chaplain. Treatment objectives are to address the immediate physical problems and to identify those who suffer either with or without pain. Treatment planning may involve physiotherapy; social work; and in some instances psychology, occupational therapy, or vocational rehabilitation...

15. The Wounded Spirit

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pp. 231-242

The arguments previously presented in this book have focused to a large extent on factors that are perceived as a threat to idea of self and how health care professionals may help patients restore their ideas of self and cope with suffering. Suffering involves a perception of threat not only to ideas of self but also to beliefs about personhood. Personhood issues involve how patients will manage work...

16. Surviving and Thriving

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pp. 243-254

Research confirms clinical observations that suffering and pain are separate and only sometimes related phenomena. In medicine, suffering is defined outside the context of, but not in opposition to, religious, spiritual, or political teachings. Suffering is a perception of threat to idea of self and personhood and has distinct and universal characteristics, the expressions of which are personal...