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On Suffering

Pathways to Healing and Health

Beverley M. Clarke

Publication Year: 2011

Currently in medicine, theories of pain regard pain and suffering as one and the same. It is assumed that if pain ceases, suffering stops. These theories are not substantiated in clinical practice, where some patients report little pain and extreme suffering and other individuals have a lot of pain and virtually no suffering.

Based on the results of a scientific questionnaire, as well as evidence from and conversations with hundreds of patients, Beverley M. Clarke argues convincingly that suffering is often separate from pain, has universal measurable characteristics, and requires suffering-specific treatments that are sensitive to the patient's individual psychology and cultural background. According to Clarke, suffering occurs when individuals who have experienced a life change because of medical issues perceive a threat to their idea of self and personhood. This kind of suffering, based on a lost "dream of self," affects every aspect of an individual's life. Treating the patient as a whole person--an approach that Clarke strongly advocates--is an issue overlooked in the majority of chronic care and traumatic injury treatments, focused as they are on pain reduction.

Clarke believes passionately that the management of suffering in medicine is the responsibility of all health care practitioners. Until they come to identify and understand suffering as distinct from pain, the entire health care system will continue to carry the financial and moral burden of incomplete diagnoses, inappropriate referrals for care, ineffective treatment interventions, and lost human potential.

Published by: Dartmouth College Press

Title Page

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pp. ix-x

Professor Beverley Clarke is a pioneer in the investigation and understanding of the concept of suffering. She has collected large amounts of clinical data on epilepsy, rheumatoid arthritis, migraine, and spinal cord injury. Professor Clarke has demonstrated...

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pp. xi-xii

The impetus for writing this book comes from my early experiences as a physiotherapist treating two young, injured military men in a veteran’s hospital. (The stories of these two young men, Dan and Roger, like other stories in this book, are imaginative conglomerations of events inspired by my many experiences as a clinical physiotherapist. These stories are not real-life reports.) The first patient...

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pp. xiii-xvi

Suffering in medical practice has long been recognized and addressed in the area of palliative care, but suffering outside the context of terminal illness is often not recognized. In 1986, in the Department of Clinical Neurology at Mc- Master University, our team of clinical researchers began to explore suffering as an entity separate from pain in patients with chronic illnesses. The projects were originally supported by the De Groote Foundation for Epilepsy Research under the...

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pp. 1-10

The dynamic of suffering is complex and rarely addressed outside the context of palliative care both in medicine and in the society at large. Linguistically, the word suffering is nonspecific and is used to describe many experiences, such as hardship, adversity, pain behaviours, discomfort, anxiety, and even religious devotion. Some believe that suffering is inevitable, immeasurable, the secondary...

1. Suffering: What Man Has Made of Man

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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...

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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...

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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...

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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...

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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...

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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...

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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...

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II: Identifying Those Who Suffer: Now is the Time to Know

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...

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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...

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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...

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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...

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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...

III: Caring for Those Who Suffer

12. The Resolution of Suffering

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pp. 183-196

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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...

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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...

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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...

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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...

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pp. 255-258

Throughout time, every age has been defined by certain characteristics that have demarcated it from previous times. There have been the Dark Ages, the Renaissance, the Age of Enlightenment, the Industrial Age, and ages of disillusionment. Each age has marked a historical, philosophical, and sociological chapter in the history of humankind. Contemporary medicine, like most postmodern...


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pp. 259-272


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pp. 273-292


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pp. 293-303

E-ISBN-13: 9781611680102
E-ISBN-10: 1611680107

Page Count: 320
Publication Year: 2011