On Suffering: Pathways to Healing and Health

6. The Language of Suffering

6 * The Language of Suffering 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 to respect the autonomy of the patient, to do no harm (non-malfeasance), and to ensure justice prevails (1). Regulated health care providers have a fiduciary relationship with the patient as determined by their respective professional colleges, which set the scope of practice and quality of care. Health care professionals have the trust and confidence of the patient and the responsibility to act solely for the benefit of the patient. When considering the relationship between health clinician and patients who suffer, the patient’s primary goal is to restore his or her idea of self, to resolve issues of self-conflict, and to pursue the central purpose of his/her life in the face of adversity. To meet the objective of beneficence with those individuals who suffer, one must have a clear understanding not only of the language of suffering but also of the concept of autonomy and its relationship to personal power and personal responsibility. The preservation of personal autonomy in individuals who have chronic illnesses and who experience suffering is particularly challenging in culturally pluralistic contemporary societies. This chapter will explore: (a) some aspects of the language of suffering and its value when there is a loss of autonomy and personal power, (b) the historical roots of autonomy and its social ramifications, (c) the problem of patient autonomy in medicine, (d) the dimensions of personal power and health, and (e) the dimensions of power and the need to hear the patient’s voice. The Loss of Power and Autonomy: The Language of Suffering . . . And then From reasonableness to the village idiot Always aware of the fool, Stumbling here, stumbling there How long before the idiot succumbs To the cold winds of winter A frozen corpse, no telling of past passions 78 Suffering: What Man Has Made of Man No fire of love, all stiff and awkward Not even the peace of decomposition A restlessness, fear, pain Drained . . . blood . . . spirit . . . personality All depleted. And still the frozen zombie gets up and walks Searching with sightless eyes, a mindless creature Searching for a soul. This poem, along with several others, was given to me as a gift from one of my patients who, on discharge from the hospital, told me that I could use it for teaching purposes as long as I kept the authorship anonymous. laura’s story I first met Laura (not her real name) many years ago when I was working in a rural rehabilitation unit. I was doing a twelve-month locum in orthopedics and Laura was a patient of mine who was the sole survivor of a terrible car crash. Her entire family perished in the tragic accident. Laura sustained multiple fractures of both her legs, pelvis, and right arm. Fortunately, she did not have a head injury. Laura’s rehabilitation process was long and often physically very challenging. She seemed to be a quiet, well-groomed, reserved woman. She smiled only occasionally, but her attendance in the clinic was punctual and she worked hard. Prior to her accident, Laura was working on a doctorate of philosophy in art history and continued with her studies while in hospital. Other patients whispered to the staff that they thought she was a hero, given the circumstances of her accident. Laura told me she hated the label because all she felt was an all-encompassing fatigue and profound sorrow. One day, after the resident on the ward had made a referral for Laura to Psychology, she broke down and tearfully told me about how badly she felt because she believed that the staff thought she was “crazy.” I tried to explain that seeking psychological help after a traumatic event was a brave and courageous act and referrals were not made because she was “crazy” but rather to help. I felt uneasy and more than a bit guilty saying this to her because although I believed that no one thought Laura was “crazy,” I was not sure that she had not been diagnosed and subsequently labeled with clinical depression, a psychological illness. The dual messages that Laura was...