Meaning in Suffering: Caring Practices in the Health Professions

2: The Gift of Suffering

2 The Gift of Suffering ingrid harris What really raises one’s indignation against suffering is not suffering intrinsically , but the senselessness of suffering. Nietzsche, n.d. In this paper I aim to focus attention on suffering in a way that seeks to be useful to the healthcare professional. I argue that suffering is a gift to both sufferer and healer and that the way the gift becomes present to them is through their interaction in what well-known phenomenologist Calvin Schrag calls a “fitting response” to the call of the other in the visage of the neighbor. Lorraine M. Wright (2005) argues that suffering is at the heart of nursing. She maintains that although reducing or diminishing suffering is the essence of nursing clinical practice, there still exists a lack of attention to suffering by the healthcare professional and the healthcare delivery system. About eight years earlier, Ira R. Byock, hospice medical director of Partners in Home Care in Missoula, Montana, and chair of the Academy of Hospice Physicians Ethics Committee, expressed concern about the lack of material available on the topic of suffering for geriatric medicine in particular and for medicine in general. He observed that most physicians get no formal education in the phenomenology of human suffering and very little training regarding the terminal phase of illness. Empirical experience , he argued, typically accumulates during practice, when opportunities for formal study and thoughtful reflection are scarce. Meanwhile, education remains focused on cure, life prolongation, and restoration of function, which, while important, do not address the relief of suffering. 60 Despite voiced acceptance of “whole person care,” Byock argues, the Cartesian separation of mind and body continues to dominate clinical training. Suffering affects not just the body but the mind and the spirit as well. How each of these dimensions is treated in a clinical setting has far-reaching repercussions for patient and healer alike. At the time when Byock was writing, suffering was understood mostly in terms of physical pain, and training in the theory and practice of controlling pain and other sources of distress remained absent from general medical and nursing curricula. The coming to awareness of the perceptual world was hampered by this manner of thinking. Byock (1996) suggests that for the patient to benefit optimally and for clinicians to feel confident in their care, the approach to a suffering patient must be preceded by thoughtful preparation . This is more and more often the way that healthcare professionals are proceeding today, and much literature is now available on the topic of suffering. Suffering is universal, and it is something we talk and write about at length and often. According to recent work of Black and Rubenstein (2004), the definition of suffering is connected to the culture in which it is defined, to the ethos of the society, and to the way an individual communicates suffering within that society. They argue that suffering is a form of social communication. As a lived experience, suffering is laden with social connotations and marked by symbols that are recognized and shared throughout the culture. Black and Rubenstein (2004) apply this to discussing the themes of suffering that they discovered in elderly patients . They found that collective interpretations of suffering create its value as well as a rejection of its value—acceptable, unacceptable, a cultural exemplar, or even an “outrage” in a given society. Following Heidegger’s understanding of the meaning and truth of being as an ever-coming-to-presence, Schrag (2002) takes up the appeal to responsibility, where we find ourselves “thrust into another space, a space of an ‘ethic,’ or more precisely a ‘protoethic,’ that is in some manner otherwise than Being” (p. 78). For Schrag, ethics is prior to ontology. Before being, the call to the ethical is the call to responsibility (Schrag, 2002). This of course implies that the ethical quality (responsibility) of the multifaceted relationship between people is a determinant of the sort of outcome (being) that might be anticipated. This relationship is largely language based, but obviously the physical dimension of caring plays a feature role as well. The Gift of Suffering 61 62 ingrid harris What Is Suffering? We all know what suffering is—no human life is without suffering of some kind. When we try to define it, however, as with many philosophical enquiries, just what suffering is becomes unclear. What is clear is...