On Suffering: Pathways to Healing and Health

12. The Resolution of Suffering

12 * The Resolution of Suffering Me, myself and you I see you, love you, and hate you, like you Care, cheer, fear for you. But I don’t know you Know you, know you Little soul of me. Fragrant flower, hiding, hiding Lone, lonely shadows Dancing, dance, dancing. Scarlet flashes on barren plains Salty teardrops Dripping. Little spirit Brave and true? Crushed beneath some careless heel. Whispers, whispers, Sacred shadow swinging wildly Silver silence haunts the night. Earthly footsteps Creeping, closer Night thieves stealing. Lost forever! Calling, calling. Softly, softly, never fear. Secret whispers Play, play, playing Screeching, raging, ripping, roaring Swirling mists and numbing fog. Calling, calling, calling. Squinting darkness, you, small self Fumbling, stumbling, heart to heart. Drumming, strumming Strains of music Faintly, Humming. 184 Caring for Those Who Suffer Monstrous mania writhes in horror. Flings my being, Crushing, smashing. Searing, screaming A thousand stars to smear the sky Blinking. Confused and helpless Comes the dawn. I remember. I remember you. You Brave little soul. Laughing, fighting, loving I remember you Dancing, swirling, lightly glancing I remember you Remember you May I? Some may interpret the above expressions of suffering using the semantics of psychic or psychological pain. But the poem is perhaps better interpreted as expressing the characteristics of suffering in which there is a perception of threat to the individual’s idea of self, a loss of central purpose expressed by the unanswered “calling, calling,” and finally the individual’s remembering the old self and the invitation to healing, as expressed by the words “may I?” Exploration of suffering, defined as the potential impact of perceptions of threat to an individual’s idea of self and personhood, has revealed that suffering and pain are separate constructs that are only sometimes directly related. Religious, spiritual, and cultural traditions influence suffering across the life span as does the effect of legal and medical discourse. These factors have the potential to either negatively or positively affect individuals’ sense of personal power and autonomy. Effective clinicians who hear and understand the language of suffering need to have high communication skills and a basic understanding of the factors that may impact on individuals who suffer . Research evidence shows that it is possible to identify those individuals who experience suffering as well as key factors common to all patients with chronic illnesses (1–6). Interviews with patients reveal that patients often speak of suffering using the language of pain because they are aware that health care practitioners may be unfamiliar with the language of suffering (4, 5). In medical practice, comprehensive problem identification involves analyses of patient stories about their illness and/or injury. For this task more extensive methods of problem identification are required than the usual empirical style in The Resolution of Suffering 185 which the clinician listens for specific signs indicative of disease. While the thrust of this text is to advocate for the implementation of suffering-specific awareness and interventions across all health care practice dimensions, specific psychological interventions, in cases of unresolved suffering, are the province of mental health care providers and are beyond the scope of this book. The purpose of this chapter is to: (a) explore a variety of methods to identify the nature of suffering through analyses of common types of stories patients tell that indicate suffering, (b) to explore the dynamic of storytelling and its relationship to self, and (c) to provide some guidelines to assist clinicians in managing the issues of suffering as it relates to restoration of self and personhood in everyday clinical practice. Detecting Suffering, Separate from Pain: Hearing the Story A key theme in the language of suffering is the expression of a lost self. Patients may describe themselves as being lost in a world in which they no longer believe they have a place or in which they are unable to create a world that is acceptable to them. They may perceive themselves as being irrevocably changed and “invisible” in the world they once knew. They may express a loss of innocence and the need to hide away from the world. One patient spoke of feelings of shame and guilt; “If only I had paid more attention, then this terrible event wouldn’t have happened to me.” He also expressed feelings of isolation and anger; “People come to me and tell me their horror stories; don’t they realize that I can’t help them, that...