On Suffering: Pathways to Healing and Health

16. Surviving and Thriving

16 * Surviving and Thriving 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 and idiosyncratic. In clinical practice, failure to make the distinction between the process of suffering and the personal expression of the experience can lead to the development of chronic health problems and even disability. The influences of religious and spiritual teachings, medical and legal discourse, cultural traditions, and the conflicts between demands of psychological developmental tasks across the life span are examples of the myriad factors contributing to the experience of suffering. Key issues of concern, as determined from studies of over 300 patients with chronic illnesses such as arthritis, epilepsy, migraine headache, and spinal cord injuries, centre on the degree of concern that patients have that their illness or injury will have a negative effect on the challenges of ageing , their relationships with a partner, children, friends, personal life goals, work beliefs, job performance, and community involvement. The importance of understanding the language of suffering and its relevance to patient power and autonomy has been shown, and strategies for care demand a multi- and interdisciplinary approach. Measures of suffering need to be included in patient assessments, and suffering-specific treatments are needed for optimal patient care as well as cost containment in health care delivery. Suffering is a life experience that impacts significantly on health and is a concern for all health care practitioners. As we have seen in previous chapters, there are many societal beliefs and attitudes that can contribute to or escalate suffering. Failure to differentiate individuals ’ idiosyncratic expressions of suffering from mental illness also has adverse effects on health and well-being. The purpose of this final chapter is to (a) delineate common misunderstandings of the differences between sorrow and depression and between depression and suffering, (b) discuss the influence of fear, anxiety, and loneliness, and (c) illustrate how facilitating personal creativity can help overcome these obstacles to surviving suffering and restore personal power. 244 Caring for Those Who Suffer Obstacles to Surviving and Thriving Sorrow and Depression The process of surviving suffering is a profound life experience, and many of the fundamental tasks essential for personal survival have been explored. We have seen that suffering is a much neglected and misunderstood concept in medicine because suffering is often related to pain but hardly ever considered in its own right. Suffering and sorrow are sometimes perceived as one and the same phenomenon . In the care of individuals with chronic illnesses, differentiation between the construct of suffering and that of sorrow is valuable. Sorrow is an expression of profound sadness, unhappiness, mournfulness, ruefulness, grief, heartache, or bereavement. It is a profound response to adversity that occurs in the human life experience. Even though patients who experience sorrow may have considerable difficulty managing everyday tasks, the element of hope that events will improve is not totally lost (1). During the process of suffering, individuals may experience all or none of these phenomena in response to a loss of central purpose in their lives or because of impaired interpersonal relationships and feelings of self-conflict. Suffering and sorrow may erroneously be thought to be one and the same, but suffering is an experience to which sorrow may or may not occur as a response. Sometimes, sorrow is further mislabeled as clinical or major depression, but psychologists clearly identify clinical depression as a disease (2). While such classifications may be useful to science, the stigma of mental illness persists in contemporary society and may negatively impact not only on an individual’s identity but also on ideas of self. One challenge to contemporary psychology/psychiatry is to accurately differentiate “normal” sadness or sorrow from clinical depression. Depression has many meanings in contemporary society. Generally, depression is a term used when individuals have a pessimistic sense of inadequacy in which there is a despondent lack of activity as well as an accompanying loss of interest or pleasure in normal activities. In medicine, clinical depression is a mental disorder and is currently understood to be characterized by a broad spectrum of symptom type, severity, and course of illness. It is generally defined as “a disease with characteristic affective, cognitive and vegetative complaints which has a typical course and predictable response...