Suffering, Hope, and Healing

The words “pain” and “suffering” are so often used together in clinical practice they sometimes seem to merge into a single concept, with clinicians simply referring to “pain-and-suffering.” Writing in the early 1980s, Eric Cassell bemoaned the fact that the medical literature contained very few studies that specifi cally addressed suffering, although there were hundreds of reports that focused on all aspects of physical pain (Cassell 1982 ) . Since then, the study of human suffering has advanced considerably, in large part due to the development of palliative medicine as a clinical specialty. Nonetheless, controversy about the primacy of pain and other physical and emotional symptoms as the causes of suffering in illness remains. Some observers argue that such symptoms are the central feature of suffering, even though emotional and cultural factors also play a role (Wall 1999 ) . Most, however, focus their attention on existential factors not directly dependent on the experience of physical pain (Kellehear 2009 ) . Suffering represents a dimension of personal distress that goes far beyond physical, or even emotional, pain. There is no consensus on a single, precise, and comprehensive defi nition of human suffering (Wilkinson 2005 ) . However, virtually all defi nitions focus on one or more of a cluster of related characteristics. According to Eric Cassell, suffering occurs when illness or other circumstances threaten a person’s intactness (Cassell 2004 ) . He defi nes the concept as “a specifi c state of severe distress induced by the loss of integrity, intactness, cohesiveness, or wholeness of the person, or by a threat that the person believes will result in the dissolution of his or her integrity” (Cassell 1995 ) . An Irish palliative care physician, substitutes the term “soul pain” for suffering and defi nes it as “the experience of an individual who has become disconnected and alienated from the deepest and most fundamental aspects of him or herself.” The psychotherapist Viktor Frankl identifi es suffering with perceived loss of meaning in one’s life (Frankl 2006 ) . Arthur Frank views suffering as a person’s experiential response to the loss of his or her sense of being “myself,” which leads the person to mourn for their previous identity (Frank 2001 ) . In an editorial entitled “Suffering and healing – our core business,” George concludes that suffering results from an attack on “integrity of, or sense of, self, dissociation or otherness, a loss of dignity – the draining of events upon one’s sense of worth or value” (George 2009 ) . Chapter 37 Suffering, Hope, and Healing