What is suffering? When people hear of someone „suffering., they typically think of “pain”. But, it is more than that. The American Century Dictionary defines suffering as “to undergo, experience, or be subject to pain, loss, grief, defeat, change, etc.” And, Cassel defines it as “the state of severe distress associated with events that threaten the intactness of [the] person.”
Suffering is more than physical pain, because a person can be having pain but not be suffering. For example, a woman in labor may be having severe pain but not be suffering because she knows the pain will soon be over. Whereas individuals who don.t see an end to their pain, who are feeling overwhelmed by its intensity or that the pain suggests a terrible outcome, or that they have lost control of their lives because of it – in these situations, the pain may be perceived as a threat to not only their life but to their individual „wholeness. as a „person., and rather than being enriched, they are diminished by the experience – and as a result, suffer.
Every chronic symptom, whether it is pain, shortness of breath, nausea, etc, has four aspects or components: physical, social, psychological (emotional), and spiritual. Imagine the symptom as a “four-legged stool”, where, if one leg is weaker than the others, the stool may tip over and you will fall off. Likewise, with pain or any chronic symptom, to treat it effectively and avoid „falling., requires paying attention to all four components: a holistic approach which reinforces that we cannot separate our body from our mind – one affects the other.
A good example is an 82 year old man with newly diagnosed lung cancer which has spread to his bones. He is having severe pain in his back which is not being relieved despite increasing doses of morphine. He is distressed and appears to be suffering miserably. His youngest son has been estranged from him for many years but upon learning of his father.s cancer, he returns home and asks forgiveness for his past. His father not only forgives him but asks forgiveness for his own behavior as well; at which point the pain is not only brought under control but his suffering is relieved.
Thus, although suffering can occasionally be considered good – as when the person is enriched by it – it is usually undesirable, needs to be prevented if at all possible, and is always to be relieved when present – the primary goal of medicine.
Specific Steps to help a patient prevent and relieve suffering.
1. Clarify what chronic or life-limiting diseases you have. [ask your doctor]
2. Determine the probable prognosis (outcome, or years of survival) for each disease. [obtain from your doctor; use the Internet]
3. Based on awareness of the diseases and their prognosis, establish your goals: longevity (live as long as possible regardless of the pain or consequences), or comfort (avoid pain or other symptoms, even if you may not live as long). [see articles on this website – Making Choices – Choosing Comfort (Palliative Care) When There is no Cure; and Goals of Care ]
4. Find out the options available for treatment of each problem, and the risks and benefits for each option. [again, from your doctor, and the Internet; to help put risks in perspective, go to Dr. John Paling.s website – http://riskcomm.com/paling_palettes.htm ]
5. Make a decision – based on your goals and after discussing it with your family and your doctor.
6. Ask yourself, “Can I live with this decision”? If you.re not sure, make another choice.
7. Complete an Advance Directive (Living Will) to make sure your wishes are known and followed.
Other suggestions to prevent and relieve suffering.
Avoid futile care. Futile (non-beneficial) care refers to any surgery, drug, or test which will not help you reach your goals. Assuming that futile care usually leads to unnecessary suffering, it is only logical to avoid it.
How to do that? By following the steps outlined above, you can hopefully avoid the well-meaning but sometimes non-beneficial interventions which physicians may prescribe when trying to “fix” a chronic or incurable problem. Doctors have been trained, a) to treat specific diseases, whether acute or chronic; and b) that every disease has a specific treatment. Unfortunately, in treating the disease, we sometimes are not aware of, or forget about, the greater illness the person has; and the treatment ordered, instead of helping, only causes more problems, which adds to their burden of suffering.
For example, the 82 year old man referred to above, has the disease lung cancer causing him pain. His illness includes his loneliness and depression – due to his estrangement from his son – which exacerbates his pain. If we focus only on his physical pain or his other diseases (such as heart disease), prescribing treatments (such as doing an angiogram of his heart for chest pain, triggered by his anxiety over his son.s situation) which do not address his “cancer illness” and take into consideration his goals, we may only end up adding more symptoms or side-effects and not help him to be “healed” prior to his death.
Accepting our mortality. If you can accept that there are many things we cannot change (such as chronic disease and dying), then your life will be more serene and you can help yourself avoid suffering.
Can you accept that nothing in life is certain, and everything we do carries some risk? Do you believe in a „pill for every ill,. or no drugs at all, or somewhere in-between? In general, the more we try to treat or „fix. something that is incurable, the more problems we generate: the Institute of Medicine has found that doctors and hospitals accidentally induce thousands of illnesses and deaths every year. We will all die eventually, but we can choose how to live before we die – and how to die with dignity. Make choices based on your philosophy, your goals, and the potential benefits vs the risks for each health care decision.
Emphasize function over longevity. If you have a chronic illness or life-limiting disease (a disease which would usually result in death), focus on choices which will help you maximize function (doing your daily activities independently) rather than length of life. Choose quality of living over quantity of years.
Have a social support group. Studies repeatedly confirm that people who have a strong social support group live longer and better. Social support includes: a strong family network, formal disease-specific support groups, close friends, and churches. Suffering is intensely personal; and therefore lonely. It can often be alleviated by having a sympathetic ear to listen to one.s story, someone to share the problem with.
If someone with a terminal illness asks for help to die, it.s not likely so much that they truly prefer death; it.s that they.d rather die than continue to live as they are — suffering. People need to know they will never be abandoned; that their doctor and their family/friends will be there for them, no matter what happens.
Minimize the use of drugs. Studies show that the more prescriptions seniors take, the more problems (such as falling and confusion) they have and the shorter their lifespan. Nothing is risk-free — all drugs have side effects. Use prescriptions and OTC medications sparingly. Information promoted by marketers is misleading: it is often difficult to take the benefits found in a large population and make them relevant at a personal level.
Follow a healthy lifestyle. Be assertive and independent; ask questions. Do all things in moderation. Eat healthy foods. Exercise/walk daily. Get 7-8 hours sleep per night. Don’t smoke. Accept others for who they are. Laugh often. Go to “Healthy Humor” on this website. All the things we were supposed to learn in kindergarten!
When it’s time, use a hospice. Once diagnosed with a terminal disease with less than six months survival predicted, seek the services of a hospice. They are trained to help prevent and relieve suffering.
First, do no harm. (Primum non nocere)
1. Schneiderman LJ. Embracing our Mortality: hard choices in an age of medical miracles. 2008 Oxford Univ.Press
2. Cassell EJ. The Nature of Suffering – and the Goals of Medicine, 2nd Ed. 2004 Oxford Univ.Press.
3. Illich I. Limits to Medicine (medical nemesis: the expropriation of health). 1976 Pelican.
4. Davis-Floyd R. From Doctor to Healer: the transformative journey. 1998 Rutgers Univ.Press.
5. Institute of Medicine 1999 Report: To Err is Human