Tuesday, November 3, 2009


In an earlier posting I mentioned the seemingly outrageous proposition that people with cancer don’t often suffer from their tumors. True, sometimes they have pain. More often, they have symptoms resulting from their treatments. But most of their suffering comes from their own normal, understandable emotions—their anxiety, fear, anger, depression, and frustration.

This being true of other diseases, too, it leaves us practitioners with a problem: we’ve been trained to treat tumors and other physical manifestations, but not to treat suffering. In fact, that disparity has been healthcare’s atmosphere so long that many of us feel it’s beyond our jurisdiction.

Yet our professional elders from Hippocrates to Sir William Osler have encouraged us to treat the person along with the disease. Osler advised,

“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with powders or potions…”

Poet and pediatrician William Carlos Williams wrote,

“To treat a man as something to which surgery, drugs and hoodoo applied was an indifferent matter; to treat him as material for a work of art somehow made him come alive to me.”

Sounds right, but how do we get there? Simple, really. Explaining the source of his own wisdom, pitcher Satchel Paige said, “I just let ‘em talk.”

Just let ‘em talk. No kidding.

It’s simple, but not easy, as the task especially challenges the medically trained: can you just listen without trying to fix?

(An aside, examples of fixing:

“I know how you feel.”

“Have your looked into clinical trials?”

“I’m sure things’ll turn out okay.”

“How about acupuncture/herbs/homeopathy/crystals/prayer?”

“Just stay positive.”)

Suffering can’t possibly be fixed, only experienced. Novelist Marcel Proust advised, “We are healed by suffering only by experiencing it to the full.” But we don’t like it, of course, so we try to avoid it, which actually perpetuates it. As a cancer support group member said, “Buried suffering is always buried alive.”

We practitioners can help by accelerating the person’s passage through suffering. In her now-classical book, On Death and Dying, Dr. Elisabeth Kubler-Ross wrote of emotional “stages” in the dying process. These stages—denial, anger, bargaining, depression, and acceptance—are examples of suffering. When we learn we have any irretrievable loss (not just disclosure of our mortality, but an impending divorce or drop in stock value), we first deny it, then get angry, and so on. These “stages” don’t necessarily happen in Kubler-Ross’ order, and suffering may include emotions she didn’t name, but once we’ve expressed them, there’s nothing left, and we’re in the state she calls “acceptance.” Acceptance is the same as serenity, the absence of emotion.

In short, here’s how to treat suffering: ask, “How are you?”

Let ‘em talk. Listening, ask yourself what their suffering consists of. Ask them questions in order to clarify. Don’t interrupt. Don’t interpret. Don’t fix.

There’s magic here. When we avoid suffering, it remains an amorphous unknown. When we enter its heart, however painful that is, we find the route to the way out. Here’s an abbreviated version of a conversation that occurred over several weeks:

“How are you?”

“How am I? I’m dying, that’s how I am.”

“How is that for you?”

“Well, I’m damned angry about it.”

“What part of it makes you angry?”

“I’ve wasted so much time. I’m angry at myself. I could’ve done so much more.”

“What haven’t you done that you could still do?”

“Well, reconcile with my kids, that’s one thing.”

Here is alchemy before our eyes. Someone has transformed her generic, undifferentiated suffering into behavioral advice. She knows now what she needs to do to approach serenity.

This work doesn’t require training in psychotherapy because there’s nothing abnormal in the situation. Nothing is wrong. Intervention here amounts to simple compassion. In other words, this is friendship.

No comments:

Post a Comment