MIND-BODY-SPIRIT
Understanding the Nature of Suffering
BY PHILIP APPEL, PHD
I always tell my patients that suffering arises from being in a state of resistance or aversion to what is. We suffer when we identify with our desires, and those desires are thwarted — when we want something to be a certain way and it isn’t, or we don’t want something to happen or to be in a certain way, and it does or it remains that way. Either way, we struggle with desires not being met. Now this does not mean you should want pain; but struggling with the pain is struggling with your body, and you don’t need to be in a civil war with yourself. People suffer with pain for a variety of reasons: when they perceive a threat to their existence and integrity; when it evokes fear involving the future; and when it is associated with social isolation and distrust of one’s own perceptions of one’s body, especially if a physician or rel - ative fails to affirm the experience as being transitory, or worse yet, fails to provide the individual with a reason for the pain. Physician and bioethicist Dr. Eric Cassell stated this tendency succinctly, “Pain is re - lated to suffering when pain is out of a person’s control, overwhelm - ing, its source unknown, its meaning is dire and the pain is chronic.” Struggling with pain is like being caught in an ocean riptide. Trying to swim against the current will exhaust you and potentially lead to your drowning. The solution is not to waste energy fighting the cur - rent, but to swim parallel to the shore until out of the current’s grasp and then swim to shore. I also compare it to how the only way to es- cape a Chinese finger trap is to push the fingers deep into the tube and then gently extricate them in a relaxed manner; otherwise, the harder you attempt to pull your fingers to free yourself, the more the tube grips you. Pain is like that — the more you resist it emotionally/cognitively, the more you will suffer. Physicians are trained primarily to apply complex diagnostic and technological methods to find out what is wrong with the body in terms of diseases or pathophysiology; they do not necessarily examine what is wrong with the person. Think about it… Have you ever been ques- tioned directly, “Are you suffering?” Or “I know you have pain, but are there even worse things than just the pain that you are experiencing in life right now?” Or “Are you frightened by all that is happening, and if so, what specifically are you afraid is going to happen to you?” There are strategies and techniques for learning how to respond to pain in your body in caring and loving ways. After all, your body did not do this to you intentionally. The pain is your body’s way of cry - ing out. Your task is to respond to your hurting body and take care of yourself. Don’t approach it with fear or anger, which intensifies the suffering; instead, learn how to care for the body as if it were your own child in such pain. It is important to start thinking about per- sistent pain in a similar fashion to other chronic conditions such as diabetes, hypertension, hypercholesterolemia, or cardiac disease in that you, the patient, must become a co-manager of your own condi- tion. Successful pain rehabilitation does not cure pain, but emphasizes self-control and self-management of symptoms. Suffering As Story of Self In many ways, suffering from a lengthy medical event is all about the wounding of Self, and how that wound becomes a narcissistic in- jury or threat to Self. There have been losses in some of your abilities (prolonged walking, sitting, standing, etc.) as well as in many areas of self expression. For example, sometimes the fear of pain prevents one from joining family and friends in an activity. The more you withdraw from life and the expression of your true nature, the more emotional distress and suffering you will create for yourself. I knew a patient of
Tarcisius, Christian martyr, by Alexandre Falguière, 1868 (Musée D’Orsay, Paris); Photo by Michelle Alonso.
mine finally understood this point when he said, “Doc, I finally got it. I can have a better time being at the football stadium with my friends and in pain than being alone at home and in pain.” When medical illness or injury creates lasting disability, then one’s sense of Self is often confronted and conflicted because your current experience of Self no longer seems to match your remembered sense of Self, the one based on familiar routines, abilities, and beliefs. When the body becomes impaired or disabled, a person can believe that their essential Self is also disabled. To restore a sense of Self, my particular professional approach is to have the person not continually identify with Self as a physical being alone or as the story of one’s life. The challenge is in preserving self-esteem independent of one’s abilities, and relying on something internal rather than external. If you can, I recommend finding a Pain Psychologist to work with. Alleviating a person’s suffering requires someone that knows some - thing about the nature of [your] suffering. To this end, bearing wit - ness can change the feelings of isolation and go a long way to restoring dignity. By being a mirror through listening and acknowledging a pa- tient’s suffering, we can restore their sense of Self. We reflect back to them more than their disability or their pain; we can reflect back the hero or heroine and the journey that s/he is on with all of its struggles and travails. Affirming the patient’s experience, and helping him or her achieve a way of understanding, will lessen their suffering. We all have a story about who we are, where we have come from, etc. Even though our story changes through the years — the story you may have had in your teens or twenties is not the same as now — we still act as if our story is an essential truth, as opposed to a changeable ref- erence. We have told our story so often we have come to identify with and believe it. Suffering may be difficult to overcome when you try to cope with your injury or disability by grasping onto your former sense of Self, and/or have an aversion to your present experience of Self. Furthermore, suffering increases when you cannot create a meaning - ful story about Self and life that integrates the loss of function and ability. We don’t recognize that we are the storyteller , not the story! Imag- ine a young football player, third season out, who gets injured so badly on the field that he cannot play pro-ball anymore. If his sole identifica - tion of Self is being a football player, he is going to suffer greatly as he
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PATHWAYS—Winter 24-25—13
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