The Idea of Suffering as a Call to the Other - Assignment Example

?Running Head: The Idea of Suffering as a' Call to the Other The Idea of Suffering as a' Call to the Other INTRODUCTION Every daynurses are involved in witnessing human suffering. In a variety of settings, within people of different ages, and across diseases, suffering is inseparable from being ill. This paper focuses on the ethical approach to care giving through exploring the nature of suffering and compassion. PERCEPTION OF SUFFERING IN MEDICINE It was not until 1982 that the idea of suffering in medicine started to be widely discussed and explored. That year Eric Cassel published a paper on suffering based on his experience as MD. This work that first appeared in New England Journal of Medicine launched a new direction in discussing suffering in healthcare setting. Lots of representatives of other disciplines used Cassel’s understanding of suffering in their publications to draw attention to the fact that suffering is not related just to physical injury or some disease, but relates to human suffering as well (Cassel, 1991). The core idea of Cassel’s perception of suffering is that the latter is “experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of a person as a complex social and psychologic entity” (Cassel, 1982, p. 639). Moreover, the author expresses the view that suffering can include pain, yet is not restricted to it. Importantly, he asserts that to relieve human suffering is the obligation of the medical care. Cassel’s comparisons and studies in the area of pain and human suffering, as well as his thoughts on meaning are compatible with the themes of nursing and medical care explored in history. However, in practice one can find that despite their historic meaning, both medicine and nursing often fail to carry out this important duty within modern healthcare. Instead, they have become over technical and depersonalized. To our exploration of suffering as a Call to the Other, Cassel’s study of the illness and its meaning seems specifically relevant since it can be well applied to the nursing practice. Cassel thinks of personal meaning as a basic and principal dimension of what we know as personhood. To add, Cassel provides explanation of the importance of recognition of personal meaning. In particular, the researcher states that this recognition is crucial in understanding people’s illnesses and sufferings. Finally, Cassel rebukes current medicine for its ignorance of person’s spirit that drives human life, or in other words for its failure to include the transcendent dimension. ORIGINS OF SUFFERING In his study “Medicine and Human Suffering”, Professor Hiram Caton asserts that the origin of suffering within humans is their anxiety of death. He writes, “The fundamental human suffering is knowledge of mortality” (Caton, 1998). However, the vision of origins of suffering is far more complex. Suffering is classified as physical and psychological. For instance, Tudor speaks of physical, psychological suffering, and affliction. Recognizing the existing dichotomy between mind and body, Tudor defines physical suffering as “suffering felt as physical pain” and psychological suffering as “suffering felt as psychological pain” (Tudor, 2001: 23). In relation to psychological suffering, the term of affliction has been successfully developed by Weil. In his interpretation, suffering is perceived as affliction and it involves a combination of psychological distress, pain felt physically, and some social elements. In addition, psychological suffering is also known as ‘sorrow’, which seems to be unable to accurately reflect such states as distress, despair, anguish, shock, etc (Wyschgorod, 1990: 34). Psychological and physical suffering differ not just in the nature of pain that the Other experiences, but in terms of expressibility as well. On the basis of careful observation, Scarry has come to the conclusion that Physical pain does not simply resist language but actively destroys it, bringing about an immediate reversion to a state anterior to language, to the sounds and cries a human being makes before language is learned. (Scarry, 1985: 4) In other words, Scarry believes that physical pain has fewer and more primitive means of expression in comparison with the psychological pain that can be described with dozens of lexical units to help people express their feelings. This idea can also be found in Virginia Woolf’s ‘On Being Ill’: English, which can express the thoughts of Hamlet and the tragedy of Lear has no words for the shiver or the headache… The merest schoolgirl when she falls in love has Shakespeare or Keats to speak her mind for her, but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry. (Woolf, 1967: 194) At the same time, one cannot deny the fact that in real life psychological and physical sufferings are intertwined. To illustrate, in order to describe their psychological experience people talk about aching hearts, being pierced by someone’s betrayal, about tortured souls, about being racked by the feeling of guilt, about boiling blood, etc (Tudor, 2001). Speaking about the origins of suffering, the latter may be a result of wrongdoing. In this case moral suffering takes place that evolves as a result of a person’s wrongdoing directed at the Other. Here the Other experiences suffering as a phenomenon of human origin and, which is deeply hurtful, conveyance. To compare, people aware of the natural origin of their suffering may bear it relatively easy, while those who know of the human sources of their suffering experience are recognized to suffer more. The causes of moral suffering are: violation, malice, disrespect, and neglect (Tudor, 2001: 35). An example of moral suffering that comes as a result of deliberate evil-doing is described in Warsaw’s Diary by Chaplain: A rabbi in Lodz was forced to spit on a Torah scroll that was in the Holy Ark. In fear of his life, he complied and desecrated that which is holy to him and to his people. After a short while, he had no more saliva, his mouth was dry. To the Nazi’s question, why did he stop spitting, the rabbi replied that his mouth was dry. Then the son of the ‘superior race’ began to spit into the rabbi’s mouth and the rabbi continues to spit on the Torah (Steiner, 1984: 246). NATURE OF SUFFERING It has been generally agreed that one of the pivotal goals for medicine is to prevent or relieve suffering of human beings. To do this properly, one needs to understand the nature of suffering and its specific features. In a relatively recent research by Canadian authors the nature of suffering, as well as its relief has been explored. Daneault et al conducted a study of 26 patients that were terminally ill with cancer. The findings of this qualitative research have led to the conclusion that patients’ suffering is related to the domains of well-being: psychological, physical, as well as social. The conducted content analysis of the patients’ interviews allowed distinguishing between three main dimensions irreducible in their nature: 1) subjection to violence; 2) deprivation and being overwhelmed; 3) and, finally, living with the feeling of apprehension (Daneault et al, 2004). Similarly, the research conducted by the Finnish colleagues led to the conclusion that suffering exists in these three dimensions (Kuuppelamaki & Lauri, 1998). They state that physical suffering is linked to having fatigue, as well as pain and chemotherapy side effects (in relation to cancer treatment). As for psychological suffering, it is expressed through patients’ depression and debilitation as they realize their death is imminent. Socially, patients are reported to experience withdrawal and seek isolation as a result of the psychological suffering. Thus, whole-person approach has been successfully reinstated. Darryl Reanney, the author of the book “The Death of Forever”, perceives suffering as a way to find a meaning in life. Contrary to the culturally accepted solution that encourages the pursuit of pleasure and happiness, Reanney contends that the way to people’s salvation includes the anguish of death acceptance and that a person has to die many times. He writes, “Is this then the meaning of life? To struggle, to bleed in silence, to grow through suffering? Is comfort the necessary adversary of growth?.. My answer has to be yes.” (Reanney, 1991) In relation to coping with patients’ suffering in practice, two postulates are applied. The first one is if certain condition is to be changed or prevented, one is obliged to know its cause. The second one is one has to either eliminate or somehow influence this cause. Despite the fact these postulates are not recognized as one hundred percent true, they lie in the foundation of modern medicine and determine the majority of deliberate actions by humans. In the context of suffering, awareness about what caused suffering is thought to be a prerequisite of its further prevention and, finally, relief. This means that in case certain kind of suffering is a result of some event, understood as damage, the preventive/ameliorative measure necessitates knowledge about the causative impact of the given event, and obliges to make every effort to prevent, eliminate this or somehow manipulate it. Another important thing to consider is the fact that the popular view in medicine on where suffering takes place within the human being refers it to the body. Only few scholars tend to locate this phenomenon in the psyche, mind, soul, or spirit. At the same time, this fact is crucial for medical understanding of suffering as a call to the other. Eric Cassel thinks, if medicine wishes to understand the essence and sources of suffering, it has to overcome the dichotomy between human mind and human body. Cassel believes that suffering is not the same as pain. It is not the same as grief or distress either. It is the metaphysical person that should be considered the locus of suffering (Cassel, 2004: 29). Suffering occurs when an impending destruction of a person is perceived; it continues until the threat of disintegration has passed or until the integrity of the person can be restored in some other manner. It follows, then, that although it often occurs in presence of acute pain, shortness of breath, or other bodily symptoms, suffering extends beyond the physical. Most generally suffering can be defined as the state of severe distress associated with events that threaten the intactness of person. (Cassel, 2004: 32) SUFFERING AND PAIN Discussing the problem of suffering as a call to the Other, it is important to explore the concept of pain. As Forrest rightfully points out, “Suffering is distinct from pain” (Forrest, 1994: 1). It is generally known that suffering may be the result of pain. At the same time, this is not always true. For example, two people with similar pain may experience various levels of suffering, or some people may be not suffering at all. Here it is worth mentioning that pain is perceived as suffering if some dire causes are present or if the patient perceives is as a never-ending process. Yet, it is not uncommon for suffering to persist even after the pain relief since a person may live in anticipation of pain return. The essence of the phenomena of suffering and pain is that both of them are totally personal experiences. Both of them are known to cause disturbance in person’s well-being: physical, social, and psychological. However, the major difference between them is that pain is characterized as an unpleasant experience, both emotional and sensory, which has a close relation to the past through the exposure to pain in the past. On the contrary, suffering is perceived “as a more conceptual emotion that is linked to our future through our fears of loss of self and purpose” (Forrest, 1994: 2) SUFFERING ‘OTHER’: PROBLEM OF RESPONSE The problem of the suffering Other and suffering as a call of/to the Other has been widely explored by Levinas, a French philosopher and the author of “the Other” concept. The ethics of Levinas is based on the recognition of the importance of the encounter with “the Other”. For the author, the irreducible character of relation, kind of epiphany of this encounter – “the face-to-face” – is perceived as a phenomenon of privileged nature since other’s distance is felt along with the Other’s proximity. He writes, “The Other precisely reveals himself in his alterity not in the shock negating the I, but as the primordial phenomenon of gentleness” (Levinas, 1991: 21) However, this face revelation produces a demand to either affirm or deny; in other words, the transcendence of the Other is acknowledged. Thus, the responsibility and ethical duty to the Other based on the Infinity idea is a person’s primary mode of conduct and thinking. Let us explore in more detail the ideas of Levinas on suffering as a call of the Other. Just as Levinas talks of the Other as a principally not me and irreducible to me, this distinction is applied to the idea of suffering. In other words, if the Other is suffering, this is totally Other to me. Consequently, if a person tries to place himself/herself in the Other’s shoes in order to understand these suffering, this is perceived unethical since it reduces the alterity of what experiences the Other. Hence, empathy (derived from Greek words “in” and “feeling” or in another meaning “suffering”) seems irrelevant response since it denies the difference that exist between myself and the Other while this difference is understood as the fundament of the ethical relation and subject production (“Suffering Others II: Responding to Suffering”, 2007). Accordingly, denying the suffering of another person is related to the denial of their alterity and person’s dependence. This seems to be the case with the modern medicine that flattens person’s suffering into pathology in an endeavor to make it thematized. It is important to remember that one is not able to know another person fully, nor is he/.she able to know their suffering. To respond adequately without thematizing evolves as a primary objective here. If to understand suffering as a Call of the Other itself, which is actually a call from destitution and desperate condition, compassion seems the only ethical response. Compassion is perceived as “suffering-with”. In this way the ethical relation is enacted and the space is opened that “opens them to the realm of the interhuman” (“Suffering Others II: Responding to Suffering”, 2007). Some other important thoughts on suffering as a call of/to the other by Levinas include: Acknowledgement that technology of medicine is rooted not just in the “will of power”, but also in “high thought”. The question is being asked: Would there be good in doing thematization and studying suffering as a pathology? Levinas insists that every case of human suffering is unique and important in terms of its alterity and unknownability; People’s concern for the suffering of the Other can be perceived as the Supreme Ethical Principle with the potential to be used to command extensive human groups; Furthermore, according to Tudor, suffering of the Other is the basis for two modes of moral acknowledgement: compassion and remorse. Tudor writes that compassion can be understood as the experience of one that is a witness to the suffering of the Other. As for remorse, it can be defined as experience of a person who recognizes himself/herself responsible for the suffering of the Other. SUFFERING AS A CALL TO OTHER: NURSING GOALS According to the findings by Ferrel and Coyle (2008), suffering in patients that have to live through some kind of illness is characterized by: Loss of control that produces insecurity, so that people that suffer may often feel helpless Feeling of Loss: this can be loss of relationship or of some health aspect. It often leaves a person broken and dinished. Recognizing suffering is an experience that has an intensely personal nature Feelings of mortality and imminent death, desire to die. Asking “Why?”, since people that suffer may strive to find out the meaning to their distress and suffering. Feelings of separation from the outer world, so that patients feel lonely and may yearn for connection. Feeling of spiritual distress; people feel hopeless; they may start reevaluating their previous life and actions; they may develop close relationship with God. Feeling of pain. Pain is not the same as suffering, but it is closely related to patients’ spiritual distress, their social and psychological plight. Voiceless experience: sometimes it happens that patients cannot describe their experience with the help of words and they feel voiceless, just screaming inside. (Ferrel and Coyle, 2008: 246). Since nurses are involved in intimate patient care and happen to witness suffering people’s struggle with a variety of conditions and ethical concepts, they are perceived as primary providers not just of “fix-it” services, but, above all, of compassion. Nurses should develop an ability to give psychological support, listen attentively and support patients spiritually. The importance of nurses’ careful compassionate listening in patient healing has been acknowledged by many researchers. For instance, Reich (1989) describes a nurse that is fully present with the patient and is able to listen carefully, without interruption or saying much, so that the patient has a chance to express his worries and fears, as a truly educated nurse. This should not be mixed with patient teaching on how to take medicine or treat illnesses. Compassion in nursing that responds to the Other’s sufferings can be expressed through providing spiritual support. Specifically, in her book “Spiritual Dimensions of Healthcare: Nursing’s Mission”, sister Rosemary Donley raises the question of spiritual support. Contrasting the spiritual approach to patient care with modern perceptions of health care system as a money-making mechanism, Donley stresses the importance of compassion in patient care and filling it with meaning and values. She writes, Concern with spiritual elements of care brings greater meaning to the work of nursing and a sense of participation in the realm of mystery and grace. When nurses, acting compassionately to alleviate suffering, also search with their patients for a spiritual meaning for the experience, there will be a rebuilding of trust in professional relationships. This restoration will have a positive effect on patients, nurses, and on the healthcare system itself. (Donley, 1991: 183). Bearing in mind the idea of suffering as a call to/of the Other, nurses should strive to: Display gentle approach to patients that are suffering Bring calm to patients that are terrified Comfort patients’ families that await the results of surgery, etc. Deliver hope to patients that may start feeling hopeless Maintain consistent presence if it is a long-term care facility Act as personal confidants for those who dread their condition Provide the maximum of competent care for physical problems, which will expectedly reduce patients’ psychological distress Listen to people’s responses to illness and enable them “voice” their problems Help patients restore their dignity through intimate care conducted with love and grace (Ferrel and Coyle, 2008: 245-247) CONCLUSION In conclusion, suffering as a call to the other suggests that nurses (as well as other medical professionals) should not be limited to “fix-it” approach to patient care, but strive to provide care on the ethical background. 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