FOUR RULES FOR MANAGING SUFFERING
By Brain Lynch, M.D.
This short piece will attempt to explore the concept of "suffering" in a new light. Over many years I have served on committees ,read much on and been involved in discussions, and experienced in the clinic, "suffering." But what do we really mean by "suffering"? The very first thing that is often neglected in such situations and discussions is to separate out the suffering of the "patient" from the suffering of the caregivers and family. This seems so obvious as to border on the ridiculous but I have found that in its obviousness we find much to consider.
The point is that we are all suffering. The sick and dying can give those around them as much care as we the "healthy" can give them. When the situation is as it should be, and even if not, we all have learned something about how to deal with illness, death and living.
There is a simple truism when talking about the dying process. We are alive until we are dead. We have the same feelings and emotions until our last breath. We can laugh and cry and love and hate until our last breath. When we are ill and not facing death we are, of course also, alive, and still have all of our emotions and feelings at our command.
One big difference between the "healthy" and the ill and dying is that the ill and dying are granted a special role. They are excused from the daily routines of work and chores although such things as bills and other necessities continue. I would point out that these later unpleasantries are evidence that the person is indeed alive. But once we allow for this special status we are left with our normal communications, needs and desires.
Can there be a way, a common ground, to make the situation as tolerable and least painful as possible?
Much has been written and many have tried to come to our aid in our times of tribulation. I, here, apply the work of others to the particular situation of being ill or dying whether we are "with" those in such a state or are the "patient." The simple guidelines for all to come out the best in any of these situations are as following:
1) We want to maximize the expression and the experience of interest and joy in our lives and the lives of those around us.
2) We want to minimize the expression of negative feelings of all concerned. Those feelings I will specifically name as: anger, fear, distress, disgust and shame.
3) The way to achieve the goals of # 1 and # 2 is to express ALL FEELING whether they be positive or negative!
4) We do this by educating ourselves and others about the importance of feelings both negative and positive. We develop understandings between us that it is ok to express any type of feeling. We develop articulated rules for doing so.
It is posited here that the origin of much "suffering" is unexpressed feeling. So many of us have been taught not to express feeling, especially negative feeling. We are on our death bed and we continue to feel so much anger at a parent but we are unable to express it, as we think we will be seen as "bad" if we do so. While often if we did express the feeling we might find that what happened thirty years ago, to make us so angry, was all a big misunderstanding. Yet, it is true, that what made us angry might have been much more than this, maybe it was some act of molestation by someone. Yet again we have felt unable to express these feelings as we might still feel that possibly we "let" the molestation happen or simply we do not know how to express our true feelings.
The same is true for those around the ill and dying. They too have the same problems of expressing feelings, especially negative ones. Often the "suffering" we talk about, so often, is the suffering of the observer! Not of the patient! We suffer for our own doubts about life and the hereafter. We suffer due to our own fears. We suffer for not resolving old conflicts with the loved one.
How do we come to learn how to overcome the obstacles to the expression of our feelings?
How do we come to make the four steps real and useful?
The first step seems to be to recognize that all in the room have an interest in being with the other otherwise they would not be there. This interest, however, is often impeded in some way. We desire and want to say “I love you", “I am sorry”,"I am afraid to lose you” but we cannot.
It is remarkable that if you think about it no one has really ever pointed out the feeling we have when we can’t do what we want. It is always the same feeling. For the purpose of this article I will name this feeling "hurt" or "confusion." You may call it whatever you want but just try and stay with the idea that there is a universal feeling when we want to do something and we find we are not doing it or "can not" do it.
We can begin by teaching ourselves and others to recognize this feeling. When we go to this basic primal feeling, we, for the moment, go behind all the "actions" of those involved. We go behind all the "thoughts" of those involved and we try and just stay "with" the person and meditate on what the major feelings in the room are, including our own. Most often those feelings will be a sense of "hurt" and "confusion" and it is paramount that we express the words that “I am confused", “I am hurt." At this point we may not even know what we are confused or hurt about. Most importantly by expressing the statement in terms of our hurt, by not say “you hurt me” we invite others to come nearer us and to be ready to accept that which follows. We often, again, come to see that our confusion is indeed a valid confusion as past scenes and feelings bring with them new understandings of what has gone on in the past. Always keep in mind that this can happen to and be expressed by anyone in the room. We need not feel guilty for expressing our suffering if we are not the ill partner. Expressing our suffering lets the other know that their suffering has meaning and is reflected in the other. We all end in recognizing, on a higher level, that to suffer is human and in the end we feel better.
I want to emphasize that the above process is a "goal" and it might seem an impossible one. We cannot be expected to always achieve the blueprint. We where all raised in such a manner that we are not yet able as humans to be "perfect." And if we are not "perfect" we should give ourselves a break. We often, due to overwhelming feelings, have to withdraw from the scene, feel guilty or attack one another due to the intensity of the moment. When we are calmer, however, we can rethink how we can come closer to the following the guidelines next time around.
Finally such a process should reduce the suffering of all involved as if negative feelings of shame, anger, fear, distress and disgust are not expressed they are "backed up" and can only serve to aggravate physical feelings of pain and discomfort.
It is suggested that caretakers of the ill and dying develop the skills to facilitate the expression of feelings of all involved using the four rules that I have laid out.
These ideas are a product of my study of Silvan S. Tomkins and his Affect Theory. I invite you to explore his ideas in depth. The four rules are generally referred to as “The Central Blueprint."I have summarized my understanding of Tomkins' work in the following:
Twelve Steps To Emotional Health
(VER ESTE EN ESPANOL)
The Role Of Emotion In Death And Dying
Brian Lynch, M.D.