Wednesday, July 15, 2015


Hieronymus Bosch

Suffering is everywhere and yet it is so hard to understand even though the motivation is very high.  Pain seems to signal something urgently, and yet it often makes the sufferer close down and pull away from everyone.  Holding still, being quiet, trying not to feel, are not good strategies for finding the cause, but that’s what our instinct tells us.  Clench, clamp, chill.

Plain ordinary pain is one thing: step on a nail, slice your finger while meaning to cut something else, strike something hard -- these traumas are clearly what pain is for, to draw your attention and motivate an effort to clean, to bandage, to protect.  Yet the mechanisms that take the information to the brain and interpret trauma there can get “stuck”:  person whose damaged part has been removed (an amputated leg) so that it theoretically CAN’T hurt, goes right on hurting.

But pain is only one kind of suffering.  A few kinds of emotional anguish can be resolved by a second person who is willing to pay close attention and offer reassurance, interpretation, hope for a better future.  An impulse to help a suffering person is present in small children or in animals.  Loneliness, guilt, an inability to see a way out of a trap, a loss of hope for an end to troubles, an inability to imagine and therefore move towards something better --
these are the anguish that religious institutions promise to ease but sometimes only make worse.

Being virtuous doesn’t seem to have much to do with avoiding suffering, it seems to me.  Entirely innocent people suffer terrible trauma and disease and some of the treatments that can save lives also impose ghastly agony.  Consider burns where the treatment is excruciating, so much so that the nurses come to hate the patient because they hate hurting a person so much.

There’s no equivalence.  In the Eastern contexts, like Buddhism, the emphasis is not on escaping but on enduring, partly by withdrawing desire which can lead into the floating detachment of opium.

For some people suffering is handled with anger, rage rage against the injustice and sometimes that will kindle fires of adrenaline and other warrior molecules that have evolved to handle attacks, hunter’s focused obsession, the molecules that paralyze the mouse in the claws of the cat by putting it into a kind of victim’s euphoria.

A while back the media and script writers discovered displaced suffering and especially torture that does not hurt you but the person you care about,  because that’s also torture, courtesy of empathy.  For a while there were crime plots about girls kidnapped in pairs so that one could be tortured to make the other obey without scarring her with lesions.  So much about suffering is suggested to us by script writers rather than shrinks or docs or priests.

Do you remember Peter Pain?

Advertising puts in its two cents worth, suggesting pains of various kinds and then offering relief through meds or some other handy product.  

There is a kind of pain that is not pain, at least not in the way we understand it as physical discomfort, but rather a psychological state like depression or even just floating nothingness.  The body wants to be busy and the brain will begin to go haywire or lose function unless there’s a steady flow.  That’s the insane punishment of solitary confinement, which doesn’t have to be physical confinement.  Just solitary.

Understanding suffering need not be a matter of book learning, but of experience.  When I was working in a nursing home there were patients who were legitimately (with medical cause) suffering who begged for relief.  The nursing staff would begin to be annoyed with them and to talk about addiction, even withholding the drugs to punish the patient for not being cooperative.  

Addiction is the big Scare Threat, and yet these were sometimes dying people.  Addiction over-rides pain, but I’ve known people who WERE truly addicted in the worse kind of dependence on that escape, but who were still able to “kick” drugs.  It wasn’t easy and the kind of pain was the kind I dread most: nausea, the invasion within.  It was a decision of some kind on their part, maybe a desire for clarity.  A goal beyond suffering.

Another kind of suffering is invasion of space, maybe as simple as coming inside that invisible circle around a person or animal or even insect close enough to be a threat.  Do not walk up behind a person who has been in prison -- the circle around that person is BIG.  There are some people who either can’t perceive the line or have somehow learned to stand very close.  In some cultures people will stand close enough to feel and smell your breath.  Personally, I have to clench my teeth to be on a crowded bus.  Why do you think I’m in Montana!

But to have one’s body invaded through orifices or with a needle or blade through skin, even with a careful and well-lubricated instrument, can add insult and outrage to real pain.  If you’re an old woman having a pelvic, prepare for pain and then the comment “Oh, these elderly vaginas are like that.”  With no easing off.  

In France the insertion of urinary catheters into a male is done with anesthesia.  You can watch this procedure on YouTube.  I’ve watched on video a careful soothing nurse do this for a boy who couldn’t even hear her through his suffering.  The passing of body-generated “stones” -- kidney stones -- is screamingly painful.

Here’s a little jargon sample.  “Finding increased levels of the translocator protein in regions like the thalamus — the brain’s sensory gateway for pain and other stimuli — is important, since we know that this protein is highly expressed in microglia and astrocytes, the immune cells of the central nervous system, when they are activated in response to some pathologic event.”  The translation is that one can see pain on a computer screen.  It turned out to be quite consistent.

But it’s not possible to see suffering.  Suffering can be moral, which is to say invisible and relative.  I found a Swedish study that looked at women with borderline personality disorder.
The main findings were that BPD patients suffer to an extent that is often unendurable, leading to deliberate self-harm (DSH) and suicide attempts to relieve suffering or just try to get away from it all (paper II). In study III the BPD patients showed significantly poorer quality-of-life (even physical) than normal population controls of comparable age. The suffering, suicide attempts, DSH and poor quality-of-life . . . put the patients in a position of voluntarily or involuntarily getting involved with psychiatric care. . . . On one hand, psychiatric professionals can add to the suffering by not being understanding and being disrespectful, on the other hand they can be helpful and relieve suffering by being respectful, understanding and validating. There was a clear relationship between the patients ́ experience of validation and the experience of being helped.” 
The third explicit goal of the study was to relieve the suffering of the counselor burdened with the task of helping!  I’ve heard more than one shrink complain about having to counsel women, interpreting them as shirking, childish, and boring.  The woman feels this, of course, and so do boys who go for help but instead get sighs over their intractability.  Myself, I find that a bad counselor is like a clumsy catheter inserter, an unjustifiable invader who only adds to the suffering.  I run.  I shirk.  I'm childish.

There are a few who enjoy authorized hurting of others.  At this point my psychiatric nurse friend will mention Dr. Mengele.  If you’re too young to remember him, use Google.  But brace yourself.

(to be continued)

No comments: