Table Of Contentmedicine & health / psychology C
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The first book to address issues of suffering r
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as separate from pain that require psychologically
Beverley M.
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and culturally sensitive interventions
n Clarke
Currently in medicine, theories of pain regard pain and suffering as one
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and the same. It is assumed that if pain ceases, suffering stops. These theories
are not substantiated in clinical practice, where some patients report little pain u
and extreme suffering and other individuals have a lot of pain and virtually
no suffering.
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Based on the results of a scientific questionnaire, as well as evidence from
and conversations with hundreds of patients, Beverley M. Clarke argues f
convincingly that suffering is often separate from pain, has universal measurable
characteristics, and requires suffering-specific treatments that are sensitive to the e
patient’s individual psychology and cultural background. According to Clarke,
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suffering occurs when individuals who have experienced a life change because of
medical issues perceive a threat to their idea of self and personhood. This kind
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of suffering, based on a lost “dream of self,” affects every aspect of an individual’s
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life. Treating the patient as a whole person — an approach that Clarke strongly
advocates — is an issue overlooked in the majority of chronic care and traumatic
injury treatments, focused as they are on pain reduction.
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Clarke believes passionately that the management of suffering in medicine
is the responsibility of all health care practitioners. Until they come to identify
and understand suffering as distinct from pain, the entire health care system hp
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will continue to carry the financial and moral burden of incomplete diagnoses, at
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inappropriate referrals for care, ineffective treatment interventions, and lost
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human potential. a
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beverley m. clarke is an associate professor, School of Rehabilitation
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Science, and a neurology associate, Division of Neurology, at McMaster t
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University, Hamilton, Ontario, Canada. e
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dartmouth college press
Hanover, New Hampshire pathways to healing
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Published by University Press of New England r
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Hanover and London
Cover illustration: o
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www.upne.com ©iStockphoto.com / Matthias Straka th
On Suffering
Beverley M. Clarke
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On Suffering
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Dartmouth College Press
Hanover, New Hampshire
dartmouth college press
An imprint of University Press of New England
www.upne.com
© 2011 Trustees of Dartmouth College
All rights reserved
Manufactured in the United States of America
Designed by Eric M. Brooks
Typeset in Quadraat and Quadraat Sans by
Passumpsic Publishing
University Press of New England is a member of the
Green Press Initiative. The paper used in this book meets
their minimum requirement for recycled paper.
For permission to reproduce any of the material in this book,
contact Permissions, University Press of New England, One Court
Street, Suite 250, Lebanon NH 03766; or visit www.upne.com
Library of Congress Cataloging-in-Publication Data appear
on the last printed page of this book.
5 4 3 2 1
*
This book is dedicated to my son,
robin blair fraser clarke,
With love and admiration
contents
Foreword ix
Preface xi
Acknowledgments xiii
Introduction 1
part i · suffering
What Man Has Made of Man
1 · Suffering in Medicine
A New Aspect of an Old Problem 13
2 · Suffering Is Not Pain
The Evidence 25
3 · The Power of Religious and Spiritual Beliefs 39
4 · Suffering and Culture 51
5 · Crises of Suffering across the Life Span 65
6 · The Language of Suffering 77
7 · Medical-Legal Disclosure of Suffering 89
part ii · identifying those who suffer
Now Is the Time to Know
8 · Power Differentials and Suffering 109
9 · How to Assess Suffering 128
10 · Standards of Care 148
11 · Key Components of Suffering in Chronic Illness 164
part iii. caring for those who suffer
When the World Is Too Much with Us
12 · The Resolution of Suffering 183
13 · The Roles of Health Care Professionals 197
14 · Habilitation and Rehabilitation 216
15 · The Wounded Spirit
Reclaiming Personhood 231
16 · Surviving and Thriving 243
Epilogue 255
Appendixes a–d 259
References 273
Index 293
foreword
Professor Beverley Clarke is a pioneer in the
investigation and understanding of the concept of
suffering. She has collected large amounts of clinical
data on epilepsy, rheumatoid arthritis, migraine, and
spinal cord injury. Professor Clarke has demonstrated
that suffering should be considered distinct from
pain. She has combined information from clinical,
research, philosophical, and legal areas in showing the
importance of suffering in all these areas. This book is
the product of a comprehensive and thoughtful analysis
of available literature and information from many
sources.
In my opinion this book provides an assembled text
on many complex issues, and it represents many years of
work on such an important subject.
dr. adrian r. m. upton,
M.A., M.B., B.Chir., lrcp, mrcs, frcp(c), frcp(e),
frcp(g), Professor of Medicine—Neurology, Director of
Neurology and Epilepsy Clinics, and Director of Diagnostic
Neurophysiology, McMaster University Medical Centre,
Hamilton, Ontario, Canada
