The Meaning of Healing: Transcending Suffering

Thomas R. Egnew

Disclosures

Ann Fam Med. 2005;3(3):255-262. 

In This Article

Discussion

Themes of wholeness, narrative, and spirituality are congruent with the derivation of the term "healing." Heal means "to make sound or whole" and stems from the root, haelan, the condition or state of being hal, whole.[31]Hal is also the root of "holy," defined as "spiritually pure."[31] Derivation from the same medieval root indicates a centuries-old association between healing and perceptions of wholeness and spirituality that challenges biomedical thinking. Medicine has no model of what it means to be whole as a person,[32] values objective more than subjective data,[33] and gives negligible consideration to spirituality.[34] Though true to the derivation of the word, these themes fail to illumine the operations of healing to help clinicians better facilitate the process.

The operational definition that is the central story line of this study resolves some of this dilemma. Ill persons undergo transformations in which they are unable to be the persons they once were. This threat to wholeness generates suffering[35] and involves the physical, social, psychological, and spiritual dimensions of personhood described in this study.[36] Suffering is an inherently unpleasant experience reflecting perceptions of helplessness.[37] It may involve pain, but it is an anguish of a different order from pain[38,39] that alienates the sufferer from self and society.[40] Suffering engenders a "crisis of meaning,"[36] a spiritual consideration of life's ultimate importance,[34] and it is reflected as an intensely personal narrative.[41] Thus, suffering subsumes the themes of wholeness, narrative, and spirituality and has major implications for facilitating healing.

Although suffering may be resolved if the threat to wholeness is removed, distress is relieved, and integrity is reinstated, the ability of medicine to resolve suffering is limited. Suffering is inherent to human experience,[42] and some types of suffering are beyond the purview of medicine.[44] Still, suffering can be transcended by accepting the necessity to suffer[42] and by finding meaning in the threatening events.[44] "Suffering ceases to be suffering in some way," Frankl observed, "at the moment it finds a meaning."[45]

Sharing suffering creates interpersonal meaning and melds the life stories of patient and physician.[46] Creating interpersonal meaning and melding life stories produce a connexional relationship, a "mutual experience of joining that results in a sensation of wholeness."[47] Connexional relationships reduce the alienation of suffering. As the physician becomes a part of patients' life narratives and "experiences with" them,[40,41,48,49,50] patients no longer suffer alone. Patients can use this intimate, transpersonal context to "edit" their life stories.[51] By reconstructing identity, reforming purpose, and revising their life narratives to accept or find meaning and transcend suffering,[52,53] patients experience healing.

The role of the physician-healer is to establish connexional relationships with his or her patients and guide them in reworking of their life narratives to create meaning in and transcend their suffering.[53,54] Even though it is the patient who must find the meaning that transcends his or her suffering, the physician can catalyze this process by sensitively attending to and engaging the patient in dialogue regarding the patient's suffering. This process is depicted in Figure 1.

The healing process.

Unfortunately, medicine does little to prepare physicians to guide sufferers.[56,57] Physicians are not trained to hear patients' stories, often fail to solicit the patient's agenda or pick up on a patient's clues, and often limit storytelling to maintain diagnostic clarity, support efficiency, and avoid confusion and unpleasant feelings.[58,59,60,61,62] How to comfort the sick or hear sensitive patient disclosures is often left to common sense.[63,64] Empathy offered inopportunely, however, exacerbates distress, and inordinately emphasizing biomedical data delegitimizes the suffering contained in the patient's story.[41,65,66] Some physicians question the legitimacy of being a guide for patients or find the moral authority associated with the role uncomfortable, whereas others fear the intense feelings encountered on the healing journey.[48,53] Not knowing how to engage suffering risks iatrogenically inducing it.

Yet changes in medicine reflect progress in addressing holistic perspectives that conceivably might augment physician attempts to effect healing. Increasing research on the potential impacts of spirituality and religion on health outcomes[67,68,69,70,71] has stimulated a vigorous dialogue regarding the place of spirituality in medicine.[72,73,74] Nearly one half of medical schools in the United States now offer courses on spirituality in medicine, and all teach interviewing and interpersonal skills.[68,75] Patient-centered approaches to clinical care are having positive impacts on the patient-physician relationship and health outcomes,[76,77,78] and curricula for teaching patient-centered communication are extending into the clinical years of training.[79,80,81] Conceivably, these efforts will better prepare physicians to establish connexional relationships, explore patients' life narratives, and help patients finding meaning in their experience to transcend their suffering.

This study is subject to both methodologic and contextual limitations. It is the product of a single researcher doing an individual analysis of data obtained from a small sample of Western-trained allopathic physicians. Interviews with a larger group of physicians—especially those from other healing traditions—with analysis by multiple researchers would likely produce different results. Likewise, interviews with patients who considered themselves to have experienced healing would be enlightening and undoubtedly change the study results. The validity of the data presented is inherently intuitive. Congruent with the subjective nature of the phenomena of inquiry, readers must judge the generalizability of this study by their own experience.

That the proposed definition of healing relies heavily upon issues of meaning, spirituality, and the physician-patient relationship for its operations is a limitation. The lack of precise definitions for spirituality inhibits systematic research in this area.[71] Conceivably, those patients who do not wish to discuss their spirituality, who are mentally incapacitated, or who are incapable of or disinterested in a connexional relationship might not be amenable to the operations of healing described herein. Whether healing in some other guise occurs for these patients is a plausible question for further study, but it could be that healing, as is cure of disease, is not possible for all patients. For all these reasons, the definition of healing proffered in this study must be considered provisional, but it provides a good starting point for further discussion and study.

The industrialization of health care in the United States may render the results of this study superfluous.[82] The episodic contact patients often have with subspecialty physicians undermines the trust generated by continuity of care[83] that might be necessary for connexional relationships to form. The economics of primary care practice force patient volumes in time increments that make the intimate connection necessary for healing difficult. That healing remains a core function of medicine is questionable, because modern medicine focuses on the efficient dispersal of biomedical services, not healing. Still, patient care remains a core function.

"The secret of the care of the patient," Peabody noted, "is caring for the patient."[84] Caring relationships are founded to foster personal growth.[85] Transcending suffering is surely personal growth. By forging connexional relationships, grounding treatment choices in the person rather than the disease, maximizing function, and actively minimizing suffering, physicians strengthen patients with the goal of maintaining intactness and integrity.[48,86,87,88] The requisite clinical methods, empathy, and communication skills for fostering connexional relationships are known and teachable,[89,90,91,92,93] and the necessary attitudes and insight are being discussed.[94,95,96,97] Still, research regarding the detection and management of suffering is sorely needed. By helping patients transcend suffering, physicians surpass their curative roles to claim their heritage as healers. In the process, medicine recapitulates its service ethic as "a work of the heart and soul"[98] and maintains its tradition as a healing profession.

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