The paradox of healing pain

Pain may be seen as a problem to be healed or as a means for healing. The secular biomedical view of pain is that it is to be avoided and alleviated; its only meaning is as a symptom of underlying disease. In contrast, there have been throughout history other views of suffering—as redemptive or as transformative, for example. This paper considers the disparity between these perspectives, examining the role of the emotions and the underlying neurobiological processes though which pain and suffering come to be experienced as meaningful, then analyzes interview material exploring how religion and religious beliefs help people cope with suffering or with pain. The experience of pain is subjective, enculturated experience; the meaning that pain or suffering holds within a given cultural context affects the experience of pain and suffering. In a context where pain and suffering are understood to be valuable, those experiences can be used for spiritual transformation and integrated within a meaningful identity. In contrast, in a context where pain and suffering are not understood to have value, that attitude can create more suffering, even in conditions meant to alleviate suffering, such as in biomedical situations.     

Suffering and Transcendence

This essay explores the experience of suffering in order to see to what extent it can be understood within the context of the human condition without diverting the reality of suffering or denying the meaning of human existence and divine reality. Particular attention is given to describing and interpreting what I call the transcendent dimensions of suffering with the intent of showing that in the experience of suffereing persons come up against the limits of what can be accounted for in ordinary terms and point towards transcendent reality. In religious faith the transcendent dimensions of suffering may be understood to come together with other transcendent dimensions of experience in a more distinctive or focused encounter with transcendent reality. The conception of God that is suggested by the transcendent dimensions of suffering, however, differs from the model of God in western theism as an absolutely transcendent, all powerful, immutable and impassible being.     

My <Emphasis Type="Italic">Ishvara</Emphasis> is Dead: Spiritual Care on the Fringes

Human suffering speaks differently to different lived contexts. In this paper, I have taken a metaphoric representation of suffering, Ishvara, from the lived context of a Hindu immigrant woman to show that suffering is experienced and expressed within one’s lived context. Further, a dominant narrative from her world is presented to show that the same lived context can be a resource for spiritual care that could reconstruct her world that has fallen apart with a suffering experience. Having argued that suffering is experienced and expressed within one’s lived context, and that lived context could be a resource, in this paper I present that spiritual care is an intervention into the predicaments of human suffering and its mandate is to facilitate certain direction and a meaningful order through which experiences and expectations are rejoined. Finally, I observe that spiritual care is an engagement between the lived context where suffering is experienced and the spiritual experience and orientation of the caregiver.     

Chronic pain as a posture towards the world

This article discusses what chronic pain is “about”, what the intentional object is of pain, and what is the intentional relation like? My approach is based on Maurice Merleau‐Ponty’s phenomenology, with an aim is to understand a two‐way relationship: how the sufferers bestow meaning on chronic pain, and how pain, on the other hand, signifies peoples’ life. In contrast to biomedical and cognitive‐behavioral theories, chronic pain is not only meaningful, but as an intentional emotion as well; it does not simply “happen” in the nervous system. I analyzed meanings assigned to pain through the narratives of three patients with chronic pain. Pain is described as creating a discontinuity in the patient’s Lebenswelt at the narrative level. When attempting to find meaning to their pain, patients point both to everyday life and biomedical referents. The structure of bestowing meaning is, metaphorically, like a necklace with everyday world and biomedical interpretations strung like beads, one after the other. The intentional object of pain, on the contrary, is constituted of the patients’ world in its wholeness. My results don’t confirm Drew Leder’s idea of disrupted intentionality, but underline directness as the basic relation of human experience also in case of pain and disease. Pain in itself is an e‐movere, an intense passionate movement, an intentional relation with and a bodily posture taken towards the world.     

Unraveling the Wonder of the Ordinary: A Narrative Analysis of Meaning Construction in Memories of Familiar Routines

Familiar routines may be a source of meaning, but just as well become habitual and lose meaning. To understand this paradox, a narrative approach was used to explore how meaning is constructed in memories of familiar routines. Two types were distinguished: routines of transition and routines of harmony. Results show how meaning construction may relate to the contrast between instrumental acts in the memories and their higher purpose. In routines of transition, meaning may emerge through a temporal transformation, while routines of harmony may become meaningful through the awareness of contrasting evaluations within the routine or a contrasting wider context.     

The Joy of Suffering: Nietzsche,Theodicy and women’s bodies

Abstract

I use Nietzsche’s work on theodicy to explore gendered valuation systems around women’s bodies. The notion of theodicy provides a different entry point to questions of ideology as it begins with an account of people’s attempts to find meaning in their lives. Nietzsche traced humans’ propensity to look for and create stories that give meaning to their lives, even when this meaning is one that may ultimately oppress them or celebrate something negative such as suffering. For him it is not the suffering that torments humans, but rather its meaninglessness. In the slums of Northeast Brazil, Afro-Brazilian women invest in the Christian glorification of suffering in a context where they experience their bodies in terms of loss, shame and alienation. I explore how, through a process of creative deception, this suffering comes to be experienced as pleasure. That is, the women reconstruct their bodies using two dominant stories to which they have access: Christianity and the glamorous Brazilian soap operas.     

Trauma and Gender

The meaning of trauma within psychology has for a long time been viewed mostly from a ‘pathologising’ standpoint. Viewed as pathology, people's trauma may become understood using a singular lens thereby leaving out broader contextual (social, environmental, political, historical, economical etc.) aspects that have been shown to play a role in the subjective experience of various forms of suffering. Psychology has for a long time been quick to diagnose victims of traumatic experiences from an individualistic perspective, almost always positioning the ‘problem’ within the person. As a result of the Vietnam War, World Wars I and II and the Holocaust, the rise in the diagnosing of PTSD gave way to the labelling of trauma. Within psychology, post‐traumatic stress disorder has become the way to operationalise suffering, and I would like to argue that this occludes how suffering lives in a family, a community and in gendered bodies. The gendering of trauma continues to be a silenced space. There is a need to highlight and acknowledge the gendered nature of suffering which begs for trauma to be understood in context and not as an isolated act or occurrence affecting the individual. Women have remained, and in many ways continue to remain, silenced with minimal opportunities to name the world for themselves. This paper seeks to provide a critical analysis of the notion of trauma (and its intersection with gender) that arises from conflict and post‐conflict situations.     

Social Constructionist Approach to Suffering and Healing: Juxtaposing Cassell, Gergen and Kleinman

To understand the experiences of suffering (overwhelming somatic pain or illness and its anticipation and other forms of severe distress arising in the socio-moral context) and facilitate healing (developing an enabling meaning and value for one??s experiences when faced with suffering) have been the focus of medicine as a social institution throughout human history. However, the goals of Western biomedicine in the last few centuries shifted from taking care of these experiential concerns of the sufferers to predominantly the diagnosis and treatment of the symptoms of a disease. This article attempts to illustrate how the assumptions of the social constructionist paradigm (with its deconstructionist and reconstructionist facets highlighted in the writings of Kenneth J. Gergen) serve as a suitable metatheoretical framework to understand human experiences of suffering and healing. A critical review of the writings of Eric J. Cassell and Arthur Kleinman on endorsing and researching such experiences resulted in four themes that reaffirmed the utility of this new paradigm. These themes help comprehend that biomedicine??s ontological claims may enhance human suffering, suffering and healing experiences are socio-historically contextualized, such experiences are performances within human interaction and dialogic partnership between the researcher and the participant becomes a meaningful medium to study such experiences.     

Carrying the Pain: The Journey from Suffering to Transformation—Perspectives from Shakespearean Tragedy and Pastoral Care

This paper proposes an admittedly difficult thesis that emotional pain and suffering can be good news. Rather than denying and running from emotional pain and suffering, we suggest embracing and carrying the pain. Through academic and spiritual writings, an observation of Hamlet’s tragic suffering, an examination of pastoral care case study data, and a B.L.E.S.S. acronym, this paper proposes that within the experience of suffering lies the transformative potential for meaning and fullness.     

慢性疼痛与心理障碍

疼痛是一种复杂的心理生物学过程。疼痛的感知和情绪活动密不可分,疼痛是一种包括感觉、情绪和认知的多维性体验,人与人之间差异很大,甚至同一个体也随疼痛的背景、意义以及心理状态而异。认知因素和情感因素对疼痛感知具有非常重要的影响。本文回顾疼痛认知和情感状态调节（身心治疗的重要组成部分）潜在的神经学机制。回顾慢性疼痛本身会改变大脑环路、包括参与内源性疼痛调节的循证证据,这些证据表明随着疼痛转为慢性,控制疼痛越来越困难。     

Suffering and interpersonal meaning: commentary

I would like to suggest that to describe suffering as a psychological phenomenon is still too general. It leaves the door open to the belief that suffering is an individual phenomenon, experienced because of dynamics arising out of the individual psyche as the pain arises out of the individual body. Instead of describing suffering as a psychological phenomenon, we should describe it as an interpersonal, even communal phenomenon....If the task of reestablishing, continuing, and creating interpersonal meaning within the context of suffering is accepted, the problem often arises concerning how the health professional can accomplish this task with the patient under the extraordinary circumstances that pain and illness, as well as the health-care environment, provide. Beyond sensitive and thoughtful dialogue, we may have to return to a sense of ceremony within health care, especially since the rationalistic naiveté of nineteenth-century positivism did so much to encourage the belief that the best health care is the one that does things efficiently and "unceremoniously"....     

Meaningful coping with chronic pain: Exploring the interplay between goal violation,meaningful coping strategies and life satisfaction in chronic pain patients

Trying to cope with chronic pain is a highly demanding and challenging task and pain patients often need to reformulate goals or aspirations due to their pain condition. This goal violation is often related with experienced distress and requires coping processes in order to decrease the distress and stimulate a healthy adaptation. Some scholars, however, argued that in so‐called unsolvable or irreparable stressors such as chronic pain, conventional coping strategies like problem‐focused coping might not be the most adaptive option. In these situations, meaningful coping strategies attempting to transform the meaning of the stressful experience would be more accurate. In this study, we aim to test if goal violation triggers meaningful coping strategies over time and whether engagement in these meaningful coping strategies result in improved life satisfaction, as an indicator of adaptation. A longitudinal three wave study in a sample of paint patients (n = 125) tests whether goal violation triggers positive reappraisal and downward comparison, two possible meaningful coping strategies. The study furthermore tests if engagement in these strategies results in a better adaptation to the pain condition, reflected in higher life satisfaction. Results partially supported our hypotheses by pointing to the benevolent role of downward comparison on life satisfaction via decreased goal violation of pain patients. Our findings however did also show that positive reappraisal predicted lower life satisfaction via increased levels of appraised goal violation which questions the role of positive reappraisal as a genuine meaningful coping strategy. Implications and limitations are discussed.     

Perchance to Sleep: Minding the Unworded Body in Psychoanalysis

In contemporary relational psychoanalysis, influenced by developmental/attachment theories, infant research, and neurobiology, the effectiveness and transformational potential of “the talking cure” can be thought of as, at times, located in areas of nonverbal engagement. It has become increasingly evident that human experience is born in the body and structured in body-based memory that informs us of what we “know in our gut” and contributes to our relating as embodied beings—experiences that as psychoanalysts we cannot or need not necessarily translate directly into declarative discourse. A detailed case presentation from work with a patient suffering from a severe sleep disorder and other forms of bodily dysregulation will be offered to illustrate and explore the affectively meaningful engagement between patient and analyst of somatically encoded, presymbolic memory within the context of a symbolically rich, verbal treatment relationship.     

Pastoral diagnosis: assessing the psychotheological themes of freedom and meaning

This article is an exploration of the psychological and theological themes of freedom and meaning within the world of those who experience emotional pain. The article focuses on how freedom and meaning can contribute to the development of a pastorally rigorous diagnostic protocol. It is in the examination of emotional freedom and the search for meaning that practitioners of the pastoral arts come to an understanding of the nature of suffering. The article offers an overview of the state of pastoral diagnosis highlighting and drawing from those resources that emphasize the need for pastoral psychology to construct a diagnostic protocol that is both theological and resonate with the lived experience of clients.     

Trauma: the seductive hypothesis

In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail.     

You still feel different: the experience and meaning of women's self‐injury in the context of a lesbian or bisexual identity

This article reports an intensive qualitative study of the subjective experience and meaning of self‐injury for 16 women who identified as lesbian or bisexual and who had deliberately self‐injured on repeated occasions. In individual interviews, the women talked about their experiences of self‐injury and the role it played in their lives as lesbian or bisexual women. Interpretative Phenomenological Analysis (IPA) was used to elicit themes arising within their accounts. These highlighted a number of ways in which social and contextual factors contributed to the development of self‐injury. Although many of these factors seemed applicable to any woman who self‐injures, there were some aspects that were specific to the experience of lesbian and bisexual women. In addition, the women's accounts raised a number of important issues about the way in which mental health services respond to lesbian and bisexual women who self‐injure. It is argued that self‐injury can be understood as a coping response that arises within a social context characterized by abuse, invalidation, and the experience of being regarded as different or in some way unacceptable. These factors are especially salient in the lives of women, and they emerge particularly strongly as part of the experience of women who are developing a lesbian or bisexual identity. Copyright © 2004 John Wiley & Sons, Ltd.     

Black client,white therapist: Working with race in psychoanalytic psychotherapy in South Africa

In post‐apartheid South Africa we speak about race extensively. It permeates our workplace, weaves a thread through the fabric of our professional and personal lives, as well as our private conversations and public interactions with others. From within psychoanalytic theory, the thread weaves through the unknown content of our racialized unconscious. When there is a focus on race in the South African psychoanalytic context it largely takes the form of the struggle to articulate the complexities of working with difference, as Swartz notes, or the struggle to map out issues of race. Such struggles are not localized in South Africa, but strongly reflect a much broader struggle within the global psychoanalytic community, as mirrored in the expanding focus on race. Although the consulting rooms seem far removed from the ongoing political tensions that have recently emerged in South Africa, psychoanalytic psychotherapy remains a space of meaningful engagement with the other, and where the therapeutic dyad is one of racial difference it permits an encounter with our racialized unconscious. This article seeks to document the experience of my black client and my white response to her racial pain and struggle; in doing so, I describe the racial ‘contact’ between us and within us that triggers a racialized transference and countertransference dynamic, which contains the space for racial healing for both of us.