The myth of the control of suffering

Is it true that the suffering associated with chronic illness can be controlled in all but a few intractable cases? The bio-ethical literature gives the impression that suffering is primarily pain and that a competent physician should be able to control suffering. This perception jibes neither with my forty years of clinical experience nor with suffering as depicted in novels. Using Kenaz' novel,The Way to the Cats as a starting point, I argue that, with regard to suffering and illness, fiction is closer to reality than professional literature, and suffering is far more than pain. I content that the control of suffering is a modern myth. This argument applies equally well to the control of non-insulin dependent diabetes. Patient selection, duration of follow-up, remembering what we want to remember, bias, self-fulfilled prophecy, and asking the wrong questions are offered as partial explanation for the gap between perception and reality. The complexity of suffering and the elusiveness of its control should be honestly recognized.