Jonathan is a Jamaican-born eighty-seven-year-old who came to this country as a young man. He is married to Claudette, also Jamaican-born, whom he met at a job when both were in their twenties. Jonathan enjoyed a career in sales and supported Claudette and their two daughters well. He came to the nursing home several years ago because of debilitation from chronic obstructive pulmonary disease (COPD) and heart disease. He is chronically weak, tired, and in need of assistance. The couple suffered the death of one daughter several years ago, and the other passed away two months ago. His wife, also a nursing-home resident owing to cancer, recently has been in and out of the hospital. Understandably, the shocking loss of their second child has deeply disturbed both of them.
On one recent visit, Jonathan looked me squarely in the eyes and asked, “How much more am I supposed to be able to take?” His question to me, which was more of a statement (“This is too much for me to take!”), highlighted the difficult reality in the nursing home and in life: There is grievous suffering. Bad things happen that cause us pain, sadness, frustration, torment, and discomfort. We get sick, lose people dear to us, lose jobs due to downsizing, experience personal rejection, have financial pressures, and are confronted by the many problems of daily life. What could I do to alter Jonathan’s health or change the devastating circumstance of the premature deaths of his children or improve his wife’s terminal medical condition? Not a blessed thing. What could I do to help him? Plenty. I realize that it is impossible to magically change the external circumstances causing Jonathan such profound distress. However, I also know that his internal circumstances can change. Pain in life is inevitable. However, suffering, the emotional reaction to pain, is a separate and optional experience.
You may think, “Here comes another psychologist trying to tell me all of my problems are in my head.” Well, right, sort of. Many different types of evidence suggest that suffering can be mitigated and that persons enduring devastating situations like Jonathan’s can be helped. Researchers investigating the human brain, studying infant development, and working with victims of trauma, confirm my own clinical experience and observations in this area. Neurologists have determined that the perception of pain registers in different areas of the brain than the experience of emotion. Although pain and suffering are strongly linked, these experiences can be separated so that it is possible for the brain to register injury to the body or psychological pain, but to block or minimize the emotional reaction of suffering. A classic example involves the medical condition of trigeminal neuralgia, which can cause intense, debilitating facial pain. For victims of this condition who do not respond to medication, surgeons can destroy neurological connections to the emotion center of the brain. The result of the neurosurgery is that patients will still describe a sense of the pain, but they feel subjectively indifferent to it. In other words, they are no longer suffering because they do not experience the emotional reaction to their pain.
Careful observation of infants has revealed interesting data concerning emotional development and health. Of particular relevance are the observations relating to caretaker-child interactions. Studies reveal that infants who are upset can be comforted when the caretaker responds in a manner sensitive to the child’s emotional state. An accurately attuned response by the caretaker results in beneficial changes in brain neurotransmitter activity, hormones, heart rate, and feelings; negative emotional states are reduced and supplanted by positive emotions. In other words, an empathic response mitigates suffering in the infant even in the absence of language capacity and even if the cause of the upset is unchanged. Of course, if an infant is hungry or wet, for example, feeding or changing the baby will be helpful. But sometimes an infant is upset for no obvious reason. Nevertheless, whether or not the cause is apparent, comforting is often necessary to calm the baby. Have you ever tried to change the diaper of a distressed, thrashing infant? Every parent knows that a tender, loving response can help soothe a crying baby, but who knew that such ministrations affect the deepest levels of the body? Not only do the visible signs of distress diminish with tender care, but biological systems change as well. A loving human response results in positive emotional, behavioral, and physiological changes regardless of the source of distress.
Emotional attunement between the caretaker and infant is communicated mainly through gaze and facial expression, but also through the caretaker’s tone of voice and manner of touching and holding the infant. The message that appears to be communicated is, “I know you are upset. I am here for you. You will be all right.” Infants handled in this manner tend to grow up to become more emotionally stable, secure, and resilient children. The caretaker does not try merely to stop or stifle the infant’s reaction; the presence, acceptance, and loving concern of the caretaker are what appear to be beneficial. In this way, infants learn that negative feelings are tolerable and temporary.
In trauma research, much attention is given to personal factors that promote recovery. Of course, it would be best if all traumatic occurrences could be prevented. However, as this is impossible, it is helpful to isolate factors that facilitate successful recovery after a trauma is experienced. In many studies of trauma victims, one of the most powerful factors associated with successful recovery is the presence of a support system, such as a loving family and friends.
Evidence from my work in the nursing home is consistent with this research. Many residents, such as Jonathan, have experienced irreversible negative life events. Through the proper response, a significant portion of their suffering can be reduced. So what was the proper response for Jonathan when he asked me how much more he was supposed to be able to take? I said to him, “This is too much for one man to bear.” He looked at me with an expression of surprise that I interpreted to reflect amazement at two things: that I clearly understood the extent of his burden and that I would state this so bluntly. In my experience, people often deny, minimize, or sugarcoat such unpleasant realities (to protect either themselves or others), and in so doing, they invalidate their feelings or fail to acknowledge them. His response? Jonathan sobbed. And he sobbed some more. And it was good. The two of us experienced a deeply felt sense of closeness based on the ingredients that help to heal suffering: the honest expression of emotion in the context of an intimate, trusting relationship. On this occasion, Jonathan expressed his sadness; at other times, he revealed his anger, hopelessness, and sense of helplessness. In a time when fake reality dominates public interest, this is the real stuff. I demonstrated my understanding, acceptance, and desire to be with him even at his lowest point. I was unafraid of his sorrow, and of my feelings stimulated by his intense emotion. The tragic causes of Jonathan’s pain remained unchanged; however, Jonathan experienced some relief from his suffering.
Contrast my response to Jonathan to a situation I saw on the evening news a few years ago. I was watching a live broadcast of a house fire in a suburban neighborhood. In the picture I could see two men. One man, presumably the homeowner, was crying and obviously distraught. Another man stood next to him, patting him sharply on the back in an effort to soothe his grief. It seemed to me that in his response the second man was in some way trying to put out the fire! Whereas his intention was to provide comfort, he reacted to the show of emotion as an out-of-control, destructive force that had to be tamped down.
In my practice I often use the following example from everyday life to illustrate the difference between pain and suffering and to show how suffering can be reduced without stopping the pain. Think of this not unfamiliar scene: a four-year-old child running toward her mother on the blacktop, falls, ends up crying, and gets a skinned knee. When the mother picks up the child, the crying stops immediately, and the child is comforted, even though nothing has been done to fix the injured knee.
When a person we care about is in distress, we mistakenly believe we must do something about it. The dual assumptions are that doing something must consist of changing the situation in order to stop the pain, and that just holding, comforting, and loving is not doing anything. We tend to think that we are inadequate if we are unable to stop the pain, fix the problem, or quickly alleviate any emotional suffering. Emotions that accompany pain demand our attention and motivate us to take corrective action. But the truth is that we can’t eliminate all suffering, nor should we want to. We cannot change the inevitability of pain and suffering in life; we can help, however, to mitigate suffering. Even people who experience extreme distress like that suffered by Jonathan, who have premature losses, disability, poor health, and the imminent loss of a spouse, can be helped to suffer less. The best part is that anybody can help to heal suffering. All that is required is compassion. No medical or religious training or any other special type of education is necessary. This is why your grandmother with a tenth-grade education could do it.
Lesson: Although suffering in life is inevitable, we can mitigate it.
Applying the Lesson to Your Life
• When you are suffering with emotional distress, reach out to family and friends. Seek practical assistance for problems that may be solvable, and get emotional support even if practical solutions are not possible.
• If you do not have a support system to provide comfort, try religious institutions, support groups, or self-help groups, or seek professional help. Just as Jonathan needed social reinforcement of his pain to move past suffering, others might find strength in having their pain acknowledged. This is why support groups, for instance, are so helpful. An alcoholic might feel alone in dealing with his addiction, and maybe he pushed away family members and friends. But through participation in a recovery network, he can attend meetings where he is surrounded by peers who are struggling with the same problems that he is. Finding strength in a group—and seeing how other alcoholics are remaining determined and becoming successful—can reduce his emotional upheaval and give him the courage he needs to begin tackling his personal issues and to overcome the obstacles he is facing.
• If you know someone who is distressed, extend practical assistance if possible. Offer compassion, love, and emotional support even if you cannot help solve the problem. Do not underestimate the healing power of loving, concerned support for a person in distress.