The Meaning of Suffering in Therapy

Suffering may be broadly referred to as a function of pain in total adaptation, affecting mood, behavior, and attitudes to self and others. Suffering—physical and psychic—may include all types of pained feelings which differ in quality and intensity. The pain of anxiety differs from the oppressive discomfort of boredom or the pained despair of depression. Moreover, the same individual responds differently to a range of painful stimuli and responds differently to the same painful stimulus at different times. It may be useful to think of suffering as an equation between the intensity of psychic or physical pain over a period of time and the individual's tolerance for it.

Although conscious awareness usually accompanies suffering, it may occur independently of awareness. I have seen individuals visibly suffer from tension states or physical pain who were unaware of it and denied it. One such patient, who had an abdominal tumor, showed the facies of pain and the easy fatigability and irritability of suffering, yet was quite unaware of any suffering until the neoplasm was surgically removed. As a result of the marked contrast in physical comfort following surgery, her previous suffering came into awareness. The same individual, on the other hand, was keenly aware of and articulate about the slightest emotional distress to such an extent that it had become the focus of her life and was carried over to her analysis. The meaning of her suffering in therapy was the same as its more generalized meaning within the pattern of all her distress responses.

As with pain denial on a physical level, patients may be consciously unaware of psychologic distress indicated by manifestations such as excessive sweating, over-alertness, and tense postures reflecting rigidity and guardedness. Particularly at the beginning stages of treatment, such patients frequently deny psychic distress and rationalize around some external situation. Anxiety, tension, defensive reactions, mal-adaptive behavio