The Meaning of Suffering in Therapy

The theme of this round table, “The Meaning of Suffering in Therapy,” provides a challenge of considerable magnitude to anyone who is asked to contribute his thoughts on the subject and to compress them within the space of twenty minutes. On the other hand, there are probably so few remaining original and illuminating ideas on the problems that the suffering of the patient poses to the therapist that the limitation of time may save the audience from struggling to digest a lot of old stuff warmed over and dressed up for the occasion. Perhaps it was with this thought in mind that our program committee decided on the format of a round table for the discussion. Since the challenge has been given to several of us to open the discussion, it seems to me that it would have been appropriate to change the title also from singular to plural, from “meaning” to “meanings.” Written or spoken in the singular, the term might be taken to imply that there is a single meaning of the experience of suffering in therapy, whereas its meanings are as varied in quality, in depth, in significance, and in purpose as there are patients undergoing therapy. I use the term “undergoing” with just one idea in mind. The idea of therapy itself implies that there is something wrong with the patient; something missing, something exaggerated, something vicious or even dangerous, something in any event that has engendered a need for its removal. The psychiatrist is the physician to the “mind,” the hypothetical system within which the congenital lack, the one-sided development, the distorted perceptions of the self and its world are situated. He may decide that a small dose of palliative nature is all that is necessary or that some minor or major surgery in the form of deep exploration is essential to the discovery and eradication of the sources of suffering. In any case, the patient is in his hands