The Meaning of Suffering in Therapy

Relief of suffering has remained a chief task of the psychiatrist. Theoretical and clinical considerations, however, point to the necessity of making a differential diagnosis of various forms of suffering. Their meaning and psychodynamics vary widely, and they require very different approaches in therapy.

There is no doubt that severe genuine suffering often occurs in mental illness. This suffering may be all-pervasive, as in a schizophrenic depression, about which Minkowski reports. The patient experiences his whole being in the world as a mere suffering imposed on him by the environment. He describes his feeling: “Everything will be cut off of me except just what is necessary in order for me to suffer.”1

Real suffering does not occur only in psychotic patients. The obsessive-compulsive and the phobic patient suffer from the self-imposed restriction of their lives, and the neurotic patient comes to us mainly to get relief from his suffering. But what does he suffer from and how does he hope to get relief? The answer to this question contains a paradox inherent in psychoanalytic therapy. Does the patient come because he is aware that he suffers from what Kierkegaard called “sickness unto death,” the loss of his self? Does he hope to find or regain it with the help of the therapist? By no means.

“The loss of one's own self,” Kierkegaard writes, “may pass off as quietly as if it were nothing. Every other loss,