JOURNAL OF PALLIATIVE MEDICINE Volume 18, Number 5, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2014.0407
Suffering to Change Jessica Pieczynski, MS
‘‘Out of suffering have emerged the strongest souls; the most massive characters are seamed with scars.’’1 —Edwin Hubbell Chapin, 1895
I
t’s 4 p.m. on a Friday and I’ve just wrapped up my last therapy session of the week with Mr. Z. who has idiopathic pulmonary fibrosis. As he slowly wheels his oxygen tank down the hall, he graciously thanks me for the session. In that moment I wondered how many therapists had been in my position before, feeling as if I was the one who owed him gratitude. I started that day at 10 a.m. in the behavioral medicine outpatient clinic feeling defeated. I had been working with a patient, Mr. A., who had an entrenched learning style that evolved into a habitual, stagnant avoidance of pain, fear, and loss—a response with which he was content, the costs of which he was able to dissociate from by using every coping mechanism at his disposal. After many weeks of therapy I felt that there was nothing I could do for this patient, and I thought he would undoubtedly continue to suffer due to his steadfast efforts of avoiding discomfort. In that moment I considered transferring him to another provider as I became consumed by a thought that felt almost anathema for a therapist: change was not possible for Mr. A. On a grander scale, this behavioral repertoire is not uncommon. Who among us prefers to put forth effort toward endeavors we think will fail? Who among us wants to experience pain and loss? Who among us experiences unwavering readiness and joy at the thought of exploring the cause and effects of deep-seated emotional suffering? Mr. A. had created a thick suit of armor to shield him from internal pain and suffering, and it weighed so heavily that he was unable to move, unable to actively engage in life. I felt hopeless. And then to my surprise, at 4 p.m. I became uplifted. I felt renewed and honored to work in the field of behavioral medicine and palliative care. My session with Mr. Z. had reminded me that suffering can be one’s greatest teacher, the most seasoned guide along the path of a life full of vitality and meaning. Mr. Z. truly knew suffering. He struggled with addiction for the better part of his young adulthood and his only child was incarcerated for this same affliction. Twice divorced, he lost his small business and then his home during the economic downturn. And now, as his lungs were struggling to function, he was no longer able to pursue his passion of riding his beloved motorcycle. Yet in the aftermath of all of this loss and now faced with a terminal illness, Mr. Z. was the epitome of equanimity, unafraid to experience what came next.
Throughout our session he recounted the sponsors, scholars, and loved ones who supported and enlightened him over the years when he was stuck in a cycle of avoidance, struggling to accept the fleeting nature of positive experiences and material comforts, and the inevitable experience of pain. After years of suffering he came to the conclusion that he was making life so much harder for himself than it needed to be, that he had spent years externalizing the source of his distress, and that he was capable of withstanding any storm. Our conversation revealed that he was gentle with himself as his functioning became increasingly limited, and he was compassionate towards those who had difficulty bearing witness to his gradual, inevitable physical decline. As Mr. Z. recounted his life story, the teachings of Pema Cho¨dro¨n appeared to lift off of the page in front of my eyes as she once wrote, ‘‘When you open yourself to the continually changing, impermanent, dynamic nature of your own being and of reality, you increase your capacity to love and care about other people and your capacity to not be afraid.’’2 Mr. Z. embodied this wisdom. He had years of practice learning what it was like to lose aspects of his identity, he was intimately familiar with fear and loss. And amidst these great struggles, he learned that he was unharmed, and he became connected with the ubiquitous, indestructible nature of humanity. This wisdom allowed him to remain sober and resilient in the face of adversity. And now, as he approached the end of his life, his countless experiences with impermanence had well prepared him to face his own death. Previously, I felt hopeless in my work with Mr. A. because I could see that his efforts of avoiding pain were unsustainable. But now, being assured of this was no longer a forgone conclusion; instead it would help me lay the foundation to his awareness. Thinking that any of us can avoid pain indefinitely perpetuates a cycle of needless suffering, and it robs us of the opportunity to let pain be an invaluable lesson, a catalyst for growth. In order for Mr. A. to move forward, to thrive, he needed to be stuck right where he was. He needed to experience his defenses failing and become exhausted from maintaining the illusion of a pain-free existence. And as his therapist, I would be there to support him while his heavy, intricate armor slowly dissolved, and I would be prepared to help guide him along a more fulfilling, albeit uncertain, path
Department of Psychiatry, University of California San Diego, San Diego, California.
465
466
in life when he was ready. I hadn’t felt confident that I could do this, or reassured that this was even possible, until I had witnessed Mr. Z. fearlessly approaching his last breaths. And for this, Mr. Z., I am truly grateful. A few weeks later, I spoke with Mr. A. over the phone. His latest efforts of avoidance had proven unsuccessful, and he despondently told me, ‘‘I can’t live like this anymore, something needs to change.’’ References
1. Chapin EH: Suffering. In: Gilbert JH (ed): Dictionary of Burning Words of Brilliant Writers: A Cyclopædia of Quo-
PERSONAL REFLECTION
tations from the Literature of All Ages. WB Ketcham, 1895, p. 567. 2. Cho¨dro¨n P: Practicing Peace in Times of War. Boston: Shambhala, 2007.
Address correspondence to: Jessica Pieczynski, MS Department of Psychiatry University of California San Diego 9500 Gilman Drive, MC 0603 La Jolla, CA 92093 E-mail: [email protected]
Copyright of Journal of Palliative Medicine is the property of Mary Ann Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Suffering to Change Jessica Pieczynski, MS
‘‘Out of suffering have emerged the strongest souls; the most massive characters are seamed with scars.’’1 —Edwin Hubbell Chapin, 1895
I
t’s 4 p.m. on a Friday and I’ve just wrapped up my last therapy session of the week with Mr. Z. who has idiopathic pulmonary fibrosis. As he slowly wheels his oxygen tank down the hall, he graciously thanks me for the session. In that moment I wondered how many therapists had been in my position before, feeling as if I was the one who owed him gratitude. I started that day at 10 a.m. in the behavioral medicine outpatient clinic feeling defeated. I had been working with a patient, Mr. A., who had an entrenched learning style that evolved into a habitual, stagnant avoidance of pain, fear, and loss—a response with which he was content, the costs of which he was able to dissociate from by using every coping mechanism at his disposal. After many weeks of therapy I felt that there was nothing I could do for this patient, and I thought he would undoubtedly continue to suffer due to his steadfast efforts of avoiding discomfort. In that moment I considered transferring him to another provider as I became consumed by a thought that felt almost anathema for a therapist: change was not possible for Mr. A. On a grander scale, this behavioral repertoire is not uncommon. Who among us prefers to put forth effort toward endeavors we think will fail? Who among us wants to experience pain and loss? Who among us experiences unwavering readiness and joy at the thought of exploring the cause and effects of deep-seated emotional suffering? Mr. A. had created a thick suit of armor to shield him from internal pain and suffering, and it weighed so heavily that he was unable to move, unable to actively engage in life. I felt hopeless. And then to my surprise, at 4 p.m. I became uplifted. I felt renewed and honored to work in the field of behavioral medicine and palliative care. My session with Mr. Z. had reminded me that suffering can be one’s greatest teacher, the most seasoned guide along the path of a life full of vitality and meaning. Mr. Z. truly knew suffering. He struggled with addiction for the better part of his young adulthood and his only child was incarcerated for this same affliction. Twice divorced, he lost his small business and then his home during the economic downturn. And now, as his lungs were struggling to function, he was no longer able to pursue his passion of riding his beloved motorcycle. Yet in the aftermath of all of this loss and now faced with a terminal illness, Mr. Z. was the epitome of equanimity, unafraid to experience what came next.
Throughout our session he recounted the sponsors, scholars, and loved ones who supported and enlightened him over the years when he was stuck in a cycle of avoidance, struggling to accept the fleeting nature of positive experiences and material comforts, and the inevitable experience of pain. After years of suffering he came to the conclusion that he was making life so much harder for himself than it needed to be, that he had spent years externalizing the source of his distress, and that he was capable of withstanding any storm. Our conversation revealed that he was gentle with himself as his functioning became increasingly limited, and he was compassionate towards those who had difficulty bearing witness to his gradual, inevitable physical decline. As Mr. Z. recounted his life story, the teachings of Pema Cho¨dro¨n appeared to lift off of the page in front of my eyes as she once wrote, ‘‘When you open yourself to the continually changing, impermanent, dynamic nature of your own being and of reality, you increase your capacity to love and care about other people and your capacity to not be afraid.’’2 Mr. Z. embodied this wisdom. He had years of practice learning what it was like to lose aspects of his identity, he was intimately familiar with fear and loss. And amidst these great struggles, he learned that he was unharmed, and he became connected with the ubiquitous, indestructible nature of humanity. This wisdom allowed him to remain sober and resilient in the face of adversity. And now, as he approached the end of his life, his countless experiences with impermanence had well prepared him to face his own death. Previously, I felt hopeless in my work with Mr. A. because I could see that his efforts of avoiding pain were unsustainable. But now, being assured of this was no longer a forgone conclusion; instead it would help me lay the foundation to his awareness. Thinking that any of us can avoid pain indefinitely perpetuates a cycle of needless suffering, and it robs us of the opportunity to let pain be an invaluable lesson, a catalyst for growth. In order for Mr. A. to move forward, to thrive, he needed to be stuck right where he was. He needed to experience his defenses failing and become exhausted from maintaining the illusion of a pain-free existence. And as his therapist, I would be there to support him while his heavy, intricate armor slowly dissolved, and I would be prepared to help guide him along a more fulfilling, albeit uncertain, path
Department of Psychiatry, University of California San Diego, San Diego, California.
465
466
in life when he was ready. I hadn’t felt confident that I could do this, or reassured that this was even possible, until I had witnessed Mr. Z. fearlessly approaching his last breaths. And for this, Mr. Z., I am truly grateful. A few weeks later, I spoke with Mr. A. over the phone. His latest efforts of avoidance had proven unsuccessful, and he despondently told me, ‘‘I can’t live like this anymore, something needs to change.’’ References
1. Chapin EH: Suffering. In: Gilbert JH (ed): Dictionary of Burning Words of Brilliant Writers: A Cyclopædia of Quo-
PERSONAL REFLECTION
tations from the Literature of All Ages. WB Ketcham, 1895, p. 567. 2. Cho¨dro¨n P: Practicing Peace in Times of War. Boston: Shambhala, 2007.
Address correspondence to: Jessica Pieczynski, MS Department of Psychiatry University of California San Diego 9500 Gilman Drive, MC 0603 La Jolla, CA 92093 E-mail: [email protected]
Copyright of Journal of Palliative Medicine is the property of Mary Ann Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
