Dr Volker Hitzeroth, Medicolegal Consultant at Medical Protection
As 2021 draws to a close some of us will be contemplating the future that awaits us and our loved ones. The past two years have affected all of us in different ways. At Medical Protection’s recent Ethics for All Healthcare Practitioners’ conference, Dr Volker Hitzeroth, Medicolegal Consultant at Medical Protection shared some thoughts – informed by recent studies – about human suffering to cultivate a flourishing life.
Many have had to overcome tremendous challenges – be they physical (e.g. Covid-19 related, other health conditions), psychological (e.g. depression, anxiety or even hopelessness and suicidality), or social (e.g. being isolated or caring for others). Even if you have not been directly impacted, you will still be aware of the tremendous difficulties and tragic circumstances experienced by many.
Coming to the end of this year gives us time to reflect and review recent literature on the subject of suffering and flourishing.
Suffering
Suffering is defined as a state of undergoing pain, distress, hardship, injury or harm. This, however, is rather generic, dry, and bland. Suffering seems to be so much more than that! Hence, more qualitative descriptors from the literature are:[i]
- “Sense of powerlessness or loss of control, feelings of sadness, loneliness or hopelessness”
- “Disconnection from self, others and the world”
- “Descent into the underworld, blackness, nothing, the void, the abyss”
- “That which cannot be put into words but is screaming to be disclosed”
Suffering means different things to many different people. It is varied and multifaceted and a very personal and subjective experience. It is also influenced by numerous factors such as traumatic events, genetics, prior experiences and whether the individual has resilience, support and treatment for their sufferings.
The philosophy and over-arching theories of suffering suggest that there are several different approaches to human suffering:
- Actively acknowledging and responding to suffering, where suffering is seen as positive and a force for the good:
With this belief, suffering serves a higher purpose, and overcoming suffering leads to a more authentic life where we can explore our limits, grow and mature. We get to find ourselves and discover what is of value and significance to us. In short, suffering is a way to turn an adversity into an opportunity for personal growth.
- Accepting suffering and possibly even becoming indifferent to it, where suffering is neutral:
Suffering is a natural part of our life and our existence. It is normal and cannot be avoided. It is neither good nor bad and has no meaning in and of itself but rather is indifferent and inherently meaningless. The challenge is to accept its presence and live with it.
- Escaping and eliminating suffering, where suffering is seen as negative and a force for the bad:
Suffering is seen as an unwanted, evil and unnecessary in life. It is best avoided, alleviated or eliminated. It requires intervention, treatment or a cure and must be actively curtailed through an intercession.
Many interventions have been posited to reduce suffering, stress, sadness and burnout. The literature is awash with suggestions and recommendations ranging from mindfulness and meditation, from therapy to treatment and from physical exercise to specific diets and healthy eating. Much of this is evidence-based and widely accepted.
Unfortunately, very few of us manage to continue with these helpful interventions for any length of time. Most people, including healthcare professionals, struggle to maintain healthy habits and often give up on our balanced diet and exercise. Our busy lives make it difficult to engage in such healing behaviour while we have family and work responsibilities, and healthcare professionals feel obligated to be available for on-calls and emergencies.
However a recent study has shown that there are several protectors of wellbeing.[ii] The research suggests that harbouring an attitude of gratitude (showing appreciation and being thankful) and practising tragic optimism (remaining optimistic in the face of tragedy) seem to be most effective at promoting and protecting our wellbeing. Social support, a connection with nature and physical activity are also helpful.
What if the suffering we experience or witness, is so extreme and profound with no relief or reprieve?
Sometimes, the suffering we experience or witness, is so immense and so unrelenting that traditional healing interventions seem unhelpful or misdirected. We are left feeling utterly helpless and even hopeless. What can we do and what may help? The literature suggests that while we may not be able to actively relieve the suffering in such tragic circumstances it may be helpful to:
- Be present – create a safe space where the sufferer is not alone and can be heard and their suffering can be acknowledged.
- Give permission – permission to talk, to share and to confirm the hurt and harm that is being experienced.
- Connect – as a fellow human who cares, shares, and supports.
- Bear witness – notice the suffering, recognise it, name it, shine a light on it, document it and give it a voice.
Finally, lest we forget, we should practise compassion. Compassion for the sufferer, but also become receptive to receiving compassion when we are in need ourselves.
Flourishing
Human flourishing is thought to be a broad and composite state of wellbeing.
Achieving a state of flourishing may seem unachievable and distant when suffering is visible all around us. We tend to think that it is only by exception that someone could reach a state where they flourish, where all the important aspects of their lives align in a state of positivity. Some believe that it is good luck and circumstances that bring forth a state of flourishing – and that there is very little that we ourselves can do to achieve this state.
A recent article outlining an evidence-based guide to activities that promote human flourishing is particularly helpful[iii]. Tyler VanderWeele from the Harvard University has reviewed numerous activities and has published a four-step guide to promote human flourishing:
- Cognitive steps:
- Gratitude – making a list of things that one is grateful for and then discussing these and reflecting thereon
- Savouring – recognising what is good and then attending to, appreciating, and enhancing any uplifting and positive experiences
- Imagining one’s best future – imagining one’s best possible future self and future life and then writing about it, reflecting, and discussing this with selected individuals.
- Behavioural steps:
- Using character strengths – identifying character strengths and using them in a novel manner daily
- Acts of kindness – engaging in acts of kindness and helping other people
- Volunteering – participating in volunteering activities enhances wellbeing and social contacts as well as fostering a sense of purpose.
- Engagement:
- Work and employment – meaningful work encompasses having to contribute to society and addressing the needs and desires of our communities
- Marriage, family, and relationships – our close relationships are the foundation of life and attempts to improve these through education, counselling and working through difficulties is likely to improve wellbeing and encourage flourishing
- Religious service attendance – the study finds that regular religious service attendance improves mental and physical health, is meaning-making and encourages social cohesion, all of which improve wellbeing and flourishing.
- Addressing psychological distress:
- Address low mood and depression – identify, and recover from depression
- Address fear and anxiety – alleviate and master anxiety
- Forgiveness – practice to forgive others for the wrongs they have done (this does not mean that one must forgo the judicial process, condone their actions, or reconcile with the individuals concerned).
According to VanderWeele, engaging in the above-mentioned activities on a regular basis we are likely to improve our wellbeing and may even flourish.
If we want to live and work in a world where human suffering is diminished, and where most of us can flourish, let us embrace strategies, encourage plans, and implement policies that reduce suffering and cultivate a flourishing life for all.
You can view the recording of Dr Volker Hitzeroth’s presentation on this topic at www.medicalprotection.org/southafrica/events-e-learning/events/ethics-for-all#HP%20Prog (from the 2-hour mark).
As part of membership, Medical Protection offers an independent, confidential telephone counselling service to members experiencing work-related stress. For more information, visit here
[i] www.researchgate.net/profile/Shelly-Russell-Mayhew/publication/322677732_By_the_Water%27s_Edge_a_Hermeneutic_Look_at_Suffering_and_Self-Compassion_in_Counselling_Psychology/links/5ac3a7d4a6fdcc1a5bd00a60/By-the-Waters-Edge-a-Hermeneutic-Look-at-Suffering-and-Self-Compassion-in-Counselling-Psychology.pdf
[ii] www.ncbi.nlm.nih.gov/pmc/articles/PMC8295471/
[iii] www.journalppw.com/index.php/JPPW/article/view/163