Suffering is the experience of distress or disharmony caused by the loss, or threatened loss, of what we most cherish. Suffering involves dissolution, alienation, loss of dignity, and/or a sense of meaninglessness. Hopelessness is an extreme manifestation of suffering. However, hope is a natural human resource that can relieve suffering and contribute to healing. Hope is also more flexible and resilient that physicians, who traditionally withheld or manipulated the truth about dire prognoses, believed it to be. Maintaining hope, especially deep hope, is an antidote to suffering.
The vocation of physicians and other health professionals is, insofar as possible, to relieve suffering caused by illness, trauma, and bodily degeneration. However, since suffering is an existential state that may not parallel physical or emotional states, health professionals cannot rely solely on knowledge and skills that address physiological dysfunction to be effective at relieving suffering. Rather, clinicians must learn to engage the patient at an existential level and to engender hope.
For several decades medical educators have taught young physicians to approach their patients with “detached concern,” a relationship that they believe preserves objectivity and protects the physician’s emotional resources, while it also acknowledges medicine’s beneficent motivation. However, in reality, contemporary medical education and practice favor a process of progressive detachment from patients that devalues subjectivity, emotion, and solidarity as irrelevant and often harmful. Such an ideal – fortunately not achieved by most clinicians – almost ensures that practitioners lose the ability to fully appreciate and respond to human suffering, or to facilitate hope. The term compassionate solidarity summarizes an alternate model of the clinician–patient relationship that promotes hope and healing.
- Palliative Care
- Palliative Medicine
- Palliative Care Patient
- False Hope
- Palliative Care Physician
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, access via your institution.
Akhmatova, A. (2004). The word that causes death’s defeat. Poems of memory (N. K. Anderson, Trans.). New Haven: Yale University Press.
Beck, A. L., Arnold, R. M., & Quill, T. E. (2003). Hope for the best, and prepare for the worst. Annals of Internal Medicine, 138(3), 439–443.
Becker, H. S., Geer, B., Hughes, E., & Strauss, A. (1961). Boys in White: Student culture in medical school. Chicago: University of Chicago Press.
Bennett, M. J. (2001). The empathic healer: An endangered species? New York: Academic.
Benzein, E., Norberg, A., & Saveman, B. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 15, 117–126.
Benzein, E., Saveman, B. (1998). http://www.letstalkpain.org/health_care/dialogue.html Nurses’ perception of hope in patients with cancer: a palliative care perspective. Cancer Nursing, 21, 10–16.
Blum, L. C. (1980). In A. O. Rorty (Ed.), Explaining emotions. Berkeley: University of California Press, pp. 507–517.
Blumgart, H. L. (1964). Caring for the patient. The New England Journal of Medicine, 270, 449–456.
Bolton, G. (1999). Stories at work: Reflective writing for practitioners. The Lancet, 354, 243–245.
Cassell, E. J. (1982). The nature of suffering and the goals of medicine. The New England Journal of Medicine, 306(11), 639–645.
Cassell, E. J. (1995). Pain and suffering. In W. T. Reich (Ed.), Encyclopedia of bioethics (2nd ed., pp. 1897–1904). New York: Simon & Schuster.
Cassell, E. J. (2004). The nature of suffering and the goals of medicine. New York: Oxford University Press.
Charon, R. (2001a). Narrative medicine. A model for empathy, reflection, profession, and trust. Journal of American Medical Association, 286, 1897–1902.
Charon, R. (2001b). Narrative medicine: Form, function, and ethics. Annals of Internal Medicine, 134, 83–87.
Charon, R. (2004). Narrative and medicine. The New England Journal of Medicine, 350(9), 862–864.
Cherny, N. I. (2004). The challenge of palliative medicine: The problem of suffering. In D. Doyle, G. Hanks, N. Cherny, & K. Calman (Eds.), Oxford textbook of palliative medicine (pp. 7–14). Oxford: Oxford University Press.
Chochinov, H. M. (2007). Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. British Medical Journal, 335, 184–187.
Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L. J., McClement, S., & Harlos, M. (2002a). Dignity in the terminally ill: A cross-sectional, cohort study. The Lancet, 360, 2026–2030.
Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L. J., McClement, S., & Harlos, M. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end-of-life. Journal of Clinical Oncology, 23, 5520–5524.
Chochinov, H. M., Hack, T., McClement, S., Kristjanson, L. J., & Harlos, M. (2002b). Dignity in the terminally ill: A developing empirical model. Social Science & Medicine, 54, 433–443.
Coles, R. (1989). The call of stories: Teaching and the moral imagination (p. 179). Boston: Houghton Mifflin.
Coulehan, J. (2005). Today’s professionalism: Engaging the mind, but not the heart. Academic Medicine, 80, 892–898.
Coulehan, J. (2011). On hope in palliative medicine. In J. Malpais & N. Lickiss (Eds.), Perspectives on suffering. New York: Springer.
Coulehan, J., & Block, M. R. (2006). The medical interview: Mastering skills for clinical practice (5th ed., pp. 29–44). Philadelphia: F.A. Davis Company.
Coulehan, J., & Clary, P. (2005). Healing the healer: Poetry in palliative care. Journal of Palliative Care, 8(2), 382–389.
Coulehan, J., Platt, F. W., Frankl, R., Salazar, W., Lown, B., & Fox, L. (2001). Let me see if I have this right: Words that build empathy. Annals of Internal Medicine, 135, 221–227.
Coulehan, J., & Williams, P. C. (2003). Conflicting professional values in medical education. Cambridge Quarterly of Healthcare Ethics, 12, 7–20.
DasGupta, S., & Charon, R. (2004). Personal illness narratives: Using reflective writing to teach empathy. Academic Medicine, 79(4), 351–356.
Daudet A. (2002). In the land of pain. J. Barnes (Ed.), New York: Alfred A. Knopf.
Dickinson E. (1960). The complete poems of Emily Dickinson. T. H. Johnson (Ed.), Boston: Little, Brown and Company, New York, p. 116.
DuFault, K., & Martoocchio, B. (1985). Hope: Its spheres and dimensions. Nursing Clinics of North America, 20, 379–391.
Farber, N. J., Novack, D. H., & O’Brien, M. K. (1997). Love, boundaries, and the patient physician relationship. Archives of Internal Medicine, 157, 2291–2294.
Frank, A. (2001). Can we research suffering? Qualitative Health Research, 11, 353–362.
Frankel, R. M., Quill, T. E., & McDaniel, S. H. (Eds.). (2003). The biopsychosocial approach: Past, present, future. Rochester: University of Rochester Press.
Frankl, V. (2006). Man’s search for meaning. Boston: Beacon.
Galanti, G. A. (1997). Caring for patients from different cultures. Case Studies from American Hospitals. Philadelphia: University of Pennsylvania Press.
George, R. (2009). Suffering and healing – Our core business. Palliative Medicine, 23, 385–387.
Groopman, J. (2004). The anatomy of hope. How people prevail in the face of illness. New York: Random House.
Gunderman, R. B. (2002). Is suffering the enemy? The Hastings Center Report, 32(2), 40–44.
Halpern, J. (1992). Empathy: Using resonance emotions in the service of curiosity. In H. Spiro et al. (Eds.), Empathy and the practice of medicine (pp. 160–173). New Haven: Yale University Press.
Halpern, J. (2003). What is clinical empathy? Journal of General Internal Medicine, 18, 670–674.
Halpern, J. (2007). Empathy and patient-physician conflicts. Journal of General Internal Medicine, 22, 696–700.
Hauerwas, S. (1990). God, medicine, and suffering (p. 69). Grand Rapids: William B. Eerdmans.
Helwick, C. (2010). Fostering hope in hopeless situations. MD Consult News, 24, 2010.
Herth, K. (1990). Fostering hope in terminally ill people. Journal of Advanced Nursing, 15, 1250–1259.
Herth, K. (1993). Hope in older adults in community and institutional settings. Issues in Mental Health Nursing, 14, 139–156.
Herth, K. A., & Cutcliffe, J. R. (2002). The concept of hope in nursing 3: Hope and palliative care nursing. British Journal of Nursing, 11, 977–983.
Hertzler, A. E. (1940). The horse and buggy doctor (p. 322). Garden City: Blue Ribbon Books.
Hojat, M. (2009). Empathy in patient care (pp. 10–15). Springer: New York.
Hojat, M., Gonnella, J. S., Nasca, T. J., Mangione, S., Vergare, M., & Magee, M. (2002). Physician empathy: Definition, components, measurement, and relationship to gender and specialty. The American Journal of Psychiatry, 159, 1563–1569.
Holstein, M. (1997). Reflections on death and dying. Academic Medicine, 72, 848–855.
Kearney, M. (2000). A place of healing: Working with suffering in living and dying. Oxford: Oxford University Press.
Kearney, M. K., Weininger, R. B., Vachon, M. L. S., Harrison, R. I., & Mount, B. M. (2009). Self-care of physicians caring for patients at the end of life. “Being connected… A key to my survival”. Journal of American Medical Association, 301, 1155–1164.
Kellehear, A. (2009). On dying and human suffering. Palliative Medicine, 23, 388–397.
Kodish, E., & Post, S. G. (1995). Oncology and hope. Journal of Clinical Oncology, 13(7), 1817–1822.
Lawrence, D. H. (1947). Selected poems. Introduction by Kenneth Rexroth (pp. 138–140). New York: New Directions.
Lief, H. I., & Fox, R. (1963). Training for “detached concern” in medical students. In H. I. Lief & N. R. Lief (Eds.), The psychological basis for medical practice. New York: Harper & Row.
Marcel, G. (1960). Fresh hope in the world. London: Longmans.
McCormick, T. R., & Conley, B. J. (1995). Patient perspectives on dying and on the care of dying patients. The Western Journal of Medicine, 163, 236–243.
Meier, D. E., Back, A. L., & Morrison, R. S. (2001). The inner life of physicians and care of the seriously ill. Journal of American Medical Association, 286, 3007–3014.
Mendiola, M. M. (1996). Overworked, but uncritically tested: Human dignity and the aid-in-dying debate. In E. E. Shelp (Ed.), Secular bioethics in theological perspective (pp. 129–143). New York: Kluwer Academic Publishers.
Miller, J. (1985). Hope. American Journal of Nursing, 85, 23–25.
Morris, D. B. (2001). Narrative, ethics, and thinking with stories. Narrative, 9, 55–77.
Nouwen, H. J. M., McNeill, D. P., & Morrison, D. A. (1982). Compassion. New York: Image Books.
Novack, D. H., Plumer, R., Smith, R. L., et al. (1979). Changes in physician attitudes toward telling the cancer patient. Journal of American Medical Association, 241, 897–900.
Novack, D. H., Suchman, A. L., Clark, W., Epstein, R. M., Najberg, E., & Kaplan, M. D. (1997). Calibrating the physician. Personal awareness and effective patient care. Journal of American Medical Association, 278, 502–509.
Ober, K. P. (2003). Mark twain and medicine “Any mummery will cure”. Columbia: University of Missouri Press.
Oken, D. (1961). What to tell cancer patients: A study of medical attitudes. Journal of American Medical Association, 175, 1120–1128.
Osler, W. (2001). Aequanimitas. In S. Hinohara & H. Niki (Eds.), Osler’s “a way of life” & other addresses with commentary & annotations (pp. 21–29). Durham: Duke University Press.
Ozick, C. (1989). Metaphor and memory. Metaphor and memory: Essays . New York: Knopf, pp. 265–283.
Pellegrino, E. D., & Thomasma, D. C. (1996). The Christian virtues in medical practice. Washington: Georgetown University Press.
Post-White, J., Ceronsky, C., & Kreitzer, M. (1996). Hope, spirituality, sense of coherence, and quality of life in patients with cancer. Oncology Nursing Forum, 23, 1571–1579.
Reich, W. T. (1989). Speaking of suffering. A moral account of compassion. Soundings, 72(1), 83–108.
Saunders, C. (1984). The philosophy of terminal care. In C. Saunders (Ed.), The management of terminal malignant disease. London: Edward Arnold.
Shakespeare, W. (1952). Measure for measure act III, scene 1. The complete works (p. 1116). New York: Harcourt Brace.
Snyder, C. R., Rand, K. L., King, E. A., Feldman, D. B., & Woodward, J. T. (2002). “False” hope. Journal of Clinical Psychology, 58, 1003–1022.
Spiro, H. (1992). What is empathy and can it be taught? In H. Spiro et al. (Eds.), Empathy and the practice of medicine. New Haven: Yale University Press.
Sulmasy, D. P. (1997). The healer’s calling. Spirituality for physicians and other health care professionals. New York: Paulist Press.
Von Roenn, J. H., & von Gunten, C. F. (2003). Setting goals to maintain hope. Journal of Clinical Oncology, 21(3), 570–574.
Wall, P. (1999). Pain: The science of suffering. London: Weidenfield and Nicholson.
Warr, T. (1999). The physician’s role in maintaining hope and spirituality. Bioethics Forum, 15(1), 31–37.
Weisman, A. (1972). On Dying and Denying: A Psychiatric Study of Terminality. New York, Behavioral Publications.
Wilkinson, I. (2005). Suffering: A sociological introduction. Cambridge: Polity Press.
Williams, W. C. (1951). The autobiography of William Carlos Williams (p. 356). New York: New Directions.
Editors and Affiliations
Rights and permissions
© 2013 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Coulehan, J. (2013). Suffering, Hope, and Healing. In: Moore, R.J. (eds) Handbook of Pain and Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1651-8_37
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1650-1
Online ISBN: 978-1-4419-1651-8
eBook Packages: MedicineMedicine (R0)