Barry Jacobs: Occasionally, a journal article arrives that knocks the pegs out from under one’s clinical assumptions. "Sorrow: A Therapist’s Reflection on the Inevitable and Unknowable” by renowned narrative and family therapist Kaethe Weingarten, Ph.D., in the current issue of Family Process, is one such essay (click here to access the full-text pdf for free until March 8, 2013).
Written in crystalline, evocative prose, its beauty and heft alone would recommend it. But its topic—helping medically ill clients make peace with ongoing suffering—is essential for medical family therapists to continually grapple with. And Weingarten’s conclusion (following her synthesis of a literature review on "chronic sorrow” and reflections on four individual psychotherapy cases) stuns: Illness may disrupt the self-narrative but the path to peace doesn’t lead toward meaning-making so much as toward tolerance of the incoherence of self and suffering.
|While incoherence is not an unfamiliar state to me, it is not what I usually aim for in my clinical work with family caregivers and ill or disabled care recipients. I’d say I’m looking for silver linings, for the expanded sense of self that can come from increased agency and communion, for the solace of greater appreciation for continued life. Weingarten is having none of this. She ends her essay with a Buddhistic image of sufferers swimming in the ineffability of suffering. She exhorts therapists to accompany but not try to save them.
When confused (or in need of a laugh or even a clever insult), I always turn to the wisest, most sorrowful person I know, Dave Seaburn. I thought that, as one of the early progenitors of both family-centered primary care and medical family therapy, he might have some interesting thoughts about Weingarten’s essay. As an ordained minister as well as a daily practitioner of meditation, he could also reflect on the spiritual implications of Weingarten’s ideas.
Barry Jacobs: Weingarten talks about "chronic sorrow” as a response to the disruption in a person’s sense of self because of chronic illness or disability. How did that strike you?
Dave Seaburn: I like the concept of chronic sorrow and I think it resonates with many people who find that their experience of personal loss (and person loss) is unrelenting and poorly understood/appreciated by others. It is non-pathologizing, which is almost always good because it frees us to see things in greater complexity, something that traditional diagnoses (in the wrong hands) often discourages.
Nevertheless, I thought Weingarten's insistence that this diagnosis was the one and only explanation for each of these cases, also did a disservice to each person’s suffering. I feel certain I saw major depression and maybe character disorders also thrown into the mix without that ever taking away from chronic sorrow as a reasonable, though not all-encompassing,frame. Perhaps her insistence on the exclusivity of this term is because of her own personal experience as a breast cancer survivor (which obviously trumps my lack of similar experience).
BJ: I thought she used several effective metaphors to describe the challenges of living with chronic sorrow. I particularly liked the "boatman’s plight.”
DS: The boatman's plight is excellent. It entails jettisoning all but what is most essential in order to stay afloat in this life. She frames this negatively and I understand why. But in another sense, it is a wonderful metaphor for what we all should address: What would each of us find absolutely essential to keep our personal boats afloat?
BJ: What I’ve struggled most with in trying to understand her essay is this idea that suffering can’t be wrapped in some redeeming meaning—that we can’t lessen the pain through intellectual means.
DS: Her discussion of the "incoherence of suffering” was terrific. It reminded me of those soldiers who debriefed concentration camp victims at the end of WWII; they were the ones who attributed meaning to the inmates’ experience ("noble suffering”) while the inmates themselves could barely speak coherently about what was done to them, let alone attribute some meaning to what they had suffered.
I like the Buddhist notion that "self” is an unreliable concept. As with subatomic structures that can be both "particle” and "wave”, perhaps we are better off to think of the "self” as a wave and not make it so firm that we count on it lasting in a single (dependable and indestructible) form for longer than a day or two. In my case, seconds.
BJ: Her whole tone seemed a bit too negativistic to me—too doom-y. Perhaps I’m still looking for "pink clouds.”
DS: I don’t know. It seems to me that chronic sorrow is something that we should all be experiencing to one degree or another, if we are inclined to look closely at our circumstances. I am not being cynical. I admire those, and I know many of them, who do not operate with much if any insight regarding their life circumstances and yet live happily and often do remarkably good things for those around them. I wish I was part of that majority. But there are also those who recognize that decline is built into life--that we lose dreams and options and paths to follow and physical capacity and spiritual certainty and, finally, time itself. That is the way of things.
I often fantasize that just before birth we understand all of this, but birth itself is so traumatic that we lose that understanding and largely go about our lives not knowing what being here is all about. Consequently, we settle for what we can do and understand--we work, we procreate, we watch the Sixers on TV, we achieve. If we remembered what we knew just before we careened down that canal, I think we'd realize that what we are here to do, more than anything else, is to appreciate this holy mess, with all its constant suffering and occasional brilliance, and to live accordingly.
||Barry Jacobs and Dave Seaburn are family medicine educators and long-term collaborators. Barry is the Director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency in Springfield, PA and the author of The Emotional Survival Guide for Caregivers. Dave recently retired from a distinguished career as the behavioral science faculty in the University of Rochester Family Medicine Residency and has taken to writing novels, including his latest, Chimney Bluffs, a novel about finding one's way through tragic loss and sorrow.|