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'Total pain': reverence and reconsideration
1Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener, ON, Canada.
Frontiers in Sociology
|December 11, 2023
Summary
Dame Cicely Saunders' concept of total pain in palliative care is multi-dimensional. This paper revisits the role of patients' mental reactions to dying, suggesting potential unintended pathologization for patients and clinicians.
Area of Science:
- Palliative Care
- Medical Ethics
- Psychosocial Oncology
Background:
- Dame Cicely Saunders' concept of 'total pain' (or 'total suffering') is foundational in palliative care.
- Saunders, with a unique background in social work, nursing, and medicine, viewed suffering as multi-dimensional: physical, psychological, emotional, social, spiritual, and existential.
- The concept remains highly relevant and revered in contemporary palliative care.
Purpose of the Study:
- To reconsider the aspect of 'total pain' related to patients' 'mental reactions' to dying.
- To examine the socio-historical influences on this aspect of Saunders' work, including her Christian faith and Viktor Frankl.
- To explore the potential for this aspect to unintentionally pathologize patients with persistent suffering and clinicians struggling to provide relief.
Main Methods:
- Analysis of Dame Cicely Saunders' writings from the late 1950s to the early 2000s.
- Drawing upon clinical experiences of a hospice social worker over a 10-year period.
- Case study approach using anonymized patient stories.
Main Results:
- The paper details the historical development and impact of viewing 'mental reactions' as a key component of 'total pain'.
- Clinical anecdotes suggest this focus may inadvertently pathologize patients and clinicians when suffering is intractable.
- A need for respectful reconsideration of this specific element of Saunders' model is indicated.
Conclusions:
- While Saunders' contributions are invaluable, the emphasis on 'mental reactions' within 'total pain' warrants critical re-evaluation.
- Palliative care philosophy and practice may benefit from a nuanced approach that avoids pathologizing persistent suffering.
- Balancing reverence for Saunders' legacy with critical inquiry is essential for advancing palliative care.
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