Addressing Suffering in Patients With Psychiatric Disorders

Abstract

Background: Patients with psychiatric disorders (as well as general medical conditions) often describe their lives in terms of suffering. Although suffering is honored as a central focus of physicians' concerns, it is not even indexed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Generally connoting severe, prolonged distress, suffering can be distinguished from pain, depression, and anxiety. The aims of this article are to consider whether attending to suffering per se in psychiatric patients merits attention independent of other commonly assessed psychiatric symptoms such as anxiety, depression, and conventional distress, and how targeting suffering per se might add value to psychiatric patient care.Methods: Sources for this article were obtained via a selective literature search in PubMed using the terms "suffering" in the title and the terms "psychiatric disorder," "mental illness," "assessment," "measurement," "scale," "existential suffering," and "unbearable suffering." Articles of interest were followed up using a snowball technique to examine "similar articles" and "cited by" titles to find additional pertinent articles.Results: Definitions of suffering in the medical literature stress its subjectivity, particularity, complexity, and connection to a wide variety of noxious sensations, as well as real and anticipated deficits, losses, and thwarted motivations. These can affect the entire spectrum of universal human needs, from basic biological issues through intrapsychic, interpersonal, and social issues, encompassing existential concerns of meaning, purpose, and transcendence. Based on these factors, a definition of suffering in patients with psychiatric disorders is proposed. Although efforts to measure suffering have been limited and numerous gaps in the literature are evident, several scales may offer suitable bases for the study of suffering in patients with psychiatric disorders.Conclusions and Implications: Ascertaining sources of suffering may require new types of inquiry and additional time. Well-described, evidence-informed strategies and time-honored psychotherapy techniques are available for addressing the numerous concerns that contribute to suffering. Patients with psychiatric disorders whose distinct, multidimensional sources of suffering are identified, acknowledged, and addressed may experience better treatment quality, greater treatment satisfaction, and possibly better outcomes than those whose clinicians' attention is limited to conventional psychiatric signs and symptoms.

A Comprehensive Clinical Model of Suffering

“…The other axes reflect the depth and breadth of suffering that may be more important to some patients. 36,[59][60][61] At the center of the model are the common patient experiences of suffering: distress, threat, loss, despair, and isolation. Surrounding the patient and shaping their unique experience of suffering is the patient's perception of context.…”

Enhancing Resilience Regarding Depression, Anxiety and COVID-19 with a Narrative Method of Ordering Memory Effective in Researchers Experiencing Burnout

“…Depression, in effect, is the past tense of anxiety [67]. With perspective regarding time [68] as their primary differentiation, COVID-19 has resulted in an increase in both depression and anxiety as the thought of contracting the virus is frightening, the virus is itself unstable, the consequences of infection range from insignificant to life threatening, the effect on any individual is unknown, the demand for debilitating social isolation measures continues, and it is unclear who to believe regarding COVID-19 in what situation [69]. As these uncertainties regarding COVID-19 are found across the temporal spectrum, it is to be expected that symptoms of both depression and anxiety would be detrimentally affected [70].…”

Encountering suffering in digital care: a qualitative study of providers’ experiences in telemental health care

“…Encountering patients who are suffering is common during the provision of care [ 1 , 2 ]. Across specialties and practices, suffering is important to attend to when providing care to help patients heal from ailments and cope with challenges they face, including in mental health care [ 3 , 4 ]. There are common attributes, but also variation, in how suffering is characterized across medical and health care sciences.…”

“…It is also construed as a loss of meaning in life, the inability to be connected to one’s core life values, or a loss of control or freedom to act and feel engaged in the world with others [ 5 ]. Suffering may be attributed to physical or psychological distress, experienced or anticipated [ 4 ]. It may also be due to personal or social consequences of illness or disorders, or it may be embodied within social problems encountered in society, such as subjugation, violence, or poverty [ 2 , 6 ].…”

“…Experiences of providers encountering patient suffering in telemental health care has not yet been explored in the literature, despite growing use of this modality [ 11 , 12 ] and the important role of attending to suffering in mental health care [ 3 , 4 ]. As such, the aim of the present study is to explore providers’ lived experiences of encountering patients who are suffering in telemental care.…”