Thank you to Lindsey (@BrunelOT3) for offering to host the first journal (media) club for 2014.
Lindsey has prepared this reflective piece to get our thoughts flowing in preparation for what looks to be a great topic for discussion on the 7th January 2014.
Speaking of suffering, Egan 2007.
I am currently leading a module on occupational science for masters’ students and as it is my first year in leading this module I have found myself (unusually) struggling to articulate theories that have more philosophy within them than the so called ‘hard facts’ of evidence based practice. But it is philosophy that attracted me to academic work and particularly psychoanalysis (as a philosophy and theory) which sustains me in times of sorrow and/or disquiet when working with clients, students or staff. So last week, in an attempt to link the philosophy within the occupational science module with clinical practice I used a single power point slide in the classroom with the words
‘What is the meaning of suffering?’
After a short silence I suggested to the students that if they could not find ways of answering that question they would find it hard to sustain themselves in clinical practice as they would see and feel too much pain from their work with clients. I am not sure that I put it very well and perhaps I should have said more to help them see the connections between clinical reasoning (based on NHS guidelines and/or research evidence) and their need to find meaning in suffering. It could be that this deeper reflexivity can sustain them in the emotionally demanding work undertaken with clients and their carers.
Egan’s 2007 Muriel Driver Memorial lecture (also a paper in the Canadian Journal of Occupational Therapy) is an eloquent and passionate appeal to occupational therapists to recognise suffering. She begins the article with a quote from Arthur Frank;
‘Fear and depression are a part of life. In illness there are no ‘negative emotions,’ only experiences that have to be lived through. What is needed in these moments is not denial but recognition. The ill person’s suffering should be affirmed, whether or not it can be treated. What I wanted when I was most ill was the response, “Yes, we see your pain; we accept your fear” (Frank, 1991, p. 71)’. Egan, 2007, p293.
Egan has discussed our professional reluctance to engage in feeling the suffering of our clients and she makes an elegant argument for why we need to think more about its impact on our clients (and ourselves). She uses the word ‘recognition’ and this seems to be beyond words that offer comfort, but an inner resonance with the ‘other’s pain. She suggests that we may find ways of avoiding (even denying) these emotional points of contact, and thereby challenges us to examine our discomfort in working with clients who face enormous losses through illness, disability and/or ageing.
In my analytic work I have tried to consider if the ‘doing’ aspect of occupational therapy was, in part, a form of defence against the painfulness of the losses that clients encountered.
In the mid 1990’s there were series of jokes told which began; ‘How many xxxx’s does it take to change a light bulb?’ This recipe was applied to occupational therapists, and so the joke became; ‘How many OT’s does it take to change a light bulb?’ The answer was; ‘Only one, but they don’t change the light bulb, but teach you how to cope in the dark.’ In this simple joke lies the inherent discomfiture in a ‘coping’ response to the world of darkness, some people may not want to ‘cope’ with the dark because it may require of them to deny that there is any dark at all. (Nicholls, 2007, p.74).
I hope, by reading and thinking about Egan’s paper we can engage in thinking about ways that suffering can be recognised in the profession, through the direct work with clients and through talking and writing about the emotional work that is part of the occupational therapy process. Not sure how we will do it in 140 characters 🙂 but it’s a good way to start the connection.
Dr Lindsey Nicholls
17 Dec 2013
Egan, M., (2007). Speaking of suffering and occupational therapy, Canadian Journal of Occupational Therapy, 74 (4): 293-301
Nicholls, L., (2007). ‘A Psychoanalytic Discourse in Occupational Therapy’ in Creek, J., Lawson-Porter, A. Contemporary Issues in Occupational Therapy: Reasoning and reflection’, Chichester: Wiley pp: 55-85