Suffering Narratives of Older Adults

A Phenomenological Approach to Serious Illness, Chronic Pain, Recovery and Maternal Care

Mary Beth Morrissey

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135009649
• Edition: 1
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

In Suffering Narratives of Older Adults, Mary Beth Quaranta Morrissey turns to the traditions of phenomenology, humanistic psychology and social work to provide an in-depth exploration of the deep structure of the suffering experience. She draws upon the notion of maternal holding to develop an original construct of maternal affordances – the ground of possibility for human development, agency and relational practices. The conceptual analysis is based on the life narratives of several elders receiving chronic care in facility environments.

Creating new fields of communication for patients, their family members and health professionals in processes of reflection and shared decision making, this book builds on knowledge about suffering to help guide ethical action in preventing and relieving chronic pain and improving systems of care. It offers a phenomenological approach to understanding the maternal as a primary domain of moral experience in serious illness and suffering, and implications for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present critical areas of ethical inquiry, including:

• pain and suffering
• maternal relational ethics
• evaluation and moral deliberation about care options
• decision-making and moral agency
• end-of-life experiences of care.

Exploring how an ecological relational perspective grounded in phenomenology may provide fruitful alternatives to traditional frameworks in bioethics, this is an important contribution to the ongoing development of an ecological ethic of care. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services, as well as practitioners in the field.

1 The Dialectics of Suffering and Maternal Care-Seeking in Serious Illness

DOI: 10.4324/9780203741887-1

The famous painting from Picasso’s Blue Period, The Old Guitarist, captures so effectively both elder suffering and the rising of hope in the midst of suffering. At the center of the painting is the guitar and its promise of music, and the suggestion that this promise seems to anchor the blind, melancholic old man whose grip on life is tenuous. The full aesthetic dimensionalities of Picasso’s image give access to a unified temporal moment of suffering in tension with hope, as well as the ambiguity inherent in this moment.

The problem of suffering among older adults, as depicted in Picasso’s The Old Guitarist, has not garnered sufficient attention and is understudied. The nature of the problem is complex, spanning social, ecological, and public health domains, and involving concerns about perception, epistemology as well as ontology, provision and ethics of care, and moral obligation and agency. The epistemological aspects of suffering may be framed in terms of accessing the suffering of the other. The problem of care presents challenges in how we respond to the suffering other. In this inquiry, I seek to understand the nature of suffering—widely viewed as situated within an existing biomedical paradigm—its origins, horizons, contexts, manifestations, and temporal movement as understood both within the scientific community and among non-scientists. The dominant biomedical paradigm, that gives primacy to curative and pharmacologic approaches to treatment, is now being called into question as part of a shift in how suffering is conceptualized. Discrepant evidence about experience of suffering and care responses to suffering that motivate recovery and resilience are prompting a move away from a purely medical perspective to a reframing of suffering as part of our human development over the life course. These reframings tease out the tension between the common sense understanding of health as an achievement of natural science and technical rationality, and the lived experience of health as an achievement of ethics grounded in social practices. They invite reflection on the gap between concrete reality, the things themselves that phenomenology allows access to, and the paradigms of science upon which conventional notions about health and health systems have been constructed. Such paradigm shifts are patterns that have been formally recognized by scholars such as Thomas Kuhn (1962), who have illuminated the role of social contexts in scientific revolutions. The emerging paradigm is fundamentally social and relational, not only helping remove barriers to understanding, but promoting more empathic access to diverse meanings in ethical encounter with suffering persons and more effective responses to such suffering in essentially and relationally constitutive human ways.

Framings of Pain and Suffering: Conceptual Swamp

A “conceptual swamp” in the medical and medical humanities literature has muddied understanding of suffering as phenomenologically distinct from pain (Morrissey, 2011a, p.18), a subject that will be elaborated on throughout the chapters of this book. Eric J. Cassell’s (1982, 1999, 2004) description of suffering as an experience that threatens the intactness of the person and personhood is often cited as the authoritative scholarship on the subject of suffering. In his work on suffering, Cassell developed a topology of the person and personhood that he described as being broader than the concept of self, positing that there are parts of the person that are not part of the self, may be known by others, but not by me. His conceptualization takes account of the bodily, social, cultural, emotional, instrumental, political, relational, historical, familial, and transcendent dimensions of personhood. Cassell also describes processes that involve personal interpretation of illness experiences and symptoms, and the assignment of meanings to such experiences. However, Cassell remains firmly committed to the personal, private and individual nature of suffering. While Cassell’s conceptualization has informed the scholarly dialogue on person-centered care and laid an important foundation for future scholarly inquiry, it does not sufficiently account for the social constitution of suffering (Morrissey, 2011b). Pain is defined somewhat more narrowly in the scientific literature as a sensory and emotional experience that involves bodily tissues, or actual or potential tissue damage (International Association for the Study of Pain [IASP], 2011), yet like suffering in some sense involves annihilation of self and world. These framings of pain and suffering share considerable overlap, and are often blurred. Generally, there is a growing and robust body of science on pain, and a newly emerging focus on developing a national pain agenda as the result of the 2011 Institute of Medicine (IOM) blueprint report on pain prevalence and pain disparities in the United States (IOM, 2011). In particular, the problem of chronic pain, its etiology, social determinants, and the design of effective approaches to its treatment are posing new challenges for researchers and practitioners (Atlas & Skinner, 2010; Gatchel, McGeary, McGeary, & Lippe, 2014; Institute of Medicine, 2011; Jensen & Turk, 2014). However, the study of suffering remains a neglected area of scientific inquiry. Through the narrative accounts in this book, a sharpened focus is brought to bear on descriptions and definitions that blur understanding of the phenomenality of pain and suffering as distinct experiences, and as part of that process, prevailing views and their underpinnings are called into question. For example, it is suggested that pain is an experience that may not always involve actual or potential tissue damage, as set forth in the IASP definition.

Narrative is a method that has been used extensively by scholars such as Arthur Frank (1995), Arthur Kleinman (1988), Kathy Charmaz (1983; 1997; 1999), Mark Freeman (2008a, 2008b), Ruthellen Josselson (Josselson, 2013; Wertz et al., 2011), as well as others (Black, 2006; Burlea, 2009; De Beauvoir, 1965; Good, 1994), in aiming to capture the voice and agency of the suffering other and the ethical relation to the other in lived experiences of illness, aging and dementia (Morrissey, 2014a, 2014c). The literature suggests that suffering may be concerned with experiences of loss and distress, and with a search for meaning (Altilio, 2004; Black, 2006; Byock, 1996; Charmaz, 1983, 1997, 1999; Ferrel & Coyle, 2008; Frankl, 1984). Narrative method is part of the shift away from explanatory approaches to the scientific investigation of suffering rooted in the current dominant biomedical models of disease diagnosis and treatment, and toward relational models of assessment, intervention and decision making that restore ethics as a central ground of humanistic understanding in the interdisciplinary study of social development and taken-for-granted experiences of suffering in everyday life (Miller, 2004; Morrissey & Jennings, 2006; Morrissey, 2011a, 2011b). Drawing on Virginia Woolf’s “A Room of One’s Own” (1957), it is asserted that the proper locus of writing, and in the present context narrative writing, is—“not in re-living or re-telling, but in more fully embodying the presence of reality—the moment which transcends temporality” and “that which is perpetually in a state of flux” (Morrissey, 1979, p. 4–5). In the last pages of “A Room of One’s Own,” Woolf describes the stream of experience that is existence as “the common life which is the real life and not… the little separate lives which we live as individuals” (p. 114).

The salient dimensions of suffering that have been prominent in my research findings and inform the suffering narratives of older adults are its excruciating immediacy, and unbounded or boundless and indeterminate qualities, and its presence to the experiencing person as such. While all things may be said to be situated against a horizon of indeterminacy, it is suggested that the human encounter with these essential dimensions of suffering arises in the context of socially and culturally constituted losses of Maternal Foundations. It is the immediate, unbounded and indeterminate dimensionalities of suffering, embedded dialectically within conditions of human finitude, temporality, and ambiguity that creates the feeling that there is no refuge from it. My research findings also suggest that these qualities of suffering cannot be easily translated into concepts and language, and may be fully accessible only at pre-conceptual and pre-theoretical levels of experience, or through non-linguistic forms of expression in art, and music and poetry. Based on these tentative findings, suffering appears as qualitatively different from more finite experiences of illness and non-chronic pain. For these reasons, I have sought descriptions of suffering that will help to deepen our understanding of it, especially in light of its elusive nature. In the last chapter of the book, I attempt to integrate all the findings as presented in the narratives and provide a fuller explication of a proposed tentative general structure of suffering that shows its essential constituents as suffering, the thing itself. We know and may say then with certainty that suffering exists empirically, yet we continue to be faced with uncertainty about its whatness and how it is constituted. Suffering therefore escapes definition as a concrete problem, and cannot be cured through technical and material interventions or solutions, even if it can at times be relieved.

Maternal Dimensions of Existence as Primary Domain of Moral Experience

Perhaps no work of art in our lifetime so powerfully and profoundly conveys the multiple intersecting realities and meanings of suffering and its associated lost Maternal Foundations, especially in the context of communities, as Picasso’s Guernica. Picasso depicts horrific violence and death amidst a community of humans and animals—a dying horse, a dying soldier, and a weeping, bereft mother with head swung back holding her dead baby. As in the painting of the old man and his guitar, Picasso evokes hope in the symbol of a small flower in the midst of a scorched landscape of death and dismemberment. The aesthetic achievements of Picasso and other great artists enrich our capacity to see what is not immediately evident or visible, but may be hidden and invisible. This is the archeological task of phenomenology in the present project—recovering and making visible the social worlds of suffering elders.

Toward a Phenomenology of the Maternal

In the chapters that follow, I interrogate the Maternal as it has appeared in my research studies in the context of suffering—the Maternal, as the “thing itself” or concrete reality (which I shall reference as “the Maternal”), as explicated by philosopher Edmund Husserl in his description of the phenomenological turn (Husserl, 1901/1970; Wertz, 2010) or by French phenomenologist Gabriel Marcel (1949) in his attention to concrete being as grasped through secondary reflection, and its appearance in the temporal horizons of suffering experience as an independent ground of relationality and interembodiment: temporality, spatiality, and the home; perception and intersubjectivity; and agency and spirituality. I aim in this inquiry to begin tracing the contours of a phenomenology of the Maternal in its temporal and dialectical movements and horizonal entanglements with suffering experience – from the origin and genetic constitution of suffering to the re-constitution of consciousness in the affordances of the Maternal. This is a genetic phenomenological analysis, focused on locating the beginnings and contexts of suffering. My goal is to uncover layers of experience and meaning, using the descriptive and reflective analysis methods of phenomenology, that may not be visible in ordinary everyday lives, or which may not be amenable to description or verbal expression using the language of “pain” or “suffering.” These methods involve the researcher’s engagement of the person being interviewed in a face-to-face encounter and bodily rapport, skills of focused attention, sensitive listening and attunement, and immersion in the qualitative data collected (Wertz, 2005; Churchill, 2010; Josselson, 2013). Employing this qualitative approach to inquiry, which has been described as “retrieval” or “depth phenomenology” (Churchill, 2010, p. 86), opens up access to meanings that may be hidden, but revelatory in helping to demystify suffering experience.

The meanings of the Maternal that I have accessed in the main and follow-up studies are multiple, and include the constituents of empathy, receptivity, Maternal holding and cradling, relational intimacy and generosity, unconditional loving care, and well-being and generativity in a welcoming home. I make a clear distinction between the Maternal as a general experience, and what is more commonly described as “mothering,” meaning the parenting of a child by a biological mother or mother surrogate, although this is not excluded from the general. I draw upon a broader concept of the Maternal that describes a certain given or condition of possibility in lived-through ordinary experiences of women, as well as men, who have never been biological mothers, surrogates, or parents. This concept of the Maternal builds on earlier work on the mother–child relationship defined in the literature on attachment (Bowlby, 1957, 1958, 1960, 1965, 1989; Bretherton, 1992), psychoanalysis (Freud, 1948, 1952, 1954, 1965), and developmental psychology (Winnicott, 1965; DeRobertis, 2010). However, it expands this earlier work in framing the Maternal as “pre-given” or a condition of possibility in the lived world not confined to the sphere of influence of the mother figure alone, or to the dyadic relationship, but as belonging to a larger social ecology. Maternal dimensions of existence may be located in social networks (Takahashi, 2005), and in non-human things such as the ground we walk on that supports us, the food we eat that nurtures us, or music that holds us, soothes us, and gives us comfort. I attempt to expand consciousness of the Maternal as a ground of the intentional structure of suffering and how it manifests itself in Maternal care-seeking behavior. More generally, the structure of the Maternal as I have articulated it forms a ground for an elder’s founding subject-world intentional connection, as situated against changing horizons and contexts, and in the process of recovering the full life of consciousness and engagement with the world. For the older adults in the chapter narratives, experience of the Maternal—recollected and re-enacted in later life—is thematized in the anchoring presence of the Maternal Ground. In its independence from suffering experience, the Maternal is also the ground of human dignity and irreducible personhood—from womb to worlding at birth, in the processes of becoming from birth to death, and in reflective moral action and creative freedom (Marcel, 1949, 1964).

Maternal Ground and Maternal Affordances

The concept of ground as founding is by no means a new one. It figured prominently in Husserl’s description of origins and horizons (Husserl, 1901/1970; Stapleton, 1983), and more contemporary phenomenologists such as Gail Weiss (2008) have made it central to the understanding of identity and social change. In identifying a general structure of suffering to which the Maternal is essential, I identify the Maternal as its own eidos of significance—independent from suffering, but founding suffering. The Maternal is a founding first, and borrowing from Gabriel Marcel (1949), a “presence,” (p. 111), “plenitude” (p. 86), or “disposability” (p. 69). Suffering is a falling away from this fullness of being—a condition of our “ontological deficiency” (Marcel, 1949, p. 174). In this sense of suffering, it has tragic dimensions, understood so well by many of the philosophers—Marcel, as well as Hegel, who had a special interest in Sophocles’ Antigone, the Greek tragedy, and its meanings (Roche, 2005; Westphal, 1998).

I have adopted the term “Maternal Affordances” to more fully describe the Maternal Ground and, in keeping with the seminal work of James Gibson (1979), the possibilities that the Maternal Ground makes available to the other. I describe the Maternal as an absolute availability. According to McGrenere a...

Table of contents

• Cover
• Halftitle Page
• Routledge Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• Acknowledgments
• Introduction
• 1 The Dialectics of Suffering and Maternal Care-Seeking in Serious Illness
• 2 The Narrative of Angelique: Maternal Affordances and Maternal Grace
• 3 The Social Ecology of Suffering and Chronic Pain in Serious Illness: Traumatic Losses of Maternal Foundations
• 4 Suffering and Care-Seeking as Moral Experience: Movement Toward Self-Actualization and Spiritual Well-Being
• 5 The Narrative of Camila: Enacting and Re-Enacting Cultural Meanings of Faith and Fidelity
• 6 Suffering as Loss of Community: The Gifts of Grapes and Maternal Grace
• 7 Seriously Ill Older Adults in Recovery: Maternal Environments
• 8 Conclusion: A Call for Broader Social Care Provision – A Maternal Turn in Ethics of Care
• References
• Index