COMMENT

http://dx.doi.org/10.5546/aap.2016.eng.196

Art as an instrument to understand the nature of suffering

We continue with our series of articles regarding Art as an educational tool in medicine.¹ This time, we will describe the nature of human suffering, an inherent partner of patients, their families and health care providers in particular, and of the entire human race in general. In this article, we will explore the nature of suffering in light of Marcel Proust's thoughts, who was an authority on this subject because he embodied both a literary genius and a chronically-ill patient with severe asthma.^2,3

So we will base our analysis on two of Proust's most recognized quotes about suffering, reflected in "The Sweet Cheat Gone"⁴ and "Sodom and Gomorrah"⁵ from his masterpiece In Search of Lost Time. Let us take a look at the first quote: "We are healed of a suffering only by experiencing it to the full".⁴

Here Proust refers to the concept of pain being unavoidable because it depends on circumstances that are external to us (pain is inherent to existence itself); on the contrary, suffering is optional because it is actually a product of our mind. It is our mind that is potentially capable of banishing suffering through re-interpretation; that is what Proust means by "experiencing it to the full". Of course voluntarily seeking pain makes no sense -that would be masochism-, but once pain is here, it should be embraced. This does not mean yielding (resignation), it means experiencing pain with composure in order to achieve its resolution (redefinition). This is to say that, although we may go through painful situations, we are the masters of the approach that we will adopt to face them (Frankl).⁶

This refers to Nietzsche's amor fati (love of fate) or accepting the pain imposed on us to transform it and prevent it from turning into suffering (a useless mental reverberation of said pain) and, at the same time, cast it into actions aimed at overcoming it.⁷

Let us take a look at the second quote from Proust: "Illness is the doctor to whom we pay most heed; to kindness, to knowledge, we make promise only; pain we obey. "⁵

With this concept, Proust conveys the idea that pain is a bitter gift of life since it implies a chance of spiritual growth. Pain shows us our vulnerability and therefore pushes us away from the comfort of our personal space (ego), a place we would have not left spontaneously, and it teaches us to appreciate the value of its absence (pain-pleasure dyad), it overrides our pride, promotes our approach to our fellow men (when pain is shared, it ameliorates) and shows us a path that, if followed, will lead us to development and transcendence. When pain, either physical or spiritual, does not result in suffering but in understanding, it turns into strength (Nietzsche).⁷

Pain may be the engine of personal development; it causes an inner shock (fracture) that is essential for an intellectual restructuring that will lead us to spiritual development. It is because pain makes us uncomfortable that it stimulates change and an ambitious transformation, but undertaking it is our task. Understanding the true meaning of pain (a real and momentary fact) and how it differs from suffering (perpetuation of a mental construct) is highly valuable for health care providers to acquire the ability to mentally grasp their personal suffering and be able to help sick patients comprehend their own suffering in a sort of "spiritual alchemy" that transforms lead (pain) into gold (mental development) (Jung).⁸

To sum up, understanding the nature and goal of suffering is essential for health care providers, both at a personal and an occupational level, and art is a valuable resource to achieve such understanding.

Carlos G. Musso, M.D. , and Paula A. Enz, M.D.

School of Medicine, Instituto Universitario del Hospital Italiano de Buenos Aires, Argentina

REFERENCES

1. Musso CG, Enz PA. El arte como instrumento educativo en medicina. Arch Argent Pediatr 2014;112(6):494-5.         [ Links ]

2. Beutler M. Los hombres de la historia. Proust. Buenos Aires: Centro Editor de América Latina; 1986.         [ Links ]

3. Musso CG. Obras maestras del arte universal y la medicina: En busca del tiempo perdido de Marcel Proust (1871-1922). Evid Actual Pract Ambul 2012;15(2):58.         [ Links ]

4. Proust M. En busca del tiempo perdido: Albertina ha desaparecido. Buenos Aires: CS Ediciones; 2006.         [ Links ]

5. Proust M. En busca del tiempo perdido: Sodoma y Gomorra. Buenos Aires: CS Ediciones; 2006.         [ Links ]

6. Frankl VE. El hombre en busca de sentido. Barcelona: Herder; 1991.         [ Links ]

7. Valesi E. Friedrich Nietzsche. La máscara de Dionisos. Buenos Aires: Lea; 2012.         [ Links ]

8. Jung CG. El libro rojo. Buenos Aires: El hilo de Ariadna; 2012.         [ Links ]