Finding Meaning in Illness

Very often when a patient is confronted with the diagnosis of a severe illness that can have life-changing consequences or a terminal illness that is actually life threatening, the inevitable questions raised are “Why me?” or “How did this happen?” or “Why do I have this diagnosis?”

Donald M. Friedman, MD
Donald M. Friedman, MD

These questions bring up many troubling issues, many of which can never be fully understood or answered.  They are a natural part of the shock and feeling of powerlessness that follow the delivery of medical bad news.

They can also signal the start of a spiritual journey that can be quite rewarding and healing for the patient, even if a cure is not imminent or possible, or they can lead a patient down a dark path of despair and despondency that can have a significantly negative effect on the disease progression and, in the case of a terminal illness, on the quality of the patient’s remaining time.  This article discusses the positive responses one can embrace when searching for the meaning of an illness.  The way the patient deals with this question can have a potentially enriching effect not only on the patient, but also on the patient’s family, friends, and caregivers.

But first of all, if the patient regards his/her illness as a punishment for some negative actions or thoughts from the past, this needs to be addressed.  There are documented cases where such patients actually refuse treatment or have poor responses to therapy because they feel they deserve the disease and don’t have the right to get well.

The idea of a punishing God who rewards good deeds and punishes those who don’t live righteously is present in parts of the Torah and some Jewish writing.  But everyone knows there are many examples of bad diseases or difficult events happening to very good and observant people who help others and make a positive difference in the world, and there are also cases of malevolent, destructive people who are never afflicted with anything.  In his book, When Bad Things Happen to Good People, Rabbi Harold Kushner writes that bad things happen in the universe in a random way unrelated to God’s will.  These events are more easily explained by the natural law that is part of the way God created the universe.  If a patient focuses on his/her illness as a punishment, that patient must be counseled to resolve those feeling of guilt.  Failure to help the patient in this area can negate the effect of any medical regimen.

So how can one search for a more positive meaning in having an illness?  As Rabbis Myriam Klotz and Dayle A. Friedman in the book Jewish Pastoral Care and Rabbi Douglas Kohn in the book Life, Faith, and Cancer comment, the more helpful question is not “Why me?”, but “How can I respond?”.

The answer to “Why me?” is, according to the book of Job, unanswerable and unknowable and in the long run, not that important.  What is important is how the patient deals with, accepts, and emotionally responds to the diagnosis and finds meaning in the suffering that may be involved.  The “responding” can be on two levels.  The first is learning about the disease one may have and participating in the medical treatment recommended and taking care of oneself physically.  The second is recognizing that the illness is an opportunity to grow and also reevaluate your life, making changes that can help you evolve spiritually and even alter your life in a new spiritual direction.  You can even redefine yourself and have a new relationship with who you really are.  There is a potential for even greater insight into what life and death are all about and the mystery that faces all of us.  It is a chance to forgive oneself and others and live more fully despite the disabilities or time restrictions a disease may impose.

Christina Puchalski, Director and Founder of The George Washington Institute of Spirituality and Health, frequently mentions a very important issue along these lines of spiritual growth – patients can learn and also teach others how to live in the present moment and how to appreciate those moments as a blessing.  It is an amazing experience just “to be” and not focus on accomplishments or tasks or obligations.  Try sitting by yourself in a beautiful park without your cellphone, blackberry or any other technological devices and take in all that is around you, savor it, and “be” with yourself.  You will see new things and have new experiences that can enrich your soul.  An illness can foster such awareness too.  Every moment becomes meaningful and precious.

What really matters is one’s attitude toward the disease one may have.  Although it is not easy, if one can let go of previous expectations and the frequently occurring sense of entitlement that many people have, it opens the door to new attitudes that can enrich our lives.  Viktor Frankl, who survived Nazi concentration camps, talked about this very poignantly in his book, Man’s Search for Meaning, when he said, “There is one last freedom that no one can take away from us, regardless of the situation we are in, and that is the freedom to choose the way we view the situation, the freedom to choose our attitude towards the situation.”   This freedom to choose how you approach an illness, how you find meaning in an illness and how you recognize what an illness can teach you about yourself and the world around you is tremendously empowering and helps confront the sense of loss, anger, and powerlessness that frequently accompany a bad diagnosis.

So practically speaking, what can one do spiritually in the face of a serious or life threatening illness?  Basic questions that are helpful to ask include “What really matters to me?”, “How do I want to spend my time, especially if I have a finite period left?”, “What do I still want to accomplish in my life?”, “Do I have a purpose, and if so, what is it?”, and finally, “What is my soul telling me about who I really am?”.  These are challenging questions, and it may be helpful to discuss them with family and friends.  If they cause distress, then help from a therapist, chaplain, or spiritual counselor may be very enlightening.

In their book, Handbook for Mortals – Guidance for People Facing Serious Illness, physicians Joanne Lynn and Joan Harrold talk about the “Four R’s for the Spirit”.

The first is Remembering – looking back on your life and the special events and accomplishments that happened, what you still need to do and what may never be finished, who were your mentors and whose lives did you positively influence, what were your significant relationships and how did they affect you, and what relationships you would still like to have.

The second R is Reassessing – thinking over what your life was really about and what does it say about you and who you really are.  Did what you accomplish materially cut you off from what you wanted to accomplish on a more spiritual level? You may find projects or tasks you still want to complete that don’t take much physical effort to get done.  You may want to tell cherished people that you appreciate them; this can make a tremendous difference in their lives and yours.  You may find you’ve already done enough and can sit back and enjoy the serenity that this awareness brings.

The third R is Reconciling – not only with yourself, but also with significant people in your life.  You can forgive yourself for not being perfect, not getting everything done that you wanted to, not always behaving in a way you were proud of, and not being everything you wanted to be.  It is also a time to forgive others and ask for forgiveness for yourself.  Focusing on these issues at a critical time can allow the illness to have meaning because of the peace that can be created by your actions and acceptance.

The final R is Reuniting – with loved ones from family or friends, especially the people you haven’t seen for a while.  It is important to be physically with the people whom you love and who have mattered and made a difference in your life.  It is part of the affirmation of who you are.  It can strengthen your spirit either to keep going when there is more to do and progress to be made toward recovery or surrender peacefully to the inevitable when not much more can be done medically.

Finally, from a distinctively Jewish perspective, our rich heritage provides some suggesstions for dealing with the randomness and uncertainty in our world and the suffering that can be inherent in an illness.

Rabbi Myriam Klotz in her cogent piece, “Wrestling Blessing: A Pastoral Response to Suffering” (in the book Jewish Pastoral Care)  says that the U’netaneh Tokef, the main prayer of the High Holiday services, gives three suggestions on how to respond to suffering and find meaning.  They are Teshuvah (repentance), Tefilah (prayer), and Tzedakah (good deeds or righteous action).

Teshuvah is the chance to learn from past mistakes and difficult behavior so that you can forge a new way of life that is more constructive and enriching.  It is using the wisdom you’ve gained to live in a better way.  It is a chance to grow and change, even under difficult physical and emotional circumstances, and rededicate your life to realizing your potential.  An illness can force you to confront how you’ve lived your life and offer you an opportunity to consider living it differently.

Tefilah, prayer, can force us to turn inward, much the way meditation can do, and to find our real souls and who we are.  Prayer can reveal our inner strengths and potential as well as act as a connection to God who can be a source of strength, comfort and peace to those enduring suffering.

Tzedakah, good and righteous deeds, can make one aware of inner compassion toward others who are also suffering as well.  By giving of one’s resources or physical efforts to help the suffering of another, one can lessen the pain of having an illness by seeing the humanity and common experience that we share.  In addition, by helping another, one can give meaning to one’s life even amidst the pain and suffering of having an illness.  Thus, Teshuvah, Tefilah, and Tzedakah can help a patient expand his/her outlook, experience, and inner and outer awareness leading to growth, change , and transformation in the face of illness.

In summary, it is very possible to find meaning in having an illness.  If one redirects effort from trying to understand or explain why the illness happened to how one responds to the illness, what the illness can teach, and how the illness can lead to growthful transformative changes, the course of that illness may be more positive, and the quality of life, even with a terminal diagnosis, can vastly improve.

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