Working with suffering.

The past century has shown that human beings are capable of genocidal destruction of millions of other humans based on ethnicity or race. Clinicians today are likely to encounter patients who are survivors of inflicted atrocities and abuse. People fleeing horrendous circumstances bring persisting memories that produce symptoms even for the next generation. Families carry the knowledge-personal, cultural, familial, and sometimes individual-of the depths of destruction that human beings can do to one another. Suffering derives from the memory, both physical and mental, of what other persons inflicted; it has multiple dimensions that patients may not express explicitly; instead they may frame their experience of suffering in terms of pain. Diagnostic labels such as post-traumatic stress disorder or somatization are inadequate to convey human comprehension of suffering. Clinicians around the world need to be willing and able to acknowledge and witness the profound sources of experiential pain in the lives of their patients.