The Yale Journal for Humanities in Medicine
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Spirituality, Religious Wisdom, and the Care of the Patient
Shame in the Context of Illness: An Islamic/Jewish Dialogue
Introduction
Alan B. Astrow, M.D.
aastrow@maimonidesmed.org
Shame in illness was the focus of our discussion on June 14, 2004, held at the Westchester Medical Center at New York Medical College. Our two speakers were Ahmed Nezar M. Kobeisy, Ph.D., Iman and Counselor for the Islamic Society of Central New York and Moslem Chaplain at Syracuse University and Michelle Friedman, M.D. Assistant Clinical Professor of Psychiatry at Mount Sinai Medical Center and Director of Pastoral Counseling for Yeshivat Chovevei Torah.
Before introducing the topic, I'd will review the discussion that took place last month at Memorial Sloan Kettering to illustrate what it is that we have been trying to get at in this series. The topic then was sadness and our two discussants were a Franciscan priest, Father Richard Rohr and Rabbi Chaim Seidler-Feller.
Rohr talked about the necessity for getting out of what he called "the fixing mode." He advised Christians not to worship Jesus, but to follow him, follow him into sadness, a sadness symbolized iconically in the crucifix. This advice would echo suggestion of secular theorists of physician-patient communication that physicians and nurses learn not to respond automatically to strong emotion on the part of the patient by offering immediate reassurance. The suggestion is that we first listen, explore and validate the emotion, and then offer an empathetic response. For a believing Christian, I would think that the knowledge that in doing so, one is following in the path of Jesus, would deepen the experience of accompanying the patient.
Seidler-Feller approached the topic from the opposite viewpoint, though it had not been planned that way. Citing an 18th century Hasidic gloss on the story of Cain and Abel, in which Cain was saddened when his sacrifice was not accepted, Seidler Feller warned about the danger of holding on to sadness. Sadness, he taught, may lead to resentment and ultimately as with Cain and Abel to sin. We are commanded to feel joyful and to help those overcome with grief to re-discover joy. This might echo the advice that we always offer our patients a strategy, a shred of hopefulness even when the outlook is not good, that we hold to the essential goodness of life, even in the face of sadness. For a practicing Jew, the knowledge that in doing so, one is performing a mitzvah-carrying out a commandment, also offers the potential to deepen the physician's commitment to the patient.
For the purposes of this series, the two talks served to demonstrate that religious wisdom is directly relevant to the practice of medicine-though it takes some work making the connection, and that different religions, by viewing the same problem from a slightly different perspective, can complement and teach one another.
Shame in illness, like sadness, is an emotion with spiritual overtones. Ever since Adam and Eve covered themselves with fig leaves, shame has played a central role in how the body has been viewed in Western culture. Shame has been identified both with the sense of failure and with the experience of unwanted exposure. Illness may be a source of shame because illness is a reminder of bodily limitation and lack of control. Patients may experience shame at any loss of function and may also feel shame out of sense that illness is visible evidence of their own personal failings. Patients may feel that they no longer fit in, are no longer complete, and are may feel secreted shamed and excluded.
Physicians and nurses need to be aware of these emotions because they can cause patients real pain that can significantly worsen the suffering caused by illness. And on an immediately practical level, patients may out of shame avoid disclosing to physicians crucial and even potentially life saving information. The Libby Zion case, where physicians lack of full awareness of a young woman's medications and habits may have contributed to her death, comes to mind.
Physicians too may feel shame when the treatments they offer fail the patient. These emotions if unacknowledged, may potentially damage the relationship between physician and patient. This may occur if the physician's feelings of shame lead the physician, for instance, to avoid visiting a patient, or if an effort to avoid painful feelings of shame the physician insists on providing treatments that are no longer working.
Religions have a complex relationship to shame sometimes helpful sometimes not. Clergy may not always be well trained in addressing the emotional impact of illness on the patient and the patient's family. In that regard, physicians and clergy may have much in common. We asked our speakers to outline how their tradition addresses shame and whether their tradition offers beliefs and practice that may help a patient both acknowledge and overcome these feelings.
Michelle E. Friedman, "Shame and
Illness - A Jewish Perspective"
Ahmed Nezar Kobeisy, "Shame in the Context of
Illness - An Islamic Perspective"
Table of Contents
Published: September 17, 2004