Witness to suffering

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As a doctor, a lot of the care that I provide has nothing to do with prescribing medications or performing procedures. Sure, they form a significant part of my training and my day to day work. However, there are also many times where all I can provide for the patients is my presence, to be a witness to their suffering and to create space for them to grieve and mourn.

This was a huge revelation to me in the earlier stages of training – recognizing that there are many things we can’t just “fix” in medicine, and that care doesn’t end with telling a patient “I am sorry, there is nothing we can do”. I never realized how difficult it is to be truly present to witness someone’s suffering until I had to do it myself. It is so easy to give into the temptation to comfort, or to give false hope or even mislead. At the beginning, I told myself that it is because I care deeply about the patients, and it was difficult for me to watch them suffer. However, the more I did this, the more I realized I was NOT helping these patients by quickly wrapping up their suffering in a neat package to replace it with something prettier – I could see how this made them feel confused and lost. Why then, was it so hard for me to change my behavior?

Problem solving engages the prefrontal cortex of our brain – the part that allows us to reason, filter and regulate our emotions. Being forced to turn away from problem solving therefore leaves us feeling exposed, out of control and yes – vulnerable. However, in turning away from problem solving, we can truly be present and focus entirely on the suffering of the individual in front of us. In psychiatry, this is called “holding space”. Having the space to grieve without feeling pressured to go into problem solving mode can be a deeply therapeutic experience that allows one to just “be” and not be judged.

Think about our daily lives – how often do we simply listen to our friends, family or significant others and be fully present to witness their experiences? As children, how many of us had the luxury of this experience when we tried to share difficult experiences with our parents?

I tried to imagine what it would feel like to have someone fully present to witness my suffering, to have an understanding of how this could help my patients. My mind shifted to when I pray or meditate at my altar. Sometimes, I am looking for answers – but more often than not, what I desire is to have the time to sit in my grief and to let it all out, and to have someone sit WITH me in my grief. The sheer presence of my goddesses and spirit guides had always comforted me in my darkest times, and this is what I could do for my patients when there is nothing else I could offer as a doctor. Simply being present in their suffering was a service I could provide in those dark moments.

Now, when I deliver bad news, I sit with them, quietly, with a tissue box in my hand. I stay present with their grief, and in doing so I hold space for them to process their suffering.

It is true that this is much harder with family and close friends – those who we consider part of ourselves and can make us feel particularly vulnerable when they share their suffering. Practice makes perfect and I am still working on it.

Shadow Work and Projection

Lately, I have been noticing that “Shadow Work”, a concept originating from psychoanalytic theory, has been appearing more than ever in mainstream media. I often hear it in the context of Wicca, a modern religion combining witchcraft practices and psychological principles, as well as many other spiritual paths.

In psychology, the Shadow is an analytic principle that identifies the part of one self that has been split from one’s conscious identity. While it is hidden from one’s conscious mind, this Shadow forms a significant part of one’s personality and how they relate to the world. While different branches of psychoanalysis calls the Shadow by different names, they generally agree that identifying the shadow is an important part of psychotherapy as it brings into awareness one’s behavioral patterns, in particular in relationships with others, that has been hidden from their conscious mind. For example, imagine a girl who has been raised by an unpredictable mother who would swing from being verbally and physically abusive to the most loving creature in the world within a split second. A belief forms in her that adults, or authority figures in general, are dangerous and not trust worthy, and that she is not worthy of receiving unconditional love and care. This belief, this way of seeing the world is so painful for her that she represses it deep into her unconsciousness – it becomes her shadow. As an adult, she has recurring issues in her life resulting from rejection of authority figures and accepting love or care from others, particularly from those that remind her of her mother. Unconsciously, she projects her belief that authority figures cannot be trusted and that she is unworthy of love and support whenever she meets a person or a situation that triggers this shadow to reappear, lifting her away from reality and making her see the world through the veil of her shadow.

Shadow work as a Wiccan principle centers around identifying one’s shadows and bringing them into consciousness, so that one can ask for help from spirits, gods and goddesses of the highest good to integrate the shadow into one’s true self. Working through one’s shadow is thought to allow for the emergence of a more whole, and integrated self, which makes them more aligned with the Universe and their magick more powerful.

The concept of the shadow has existed far before modern psychology and Wicca. Many spiritual paths dating back thousands of years and religious teachings have identified the role of the unconscious mind in how we see the world. Many meditation practices, in particular, focuses on making room for one’s shadows to appear into the conscious mind so that they can perceive the world as it is without the cover of the shadow. In Buddhism, it is said that when Buddha was born, he looked up at the sky, down at the earth, and said “Between the earth and the sky, only I exist”. There are a number of different interpretations for this saying. My favorite one is that Buddha understood that he himself, was most responsible for how he sees and relates to the world; that he understood that only himself is the true builder of his Universe.

What can we do then, once we become aware of this shadow? Freudian psychoanalytic theory states that bringing the shadow into one’s awareness, also known as “insight” is enough of a treatment in itself to alleviate the impact of one’s unconscious influences in their psychopathology. Internal family systems talk about making space for the shadow in one’s mind by accepting it and allowing it to co-exist peacefully with the other parts of one’s identity, so that they can be integrated into a more mature and resourced part of themselves. Dialectic behavioral therapy, which incorporates a significant amount of its techniques from Zen principles, suggests that one should mindfully notice, without judgment, one’s shadows as they emerge, accept and honor them, AND at the same time, make an active effort to see the world without the influence of their shadow. In Gabrielle Berstein’s “Universe has your back”, she shares a mantra/ prayer where she beautifully demonstrates this principle of honoring one’s shadow while a making a commitment to see the world without it.

In ancient witchcraft or paganism, the influece of the Shadow or the unconscious was at times descirbed as being “posessed” by the evil spirits and energies from one’s past. For example, exorcims or banishing spells were often targeted at expelling the evil spirits hunting a person’s mind that originated from a traumatic event(s) from their past, such as war or rape, producing anxiety, depression, and even psychosis.

As a physician and a practicing witch, I find myself adopting both approaches. As you have probably already guessed, the above example of the abused and neglected girl is my own story, my own shadow. Using the psychoanalytic theory, I recognize that unconscious beliefs originating from my childhood trauma influences how I relate to others and the world. I try to keep this in mind when I find myself suddenly spiraling into fear-based decisions and judgements of others so that my world is not always covered by my shadows. I embrace my younger self and tell her, Of course you had to guard yourself from trusting authority figures, because trusting them was not SAFE. I understand and honor you, and I also recognize that we are at a safer place now where we are surrounded by wonderful mentors and have the resources to defend ourselves. I also recognize that I am still hunted by the evil spirits of my past, the spirits that hunted my mother, and hunted her mother. I ask for strength from my goddesses and higher spirits to help me see the world in its truth, and to shine light in my path to banish the evil spirits of my past. I used to struggle with consolidating magick and medicine especially with matters of the mind, seated in the brain which we understand so little about. Now, I understand that they are in fact two slightly different paths that ultimately aim to get us to one shared destination – moving us closer to peace and love.