Embracing Cicely Saunders's concept of total pain

doi:10.1136/bmj.331.7516.576-d

BMJ 2005;331:576-577 (10 September), doi:10.1136/bmj.331.7516.576-d

Letter

Embracing Cicely Saunders's concept of total pain

The first 150 words of the full text of this article appear below.

EDITOR—Dame Cicely Saunders defined the concept of totalpain as the suffering that encompasses all of a person's physical,psychological, social, spiritual, and practical struggles.¹Coyle also wrote that a diagnosis of a life threatening illnessjars open a door of awareness,² the same door that, for mostof our lives, comfortably allows us to keep thoughts about deathin the background.

For many people the opening of this door precipitates a crisisand an acute encounter with great total pain. All of this occursin the context of a modern society that is ill equipped to handlenews of possible death.³ Consequently, after diagnosis of alife threatening or life limiting illness, a patient's closefamily and friends may deny that their loved one is dying ormight die from his or her illness. Additionally, as death isnow routinely hidden from social view and medicalised,^4
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