What About the Witness to Pain and Suffering?

by Kaethe Weingarten, PhD, founder and director, the Witnessing Project, and associate clinical professor of psychology, Harvard Medical School, 1981–2013

Whether we like it or not, all of us are witnesses to violence and violation. Sometimes the violence we observe occurs between people we know. At other times, we may just happen to be somewhere – in a neighborhood park, for example – and see a gratuitous example of violence, such as a mother swatting her toddler hard on the buttocks. Unexpected scenes may accost us when we are following our usual routines, like turning on the television moments before our favorite show and having the horrific dramatic finale of the previous program assault us. Or, a once-in-a-lifetime occurrence happens that creates a disturbance that ripples throughout our lives.

Grace’s accident catapulted her family, friends, colleagues, healthcare providers, and community into the position of witnesses to her extreme physical, emotional, and spiritual suffering. While they may not have experienced the degree of trauma that Grace did, they experienced trauma nonetheless. As noted trauma scholar Judith Herman, MD, wrote: “Witnesses as well as victims are subject to the dialectic of trauma.”

Many aspects of trauma are depicted in States of Grace. Witnessing a loved one struggle as Grace does — truly taking in the magnitude of suffering — can be excruciating, and people handle this in (at least) four different ways: A loved one may use denial and avoidance, seemingly feeling nothing and withdrawing to manage that which is overwhelming. Alternatively, a loved one can stay fully aware of the person’s situation but feel overwhelmed by it, leading to fear, despondency, helplessness, loneliness, and demoralization; while empathically in touch with the person, the loved one cannot mobilize an effective response. By contrast, a family member may protect him or herself by emotionally distancing, not allowing the impact of the person’s situation to come into focus, yet still give advice or make suggestions, thus behaving in ways that are misguided, clumsy, intrusive, and likely hurtful; at the very least, this person’s behavior will be experienced as unsupportive when support is so very necessary. The only position that works is if the loved one is able to stay aware of the person’s experience and act in ways that are attuned, aligned, and useful.  

These positions are not static or stable. In one phase of an illness or recovery from an injury, a loved one may feel unable to cope; in another, quite able. In one phase, a family member may feel great compassion; in another, nothing but frustration. Furthermore, family members, caregivers, and care providers may not adopt the same stance or have the same experience as they witness a person’s suffering. This can produce another layer of tension and conflict in families and support teams.

In a health crisis, some of the traumatic experiences may even happen to the witnesses and not to the patient, who may be asleep or so “out of it” during medical crises, procedures, or interactions with medical staff that she is unaware of experiences that her family or support team have gone through. I have even heard family members describe dealing with the billing department as traumatic!

It is just plain helpful to understand that witnesses, too, are going through something. They, too, are experiencing challenges. It is not just the person who is injured or ill who is affected. Although the experience of being a witness to suffering may be pervasive, people often have no frame, concepts, or language for it. It is a relief to identify it as such and understand how normal it is. Additionally, people do feel better when they can identify actions to take to ameliorate suffering, even if they are small and temporary.