Finding meaning in serious illness and suffering
Rev Kevin McGovern
Issue 32, November 2010
When we experience serious illness, one of our deepest challenges is to make sense of what is happening to us. This article considers how we might do this. It particularly explores John Paul II's Salvifici Doloris, which suggests that Christians might discover meaning by uniting their sufferings with the sufferings of Christ.
Illness challenges us at every level of our being. Modern methods of pain control are extremely effective, but there can still be some residual pain, shortness of breath, discomfort and tiredness. Emotionally, there can be worry, anger, loneliness, depression, anxiety and many other difficult feelings. Socially, there are sometimes drastic changes to our plans, the difficulties of letting down both people we care about and projects we value, and at least some social isolation from the people we love. Illness also presents spiritual challenges. Almost all of us have a narrative which makes sense of our lives, a story in which we are in some sense a hero on a quest. Serious illness requires that we re-consider and revise this narrative and even our understanding of who we are. For people of religious faith, there are additional challenges in discerning the meaning of their illness for their faith and their understanding of God. Out of all this, we find ourselves asking the hard and essentially spiritual questions: Why is this happening to me? What is the meaning of this? What is this all about?
Here are two examples of people with fatal illnesses answering these questions. Towards the end of her twelve-year journey with breast cancer, Rita Magris wrote:
Illness brings out the best in people. They have to find courage they never knew they had.... I didn't realise how much power I had until I had to dig. Each day is urgent and important. I have fitted so much into the last 10 years. 
Or again, a man dying of cancer in his mid-fifties said:
No, I'm not afraid of dying, though I'm finding this hard.... I have a very loving family and so many friends... but I'm deeply alone inside of this. But I'm really only afraid of one thing, of not doing this with dignity. I want to make this, the way I die, my final act of love for my family. I want to do this right! 
In answering these questions, we draw particularly on those things which have already made our lives meaningful, including our relationships, our commitments, and our understanding of who we are. People of faith also draw on their faith, on prayer, and on the rituals of their religion. For Catholics, these include the sacraments, especially the Eucharist, Reconciliation, and the Anointing of the Sick.  Other helpful insights may be gleaned from writings about theodicy – philosophical and theological works which consider how there can be evil and suffering in the world created by God. This article explores a significant but somewhat neglected work of theodicy, John Paul II's Apostolic Letter On the Christian Meaning of Human Suffering (Salvifici Doloris).  Before doing so, however, we should note the importance of this reflection on the meaning of suffering. It is important both for us as individuals and for society as a whole. For each of us as individuals, this reflection helps us make sense of our own times of suffering - and even to continue to endure them. As Viktor Frankl noted, "He [or she] who has a why to live for can bear with almost any how."  As regards society as a whole, contemporary culture regards suffering as "meaningless and hence to be avoided at all costs and by all means." This is one reason why euthanasia receives "substantial popular support."  So perhaps these reflections can also offer the men and women of contemporary society a more life-giving alternative than choosing to be killed.
In his Letter to the Colossians, St Paul wrote, "In my flesh I complete what is lacking in Christ's afflictions for the sake of his body, that is, the church." (Col 1:24) John Paul's Salvifici Doloris is essentially an extended commentary on this text. The pope addressed this theme earlier in his pontificate – for example, in his Address to the Sick at Czestochowa on 4 June 1979 and at Knock on 30 September 1979.  Compared to these early, brief comments, however, the Apostolic Letter is enormously developed in both its scope and its depth. The impetus for this development was the assassination attempt on the pope on 13 May 1981. He almost died. Shot four times, John Paul suffered severe abdominal wounds, massive blood loss, and a cardiac arrest. After five hours of emergency surgery, he endured a slow recuperation with some setbacks and further surgery along the way. During this time, as most of us would, John Paul pondered the deep questions of the meaning of suffering. Salvifici Doloris is the beautiful fruit of this reflection. 
It is also clear that these insights remained with the pope for the rest of his life. In 1994, his message for the Second World Day of the Sick was about this Apostolic Letter. In the same year, when he answered a series of questions for an interview, he again returned to these insights.  In his later years, John Paul experienced a great deal of physical suffering. From 1991, he suffered increasingly from the trembling hands and slurred speech of Parkinson's disease. Beginning in 1993, a series of falls resulted in broken bones, surgery, and a hip replacement. He relied increasingly on a cane and then a wheelchair. Before his death on 2 April 2005, his final illness spanned several months, and included a tracheotomy and nasogastric tube, a urinary tract infection, fever and septic shock, and ultimately kidney and heart failure. In all of this, he must surely have reflected that he continued to share in the sufferings of Christ.
Salvifici Doloris was released on 11 February 1984. It is about seventeen thousand words (including about a thousand words of footnotes). It has eight sections, which we will consider in turn:
1. Introduction (#1-4)
The pope notes that suffering is a "universal theme that accompanies man at every point on earth." It "thus demands to be constantly reconsidered." He adds that suffering "seems to be particularly essential to the nature of man." Belonging to "man's transcendence," it is "one of those points in which man is in a certain sense 'destined' to go beyond himself." (#2) He also adds that it is on the "long path of suffering" that "the church at all times... should meet man." (#3)
2. The World of Human Suffering (#5-8)
In this section, John Paul reminds us of the vast array of human suffering. He offers many examples from the Bible and from recent world history. There is both physical suffering, and emotional or "moral" suffering.
The pope adds that people suffer when they experience any kind of evil. Such evil is essentially a "lack, limitation or distortion of the good." Thus, "man suffers because of a good he does not share... He particularly suffers when he 'ought' – in the normal order of things – to have a share in this good and does not have it." (#7)
3. The Quest for an Answer (#9-13)
One possible explanation for suffering is that it is punishment for sin or wrongdoing. As John Paul II notes, this possible explanation is explored in the Old Testament book of Job. Job is a good man who undergoes enormous suffering. His friends – Job's Comforters – come, and try to convince him that his great suffering must mean that he has sinned greatly. Job protests his innocence. Ultimately, God appears, confirms Job's innocence, and rebukes Job's friends. From the book of Job, we may conclude that "it is not true that all suffering is a consequence of a fault and has the nature of a punishment." (#11) However, for a fuller explanation for suffering, we must turn to the New Testament and to Christ.
4. Jesus Christ: Suffering Conquered by Love (#14-18)
At the beginning of this section, the pope expands his analysis of suffering and evil. There is temporal suffering and temporal evil – that is, suffering and evil in this world. But there is also definitive suffering and definitive evil – suffering and evil in the world to come: "the loss of eternal life, being rejected by God, damnation." (#14) Christ's messianic or salvific mission is to overcome suffering (both temporal and definitive), as well as sin and death.
Christ's healing miracles are therefore part of his messianic activity. But above all Christ fulfilled his mission through his suffering and death. Christians believe that Christ is both truly God and truly human. Christ's suffering was therefore truly human suffering. But at the same time, because he is also the only-begotten Son of God, Christ was able to take on the full measure of human sin, "embracing the measure of evil contained in the sin of man: in every sin and in 'total' sin."  His suffering under the "horrible weight" of this sin was immense. (#17)
Salvation was achieved because Christ did not turn away from this intense suffering but instead through it all continued to love. "In his suffering, sins are cancelled out precisely because he alone as the only-begotten Son could take them upon himself [and] accept them with... love." (#17) Through the passion and death of Christ, human sin and human suffering have "entered into a completely new dimension and a new order." They have been "linked to love... to that love which created good, drawing it out by means of suffering." (#18) In this encounter, sin is conquered, death and definitive suffering are overcome, and even temporal suffering is transformed. In the next section, John Paul will reflect further on the transformation of suffering even in this world.
5. Sharers in the Suffering of Christ (#19-24)
Four sentences from the Apostolic Letter summarise this section: "In the cross of Christ not only is the redemption accomplished through suffering, but also human suffering itself has been redeemed.... In bringing about the redemption through suffering, Christ has also raised suffering to the level of redemption." (#19) "Man, discovering through faith the redemptive suffering of Christ, also discovers in it his own sufferings; he rediscovers them through faith, enriched with a new content and new meaning." (#20) "Insofar as man becomes a sharer in Christ's sufferings – in any part of the world and at any time in history – to that extent he in his own way completes the suffering through which Christ accomplished the redemption of the world." (#24)
For Christian believers, this section presents a great challenge. If we believe that Christ brought salvation through his suffering, are we able to see our own suffering as our share in the sufferings of Christ? And are we able in this way to find meaning in our own suffering?
6. The Gospel of Suffering (#25-27)
Even as he recovered from an assassination attempt which almost killed him, John Paul did appreciate that he was sharing in the sufferings of Christ. For this reason, he is able to discuss in this section the Gospel of Suffering. As he notes, the Gospel of Suffering "signifies... the revelation of the saving power and salvific significance of suffering in Christ's messianic mission and subsequently in the mission and vocation of the church." (#25) This involves firstly "suffering 'for Christ'" – "persecutions" or "tribulations experienced because of Christ." But it also involves "all those who suffer together with Christ, uniting their human sufferings to his salvific suffering." (#26)
As well as contributing to the salvation of the world, such suffering can transform the person suffering. For example, John Paul notes that many saints including Francis of Assisi and Ignatius of Loyola underwent profound conversion during times of illness. The pope offers at least two comments about this transformation. Firstly, it occurs through the grace of the crucified Christ and the power of the indwelling Spirit. And secondly, "it often takes time, even a long time." (#26) 
7. The Good Samaritan (#28-30)
To this point, John Paul has considered suffering from the perspective of the sufferer. In this section, he uses the parable of the Good Samaritan to consider suffering not from the perspective of the sufferer but from the perspective of those who encounter the suffering person. Quite simply, our task in these circumstances is to be like the Good Samaritan: to notice the suffering person, to stop whatever else we are doing, to feel compassion for them, and to provide them with generous help. Thus, the pope suggests that suffering "is also present to unleash love in the human person," and that "the world of human suffering" should summon forth "the world of human love." (#29) This is a challenge for all of us. It is perhaps a particular challenge for those who work in health care. 
8. Conclusion (#31)
The Apostolic Letter's conclusion summarises its main insights about the mystery of suffering. And we are left with much to ponder: Whether we are Christian or not, how might we find meaning in our times of suffering? If we are Christian, might we find meaning by uniting our sufferings with the sufferings of Christ? And if we encounter people who are suffering, are we able to respond to them like the Good Samaritan?
 Rita Magris, in A Life Well Lived: A Decade of Palliative Care at Cabrini Prahran, ed. Amanda Place (Melbourne: Cabrini Health, 2009): 16-21 at 20.
 Ron Rolheiser, "Blood and Water Poured Out!" Ron Rolheiser, http://www.ronrolheiser.com/columnarchive/archive_display.php?rec_id=391
 For a thoughtful examination of how the prayers and sacraments of the Catholic Church help us find meaning in illness, suffering and death, see Vivian Boland, "The meaning of suffering and death in the Catholic Faith," European Journal of Palliative Care 19, no. 1 (2010): 18-21.
 John Paul II, On the Christian Meaning of Suffering (Salvifici Doloris), Holy See, http://www.vatican.va/holy_father/john_paul_ii/apost_letters/documents/hf_jp-ii_apl_11021984_salvifici-doloris_en.html
 Viktor E. Frankl, Man's Search for Meaning, trans. Ilse Lasch (London: Hodder and Stoughton, 1964): 76, 106. Frankl is quoting Friedrich Nietzsche.
 J. Daryl Charles, "Protestant Reflections on Salvifici Doloris," National Catholic Bioethics Quarterly 2, no. 2 (Summer 2002): 211-220 at 212.
 John Paul II, "Address to the Sick at Czestochowa" and "Address to the Sick at Knock," Holy See, http://www.vatican.va/holy_father/john_paul_ii/speeches/1979/june/documents/hf_jp-ii_spe_19790604_polonia-jasna-gora-ammalati_en.html & http://www.vatican.va/holy_father/john_paul_ii/speeches/1979/september/documents/hf_jp-ii_spe_19790930_irlanda-knock-ammalati_en.html. Even before Salvifici Doloris, George Hunston Williams noted this and recognised a "very important shift of emphasis in [this] Pontiff... [Christ] is in the suffering, not the poor as such." For this, see George Hunston Williams, The Mind of John Paul II: Origins of his thought and action (New York: Seabury, 1981), 295-296.
 Peter J. Vaghi, "Challenge and Opportunity: John Paul II on the gift of Christian suffering," America 193, no. 13 (31 October 2005): 19-21 at 20.
 John Paul II, "Message for the Second World Day of the Sick," Holy See, http://www.vatican.va/holy_father/john_paul_ii/messages/sick/documents/hf_jp-ii_mes_08121993_world-day-of-the-sick-1994_en.html; ________, Crossing the Threshold of Hope, ed. Vittorio Messori (New York: Alfred A. Knopf, 1994), 25.
 In 1099, St Anselm of Canterbury wrote the enormously influential Cur Deus Homo? When Man sinned, Anselm argued, he incurred an infinite debt to God. Only a Man should pay this debt. However, only God could pay this infinite debt. Therefore, Anselm concluded, only a God-Man both could and should reconcile God and Man. John Paul's argument here obviously has echoes of Anselm's. However, whereas Anselm spoke of forensic debt, John Paul speaks of the existential or ontological transformation of suffering by divine love. In my opinion, this is a very significant development.
 John Paul also notes that Christ does not offer an "abstract" or theoretical explanation for suffering. (cf #26) To the contrary, suffering "always remains a mystery" and "we are conscious of the insufficiency and inadequacy of our explanations." (#13) What Christ offers instead is not an answer made of words, but rather an answer made of life: "as the individual takes up his cross, spiritually uniting himself to the cross of Christ, the salvific meaning of suffering is revealed before him." (#26) John Conley notes perceptively that in this the pope "challenges the power and range of metaphysical reason." For this, see John J. Conley, "The Limits of Metaphysical Reason: Re-reading John Paul II," Proceedings of the American Catholic Philosophical Association 76 (2002): 117-123 at 117, cf 119-121.
 When John Paul II visited Australia in 1986, he met with sick and disabled people and their carers in Brisbane on 25 November. Significantly, he reminded "those who work with the disabled, the handicapped and the sick" that they "have chosen – either professionally or as volunteers – the life of the Good Samaritan..." For this, see John Paul II, "Address to the Handicapped, Sick and Disabled People," in The Pope in Australia: Collected Homilies and Talks (Homebush, NSW: St Paul, 1986), 32-35 at 34.
All online documents accessed 20 May 2010.
Rev Kevin McGovern is Director of the Caroline Chisholm Centre for Health Ethics in Melbourne, Australia. This article originally appeared in the Chisholm Health Ethics Bulletin Winter 2010. The Nathaniel Centre is grateful for permission to reprint this article for our readers.