Currently in medicine, theories of pain regard pain and suffering as one and the same. It is assumed that if pain ceases, suffering stops. These theories are not substantiated in clinical practice, where some patients report little pain and extreme suffering and other individuals have a lot of pain and virtually no suffering.

Based on the results of a scientific questionnaire, as well as evidence from and conversations with hundreds of patients, Beverley M. Clarke argues convincingly that suffering is often separate from pain, has universal measurable characteristics, and requires suffering-specific treatments that are sensitive to the patient's individual psychology and cultural background. According to Clarke, suffering occurs when individuals who have experienced a life change because of medical issues perceive a threat to their idea of self and personhood. This kind of suffering, based on a lost"dream of self," affects every aspect of an individual's life. Treating the patient as a whole person-an approach that Clarke strongly advocates-is an issue overlooked in the majority of chronic care and traumatic injury treatments, focused as they are on pain reduction.

Clarke believes passionately that the management of suffering in medicine is the responsibility of all health care practitioners. Until they come to identify and understand suffering as distinct from pain, the entire health care system will continue to carry the financial and moral burden of incomplete diagnoses, inappropriate referrals for care, ineffective treatment interventions, and lost human potential.