The Lament: Hidden Key to Effective Listening

This free example article is from the recently released 2nd edition of Seeking and Soaring: Jewish Approaches to Spiritual Guidance and Development, published in honor of Rabbi Zalman Schachter-Shalomi. Eds. Rabbis Goldie Milgram and Shohama Wiener, Reclaiming Judaism Press.
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The author of this free article, Barry Bub, M.D., is a skillful and innovative teacher of communication arts, and also has served as a family physician, Gestalt psychotherapist and chaplain. He is also the author of Communication Skills that Heal: A Practical Approach to a New Professionalism in Medicine [3] (Radcliffe Medical Press).

         Simply stated, the lament is an expression of suffering. Since suffering is universal, laments are pervasive everywhere humans are found—from the checkout counter to the workplace to the street corner to the assisted living facility. Laments are particularly pervasive in healthcare settings where patients, their loved ones, physicians, and the staff, all in their own ways, experience suffering. Not surprisingly, the word patient is derived from the Latin word patiens meaning “to suffer.”

         Regardless of where they are found, laments contain elements of hopelessness, helplessness, disempowerment, absence of choice, pessimism, grief, weariness, lack of meaning, isolation—from others, from God, from self—perhaps anger, fear, shame, anguish, self blame, guilt, and cynicism. The chronic lament also includes hope, since when lamenting, the individual is reaching out from a place of isolation, with the hope (often unaware) that the cry will be heard.
         Sometimes a lament becomes chronic, seeming to take over the very identity of the chronic sufferer. Like the playing of a tape, there seems to be an endless retelling of the trauma story, In this case, there is little that the listener can say or do that is helpful and this is one instance when interruption may be appropriate. Normally, what is most indicated is listening.
         Laments involve the vocal expression of suffering. Good examples are provided in the Book of Lamentations. The Hebrew title is Eikhah, meaning "How?!: Like a "howl", the rough sound of this Hebrew word embodies the harshness of the pain. Laments are also found in other books of the Bible, particularly Job and Psalms. For example:

If so, why me, why me - if so - why me? Genesis 25:22

Bitterly she weeps at night, tears upon her cheek. With not one to console her… Lamentations 2:2

I am weary with calling, my throat is dry; my eyes fail while I wait for God. Psalm 69:4

I call God to mind, I moan, I complain, my spirit fails. Psalm 77:4

I am disgusted with life; I will give reign to my complaint, speak in the bitterness of my soul. Job 10:1

Why Lord do You reject me, why do You hide Your face from me? From my youth I have been afflicted and near death; I suffer Your terrors wherever I turn. Psalm 88:15-16

My God, my God, why have you abandoned me; why so far from delivering me and from my anguished roaring?  My God, I cry by day, You answer not; by night, and I have no respite. Psalm 22:2-3

Lord, hear my prayer; let not my cry come before You. Do not hide Your face from me in my time of trouble. Turn Your ear to me when I cry, answer me speedily. Psalm 102:2

The Evolution and Types of Lament

         It is helpful to understand the evolution of a lament. Trauma (physical, psychological, spiritual) always results in losses. These losses need to be borne or carried (suffere Latin to bear or carry) until the self reintegrates around these losses. In the process the suffering is expressed (lament). When listened to, understood and validated the sufferer is no longer as isolated and healing occurs.
         A lament may be considered acute or chronic. The differences are important to recognize so that the proper listening can be provided:

The acute lament

         The acute lament is a normal, healthy, integral part of the healing process. Traumas always result in losses. In the face of sudden severe losses, screaming, crying, bemoaning, and wailing serve to generate the energy that frees the individual from the numbness created by the shock of trauma and allows the traumatized individual to adjust and realign to the new reality.
         With the lament, it is useful to think of energy being transformed into movement. In the acute lament, movement is vertical: "descent for the purpose of ascent" as Rebbe Nachman of Breslov described it in the 18th century.²⁵ [4] Sometimes the deep, dark despair is so severe that descending into it feels like death and then, as hope begins to return, ascending into a world of new possibilities feels like rebirth. The poet David Whyte describes this experience as a descent into "the well of tears".²⁶ [5]
         In the usual course of events, trauma is followed by what we term The Healing Sequence. A simple metaphor that illustrates this healing sequence is one of a child falling and scraping a knee. The injury (trauma) results in pain (suffering), which leads to crying (lamenting); the parent hears and comforts the child (listening) and the child runs off and plays again (healing).      
         In relationship to hashpa'ah, let's take the situation where a person has lost her job. The injury (trauma) results in pain (suffering), which leads to lamenting; the person eventually seeks counseling (listening) and as their pain is witnessed, and their ego marinates in awareness and gradual understanding, life energy returns and ascent into a new, even better direction in her life as it comes into focus (healing). With serious traumas, such as a financial reversal, an accident, an illness, a death, abuse and more, the emotional, spiritual or physical (suffering)—which leads to crying, wailing, collapsing, moaning (lamenting), so that when recognized and validated by the self or another (listening), the losses and suffering become integrated (healing) and the individual moves on.
         Alternatively, with overwhelming trauma the response may be stunned, numbed, silence, just as Aaron was silent when his sons were burned to death by God [Leviticus 10:1-3], In such a situation, movement is frozen rather than directed. For some, this Acute Stress Reaction (ASR) may eventually lead to Post Traumatic Stress Disorder (PTSD). ASR and PTSD can manifest when patients have been exposed to traumas such as accidents, acts of violence, sudden loss of a loved one, acute myocardial infarction, spontaneous abortion, diagnosis of cancer, or even a serious lawsuit.²⁷ [6]

The chronic lament

         A lament may become chronic when grief following an acute trauma is interrupted, disowned, or disenfranchised and there is no opportunity for complete mourning. It may also occur when the onset of trauma is gradual or trauma or overwhelming stress is unrelenting.
         Being denied the transformative power that comes from openly expressing grief, energy, needing to go somewhere, seeps out. The poet Rumi described this in the 13th century: "I spill sad energy everywhere. My story gets told in various ways: a romance, a dirty joke, a war, a vacancy."²⁸ [7]
         The chronic lament is frequently expressed in a flat repetitive way and as such is mostly counterproductive, alienating rather than drawing others closer. This lamenter, needing to be heard, repeats the lament constantly, often unconsciously and in a number of vague ways. It creates a frustrating experience for the listener who may feel helpless and trapped. When the light bulb of awareness goes on and the listener recognizes the repetitions for what they are, a lament, then the listening experience changes. Now the listener becomes empowered and useful, for the lament can be responded to appropriately and sometimes, transformed through the release that yields awareness of desirable change of direction or expression.
         The movement of energy with the chronic lament is circular and non-linear. It does not lead to healing. Dr Simcha Raphael, psychotherapist, calls this "stuck movement". Like a tape recording played over and over, the lament leads nowhere, although may be responsive to skillful help, as will be described below.

Why is recognizing the lament important?

         As already stated, the acute lament is a normal, healthy response to a painful trauma. It is integral to the healing process. Tears have been described as “nature’s way of washing a wound” i.e. removing particles that obstruct healing. Appreciating this, the listening avoids the error of interrupting the process by failing to provide a safe place to grieve or by premature comforting.
         The chronic lament is important for the opposite reason. It may go unrecognized and like a foreign body in a wound, it draws attention to itself and inhibits healing rather than facilitating it. Only when genuine emotion is felt and expressed can the lament begin to shift into constructive action. In other words, when the chronic lamenter experiences sadness or weeps in the course of talking, this is a positive sign.
         Certain groups of individuals are at higher risk for chronic laments—the recently separated or divorced, the unemployed, patients, particularly the elderly and nursing home patients. In these groups, lamenting can be anticipated and responded to quickly and effectively.

How to recognize a lament

         The acute lament is usually obvious. The chronic lament might be recognizable as a chronic complaint. On the other hand it may also be almost totally masked—the individual with a fixed smile, the always joking physician, the cynic, the intellectual, the loner, the disruptive physician (or patient), the workaholic. Consequently, the lament is frequently missed. Similarly the lament may be expressed as physical symptoms such as chronic backache, fatigue, vague abdominal pain, and headaches.

Anticipate it

         Common things occur commonly; therefore expect to hear suffering from certain groups of individuals such as those who are unemployed, nursing home patients, those who are overworked or suffering burn-out, experiencing marital difficulties, recently divorced or widowed, etc.

Listen for clues

         All senses are utilized in active listening. Notice the manner of handshake, eye contact, facial expression, body posture, speech pattern, and choice of language. The theme of the lamenting person’s narrative is often peppered with disempowering words such as buts, can’ts, shoulds, musts, and if onlys. Notice also: hopelessness, pessimism, weariness, loneliness, and negativity.

Notice your own response:

Am I finding myself wanting to avoid this person?
Do I find myself yawning, bored, and irritated by our conversation?
Do I feel redundant here, as if this person doesn’t see me?
Am I hearing a tape and it doesn’t matter if I am in the room or not?
Were we talking and then the conversation became hijacked by a lament?
Do I feel stimulated to offer advice, counsel, or fix a problem?
Do I notice an emotional mismatch? Is the story powerful but the delivery flat and emotionless?

Any of the above suggests one is hearing a lament.

An example of a subtle lament:

         Returning from presenting at a conference, I found myself sharing a cab to the railway station with a young medical fellow. As we pulled up to the station, she commented: "I hope the train is on time. Amtrak is often late."
         She sighed and repeated: "Yes, they’re erratic".
         While we waited for the train, which incidentally arrived on time, she asked what I taught.
         "Listening skills—for example, how to recognize a lament." I responded.
         "What is a lament?" she asked.
         "You just did it, a few minutes ago" I replied.
         She looked at me quizzically.
         "Remember your comment about Amtrak, that was a lament. You sighed as you said it, and you repeated yourself. You know when a word or a phrase is repeated in the Bible, it’s always significant. Same in real life. Neither of us wants the train to be late, but for you it has a special significance."
         We seated ourselves across the aisle from one another. She chatted easily about her job. How fortunate she was to have it. It required some travel, but was otherwise a "plum". There were many perks, such as her recent eight weeks maternity leave instead of the usual six. "Yes," she told me, "my friends envy me having a job I actually enjoy, something unusual in this day and age."
         "How old is your baby?" I asked. "She’s eight months old, the joy of my life. My husband’s babysitting. She will be asleep by the time I get home, I guess," she replied, her smile now less pronounced.
         "Is it hard for you to be away from them?" I asked.
         "It is," she said, her voice now dropped to barely a whisper. "It’s been tough. Still, it’s too good a job to give up." Her eyes were misty.
         Leaning forward across the aisle toward her, in an invisible "bubble" of rapport, I responded that it had to be wrenching having to make the choice between work and baby. Regardless how great the job, her losses were big. She nodded, silent now.
         After a while: "What will you do with the next one?" I asked.
         "No way will I return to work!" her voice now assertive and strong. She then paused for a moment: "So, I was lamenting, ha? Go figure."
         A short while later, when I disembarked at my stop, she flashed a broad goodbye smile. She was sitting straighter. A lightness had come over her.

It is important to note that lamenting, particularly if accompanied by physical symptoms, loss of appetite, weight loss, fatigue, aches and pains may be indistinguishable from, or associated with, a concomitant depression or serious physical illness.

First published in the 2nd Edition of Seeking and Soaring: Jewish Approaches to Spiritual Guidance and Development. Order Now at Amazon.com [8]  or at www.ReclaimingJudaism.org [2]

Appropriate response to a lament:

         At a recent symposium, the speaker was asked what one does when encountering someone who expresses suffering. His answer was to the point: “Simply listen.” He was technically correct – one does listen but he was totally wrong about it being simple. Sure, there are those labeled “born listeners” but the harsh reality is that truly skilled listening, an activity that includes understanding and helpful response requires training, practice and supervision.

         Apart from the notion that listening is a passive, simple activity, there are many other misperceptions concerning listening. One prevalent one is that quality listening is motivated by compassion. The reality is that no one is compassionate all the time and for listening to be compassionate, it must emerge authentically. This generally occurs when one offers support and is listening actively and non-judgmentally. Another myth is that listening is time consuming. Good listening actually saves time in the long run.

The acute lament

A quiet supportive presence is helpful, meaningful, and healing. Silence may be an appropriate and active response since space is being created for grief. Here the listener serves as an invaluable witness to the experience. There are different types of silences—icy, cold, warm, intimate, etc. A helpful image of silence here is one in which "You hold in your heart the person with whom you are sitting, creating a warm silence where s/he knows you are not off somewhere else in your thoughts" (Rabbi Goldie Milgram, personal communication, 2003). Attention to "simple" details, such as having tissues on hand and ensuring privacy is important. Often long after the event, the sensitive role played by the attendee will be recalled with appreciation.

The chronic lament