TY - JOUR T1 - Suffering and hope: Helen Lester Memorial Lecture 2016 JF - BJGP Open JO - Br J Gen Pract Open DO - 10.3399/bjgpopen17X100605 VL - 1 IS - 1 SP - bjgpopen17X100605 AU - Christopher Dowrick Y1 - 2017/04/05 UR - http://bjgpopen.org/content/1/1/bjgpopen17X100605.abstract N2 - In her magnificent 2012 James Mackenzie Lecture, Helen Lester directly challenged the persisting stigma of mental illness, calling us all to change from being bothered by to bothering about Billy, a homeless, alienated human being living with psychosis. She talked passionately about her drop-in medical service for the homeless of Birmingham, where she heard stories of unemployment and divorce, of childhood traumas and teenage breakdowns, and how she was ‘... left with an unshakeable impression that psychosis was something that primary care could and should engage with.’1 Helen demonstrated in this lecture, and in her life’s work, two themes that are fundamental to medicine in general,2 and to primary mental health care in particular: acknowledging suffering and offering hope. These are the themes that I wish to discuss, in her memory, this evening.I will explore our ambivalence to acknowledging suffering, how despite our best intentions we often find it hard to really listen to our patient’s distress, and I will suggest some things that might help us to listen better. I will then discuss how we can offer hope: through compassion, by being thoughtfully positive, from the discovery and application of new knowledge, and perhaps by changing the ways in which we think about ourselves and our patients.Acknowledging sufferingListeningWhen presented with suffering, the first thing we need to do is to listen. In the words of psychoanalyst Wilfred Bion, we should be listening without memory or desire: when we listen with memory, we are intent on making the speaker part of an old agenda; when we listen with desire we are intent on making them part of a new one.That suffering may be expressed in poetic form, as composed here in Dublin by Gerard Manley Hopkins:‘No worst, there is none. Pitched past pitch of griefMore pangs … ER -