Series: Seeds of Hope

Title: Facing Sufering

Original title in Spanish edition: Frente al dolor

Author: Roberto Badenas

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Dedicated to all those with whom pain has united me:

To those to whom I have caused pain,

And to those who have made me suffer;

To those who have shared their sorrows with me,

And to those with whom I have shared mine….

And especially, to the millions who suffer

not being able to do anything for them,

Apart from writing presumably on their behalf.

Roberto Badenas

holds a Doctorate in Theology from Andrews University (Michigan, USA). He is a specialist in Biblical Studies and professor of New Testament. From 1990 to 1999 he was dean of the Adventist Theological Seminary at the Adventist University of France (Collonges-sous-Saleve), and from 1999 to 2010, president of the Biblical Research Committee, and director of Family Ministries and Education (EUD, Berne, Switzerland). Before this book, Professor Badenas published many other texts in other languages (including numerous articles), and the books Christ the End of the Law. Romans 10:4 in Pauline Perspective (JSOT Press, Sheﬃeld University, 1985) and Meet Jesus (Autumn House, 1995), also published in Spanish, French, German, Italian, Portuguese, Romanian, and Catalan.

Contents

Introduction: An Ever-Present Enemy 10

Part i. Awareness 15

1 What We Mean By Pain 17

2 Expressing Our Pain 29

3 Heeding the Warning Signs 39

4 A Hard Why to Accept 55Part II. A Clooser Look 71

5 The Enigma of Evil 73

6 Traditional Explanations 89

7 God’s Silence 103

8 Faith and Healing 119Part iii. Support 141

9 Learning to Ease the Pain 143

10 The Keys to Survival 161

11 Aging With Serenity 177

12 Being There at the End 189

13 Facing Death 205

14 Grief and Mourning 225

15 Epilogue: No More Pain 207

Introduction:

An Ever-Present Enemy

Few human experiences are as universal as pain. It is almost impossible for us to go through life without suffering from a health problem, without having an accident, without a friend or spouse, failing us, or without a loved one dying.

We only have to exist to suffer and cause pain. From Adam to the most recent newborn, from Job and Jesus, to the most uncelebrated soldier from the most forgotten war, the shadow of pain darkens the lives of everyone. We are not safe from suffering, regardless of how well we plan our lives. We are all exposed to suffering in one way or another, from our first baby teeth to the last aches of old age. Disease, decrepitude, remorse, existential angst, heartache…. If someone claims never to have suffered, that person has lost his memory. In a myriad of forms, be it acute, violent, dull, excruciating, or persistent, pain wears down the body and oppresses the spirit. It abounds in the life of the poor and ruins the life of the rich. It makes a child cry, disfigures a young person’s body, mars an adult’s face, and slumps the shoulders of the elderly. From the cradle to the grave, our suffering is relentless. Work and pleasure, dependence and freedom, virtue and vice, love and hate, all can make us suffer. Pain is part of our human condition.1We could say that we are no longer children when we realize that a mother’s kiss cannot take away all of our sorrows….

We only have to open a newspaper, walk down the halls of a hospital, or visit any cemetery to prove that this is the reality of life. Suffering haunts us and plagues us.2 In the last years, while I was writing this book, twenty people I know well have gone through some sort of intense suffering, and ten of them have since died. One of them was my father….

In the face of this unforgiving reality, our first instinct is to rise up and rebel in a thousand ways. Any twinge of pain puts the sensitive defense mechanisms of our bodies on alert. Like Ponce de León,3 we seek the fountain of eternal youth or of happiness in pleasures, medicines, therapies, treatments, and a thousand other practices…Like Ponce de Leon we fail to find it. The risk—and the certainty—of suffering and dying dominate our naive dreams. We attempt to avoid or fight both realities, but ultimately resign ourselves to accept them when we have no other choice. The question of suffering is so vast and complex that it would be pretentious to try to cover all of its dimensions ––medical, psychological, social, philosophical, and spiritualin a single book. Thus this book only addresses some of the more practical and existential aspects of pain in our daily life, from my personal perspective of believer. Despite millennia of reflection and research, the realm of pain has yet to be completely explored. This book attempts, in all modesty, to help us face suffering with dignity and realism.

Part One of the book, which is of an informative nature, outlines an awareness of the complexity of the issue and its various implications. Part Two presents a series of theoretical and practical reflections regarding the ultimate why behind suffering and attempts to understand its meaning. Part Three, with the layman in mind, provides simple resources to face suffering with compassion, effectiveness, and tact. The goal is seeking to avoid pain in the first place, and when that is unfeasible, to alleviate it.

The ultimate objective of this book is to help face and cope with the reality of pain as much as possible.

I am not an expert on the subject of pain. I have no doubt that many of my readers, through personal or professional experience, know more of the subject than I do. I write only as a witness, almost as a “suffering subject.” If my optimistic nature tends to dodge pain, my philosophical training, and above all my personal and pastoral experience, have made me quite sensitive to the subject.

This book has been much more difficult to write than my previous books, and undoubtedly it would never have come to fruition without the collaboration of an excellent group of especially dear people. First I would like to thank my physician friends, José Manuel Prat, Miguel Gracia Antequera, Marcelle Lafond, and Caleb Mercier, who were kind enough to review these pages from a professional point of view, and who have provided me with much invaluable advice beyond their respective specialties. My gratitude also goes to my dear colleague Roberto Carbonell, hospital chaplain, who daily confronts suffering and death, for generously sharing his personal testimonies with me; to chaplain Dr. Mario Ceballos, for his helpful contributions in bibliography; to Dr. Angel Manuel Rodriguez, for his useful theological insights; to Dr. Herold Weiss for his intelligent and sensitive thoughts on the subject; to my young friends, Ramon Junqueras and Guillermo Sánchez, for sharing the priceless contributions of their creative talents with me; to Juan Fernando Sánchez, for his tireless and competent editorial assistance, and again, to Marta Prats, for her valuable literary advice and unconditional support.

I write this book out of solidarity with those who suffer, out of a sense of duty, I would almost say “in self-defense,”4motivated by my own rejection and powerlessness in the face of our common experience. This book seeks to answer the following questions:

To what extent is it possible to avoid pain? What can we do to understand pain or learn to control it? How do we transcend pain in order to put this minion of death to the service of life?

As Leon Gieco sang:

“I only ask God

That I not be indifferent to suffering,

That skeletal death does not find me

Empty and alone, without having done enough.”

The Author

1 . «The most basic human experience is pain: “Human reality by nature is doomed to suffering” (Jean-Paul Sartre, Being and Nothingness, London: Routledge, 2003 (1958). “Let us imagine a number of men in chains, and all condemned to death, where some are killed each day in the sight of the others, and those who remain see their own fate in that of their fellows, and wait their turn, looking at each other sorrowfully and without hope. It is an image of the condition of men” (Blaise Pascal, Pensées [Thoughts], § 199). Cf. Eugene C. Kennedy The Pain of Being Human. New York: The Crossroad Publishing Company, 1997.

2 . See Paul Heubach, The Problem of Human Suffering, Hagerstown (Maryland, USA): Review and Herald, 1991, p. 4.

3 . Juan Ponce de León (c. 1460-1521), conquistador from Spain, was the first governor of Puerto Rico and the discoverer of Florida (USA). According to legend, he sought the Fountain of Youth in his travels.

4 . See Ronald Dunn, Quand le ciel est silencieux [When Heaven is Silent], Marne-la-Vallée (France): Farel, 2003, p. 23

Note on Bible versions used: While writing this book, the author simultaneously used three different versions of Scripture: the New International Version, the NASB, and the Message. As the content of the biblical texts cited above is essentially the same, the reader is invited to consult his or her preferred version, even if it is different from the versions mentioned above. The author turns to other versions only on rare occasions (as outlined) or to his personal translation.

Part I

Awareness

“He who increases knowledge increases sorrow.”

Ecclesiastes 1:18

1

What We Mean

by Pain

“Happiness is a fundamentally

negative feeling: the absence of pain.”

Gregorio Marañón

It’s midnight. Our first child, a premature baby boy only two months old, who we had just brought home from the hospital, wakes us crying. His diaper is dry. He doesn’t want the bottle. He doesn’t have a fever. His mother takes him in her arms, coos to him, trying to calm him, but he keeps on crying. He can’t say what’s wrong, and we, his first-time parents, don’t know how to interpret his cries. Indigestion? An ear infection? Just plain fear? Undressing him completely one more time, trying to find the reason for his crying, we notice a bulge that turns out to be an inguinal hernia. Not even the pediatrician could tell us if the hernia was the cause or the consequence of his crying.

Quite some time later, I awoke with a strange pain in my upper jaw up near my wisdom tooth or behind it. The pain, vague at first, became increasingly widespread and intense. I could not get a dentist appointment for several hours and my teeth had never hurt this way before. By the end of the day I no longer knew if I had a terrible toothache, headache, earache, or everything all at once.

Many years later, my wife, a happy and cheerful woman who spends her days singing, began to feel ill without being able to say exactly what was the matter.

“I don’t know what’s wrong. I don’t feel good, and I can’t say why. Could it be menopause? I don’t feel like doing anything. I feel exhausted, weak. Everything bothers me. I’m sad. Every little thing makes me want to cry. I just want to sleep, to get away from everyone and from myself.”

My wife couldn’t seem to put a name to her growing depression.

These three simple, personal experiences, among thousands of others that we could mention, serve as an example to illustrate how difficult it is to describe pain.

What is pain?

Although we all feel its sting in some way during our lives, it is not easy for us to define suffering. The experience of pain is very broad and extremely complex to convey because it affects our lives differently, experienced by each individual in a personal and unique way. Pain is, in reality, a mystery.

The term “suffering” has, in many languages, a double meaning that includes both the feeling of unhappiness or displeasure and the feeling of sorrow or grief. If in pleasure we enjoy the sensations of the body, in pain they become a disagreeable nuisance. In joy, we feel exultant; in pain, we know we are powerless. Facing pleasure, our whole being reaches eagerly for new experiences; facing pain, the body recoils as if to protect itself from an intruder. Health takes for granted “the silence of the organs”; physical pain is felt, to the contrary, like “a cry of the body.”1

If health is a state that permits us to live an independent, happy and full life, as much in the biological sense as in the psychological and social senses, pain upsets this state in all its dimensions.

A lot of ink has been put to paper to try to define the elusive contours of human suffering, without convincing results. The philosopher Spinoza defined pain in the 17th century as “a fundamental affect, contrary to pleasure.” The International Association for the Study of Pain defined it in our times as “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage.”2 But we no longer limit the definition of pain to the effects of an injury. This classical definition has been revised many times, with results not yet satisfactory for everyone.3

Pain and suffering

There are those who distinguish pain and suffering as two different realities. They argue that pain is organic, while suffering would be more psychological in nature. According to this thesis, what hurts is the body. Rather, suffering affects the spirit, our ability to think. In that sense pain floods the being, suffering faces it. The concrete nature of pain makes experiencing it doable and facilitates therapeutic action. Suffering, however, is expressed in a dark form and its innermost center remains in darkness, including for those who suffer from it.4

Science has the means to fight organic-physiological pain, but suffering is a more complex reality that can, although not necessarily, include the presence of pain, and whose therapy requires other treatments. So, a paraplegic has no reason to feel pain, but the patient can suffer from it beyond what is imaginable.

Cicely Saunders, founder of the Hospice movement,5 coined the term “total pain,” which includes, in addition to physical discomfort, emotional, mental, social, and spiritual suffering, because all these aspects are interrelated. Suffering is linked to the circumstances that affect us in our whole being and in that sense it becomes more all-encompassing that the pain itself. But the popular use of the terms pain and suffering make them almost interchangeable.6 They are concepts that often are intertwined and get mixed up. Here we will refer to them interchangeably.

Physiologists describe pain as a protective reflex designed to alert the person to avoid worse harm. According to them, pain would involve, in the first place, an alarm signal through which the body indicates that something is not right, warning of some form of aggression7 or approaching danger. The burning sensation that causes us to avoid fire prevents us from suffering more severe burns. A thorn prick keeps us away from thorns and prevents us from worse injury. And so on.

Although this positive definition of pain is valid in many cases, it is not applicable to all situations. If pain is capable of protecting us from destruction (for example, keeping us away from fire), it is also capable of destroying us. As it has been observed,8 for all those who in direct contact with the sick, pain is no more than a contingency, a harmful symptom, distressing and injurious, that often makes an already irreversible situation more grievous and unhappy. We should dismiss the idea that pain is beneficial in all cases. Pain is too often a grim gift. It debases us and makes us fill sicker than we really are. The professionals have the inescapable duty to prevent it, if they can.9

Friends or foes, pain and suffering always need to be taken seriously.

Pain, a personal experience

Although pain repulses us all, it has different effects on each individual. We don’t all suffer in the same way. It could be said that instead of kinds of “pain” or “suffering” there are people who suffer. My pain or that of any other person is always a personal experience. Perhaps there is no experience more personal than that of suffering. It affects the whole being: the body and the spirit. Whether physical or spiritual, pain reminds us of the fragility of our existence; it focuses our attention on our own discomfort and turns getting rid of it into the highest priority.

Pain and suffering are perhaps the human experiences that most isolate us from others. No matter how much we may have read about the subject or how well we are able to sympathize with those who are suffering, their pain will always be theirs alone, personal and unique.

In reality, there is no way to share pain.10 Our suffering is a circle that is closed to the outside. “You cannot feel the pain of any other, nor can any other experience yours […]. Holocaust, famine, pandemics…. It does not matter. Suffering always comes in individual packages.”11

Our difficulty in understanding pain is further complicated by the fact that, permeating all the aspects of our being, it affects our objectivity to a greater or lesser extent. Whether it comes upon us suddenly in an accident or we get forewarning with a chronic illness, we are never prepared for pain: it disrupts our lives and can paralyze it completely.

Each time pain comes crashing into our lives, we somehow become passive victims of what is happening to us. No matter how responsible we are for its causes, we always perceive it as an intruder attacking us.

How much does it hurt?

Pain is a very difficult sensation to measure. Measuring its intensity is still very random and differs considerably from one patient to the next and from one doctor to the next. Reliable techniques for measuring pain are very recent and are still not well-known or completely recognized.

Nor is it easy to compare some discomforts with others and assert that one kind of pain is worse than another. For example, an intense but short-term pain, like that in many natural births, kidney stones, etc., versus the rooted pain, much less intense, but much more persistent, of certain types of cancer or arthritis.

Chronic pain, albeit relatively moderate, can become unbearable precisely because of its duration. It affects a large percentage of patients for different lengths of time, during which it radically alters their lives.12 Chronic pain interrupts sleep, reduces mobility, impairs the ability to work and affects even the most daily routines like getting out of bed or going up and down stairs. Even walking can become an ordeal. Suffering from chronic pain without knowing the cause or without finding relief disrupts normal life and can even cause severe cases of depression and anxiety.

Reactions to pain

Attitudes toward pain are almost as varied as the people suffering from it. It is difficult to generalize on the subjective aspects of pain, because there are as many kinds and degrees of suffering as there are variations in sensitivity thresholds. Certain medical conditions can be borne incredibly well by those individuals who have suffered the most and particularly feared by those who have suffered less. Because of this, the assessment of suffering is very relative and varies by populations, individuals, and cases. In some wars, soldiers who went under surgery without anesthesia didn’t seem to feel more pain than that caused by their wounds. In certain ethnic groups, there are woman who give birth and go on working almost as if nothing special had happened.

Suffering transcends the personal circumstances of those experiencing it. As H.G. Wells wryly observed, “The Royal Crown cures not the headache.”13 This poses many interesting theoretical questions, though they are totally irrelevant from a practical point of view. Who suffers more, men or women? Adults or children? The young or the elderly? The well-informed or the ignorant? Believers or non-believers? And so on.

Because it affects us in such a personal way, when we suffer we tend to think that the adversity befalling us is unique, that no one else suffers like we do, or that our pain cannot be compared to any other. And that’s how it is, in a way.

Our developed societies have battled physical pain with undeniable success. Medicine and pharmaceuticals are changing the experience of pain into a technical problem. So they are to be blamed, fairly, for the risk of reducing pain to a mere malfunction of the body.14 But pain is a broader problem that affects the absolute uniqueness of human beings. In fact, no physiological law can entirely account for this experience.15 The privileged beneficiaries of what we call a “state of well-being,” we systematically resort to the healthcare system in our fight against pain, as if it were a fundamental right. Doctors prescribe us medications that take away our physical discomfort. Psychological therapies soothe our emotional problems. And if they don’t, drugs help us escape, even if momentarily, from our painful reality.

Today, in the West, the statistics on the use of painkillers and sedatives are on the rise. Other societies and other times have dealt with pain in ways that to us seem too resigned and cruel, attributing religious or spiritual dimensions that become more and more difficult for us to understand. They have regarded suffering and pain not as mere health or medical issues but rather as existential problems. But in our post-Christian world, the cures have ousted the curates. Medications and therapies have taken the place of fasting and prayer, and they have become the modern substitutes for what, in another time, depended heavily on personal strength, self-control, or faith.16

Is it true that no one wants to suffer?

Although in theory we all seek well-being and each one of us fights against pain in our own way, in reality suffering is also fostered. It is surprising to discover how determined we are to stay in situations that cause us suffering, and how much energy we are capable of exerting to maintain the causes of our problems.

Let’s look at a simple example. A child has a loose baby tooth that is about to fall out, but it doesn’t really hurt if he doesn’t touch it. Nevertheless, he feels the need to touch the tooth constantly (with his tongue or with his fingers), as if he wants to make sure that the pain is still there!17 At a much more serious level, countless victims of ailments that are a direct consequence of bad habits (diet, tobacco, alcohol, lack of exercise, etc.) would like to stop suffering, but they want to do so without changing their lifestyles. Instead of attacking the cause of their ills by changing their habits, they prefer to seek surgery or miracle cures that might free them from their undesirable consequences.

There are types of suffering that take forms similar to masochism. They are fostered by those individuals who gain some advantage through them. Many types of dependency, including forms of selfdestruction—some quick and some slow—“excuse” the patient from having to deal with unresolved problems, putting on others their own inability to solve them. There are degrees of illness whose seriousness silences any criticism or reproach against the one who is suffering, regardless of the cause of the situation.

That makes certain chronically ill persons acquire a kind of “dependency” that makes them less responsible than they would be if they were more autonomous. Through their behavior, by arousing pity, they get the help they want without having to ask for it.18 In some cases, their very suffering provides them with the perfect tool to punish someone—spouse, children, or parents—blaming that person indirectly for their own problems.

Moreover, as demonstrated by Dr. Sylvie Galland, there are many patients who repeat models of painful relationships that they experienced in childhood, which would often be inevitable. For example, the child of an alcoholic tends, more easily than someone else, to take on a painful role similar to the one her mother suffered because of her father’s problems, subconsciously predisposing her to put up with the behavior of a husband…preferably alcoholic! “Perhaps our competitive society has something to do with this. Honors and gratification belong only to those who succeed. But affection, compassion and general favor naturally go to those who suffer. As it is much easier to fail in life than to succeed and to be unhappy than to be happy, the tendency for some is to prefer the easy way.”19

To make matters worse, there are conditions that, for some patients, have a captivating, almost heroic aspect, whose intensity they would never find in the routine of their mediocre lives. An emergency physician friend told me about a homeless man who “had accidents” on a regular basis, to the point where the medical team believed that he did it on purpose, because he missed the excellent care that he received in the hospital each time that he was admitted for his recovery period. Obviously, this is an extreme case, but even to lesser degrees the nostalgia of suffering is not unusual. Some patients confine themselves to their problems as if they did not wish to leave a jail cell to which they had grown accustomed.

These kinds of patients have, in a way, resolved their situation in life. Regaining their health would mean rethinking work, personal, or family issues that they don’t have the courage to face. Their healing—or that of a disabled child, etc.—would obligate them to look for work, or allow their spouse to finally file for a divorce that the spouse does not dare file under the present circumstances. Nothing can cure an illness that the patient benefits from….

In these cases that are close to pathology, in order to begin to regain freedom, the patient would have to get to the point of being willing to give up certain present “benefits” and recognize that they are prolonging in some way a situation that they could overcome. The patient would have to ask themself seriously what would happen if the problems they suffered suddenly disappeared: How would I deal with this new situation? How would my loved ones react? Etc. But to reach that point of ideal clarity and liberating awareness, something more than maturity and intelligence is needed. Human nature is very complex. Taking on the responsibilities of one’s autonomy is never easy and even less so for the patient. In general, people who get stuck in these types of problems need a lot of understanding and professional help to overcome them.

1 . The World Health Organization (WHO), in its 1946 Constitution, defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

2 . See http://www.iasp-pain.org (updated 22 May 2012).

3 . See for example, K. J. S. Anand, D. Craig and D. Kenneth, “New perspectives on the definition of pain”. in Pain, Vol 67 (1), Sep 1996, 3-6. Cf. Jan Frans van Dijkhuizen, Pain and Compassion in Early Modern English Literature and Culture (Boydell & Brewer Publishers). 2012.

4 . Phillip Moffit, Dancing with Life: Finding Meaning and Joy in the Face of Suffering, New York: Rodale, 2008, p. 86, 91.

5 . Cicely Saunders began a revolutionary movement in 1967 in favor of care for the dying, in St. Christopher’s Hospice, located South London, England. Today the movement has transformed the treatment of the terminally ill in hundreds of hospitals around the world, based on the principle of integral care, meeting the patient’s physical, social, emotional, and spiritual needs. Their motto is: “You matter because you are you. You matter to the last moment of your life.” (See Cicely Saunders, “The Care of the Patient and His Family,” in Documentation in Medical Ethics, n° 5 (London Medical Group, 1975).

6 . David B. Morris, The Culture of Pain. Berkeley: University of California Press, 1991. Cf. by the same author, Illness and Culture in the Postmodern Age, Berkeley: University of California Press, 1998.

7 . Cf. W. J. Roberts, “A hypothesis on the physiological basis for pain”, Pain, nº 24 (1986), pp. 297-311.

8 . See Stanley Hauerwas, God, Medicine and Suffering, Grand Rapids: Eerdmans, 1990.

9 . Janice M. Morse and Barbara Carter, “The Essence of Enduring and Expression of Suffering: The Reformulation of Self,” in RTNP vol. 10/1 (1998), pp. 43-60. See further Joseph A. Amato, Victims and Values: A History and a Theory of Suffering, New York: Praeger, 1990.

10 . T. S. Eliot, “The Burial of the Dead”, in The Waste Land, I (1922).

11 . “Pain is personal, more private than thought (you can share thought but not your pain), and so not one of the billions in the world’s cauldron of disease and death ever suffered more than what each one, individually, could.” Clifford Goldstein, Life Without Limits, Hagerstown: Review & Herald, 2007, pp. 106-107.

12 . The International Association for the Study of Pain (IASP) defines the pain tolerance level as the maximum intensity of a pain-producing stimulus that a subject is willing to accept in a given situation. “As with pain threshold, the pain tolerance level is the subjective experience of the individual. The stimuli which are normally measured in relation to its production are the pain tolerance level stimuli and not the level itself ” (H. Meskey, “Pain terms: A list with definitions and notes on usage recommended by the IASP subcommittee on taxonomy”, Pain 1979; 6:249-252).

13 . Quote attributed to Herbert George Wells (better known as H.G. Wells, 1866-1946), author of The War of the Worlds.

14 . Lawrence W. Wilson, Why Me? Straight Talk about Suffering, Kansas City: Beacon Hill Press, 2005, p. 19.

15 . Viktor E. Frankl, Man’s Search for Meaning, New York: Washington Square Press, 1963, p. 166.

16 . Doug Manning, Don’t Take My Grief Away, San Francisco: Harper, 1979.

17 . Unless what he wants is to pull out the tooth as soon as possible to get a reward from his family members! (Cf. Sylvie Galland and Jacques Salomé, If Only I’d Listen to Myself! Resolving the Conflicts that Sabotage our Lives, Element Books, 1997).

18 . To say nothing of the “sick tyrant,” who doesn’t ask for anything, but never ceases to brag about it!

19 . S. Galland, “L’attachement à la souffrance”, ” [Attachment to suffering], Optima, nº 217, February 1992, pp. 27-28.

2

Expressing Our Pain

“Give sorrow words.”

Shakespeare1

–I can’t find the words to express the sorrow I feel…

Many of the sympathy cards that we send or receive begin with words like these. Whether it is the unexpected loss of an unborn child or any other misfortune, even if it was anticipated, it seems like we are left speechless when confronted with pain. It is not easy to express what we feel when we find out that a friend has been diagnosed with cancer, or when a senseless accident leaves a young neighbor maimed, or when an acquaintance has been the victim of an assault…. An inner need compels us to express our feelings of sorrow, so difficult to shape out of a mixture of emotions, confused with feelings of anger or helplessness.

If enduring pain is difficult, it seems even more difficult to bear it silently. It seems that we have a basic need to express it, although we don’t know how. Upon arrival into this world, the first thing a newborn does is cry in protest, from separation, from fear, perhaps. He who suffers, no matter his age or cultural situation, usually speaks up, whether by complaining or crying about his pain.

Recounting your sorrows, writing them down to feel heard, talking about your illnesses and surgeries, is part of a real therapy. Who hasn’t ever noted the expressions of satisfaction or relief on older women’s faces when share stories with others about their surgeries, childbirths, or illnesses?

But many of us have been taught to reject the best channels for releasing pain. Someone didn’t know how to tell us that at the right time tears are an undeniable relief. And there are countless people who go through life without even venturing to share their sorrows with those with whom they should share them. Because of their personality, because of their upbringing, they think that sharing their problems with someone else is a weakness. Or, because of the nature of their problems, they are ashamed to share them. They ignore the fact that sharing what they feel with someone they trust could help them to see more clearly and release negative emotions, especially if that person is a professional who can provide solutions for their personal situation.

Just being listened to and finding our suffering reflected in the stories of others, such as in support groups, helps us to feel less isolated and to better understand our situation. Upon realizing that others share our problems, and even suffer and struggle as much or more than we do, it is easier for us to gain perspective on our own pain and cope with it. In reality, “people who do not find a way to express their suffering run the risk of being destroyed by it […]. Without the possibility of communicating with others, change is not possible. Remaining silent, shutting oneself off from relating to others, is death.”2

The courage to cry

When emotions overcome us, sometimes we cannot hold back the tears. Although tradition reminds us in many parts that “big boys don’t cry,” all human beings, including men, feel the imperative need to cry at some time or another. We are designed to cry: crying is natural.

It is true that, in some societies, those gentlemen who cannot hold back their tears in the face of sorrow are still treated as weak and unmanly. But attitudes are changing, and today we see more and more men who have the courage to cry in public, something that would have been unthinkable only a few years ago. There are some men who look too brave and masculine to cry, like when the volunteer firemen in Haiti rescued a boy from the rubble of the earthquake in 2010, when the soccer player Iker Casillas won the World Cup in South Africa that same year, or when tennis player Roger Federer lost the Australian Open in 2009. From pain, sorrow, or joy, we all need to cry sometimes.3 Some hold it in, others cannot. Crying is natural, and it is part of our body language to express our extreme emotions. Our reaction to the need to cry is cultural and depends largely on our education.

The language of pain

The language of pain is complex and ambiguous. If pain compels us to complain, there is the paradox that, when we try to explain our suffering, few of us know how, including those who suffer most. Our response to pain is, for the most part, learned. It depends mostly on personal context and culture. So, the great tennis player Rafael Nadal, after an epic game against the equally famous Novak Djokovic, claimed to have “enjoyed suffering.”

For millennia the language of pain was tinged with religious and philosophical connotations. But with the advent of scientific medicine, our modern societies refer to disease with more and more secular terminology. When facing illness, pain, and death, a growing number of our contemporaries no longer rely on spirituality; instead, they turn almost exclusively to science and public services in which they have placed their remaining faith. In place of the undeniable benefit of meditation or prayer, they prefer immediate, technical solutions. So the management of these quite personal realities is passing from the existential to healthcare, as if they fell to the social healthcare system in the first place.

In other times periods or latitudes everyone has had to live with the elderly, the sick, and the dying. In our environment the attention to those who suffer has become so socialized and technical that the majority of our citizens have almost no contact with the final stages of life until it affects them directly. Hospitals and mortuaries keep the sick and the dead separated from the healthy and the living. One of the most immediate consequences is that today very few of our contemporaries are emotionally prepared for a personal encounter with suffering, and even fewer still have adequate words to express their pain or to communicate with those who are suffering. We don’t know what to say in painful situations, for the simple reason that we have never faced them and we haven’t learned from family tradition what to do in these cases.

Not even medical terminology has found a way to adequately express the level of pain we experience. We don’t know how to describe our own suffering, and when we try we often find that we cannot go beyond a superficial communication, because we are unfamiliar with the language that pertains to it. Hardly anyone speaks of those things in a society that maintains the illusion that it is entitled to avoid every inconvenience. This amplifies the feeling of a lack of understanding of those who are suffering, including with those people they trust.

At the doctor’s office, the physician uses scientific medical terminology that leaves the patients unsatisfied because they do not understand it, but it protects the professional from uncomfortable questions from the patient and family, in case they begin to ask profound existential questions to which the physician often does not have an answer.

Our growing confidence in science is accompanied by a growing fear of the effects of disease and of the power of health professionals. So pain not only grips us with a sense of helplessness, but often it also leaves us without words. And this silence adds the weight of loneliness to our suffering.

The right to be happy

The situation becomes more complicated in our societies because the media have convinced us that we should all be happy. Although no one guarantees us the right to happiness, we are frequently bombarded with advertising that says happiness is within everyone’s reach, immediate and with minimal effort. But it’s one thing to have the right to pursue happiness and it is another to try to get it, no less, by buying a car, a house, or an insurance policy. Reality does not always conform to our wishes, and making our happiness dependent upon the things we have or the people who surround us is a sad illusion. As much as this and that can contribute to our moods, in the case of subjective experiences, the roots of happiness are planted in our attitudes, in our inner being.

This explains why, even if we are able to avoid many problems, we continue to feel unhappy. Not suffering does not mean being happy. Our inevitable clashes with reality poison our existence, laying waste to the small patches of happiness—passing and ephemeral—that are within our reach. All too often events are not responsible for our discomfort, but the interpretation and the attitude that we take toward them.4

To prevent a lot of avoidable unhappiness we would have to learn to accept things as they come to us, and the rest as they are.5 Acceptance does not mean resigning ourselves to reality, rather, recognizing its existence and reacting intelligently and positively in the face of it. Living is not an easy matter. So, instead of fearing that our happiness is running out, it is easier to fear that it never begins. Someone once said, with a bit of humor, that “looking on the bright side of life won’t damage your eyesight.” Therefore, considering the large amount of pain that already exists in the world, our best option is to look more on the bright side, to try to help and even smile—if possible—even though we are hurting. Because every minute wasted on negative thoughts is a minute of life that we cannot get back.

Constructive suffering?

That doesn’t mean unhappiness is inherently good. It means that we can deal with it in ways that are more positive and intelligent than others. Stefan Zweig was certainly very adamant when he said that we owe everything to pain: “All science comes from pain. Suffering always looks for the cause of things, while well-being encourages passiveness and does not look back.”6 Without going that far, we must acknowledge that at least an essential part of universal literature arises from the need to express human drama or overcome it. The Debate between a man and his soul (Egypt, 2000 A.C.) reads: “To whom can I unburden myself today? Anguish chokes me. Not even the silence wants to listen to me. Perhaps my only confidant is death…”

The most beautiful poems are often the most desperate. The strength of Greek tragedy lies precisely in having given expression to the drama that battles in each human being faced with an inevitable, mortal destiny against which he rebels and of which he feels simultaneously victim and culprit. In their conflicts, tears, and anguish, love and suffering intersect at the same time like cause and effect. A large number of literary works express man’s fight against adversity and his ceaseless efforts to communicate pain, understand its meaning or overcome it somehow.

Biblical literature, deeply rooted in our culture, continues to provide comfort in suffering because it contains some of the strongest testimonies to pain. As Pascal said, “Solomon and Job knew and expressed human misery better than anyone: one in prosperity (see Ecclesiastes) and one in adversity. One experienced the vanity of the pleasures and the other experienced the reality of suffering.”7 The book of Psalms contains 150 prayers, including many inspiring psalms of “orientation” and some appalling psalms of “disorientation,”8 that is to say, of complaint, lament, and protest over the injustice in life. Meditation or prayer with those prayers is good for us because it helps us to put our hurt into words, through the experiences of those who felt heard and received comfort in their suffering.

In the art world, works of art that are downright cheerful are scarce. Comic art and laughter often mask grimaces of pain. For example, of Don Quixote it is very aptly said that “when you finish laughing, you should cry.” It has been said that the great artists are beings “cursed by suffering” and that someone who has not suffered has nothing to say.

In fact, many artists have appointed themselves as a spokesperson for suffering, lending a catalyzing aspect to their artistic creations. Some of the greatest works of art are inspired by pain.

Sensitivity—an essential trait in an artist—either makes you suffer more than other people or it enables you to express your pain with more emotion.

Although it may seem exaggerated, the truth is that if we take a list of the greatest artists in history, and we go through it almost at random, starting with musicians, this thesis seems to be confirmed. Johann Sebastian Bach was orphaned at the age of 10. Mozart died of illness and misery at 35. Beethoven, grandchild of a madwoman, son of an alcoholic and a maid, was deaf as an adult, and still wrote the sublime Pastoral. Debussy, who had such refined taste, grew up in a very poor neighborhood with a mother who had, among her other faults, a heavy hand and a fondness for using the whip.

Edgar Allan Poe, who lost his mother at the age of 3, wrote: “I could not love except where Death / Was mingling his with Beauty’s breath.” R. M. Rilke, in his Letters to a Young Poet (written when he was only 27 years old and the recipient, 20), wrote that “the creator must be a world for himself and must find everything in himself. […] I learn it every day of my life, learn it with pain I am grateful for […]. The quieter we are, the more patient and open we are in our sadness, the more deeply and serenely the new presence can enter us […]. Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don’t know what work these conditions are doing inside you?” Later he would add, “Give every man his own death,” a statement that turns out to be almost prophetic for someone who died young as a result of a wound caused by a rose thorn….9

Vincent Van Gogh, the afflicted painter, ended up losing his mind after fighting desperately against madness. After painting day and night, up to one painting a day without any success or recognition, he experienced self-mutilation, hospitalization, and finally suicide at age 37, without having ever sold a single painting. In 1888, two years before his death, he wrote from Arles to his brother, Theo, who sent him funds so that he could continue painting, “Sometimes I feel too weak in the face of the given circumstances, and I’d have to be wiser and richer and younger to win the fight. Fortunately for me, I no longer count at all on any victory, and in painting I look for nothing more than the means of getting by in life.”10

Edvard Munch, the great Norwegian painter of anguish, wrote the following: “Disease, Insanity and Death were the angels which attended my cradle, and since then have followed me throughout life. […

] I learned early about the misery and dangers of life. […] When [my father] punished us, he could be almost insane in his violence. […] In my childhood, I was always treated in an unjust way, without a mother, sick, and the threat of punishment in Hell hung over my head.”11

The great genius of dance, Vaslav Nijinsky, was forced at 16 to give in to the sexual demands of the great Diaghilev, director of the famous Russian ballets, in order to study and further his career. All his short life, which ended in insanity, was consumed with the fear of misery. Towards the end of his life he wrote in is his Diary: “I live, so I suffer. But my face has rarely seen tears: my soul has had to swallow all them.”

Anguish and worry may indeed be conducive to artistic creation because the artists, being more sensitive that the average person, express their pain in their works. Their art, like therapy, helps them overcome especially difficult circumstances. A creative personality finds new means of expression even for pain. Moreover, artists suffer the chasm between the imperfect reality in which they live and the marvelous art that they long to create. Through their art, they build bridges between those two worlds. In the face of the horrors of pain and their admirable struggle to not allow themselves to be destroyed by it, it isn’t surprising that artists feel an overwhelming need to create beauty. But there is no doubt that their masterpieces emerge more from their genius talent than from their misfortunes.

1 . “Give sorrow words: the grief that does not speak / Whispers the o’er-fraught hear, and bids it break.” (Shakespeare, Macbeth).

2 . Dorothee Sölle, Suffering, Philadelphia: Fortress Press, 1975, p. 76.

3 . Former US president George H. W. Bush, after the death of two of his crew in a plain crash, wrote the following: “I’m afraid I was pretty much a sissy about it, cause I sat in my raft and sobbed for a while. It bothered me very much. I did tell them, and when I bailed out I felt that they must have gone, and yet now I feel so terribly responsible for their fate, oh, so much right now...” (All the Best: My Life in Letters and Other Writings, New York: Touchstone, 1999, p. 51).

4 . See Eduard Punset, The Happiness Trip: A Scientific Journey, White River Junction: Chelsea Green Publishing Company, 2007.

5 . “Each player must accept the cards life deals him or her: but once they are in hand, he or she alone must decide how to play the cards in order to win the game” (Voltaire).

6 . Stefan Zweig was an Austrian writer who lived from 1881 to 1942, author of Decisive Moments in History: Twelve Historical Miniatures, Ariadne Press, 1999 (1927/1940).

7 . Pascal, Pensées [Thoughts], § XV.

8 . W. Brueggerman, The Message of the Psalms, Minneapolis: Augsburg Fortress, 1984, pp. 51-52.

9 . See Paul Tournier, Creative Suffering, Harper & Row, 1983.

10 . See The Letters of Vincent Van Gogh, (Selected and edited by Ronald de Leeuw, translated by Arnold Pomerans), London: Penguin Classics, 1997.

11 . Reine Caulet, « Je crée danc je souffre, » dossier Douleur, pp. 35-36.

3

Heeding the

Warning Signs

“The art of life is the art of avoiding pain.”

Thomas Jefferson

According to William James, the greatest discovery of our time is that we can influence many aspects of our lives just by changing our attitude.1 Shakespeare already said poetically, “We are such stuff / As dreams are made on.”2 Or as Ramon y Cajal stated more clearly, “Every man, if he so desires, can become the sculptor of his own brain.”3 In the past, artists and wise men said it—now science also supports it.

“Today we know that self-confidence, enthusiasm, and excitement have the ability to promote higher brain functions. […] When our brain gives meaning to something, we live it as absolute reality.”4 According to the experts, this means that “the healing process greatly depends upon what is happening in the mind of the patient. The challenge for medicine is to find a way to put into motion the body’s extraordinary healing powers.”5

Pain has allies

What happens in a person’s mind is the aspect of suffering that is most difficult to understand and control.6 Running a race with his friends, a young boy falls and scrapes his knee. But in the excitement of winning the race, he ignores it and keeps running. At the end of the race, the pain in his knee regains his attention. Seeing blood, he realizes what has happened, gets scared, bursts into tears, and runs to his mother. She hugs him, calms him, cleans the scratch, and puts a Band-Aid on it. Soon the boy goes back to his toys and forgets about his wound. There are men who work at gruesome jobs (slaughterers, butchers) or who play violent sports (rugby, boxing, etc.) that require a lot of strength and the ability to sustain blows, but they are unable to watch the birth of their own children, or they faint in the hospital when they see a needle approaching.7

There are factors that increase pain perception and others that reduce it. But we ignore them for the most part. The psychoanalyst Carl Jung said that we all have a hidden side of our personal reality that we cannot face openly and that we cannot change. It is our unconscious, which he called simply our “shadow aspect.” We cannot run away from it or make it disappear. “Shadows make up part of our life.”8 We should listen to what they have to say. Now, listening to pain does not mean letting us be monopolized by it, because there are certain attention levels that aggravate situations.

Fear

Fear is, without a doubt, our worst ally against pain. Suffering always grows with the specter of fear. We all fear suffering. But often our own fear aggravates and intensifies pain, turning it into an obsession that is as or more destructive than the actual cause of harm. Fear involves additional stress that can paralyze a life or make life unbearable when it confines the sufferer in a prison of panic. For those who live under the constant threat of a sword of Damocles, it is very difficult to live in a state of tense anticipation.9 But this state does not resolve their problems; rather, it worsens them. Pain may be inevitable, but our sense of misery is, to some extent, optional.10 Hence the benefit of learning to face our problems realistically and to take control of our emotional reactions.

Many people can overcome their fear by relying on some form of outside help, professional or spiritual.11 But how can we overcome it when we don’t have help from anyone?

Loneliness and abandonment

Because suffering is such a private feeling, it is often accompanied by a strong sense of loneliness. People who suffer chronically often aggravate their situation with the feeling that no one understands or sympathizes with them as they deserve. If they then begin to think that they are a nuisance, or a bother, this further increases their discomfort.

There are many kinds of pain that we cannot deal with alone. In many cases, assistance from a health professional is essential. But family, friends, and the religious community can successfully help us to cope with adversity and misfortune. Loneliness is one of the most distressing aspects of suffering to bear. If burdens are shared, they become lighter. If we cannot share our burdens with someone, they often become heavier. So, when we suffer, what we need most is not for someone to explain why to us, but for someone to be with us and express sympathy. At the same time there is nothing that relieves misery—others’ and our own—like doing our best to help others with their pain. To this end, professional training is useful but not essential. The most important thing is sensitivity. Sitting beside someone who is suffering and listening quietly can be enough.12

Frustration and discouragement

A lot of our suffering comes from the mere realization that our reality does not match our desires. One day it dawns on us that we will never have again what we had in the past, or that we will never achieve in life what we had dreamed. And so we further poison our present, incapable of accepting our reality as it is. The wounds of the soul may scar badly, and only those who feel them can know how much pain is caused by a thwarted love, a lost job, a failed marriage, a friendship that ended in betrayal. The passage of time often helps, less so when the consequences are permanent. In that case, time does nothing but aggravate the constant pain of deterioration or of aging. And an endless problem can destroy anyone’s spirit. As the poet wrote:13 “The worst pain in the world

Is not the one that kills with a blow,

But the one that, drop by drop,

Undermines the soul and breaks it.”

Nevertheless, all these trials can help us learn. Experience teaches us to be wiser and more prudent, to protect ourselves. We should also understand that it doesn’t mean that we should put our protective barriers up so high that they isolate us from reality. Because if after a broken heart, we don’t love again, we can fall into the trap of resentment and hatred. Disappointment, if untreated, worsens into bitterness, and bitterness into cynicism. After we hit bottom in the sea of life, it is only by trying to swim that we can float again.

It is human to make mistakes. But one of the most important things we can learn in life is to take away positive lessons from our mistakes and move on. If we are self-indulgent in our status as victims, if we insist on blaming everything on life’s events, if we anchor ourselves in situations of complaint and pity, it will be difficult for us to take charge of our lives. Resentment and frustration do nothing but exacerbate suffering. The cure for bad memories is not fighting them but making good ones.

The shadow of the past

One of the greatest sources of our unhappiness can be the shadow of the past. We cannot will ourselves to forget just by wishing it, and the more we try not to remember certain problems, the more they are on our minds. Memory is fickle and selective. We forget countless good things that we enjoyed, but we remember setbacks, defeats, disappointments, insults, and betrayals…. John Irving said, “Your memory is a monster; you forget –– it doesn’t. It simply files things away. It keeps things for you, or hides things from you –– and summons them to your recall with a will of its own. You think you have a memory; but it has you!”14 If we let it, our memory can take us to the cemetery of disappointment, bury us in the past, and haunt us mercilessly with our dead dreams.

Perhaps nothing causes as much chagrin as happiness lost. After having found happiness, sadness stings deeper and more cruelly than if we had never known felicity to begin with. A famous beauty watches herself age in the mirror, battling gray hair, weight gain, wrinkles or flabbiness. An athlete who was admired for his physique suffers the withering of his body to a greater extent than the rest of us who were always average or unattractive. Those who loved or were loved despair after being abandoned. Those who possessed wealth and lost it are much more unhappy than those who were always poor. Whether we like it or not, our past casts its shadow over our present.15 As Lord Byron said, “The memory of joy is no longer joy; the memory of pain is pain still.”

The actor who was an idol cannot stand to be forgotten. The athlete who dreads being replaced may try to prolong his career by using chemicals…. It is difficult to cure yourself of past triumphs— of glory lost. The writer becomes depressed if her latest book sells fewer copies than her previous book, and the singer grows somber if he books fewer performances than before…. Far from being content with what life gave us for a time, we feel that the past no longer counts, no matter how great it was. Money accumulated no longer satisfies if we don’t keep earning. Admiration once received is worthless if it is no longer given. Beauty once possessed becomes a bitter memory once it is lost…

Why do we place so little value on what we have accomplished, once it has passed? A growing number of people undergo countless operations and inject any chemical into their bodies just to look younger, but they often end up looking deformed…. And there is the vain politician who isn’t adverse to making any compromise to improve his image, trying to get the votes that will enable him to remain in power….

The phrase “time heals all wounds” expresses a relative truth. The wounds, it is true, often heal. The skin pulls back together, renewing itself until it forms a new barrier against infection. But the new skin, the healed area, usually remains more sensitive than the surrounding skin. More fragile. And each time that the scar comes into contact with a foreign object, there is a memory of the initial wound. The injury heals but remains fragile. The same thing happens when a word, a thought, an image, brings back the memory of suffering from long ago. The wound is healed, but the fragility of the memory remains. Years pass and the scar lingers…as long as love or memory remains.16

A sense of failure

We humans are the only living beings that trip over the same stone a thousand times and then blame the stone. Nevertheless, what we suffer from could help us to identify the causes of our failings. This realization can allow us to take personal responsibility for what happens to us, to question the beliefs that society imposes on us, and then change direction. That’s the opinion held by Jose Luis Montes (Spain, 1965), former administrator of several international corporations such as Epson, Xerox, and Tech Data: “I believed that success meant reaching the top and making lots of money,” he admits. “I achieved everything the system says you should to be happy, but when I got to the top I felt empty.”17

Moved by a profound longing to find himself and undertake a life project based on values, not on profit, Montes sold his business a few years ago. What he calls his “inner transformation” has led him to become the founder of the social movement Wikihappiness. This successful former administrator now gives conferences for administrators, at which he speaks of triumph and failure.

“When you don’t know who you are or what you want, you are a slave to your own low self-esteem and insecurity. This lack of confidence leads you to think and do what others think and do. Authentic people are free, consistent, and honest with themselves. When we are very young other people fill our heads with preconceived notions about how we should live our lives. They condition us to triumph at all costs, to take that route into the temple of happiness. But it is a big lie. I have lived in that place and it’s empty. Happiness doesn’t depend on what we possess, but rather on what we are and our ability to live in accord with ourselves. Often the race to possess becomes an obstacle in the path to being.”

“I have proven”—Montes continues—“that if your main goal is to achieve success, power, and money, then you need to be selfish and ambitious, and you end up destroying the innate humanity inside you…. You disconnect from your essence and you forget the values and projects that really are worth the effort. They have programmed us to be unhappy, and the majority of us are—only very few of us have the humility and courage to recognize it. Our worst enemy is self-deception, not wanting to recognize the uneasiness we feel inside. There is no worse failure than setting wrong goals and reaching them. That is why there are so many successful people who are so unhappy: because they have done what the system has imposed on them and not what their heart dictates. Success is to be consistent with yourself, with the dictates of your conscience. If you don’t learn to be happy with yourself, it is certain that you will end up thinking you are a failure.”18

Frustration is produced by depending on others for our happiness. The sense of failure is a major source of suffering. And from frustration to anger there is but a single step.

Anger and feelings of guilt

Anger is an almost inevitable emotion brought on by annoyance. It is positive when we rebel against injustices or abuses. But it becomes negative, and even dangerous, when it interferes with our ability to think, when we are blinded with the desire for vengeance or determined to be destructive, letting ourselves be brought low by violence against others or against ourselves.19 Hatred and anger are the most natural responses to pain, but they are also the most damaging. Hate is a deadly poison, and anger is self-destructive.20 Marcus Aurelius said, with sound judgment, “How much more grievous are the consequences of anger than the causes of it.”21

Driven by anger, convinced that their problems are dependent on factors outside themselves, many patients develop an additional feeling of hatred that can poison their lives if it is not resolved in time.22 Others, without reason, turn their anger against themselves, convinced that their situation is a just punishment for some fault.23 The antidote to anger is serenity, one of the most useful virtues in life, especially for those who suffer. Mental and spiritual healing—which includes overcoming feelings of hatred, guilt, and remorse—is as important or more important than somatic recovery, if the aim is to achieve total healing.24 But both require patience, and positive attitudes.

Positive attitudes

The wise Solomon said, “A cheerful heart is good medicine, but a crushed spirit dries up the bones.”25 To face our existence realistically, we first need to be conscious of all that is positive about our situation and recognize that any glass half empty is also half full. There is always something to be grateful for.

Even in the midst of our pain, we can remember that the body contains countless cells that are working continuously on our behalf:

1 Our brains have countless active neurons that keep our thinking alert and make us conscious of the world around us.

2 Our eyes are wonderful receptors that allow us to enjoy the magic of colors and shapes, the wonder of light, the beauties of nature, the immensity of the universe and relationships with our fellow man.

3 Our ears contain fine filaments that vibrate with children’s laughter, birdsong, orchestra music, the soft patter of raindrops, and the voices of the people we love.

4 Most human beings can move. We can walk, jump, run, dance, or play sports. We have hundreds of muscles and bones coordinated by prodigiously synchronized nerves, ready to obey us and take us where we want to go.

5 Our lungs are amazing filters. Through millions of alveoli, they purify the air that they take in, oxygenate our blood and free our bodies from harmful waste. There is no doubt that we were created for life. We have been designed to be happy.

How can we complain about pain in our arms or legs, when we see others who don’t have any of these limbs and still laugh?26 I have known blind people who are happy, because they know how to see the light beyond the shadows, and I also have met people whose eyes work perfectly and yet live in the shadows, because they don’t know how to truly see…. Why limit ourselves to thinking of the few things that make us suffer and not remember the many things for which we should be grateful?

I must add, however, that it is dangerous to let ourselves be seduced by the siren songs of the preachers of positive thinking who cultivate the myth that we can achieve everything that we set out to do. It’s okay to aim for great things, and we should try. But we all have limits set by nature or our circumstances. In every life, there are situations and moments of darkness, disease, frustration, failure, grief.

We can often overcome them on our own, but sometimes it is impossible to face them alone. Fragility is part of the human condition. We need help in difficult moments. Aside from getting appropriate care, which is most important and most urgent, there are three basic steps that will help us cope with suffering: heeding the warning signs, practicing spiritual serenity, and learning to live with inevitable pain.

Heeding the warning signs

No matter how we prepare ourselves, pain always takes us by surprise. Especially in Western societies, where we have passed on the responsibility for pain management to the experts. We forget that we ourselves are the main stakeholders, and that our own bodies put the most immediate curative resources into action. Patients are not mere damaged machines that need to be repaired. Actually, we are the first involved in our healing process. Each one of us has an “inner doctor,” as Albert Schweitzer called it,27 with amazing abilities to activate our recovery mechanisms. All treatments are, to a greater or lesser extent, a joint effort between the medical team, the patient, and that inner doctor.

Our first reaction to pain should be to listen to its messages. Instead of limiting ourselves to taking an aspirin and going on, it would be better for us to stop and see what’s wrong and ask ourselves, “When do I have these problem? Before or after I eat? During the day or at night? Is this related to my work or to my relationships? Does it have a connection to my fear of the future or with a past event? Etc. Instead of silencing pain at all costs, it would be better to start by listening to its warning voice. Perhaps we should thank it for the warning and act accordingly.

Practicing Spiritual Serenity

Since Dr. Hans Selye28 —the great pioneer—discovered the undeniable impact that emotions have on our health, we know for a fact that anxiety does nothing more than exacerbate pain. Bitterness and resentment, together with the desire for revenge, are negative responses that only intensify discomfort and increase stress.

It has been proven that suffering is alleviated by maintaining a calm and positive attitude. In all cultures, prayer and meditation are traditionally associated with the solution to certain personal problems. Modern medicine has demonstrated the beneficial effects of these and other relaxation techniques, without understanding their mysteries. Meditation and prayer positively affect respiration, heart rate, and consequently, the activity of the sympathetic nervous system. The muscles relax and inner calm neutralizes the stressful situation. Current research29 shows that individuals who have a deep spirituality have a much lower risk of heart problems, arteriosclerosis, and hypertension.

As we will see later in the book, hope is a deep conviction that provides us with the inner strength to keep going in the midst of adversity. There is nothing we need more when we are suffering. And there is nothing worse for healing than hopelessness. As one patient said, “My dignity consists of not giving up and continuing to fight.”30

Learning to live with pain31

Serenity emerges when we accept our reality and we have the courage to face it until the end. It’s not about mastering the art of autosuggestion. It’s about learning to implement mechanisms that lighten our burdens. It’s about learning from the past to know how to live in the present and face the future, whether it is to accept fate or to fight to change it.

Barbara Wolf recommends conscious distraction as an effective way to cope with chronic suffering: working, reading humorous books, doing a hobby that we enjoy, playing sports, amusing ourselves with something that interests us (nature, music, art, etc.). That is to say, enjoying any positive activity, preferably creative or useful, that pleases us and can somehow distract the mind from the reality of suffering. It means using our own faculties as allies against suffering. Immanuel Kant, Robert Schumann, and Blaise Pascal all declared that when they began to write, compose, or reflect deeply, they forgot—at least partially—their suffering, while resigning themselves to wait until their pain was relieved in order to do those things made them suffer much more.32

Mary Craig wrote: “The only cure for suffering is to face it head on, grasp it around the neck, and use it.”33 In this struggle between submission and resistance, there is nothing better to help us forget ourselves—if only for a few moments—than doing something for someone else.34 When we are determined to give more to life than we have received, being useful to others is, without a doubt, a huge pain reliever and a wonderful therapy.35

1 . William James, The Principles of Psychology, Harvard University Press, 1983 (1890),

2 . Sentence that William Shakespeare puts in the mouth of Prospero en The Tempest. Along the same lines, Ellen G. White says: “Life is what we make it, and we shall find what we look for. If we look for sadness and trouble, if we are in a frame of mind to magnify little difficulties, we shall find plenty of them […]. But if we look on the bright side of things, we shall find enough to make us cheerful and happy. If we give smiles, they will be returned to us; if we speak pleasant, cheerful words, they will be spoken to us again.” (The Adventist Home, p. 430).

3 . Santiago Ramón y Cajal was awarded the Nobel Prize in Physiology or Medicine in 1906.

4 . According to Dr. Mario Alonso Puig, it has been shown in several studies that one minute of entertaining negative thinking puts the immune system delicate situation for six hours. The prefrontal region of the brain, where more advanced thinking occurs, where our future is determined, where we weigh strategies and alternatives to solve problems and make decisions, is tremendously influenced by the limbic system, which is our emotional brain. So, what the heart wants to feel, the mind will end up showing (See Mario Alonso Puig, Reinventing yourself: Overcome Your Anxiety and Fera When Faced with Lifes’s Problems and Challenges, London: Marshall Cavendish Editions, 2011).

5 . Dr. Paul Brand and Philip Yancey, Pain: The Gift Nobody Wants, New York: Harper Collins, 1993, p. 61.

6 . Johann Wolfgang von Goethe rightly stated that “thinking is easy, acting is difficult, and to put one’s thought into action is the most difficult thing in the world.”

7 . This is called the “Anzio Effect”. When It Hurts: Prayer, Preparation and Hope for Life’s Pain, Grand Rapids: Zondervan, 2006, p. 33.

8 . Daniel Gottlieb, Letters to Sam: A Grandfather’s Lessons of Love, Loss and the Gifts of Life, Sterling, 2008, p. 134.

9 . “Tell your heart that the fear of suffering is worse than the suffering itself ” (Paulo Coelho, The Alchemist, Harper Collins, 1993, p. 130).

10 . See Nelson Hochberg, “An Explanation of the Quotation: Pain is inevitable, Suffering is Optional.” (http://www.nosuffering.com). “Even in the midst of the trials of life, we can choose joy.” (Tim Hansel, You Gotta Keep Dancing, Elgin [Illinois, USA]: David C. Cook, 1998, p. 83.

11 . The Bible contains many words of encouragement so that we can face fear, such as: “Be strong and courageous! Do not be afraid; do not be discouraged! For the Lord your God will be with your wherever you go.” (Joshua 1:9; cf. Psalm 27:1; Matthew 6:45-52, etc.).

12 . Simone Weil said, “compassion is the visible presence of God here below.”

13 . Francisco Villaespesa, Spanish writer (Laura de Andarax, 1877 –– Madrid, 1936).

14 . John Irving, Une prière pour Owen Meany, William Morrow, 1989, p. 50.

15 . See the books by Ruth Carter Stapleton on inner healing: The Gift of Inner Healing, Waco (Texas, USA): Word Books, 1976, and The Experience of Inner Healing, New York: Bantam Books, 1977.

16 . See Robert Alter, Life Does Not Get Any Better Than This, Liguori (Missouri, USA): Triumph Books, 1996, pp. 48-49.

17 . José Luis Montes, El hombre que tuvo la fortuna de fracasar [The Man Who Had the Fortune to Fail], Barcelona: Plataforma Editorial, 2009.

18 . Interview with José Luis Montes, “Nos programan para ser infelices” [They Program Us to be Unhappy], El País, 9/13/09, p. 40.

19 . See William DeFoore, Anger: Deal with It, Heal with It, Stop It from Killing You (Health Communications, 1991).

20 . See Robin S. Sharma, The Monk Who Sold His Ferrari: A Fable About Fulfilling Your Dreams and Reaching your Destiny. New York: Harper Colins, 1999.

21 . Marcus Aurelius Antonius Augustus (121-180), was Roman Emperor from 161 until his death (180), and is considered to be one of the most important stoic philosophers.

22 . The Bible says, “Do not let the sun go down while you are still angry.” (Ephesians 4:26).

23 . For more about the subject, see Paul Tournier, Guilt and Grace, New York: Harper & Row, 1962.

24 . Also see Paul Tournier The Healing of Persons, New York: Harper & Row, 1983.

25 . Proverbs 17:22.

26 . See, for example, the case of Kyle Maynard or Nick Vujicic (see p. 161 of this book).

27 . Albert Schweitzer (1887-1965), was an Alsatian doctor, philosopher, musician, theologian, and protestant missionary. He received the Nobel Peace Prize 1952) for his life in service of the sick and disadvantaged. He spent most of his life, and died serving, in the hospital that he founded in Lambaréné, which is now in Gabon, Africa.

28 . Dr. Hans Hugo Bruno Selye (1907-1982), Austro-Hungarian physiologist, Director of the Institute of Experimental Medicine and Surgery at the University of Montreal (Canada), is famous for his studies on stress and anxiety.

29 . In particular, see Harold G. Koenig, David B. Larson and Michael E. McCullough, Handbook of Religion and Health, New York: Oxford University Press, 2001. This is a comprehensive book on the relationship between faith and health, resulting from the scientific analysis of over 1,700 different studies and research on the subject.

30 . Fitzgerald Helen, The Mourning Handbook, New York: Simon and Schuster, 1994.

31 . Barbara Wolf, Living With Pain, New York: Seabury, 1977.

32 . The Apostle Paul, in hard circumstances, found encouragement by thinking of divine promises: “For I consider that the sufferings of this present time are not worthy to be compared with the glory which shall be revealed in us” (Romans 8:18). “Therefore we do not lose heart. Even though our outward man in perishing, yet the inward man is being renewed day by day. For our light affliction, which is but for a moment, is working for us a far more exceeding and eternal weight of glory, while we do not look at the things which are seen, but at the things which are not seen. For the things which are seen are temporary, but the things which are not seen are eternal” (2 Corinthians 4:16-18).

33 . Mary Craig, Blessings, London: Hodder & Stoughton, 1979 (2012), p. 77.

34 . From a spiritual perspective, Bridget Meehan, The Healing Power of Prayer, Ligouri: Ligouri Publications, 1988.

35 . Schwartz et al., “Altruistic Social Interest Behaviors are associated with Better Mental Health,” Psychosomatic Medicine (American Psychosomatic Society) 65:778-785, 2003.

4

A Hard Why

to Accept

“No one knows himself until he has suffered.”

Alfred de Musset

The test results left no room for doubt: lung cancer. Sara, a friend of ours, young and very pretty, has never smoked and neither have her parents. She’s a vegetarian and lives as healthy a lifestyle as anyone could ask. The terrible diagnosis not only moved us to express our pain; we also wanted to understand its causes. We asked ourselves: “Why is this happening?” “Why to her?” “Why so young?” It is paradoxical that suffering, being one of our most familiar realities, turns out to also be one of the most incomprehensible. Even for science, pain is still an enigma.

Useful pain?

Trying to understand the cause of our ailments in order to cure them is the most logical thing in the world. Much of our suffering comes from trauma to the body: blows, wounds, infections. Our immediate reaction to them is to reject them. The feeling of injury caused by pain generates a sudden sympathetic reflex from our whole being, reacting to the injury, mobilizing our resources for the restoration of harmony. Various kinds of discomfort intervene to protect life. An intricate system of nerve endings sends out uncomfortable sensations, like alarm signals warning of danger (a burn, a sting, etc.), implementing the mechanisms responsible for avoiding greater harm. In that sense, pain first has a protective role, which is very positive. In a large number of cases, pain is the main reason why the wounded or sick individual decides to go to the doctor.

Healthy babies are born with a complex sensory system, perfectly equipped for detecting pain in its many forms. This system will protect them from countless problems throughout their life. Those who suffer from some form of congenital analgesia, i.e. the inability to feel pain, run more serious risks than those who are susceptible to suffering. A larynx that doesn’t have cough reflexes allows pneumonia to develop easily. Joints that don’t hurt (and that don’t require a change in position) run the risk of becoming dislocated. The victims of rare diseases that decrease their sensitivity to pain tend to die young due to wounds that never hurt. Many of the deformities affecting those with leprosy result from the fact that leprosy destroys their ability to perceive pain and their bodies become mutilated due to this lack of sensitivity.

In this basic preventative role, pain is not our enemy, but a faithful guardian that warns us of danger. But pain is a resource that we value very little. Our rebellious nature, prone to hedonism and convinced that technology should fix everything, perceives any discomfort, even the most benign, as an assault. If pain reliever X takes away the pain from the onset, so much the better. And we run the risk of being left without an alarm system.

Dr. Paul Brand advises: “First, listen to your pain. It is your own body talking to you. I, too, may take an aspirin to relieve a tension headache, but only after pausing to ask what brought on the nervous tension that provoked the headache. I have taken antacid for stomach pain, but not before considering what I might have eaten to give me such pain. Did I eat too much? Too fast? Pain is no invading enemy, but a loyal messenger dispatched by my own body to alert me to some danger.”1

Natural suffering

There are many kinds of pain or suffering that have a functional cause we all know and understand: unmet physical needs such as hunger or thirst, tiredness after hard work, strain from the effort an athlete puts into exercise, the discomfort caused by heat or cold, the pain that comes with childbirth as a physiological function necessary for giving life, etc. These kinds of suffering are relatively easy to cope with. We are all willing to suffer to a certain extent when we understand why or we hope to gain something better in return: to earn an income, keep in shape, have a family…. Each day millions of men and women do difficult things because of their work, braving inclement weather, difficult work schedules, harsh working conditions, or social injustices. For all of us—though, of course, for some more than others—suffering is an integral part of daily life.

Most privileged people suffer, too, but often for different reasons. Apart from having to face the inevitable ups and downs of life we all experience, many affluent individuals inflict additional tortures on themselves, investing their considerable resources and effort in cosmetic treatments, gym workouts, fad diets…or in plastic surgery to correct the shape of their noses, change the size of their breasts, implant hair in bald spots, or inject Botox into their wrinkles. Why? Because even when we are enjoying great privileges, we cope poorly with the limitations of life, our physical imperfections bother us, and we are willing tosuffer a little in exchange for other benefits. This type of voluntary suffering is accepted, since it is a way of fighting the ups and downs of our human condition with the hope of relief, however fleeting.

Avoidable suffering

Besides these kinds of assumed suffering, there are numerous sorrows that are totally avoidable. They are the result of our own behavior, the fruit of the misuse of our freedom. From the moment that we have the power to choose for ourselves, we must reap the consequences. Our unhappiness is not only a technical problem: it is also, and perhaps mainly, the result of us taking the wrong path.

We are all more or less guilty of losing some points from the “driver’s license” of our lives.2 Imprudent choices, risky behaviors, bad habits, irresponsible acts, infidelities…an endless list of mistakes reminds us that many decisions come with painful consequences, mostly avoidable ones. Nevertheless, we often risk suffering, and even death, because we don’t resign ourselves to respect certain limits. Unless we make better choices, we can all continue to suffer needlessly and reap painful and unnecessary consequences. In this regard, there is a way for everyone to prevent some pain. And the laws of life have their own, often unforgiving, logic. We are limited by time and space. Some of our actions have irreversible consequences that eventually will reveal either the benefits of our good decisions or the seriousness of our mistakes. We can avoid behaviors that expose us (and others) to unnecessary suffering. An unhealthy lifestyle causes countless problems.

That’s reality, and it doesn’t make sense to claim a right to not suffer from it. What would make sense would be to claim the right to abstain from deliberately harming ourselves and others, and at the same time explore our possibilities for reducing discomforts from other sources. For this we would have to assume that we do not have the right to inflict pain on our fellow man under any circumstances, except to protect him from worse harm. We can take inspiration from medical ethics, which requires us to combat pain by all means, knowing that sometimes it is necessary to do some small harm so that a greater good can come of it.3

Can we claim the right to be absolutely free from pain? The affirmative answer is based on the fact that, if it were possible, it would be cruel not to try to achieve that goal. In an ideal situation, all human beings would be able to access palliative care services and be able to count on appropriate analgesic treatments to meet the needs of each individual. But it doesn’t happen like that. The distribution of resources remains unequal and unjust. And we still complain that much of human suffering continues to be, ultimately, avoidable.

Destructive suffering

But not all instances of suffering are avoidable. And they cannot be compared to one another. The hunger pangs a person feels who knows she is going to eat soon are not nearly of the same caliber as the desperate, ravenous hunger someone feels who knows he will not be satiated in any way because he cannot obtain food. In this case, hunger pangs lose their functional purpose and become an added torture. Rather than leading us to a solution, our suffering is compounded by the powerlessness of experiencing to what extent we are vulnerable, to what extreme our own bodies are capable of turning against us.

So, much of our suffering, far from being natural or “deserved,” is terribly unjust. Our friend Sara took good care of her health and still developed cancer. Our wonderful neighbors’ son, a very careful young policeman, died in a senseless traffic accident. Among my work colleagues are some excellent parents who gave their children the best education and yet have not been able to prevent them from falling into the clutches of drug addiction. And to these examples we could add many, many more.

So we can say that in some cases we are alive thanks to pain’s protective function, but in others we succumb due to its destructive consequences.44 When we reach certain limits, and we face situations without solutions, we must abandon the idea of positive suffering. All too often, pain becomes a sinister addition that destroys us without giving anything in return. If a “healthy” suffering exists, warning us to live better, then there are also destructive torments that defy reason. These we suffer from without any benefit in return, and they make us worse or even lead to death.

Chance and tragedy

Those of us who live in democratic societies, accustomed to expecting responsibility from everything, tend to think—without grounds—that behind every misfortune there must be someone responsible. But this is not always true. It is correct that if we all did our part, and if we were able to make use of all the means at our disposal, we would avoid many misfortunes. But may be not all. Social injustices and economic inequalities cause a lot of gratuitous harm, but random chance also exists, and catastrophes—natural or man-made—will continue to be a reality. A tsunami affects thousands of people, but we cannot pinpoint its direct cause. Even so, parents will blame themselves for letting their children go to the beach that day, victims’ family members will blame the weather service for not issuing a warning in time, and the survivors will feel guilty for being alive.

That culpability is not real. There are things for which no one is directly responsible. But the feeling of guilt is one of the most stubborn blights of humanity, the cause of many of its problems. The feeling of guilt is both the lucid flash and the bitter dregs of the human conscience.5

Traditional approaches

Clearly, “natural” explanations of suffering are only satisfying to a point. From time immemorial, man has tried to understand the mystery of pain, resorting to explanations that go beyond the realm of our existence. All religions offer metaphysical answers to the question of evil. Some explain it as a result of a violation of the natural order (see the notion of taboo in animistic societies); others, as divine punishment for the sins of humanity (theistic religions); and still others, as a privileged means for progressing, purifying oneself, or purging faults (Eastern traditions).

The attempt to explain suffering within a philosophical or religious concept of the world is marked by various ideologies. Depending on the notion that one has of life, one explanation or another will be given for the question of pain and it will be spoken of with a specific language.

Fatalism

The Homeric texts, like many other expressions of the ancient pagan cultures, raise the question of the meaning of suffering, but they don’t really answer it. The heroes of the Iliad and the Odyssey live in an environment of fatalistic pessimism, enveloped in a permanent feeling of sadness. They believe that they will wander this earth for only a short time, and that later they will be taken to Hades, where an uncertain and gloomy fate awaits them. Their lives have no meaning. Not even the gods can alter the misfortunes of fate or chance. For the ancient Greeks, fate was a force greater than that of the gods themselves. Its power was especially feared, because it was believed to affect the human condition in an inexorable way. Both Greek mythology and literature taught the futility of trying to change the course of things, since destiny is predetermined before the birth of each individual, so that it can even be foretold by oracles and omens. This belief pervades Greco-Latin mentality to such an extent that Greek tragedy consists of describing how anyone who dares to defy his destiny or social order is punished with madness or death.

Denial of Pain

With the idea that it is useless to fight against fate, some philosophers tried to fight pain by developing a doctrine focused on the sufferer’s attitude. Their big question was: What can we do so that what happens to us causes us less harm? The famous Stoic response said: “If I voluntarily accept my fate (which I cannot change) nothing bad can happen to me. That is to say, I am free, because I have accepted from the beginning that I will take whatever happens to me.” Stoicism looked for a way out of the problem of suffering through the path of denial, the repression or lack of expression of pain. So, Epictetus taught his disciples to fight pain by repeating the following sentence: “Pain, you are nothing but a word.”6 But his own followers soon discovered that the theory of apathy (impassibility) proposed by the master of Stoicism doesn’t tend to work in practice. Harsh reality imposes itself on this philosophy and at times pain is so violent that not even the most stoic individuals can accept it. The only course left to them is suicide, a final act of the assertion of freedom and the suppression of pain.

A similar response is found in various Eastern traditions, with practices that tend to fight suffering through the elimination of desire. Buddha says: “This is, my brothers, the truth about suffering: Birth is dukkha, aging is dukkha, death is dukkha; sorrow, lamentation, pain, grief and despair are dukkha; association with the unbeloved is dukkha; separation from the loved is dukkha; not getting what is wanted is dukkha...”7 In a word, the origin of suffering is the desire for happiness, the desire for existence. With the premise that suffering comes from frustration, the proposed solution is the renunciation of individual will, the annulment of self, and the struggle for the abandonment of all desire.

There is a lot that is positive about some self-control techniques. However, while some serenity practices can relieve certain kinds of pain, mostly physical pain, it doesn’t always work for emotional suffering, others’ or our own. Denying its existence does not eliminate it. Some practices of “diversion of attention” remind me of the case of a smoker that a doctor friend of mine told me about: He was so terrified about what he had read in a newspaper article about the harmful effects of tobacco, that from that day on he stopped reading the newspaper…. And one asks oneself if, long-term, it is beneficial for the human being to become insensitive, particularly to the suffering of others.

Resignation to Fate

Various traditions teach their followers not to rebel against misfortune. They believe that it is always a result of personal faults or divine will. As an example, they often use individuals affected by sexually transmitted diseases due to lifestyle choices. For them, suffering is a direct result of specific transgressions, although the guilty person may not be aware of them. In a way, it is the fatalistic idea of Insha’Allah, which in many cultures is rooted in a religious education of blame. If a child falls trying to reach a jar of jam in the kitchen cupboard, there are parents who will say: “It is God’s punishment. You have disobeyed your mother and that is your punishment. You deserve it.” And so the child ends up believing that every form of suffering comes from direct—and divine—sanction of their faults.

Rebellion

But the idea that human suffering is due to divine punishment makes us rebel. As a neighbor of mine once said: “They say that God makes those who He loves the most suffer, but I’d rather He left me alone. What could I have done to Him so that He would give me such a difficult daughter?”

In my pastoral ministry, I have heard many reactions to painful situations:

“How can God allow my baby to suffer?”

“What wrong have I done to have cancer? I’ve always attended church…. I don’t think I’m any worse than my friends, but everything is going well for them.”

“Why does God allow children to die in wars?”

“How am I going to have an operation to remove this tumor if maybe God sent it to me?”

In secular societies, loss of faith, trust in medicine as the solution for everything, and the utopian dream of a world in which science one day eradicates pain, have led many people to stop looking for answers in philosophy and religion to the problem of suffering. Most end up ignoring the enigmatic dimension of the issue and look elsewhere.

Emotional Suffering

From the point of view of bioethics, pain is usually distinguished—with reason—from suffering. If pain can be fought at all costs, suffering does not have the same possibilities for therapeutic treatment because the circumstances that produce it cannot be modified with concrete formulas. The doctor may not know the suffering that a given situation causes for a particular patient and may limit the treatments to merely symptomatic ones. And the patient may make incorrect personal decisions that counter the effects of any therapy.

Given the complexity of the task, medicine continues to seek out new resources for fighting or relieving different kinds of pain. Among other things, it has been found that a number of physical ailments proceed, at least in part, from unhealthy attitudes about life and, in particular, from unresolved emotional problems. Unlike physical pain, mental suffering does not come from accidents or disease states. It arises, most of the time, from the conflict between our desires and reality: the death of a loved one; the loss of a job; reduced faculties due to an illness, accident or decrepitude; emotional wounds due to a divorce or a breakup; etc. This kind of suffering is caused by our physical limitations (we find ourselves deformed, diminished, or elderly), our social disadvantages (we feel excluded because of our gender, race, nationality, marital status…

), our financial difficulties (debts or troubles), our emotional problems (a betrayal or rejection), and so on.

This anxiety grows when we are faced with barriers, sometimes insurmountable, that are between us and our hopes and dreams. As John Lennon used to sing in Beautiful Boy, “life is what happens to you while you’re busy making other plans.” Emotional suffering emerges from painful situations for which we cannot find a solution: guilt from wrongs that cannot be righted; unrequited love; feeling hopeless because it is too late to change a fault; feeling powerless at the death of a loved one; feeling despair at the proximity of one’s own death; etc.

Emotional suffering is inevitable in an unjust world. And deeply human. We could almost say that it is sane and positive to feel it, because it comes from some of the best abilities of a person: sensitivity and compassion. It is part of our humanity. It would be inhuman to remain insensitive to injustices or misfortunes, whether they are others’ or ours own.

Anxiety, stress, and depression

A classic example of how difficult it is to separate pain from suffering is provided by anxiety, stress, and depression. According to statistical estimates, in the year 2000, there were already hundreds of millions of individuals suffering from depression, two times the number in 1950, mostly in the West. In 2009, between 7% and 10% of the world’s population suffered from some form of depression, mostly in the countries with a Western lifestyle.8 The causes behind this growing problem are very complex, as its physiological components are difficult to separate from its psychological factors, and include genetic predisposition, lifestyle, the impact of environment, family tensions, and personal problems.

According to experts, stress and loneliness are two of the main causal factors of depression. Stress comes from fear and hurry, from emotional overload at work, from worry about personal problems, from pressure to do more without ever knowing how much more. Loneliness, meanwhile, hurts us by a lack of emotional support, a lack of affection, a lack of communication with others, the inability to count on someone with who can provide us with a less subjective frame of reference than our own on the reality in which we live. And it also comes from the assumption that all of the above makes us feel alone, even when we are not alone in reality. Every day there are more people who have unmet emotional needs or a weakening self-esteem. Many depressed individuals suffer from a lack of recognition or appreciation. They don’t need fame, fortune, or medals to be happy. They just need someone to recognize their achievements, help them accept their reality, soothe their concerns about their burdens, and help them find inner peace. Stress and loneliness alter personality, affect self-perception, and disrupt serenity in the face of reality, creating unnecessary anxiety and distress.9

The complexity of this condition is described by its victims in distressing terms: “I cannot forget the horror of depression, the intolerable pain, the loneliness, the isolation, the despair that excludes all hope […]. Nothingness was the only escape from pain.”10 So its treatment requires professional medical care. When depression is addressed in only psychological or spiritual terms, we fall in the trap of requiring faith or motivation when these are impossible to create for oneself. It is of little use to treat the symptoms without addressing the causes of the ailment. It is cruel to try to impose worship on a bleeding heart.11

The many causes of pain

At this point in our reflections, we realize that there is no easy answer to the question “why do we suffer?”, because we really suffer for many and varied reasons. In summary, we can list them in the following way :

1 We suffer, chiefly and obviously, because we are human. Our physical reality is sensitive, vulnerable, and mortal. We get wounded, get sick, and grow old. In this sense, our suffering is “natural,” at least under our current circumstances.

2 We also suffer because we are free, able to make painful choices and take risks that may cause pain.

3 And we suffer, in large part, because we are intelligent, conscious of our painful reality, and very capable of using our intelligence to cause suffering.

4 There is no doubt, therefore, that we suffer all too often because our own wickedness is capable of causing a lot of harm, individually and collectively.

5 Paradoxically, we also suffer because we don’t always act with the intelligence that we should. Many of our problems come from the senseless mistakes that we make involving ourselves and others.

6 We also suffer, logically, because we live in a society, and we are often victims of the decisions made by others. Someone affected by secondhand smoke can suffer serious harm because to the irresponsibility of others.

7 We also suffer, finally, because of sympathy or compassion for the pain of others. This means that a large part of our suffering is not physical but can be emotional.

But human beings are not satisfied with technical answers, or even scientific ones, to the question of suffering. We also need existential and metaphysical answers. Besides asking ourselves how we can reduce or eliminate pain, we also ask what meaning suffering has when all our efforts to diminish it or avoid it reach their limits. We have all felt the need, confronted by our own pain or that of our loved ones, to know what to do or say. When our efforts fail, we are faced with our own powerlessness, and what we don’t want to happen, happens.

There remains therefore the need to look beyond one’s own suffering, to find its root causes; adopting, meanwhile, the maxim of the Ragmen of Emmaus: “fighting against suffering and eliminating its causes.”12 Having the clarity and courage necessary to fight or endure, depending on the situation. But knowing that pain will sometimes be inevitable, sometimes long and painful, and sometimes end a life.

1 . Quoted by Philip Yancey in When We Hurt. Prayer, Preparation and Hope for Life’s Pain, Grand Rapids: Zondervan, 2006, p. 21.

2 . Ruth Frikart, La mort en bandoulière [Death on my Shoulder], Paris: Éditions Société des Écrivains, 2005, p. 161.

3 . This basic principle of natural ethics is in the foundations of the Ten Commandments, the Universal Declaration of Human Rights, and the health protection assured by modern constitutions, or the Kyoto Declaration. So, it goes against the precepts of bioethics, for example, to deny analgesics for fear that the patient maybe become addicted, and it is the responsibility of the health personnel to provide adequate medication so that the patient suffers as little as possible. For a classical philosophy of pain management, see “Working together to relieve your pain” in Patient Education (National Institutes of Health Clinical Center) www.cc.nih.gov/ccc/patient_e

4 . Cf. Chris J. Main & Chris C. Spanswick, Pain Management : An Interdisciplinary Approach, Churchill Livingstone: Harcourt, 2000.

5 . Paul Tournier, Guilt and Grace, New York: Harper & Collins, 1982.

6 . For the Stoics the ultimate virtue is ataraxia (“imperviousness to perturbations”). They taught that embracing reality as it is would lead to happiness, for our thoughts cause our joy and suffering. By having a positive attitude we would enjoy our life. By “rejecting reality” and thinking about injustice, we will make ourselves miserable (Epictetus, Manuel, chapter 8. Cf. J. W. Gray, “Stoic % Buddhist Arguments Against Intrinsic Values,” in ethicalrealism.wordpress.com/2010/03/23).

7 . Extracted from “Setting the Wheel of Dharma in Motion” (SN 56:11). Dharma is a Buddhist method of protecting ourselves from dukkha, a term commonly translated “suffering” or “pain”. This definition of dukkha is identified as the first of “The Four Noble Truths”. Cf. The Buddhist Society, 1001 Pearls of Buddhist Wisdom: Insights on Truth, Peace, and Enlightenment (selected by The Buddhist Society,), London: Duncan Baird Publishers, 2006, p. 7; Peter Harvey, Buddhism, Cambridge University Press, 1998/2006, p. 198.

8 . See www.depressionhelpspot.com/depression_statistics.html (cf. David B. Morris, The culture of Pain, University of California Press, 1993).

9 . Lori A. Leyden-Rubenstein, The Stress Management Handbook: Strategies for Health and Inner Peace, Keats Publishing, 1998.

10 . R. Dunn, Quand le ciel est silencieux [When Heaven is Silent], Marne-la-Vallée (France): Farel, 2003, pp. 144-145.

11 . John White, The Masks of Melancholy, Westmont (Illinois, USA.): Intervarsity Press, 1982, p. 77.

12 . Motto for the Ragpickers of Emmaus Association: “In the face of human suffering, try, as best you can, not only to alleviate it as best you can, but above all eliminate its causes. Try, as best you can, not only to eliminate the causes of the evil, but to alleviate, as best you can, the suffering that it causes.” (www.emaus.fr).

Parte II

A Closer Look

“To understand pain, there is nothing like having suffered.”

Jacinto Benavente

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