In Buddhist philosophy there has been an extensive and detailed analysis of human suffering. It is a basic human instinct to seek the relief of suffering and the attainment of happiness. And it is the health practitioner above all who is called to assist individuals with this basic aim of human life. Yet at no time in my medical education did the issue of suffering receive even the most brief acknowledgment. There is an unstated assumption in most all practitioner education that the relief of suffering is a mere by-product of the diagnosis of physical disease and the application of appropriate remedies and therapies. When it comes to an understanding of suffering we are quite ignorant. As a result we are unable to address and permanently relieve human suffering which is the basis upon which we can strive for the flourishing of our human possibility - a sustained and profound health, happiness and wholeness.

The topic of suffering is a large and extensive one that I can only touch on in this note. The first type of suffering is the most apparent one. It results form the adversities of the human condition such as aging, disease, disability, and death. This is called evident suffering as we can all see it and relate to  it. This material suffering, a suffering based on the inevitable degeneration of our body, is experienced by animals as well as humans and is the major focus of both conventional and alternative medicine.

The second type of suffering applies uniquely to humans. It is far more subtle. We can call this disguised suffering as it is not as apparent as the overt suffering based on our physical nature. This aspect of suffering arises from our misguided efforts to attain happiness through temporary pleasures that we reflexly use to alleviate both physical and mental suffering. We chase after pleasures such as material possessions, wealth, consumerism, relationships, sexuality, drugs, endless entertainment, busyness and so on as antidotes to life's difficulties. A moment of pleasure, which is labeled such as it relieves a previous moment of suffering, elicits both the desire for more of the same as well as an increasingly strong attachment to and craving for the experience. Unfortunately all pleasures based on external sensory experiences are transient unlike the inner happiness that occurs with inner development. So after the first rush is over we seek more and more as if we were on an unstoppable treadmill. If we gain pleasure we fear losing it and naturally seek to protect it. If anyone gets in the way of our pleasure it arouses anger and resentment within us. Outer pleasures invariably become our addictions and the necessary result is suffering. This second type of suffering, disguised suffering, can also be called the suffering of pleasure or the suffering of change.

The root source of suffering lies in the third type of suffering - the exile from our deepest and most authentic self. When we lose awareness of our most inner self we become enmeshed in the habituated, fabricated, and afflictive daydreams of our life.  Further, we become isolated in our separateness and disconnectedness from others and from the wholeness of life.

So it is apparent that the lack of attention in my medical education to a  holisitic understanding of suffering has prevented me from accurately understanding the nature of my own suffering and distress as well as those of my clients. The result is an incomplete "diagnosis" and partial, limted, and too often inappropriate therapy that cannot permanently relieve suffering. And  without addressing the basic issue of suffering it is not possible to move towards a sustained integral health of human flourishing.