Why must we Suffer?

‘‘Why must we suffer?’ - a psychiatrist reflects’

Dr. Andrew Powell

Introduction

Philosophers and theologians have argued about the nature of

suffering since we humans developed the capacity for self-reflection, and I

dare say the collective intellect of humankind is as much exercised, and as

likely perplexed, today as it was in the time of Shankara, or Lao Tse, or the

Buddha, or Plato, or Jesus Christ or the Prophet Muhammad; for suffering is a

condition of life.

Being a doctor has brought me into contact with a great deal of

suffering, both physical and emotional. Now, reflecting on my time in general

medicine and psychiatry, and my own life this far, I would like to offer some

thoughts about the problem of suffering, what it does to our minds for good or

ill, and how we may try to work with suffering to relieve despair and bring

hope.

What is suffering?

First I had better define what I mean by the word. I am drawing a

distinction between pain and suffering in that pain is a sensation, while

suffering means to be aware of what pain signifies. It is a function of mind.

Suffering arises when we learn the meaning of loss – for instance,

never to walk again, or to live with the prospect of chronic pain, or to have to

face the ending of life, your own or that of others. Less visibly, there is the

suffering of loneliness, or alienation, or despair, and of oppression, in which

the projected future holds nothing but the desolation of the present.

The list is a long one and accompanies consciousness like a dog its

master. At the heart of this is the knowledge that once we have grasped that

birth brings with it the inevitability of death, the desire to be well carries with it,

consciously or not, the fear of falling ill, and the realisation that happiness, like

health, and everything else, is at best ephemeral.

This poignant truth is recounted in the myth of Adam and Eve and their

fall from the Garden of Eden on account of eating the fruit of the tree of

knowledge. Their trauma, (the word derives from the Greek for ‘wound’) was

to live ever after with a yearning for the paradise they could never regain. But

expulsion into the world of birth, ageing, sickness and death also meant

growing from Homo innocens to Homo sapiens.

The theme of loss informs all great art and literature. These days it also

plays an important part in our understanding of mental health and so I want to

start by looking at how the pain of loss shapes the future of every human

child.

1The ordeal of birth

Let us start at the beginning. Before birth, we now know the baby is

actively responding to the environment of the womb. There is plenty going on;

the baby is testing out the limits of its world, kicking, sucking its thumb,

listening and busy getting on with growing. Amniotic fluid cushions the baby

from impact, life is one long feed and there is warmth and the comfort of the

mother’s heartbeat.

There are occasional disturbances to the well-being of the foetus - the

highly anxious mother whose adrenaline is flooding the baby’s circulation, or

conflict in the outer world, when the baby hears raised voices and angry

exchanges, or if the mother has a fall. Despite this, most babies reach full

term in a reasonably tranquil state.

Then comes the trauma of birth, which leaves indelible traces in the

psyche of the infant. The comfort of the womb is exchanged for almost heartstopping compression as the birth process gets under way.

Paediatricians refer to foetal distress when the oxygen supply to the

baby is seriously compromised, but every baby passes through a rite of

passage in which the forces of life and death are pitted one against the other.

The terror of suffocation is only assuaged when the newly born is held in the

arms of the mother, feeling the softness of her skin, taking in her smell and

tasting the sweetness of her milk.

The psychology of early years

Imagine how a child first comes to understand the world. To begin with

the baby is at the mercy of unpredictable sensations, like being full of milk or

at other times hungry. But what begins as a jumble of sensations soon

acquires a rhythm and meaning. Hunger is relieved by crying for the mother,

so that before long the feeling states of hunger and satiation get paired. Later,

the infant matures enough to know that an absent mother has not

disappeared for ever but can be called to the cot by its crying. When it has

discovered that its needs can be periodically satisfied, it learns to let go of its

mother from time to time and be comfortable with its own inner state. The

infant is learning a lesson for life - that human relating is found in perpetual

oscillation between the states of merging and of being alone.

As the infant develops, other pairs of constructs begin to structure the

sensorial world: big and small, soft and hard, light and shade. This act of

discrimination gives to each its special, contrasting attribute. At the same time

that this perceptual complexity is growing, a parallel inner conceptual world is

evolving. The child learns to distinguish between me and not me, mine and

not mine, bad and good, and later, right and wrong, all cognitive steps that are

mirrored by an increasing complexity of feeling states.

First encounters with loss

Nature has infinite wisdom in how things should be arranged, provided

that we don’t mess it up with dogmatic and largely fashionable opinions as to

what is ‘good for the child’. In the 1940s, a fanatical paediatrician called Truby

King urged mothers never to go to their babies except for the four-hourly feed,

to teach them ‘independence’ and thereby causing untold suffering to

thousands of babies, some of whom carry the imprint of that deprivation to

this day.

2All severe privations of childhood leave their mark and an infant can

only respond to overwhelming loss in one of three ways - to take refuge in

withdrawal, to become clinging, or to learn to survive without any attachments,

a development which leads to psychopathic disorder in later life.

In contrast, the child with a healthy and confident attachment to its

mother can risk losing her for a time, not least out of sheer curiosity to explore

the world, which may be a matter of just going into the next-door room. When

something frightening happens, real or imagined, the child runs back to the

safety of its mother. Similarly, the loss of the comfort of breast milk is more

than compensated for by the excitement of tasting different foods. Childhood

at its best is a great adventure, in which the child plays the hero protagonist of

the drama. Key dramatis personae come and go, while the child holds centrestage. This confidence and security is the greatest gift that parents can give a

child.

Then comes the challenge of the wider social world. Every young

person will feel frightened at times - the fight/ flight response is built into all of

us, and where there is a serious risk to our safety, emotional as much as

physical, the barriers go up to keep out the perceived threat. We all have egodefences in place; but this is only to be expected, unlike the extreme

hypersensitivity that results from emotional insecurity.

The first day at school is etched into most people’s memories. The

child is no longer at the epicentre of the social world. But this big loss can be

managed if kindly teachers step in to help, there are friends to be made and

the lessons are fun. Then the child goes home with pride in a new

accomplishment. But it is not always such a happy occasion and school

phobia is a major problem for child psychiatry services.

So far, I have focussed on how losing what we count as safe and

familiar is built into the blueprint of life and how, in the right measure, it can be

the spur to growth. It holds true whether for that first day at school, or the

young adult brave enough to fall in love and run the risk of being jilted, or

when facing a life-threatening illness, or for the person whose career falls

apart but who manages to snatch victory from the jaws of defeat.

The neurophysiology of emotion

The mind is not reducible to the brain, but it certainly can’t do without it.

Take the fight-flight response mentioned earlier. When a threat is perceived,

the brain tells the adrenal glands to release adrenaline in preparation for fight

or flight; this is accompanied by the emotions of anxiety and fear. (In fact, an

injection of adrenaline will have the same result.) Importantly, the fear may

equally be triggered by what is imagined, so that an insecure child, for

example, cannot tolerate the absence of its mother without becoming anxious

because of its fantasy of abandonment. On the other hand, circulating

endorphins, which are opioid peptides produced by the pituitary gland and

hypothalamus in the brain, induce an immediate feeling of well-being. Nature

makes us this gift in the first few hours of life, for endorphins reach peak

levels in the mother’s bloodstream during labour and are imbibed by the baby

in its first feed, enormously facilitating the bonding between them.

However, the nerve centre of emotions, so to speak, lies in a

specialised neural structure in the white matter of the brain called the limbic

system. This ‘limbic brain’ mediates the basic emotions common to all the

3mammals. For example, removal of its amygdala nucleus leads to passivity

while over-activity (as may occur in epilepsy) can cause aggression.

The brain has further evolved during the more recent evolutionary

history of the primates and the limbic system is now buried deep beneath the

neocortex, or grey matter. In the case of the human being, the neocortex has

massively expanded to form the frontal lobes, the seat of reason and

empathy.

The problem for humankind lies in the way the limbic system and the

neocortex don’t pay much attention to each other, and not infrequently are at

odds. This evolutionary birthright is a blessing or a curse, depending on what

we do with it. In the case of the well-functioning human ego, reason and

emotion are able to work together, and they serve us faithfully, enabling us to

love, to bond and, through facing the many challenges of emotional conflict, to

grow in maturity. But when the same biological legacy results in our being

ruled by our emotions, they become ruthless tyrants, dedicated to destroying

anyone or anything felt to be a threat to self-survival. Before the advent of

modern technology, this served to protect tribal and national identities but

coupled with science, the result has been disastrous. Over 100 million people

were murdered in the 20

th

century, more than in the whole previous history of

humankind.

Life without soul

Not for nothing has ‘mind, body and spirit’ become the mantra of

holistic healthcare and I now want to put the spotlight on soul. If my thesis is

correct, much of the suffering we see today is on account of denial of the soul

in a post-modern secular world, in which case treating disturbances of mind

and body without reference to soul is deeply misguided.

The use of the word soul to mean the spiritual essence in every human

being does not have to imply the survival of consciousness after bodily death,

as atheists and humanists will avow. Just as water finds its own level, people

will incline to their own deepest level of meaning, and if their existential

concerns can be comprehended within the compass and purpose of a single

lifespan, well and good. Yet many of us have a steadfast belief in the

indestructible essence we call soul that transcends the temporal bounds of

birth and death.

Unfortunately, in the Western world, there has been an intellectual

schism between materialist science and metaphysics, which has grown

steadily over three hundred years. The dominant worldview of the last century

has been that of a mechanical universe. Karl Marx called religion ‘the opium

of the masses’ and Sigmund Freud described it variously as ‘a universal

obsessional ritual, a reaction to infantile helplessness and a mass delusion.’

Despite such pronouncements, surveys have shown that well over two thirds

of the population continue to believe in God or a ‘higher being’. However, for

people who do not belong to a faith tradition, the significance of an afterlife is

dumbed down by a society that no longer cherishes any such belief and often

it is only when faced by a crisis such as life-threatening illness that these

concerns come to the fore.

4The existential void

Many people, aside from the distraction of consumerism, are left

deeply puzzled about what life is for. For those that have children, there is the

hope that the love shown them will bear fruit in the course of their lives. No

less important is the value of friendship and community, while for others there

is the wish that one’s work will contribute in some small way to the progress of

life on this planet.

However, when mental distress reaches a certain pitch, none of these

expectations can entirely sustain a person. Worse still, the crisis may follow

on the failure to make a success of one’s work or when a family is breakingup. What then is left that is worth living for?

The life instinct is a powerful inborn force and the foundation of the

human ego. Small surprise that many psychiatrists treat suicidal thinking as

the cardinal sign of depression. But is it necessarily so? It is always tempting

to pathologise the existential anguish that leads a person to ask ‘is there no

purpose to my life anymore? Am I a failure? Should I give up? What’s the

point in going on when I cannot feel love, only despair?’

In the face of such misery, mental health professionals are liable to

distance themselves from the anguish that is being expressed. This may be

understandable, but it won’t be much help to someone needing to explore his

or her spiritual resources when facing an existential crisis.

What are called for are openness, empathy and genuine interest on the

part of the psychiatrist, coupled with a wide spiritual frame of reference.

Unfortunately, unlike the general public, less than one third of psychiatrists

hold a spiritual or religious outlook. The great majority subscribe to a

physicalist worldview and this makes it all the harder to venture into the inner

world of their patients and be open to solutions that acclaim a person’s innate

spirituality.

There is a great irony here. Psychiatrists who cannot draw on their own

spiritual resources will experience far greater pressure coming from their

patients because they feel all the more obliged to provide answers. For

someone in deep distress, the psychiatrist, short of God, is where the buck

stops. However, it is unwise to be drawn into playing God. It is much better to

go with that question to the place where a person can find the answer, by

asking it of their soul. The psychiatrist will greatly help by keeping faith with

the ultimate goodness of the universe at a time when it may be utterly lost to

the patient.

Intimations of hell or heaven

I indicated earlier how no sooner is the developing ego is celebrating

its mastery over life than it is faced with intimations of its own decline. Pain,

unforeseen injury, the realisation that relationships cannot be forced,

disappointments in love, the loss of loved ones, and the certain knowledge of

ones own ageing and eventual death, compel us to relinquish the cherished

dreams of yesterday in favour of the stark truth that we do not, and cannot

have, control over much of what happens to us. It would seem that from a

perfect beginning, we are destined for a miserable end.

Everyone wants to be happy, but happiness is not a right, neither is it

something that can be bought or borrowed. If our ego defences could give

way gracefully to the inevitability of personal loss, we could be consoled in the

5knowledge of the greater gain – to have contributed to life, the welfare of

others and even to have advanced the soul a little. But though the neocortex

provides us with the intellect needed to address the task, the limbic system

will have none of it. Reason and emotion are at odds, and the greater the

degree of neurosis, the more they battle it out; where love is lacking and the

emotions are unchecked, human beings survive by finding their place in the

pecking order, a hierarchy governed by domination and submission. The

basic need is for safety - from hunger, attack and isolation - and the

behaviours that will secure this are driven by primitive emotions; envy,

jealousy, dependency, hostility, along with all the negative attributes of the

ego - contempt, arrogance, ruthlessness, and manipulation.

How different in a loving home! There, the self, feeling itself well loved,

has love to give, and to ‘love your neighbour as yourself’ (Leviticus 19: 17-18,

Matthew 22:39) is a natural response, for giving to another means also to give

to oneself. This happiness that comes of giving help whether to individuals,

communities or causes, entails a paradox as found in the Gospels. ‘For he

that has, to him shall be given; and he that has not, from him shall be taken,

even that which he has.’ (Mark 4:25)

Such a statement is counter-intuitive. Surely those with the greatest

need are the most deserving? But when we look at the misery wrought by

neurosis, we find that the failure of relationships usually stems from the desire

to obtain from the other what feels to be lacking in the self. Once the

honeymoon is over the battle begins, for no one wants their energy and their

love extracted to fill the void in the other.

From the psychiatric point of view, here lies the rub. It is hard for

people who have been seriously abused, deprived or otherwise traumatised to

feel much love for themselves, and neither can they easily love anyone else.

What gets called love is in fact need, which is not about giving but taking.

The egotistical behaviour that results comes from a lack of healthy ego

development. Insecurity and poor self-esteem, not infrequently coupled with

compensatory self-inflation (narcissism) actually point to this underlying

deficit. When there is no trust in the goodness of self or other, life becomes an

obstacle course to get through by resorting to manipulation.

The future in our hands

There has been much confusion about the meaning and purpose of the

ego, for just as a knife can cut bread or kill, so the ego can be an instrument

of destruction or creation.

The passions of the ego show us what it means both to love and hate.

Where love and security are lacking, aggression is the instinctive response to

a perceived threat to the self and its possessions - just try taking a bone from

a wild dog. Yet a dog that loves its master will yield the bone, for it trusts that

loss is followed by gain – maybe getting stroked, or taken for a walk, which in

turn strengthens the bond of affection. People are not dogs but there are

some similarities! People who can love and trust others are willing to risk

being vulnerable, and to show openness and a generosity of spirit. Such

persons are far more likely to share in mutually rewarding and stable

relationships.

I don’t want to suggest that the human being is simply controlled by

punishment and reward but I am describing the difference between a fixed

6defensive pattern of behaviour and being open to new experiences. The

implications of a difference such as this will probably determine the future of

the human species. We have an evolutionary history of tribalism rooted in

fight/flight mentality based on the ego under threat, just as we see to this day

in the behaviour of insecure children. In contrast, secure, happy children show

something very different – the capacity to grow into adults who value not

competition but co-operation.

Co-operation is a sure sign of spirituality in action. There is an old story

that compares Heaven and Hell. In Hell, lost souls are seated around a large

dish of appetising food. They are obliged to use spoons with handles longer

than their arms but since no one can get their spoon to their mouth, they are

all starving. In Heaven, they must use the same spoons, but instead everyone

sets about feeding each other.

Spirituality East and West

There is a commonly held assumption that spirituality necessitates a

suppression of the ego. It is my impression that this never really works, since

the ego constantly fights back. The skill is to find a way to liberate the self

from the negative and limiting aspects of the ego.

Different religions go about this in different ways. For example, in

Buddhism, desire and attachment are regarded as the cause of suffering. The

Third Noble Truth teaches that ending desire, which leads naturally to letting

go of attachment, brings suffering to an end. But in the Judeo-Christian

tradition, the accent is on suffering and redemption. Suffering is seen to be a

necessary spiritual challenge and a profound test of faith, as recounted in the

story of Job. The most extreme challenge, the ‘dark night of the soul’, is that

of feeling abandoned by God. Jesus himself cried out on the cross, ‘Eli, Eli,

lama sabachthani’, or ‘Lord, Lord, Why have you forsaken me?’ (Matthew

27:46).

Although I was brought up in the Anglican Church, I have been

influenced by the spiritual traditions of both East and West. Personally, I like

to picture the influence of soul on the ego rather like a good parent dealing

with a wayward child. As the ego becomes infused with soul virtues, its

agitation subsides, it becomes more peaceful and its energy can be put to

good purpose. But such a child needs understanding, loving and forgiving, so

that reconciliation can take place, and a new start made.

It is no accident that the systematic study of mental disorder has

flourished in the West, where we have a history of fascination with the

contents of the individual psyche that began with the Renaissance. In the East

there is a more pragmatic tradition, of freeing oneself from burdensome

mental contents by purifying the heart through meditation. Consequently there

are cultural differences towards the negative aspect of the self.

The Buddhist and Hindu approach is to concentrate on right conduct

and the development of wisdom that will influence successive incarnations

according to the law of Karma. Daoists hold that all life depends on the

harmonious flow of qi. There is no such thing in itself as badness, only the

manifestation of the imbalance of yin and yang, and goodness is held to arise

naturally when the rhythms of the cosmos are understood and honoured. But

in the West, we mostly turn away from nature and struggle with our ‘demons’.

Excepting spirit release (which has not found acceptance in mainstream

7psychology), western secular spirituality seeks to find healing in bringing the

‘Shadow’ to consciousness and divesting it of its power by integrating it with

the psyche, where Christianity underlines the need for repentance, as in the

parable of the prodigal son (Luke 15: 11-32). In stressing the importance of

repentance, Christianity and Islam are united. The Koran states that

repentance is the most noble and beloved form of obedience in the eyes of

Allah.

Suffering, individual and collective

In the title of my talk, I ask why it is we have to suffer. This is a very

western kind of question since it implies that there is an answer, rather than

suffering simply being a fact of life. Yet it is a worthwhile line of enquiry since,

from the transpersonal perspective, the soul always incarnates with an

agenda perfectly attuned to its chosen circumstances. A soul that incarnates

as a Buddhist has one agenda and the soul that incarnates as a Christian has

another. In the case of Christianity, the hope is that pain leads to gain, since it

is held that God never sets us a challenge it is not in us to overcome.

People with mental health problems are certainly among those who

have taken on lives of great suffering. Nevertheless, it is my belief that each

soul is provided with the exact requirements for the journey ahead, the

lessons to be learned, the knowledge to be gained and the opportunities that

will be needed. And yet, all this is subject to our free will, so we are

instruments of our own spiritual destiny.

It may seem callous to suggest that a person’s suffering might be in the

service of helping another awaken to the qualities of caring and concern and,

who knows, if these are two souls working out their karma from a previous life,

to make reparation. But to take the greatest exemplar in human history, by

willingly submitting to torture and execution, Jesus offered to awaken the

conscience of the world. This highlights the ambiguous status of psychiatry,

for had Pontius Pilate been in the position to order a psychiatric examination,

imagine what may have happened – no crucifixion but instead detention under

the Mental Health Act! And before we dismiss Judas Iscariot as a thoroughly

bad character, we must remember that without him, the law of the prophets

could not have been fulfilled. Is it right to condemn him? Possibly he was

entrusted with the most difficult task of all the disciples.

Indeed, from the transpersonal perspective there is no such thing as a

bad experience. The soul regards a single lifetime as we might look on one

day in the year, and each life is but a very small corner of the field of action.

Ultimately there is only the gathering in of experience, the expansion of

consciousness and, always, the opportunity for transformation.

Though karma may be rooted in the behaviour of individual souls,

collective karma is no less important. Genocide can never be condoned or

excused, but it happens, like everything else, for a purpose. The Jewish

Holocaust raised the conscience of the world by several degrees. Yet,

tragically, there has been constant genocide since that time, for example, in

Biafra, Uganda, Cambodia, Rwanda, the Balkans and Iraq. How bad does it

have to get before we learn to break the cycle of persecution? The cycle can

only be broken one way, with forgiveness. This is something not in the power

of the human ego, for forgiveness comes from a higher place.

8Why should we forgive?

People who have suffered profoundly, be it from child abuse, or rape

and torture, or severe mental illness, or spirit possession, or from genocide or

the impact of natural and man-made disasters, are faced with the need to find

forgiveness, whether of God for his allowing it, or the Devil for doing it, or

humankind for carrying it out, and this is just about the hardest thing in the

world to do. Yet without forgiveness, anger will have a deeply corrosive effect

on a person’s life. Far from letting go, that person remains trapped in hurt and

anger, and this can last a lifetime and more.

This is the pivotal point of development that confronts every individual

and equally the whole world community. How can we use the many and deep

wounds of life to help raise the consciousness of this planet to a higher level?

The workings of the limbic brain make sure we live in a state of high

emotional reactivity. Our personalities clash and compete, we jealously pair,

bond, and raise children, and each make our temporary impression on the

world. This is all to the good, otherwise we would have nothing to learn in the

classroom called life. Yet the need of the ego is always self-protective and as

long as the self is felt to be separate from, and different to, all other selves,

the fight is on.

Mainstream psychotherapy is primarily concerned with helping people

make their best adjustment to this state of affairs. In contrast, psycho-spiritual

therapy invites the soul to speak, and it tells a very different story. Since the

soul transcends the body, it does not know death, and can therefore view all

the comings and going of life with compassion and serenity. It is in the original

nature of soul to want nothing more than for the incarnated self to outgrow the

narrow concerns of the ego and become conscious of the beauty and unity of

life. From this quiet place within, we can observe ourselves being tossed

around by the drama of life with a kindly and loving eye, much as we would

watch the antics of a child. The intended lessons are plain to see, in the here

and now, and we don’t have to wait for Kingdom Come.

As a psychiatrist, I am not claiming any special knowledge of the ways

of soul. All rivers lead to the sea and I am simply speaking about the one I

know best. It is a river of tears, tears shed in anger, tears shed in sorrow and

tears shed in despair. It is, in places, a raging torrent and a river to drown in,

unless a person is prepared to swim hard! But when someone has come

through the ordeal, there is pride in having made the effort, in facing one’s

worst fears and in discovering new strength.

To stay well means to find wholeness, in other words healing, or else

one falls into the same river all over again. The ego is indifferent to healing,

since it is more occupied with things of the world like ambition and success.

But healing is the soul’s greatest desire. In a world driven by the human ego,

every human being inflicts and receives pain. Yet throughout the whole

turbulent business of growing up, the soul is flexing its muscle, in small ways

at first, showing kindness, the expression of sympathy, concern for others and

charitable acts. All this is premonitory to an occasion that, sooner or later, will

challenge every person to his or her core, and which calls on the soul to give

of its very best.

This occasion is invariably one that deeply tests a person’s capacity to

forgive. It means finding love for those that have badly hurt you. A recent book

9by Immaculee Ilibagiza,

∗

whose family were slaughtered in the Rwandan

Holocaust, is an inspiring such account. In the midst of her terrible grief, she

came to recognise through prayer that even the killer of her family was God’s

child as much as she, and face to face she was able to forgive him.

Forgiveness is the supreme test of love. Jesus spelled it out like this:

‘Love your enemies, bless those that curse you, do good to those that hate

you, and pray for those who treat you badly and persecute you, so that you

may be the children of your Father which is in heaven’ (Matthew 5:20). Just as

the symbol of transformation, the lotus, cannot flower without its roots in the

mud, the burgeoning soul finds an opportunity for forgiveness in every hurt

given and received.

Desirable though it may be, a person cannot always forgive, and it is

not for anyone to try to insist. What I have generally found, though, is that

people would wish, if only it were possible, one day to be able to forgive. This

is because despite the outraged ego, the soul impulse cannot be killed off.

Once we make contact with the desire to forgive, however improbable it may

seem, we are starting out on a journey of love in which we too can be

forgiven, find redemption and, at last, return to where we began - the Garden

of Eden, no longer the garden of innocence but of wisdom.

∗

Ilibagiza, I (2006) Left to Tell Hay House Inc: Carlsbad CA

Dr. Andrew Powell’s publications on Spirituality and Mental Health can be

downloaded from the publication archive of the Website of the Spirituality and

Psychiatry Special Interest Group of the Royal College of Psychiatrists UK,

see: www.rcpsych.ac.uk/spirit

© Andrew Powell 2006

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