# Suffering Is Not Pain

“*Pain is inevitable; suffering is optional*.”

The motivation of this post is to address the persistent conflation between suffering and pain I have observed from members of the EA community, even amongst those who purport to be “suffering-focused” in their ethical motivations. In order to best address the problem of suffering, it is necessary to be clear about the difference between suffering and mere pain or ordinary displeasure.

The parable of the second arrow
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In [the Buddhist parable of the second arrow](https://www.accesstoinsight.org/tipitaka/sn/sn36/sn36.006.than.html), the Buddha illustrates the distinction between suffering and pain with the tale of a man struck by two arrows. The first arrow represents the pain that life inevitably brings. The second arrow, however, represents the suffering that arises from his reaction to the pain. The Buddha teaches that while the first arrow (pain) is unavoidable, the second arrow (suffering) is optional, and that by letting go of the resistance to the pain (aversion), one will not suffer the sting of the second arrow.

Defining pain and suffering
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*   **Pain**: An unpleasant physical sensation or emotional experience.[^x9qq4f40x67]
*   **Suffering**: The unsatisfactoriness that arises from craving, aversion, and clinging/attachment to sensations and experiences; [dukkha](https://www.accesstoinsight.org/ptf/dhamma/sacca/sacca1/dukkha.html).

I feel it is important to clarify at this point that, while the above definition of suffering derives from historically-Buddhist teachings about dukkha and its cause, I am not endorsing this definition because it is Buddhist but rather because I believe it best identifies suffering as it can actually be observed in phenomenal experience. For those who are skeptical (possibly deeply so) about the claims and teachings of Buddhism, I ask that you consider the distinction I am advocating with reference to your own experience(s) of pain and suffering. While both pain and suffering are phenomena that “feel bad” experientially, I maintain that the sensations and experiences to which the terms/concepts “pain” and “suffering” respectively refer are actually distinct as differentiated by the above definitions. As a tradition, Buddhism is almost entirely concerned with suffering, its cause, its cessation, and the way to its cessation, so I do not consider it far-fetched to think that the way(s) in which it describes suffering are quite useful in distinguishing it as it is to be found in actual experience.

Additionally, a distinction between pain and suffering has not only been made in the context of Buddhism. For examples of papers in the context of Western academic philosophy which argue for such a distinction, see [Kauppinen (2019)](https://philpapers.org/archive/KAUTWA-5.pdf) and [Massin (2017)](https://philpapers.org/archive/MASSP.pdf).  Further, empirical work which investigates the effects of meditation on responses to painful experiences, such as [Zeidan et al. (2011)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090218/), [Grant et al. (2011)](https://pubmed.ncbi.nlm.nih.gov/21055874/), and [Perlman et al. (2010)](https://pubmed.ncbi.nlm.nih.gov/20141303/), as well as studies investigating the effectiveness of therapeutic techniques like Cognitive Behavioral Therapy (CBT), such as [Thorn et al. (2011)](https://pubmed.ncbi.nlm.nih.gov/21920668/), [Ehde et al. (2014)](https://pubmed.ncbi.nlm.nih.gov/24547801/), and [Wetherell et al. (2011)](https://pubmed.ncbi.nlm.nih.gov/21683527/), suggest that in changing perceptions of and reactions to pain, individuals may experience a reduction in suffering, even when the physical sensation of pain remains. Thus, even outside the context of Buddhism, it seems there is strong evidence for there being a difference between pain and suffering as actually experienced.

Defining these terms clearly and accurately is crucial in differentiating between two concepts that are often conflated. By clearly defining pain and suffering, we can better understand their relationship and address suffering more effectively with the identification of its root causes.

The relationship between pain and suffering
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**Pain is not the cause of suffering.** As illustrated by the parable of the second arrow and made clear in the above definitions of the terms, the cause of suffering is not pain but rather the reaction of craving, aversion, and clinging/attachment to sensations and experiences (which may or may not be painful or unpleasant).

It is sometimes said that “suffering = pain * resistance.” While I believe this formula is useful insofar as it makes a distinction between pain and suffering and indicates that resistance or aversion to pain results in suffering, I do not think it entirely captures the truth of the matter in that it suggests that suffering would not arise in the absence of pain. As my definition of suffering indicates, craving pleasure, even in the absence of pain, will result in suffering.

**There can be pain without suffering.** If pain is experienced without attachment and aversion, there is no resulting suffering. If the Buddha were to stub his toe, there would be pain, but he would not suffer as a result.

**Suffering can occur without pain.** Consider, for example, a drug addict, who suffers because they crave the pleasure of a high and/or are averse to sobriety, or the stereotypical rich-but-miserable millionaire, who may have a relatively pain-free life but suffers regardless.

Examples of the conflation of suffering and pain
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I was moved to write this post as a result of reading Magnus Vinding’s book *Suffering-Focused Ethics: Defense and Implications*, where, while I agree with much of the thrust of the book, I perceived a consistent failure to distinguish between suffering and pain or displeasure. Here, I will provide examples of this conflation, from Vinding and those he quotes and cites on the subject. I take the ubiquity of this conflation from Vinding and his sources to be an indication of the extensivity of the conflation in suffering-focused literature at large, although I am certainly interested to know if anyone is aware of sources that make a careful distinction between suffering and pain in arguing that suffering and its reduction is what we (should) care about.

To start, Vinding defines suffering as “an overall bad feeling, or state of consciousness.”[^779y48x9pir] If he means to specifically pick out suffering and not pain or displeasure with his use of the term “bad,” then this is not necessarily wrong, but I believe this to be too imprecise to be useful as a working definition of suffering. Would Vinding consider a state of consciousness to be suffering(ful) merely by virtue of being quite painful? If so, this ignores the genuine possibility of experiencing pain without suffering.

Here are some other examples, from those whom Vinding cites:

*   Karl Popper: “I believe that there is, from the ethical point of view, no symmetry between suffering and happiness, or between pain and pleasure.”[^wycqkhqsx8]
*   David Pearce: “\[N\]egative utilitarianism… challenges the moral symmetry of pleasure and pain.”[^zyzzkg4nme]
*   Richard Ryder: “At some point, ... justification \[for a moral theory\] must end. But where? I believe it ends upon the reality of pain.”[^dkzsv9ovteb]
    *   Vinding notes that “Ryder defines pain ‘broadly to cover all types of suffering whether cognitive, emotional, or sensory’.”[^gw15cw748pf] Defining pain to include all kinds of suffering is surely as much of a mistake as defining suffering to be just pain or displeasure, because in both cases one is entirely eliding the differences between the two as they are observed in experience.
*   “So did utilitarian philosopher Henry Sidgwick, who considered it a fundamental ethical principle that ‘all pain is to be avoided’.”[^04twvpae82bn]
*   “Both \[Mancini and Pearce\] predict it will become technically feasible to abolish pain and suffering, and they both explore genetic engineering and direct brain stimulation as viable and complementary options toward this end.”[^yteyv5qjjg9]

These examples illustrate a general trend in suffering-focused literature to conflate suffering with pain. I think this is a crucial mistake; if we really care about reducing suffering in expectation, then we should be careful to distinguish the two, so as to avoid misspending our resources and efforts on approaches that do not actually address suffering as distinct from pain or displeasure.

The importance of this distinction
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If you care about reducing suffering, it’s quite important to be precise in identifying and distinguishing what you actually care about.

Having this distinction in mind is critical in order to develop ethical policies and effective interventions. For instance, as previously mentioned, CBT and mindfulness practices have been shown to reduce suffering by altering the mental response to pain rather than addressing the pain itself. If (the alleviation of) suffering is what we care about, this distinction guides us to focus on the root causes of suffering in our ethical considerations, rather than merely alleviating pain. Recognizing that suffering often lies in an aversive mental reaction to pain rather than the pain itself enables more precise scientific research and more effective strategies for reducing overall suffering.

Without recognizing the distinction, one may think alleviating pain causes a reduction in suffering. Perhaps it is usually the case that more moments of suffering, or moments of “greater suffering,” tend to accompany the arising of increasingly severe pain, and it may be that by alleviating the severe pain, there is a reduction in the associated suffering because of a tendency to be less averse to less painful experiences. However, as I have argued, it is not the pain itself which causes suffering, so approaches like pain alleviation are merely palliative and not an effective cure that addresses the cause of suffering itself.[^o76q3yhxne]

Conclusion
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Understanding the distinction between pain and suffering is crucial for developing effective strategies to reduce suffering. By directly addressing the craving, aversion, and clinging which cause suffering, we can create more compassionate and impactful interventions.

I encourage you to reflect on your own experiences of pain and suffering. Notice how your reactions contribute to your suffering and consider how distinguishing between pain and suffering can help you develop a deeper understanding of your experiences and suffer less. By being precise in identifying and distinguishing what you care about, we can collectively create more effective strategies to alleviate suffering.

*Thanks to Kaj Sotala, Jonathan Leighton, and Jack Auen for feedback on drafts of this post.*

[^x9qq4f40x67]:  This definition is quite close to the International Association for the Study of Pain’s definition of pain. 

[^779y48x9pir]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 13. 

[^wycqkhqsx8]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 30. 

[^zyzzkg4nme]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 31. 

[^dkzsv9ovteb]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 79. 

[^gw15cw748pf]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 79. 

[^04twvpae82bn]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 79. 

[^yteyv5qjjg9]:  Vinding, Magnus. Suffering-Focused Ethics: Defense and Implications. Center for Reducing Suffering, 2020, p. 240. 

[^o76q3yhxne]:  In fact, we might take this as an indication that the best we can do in the case of suffering of non-human animals, whom lack the cognitive capacities required to develop mindfulness, let go of clinging, and attain the cessation of suffering, is to provide them with less painful circumstances of existence. I do not expect a chicken, for example, to be able to practice meditation, so ending factory farming still seems like the best way to reduce chicken suffering in expectation. However, I do expect pretty much any cognitively mature human to be able to learn how to reduce or cease suffering by addressing its fundamental cause through the development of mindfulness.