# Motivation and emotion/Book/2022/Suffering as emotion

* Multimedia presentation (3 min)

## Overview

Suffering is an intense emotion that both humans and animals are capable of experiencing. The emotional experience of suffering can occur in many forms, impacting the physical, psychological and emotional well-being of the individual impacted[Rewrite to improve clarity]. Understanding the emotional experience of suffering in humans is an important step in identifying the adaptive coping mechanisms that can be helpful to cope with suffering, and also determining the maladaptive forms of coping with suffering that may be unhelpful and ineffective.
* Focus questions
* What is suffering?
* What is the emotional experience of suffering?
* What are the forms of suffering?
* What is the purpose of emotional suffering?
* What are helpful mechanisms to cope with suffering?
* What are unhelpful mechanisms to cope with suffering?
* In Davies[grammar?] 2011 book;[grammar?] 'The Importance of Suffering', it's proposed that two cultural visions of suffering have evolved. The first is a 'positive vision' which sees pain as a liminal region through which individuals can pass from a worse to a better place. The second is a 'negative vision' which finds suffering fundamentally repugnant, deforming and in need of quick removal. The positive perspective enhances self-knowledge and spurs introspection whereas the negative vision creates new syndromes and devises therapeutic strategies (Akhtar, 2014).

## What is suffering?

As a general term, suffering is defined by the APA Dictionary of Psychology as "the experience of pain or acute distress, either physical or psychological, in response to a physical trauma or a significant event, particularly one that is threatening or involves loss" (American Psychological Association, n.d.).
The term 'suffering' is synonymous with pain and distress, therefore it may be referred to as such throughout this chapter.
There are many different types of suffering that individuals can experience, these being the most prevalent:
* Emotional suffering: emotional response to an experience that arises from the effect or memory of a particular event, occurrence, pattern of events or condition, (LII, 2020).
* Psychological suffering: discomfort, dysfunction or distress of the mind.
* Physical suffering: pain derived from a physical cause.
* Hayes and Smith, (2005), found that the extent of global psychological suffering is revealed by the response of communities to the introduction of government-funded access to psychological services. Progressive initiatives by governments to increase access to community mental health services have been typically followed by an inundation of individuals seeking care, usually in far higher numbers than anticipated (Rhodes, 2020).

## What is the emotional experience of suffering?

There are a variety of factors that can influence the impact of emotional suffering among individuals differently (see Table 1).[factual?]
Table 1:
Factors affecting emotional suffering: :
| Gender | Age | Culture | Ethnicity |
| Health disparities | Access to care | Support systems | Spiritual beliefs |
| Medical care experience | Life before pain onset | Social determinants of health | Pain threshold and tolerance |

### What are the causes of suffering?

“Suffering is so pervasive, so universal, and such a persistent and chronic phenomenon that it makes one wonder whether it is not just part of life, part of living, part of being alive, and yes part of being human” (Sidor & Dubin, 2021). As pain and suffering are synonymous, it is important to explain the causes of pain, which in turn can result in suffering. The first type of physical pain is caused by tissue damage, which is also called nociceptive pain. The second type of physical pain is caused by nerve damage, also called neuropathic pain. A third type of pain refers to the psyche, called psychogenic pain which is caused by psychological factors. Psychogenic pain can often stem from physical pain, which can be increased and prolonged depending on factors including fear, depression, stress, and anxiety. Psychogenic pain can also be experienced as a result of psychological conditions. Suffering does not always originate from physical pain or illness, as, “social problems like poverty, social exclusion, forceful social inclusion, forced displacement and uprooting; existential and personal problems like grief and stress, conditions like nausea, paraesthesia, a non-painful illness, anxiety or fear can likewise be a cause of suffering” (Bueno-Gomez, 2017).

### What is the purpose of emotional suffering?

Emotional pain can feel as debilitating and distressing as physical pain and is something we all experience in life at one point or another. Emotional pain serves the purpose of telling us when something is amiss in our psyche and is impacting upon our cognitive, physical and emotional functioning (Stanica, 2020). Scheler’s theory of suffering proposes that this feeling serves a purpose. Commonly it is thought that the experience of suffering needs to be avoided, [grammar?] this thought process results in an unhelpful denialist attitude [grammar?] however, as suffering is unavoidable in life. Although the emotional experience of suffering is bound to impact upon all individuals at some point in life, Scheler took a positivist view of suffering theorising that it is “an experience that can be both approachable and meaningful” (Exploring your mind, 2022), when looked at from this positivist perspective. Scheler believed that the experience of suffering has three possible levels, depending on the gravity at which it’s[grammar?] felt. The biological level refers to the ‘organism’ impacted, the psychological level refers to the ‘I’ and the spiritual level refers to the ‘person’. This theory states that suffering takes place in the dimension of the ‘person’, in this aspect it is possible for action to take place when faced with emotional pain. Scheler also points out that suffering can be equivalent to sacrifice as an action can cause pain but can be carried out deliberately to obtain something of higher value. In this sense, suffering can be seen as purpose for spiritual development, and the suffering is deliberate to obtain something higher.
* Viktor E. Frankl was an Austrian neurologist and psychologist who developed the field of Logotherapy. Logotherapy is based on the premise that the primary motivational force of an individual is to find meaning in life (Shantell, 2020). Frankl developed this therapy over years of his search for the meaning of life. Through his individual experiences as a prisoner in a Nazi concentration camp, Frankl focuses on how love, hope, responsibility, and inner freedom gives one the potential to endure and overcome harrowing experiences. Frankl states “we can discover the meaning of life in three different ways:
* by creating a work or doing a deed;
* by experiencing something or encountering someone; and
* by the attitude we take toward unavoidable suffering” (Batista, 2010).

### What are the types of emotional suffering?

Emotional suffering originating from non-physical causes, can have many different symptoms and explanations. The emotions associated with this psychological suffering can be the result of other’s actions, internal feelings or can be the result of an underlying mental health condition. Emotional suffering and the symptoms associated with such, can have a severe impact on the individual’s psyche and physical form.
Table 2:
Example types of emotional suffering: :
| Type of emotional suffering | Characteristics of behaviour |
| Depression | Depression refers to a "constellation of experiences including not only mood, but also physical, mental and behavioural experiences that define more prolonged, impairing and severe conditions" (Hammen & Watkins, 2018). This form of suffering can either be a temporary and slightly noticeable mood decrease or a serious life-threatening disorder. |
| Anxiety | Anxiety is the "feeling of fear that occurs when faced with threatening or stressful situations...it is a normal response when confronted with danger" (Dean, 2016). If this feeling becomes overwhelming and persists however, it can be regarded as an anxiety disorder. |
| Grief | Grief is emotional "distress and intense sorrow in response to the loss of someone or something to which one is strongly attached" (Colman, 2015). |
| Shame | Shame is a feeling of "distress or humiliation caused by consciousness of the guilt or foolishness of oneself or an associate" (Barber, 2004). |
| Panic | Panic as a mental disorder is a "condition featuring recurrent episodes of acute distress, mental confusion, and fear" (Law., & McFerran, 2021). |
This emotional pain and suffering not only has an intense impact psychologically, but also physically.
Some common types of physical pain linked to emotional distress include:
* Diarrhea
* Dizziness
* Headaches
* Muscle pain
* Nausea
* Stomach ache
This emotional suffering can also be accompanied by; aggression and violence, alcohol and substance abuse, compulsive behaviours, risky behaviours, self-harm and suicidal ideation (Hartney, 2020).

### Schadenfreude - the enjoyment of suffering

Schadenfreude is a German word coming from the joining of “schaden”, meaning harm, and “freude”, meaning joy. This word defines the emotion of pleasure derived from another person’s misfortune (Smith, 2013). Heider, explained how Schadenfreude is a malicious emotion and that it is not associated with feelings of sympathy to others suffering, which would be the socially and morally acceptable response (1967)[grammar?]. Despite this, it is depending on the type of suffering that one is enjoying as to whether there is cause for concern or not. Schadenfreude can be experienced by individuals when a friend may trip, as it can also be entertaining, this emotion could also be experienced if a member of another sports team is injured as it may benefit your team.
* A 2017 study challenged the view that Schadenfreude is an emotion that can have negative implications among workplace relationships. This study instead aimed to explore more about the possible positive effects of this unexplored and often misunderstood emotion. Dasborough and Harvey, (2017), found that socially sharing the experience of Schadenfreude signalled to others within the workplace ethical behavioural norms. This emotion was able to indicate to others what behaviours were morally correct within this workplace setting whilst also highlighting what behaviours should be avoided. This study does not underpin the fact that Schadenfreude is a pleasurable emotion in the face of other’s suffering, but instead explores how this emotion can also be socially functionable.[for example?]

### The emotional experience of suffering in animals

Suffering can impact upon all living beings including non-human animals. Scientists have “ample, detailed, empirical facts to declare that non-human animals are sentient beings” (Bekoff, 2013). With this information it is concerning to know the gravity of suffering; emotional and physical, animals endure at the hands of humans. Animals are used and often suffer in 7-8% of psychological research, (Kaur, 2020), although the APA have rules and regulations in place to ensure no animals are being caused necessary harm. With this, it is still important to question if any amount of harm caused to a sentient being is necessary. According to the United Nations, the number of animals classed as ‘industrial livestock’ sent to slaughter each year is equivalent to eight times the human population; approximately 64 billion animals, (Animalequality, 2016). Vegan diets are now widely being recommended and adopted as concern for the environment and animal welfare grows and as it is possible to survive and thrive without consuming animal-based products (Minassian, 2022).

## How can people cope with suffering?

There are a number of different coping mechanisms and strategies that can be implemented in order to help individuals suffering from emotional distress. There are also specific therapies and medications that can be helpful in addressing and managing emotional suffering.

### Coping mechanisms

When suffering emotionally it is vital to acknowledge and validate the pain being experienced as repressing or dismissing this internal struggle can intensify the emotional suffering and invite more physical health consequences. In times of emotional strife it can be helpful to know immediate strategies that can increase your mood, whether this being watch your favourite movie, baking, or seeing friends. It can also be beneficial to write down your feelings, this can help your mind process what your experiencing[grammar?]. Accessing social support from friends and family is vital when suffering emotionally as often individuals will alienate themselves and then suffer from loneliness also[Rewrite to improve clarity]. Checking in with your body also helps alleviate the impact of emotional suffering; taking deep breaths to slow your heart rate, practicing mindfulness, relaxation techniques and meditation are also good ways to decrease the impact of emotional pain (Stanica, 2020).

### Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) was developed by psychiatrist Aaron T. Beck in the 1960's[grammar?] and has become a popular therapy for treating individuals with cognitive functioning issues. CBT consists of interventions that follow the theory that mental disorders and psychological distress are caused and maintained by cognitive factors (Hofmann et al., 2012). It is maladaptive cognitions that results in individuals emotional distress and therefore suffering[Rewrite to improve clarity]. According to Beck's CBT model (2016), these maladaptive cognitions include; "general beliefs, or schemas, about the world, the self, and the future, giving rise to specific and automatic thoughts in particular situations". The purpose of CBT then is to retrain individuals[grammar?] cognition to develop adaptive and reasonable thought processes, with the overall goal of treatment being "symptom reduction, improvement in functioning and remission of the disorder" (Hofmann et al., 2012).

### Medicating suffering

Antidepressants are medicines used to treat a number of mental health conditions that cause emotional suffering. These medicines affect chemicals in the brain including serotonin, noradrenaline and dopamine that influence moods and anxieties. These medicines can help to improve individuals[grammar?] moods and increase motivation. Antidepressants are usually more suitable for individuals suffering with severe emotional distress and are not particularly effective for those with mild symptoms of emotional distress, depression and anxiety[factual?]. Those who are only suffering from mild emotional distress would be better suited to trying coping mechanisms. Antidepressants shouldn't necessarily be used alone though, as they are more effective alongside psychological therapies and strategies. Individuals do not need to be concerned about needing antidepressants however as they are not an addictive substance, yet they can have unpleasant side effects if not discontinued properly (Health Direct, 2021).

### Maladaptive forms of coping with suffering

As emotional suffering can be intense and distressing, it is common for individuals to develop maladaptive pain beliefs and turn to substance abuse. Studies show that in western cultures, up to half of all psychiatric patients who are emotionally suffering abuse substances such as tobacco, alcohol and drugs (Gupta, et al., 2016).
The following are maladaptive pain beliefs (Pasquale., & Murphy, 2022):
* Catastrophising pain can lead to the increase of emotional suffering symptoms
* Pain is a sign of being damaged; not whole or worthy
* Pain means activity and exercise should be avoided
* Pain is uncontrollable, it can't be managed
* Pain is permanent, nothing can help
* All or nothing thinking, one is either well or not well
It is important to recognise what coping mechanisms are maladaptive and should be avoided when experiencing suffering as the implementation of the strategies and thought processes can be detrimental to one's capacity to cope and manage with emotional suffering.

## Conclusion

Suffering is an intense emotion that can be experienced emotionally, psychologically, and physically. This chapter focused on the experience of emotional suffering which can be affected by several factors including age, gender, culture and support systems. The main cause of emotional suffering was found to be a type of psychogenic pain which stems from psychological factors and can be prolonged or worsened based on factors including fear, stress, depression and anxiety. Emotional suffering was found to have a purpose; however, as it indicates when something is amiss in the psyche. Scheler’s theory took the positivist view that individuals suffer to obtain something of higher meaning or value. A range of coping mechanisms have been explored and discussed, relaxation and meditation techniques were found to decrease the impact of emotional pain whereas CBT aims to reframe cognitive functioning to reduce symptoms of emotional suffering, improve cognitive functioning and achieve remission. Medications such as antidepressants can also be helpful for those severely suffering emotionally. Lastly, maladaptive coping mechanisms were discussed as well as the concern of substance abuse as a form of self-medicating among individuals who are emotionally distressed. This chapter provides an overview into what emotional suffering is, how this is experienced, and the ways in which individuals can cope through the experience.