The Buddhist concept of “Dukkha” describes the true nature of all existence. It has a profound philosophical meaning. The term “Dukkha” has been commonly misunderstood and misused. 

The word “Dukkha” means not suffering. Suffering can be found in the pathogenic paradigm. Suffering involves somatic, mental, social, and spiritual forms of distress causing psychopathological alterations. Suffering is a subjective experience that can involve physical, emotional, or mental pain. These types of suffering can be mitigated via therapeutic or socioeconomic interventions.

Dukkha is more than subjective suffering, and a vast conscious experience and words cannot fully or accurately describe it. It goes beyond the pathogenic paradigm, disintegrating the internal sense of coherence.

The Buddhist concept of Dukkha is not suffering, despair, anguish, misery, wretchedness, or disheartenment. It is not total pessimism either. Dukkha is a multidimensional concept and a complex construct that has no precise linguistic meaning. It is a vast universal experience connected to the universal consciousness based on the reality of human life. Dukkha exemplifies the true human condition.

The mundane understanding of suffering is related to the bearing of pain, inconvenience, and distress that is connected with hopelessness. According to the Buddha, the word “suffering” has a deep existential meaning. It is a universal explanation of the true human condition.  

Many Western psychologists misinterpreted the word Dukkha or universal suffering, and they viewed it as an agonising human condition. This was due to the mistranslation done by the French author Anatole France. France translated the word Dukkha into French as “souffrance” and then into English as “suffering”. Ever since, many Western scholars grasped the concept of Dukkha incorrectly. Therefore, many thought that Dukkha symbolised the dark side of human existence filled with pessimism and despair.

Dukkha narrates about the veracity and the accurate nature of existence. Existence has three major characteristics: impermanence, un-satisfactoriness a.k.a. Dukkha, and the absence of a self. These are interconnected and interdependent.

Some view impermanence as the philosophical problem of change. It is the absence of permanence and continuity. Impermanence denies the unchanging, transmigrating human soul. The universe is incredibly vast and complex and constantly changing. It is not a permanent entity. The universe has normal matter, “dark matter”, and “dark energy” which all constantly change. Nothing is permanent in an ever-changing universe. There is no physical or mental object which is permanent. The Greek philosopher Heraclitus once stated: “No man ever steps in the same river twice.” The world is constantly changing. Humans change on the personal level as well as on the collective level.

The phenomenal world is transitory. According to Buddhism, matter is impermanent; feeling is impermanent perception, which is impermanent; and determinants are impermanent consciousness, which is impermanent. When a person tries to resist the impermanent world without understanding its true nature, Dukkha arises. He/She does not want things to be changed. But things around him/her change constantly. He/She can never go back to the same exact moment or experience again. The person is ageing. He/She cannot stay forever young. It creates immense distress in the person. This distress is part of Dukkha. The person wants an internal life for himself/herself and his/her loved ones. But death is inevitable. No one can escape death. Fear of death and the dying process is associated with Dukkha.

The world is filled with illusions. The person takes many imagined mental concepts as real. The mental-physical ego self is a mere deception.  Although we perceive the self as a distinct conscious entity, there is an illusion of self. The brain creates self-identity with perceptual illusions via neural activations. The brain takes experiences, thoughts, and behaviours into a narrative to create a mythical sense of self. 

According to some neurologists, the brain is a narrative-creating machine. Reality is a subjective experience. Self is not a single unified entity, but a bundle of sensations, perceptions, and thoughts lumped together. All physical and mental existence is not metaphysically real. There is no permanent mental physical self. Self consists of the moment-to-moment flow of consciousness. When a person is trapped in this illusion, Dukkha arises.

The mundane understanding of Dukkha is suffering, related to bearing pain, inconvenience, and distress that is connected with hopelessness. Dukkha is not mundane suffering or general unhappiness, uneasiness, severe mental pain, or mental agony. If Dukkha is suffering, then suffering is impermanent. It is not everlasting or perpetual. Suffering is a subjective experience. The word “Dukkha” has a deep spiritual, existential, and dialectical meaning. Dukkha does not symbolise the dark side of human existence filled with dread and misery. Instead, it highlights the authentic nature of all existence. It is associated with the impermanent nature of self.

Dukkha is not a pessimistic or nihilistic concept. It represents an array of emotions from happiness to despair. Dukkha refers to a state of existential confusion and fixation on deceptiveness and deviation from the reality of existence. It is an inability to understand the true nature of existence. It is the tension, conflict, friction, resistance, and change caused by circumstances of life. 

The illusion of self causes Dukkha. It is an existential and spiritual crisis that every male/female confronts, and some find the universe irrational and meaningless. Dukkha is the conflict between a rational male/female and an irrational universe. Dukkha is a form of absurdism that males/females face. It is the struggle to find meaning in a meaningless world. Dukkha is about the universal unsatisfactoriness of life. Dukkha is intertwined with the whole existence.

A worldly person experiences two types of suffering: one is mundane suffering due to low socioeconomic deplorable living conditions and health-related issues. These types of suffering can be fixed through worldly interventions. The second kind of suffering, which is called Dukkha, is more than mundane day-to-day suffering. It cannot be fixed via worldly interventions.  

Is human life full of unbearable suffering? However, most former Gulag prisoners of the Soviet Union, Holocaust survivors, and prisoners of war who underwent unbearable and tortuous suffering concurred that despite their suffering, there were happy and content moments in their lives while under bondage. Despite their suffering, they had moments of inner contentment. This may be an innate survival mechanism that humans achieve through evolution.

Smith (a fictitious character) lived a productive life of 84 years. He had a happy childhood, a good education, and a fruitful adult life with a respectable profession. He was happily married. He was a delighted man for most of the time. He disregarded some of the life stresses, negativity, and disappointment and had a positive outlook on his life. He died at the age of 84 in his sleep without any old-age suffering. Although Smith is a fictitious character, we know many people who led similar lives to Smith.  Did they ever complain that life is full of suffering?

Suffering can be external. A chronically depressed person might suffer due to his/her erroneous worldview, his/her negative life philosophy, and his/her detrimental perceptions. A person from a war-torn region might suffer due to geopolitical reasons. The internal suffering could be due to the disruption of brain chemistry. Think about a person suffering from drug-resistant depression with altered brain chemistry. He/She is experiencing prolonged suffering.   

Some people are not aware of their suffering. For instance, patients with Alzheimer’s disease are in an intriguing condition, yet these patients are not aware of their worldly suffering.

In the past, people suffered as a result of various diseases such as smallpox, polio, measles, mumps, and rubella. With the progress of medical science, this suffering has been eradicated. Therefore, we do not see suffering due to these infectious diseases. However, cellular ageing (the cell biology of ageing) is a universal factor that is associated with pain and discomfort. There is suffering from the consequences of old age. Due to bodily decline and physical and mental deterioration, there is suffering.

Suffering is a personal matter as well as a collective matter. Universal suffering covers a wide range of human experiences, and it has physical, psychological, social, and existential dimensions. These universal characteristics are common to every human. As a result, these universal characteristics bring a conscious awareness of the self’s vulnerability. They feel that life no longer makes sense. This awareness is Dukkha.

Dukkha is not clinical depression, mundane suffering, alienation, or tiredness of life that is associated with suicidal intentions. These conditions can be treated with antidepressants and psychotherapy. But Dukkha cannot be treated with antidepressants. It is a profound and strong awareness of life’s universal maladies.

Some Buddhist texts state that birth is suffering. Here, it does not refer to normal childbirth. Childbirth is often a happy occasion for parents. In the Buddhist context, birth refers to the birth of the ego. The birth of the ego and fixation leads to universal suffering. Following ego fixation, the person is mentally preoccupied with a fixed belief. He/She has grasped a false sense of self. When his/her beliefs are changed or challenged, his/her false sense of self is compromised, and he/she is experiencing discomfort and anxiety. This leads to Dukkha.

Ageing is suffering. However, modern scientific technology, especially gene therapy, decelerates the ageing process. Sometimes, within the next 100-200 years, medical science will develop anti-ageing treatments and humans will be able to live 250-300 years. Even that will not resolve Dukkha. Because ageing and demise are inevitable, finally, people would experience universal suffering.

Sickness is suffering. But medical science has found treatments for many diseases. Perhaps, within another 200-300 years’ time, humankind might eradicate 95% of infectious and non-communicable diseases including cancer. Then, sickness would not be viewed as a factor that brings human suffering.  

Indeed, death is suffering. Medical science can prolong the human lifespan. Bio-printing technology can replace skin and other internal organs and rejuvenate the human body. Although these measures would give a long life, death is unavoidable. Therefore, death will be a part of human existence. Dukkha is associated with death anxiety.

A lack of meaning in life can result in Dukkha. Although people have every comfort and many materialistic things, often they are hit by the meaninglessness in life. They do not have a clear sense of purpose. According to Austrian psychiatrist Viktor Frankl, without meaning, people fill the void with hedonistic pleasures, power, materialism, hatred, boredom, or neurotic obsessions and compulsions. A lack of meaning in life would bring Dukkha.

Dukkha is not about pessimism or cynicism. It is connected with true human nature. It is not an enigma without an answer. The Buddha described the comprehensive nature of Dukkha and its cessation.

(The writer is a Doctor of Medicine)

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The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication.