In Man’s Search for Meaning, Viktor Frankl, a Jewish psychiatrist, wrote about the psychological impacts of life as a prisoner in the Nazi concentration camps of World War II. His mother, father, brother, and pregnant wife were all killed in the camps. Dr. Frankl describes in chilling detail how his captors took from him virtually everything of personal value and basic human dignity. The only thing that the Nazis were unable to take away was his choice as to how to respond to the deprivation, degradation, and trauma to which he was subjected. He made a conscious decision to focus his energies on “owning” that small but all-important space between the stimulus (whatever was said or done to him) and his response to it. His ability to retain that degree of psycho-spiritual autonomy in the most horrific circumstances imaginable provides a remarkable example of intrapersonal strength, grace under extreme duress, the power of personal choice, and the Serenity Prayer in action. Although Buddhism predates the establishment of Western psychology and psychotherapy, and twelve-step recovery by well over two millennia, these three distinct provinces—spiritual, professional, and self-help— share certain underlying commonalities in theory and practice. Most importantly for our purposes, each of them represent approaches to understanding and ameliorating suffering, and all three offer pathways toward transformation and healing. In the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are hundreds of diagnosable conditions. Each of them is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that causes current distress (such as painful symptoms) or disability (impairment in one or more important areas of functioning)—in other words, suffering. Behavioral health treatment, including psychotherapy, exists to help people find relief from their suffering and lead healthier, more satisfying lives. The Four Noble Truths of Buddhism address suffering as innate to the human condition. The First Truth is that suffering is a part of life. Suffering in all its forms represents lack of satisfaction/contentment/ fulfillment. The Second Truth is that suffering is caused and exacerbated by attachment to/desire for something different than “what is.” This includes having things we don’t want, as well as wanting things we don’t have. The Third Truth is that, though a part of life, suffering is not inevitable. And the Fourth Truth is that there are paths out of suffering. The Buddhist way out of suffering is the mindfulness-focused Eightfold Path: 1) Right Understanding, Right View; 2) Right Aspiration, Right Thinking; 3) Right Speech; 4) Right Action; 5) Right Livelihood; 6) Right Effort; 7) Right Mindfulness; 8) Right Concentration. Twelve-step programs provide another such pathway that in many respects parallels the principles of the Eightfold Path. From an early age, through effectively downloading data from everything we observe and experience, we are conditioned to categorize experiences, including emotions and physical sensations, in terms of whether they are “good” or “bad.” Sadness, anxiety, fear, and physical pain are viewed as bad or negative, while happiness, joy, and being pain-free are perceived as good or positive. Consequently, it becomes natural to want to avoid experiences judged to be bad, negative, or painful. When we experience pain, whether the source of that pain is emotional or physical, we generally attempt to avoid it. After all, who wants to be in pain? As discussed in previous blog posts, addiction frequently originates as a way to escape from, numb, and ultimately avoid pain via mood-altering substances or behaviors (such as gambling, eating, and sex) that then become reinforced and habituated through repetition. Ironically, these efforts to keep emotional and physical pain at bay end up creating even more of it. Avoidance doesn’t work because pain is an inevitable part of life. It is an essential aspect of being human. Everyone experiences uncomfortable, painful thoughts, emotions, and physical sensations. Avoiding pain is quite simply impossible. It is in how we choose to respond to the emotional and physical pain we experience that determines whether we are able to get through that pain, or unwittingly extend and amplify it. For those who struggle with addiction and/or chronic pain, at times the challenges of living can seem insurmountable. Chronic pain has many of the same adverse bio-psycho-social-spiritual impacts as active addiction, including: damage to relationships—such as primary relationships, marriages, parent-child, family, and friendships, and job/career and financial problems, along with impairments in eating, sleeping, and mood. Discouragement, fear, isolation, feelings of inadequacy and worthlessness, depression, grief/loss, desperation, guilt, shame, and often self-loathing ensue from the experience of being enslaved by debilitating repetitive behaviors and chronic conditions. These emotions generate yet another layer of pain to fend off, ratcheting up reliance on avoidance strategies that are doomed to fail. Trying to escape painful thoughts, feelings, and physical sensations may work temporarily, but in the long run it only prolongs those experiences and intensifies the suffering connected to them. Suffering is a function of how people think and feel about the emotional and physical pain they experience, and the beliefs they attach to it. Whenever the belief exists that someone shouldn’t be in pain or that pain is something to be avoided at all costs, and in turn they feel angry or depressed about being in pain, then that person will experience suffering. There is a direct correlation between the amount of effort expended to avoid pain and the degree of suffering experienced—the harder someone works to avoid pain, the greater his or her suffering tends to be. This blog post is an excerpt from Some Assembly Required – A Balanced Approach to Recovery from Addiction and Chronic Pain by By Dan Mager, MSW; Published by Central Recovery Press (CRP).