Dr Matthew Doré – Palliative Care Consultant and Dr Alan McPherson
Northern Ireland Hospice & Belfast Trust
Hon Sec of APM and Co-lead Clin ECHO
What is ‘suffering’? At its most fundamental, suffering is the state of undergoing pain, distress, or hardship. It is an aversive, negative experience that an individual experiences and wishes to escape.
However, this simple definition belies its complexity. Suffering is not the presence of pain per se, but the experience of it. It involves a physical, psychological, relational, social, spiritual and emotional response that makes the situation intolerable with or without any particular component.
Thus, step aside Newton, here are the Fundamental Physics of Palliative Care – may I boldly introduce the 3 Laws of suffering… (please discuss and debate)
First Law: The Law of Universal Latent Potential
“All sentient beings possess a latent, inherent potential for suffering, stemming from their biological, psychological, spiritual and social vulnerability. Suffering is revealed rather than imposed. This potential is an intrinsic condition of a conscious existence characterised by needs, attachments, and a perception of self.”
Explanation: Suffering does not need to be imported into a life; the capacity for it is already present. This latent potential is like stored energy, waiting to be activated by life’s inevitable challenges – illness, loss, change, or unmet desires. Our nervous system is wired for pain, our psyche for fear and loss, and our social nature for rejection. This law states that the “fuel” for suffering is universally pre-existing.
Example: Cancer reveals the frailty of our body/mind and results in suffering. Bullying, abuse, and discrimination appear to ‘give’ suffering, but rather they are deliberately causing the circumstances which manifest our suffering, as it lies as a potential in all of us to suffer.
Second Law: The Law of Conservation and Redistribution
“Within a closed psychological and social system, suffering is always conserved. It cannot be destroyed, but only transferred to others and redistributed within the system. The total amount of suffering remains constant until it is converted into a non-suffering state by an external process outside the system – see the Third Law.”
Explanation: Suffering is like energy; it cannot be created (just revealed from latency), nor can it be destroyed, only distributed within the system. Suffering can be transferred, thus diluted, by distribution to family, friends, healthcare staff or society. If one person suffers, all of society suffers. ‘Walking with suffering’ spreads and distributes the suffering to lessen its individual impact, but does not remove it.
Example: Family and Healthcare staff often absorb part of the suffering to dilute as much as they can from the original sufferer, but they, in this act, also suffer.
Third Law: The Law of Transformation
“Suffering persists indefinitely until transformed. The transformation of suffering to another energy state requires a connection to a resource outside of its own originating framework. This external independent catalyst (e.g. new perspective), breaks into the closed system described by the Second Law.”
Explanation: This law provides the pathway to resolution. The suffering can be transformed by an external “catalyst” outside the original system – such as: given hope, compassion, insight, meaning-making, or resources – that facilitates its transformation into something else: resilience, wisdom, empathy, or purposeful action.
Example: A person trapped in their own painful narrative cannot escape it using the same thinking that created it. The suffering is a closed loop. Relief comes from a “relational” input, whether that relation is:
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- With a wiser part of oneself: Accessing self-compassion instead of self-criticism.
- With another person: Receiving empathy and a new perspective.
- With a broader framework: Finding meaning in a spiritual context or a cause greater than oneself.
This law states that the transformation mandated by the Second Law is always an interactive process. The “equal and opposite reaction” to suffering is not automatic; it is the deliberate introduction of a healing element from beyond the sufferer’s own boundaries. Physical pain (or any symptom) can exist with or without suffering. They overlap but are not congruent, as suffering is the experience, and the resolution is in the treatment of both the cause of the experience and the experience itself.
Summary of the Laws
- The First Law (Latent Potential) establishes the why: Why we are all susceptible.
- The Second Law (Conservation) establishes the what: How suffering behaves and endures.
- The Third Law (Transformation) establishes the how: The necessary condition for its resolution.
Together, I hope, they form a complete logic: Suffering is a latent potential in all of us (First Law). When revealed, it conserves itself by transferring throughout its available system (Second Law). Suffering can only be transformed by connecting it to something outside the original cause- be it internal or external love (Third Law).
Let us move our understanding of suffering from a mere state to be treated ineffectively to a dynamic system that can be navigated and transformed.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.