Choosing to Suffer

One of the most beautiful aspects about my clinical work is empowering my patients to take charge of their lives. Any improvements are far more meaningful when they, the patient, sees themselves as agents of their own change. When we adopt authorship of our lives, we can then truly make peace with our failures and shortcomings. In my experience, however, this applies predominantly to those with the ego strength to endure such injuries. A big portion of my work is then to build and cushion the ego suitable for tolerating distress.

Everyday, I see people who struggle to tolerate the distress of the very lives they’ve authored. The weight of responsibility is something I know to be very heavy. As a psychiatrist, I subscribe to a style of practice that caters to the belief that we are masters of our own destinies. That is, I believe that my work is rooted in leading people to direct their own change. It reminds me of the joke of how many psychiatrists it takes to change a light bulb. (Answer: one, as long as the bulb really wants to change).

There are so many distinct schools of therapy. For all of the major psychotherapy modalities, this recurring principle underlies the treatment process. Analytic and dynamic psychotherapies (a la Freud) uncover the subconscious, bring the patient to insight, and the rest depends wholly on the patient to act. Behavioral psychotherapies focus directly on the patient’s ability to modulate their own behaviors. Even the sensory or somatic psychotherapies (growing ever more popular these days) are predicated on the patient’s ability to engage in and move beyond uncomfortable bodily sensations.

Though it is so rudimentary of a concept, it has become more prescient in this past week. This topic comes up in conversation with Peter nearly daily: both in the context of our own relationship, and in the context of my work. I often lament to him about my frustrations about being unable to help my patients, often receiving requests or pleas out of my control. One of the hardest lessons I’ve learned in this line of work is that I cannot adopt the responsibility of and for others, even when consciously or subconsciously displaced upon me. I have to choose not to let the emotional burdens consume my own life.

A direct corollary to this idea is that we choose our own suffering. Many people with whom I’ve had this conversation misinterpret this to mean that they choose to suffer. In many instances, that is actually very much true. But moreover, what I try to convey is that we choose the ways in which we suffer. There is a duality to nearly every decision we make: to leave a stressful job for freedom, or to stay shackled for the promise of a paycheck? To feel lonely in singlehood or to experience constraint within a relationship? As one of my friends jokingly once said: going to the gym is hard, but being ugly is also hard—pick your “hard.”

Suffering is a process that is so inherent to living—and as morbid as that may sound, it is even more preposterous to think that there is life without suffering. So many people have this notion (or expectation) that suffering or pain can be eliminated altogether. There is a great disappointment in that thinking. At least for my own dilemmas, I try to find meaning within my own suffering—and it is this meaning that provides color to my life.

Peter and I have been coming up on big discussions for big decisions coming up. These talks in of themselves are deliberate choices, painful and difficult as they are. In every relationship, people are tasked with the choice to even simply talk about topic matters that tug at their heartstrings. It is no different for us, and yet something so commonplace can feel so liberating.

He would often say that I help bring clarity to big or daunting questions. That is, he enjoys a more thorough understanding of the value, implications, and consequences of each decision. I, however, find it tremendously helpful that he removes roadblocks to even making such decisions. Systematically, he breaks down walls for decisions that I typically would find insurmountable. Even greater is his ability to pave the path for new choices that did not previously exist.

In this way, we are so privileged to have each other. We work as a team to access the most favorable choices that lay ahead. There is no denying that we are still very much stressed with some of our decisions. But at every crossroad thus far, we have been to assuage each other’s fears, pain, and anxieties. Generally speaking, life seems so much easier to traverse with teammates who can halve and help bear the suffering for you. Choose the wrong people and you might find the suffering doubled.

We’ve encountered a range of junctions that have taken a great emotional toll. Often, these decisions come with very real and concrete cost. However, one choice that is seemingly free of any consequence is that of gratitude. This is an everyday practice that underlies all other decisions: it lessens the hardship endured. In this sense, one may choose to suffer if gratitude is not exercised.

For example, people have often asked why we choose to live so frugally as though still medical residents—in their eyes, it’s almost like we choose to suffer. It is not that we choose to suffer, but rather that we find contentment in the simplicity of our lives. On the superficial level, it aligns with our philosophy of FIREing sooner rather than later. But really, our endurance sources strength from the gratefulness we have for the abundance in our lives.

In his book, Man’s Search for Meaning, psychiatrist Viktor Frankl delves into what he labels as a “delusion of reprieve.” As a prisoner of a concentration camp during World War II, he made observations of the behaviors and attitudes of those around him. Even when there was no sign rescue, his fellow prisoners held on to a firmly rooted belief that they would make it out alive—despite overwhelming (and grim) evidence suggesting the contrary. Suddenly, all other worldly woes melted away in the face of the terror and fate that awaited them. The harsh conditions paled in comparison to things like the squabbling with one’s spouse, monotony of work, or even battling medical illness.

The lesson here is that gratitude is a practice heavily entrenched in, if not inseparable from, perspective. Fortunately, we have control over our perspectives, and thus anybody is capable of practicing gratitude. We can choose to be grateful, and we can choose to persevere despite hardship. As the age-old adage goes, things could always be worse. This is why I believe that, at times, we not only beget our own mental anguish, but also that we have agency in the way we suffer. This is one of the reasons I find Peter’s aura so magnetic: he loves viewing challenges as opportunities.

Throughout my time with him, I’ve rambled incessantly about this topic to Peter. Fortunately enough, he shares a similar philosophy, albeit with less of the mumbo jumbo. Perhaps the easiest decision I’ve made in all of this is to join him on life’s adventure. Though lucky to have met each other, it is with a conscious mind that we choose each other. I think this decision is made easier because we seek out ways to make the other person’s life just a tad bit easier. In other words, suffering with (and sometimes because of) Peter is much better than suffering alone!