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Dukkha (Pāli; Sanskrit: duḥkha; Tibetan sdug bsngal) is a Buddhist term commonly translated as "suffering", "anxiety", "stress", or "unsatisfactoriness". The principle of dukkha is one of the most important concepts in the Buddhist tradition. The Buddha is reputed to have said: "I have taught one thing and one thing only, dukkha and the cessation of dukkha." The classic formulation of these teachings on dukkha is the doctrine of the Four Noble Truths, in which the Truth of Dukkha (Pali: dukkha saccã; Sanskrit: duḥkha-satya) is identified as the first of the four truths.

Dukkha is commonly explained according to three different categories:
 * The obvious physical and mental suffering associated with birth, growing old, illness and dying. These outer discomforts are referred to as the dukkha of ordinary suffering (dukkha-dukkha).
 * The anxiety or stress of trying to hold onto things that are constantly changing; these inner anxieties are called the dukkha produced by change (vipariṇāma-dukkha).
 * A basic unsatisfactoriness pervading all forms of existence, due to the fact that all forms of life are changing, impermanent and without any inner core or substance. On this level, the term indicates a lack of satisfaction, a sense that things never measure up to our expectations or standards. This subtle dissatisfaction is referred to as the dukkha of conditioned states (saṃkhāra-dukkha).

The Buddhist tradition emphasizes the importance of developing insight into the nature of dukkha, the conditions that cause it, it how it can be overcome. This process if formulated in the teachings on the Four Noble Truths.

Centrality to Buddhist thought
The principle of dukkha is one of the most important concepts in the Buddhist tradition. The Buddha is reputed to have said: "I have taught one thing and one thing only, dukkha and the cessation of dukkha."

Piyadassi Thera states:
 * To the Buddha the entire teaching is just the understanding of dukkha, the unsatisfactory nature of all phenomenal existence, and the understanding of the way out of this unsatisfactoriness.

The classic formulation of these teachings on dukkha is the doctrine of the Four Noble Truths, in which the Truth of Dukkha (Pali: dukkha saccã; Sanskrit: duḥkha-satya) is identified as the first of the four truths.

Neither pessimistic nor optimistic, but realistic
The central importance of dukkha in Buddhist philosophy is not intended to present a pessimistic view of life, but rather to present a realistic practical assessment of the human condition—that all beings must experience suffering and pain at some point in their lives, including the inevitable sufferings of illness, aging, and death. Contemporary Buddhist teachers and translators emphasize that while the central message of Buddhism is optimistic, the Buddhist view of our situation in life (the conditions that we live in) is neither pessimistic nor optimistic, but realistic.

Walpola Rahula explains the importance of this realistic point of view: "First of all, Buddhism is neither pessimistic nor optimistic. If anything at all, it is realistic, for it takes a realistic view of life and of the world. It looks at things objectively (yathābhūtam). It does not falsely lull you into living in a fool's paradise, nor does it frighten and agonize you with all kinds of imaginary fears and sins. It tells you exactly and objectively what you are and what the world around you is, and shows you the way to perfect freedom, peace, tranquility and happiness.

One physician may gravely exaggerate an illness and give up hope altogether. Another may ignorantly declare that there is no illness and that no treatment is necessary, thus deceiving the patient with a false consolation. You may call the first one pessimistic and the second optimistic. Both are equally dangerous. But a third physician diagnoses the symptoms correctly, understands the cause and the nature of the illness, sees clearly that it can be cured, and courageously administers a course of treatment, thus saving his patient. The Buddha is like the last physician. He is the wise and scientific doctor for the ills of the world (Bhisakka or Bhaisajya-guru)."

Surya Das emphasizes the matter-of-fact nature of dukkha: "Buddha Dharma does not teach that everything is suffering. What Buddhism does say is that life, by its nature, is difficult, flawed, and imperfect. [...] That's the nature of life, and that's the First Noble Truth. From the Buddhist point of view, this is not a judgement of life's joys and sorrows; this is a simple, down-to-earth, matter-of-fact description."

The Buddha acknowledged that there is both happiness and sorrow in the world, but he taught that even when we have some kind of happiness, it is not permanent; it is subject to change. And due to this unstable, impermanent nature of all things, everything we experience is said to have the quality of duhkha or unsatisfactoriness. Therefore unless we can gain insight into that truth, and understand what is really able to provide lasting happiness, and what is unable to provide happiness, the experience of dissatisfaction will persist.

Three patterns
Within the Buddhist tradition, dukkha is commonly explained according to three different patterns or levels or categories:


 * Dukkha of ordinary suffering
 * Pali: dukkha-dukkha
 * Also referred to as the suffering of suffering.
 * Includes the physical and mental sufferings of birth, aging, illness, dying.
 * Includes the anxiety or frustration of coming across what is not desirable.


 * Dukkha produced by change
 * Pali: viparinama-dukkha
 * Also referred to as: suffering of change or suffering of impermanence.
 * Includes the anxiety or stress of trying to hold onto what is desirable.
 * Includes the anxiety or frustration of not getting what you want.
 * Buddhist author Chogyam Trungpa includes the category "not knowing what you want."
 * Pema Chödrön described this type of suffering as the suffering of trying to hold onto things that are always changing.


 * Dukkha of conditioned states
 * Pali sankhara-dukkha
 * Also referred to as all-pervasive suffering
 * This category is also identified as one of the "eight types of suffering".
 * Pema Chodron describes this as the suffering of ego-clinging; the suffering of struggling with life as it is, as it presents itself to you; struggling against outer situations and yourself, your own emotions and thoughts, rather than just opening and allowing.
 * This is a subtle form of suffering arising as a reaction to qualities of conditioned things, including the skandhas, the factors constituting the human mind.
 * This is the deepest, most subtle level of dukkha; it includes "a basic unsatisfactoriness pervading all existence, all forms of life, due to the fact that all forms of life are changing, impermanent and without any inner core or substance."
 * On this level, the term indicates a lack of satisfaction, a sense that things never measure up to our expectations or standards.
 * Phillip Moffitt states: "Furthermore, every day, even during the pleasant moments, do you not experience an underlying unease about the future? This worry and anxiety is a manifestation of the third type of suffering the Buddha identified-life's inherent unsatisfactoriness due to its insubstantial compositional nature. Each moment arises due to certain conditions, then it just disappears. There is not a lasting or substantial "there there" in daily life, thus it is often described as being like a dream."
 * Phillip Moffit also states: "How often in your adult life have you experienced the queasiness and unease that come from a sense of meaninglessness in your life? Think of all those occasions when you felt as though you were wasting your life, or sleepwalking through it, or not living from your deepest, most heartfelt sense of your self. Remember the times when you've felt as though there is little you do each day that has any real, lasting significance. We've all fallen prey at some point in our lives to such dark times of self-doubt and existential angst."

Eight types
Dukkha can also be categorized into eight types belonging to the three categories of: inherited suffering, the suffering between the period of birth and death, and general misery. Chogyam Trunga explains these categories as follows:

Inherited suffering:
 * Birth (jāti): the discomfort of birth and experiencing the world for the first time; and the discomfort of relating to new demands or experiences.
 * Old age (jarā): the discomfort involved in the process of aging and growing old; this can apply to psychological as well as physical discomfort of aging.
 * Sickness (byādhi): the discomfort of physical or psychological illness.
 * Death (maraṇa): includes the pain of separation and not being able to continue on in your endeavors, as well as the physical discomfort of dying.

Suffering between the periods of birth and death:
 * Getting what you don't want: being unable to avoid difficult or painful situations.
 * Not being able to hold onto what is desirable: the pain of trying to hold onto what is desirable, lovely, splendid, terrific.
 * Not getting what you do want: this underlies the previous two categories; the anxiety of not getting what you want.

General misery:
 * All-pervasive suffering: a very subtle dissatisfaction that exists all the time; it arises as a reaction to the qualities of conditioned things (e.g. the impermanence of things).

Six types
Aung San Suu Kyi presented a list of six great dukkha at her Nobel Lecture, delivered on 16 June 2012. These are:


 * To be conceived (jāti)
 * To age (jarā)
 * To sicken (byādhi)
 * To die (maraṇa)
 * To be parted from those one loves
 * To be forced to live in propinquity with those one does not love

Four Noble Truths
The Buddhist tradition emphasizes the importance of developing insight into the nature of dukkha, the conditions that cause it, it how it can be overcome. This process if formulated in the teachings on the Four Noble Truths.

Meditation
Meditation (Pali: jhana) is considered to be an essential tool for developing insight into the nature of dukkha. Contemporary Buddhist teacher Ajahn Brahm emphasizes that without the experience of meditation, one's knowledge of the world is too limited to fully understand dukkha. In the following simile, Ajahn Brahm compares the experience of dukkha to being in prison, and compares meditation (Pali: jhana) to a tunnel that leads out of the prison:

"Another simile [...] is that of the man who was born and raised in a prison and who has never set foot outside. All he knows is prison life. He would have no conception of the freedom that is beyond his world. And he would not understand that prison is suffering. If anybody suggested that his world was dukkha, he would disagree, for prison is the limit of his experience. But one day he might find the escape tunnel dug long ago that leads beyond the prison walls to the unimaginable and expansive world of real freedom. Only when he has entered that tunnel and escaped from his prison does he realize how much suffering prison actually was, and the end of that suffering, escaping from jail is happiness.

In this simile the prison is the body, the high prison walls are the five senses, and the relentless demanding prison guard is one's own will, the doer. The tunnel dug long ago, through which one escapes, is called jhana [meditation] (as at AN IX, 42). Only when one has experienced jhana does one realize that the five-sense world, even at its best, is really a five-walled prison, some parts of it is a little more comfortable but still  a jail with everyone on death row! Only after deep jhana does one realize that "will" was the torturer, masquerading as freedom, but preventing one ever resting happily at peace. Only outside of prison can one gain the data that produces the deep insight that discovers the truth about dukkha.

In summary, without experience of jhana, one's knowledge of the world is too limited to fully understand dukkha, as required by the first noble truth, and proceed to enlightenment."

Contemporary scholar Michael Carrithers emphasizes the need to examine one's life. Carrithers asserts that insofar as it is dynamic, ever-changing, uncontrollable and not finally satisfactory, unexamined life is itself precisely dukkha. Carrithers also asserts that the question which underlay the Buddha's quest was "in what may I place lasting relevance?" He did not deny that there are satisfactions in experience: the exercise of vipassana assumes that the meditator sees instances of happiness clearly. Pain is to be seen as pain, and pleasure as pleasure. It is denied that happiness dependent on conditions will be secure and lasting.

Contemporary teacher Chogyam Trungpa presents a perspective on how meditation practice can help the practitioner relate with dukkha; he states: "Understanding suffering [dukkha] is very important. The practice of meditation is designed not to develop pleasure, but to understand the truth of suffering; and in order to understand the truth of suffering, one also has to understand the truth of awareness. When true awareness takes place, suffering does not exist. Through awareness, suffering is somewhat changed in its perspective. It is not necessarily that you do not suffer, but the haunting quality that fundamentally you are in trouble is removed. It is like removing a splinter. It might hurt, and you might still feel pain, but the basic cause of that pain, the ego, has been removed."

Within the discourses
The Buddha taught on dukkha repeatedly throughout his lifetime. In the Alagadduupama sutta, the Buddha states:
 * "I have taught one thing, and one thing only, dukkha and the cessation of dukkha."

In the Anuradha Sutta, the Buddha states:
 * "Both formerly & now, it is only dukkha that I describe, and the cessation of dukkha."

The classic formulation of these teachings on dukkha is the doctrine of the Four Noble Truths, in which the Truth of Dukkha (Pali: dukkha saccã; Sanskrit: duḥkha-satya) is identified as the first of the four truths. The Four Noble Truths are presented within the Buddha's first discourse, Setting in Motion the Wheel of the Dharma (Dharmacakra Pravartana Sūtra); in this discourse, the Buddha defines dukkha as follows:


 * "This is the noble truth of dukkha: birth is dukkha, aging is dukkha, illness is dukkha, death is dukkha; sorrow, lamentation, pain, grief and despair are dukkha; union with what is displeasing is dukkha; separation from what is pleasing is dukkha; not to get what one wants is dukkha; in brief, the five aggregates subject to clinging are dukkha."

In the Cula-Malunkyovada Sutta, the Buddha states:
 * "And what is declared by me? 'This is dukkha,' is declared by me. 'This is the origination of dukkha,' is declared by me. 'This is the cessation of dukkha,' is declared by me. 'This is the path of practice leading to the cessation of dukkha,' is declared by me. And why are they declared by me? Because they are connected with the goal, are fundamental to the holy life. They lead to disenchantment, dispassion, cessation, calming, direct knowledge, self-awakening, Unbinding. That's why they are declared by me.

In the sutra Samyutta Nikaya #35, the Buddha says:
 * What ordinary folk call happiness, the enlightened ones call dukkha.

The Anapanasati Sutta and Mahāsatipaṭṭhāna Sutta emphasize the importance of the practice of meditation (jnana) to purify the mind of the five hindrances before contemplating the nature dukkha in the context of the Four Noble Truths.

Relation to the five skandhas
According to the Buddhist tradition, the dukkha of conditioned states (saṃkhāra-dukkha) is related to clinging to the skandhas. Oxford scholar Noa Ronkin presents her understanding of the relation between the skandhas (Sanskrit; Pali: khandhas) and dukkha: "Her conclusion is that the associating of the five skandhas as a whole with dukkha indicates that experience is a combination of a straightforward cognitive process together with the psychological orientation that colours it in terms of unsatisfactoriness. Experience is thus both cognitive and affective, and cannot be separated from perception. As one's perception changes, so one's experience is different: we each have our own particular cognitions, perceptions and volitional activities in our own particular way and degree, and our own way of responding to and interpreting our experience is our very experience. In harmony with this line of thought, Gethin observes that the skandhas are presented as five aspects of the nature of conditioned existence from the point of view of the experiencing subject; five aspects of one's experience. Hence each khandha represents 'a complex class of phenomena that is continuously arising and falling away in response to processes of consciousness based on the six spheres of sense. They thus become the five upādānakhandhas, encompassing both grasping and all that is grasped.'"

Three marks of existence
Dukkha is also listed among the three marks of existence. These are:
 * Impermanence (anicca)
 * Suffering (dukkha)
 * Not-self (anatta).

In this context, dukkha denotes the experience that all formations (sankhara) are impermanent (anicca) - thus it explains the qualities which make the mind as fluctuating and impermanent entities. It is therefore also a gateway to anatta, not-self.

Translating the term dukkha
Early Western translators of Buddhist texts (prior to the 1970s) typically translated the Pali term dukkha as "suffering", a translation which tended to convey the impression that Buddhism was a pessimistic or world-denying philosophy. Later translators, however, including Walpola Rahula (What Buddha Taught, 1974) and nearly all contemporary translators, have emphasized that "suffering" is too limited a translation for the term dukkha, and have preferred to either leave the term untranslated or to clarify that translation with terms such as unease, anxiety, stress, unsatisfactoriness, etc.

For example, Piyadassi Thera states:
 * The word dukkha (or Sanskrit duhkha) is one of those Pali terms that cannot be translated adequately into English, by one word, for no English word covers the same ground as dukkha in Pali. Suffering, ill, anguish, unsatisfactoriness are some favourite render­ings; the words pain, misery, sorrow, conflict, and so forth, are also used. The word dukkha, however, includes all that, and more than that.

Contemporary scholar Rupert Gethin states:
 * Rich in meaning and nuance, the word duḥkha is one of the basic terms of Buddhist and other Indian religious discourse. Literally 'pain' or 'anguish', in its religious and philosophical contexts duḥkha is, however, suggestive of an underlying sense of 'unsatisfactoriness' or 'unease' that must ultimately mar even our experience of happiness.

Contemporary translator Bhikkhu Bodhi states:
 * The Pāli word [dukkha] is often translated as suffering, but it means something deeper than pain and misery. It refers to a basic unsatisfactoriness running through our lives, the lives of all but the enlightened. Sometimes this unsatisfactoriness erupts into the open as sorrow, grief, disappointment, or despair; but usually it hovers at the edge of our awareness as a vague unlocalized sense that things are never quite perfect, never fully adequate to our expectations of what they should be.

Many contemporary teachers, scholars, and translators have used the term "unsatisfactoriness" to emphasize the subtlest aspects of dukkha. For example, contemporary scholar Damien Keown states that in the context of the subtle aspects of dukkha:
 * [...] the word dukkha has a more abstract and pervasive sense: it suggests that even when life is not painful it can be unsatisfactory and unfulfilling. In this and many other contexts ‘unsatisfactoriness’ captures the meaning of dukkha better than ‘suffering’.

The writer Mark Epstein states: 'A more specific translation [of the term dukkha] would be something on the order of “pervasive unsatisfactoriness.” '

Many translators recommend to leave the term untranslated. For example, scholar and translator Walpola Rahula states:
 * It is true that the Pali word dukkha (or Sanskrit duḥkha) in ordinary usage means ‘suffering’, ‘pain’, ‘sorrow’ or ‘misery’, as opposed to the word sukha meaning ‘happiness’, ‘comfort’ or ‘ease’. But the term dukkha as the First Noble Truth, which represents the Buddha’s view of life and the world, has a deeper philosophical meaning and connotes enormously wider senses. It is admitted that the term dukkha in the First Noble Truth contains, quite obviously, the ordinary meaning of ‘suffering’, but in addition it also includes deeper ideas such as ‘imperfection’, ‘impermanence’, ‘emptiness’, ‘insubstantiality’. It is difficult therefore to find one word to embrace the whole conception of the term dukkha as the First Noble Truth, and so it is better to leave it untranslated, than to give an inadequate and wrong idea of it by conveniently translating it as ‘suffering’ or ‘pain’.

Alternate translations
Translations used for dukkha in the context of the four noble truths are:
 * Anguish
 * Anxiety (Chogyam Trungpa, The Truth of Suffering, pp. 8–10)
 * Affliction (Brazier)
 * Dissatisfaction (Pema Chodron, Chogyam Trunpa)
 * Discomfort
 * Discontent
 * Frustration (Dalai Lama, Four Noble Truths, p. 38)
 * Misery
 * Sorrow
 * Stress (Thanissaro Bhikkhu, Jon Kabat-Zin)
 * Suffering (Thich Nhat Hanh, Ajahn Succito, Chogyam Trungpa, Rupert Gethin, Dalai Lama, et al.)
 * Uneasiness (Chogyam Trungpa)
 * Unease (Rupert Gethin)
 * Unhappiness
 * Unsatisfactoriness (Dalai Lama, Bhikkhu Bodhi, Rupert Gethin, et al.)

Translations into other languages
In Chinese Buddhism, dukkha is translated as kǔ (苦 "bitterness; hardship; suffering; pain"), and this loanword is pronounced ku (苦) in Japanese Buddhism and ko (苦) in Korean Buddhism and khổ in Vietnamese Buddhism. The Tibetan (phonetic) is dukngal. In Shan, it is and in Burmese, it is.

Etymology
In ordinary usage, the Pali word dukkha (Sanskrit duḥkha) means ‘suffering’, ‘pain’, ‘sorrow’ or ‘misery’, as opposed to the word sukha meaning ‘happiness’, ‘comfort’ or ‘ease’. Contemporary scholar Winthrop Sargeant explains the etymological roots of these terms as follows:
 * The ancient Aryans who brought the Sanskrit language to India were a nomadic, horse- and cattle-breeding people who travelled in horse- or ox-drawn vehicles. Su and dus are prefixes indicating good or bad. The word kha, in later Sanskrit meaning "sky," "ether," or "space," was originally the word for "hole," particularly an axle hole of one of the Aryan's vehicles. Thus sukha … meant, originally, "having a good axle hole," while duhkha meant "having a poor axle hole," leading to discomfort.

Nineteenth century translator Monier-Williams states that according to grammatical tradition, dukkha is derived from ' "uneasy"; but Monier-Williams asserts that the term is more likely a Prakritized form of ' "unsteady, disquieted".

Hinduism
In Hindu literature, the earliest Upaniads &mdash; the Brihadaranyaka Upanishad and the Chandogya Upanishad &mdash; are believed to predate or coincide with the advent of Buddhism. In these texts' verses, the Sanskrit word dukha (translated below as "suffering" and "distress") occurs only twice. In the, it states (in English and Sanskrit):

In the, it is written:

Thus, as in Buddhism, these texts emphasize that one overcomes dukha through the development of a transcendent understanding.

Panetics
In 1986, the Journal of Humanistic Psychology published an article by Ralph G.H. Siu entitled Panetics—The Study of the Infliction of Suffering. In the abstract for the article, Sui proposed using the term dukkha as a quantitative measurement; he wrote: After analyzing the unceasing mutual inflictions of suffering by practically everyone and the neglect of this pervasive and degenerating human deficiency by the academic community, I urge the immediate creation of a new and vigorous academic discipline, called panetics, to be devoted to the study of the infliction of suffering. The nature, scope, illustrative contents, and social value are outlined. The dukkha is proposed as a semiquantitative unit of suffering to assist in associated analytical operations.

Related publications include:
 * Panetics: The study of the infliction of suffering. J. Humanistic Psychology 28(3), 6-22. 1988
 * The humane chief of state and the Gross National Dukkhas (GND). Panetics 2(2), 1-5. 1993.
 * Panetics Trilogy. The International Society for Panetics, 1994.
 * Vol. I, Less Suffering for Everybody. Ibid.
 * Vol. II, Panetics and Dukkhas. Ibid.
 * Vol. III, Seeds of Reflection, Panetic Word Clusters. Ibid