The Buddha's Medical Model
The Buddha structured his teachings like a physician would approach a patient. First, he diagnosed that there was a problem. Second, he identified the underlying cause of that problem. Third, he determined the prognosis: could the condition be treated? Fourth, he prescribed a course of treatment.
These became known as the “Four Noble Truths”, though I prefer to think of them as four observations about the human experience that, once understood, can fundamentally change how we relate to life.
First Observation: Life Contains Suffering
The first observation is simple and undeniable: in life, there is suffering. That's it. Not "life IS suffering"—that's a mistranslation that makes Buddhism sound depressing. The observation is just that suffering is woven into the fabric of human existence.
This could be major disruptions: losing a job, the death of a loved one, a cancer diagnosis. But it also includes smaller, subtler experiences: getting stuck in traffic when you're already late, the ache of aging, the frustration of waiting in line, the anxiety that comes with uncertainty.
Here's a helpful analogy: Imagine you're walking through a forest at night, and suddenly, someone jumps out wearing a bear costume, trying to scare you. You'd be terrified, right? But now imagine that before you entered the forest, a friend warned you: "Hey, there's someone in there dressed as a bear who's going to jump out and try to scare people. Just so you know, at some point, that person is going to startle you."
Now when the person jumps out, you'll still be startled—but not nearly as much as if you weren't expecting it. The experience is the same, but your relationship to it is completely different because you were expecting it.
The First Noble Truth is like that warning. It's saying: "Life is going to surprise you with difficulties. You don't know when or how, but they're coming. This isn't personal. This isn't punishment. This is just how life works for everyone."
Simply knowing that suffering is universal, not something that happens to you specifically because you did something wrong, can reduce a tremendous amount of additional suffering. When challenges arise, instead of asking "Why is this happening to me? What did I do to deserve this?" you can recognize: "This is just life being life. This is what I was warned about. Now, how do I work with it?"
Understanding the Three Types of Suffering
Let me illustrate this with a personal story. A few years ago, I was riding my onewheel, a kind of electric skateboard that's become one of my favorite ways to get around. I was cruising along a familiar path when I hit an unexpected bump and was thrown off, landing hard on my shoulder. I heard a distinct pop and knew immediately something was wrong. Three types of suffering unfolded from this single event:
The First Type: The Suffering of Pain
This is the immediate, unavoidable physical suffering: the sharp pain shooting through my shoulder, the awkward walk back to my car while cradling my arm, the discomfort of the emergency room visit, the ache during recovery. This is what Buddhist teaching calls the "suffering of pain" (dukkha-dukkha). It's the direct, immediate result of what happened, and there wasn't much I could do except treat the injury and let it heal.
The Second Type: The Suffering of Change
In the weeks that followed, I discovered layers of loss I hadn't anticipated. I couldn't ride my onewheel, which had been a daily joy. More significantly, I couldn't lift my arms above my head, which meant I couldn't paraglide, my greatest passion and, at the time, also how I made my living teaching others to fly. Suddenly, both my favorite recreational activity and my work were taken away. This is what Buddhism calls the "suffering of change" (viparinama-dukkha): the pain that comes when things we depend on for happiness are taken away or altered. It's the suffering of impermanence, the inevitable grief that comes when we lose what we love.
The Third Type: The Suffering Woven Into Existence
But there was a subtler, more pervasive form of suffering that emerged from this experience: one that persists even now that my shoulder has healed. It's the quiet recognition that my body is fragile and aging. When I ride my onewheel now, there's an awareness that wasn't there before: this could happen again. Not just another shoulder separation, but the gradual recognition that there will come a time when I can't do the things I love. My body will age, weaken, eventually fail.
This isn't anxiety or catastrophic thinking; it's a sober understanding of what Buddhist teaching calls "all-pervasive suffering" (sankhara-dukkha). It's the suffering that's woven into the very fabric of conditioned existence. Even in my happiest moments paragliding or enjoying a perfect onewheel ride, there's now a background awareness of impermanence and vulnerability. Not in a way that ruins the experience, but in a way that adds a poignant quality to it: the recognition that all conditioned things, including this body and these experiences, are inherently unstable.
This third type of suffering isn't something we create with our stories or mental commentary, though those can certainly make it worse. It's built into the nature of existence itself. Everything we depend on for happiness (our bodies, our relationships, our circumstances) is subject to change and loss. Even when life is going well, there's an undercurrent of uncertainty because we understand, consciously or unconsciously, that this too will pass.
Why This Understanding Matters
When we talk about the possibility of ending suffering, we're primarily addressing our relationship to all three types. The first type, physical and emotional pain, is largely unavoidable as long as we're alive. The second type, the pain of loss and change, is also part of being human in a world where nothing lasts forever.
But the third type, all-pervasive suffering, can be transformed through understanding. When we truly grasp the impermanent, interdependent nature of all conditioned existence, we can find peace even within uncertainty. We can love fully while understanding that loss is inevitable. We can enjoy deeply while remembering that nothing lasts forever.
This isn't about becoming detached or indifferent. It's about finding a way to engage wholeheartedly with life while accepting its fundamental nature. My onewheel accident taught me that I can still ride with joy, knowing that another fall is possible. I can still paraglide with passion, understanding that age will eventually ground me. The recognition of impermanence doesn't diminish these experiences; it makes them more precious precisely because they won't last forever.
Recognizing the different kinds of suffering is only the first step. The Buddha’s next question was: if suffering shows up in so many forms, what’s actually causing it?
Second Observation: The Cause of Suffering
This brings us to the Buddha's second observation: suffering doesn't primarily come from external events, it emerges from craving for life to be other than it is. The Buddha described the cause of suffering (samudaya) as craving (tanhā), the “thirst” for things to be other than they are.
Let me repeat that because it's super important to understand: suffering arises from craving for life to be other than it is.
Notice this isn't about the events themselves. Getting injured isn't inherently suffering-inducing (of course, it's painful, but pain is not the same as suffering). Losing a job isn't inherently traumatic. The suffering comes from our relationship to these events, specifically from wanting reality to be different than it actually is.
Think about the last time you were really frustrated. I'm willing to bet it wasn't just because of what was happening; it was because what was happening wasn't what you wanted to be happening. You were stuck in traffic, but you wanted to be moving. Your computer crashed, but you wanted it to work. Someone was rude to you, but you wanted them to be kind.
The Buddha identified three specific patterns of craving, often referred to as the three poisons, that create suffering:
Greed (or Attachment): "If I could just have this, then I'd be happy." This could be more money, a better job, a different partner, a bigger house, or even something as simple as "if this person would just listen to me" or "if my boss would just appreciate my work."
Aversion (or Resistance): "If I could just avoid that, then I'd be happy." This could be avoiding illness, avoiding conflict, avoiding failure, or avoiding discomfort of any kind.
Ignorance (or Delusion): The inability to see that both of the above strategies are flawed. It's believing that there actually are things that, if we could just get them (winning the lottery) or avoid them (cancer), would provide lasting happiness. In Buddhist teaching, ignorance doesn't just mean "not knowing." It means misunderstanding the nature of reality itself, such as believing that impermanent things can bring permanent happiness.
The Three Poisons in Daily Life
Let me give you some concrete examples of how the three poisons show up in ordinary life:
Greed in Action: You're scrolling social media and see a friend's vacation photos. Suddenly, you feel dissatisfied with your life. The thought arises: "If I could just take a vacation like that, then I'd be happy." You weren't unhappy five minutes ago, but now you are because you've created a story about what you need to feel good about your life.
Aversion in Action: You’re enjoying your evening when you notice the sink full of dirty dishes. Instantly, irritation arises. The dishes aren’t actually causing suffering—they’re just sitting there. The suffering comes from your resistance to doing something you don’t want to do.
Ignorance in Action: You believe that once you save enough money, buy the right house, or land the perfect job, you’ll finally feel safe. But security based on conditions can never be absolute. The ignorance is not seeing that everything you depend on is itself fragile and changing.
A Different Way to Respond
Understanding the cause of suffering points toward a radically different way of living. Instead of constantly trying to arrange life to match our preferences, we can learn to work skillfully with whatever life presents.
This doesn't mean becoming passive or never working to improve difficult situations. It means recognizing the difference between:
Skillful Action: "This situation isn't ideal, and there are things I can do to improve it. Let me respond thoughtfully and see what's possible."
Suffering-Creating Resistance: "This situation is wrong and shouldn't be happening. I refuse to accept this reality."
The difference is subtle but profound. One approaches challenges as problems to be solved; the other approaches them as personal affronts to be resisted.
Third Truth: Freedom Is Possible
The Buddha's third observation offers hope: it's possible to end the cause of suffering. Not by getting everything we want or avoiding everything we don't want—that's impossible. But by changing our relationship to wanting/craving itself.
This doesn't mean becoming emotionless or not caring about anything. It means learning to hold our desires and aversions more lightly. To want things without demanding them. To work for positive change without being destroyed when change doesn't come as quickly or in the form we expected.
People who understand this third truth often seem to have a magical ability to remain calm in chaos, to find joy in simple moments, to maintain hope without being attached to specific outcomes. They haven't figured out how to control life—they've learned how to dance with it.
Fourth Truth: There's a Path
The Buddha's fourth observation is that there's a practical path for learning this new way of relating to life. It's not just a nice philosophy—it's a set of trainings that can gradually transform how you experience being human.
We'll explore this path in detail in the coming modules, but for now, just know that it's not about becoming a monk or renouncing the world. It's about becoming more skillful at the art of living. More aware of your thoughts and reactions. More intentional about your words and actions. More able to respond rather than react.
Why This Matters Now
You might be wondering: "This is all very philosophical, but how does it help me deal with my actual problems?" Here's how:
The next time you're stuck in traffic, instead of spending twenty minutes fuming about how the traffic "shouldn't" be this bad, you can recognize: "This is traffic. This is what's happening right now. Getting angry at reality won't make it move faster. How can I use this time skillfully?"
The next time someone treats you rudely, instead of carrying that interaction around all day, building a story about what a terrible person they are, you can think: "That person seems to be having a difficult day. Their behavior is about them, not about me. I don't need to carry their bad mood with me."
The next time you don't get something you really wanted, instead of spiraling into self-pity or resentment, you can recognize: "I wanted a different outcome, and I'm disappointed. That's natural. But my happiness doesn't depend on getting everything I want. What can I learn from this? How can I move forward skillfully?"
These might seem like small shifts, but they're revolutionary. They're the difference between spending your life fighting with reality and learning to work with it creatively.
The Universality of Struggle
One final thought: recognizing that suffering is universal can actually be a great source of connection and compassion. When you're going through a difficult time, you're not alone in some unique personal hell. You're sharing the fundamental human experience.
That person who cut you off in traffic might be rushing to see a sick parent in the hospital. That coworker who's been difficult lately might be dealing with problems at home you know nothing about. That friend who seems to have everything together might be struggling with anxiety or depression in private.
Suffering connects us. Understanding this can transform your relationship not only with your own difficulties but with the difficulties of others. It's the foundation of genuine compassion.
Put It Into Practice
This week, practice noticing the difference between what's actually happening and the story you're telling yourself about what's happening. When you find yourself frustrated or upset, pause and ask:
- What actually happened here? (Just the facts, like a journalist would report them)
- What story am I telling myself about what happened?
- How much of my suffering is coming from the event itself, and how much is coming from my story about the event?
You're not trying to stop telling yourself stories—that's impossible and probably not helpful. You're just trying to recognize the difference between reality and your interpretation of reality.
Journaling Prompts
- Think about a recent time when you were really frustrated or upset. Can you identify which of the three types of suffering you experienced? Was there physical or emotional pain (first type)? A sense of loss or change (second type)? Or the deeper awareness that things are fragile and uncertain, that even good moments won’t last (third type)?
- Looking back at that situation, what were you wanting to be different? In other words, how were you craving for reality to be other than it was?
- More broadly, what are some things you often think would make you happy if you could just have them? (These might be big things like a new house, or small things like your spouse doing the dishes without being asked.)
- On the flip side, what are some things you try to avoid because you believe avoiding them will make you happy? (This could be dramatic, like illness, or ordinary, like uncomfortable conversations.)
- Can you think of a time when getting something you really wanted didn’t make you as happy as you expected? Or when something you were dreading turned out to be not so bad, maybe even beneficial?
- How might your approach to daily frustrations change if you really believed that suffering was universal—not a sign that something is wrong with you or your life, but simply part of the human experience?
Going Deeper
To explore these themes further, listen to Episode 2 of the Secular Buddhism podcast: "The Nature of Human Suffering." You can also check out the episode on "The Path of Liberation" for more depth on the Four Noble Truths.
In the next module, we'll explore one of the most liberating insights from Buddhist psychology: the illusion of the fixed self. We'll examine what we mean when we say "I" and discover why understanding the fluid nature of identity can free us from so much unnecessary suffering.