To hell and back and what I have learned about happiness

Dr WongPaul T. P. Wong
Ph. D, C.Psych
Toronto, Ontario

About three weeks ago, I experienced an unexpected setback in my recovery from radical prostatectomy -- my body reacted very badly to a medication (Detrol-LA). This drug was prescribed by my urologist to slow down my overactive bladder after the surgery, but it shut down not only my bladder activities but also all my bowel functions, resulting in excruciating stomach pain, which was extended to my back muscles and my chest. I frequently broke out in cold sweat and my vomiting reflex took over, but nothing came out.

For several days, I was writhing in pain and could not find a single spot or position that could grant me temporary relief. My world was turned into a torture chamber, a hell hole. I was reduced to a bundle of exposed raw nerves. I clinched my teeth and tightened my muscles, bracing for the endless waves of brutal assault on my body and mind. Time crawled ever so slowly. Pain was what I breathed in and breathed out. It consumed all my energy and all my inner reserve.

During those days and nights of misery, nothing mattered anymore except for instant relief from the wrenching pain, which was killing me slowly. It was death by a thousand cuts! I would probably would have said anything and done anything just to find relief from the unrelenting torture. How much pain can one endure before losing one’s mind?

All my scientific knowledge about what contributes to happiness and well-being faded into a distant background. All the projects that made my life worth living also evaporated into thin air. What occupied my entire conscious mind was how to find relief from pain. Pain trumps happiness and meaning any time, until we find a way to confront and transcend it! Other than groaning and mourning, all I could utter was: Help, Help! Have mercy, Jesus! Please come, come quickly to rescue me from this ordeal! Have compassion, Buddha! Show me how to be free from pain through mindful meditation!

I used to give positive psychology workshops to various health professionals on how to help restore hope, meaning and happiness to patients suffering from severe disabilities, chronic conditions and terminal illnesses. When I had to practice what I preached, it became a different story. It was a real challenging task to maintain equanimity and a sense of coherence while in the grip of excruciating pain.

This article is a brief account of my journey through hell and my own reflection on what happiness means when one is in the crucible of suffering. The writing did not come easy – it was written by fits and starts on 3M Post-It notes, whenever I could muster some strength. On Easter Sunday (three days ago), I finally felt strong enough to string together a big pile of Post-It notes into an article.

Looking back, every sentence was a product of tears and blood. I hope that people would not dismiss this article offhand, simply because it sounds foreign and disquieting and it challenges some of our common assumptions about happiness.

It would mean so much to me if you would care to give me some feedback. I do hope that my story would resonate with other people who have gone through a very trying time.

Life in the emergency room

After three days of intense suffering, my wife took me to see our family physician. He examined my bloated stomach and decided to send me to the emergency room of a nearby hospital right away.

Life in ER was a world by itself. While I was lying on a bed in the hallway waiting for a room, I saw one severely burnt patient being wheeled in by the ambulance staff. A nurse helped a disoriented and frail Chinese elderly who had got out of his room. An anxious young couple came in with a sick baby – within half an hour, I heard the baby scream bloody murder as if some one was operating on the little thing without anesthesia. In one room close to me, an elderly big fellow repeatedly cried out for help: “Is there any nurse or doctor? Can someone help me? I can’t take it anymore. I want to die!” His pleading for help went on for many hours. In another room opposite to my bed, another patient whispered on and off: “Water, water, can someone give me water!”

When they finally found a room for me, I was re-cathetered (a very unpleasant experience) and re-connected with IV. The doctor did all kinds of medical test on me; some of the procedures were very intrusive and painful. His conclusion: my medication had put my intestine to sleep and only morphine could reduce my pain, but that would make my intestine sleep even longer.

I spent two days and one night in the ER. At night, the activities slowed down considerably except for the occasional victims of accidents. I was still struggling with my pain; my wife (who stayed with me all the time) went to the nursing station and asked for a sleeping pill; the male nurse assigned to my room said, “I’ll see what I can bargain for you.” At long last, a reluctant doctor prescribed a small pill of sedative, which did not help very much. I was awake most of the night and witnessed a remarkable scene.

The nursing staff on the night shift was having a great time out there.

In fact, they were having a party, with a lot of laughter and bantering. Yes, they were having good conversations about their positive life experiences, such as love life, college education, career aspirations, and all the things that make people happy.

Since there was no “call button” in emergency rooms, the only way one could get help was to actually go to the nursing station and ask for it. The nurses or nursing aids did not visit your room, nor could they hear you cry for help. If my wife did not stay with me and take care of all my needs, I would be in deeper trouble.

In the midst of the cacophony of groaning and moaning, I found the laughter and frolicking in the nursing station jarring to my ears. How could they turn a deaf ear to patients’ persistent cry for help? What had happened to their humanistic instinct?

At the same time, I questioned the reason for my own resentment to other people’s merriment. Was it because I was just a sick old man on the outside, looking into the “happiness club”? Was it because I felt excluded and marginalized (a common sentiment among minority people)? Or, was it because of my realization that “gone are the days when my heart was young and gay?” (Stephen Foster’s Old Black Joe).

I also tried to understand the nurses’ perspective. I could see why they needed to create a little world of their own and keep the disturbing aspects of human existence out of their consciousness. Who does not prefer laughter to sounds of human misery? Who does not prefer a sunny day to the ominous darkening sky? It seems natural for the nurses to resort to defense mechanisms to protect them from the terror of suffering and death, which would remind them of their own mortality.

Death is indeed a kill-joy. It questions the very value of our single-minded pursuit of happiness and success. Death inevitably casts a pall over all festivities and celebrations, and all the human aspirations for success and greatness.

Two different worlds

As I pondered the stark contrast between the nurses and the patients, the idea of a parallel universe suddenly hit me. It was a moment of epiphany. I was awakened to the fact that on this planet earth, in the same space-time continuum, there are actually two very different worlds with very different life experiences and perspectives: the normal world and the noxious world.

The normal world

This is the world where:

  1. People expect positive things to happen and dismiss the occasional negative outcomes as a temporary and unfortunate setback
  2. People are confident about their freedom and efficacy to exercise control over their own lives
  3. People enjoy relatively good health and take basic biological functions for granted
  4. People work hard for a better future, because they believe that the American dream of success and happiness is still within reach
  5. People believe that the world is benign with plenty of life opportunities
  6. People pursue more happiness, lasting happiness and optimal happiness
  7. Happiness is based on positive experiences, positive traits, and positive affects
  8. The pursuit of happiness is closely linked to ever rising expectations of achieving greater personal success, bigger return on investment, better consumer goods, and more recognition
  9. Happiness is considered the norm and suffering as an unwelcome intrusion
  10. The happy people jealously guard their happiness through both unconscious and intentional defense mechanisms to keep suffering and death away from their consciousness
  11. The science of happiness is primarily based on studying samples from the normal world.

People who enjoy peace and prosperity in liberal democracies are familiar with the normal world – it is the preferred way of life and it is a good life. Unfortunately, all good things will come to an end, just as surely as life moves inevitably towards death. There are seasons of life as surely as there are reversals of fortune. When there is a sharp down turn in finances, relationships or health, one may suddenly find oneself in an unpleasant territory – the “noxious world”. My own life was drastically changed after radical prostatectomy because of a very aggressive type of prostate cancer.

The “noxious world”

It is a very different world, a world we would rather ignore. It is a world of extremely trying situations and costly sacrifices. It is the boundary country between the dead and the living. It is a shadowy land with constant overcast. It is a world where most days are bad days. There is prevailing belief in traditional Chinese culture that 9 out 10 events in life are contrary to our wishes (Wong, in press a).

The Chinese mindset also believes that this is a hostile world, over which individuals have little control. The long Chinese history is replete with ruthless tyrants who committed brutalities against innocent citizens. European and American histories are no less bloody.

Evil has always been part of human existence and it continues to have a way of ruining people’s life in all sectors of the human society. Evil in all its varieties pose a challenge to positive psychologists, who need to grapple with the dark side of human nature (Baumeister, 1996; Peck, 1983).

Who can plumb the cesspool of evil? Who can fathom the depth of human miseries? Who can penetrate the heart of darkness? Who can rationalize the atrocities committed against fellow human beings? Why can’t we stop the ongoing holocaust and genocide in various parts of the world? From the bowel of the earth arises a constant stream, a scream of agony and anger. Cries of victims circle the globe and reach the highest space, but does any one listen?

We cannot wish the noxious world away. Nor can we create a utopia through science. The noxious world will not go away as long as we are locked in our creaturely bodies, driven by insatiable desires, and threatened by the capricious nature which often unleashes its deadly destructive power. The tragic triad – human physicality, desire and nature – has the power to make life miserable, unless we find a way to transcend and transform inescapable suffering and death.

But this is also a world of heroism and extreme self-sacrifice. Who can comprehend the paradox of Good Friday? What compelled Christ to die on the cruel cross so that multitudes might find hope and redemption? Who can understand the logic that one person should endure hell so that others may find heaven? Who can scale the pinnacles of human spirit, when individuals, compelled by their conscience and vision, willingly sacrifice all they have, including their own lives, to fight against evil so that ordinary people can live with freedom and dignity?

Suffering and death

In spite of our pre-occupation with happiness, life in this world remains a sad story. How can it be otherwise? All our efforts invested in learning, growing and achieving are doomed to inevitable decline and death. All our attempts to cling to the success and happiness we have already achieved are doomed to failure, because in old age, life is a series of losses.

Life is a journey with a beginning and an end. All good things must come to an end. Even the happiest and most successful lives will come to the same end as the most miserable lives. The irony is that the more intensely we pursue happiness, the more fearful we will be about losing what we hold dear.

Earnest Becker (1973) has pointed out that our hunger for happiness actually awakens our death anxiety and our unconscious defenses against death anxiety may prevent us from living fully and vitally. Is that the reason why so many positive psychologists shy away from the topic of suffering and death?

The reality is that the “noxious world” may be more common than we care to admit. The First Noble Truth of Buddhism is Dukkha, which may be roughly translated as life is full of suffering and dissatisfaction. This profound truth reveals that throughout life, people suffer from various kinds of troubles, ranging from physical pain to psychological distress, from losing what they value most to the disillusion that happiness does not last. We are all acquainted with both external and internal sources of troubles. It is sad but true that often bad is stronger than good (Baumeister, Bratslavsky, Finkenauer & Vohs, 2001).

For all human beings, the inescapable existential givens – sickness, aging, death, aloneness, meaninglessness – cast a long, dark shadow over all our activities, even when the sky is shining bright. The challenge is how to live fully with constant awareness of the noxious world of suffering and death

In final analysis, those who are able to make it to the end with their integrity intact can find some comfort that they have fought a good fight and they have run the race with honor. Just to complete a long and difficult obstacle-course is indeed a heroic achievement by itself.

Profiles of the suffering people

Interestingly, the noxious world is populated by a wide spectrum of individuals sharing a common fate – suffering.

  1. They are the hidden dark belly of a prosperous nation
  2. They are the common citizens living in dictatorial police states
  3. They are victims of abuse, violence and military conflicts
  4. They are innocent people languishing in cruel prisons,
  5. They are victims of Katrina, Tsunami and other natural disasters
  6. They are the chronically disabled, the frail elderly and the terminally ill
  7. They are the families grieving the loss of a loved one
  8. They are the children suffering from cancer and AIDS
  9. They are the soldiers maimed and killed in a foreign land
  10. They are the broken hearted pierced by a thousand arrows
  11. They are the losers, destined by fate and circumstances, to live with broken dreams
  12. They are the oppressed, persecuted, exiled, ostracized, and targeted for personal destruction for no other reasons than not belonging to the right group
  13. They live in destitute poverty and constant privation
  14. They are the shut-ins and the lonely souls living alone.
  15. They are in countries with a tyrannical system, in which they have to find a way to stay alive
  16. They live in refugee camps or labor camps
  17. They work in sweatshops or slavery
  18. They live in slums and skid row
  19. They live in golden cages without meaning and love
  20. They hit the rock-bottom, knowing that the next step is death unless their lives are turned around
  21. They live from rehab to rehab
  22. They are the heroes who sacrifice everything to make this a better and safer world for others
  23. They are the misfits who cannot make a living because of their unwillingness to compromise their principles and ideals
  24. They suffer costly consequences for doing what is right in a morally ambiguous world

We simply cannot ignore or dismiss the long litany of painful life experiences. History bears witnesses to the scope and depth of human tragedies. Every day the mass media bombards us with bad news about suffering. Tons of statistics are available on most of the sufferers listed above. They number in hundreds of millions and they are a growing majority, but they remain largely invisible and voiceless.

This is no country for sufferers. They are the faceless and invisible pariahs. They are relegated to the realm of negative psychology. They are not even represented by the lowest scores on the thousands of happiness studies. They are three standard deviations away from the mean scores. The scientific findings based on samples from the normal world may not be generalizable to people in the noxious world.

The co-existence of two different worlds

Different as they are, the two worlds actually co-exist as day and night. They even intermingle as wheat and tare -- one may enjoy a blessed married life, but work in a toxic organization. Birth and death can happen in the same family on the same day. Painful memories and happy ones are locked inside the same brain.

The truth is that the sufferers are all of us. We move back and forth between the two worlds, and we move through the two worlds in different stages of life.

As the baby boomers age, many of them will eventually join the “noxious world” of suffering, life-threatening illness and death. The noxious world is an equalizer, where all the past achievements and happy memories retreat into the background and all people can think of is how to find relief from pain and how to regain some sense of hope in the face of suffering and death.

A different kind of happiness

On really bad days – which will come to all of us sooner or later – we need something higher and something deeper to get us through; we need a different kind of happiness in extremely trying circumstances.

Happiness in the noxious world is predicated on the human capacity to transcend and transform negative experiences through meaning and faith (Wong, 2008a). The greatest achievement of humanity is its ability to experience the invisible spiritual reality and discover shining stars in the darkest night of the soul (Wong, 2008b)

We become nobler, purer, kinder and more generous, when we dig deep into our innermost being and reach out to the highest heaven, while struggling to survive unimaginable terror and torment. For suffering beings (Homo Patients), happiness has a deeper meaning than positive affect, life satisfaction or subjective well being.

For the sufferers, happiness primarily means:

  1. Relief from suffering
  2. Tragic optimism
  3. Faith in God or Higher Power
  4. Compassion and kindness
  5. Enlightenment and wisdom
  6. Meaning and purpose

Relief from suffering

Relief is the dominant theme. It is similar to negative reinforcement or the contrast effect according to Richard Solomon’s opponent-process theory of emotion. It is also related to liberation theology and the purification effect of suffering.

  1. Relief from suffering, terror, anxiety, lingering illness and the endless struggle
  2. Release through crying and screaming from pent up emotions of pain and grief
  3. Liberation from injustice, discrimination and oppression
  4. Cleansing from all the toxins in my body and mind (purification through suffering)

Tragic optimism in the throes of suffering

It is hope against all odds; it is affirming the positive in extremely negative circumstances (Frankl, 1984; Wong, 2008b)

  1. Courage to accept and endure the seriousness of my condition
  2. Assurance that help is on the way
  3. Expectation that life can be made better
  4. The hope of restoration of some semblance of normalcy
  5. The resolve to hang on to the hope that I’ll survive this ordeal and become a better person
  6. Celebration of every baby steps of progress

Faith in God or Higher Power

Faith is more than cognitive reframing. It opens the door to the invisible transcendental reality and allows us to access spiritual resources. The benefits of religious faith for different cultures have been well documented (Wong and Wong, 2007).

  1. Faith that God is my Refuge and Rescuer, no matter how bad the situation
  2. Belief in redemption and deliverance
  3. A sense of oneness with God who comforts me
  4. Drawing strength from God or Higher Power
  5. Belief that God’s grace will be sufficient
  6. Transformation through spiritual encounters
  7. Sacred moments of experiencing a deeper spiritual reality

What kept me going was the belief that Jesus would see me through. I kept on saying to myself: “Yes he can, yes he can; he will come to my rescue.” Faith is my hope; faith is my comfort.

Compassion and kindness

This is the feeling of being part of a fellowship of suffering bonded by compassion. It is deeper than social support. Compassionate care is an integral part of holistic medicine and hospice care (Wong, 2005, Wong, in press b).

  1. Appreciation of the kindness and compassion shown by others
  2. Gratitude to the loved ones who do everything possible to make suffering bearable
  3. Satisfaction of bringing help and comfort to fellow-sufferers
  4. Feelings of solidarity and compassion towards all who suffer

Enlightenment and wisdom

It is informed by both Eastern religions (Buddhism, Taoism) and Christianity. It is related to the wisdom traditions from East and West.

  1. Contentment that the situation could have been worse
  2. The wisdom of letting go of what cannot be kept
  3. The wisdom of accepting what cannot be changed
  4. Feelings of equanimity that worst would be death, which is inevitable anyway
  5. Knowing that life is transient and that all suffering will pass away
  6. Knowing that as long as I still have life, I need to be mindful of every passing moment

Meaning and purpose of suffering

It is based on Frankl’s (1984) logotherapy and Wong’s meaning-centered counselling (Wong, 2008c).

  1. An abiding sense of meaning and purpose that makes my suffering bearable
  2. The confidence that I will not suffer in vain and that my message of hope and happiness to suffering people will find acceptance somewhere in the world
  3. The satisfaction that I may be broken, but I am not defeated
  4. I will take a defiant stance towards whatever suffering I may have to endure
  5. I am glad that I am worthy of suffering for others – that my experience of hell can open a door to heaven for people I don’t even know

The above threads of thoughts and feelings once sustained Viktor Frankl in Nazi death camps; they also sustained me in my journey to hell.

For want of a better term, the kind of happiness I have just described may be called dark-happiness, because it can only be found in the dark night of the soul. It is rejoicing in the midst of suffering. It is the process of becoming our best when we are in the worst possible situations. Such dark-happiness may be best described in metaphors. It is a tapestry of dark colors with a few bright threads. It is the rainbow after a storm, or silver lining of a dark cloud. It is the rejoicing after surviving a terrible trauma. It is the sweet aftertaste of eating something bitter. One has to feel bad before one can feel good, and one has to let go before one can receive the blessings.

Happiness through suffering can also be described as chaironic happiness, because it is an unexpected gift from suffering – a gift of new insight and an inner peace beyond understanding. It is something spiritual and transcendental, independent of the negative experiences.

There is plenty of empirical evidence supporting the above six ingredients of dark-happiness. At this point, I don’t have the strength to marshal all the empirical findings about the beneficial effects of these six factors on well-being in noxious situations.

The ultimate test of positive psychology

When I was writing in pain, I was definitely not in a mood for anything jovial. I did not want to hear a cheerful song or a merry tune. I would rather listen to the good old hymns about suffering and redemption, the haunting melancholy songs of Leonard Cohen, or the Negro Spirituals in cotton fields.

Therefore, I can understand why people who are flying high on wings of success and happiness are likely to be turned off by my soulful blues of sorrow and pain.

But the ultimate test of positive psychology is whether it is relevant and efficacious for the multitudes in extreme and noxious situations. This reminds me of Skinner and his students.

In order to demonstrate that positive reinforcement is a universally valid scientific principle, Skinner and his students were able to demonstrate that reinforcement worked with severely retarded people as well as psychotic patients locked up in the back wards of psychiatric hospitals.

The same test is needed for positive psychology. I hope that happiness researchers would join me in studying the nature of dark-happiness.

Meanwhile, research on character strengths (Peterson and Seligman, 2008; Petersen, Park, & Seligman, 2006) represent a promising avenue to expand positive psychology to noxious situations, because courage and transcendence are related to the six factors I mentioned earlier, which tend to grow best in the crucible of suffering.

Now, my back and my neck are aching from keyboarding. Therefore, I must stop right now. However, I am glad that I have finally told the story about what I have gone through in the past three weeks.

In a sense, I am grateful for the painful journey into hell. At least, I can say that I have directly experienced dark-happiness and discovered that it is indeed a gift from suffering.


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