The Pandemic and Suffering

The stark COVID-19 global statistics as of September 19, 2021 (Worldometer):

• Deaths: 4,702,758
• Infected: 229,105,331
• Long COVID-19: Of those who have “recovered,” almost 21,000,000 continue to suffer long-term, disabling symptoms.

Thankfully, much of the public has struggled reasonably well with mental health issues during the pandemic, but a significant proportion continues to suffer debilitating problems. In Canada and the United States, for example, substance use and overdoses have risen significantly, as has domestic violence. Suicide ideation and attempts have escalated. Financial anxiety has increased with the battered economy, but many businesses cannot lure wary employees back. The social conflict between the vaxxers and anti-vaxxers has erupted into public protests and rebukes. Racism against Asians is up. And, of course, we’ve heard story after story of loss and grief, such as the teen who broke social distancing rules to attend a party, where he unknowingly contracted COVID-19 and then infected his family, leading directly to the death of his father.

Authorities have relied mainly on our expensive bio-psycho model of care to help those in physical and mental distress. Physicians and nurses care for the physical complaints, and psychiatrists, psychologists, and counselors work with mental health issues. But the pandemic has revealed this approach is not up to the task. The cost has necessarily limited the supply of professionals, and overworked professionals have burnt out at an unhappy rate. Beyond cost, current research has concluded that the psychologists’ recommendations to support the mental health of workers—such as by providing counseling, relaxation techniques, and quiet rooms—have not been particularly useful. Similarly, their recommendations for the general public to exercise, use mindfulness techniques, eat right, and rely on the internet to maintain relationships do not appear to have provided general relief from the pandemic’s effect on mental health. High levels of depression, anxiety, suicide, trauma, and substance use remain a worry.

Conference Vision

The global pandemic has made clear that we need to rethink how we can best help those who are suffering from mental health problems. The vision of INPM’s 2021 conference was to confront the limitations of our current systems of care and offer new ideas and practices that promise a more effective response.

Move Beyond Happiness

The ideal of happiness, as conceived in the West (and particularly the United States), has typically linked wellbeing to personal pleasure and comfort. When mental health workers meet a client, they believe their primary task is to ease suffering, just as physicians ease pain. With so many prescription pills and cognitive-behavioral coping skills available, it’s almost as if we assume that suffering is optional.

Yet this popular approach has not led to sustainable happiness as the pandemic has made clear. Indeed, research has consistently shown that simply eliminating suffering has never led to the good life, any more than getting rid of a headache leads to smiles and laughter. We have to appreciate that our vulnerabilities, and the suffering attached to them, are part of what it means to be human. Any attempt to simply avoid or eliminate uncomfortable feelings is, thus, at odds with human nature and leads to unnecessary suffering.

How can we help people marshal their inner and outer resources to pursue more fulfilling lives, in spite of vulnerabilities?

Use Vulnerability to Flourish or to be Victimized

Frankl declared that if we have a reason to live, we can overcome any obstacles and pain. In the last year and a half, we’ve seen hospital staff members put themselves in harm’s way to care for those who are infected with the virus, and studies have shown that medical students are typically eager to join the frontlines because they feel it their calling. These healthcare workers are not yearning for pleasure and comfort; rather, they are pursuing what they feel is their mission.

Obstacles and pain, said Dante in The Divine Comedy, were prerequisites for the good life. The path to Heaven first goes through Hell. No one ever achieved sustained happiness by living a comfortable and pleasurable life. Psychological research supports this idea. Indeed, the recent spate of studies on ‘resilience’ has shown that it develops when times get tough.

Yet so many people feel victimized by COVID-19. How can we help them develop resilience and wellbeing, in spite of suffering?

Existential Coping

Much of the suffering in the pandemic has been at an existential level, and one of the more obvious anxieties is the fear of death. Nurses worry that they will be infected with the SARS-CoV-2 virus and bring it home to their children; neighbors turn down dinner invitations because they are wary of unvaccinated guests. And there are many other existential issues. Boredom has been rampant, often because our usual distractions to avoid suffering—theatres, gyms, concerts, casinos, bars—have been locked shut. Loneliness, which many psychologists argue was an epidemic even before the COVID-19 pandemic, has increased because of social distancing. Uncertainty has become part of most of our lives as we struggle, for example, to make sense of the conflicting information and recommendations from governments. Indeed, many people are questioning whether their motivations and goals have led them to the good life or merely kept them trapped.

Basic coping skills, such as stress reduction techniques, aren’t good enough to cope with these existential stressors. There is no quick or easy fix. As Paul Wong pointed out in a previous issue of this newsletter, it’s better to use suffering as a catalyst to understand oneself better and discover new ways of positive living.

What approaches can help individuals dig deep within and tease out their inner courage, positive attitude, and other character strengths?

Conference Themes and Takeaways

Examining the collection of speakers as a whole, we can discern five major themes arising from the conference: vulnerability as a natural aspect of life, how we transform vulnerability into flourishing, the necessity of positive relationships, the need for multicultural and multidisciplinary psychological perspectives, and shifting focus away from professional healthcare models and toward grassroots movements.

Vulnerability is Inherent in the Human Condition

The pandemic has forced us to confront the fact that human beings are vulnerable. Contrary to what many people in the West believe, presenters emphasized that vulnerability is not a bad thing. Indeed, pain is a great motivator to change for the better.

Paul Wong, emeritus professor of psychology at Trent University, pointed out that most Westerners believe that vulnerability and flourishing are opposite poles on a continuum. They aren’t. Rather, they are separate constructs, which must be integrated in one’s life. He cited the philosopher Friedrich Nietzsche: “Happiness and unhappiness are twins that grow up together.” And Carl Jung: “In the self, good and evil are indeed closer than identical twins.” Vulnerability and flourishing were both essential to human nature.

Presenters described a broad range of vulnerabilities that are inherent in the human condition: fear, shame, anger, being hurt by others, sickness, loneliness, loss, uncertainty, dependence. Several presenters singled out fear as particularly demoralizing and the need for courage to overcome barriers to flourishing. Claude-Héléne Mayer of the University of Johannesburg described our deliberate avoidance of confronting ‘shame’ as an unnecessary barrier to flourishing.

Transforming Suffering to Flourishing

Can a suffering person flourish? This was a key question at the conference and one that several audience members asked presenters. Although Piers Worth of Buckinghamshire University preferred the term ‘vulnerability’ rather than suffering, there was general agreement that not only was it possible to flourish, but that vulnerability/suffering was likely a prerequisite for achieving the good life.

Brent Dean Robbins, professor of psychology at Point Park University, reported his research on joy, in which he found, among other things, that “participants talked about brokenness. They lacked a sense of wholeness.” Robbins emphasized that participants were grounded in their experience of suffering in that they used it to develop humility and to take action.

Other presenters—including as Andrew Kemp of Swansea University and student presenter Adeeba Hakkim of the Indian Institute of Technology Hyderabad—provided studies that showed how those suffering from trauma, depression, suicidal thoughts, and other struggles used their suffering as a catalyst to lift themselves out of the abyss.

Richard Cowden of Harvard’s Human Flourishing Program cautioned that more research is necessary. He described his quantitative work building a stronger body of evidence to answer the question, “Can we flourish through suffering?” He suggested that it is difficult to measure suffering directly and discover its causal determinants. Current efforts are cross-sectional and longitudinal evidence is lacking. Similarly, we need more research differentiating suffering from conditions such as depression.

“Wake up!”

Those who live contented lives don’t think about how meaningful their lives are. They just live. Frankl said that meaning was often latent and needed a trigger to be expressed. In research, questions of meaning are not associated with ‘happy’ people. Rather, these questions emerge mainly when one’s life goes off the rails, as Kirk Schneider of Saybrook University reminded us. Asking questions such as “Why did this happen to me?” or “What can I do to live a more fulfilling life?” force us to dig deeper within ourselves. Because of suffering, we can choose to tap into our courage and other hidden strengths.

Matthew Lee of Harvard’s Human Flourishing Program suggested that meaningful stressors may “enrich our soil by enabling warm connections and valued contributions.” He quoted from Rebecca Solnit’s A Paradise Built in Hell: “Natural disasters can release survivors from the ‘social disaster’ of daily life (meaningless stressors: alienation, loss of identity, undignified work) into a deeply compassionate and meaningful ‘paradise of unbroken solidarities’.”

Farooq Naeem, chief of general and health systems psychiatry at CAMH and professor of psychiatry at the University of Toronto, relayed a personal story of how a diagnosis of diabetes later in life—the result of his stress-filled career—transformed how he made sense of what it means to be successful. He realized that his personal wellbeing demanded more than simply being a very successful medical professional.

It’s a curious paradox that resilience and wellbeing emerge from tough challenges.

Self-Transcendence

The agent of change in transforming vulnerability to wellbeing is ‘self-transcendence’, as many speakers described it. Scott Barry Kaufmann, author and cognitive scientist, discussed a healthy transcendence as “an emergent phenomenon resulting from the harmonious integration of one’s whole self in the service of cultivating the good society” (from his book, Transcend: The New Science of Self-Actualization). This perspective moves beyond the old idea that self-actualization is the pinnacle of human experience and recognizes that transcending the suffering self through service to others is actually a more direct path to happiness. Self-transcendence may be an inside job, but it is not a solipsistic one.

An example of a transformational, self-transcendent experience during the pandemic is immersing oneself in the natural world. Lia Naor of Haifa University presented research on Back to Nature Therapies (BNTs). The pandemic has shown that our old way of thinking about nature—our job is to master nature and use it for our material gain—is no longer sustainable. Our invasion of the natural world (and particularly with bats, the scientists tell us) among other factors essentially invited the pandemic. BNTs remind us that we are not separate from nature but a part of it. Naor summarized research on BTNs that has shown significantly increased health benefits. “Nature has been defined as ‘one of our most vital health resources’.” “These approaches harness the significant connection between humans and nature, in order to help people heal, develop, grow, and thrive—physically, psychologically, and spiritually.” Kemp, too, described his research that showed significant benefits using the natural world as therapy, such as nature therapy for those suffering from traumatic brain injuries. Connecting with nature helped participants live more fulfilled lives, even though their brain injuries were permanent.

Several speakers pointed to posttraumatic growth as an example of transcending the suffering self. Others pointed to developing character strengths, such as those studied at the VIA Institute on Character. Lee provided a caveat that it is not only traits that determine how we act, but the specific situations, an observation that moves us beyond a concern for the self to our relationships with others and the environment.

The pandemic appears to have severely affected the mental health of many young people. Presenters interested in education spoke of the need to reimagine public school curriculum to help children rise above their fear and confusion in the modern world. School should not be merely about acquiring knowledge; it should also be about developing character strengths and social interests to help youth thrive in a world of the pandemic, competition, and existential crises.

Experiencing Life Fully

The pandemic has intensified existing social divisions, such as between rich and poor, and various ethnicities. Each side appears to be digging in, preferring to dismiss the ‘other’. Media pundits have pointed out that many of us seem to have barricaded ourselves against the world.

Yet, a route to transforming vulnerability to wellbeing requires us to experience the full range of life experiences. Todd Kashdan, professor of psychology at George Mason University and author of Curious?, pointed to our need to experience the wholeness of life, not merely attach ourselves to the comfort and predictability of old ways of thinking. He suggested making a plan to intentionality seek out those we disagree with in order to broaden our experiences. Similarly, Schneider argued that our current polarized minds need to deliberately seek out and learn from others we disagree with. This full range of experience is almost like learning how to be an artist: We discover that life, including our own, blossoms with meaning as it becomes more complex.

Relationships

Developing authentic relationships with others is foundational to a flourishing life. Logically, this effort is part of how we can transform vulnerability, but it is so important that it deserves its own heading in the conference summary. It is not hyperbole to suggest that the importance of relating authentically to others was the outstanding theme of the speakers.

The global pandemic has made it obvious that “We’re all in this together,” a phrase half a dozen presenters used. Controlling the pandemic must mean, therefore, that we’re each responsible for others. Sadly, many people have rebelled against prevention measures, justifying their position that masks, vaccinations, etc. intrude on their rights. This appears to be a deliberate refusal to accept that the SARS-CoV-2 virus, left unchecked, will continue mutating putting us all at risk. Similarly, they deliberately ignore the fact that wearing a mask and social distancing are ways to keep others safe. Indeed, several presenters pointed out that those who are against prevention behaviors had a “me-me-me” attitude, as one speaker described it. This attitude is reminiscent of Frankl’s caution against wandering about asking, “Is this good for me?” A flourishing life is not a self-centered one.

Suffering can be transcended through solidarity. Confronting the Western cult of the individual, Blaine Fowers, professor of counseling psychology at the University of Miami, Schneider, and Lee reminded us that human beings are vulnerable because we are dependent on others. Schneider considered our “emotionally impoverished relationships” as the major crisis in our society (and he included the emotionally impoverished self). Mayer reported that ‘sharing’ is universal in non-capitalist societies, which provides them physical and mental stability. This is not about reciprocity or market exchange since some people receive more than others depending on need. Lee described the power of religious communities to provide a full spectrum of support to their residents, leading to lower rates of addiction, depression, and other mental health problems.

José Rodriquez of California State University spoke of self-transcendence as ethical awareness: “Moving beyond ego by becoming aware of the roles we play in minimizing suffering and enhancing the wellbeing of others.” This movement allows us to “create the best version of ourselves.” Rodriquez’s “poetic version of above”: “I surrender all of me for all of you, so that there’s nothing left but us [sounds like love].” Agape love was invoked by several speakers to describe an increased caring for others that brings with it a new awareness of self.

Fowers answered the question, How is it we can flourish despite vulnerability/frailties? Positive psychology says “buck up,” but that advice is not going to do it, because positive psychology “does not incorporate frailty.” Good dependence is existential. Indeed, loneliness increases mortality “more than smoking or obesity or lack of exercise.” Fowers was especially conscious of this during the pandemic. “We’re not built to be separate.” He provided many examples. Identity requires others: If I am a psychologist by virtue of having a PhD in psychology, it’s only because other psychologists agree that I am one. Language obviously requires others. Even traffic laws express our dependence on other drivers. Human beings have evolved to cooperate.

Gratitude is one more example of our need for healthy and positive relationships. Robert Emmons, professor of psychology at the University of California, Davis, discussed gratitude as the “deepest touchstone of human existence.” According to Emmons, gratitude is “an affirmation of goodness and a recognition that this goodness is sourced outside the self. We don’t feel responsible for this goodness.” He also pointed out that receiving a gift typically results in a natural tendency to pay it forward.

Vulnerability and Flourishing as Multidisciplinary and Multicultural

Today, we have so much information that we’re forced to become specialists only in a narrow field. Yet this situation does not give us permission to ignore how other disciplines and cultures interpret the human condition. The spirit of the times should be “integrate, integrate, integrate.” Many speakers, directly or indirectly, concluded that our mainstream Western psychology—with its emphasis on individualism and its positivist epistemologies—needs a broader perspective.

One way of broadening our scientific approach is to invite to the table experts in other disciplines. Lee told us he was trained as a theologian, which has helped him pursue psychological constructs, such as the health benefits of living in a supportive religious community. Kashdan and Kemp, among others, spoke of the influence of affective neuroscience on their work. INPM calls itself a multidisciplinary society, because we recognize that art, philosophy, theology, neuroscience, and so on can expand our understanding of human suffering and flourishing.

Another way to broaden our scientific understanding is to gain awareness of how other cultures interpret the good life. Many presenters described the health benefits of a communal or collectivist society. Tim Lomas of the University of East London, for example, pointed out that the idea of “harmony” is far more powerful in Easter psychologies than in Western ones. Naaem provided a brief historical perspective of Western versus Asian perspectives of vulnerability and flourishing, and described his own work promoting cognitive-behavioral therapy tailored to the cultural influences on, for instance, how Asian clients communicate.

Lomas discussed his work with Gallup’s Wellbeing for Planet Earth. Comparing Western and Eastern psychologies, he pointed out that Westerners typically think of happiness in terms of ‘high arousal’ affect, such as ‘enjoyment’. Easterners, however, tend to favor lower arousal affects, such as peace, calmness, and tranquility. He argued that we must engage with non-Western perspectives to evaluate these constructs. Similarly, Lee argued, “The structural factors that are often posited to account for variations in flourishing across groups, such as material wealth, are frequently moderated by cultural factors.”

The conference summit on ‘Wellbeing During the Pandemic’ highlighted the pioneering work of Ed Diener on wellbeing. Diener discovered that residents of poor nations had a greater sense of meaning in life than residents in wealthy nations. Wellbeing was contingent on social relationships, above and beyond material conditions. And those who followed cultural values enjoyed greater wellbeing than those who pursued material possessions.

Wong provided a Shakyamuni Buddha perspective: “A man struggling for existence will naturally look for something of value. There are two ways of looking…if he looks in the right direction, he recognizes the true nature of sickness, old age, and death, and then he searches for meaning in that which transcends all human suffering. In my life of pleasures, I seem to be looking in the wrong way.”

Grassroots Movement

Given the limitations of our healthcare systems, it isn’t surprising that the pandemic has triggered many private, community initiatives to help those struggling with mental health. Computer apps, support meetings, free online concerts and art lessons, offers to buy and deliver food to those who are not mobile, self-help groups, and so on have spontaneously arisen in many countries. Encouraging as this effort is, these individual initiatives are too scattered and lacking scientific direction to offer more than temporary relief to a local audience.

Recognizing that the pandemic’s effects on global mental health are far too pervasive to be handled in formal therapy, Wong, Schneider, and others suggested that we need a more grassroots movement.

Psychologists can play their role helping provide this movement with scientifically-based direction for confronting mental suffering at a global level. Deb Lindh of Mindful Effect LLC, for example, highlighted trauma in the workplace as a major consequence of the pandemic. She proposed that stories in peer-led interventions and lived-experience interventions as important work. Rather than rely on our expensive models, her approach had a cost of “$0.00 USD,” but required presence, listening, supporting, caring, and kindness.

A Summing Up

This brief article provides only a glimpse of the range and variety of conference presentations. Still, here are some take-aways:

• The pandemic has put a spotlight on human vulnerability. If we choose to, we can learn to use vulnerability to our advantage. This choice means recognizing that being vulnerable is not something to dismiss as an aberration or contrary to our better nature. It is a natural part of what it means to be a human being.
• We can learn how to thrive, in spite of suffering.
• We need to cultivate our responsibility toward others. Our current Western focus on the individual needs to be expanded to include others and the environment. To overcome pandemic suffering, we need to appreciate that human beings are, to borrow a phrase from philosopher John Macmurray, “persons in relation.”
• Wellbeing is mainly about authentic connections to self, others, nature, and, for many, a higher power. This principle is expressed in different ways by different cultures.
• We need to recognize our current systems of care are too limited to operate successfully at a global level (or even at a local level where the pandemic has threatened to overwhelm local hospitals and clinics). What is needed to prevent and manage mental health is more focus at the community level.