The Gap Between Is and Ought: Navigating Suffering

One of the unfortunate things about being human is that, at one point or another, we all suffer.

As healthcare providers, we witness suffering every day through our patients' pain and the grieving of how their disability has altered their lives. As students and professionals, we feel the sting of imposter syndrome, the pressure of accomplishment and high performance, as well as all the other pressures of life. Things like financial stress, relationship challenges, and the weight of expectations we carry for ourselves and from others.

The Buddhists can teach us a lot about suffering. In fact, they've been studying it systematically for over 2,500 years. When the Buddha emerged from his enlightenment, his very first teaching, the Four Noble Truths, started with a profound yet simple observation: suffering is woven into the fabric of human experience. They called it dukkha in Pali, and this term carries more nuance than our English word "suffering."

Think of dukkha as having three layers, each relevant to our daily experience. The first layer is the obvious suffering we see in our clinics every day: physical pain, illness, the frustrations of aging, and the fear of death. The second layer is more subtle: it's the suffering that comes from change itself. That patient who finally achieves pain-free movement but fears its return, that moment of professional triumph that fades into memory, the good days that inevitably give way to difficult ones. The third and deepest layer is the persistent sense that something's not quite right. It's that nagging feeling of incompleteness, even when things are going well, arising from our constantly shifting and impermanent nature.

Yet within this seemingly pessimistic framework lies profound hope. 

As I often reflect: 

"Much of human suffering can be found in the gap between the way things are and the way we wish them to be. As you close the gap, you lessen the suffering. To do this, you have two choices: one is to change the way things are, and the other is to change the way you feel about how things are. Perhaps do both."

The Architecture of Modern Suffering: Anxiety and Inadequacy

In our contemporary world, this ancient wisdom meets the particular flavors of modern suffering: anxiety disorders affecting 301 million people globally (World Health Organization, 2023), imposter syndrome plaguing 70% of professionals at some point in their careers (Sakulku & Alexander, 2011), and what researcher Brené Brown (2012) calls our "culture of scarcity"—the never-enough problem that haunts our daily experience.

These modern manifestations of dukkha all share a common thread: they emerge from that gap between reality as it is and reality as we believe it should be. Anxiety arises when we project fearful futures that haven't happened. Feelings of inadequacy bloom when we compare our inner experience to others' curated external presentations. Disappointment crashes over us when outcomes don't match our expectations.

Mindfulness: The Art of Closing the Gap

Mindfulness, defined by Jon Kabat-Zinn (2003) as "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" (p. 145), offers a direct path to addressing this gap. Rather than constantly trying to manipulate reality to match our preferences, mindfulness invites us to meet reality as it actually is.

The neuroscience is compelling. Research by Hölzel et al. (2011) using neuroimaging shows that just eight weeks of mindfulness practice leads to measurable changes in brain regions associated with learning, memory, emotional regulation, and perspective-taking. The amygdala, our brain's alarm system, actually shrinks with consistent practice, while the prefrontal cortex, associated with executive function and emotional regulation, thickens.

But mindfulness isn't about becoming a passive observer of life. As Shapiro, Carlson, Astin, and Freedman (2006) articulate in their model of mindfulness mechanisms, the practice involves three core components:

• Intention (why we're practicing)
• Attention (observing present-moment experience)
• Attitude (how we pay attention: with kindness and curiosity)

This third component (attitude) brings us to a crucial element often missing from discussions of mindfulness: self-compassion.

Self-Compassion: The Missing Piece

Dr. Kristin Neff (2003), the pioneering researcher in self-compassion, identifies three core components of this practice:

1. Self-kindness versus self-judgment: Treating ourselves with the same kindness we'd offer a good friend
2. Common humanity versus isolation: Recognizing that suffering and imperfection are part of the shared human experience
3. Mindfulness versus over-identification: Holding our painful thoughts and feelings in balanced awareness

Neff's research reveals something remarkable: self-compassion is strongly associated with emotional well-being, lower levels of anxiety and depression, and greater life satisfaction (Neff, 2011). Moreover, contrary to fears that self-compassion might lead to complacency, studies show it actually provides a more stable foundation for motivation than self-criticism (Breines & Chen, 2012).

Consider how this applies to our modern struggles. When anxiety arises, self-compassion invites us to acknowledge: "This is a moment of suffering. Suffering is part of human life. May I be kind to myself in this moment" (Neff, 2011, p. 119). This simple practice, which Neff calls the self-compassion break, can transform our relationship to difficult emotions.

The Paradox of Acceptance and Change

Here we encounter what Acceptance and Commitment Therapy (ACT) researchers call the "paradox of acceptance" (Hayes, Strosahl, & Wilson, 2012): when we stop struggling against our internal experiences and accept them with compassion, they often naturally begin to shift.

This doesn't mean resignation. As psychologist Tara Brach (2003) writes in her book Radical Acceptance, "The boundary to what we can accept is the boundary to our freedom" (p. 25). Acceptance creates the psychological flexibility needed for effective action. When we're not exhausting ourselves fighting reality, we have energy available for constructive change.

Research on psychological flexibility (defined as the ability to stay present with our experiences and act in accordance with our values even when facing difficult thoughts and feelings) shows it's one of the strongest predictors of psychological health (Kashdan & Rottenberg, 2010).

Practical Integration: Mindfulness and Self-Compassion in Daily Life

The RAIN Technique

Tara Brach (2013) offers the RAIN technique as a practical tool for combining mindfulness and self-compassion:

• Recognize what's happening
• Allow experience to be there, just as it is
• Investigate with kindness
• Natural awareness—not identifying with the experience

The Self-Compassion Break

When facing anxiety, inadequacy, or disappointment, try Neff's (2011) three-step practice:

1. Acknowledge: "This is a moment of suffering"
2. Remember: "Suffering is part of human life"
3. Offer kindness: "May I be kind to myself"

Mindful Breathing with Compassionate Intention

Combine mindfulness of breath with compassionate phrases. As you breathe in, silently say, "Breathing in, I acknowledge my suffering." As you breathe out, "Breathing out, I offer myself compassion" (adapted from Thich Nhat Hanh, 1999).

The Liberation in the Gap

Ultimately, the gap between how things are and how we wish them to be is not our enemy; it is our teacher. It shows us where we're caught, where we're grasping, where we're at war with reality. It invites us into a deeper engagement with life, one that includes both the fierce courage to change what can be changed and the gentle wisdom to accept what cannot.

The Vietnamese Zen master Thich Nhat Hanh wrote, "When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help." We might say the same of ourselves: when we suffer in the gap between is and ought, we don't need punishment for our inability to accept or our failure to change things; we need compassion for the difficulty of being human, caught between acceptance and action, between what is and what might be.

The invitation, then, is not to eliminate the gap, for to be human is to imagine different futures, to hold ideals, to dream of better worlds. The invitation is to recognize the gap and relate to it with wisdom and compassion, to see it clearly, to work skillfully within it. To realize that suffering is not mandatory, that we have choices, that between stimulus and response there is a space, and in that space lies our freedom.

In each moment, we can ask ourselves: Am I suffering because I'm at war with what is? Or am I suffering because I'm not taking action where action is possible? And can I hold both truths ( this moment is already whole and complete exactly as it is, and that the next moment might be different if I act with wisdom and compassion) simultaneously?  

This is the profound simplicity hidden in plain sight: Much of human suffering can be found in the gap between the way things are and the way we wish them to be. As you close the gap, you lessen the suffering. To do this you have two choices, one is to change the way things are and the other is to change the way you feel about how things are.

Perhaps do both.

The Wisdom of "Perhaps Do Both"

Returning to our original insight about closing the gap between "is" and "ought," we find that mindfulness and self-compassion offer us tools for both paths. They help us:

1. Change what can be changed: By reducing reactive patterns and increasing psychological flexibility, we become more effective agents of change
2. Accept what cannot be changed: Through compassionate awareness, we can hold difficult realities without being crushed by them

The word "perhaps" in "perhaps do both" contains profound wisdom. It acknowledges that each moment requires fresh assessment, what Zen teacher Suzuki Roshi (1970) called "beginner's mind." Sometimes action is needed; sometimes acceptance; often both in delicate balance.

Moving Forward with Gentle Strength

As we navigate the inevitable gaps between how things are and how we wish them to be, mindfulness and self-compassion offer us a third way; neither passive resignation nor frantic striving, but what Buddhist teacher Jack Kornfield (2008) calls "a wise heart."

This path doesn't promise the elimination of suffering; remember, dukkha is woven into the fabric of existence. But it offers something perhaps more valuable: a transformed relationship to suffering. When we can meet our anxiety with mindful awareness, our feelings of inadequacy with self-compassion, and our disappointments with gentle acceptance, we discover what poet Rainer Maria Rilke (1929/1984) called "perhaps the only courage demanded of us: to have courage for the most strange, most singular, and most inexplicable that we may encounter" (p. 88).

The gap between "is" and "ought" need not be our enemy. With mindfulness as our method and self-compassion as our companion, it becomes our teacher, constantly inviting us into a deeper, kinder, more authentic engagement with life exactly as it is, and as it might become.

References

Brach, T. (2003). Radical acceptance: Embracing your life with the heart of a Buddha. Bantam Books.

Brach, T. (2013). True refuge: Finding peace and freedom in your own awakened heart. Bantam Books.

Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Personality and Social Psychology Bulletin, 38(9), 1133-1143. https://doi.org/10.1177/0146167212445599

Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. Gotham Books.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36-43. https://doi.org/10.1016/j.pscychresns.2010.08.006

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. https://doi.org/10.1093/clipsy.bpg016

Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865-878. https://doi.org/10.1016/j.cpr.2010.03.001

Kornfield, J. (2008). The wise heart: A guide to the universal teachings of Buddhist psychology. Bantam Books.

Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223-250. https://doi.org/10.1080/15298860309027

Neff, K. D. (2011). Self-compassion: The proven power of being kind to yourself. William Morrow.

Rilke, R. M. (1984). Letters to a young poet (S. Mitchell, Trans.). Random House. (Original work published 1929)

Sakulku, J., & Alexander, J. (2011). The impostor phenomenon. International Journal of Behavioral Science, 6(1), 73-92.

Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373-386. https://doi.org/10.1002/jclp.20237

Suzuki, S. (1970). Zen mind, beginner's mind. Weatherhill.

Thich Nhat Hanh. (1999). The heart of Buddhist meditation. Parallax Press.

World Health Organization. (2023). Anxiety disorders. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders The Gap Between Is and Ought: Navigating Suffering