Deep Dukkha: Part 2 – The Three Kinds of Suffering

By Toni Bernhard, Part 2 of 3.

In Part 1, we looked at dukkha as “dissatisfaction with the circumstances of our lives” and examined its origin in our self-focused desire to get what we want.

As I looked more deeply into the first noble truth, I learned that even the singular term dukkha is not adequate. In the Dukkhata Sutta, the Buddha described three kinds of dukkha:

Dukkha dukkha: This kind of dukkha arises in response to unpleasant physical or mental experiences (often referred to as unpleasant feelings or sensations). When I broke my ankle in 2008, the circumstances of my life (to reference my definition of dukkha) included unpleasant physical sensations. When I lost my best friend to cancer fifteen years ago, the circumstances of my life included unpleasant mental feelings; there was nothing I could do to prevent the painful experience of sorrow and grief from arising.

The circumstances of everyone’s life will include unpleasant experiences. But these are not in themselves what the Buddha meant by dukkha dukkha. It’s the aversion to the unpleasantness that is dukkha dukkha. And so, the origin of dukkha dukkha is tanha – that craving or longing for the circumstances of our lives to be different. That craving is like hitting our heads against a wall because this is how things are: we were born and so are subject to injury, illness, old age, and loss. Our loved ones are subject to the same conditions and so we will experience unpleasant feelings of separation and loss.

The only way to keep dukkha dukkha from arising is to change our response to unpleasant experience. If we can acknowledge unpleasant feelings and sensations, be with them and let them run their course, dukkha dukkha will not arise.

This is easier said than done. It requires mindfulness. When I could be consciously aware, “This broken ankle is physical pain,” or “This grief from my friend’s death is hard to bear” – and not add the craving for my life to be different dukkha dukkha would not arise. The physical pain from my broken ankle ran its course. Eventually, so has the grief from the loss of my friend. Dukkha dukkha only arose when I responded with aversion to the physical and mental pain, that is, when I longed for them to go away and be replaced with pleasant sensations and feelings.

Sankhara dukkha: Sankhara refers to the intentional formation of thoughts (often translated as “mental formations”). Sankhara dukkha arises when we take that step beyond simple aversion to an unpleasant physical or mental experience and engage in stressful mental activity, such as concocting “shoulds” and “shouldn’ts,” judgments, and anxiety-filled thoughts and questions. Sankhara dukkha has its origin in tanha (craving) because that mental activity reflects a craving for things to be how we want them to be.

Returning to the examples I used earlier, I broke my ankle and it hurt. When I could mindfully acknowledge the unpleasantness of the pain, dukkha dukkha did not arise. It arose only when I reacted with aversion to this circumstance of my life (craving for the pain to stop). And then, sankhara dukkha was not far behind. “It’s not fair that I broke my ankle.” “What if it doesn’t heal correctly?” “I can’t bear being sick and injured at the same time.” Sankhara dukkha was in the anxiety-filled stories I would spin about my ankle.

When my best friend died, dukkha dukkha arose in those moments when I felt aversion to the grief. When I then added mental formations such as, “I shouldn’t feel this much grief,” and even “I should never get over this grief,” I was in the throes of sankhara dukkha. (Note how I’d managed to conjure two contradictory scenarios regarding the circumstances of my life and found both to be unsatisfactory. Sankhara dukkha in abundance!)

We can alleviate sankhara dukkha by bringing these mental formations into conscious awareness. In mindfulness practice (inside or outside of meditation), we become aware of whatever sensations or feelings have arisen. They could be from outside stimuli (someone honking a car horn), body stimuli (that painful broken ankle), or from our mental reaction to these stimuli. If that stimulus is unpleasant, our mental reaction can range from a simple craving for it to stop (dukkha dukkha) to the mental formations of sankhara dukkha, such as “If he doesn’t stop honking that horn right now, I’m going to start screaming.”

As we get more skilled at maintaining mindfulness, we’re better able to shift our focus from the pleasantness or unpleasantness of our experience to its impermanent nature. This insight into impermanence enables us see that trying to control our experience to make it only pleasant just increases the presence of suffering in our lives. This can be the first step in letting go of craving or longing for our life to be other than it is in the present moment.

Cultivating mindfulness can also help us question the validity of our thoughts. Was it true that breaking an ankle when I was already sick wasn’t “fair”? (Living in parts of Haiti or Japan right now seems much more unfair, doesn’t it?) Was it true that I shouldn’t feel so much grief over my friend’s death… or that I should never stop grieving it? (Neither assertion is constructive.) Learning to question the credibility of these mental formations can free us from thought patterns that perpetuate suffering.

We can also alleviate such suffering by cultivating more skillful mental states, such as Buddhism’s Four Immeasurable Attitudes: loving-kindness, compassion, sympathetic joy, and equanimity. “Take care, my dear broken ankle, hurting, hurting, hurting.” “Grieving is painful but this is what my life is about right now.”

Viparinama dukkha: Whereas dukkha dukkha arises in response to unpleasant experiences, viparinama dukkha arises in response to pleasant ones; it is tied to impermanence or change. (Viparinama means “changing.”) As with the other two kinds of dukkha, the origin of viparinama dukkha is craving. When we’re enjoying a pleasant experience, we crave for it to continue. In fact, we’ll go to extremes to keep it going (driving too fast, eating too much). Viparinama dukkha arises when, inevitably, the universal law of impermanence leaves that craving unsatisfied.

More profoundly, it can be present during a pleasant experience There’s often an underlying unease or dissatisfaction even when we’re happy or joyful because, at a gut level, we know it won’t last. I used to sit outside in the evening on the Island of Moloka’i, watching spectacular orange and red sunsets with palm trees silhouetted in black in the foreground. I remember wondering why that joyful experience always contained an underlying discontent. Now I know: viparinama dukkha.

As Richard Gombrich points out in What the Buddha Thought, nothing that is impermanent can be fully satisfactory.

The Buddha saw that normal experience is vitiated by the transience of all worldly phenomena, a transience which must sooner or later render them unsatisfying. Our experience of their transience can only successfully be handled, he argued, by coming to terms with it: we should not want permanence, for ourselves or our loved ones, because we are not going to get it. [p. 74]

This excerpt illustrates that tanha, or craving, underlies viparinama dukkha too – in this instance, our craving for the impermanent to be permanent. But, as the Buddha told us, it’s not going to happen. Thus, as with dukkha dukkha and sankhara dukkha, we would do well to cool the fire of viparinama dukkha.

Next and Final Installment: A Practice to Alleviate Suffering, coming soon.

More from Toni Bernhard:

Why would a law professor write a Buddhist book on chronic illness?

Shambhala Sun Audio: An interview with “How To Be Sick” author Toni Bernhard

Until she had to retire due to illness, Toni Bernhard was a law professor for 22 years at the University of California – Davis, serving six years as the law school’s dean of students. She had a longstanding Buddhist practice and co-led a weekly meditation group with her husband. Forced to learn to live a new life, Toni has written How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers (Wisdom Publications, September 2010). She lives in Davis, CA with her husband, also named Tony, and their hound dog, Rusty. She can be found online at


  1. Emma says

    Excellent article Toni. I could relate to so much of what you wrote, especially to Sankhara Dukkha. Thanks!

  2. says

    Thanks Emma. I've been trying to watch for sankhara dukkha in my life too. I think of it as all the stories I spin that make me miserable…for no reason other than that I'm spinning them!