Three Kinds of Dukkha Explained

Toni Bernhard discusses suffering as it is understood in Buddhism. She introduces three kinds of dukkha and then a helpful practice for working with these.

Toni Bernhard
1 April 2011
Lion's Roar

The Truth About Suffering

In his Second Noble Truth, the Buddha said that the origin of dukkha – the dissatisfaction with the circumstances of our lives – is tanha, or thirst. I like to translate tanhha as craving or longing, as this refers to a self-focused desire to get something for ourselves, whether it be a material thing (an iPad), a sensory experience (the taste of ice cream, the feel of ocean waves on the body) or an identity (law professor, award-winning author).

I think of tanha as the constantly recurring experience of “want” and “don’t want” in my life. I want (crave) pleasant experiences (mental and physical); I don’t want (am averse to) unpleasant ones. The Buddha wasn’t mincing words when he said: “Dukkha is (1) not getting what you want and (2) getting what you don’t want.” And so, dissatisfaction and craving go hand in hand. No dukkha, no tanha. No tanha, no dukkha.

Sometimes commentators claim that the Buddha was saying that life itself is dukkha because having been born, we are subject to sickness, injury, and loss. But the bare fact of these three phenomena cannot be dukkha because that wouldn’t be in accord with the Second Noble Truth which ties dukkha to tanha. It’s the aversion to sickness, injury, and loss (that is, the craving for them not to be a part of our life) that gives rise to dukkha.

The Three Kinds of Suffering

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:

Dukka 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.

A Practice to Alleviate Suffering

I call this the tracing exercise. First, I try to become aware of when dukkha is present. This requires mindfulness because all three kinds of dukkha can be subtle and hard to recognize. I’m helped by a Chinese Buddhist image of dukkha: a cart with a slightly broken wheel that jolts us each time the wheel rolls over the broken spot. So, as soon as I feel a little “off kilter” or dissatisfied, I stop and say: “Ah, this is dukkha.” Then, I trace my experience backwards until I find the place where I’m not getting what I want, or I’m getting what I don’t want: the craving or longing that is tanha. Lastly, I consciously try to let go of this craving – to just accept the circumstances of my life as they are.

Here’s an example of how I could have used this tracing exercise to alleviate viparinama dukkha – which arises when, inevitably, the universal law of impermanence leaves that craving unsatisfied. Remember that Moloka’i sunset that I wrote about above? First, I’d become aware that in the midst of this joyful experience, I’m feeling “off kilter” – a bit of unease and dissatisfaction. Then I’d trace that dissatisfaction backwards until I found its origin. And there it would be – in my craving for that sunset to last for hours. That’s not going to happen, but, with the insight into anicca (impermanence) as my guide, I could have then made a conscious choice to let go of my craving for the sunset to be other than the fleeting phenomenon that it is. Having done that, I would have had a chance to really enjoy the pleasant experience while it did last.

Here’s how I’ve used the tracing exercise to alleviate sankhara dukkha, or stress-filled mental formations. This last holiday season, I was home by myself and began to feel uncharacteristically blue and cranky. It took me by surprise because I’ve grown to enjoy solitude. But there I was, “off kilter.” Instead of letting it brew until it turned into full blown anguish and misery, I began the tracing exercise.

I soon found the source of my discontent. It was in my mental chatter or “formations.” Without being mindful of it, I’d been spinning stories about how I thought the holidays should be. “I should be able to go to my daughter’s house.” “It’s not fair that I can’t travel.” But the circumstances of my life (chronic illness) prevent me from getting what I want. I knew immediately that I’d found the source of my crankiness and that I had a choice. I could continue to stay in the throes of sankhara dukkha or I could let go of my longing for what I could not have… I let it go and immediately felt a great sense of relief.

Getting to the root of dukkha – this constant dissatisfaction with our lives – is the key to being able to let go of craving. If we heed the words of the Buddha in Samyutta Nikaya 56.11 and become mindful of when we’re not getting what we want or when we’re getting what we don’t want, we can then make a conscious choice to let that craving go.

When I use this tracing exercise – even if I only succeed in letting go for a few moments – it’s a welcome respite from being mindlessly driven to try and fashion every circumstance of my life to be to my liking. It’s also a taste of freedom – a taste that lingers.

This freedom has a spacious, open quality to it. It’s a moment of “cessation” which is the promise the Buddha gave us in the third noble truth: through the abandonment of craving, cessation of suffering is possible. The eightfold path of the fourth noble truths contains the Buddha’s complete lesson plan for understanding suffering and abandoning craving; it’s the path that offers us the possibility of fulfilling our human potential through the cultivation of wisdom, ethical intentions, and mind training.

The Buddha gave us a lot to do in this short lifetime, starting with getting down in the trenches with dukkha and culminating with its cessation through the cultivation of the eightfold path. I, for one, need to get to work.

Toni Bernhard

Toni Bernhard

Toni Bernhard is the author of the award-winning How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers and How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow. Her newest book is called How to Live Well with Chronic Pain and Illness: A Mindful Guide. Before becoming ill, she was a law professor at the University of California—Davis. Her blog, “Turning Straw Into Gold” is hosted by Psychology Today online. Visit her website at