Recently, I was finishing the excellent memoir What My Bones Know by Stephanie Foo, who writes about her journey to healing as someone with complex posttraumatic stress disorder. In the final section of the book, her psychologist introduces the concept of the important distinction between pain and suffering. 

I am not exactly sure when I first came across the concept of pain not being suffering. It might have been in one of my first clinical psychology graduate courses while exploring radical acceptance. Or reading about Buddhist philosophy and how it has informed modern Western psychological ideas and psychotherapy models. Regardless, it has stayed with me personally and professionally because it has been so useful. Understand that pain is a given in life while suffering is a function of our own causal attributions and meaning-making around that pain is liberating. 

Being reminded of this concept helped me realize a deeper truth. If pain is a universal constant that ebbs and flows, then shame might be the particular type of meaning-making that leads to suffering. Shame tells us that our pain is our fault, our failure and defines who we are. If that is the story about our pain, then we are going to experience deep suffering. 

That’s why I believe that a trauma-informed approach doesn’t go quite far enough even though it is an essential first step. Trauma is the injury—a profound, shattering type of pain. Suffering comes when one believes the pain was deserved and is evidence of personal failure or unworthiness.

The pain is the given. Asking the person in pain what is wrong with them is the old blame-the-victim model. The trauma-informed model asks “what happened to you?” The shame-sensitive framework takes it a step further, asking what the story you are telling about what happened to you, getting at the meaning-making aspect of one’s suffering.  Then it goes even deeper, to core aspects of one’s identity that may have been shaped by the story they have been told by others or to themself, about their pain.

Instead of adjudicating one’s ability to justify if their experience rises to the degree of being called trauma, we can focus on the way a person makes sense of what they have been through. By shifting the focus of the friend or helper to the modifiable part, the shame aspect, we open up a way to connect and join, a natural antidote to shame. In a shame-sensitive framework, we don’t ask people to bear their pain or trauma; we offer them a way to untangle themselves from the suffering.