The Patient Who Taught Me About Suffering
Dr. Michiko Kimura Bruno, a movement disorder neurologist practicing in Honolulu, shares the story of Henry—a 53-year-old man diagnosed with Parkinson’s disease after years of dismissing hand tremors and stiffness as normal middle-age changes. But what tortured Henry most weren’t the physical symptoms of Parkinson’s; it was the expectation-reality gap that consumed his mental health.
"I should be working. I am still young. I should not have to go on disability," Henry told his doctor. Losing his identity as a provider for his family became the biggest blow, leading to depression and anxiety.
When Henry later strained his back—resulting in multiple ER visits and a mental health setback—his wife’s well-meaning advice suddenly sounded cruel: "You should be taking your medicine on time, and you should have been exercising like the doctor said."
Notice how those "shoulds" slipped into her tone even though she’d never changed the clinical advice. It wasn’t what was said; it was how it landed.
The One Word That Torments Us
The word "should" is uttered every day, both to ourselves and to others. "I should be able to do basic things like play with my grandson. Why am I so tired?" Another of Dr. Bruno’s patients with Parkinson’s said this on the exact same day.
We all have goals. Aspiring to the idealized self, our goal, is the essence of human growth. Sometimes, the word "should" helps us orient and move one step closer to that goal.
Neuroscience tells us that the concept of "should" is deeply ingrained in our brains. Our brains constantly compare reality with expectation. Every mismatch generates an error signal that pushes us to learn, adapt, and improve. Without this mechanism, we would never acquire new skills or solve problems.
But the same system that allows us to grow can also become a source of suffering when every difference between reality and expectation becomes a personal failure. That mismatch—between what is and what should be—isn’t just a thought. It’s a physiological event, triggering cortisol spikes and shrinking our window for resilience.
Ancient Wisdom, Modern Science
More than 2,500 years ago, Buddhism recognized that suffering arises from this gap. The First Noble Truth describes dukkha—this is often translated as "life is full of suffering," but could be better understood as a persistent sense that life never quite matches our expectations.
Interestingly, the Stoic philosophers arrived at a remarkably similar conclusion from the opposite side of the world and proposed to focus on what we have control over (our beliefs, decisions, and character) and let go of things we have no control over (our body, property, reputation, and other people’s behavior).
The irony? Both systems arrive at the same pivot point: your interpretation, not the event itself, is what triggers suffering. Henry’s diagnosis didn’t break him; it was his belief that he should still be working, shouldn’t need help, and should feel normal that fractured his peace.
In real-time brain imaging, the anterior cingulate cortex lights up precisely when expectations and reality don’t align—not because something’s wrong, but because your brain expects the world to behave predictably. The problem isn’t mismatch; it’s moralization. You don’t just notice the gap—you judge yourself for falling into it.
Making the Linguistic Shift
So here is some practical advice. We can reduce our frustration and suffering by starting to pay attention to our vocabulary.
If you catch yourself using the word "should," pause. Ask yourself: Who am I saying this to? Why am I using this word? What assumption am I making? Can I reframe it—and rephrase it?
Rather than saying, "I should exercise," try, "I’d like to try to exercise today." Rather than "I should be grateful," it is okay to accept and say, "I’m disappointed today."
Small linguistic shifts can result in emotional shifts.
This does not mean we can remove all disappointments. Pain and disappointment will be ubiquitous in our lives. In a way, that is one constant of life. It is integral because of how we and our brains evolved to be who we are now.
But the judgment we make toward ourselves creates additional, unnecessary suffering on top of the pain and suffering that is inherent.
Henry’s Transformation
My last visit with Henry caught me by surprise. He came in with a big smile. Always eloquent, his wife spoke first.
"We came up with a way for him to take medicine one time. He is doing the exercise when he can, and we just came back from a trip to Texas last month; our kids also said he is doing much better compared to last year."
Not to be outdone, Henry opened his mouth.
"Our youngest had a daughter. We love our granddaughter, and I want to live for her."
He was finally able to feel better, not because his Parkinson’s improved, but because he was able to create his own meaning in life.
And that is something we have control over, even if our day is not going our way.