u/Ok_Disaster6456

I’m a psychiatry registrar (resident equiv) and this essay grew out of a question I keep encountering clinically: what do we do with forms of suffering that are real, profound, and clinically consequential, but not reducible to pathology?

The ideas behind this essay have come about from 8 years of being a doctor and over a decade of meditative practice and study of Buddhism.

I argue that medicine lacks a satisfying mechanism for this kind of suffering; that the Buddhist account of dukkha names something important here; and that the predictive processing account of mind, may offer a way to understand this suffering mechanistically, through a serious conversation with contemporary cognitive science, contemplative wisdom and clinical care.

I’d be particularly interested in critique of the core mechanistic claim and whether the bridge I’m making between dukkha and predictive processing holds.

This is really a follow up, to an essay I posted a couple of months ago here, that sparked some interesting discussion. This piece is much less metaphysical, and deeply grounded in human suffering and how we approach it in medicine in a practical sense. Whilst I relate it to medicine, I think the core idea here is relevant to all humans.

The full essay can be found here: https://open.substack.com/pub/liambaker677130/p/the-suffering-medicine-cannot-name?r=6tdtsz&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true

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I recently wrote an essay exploring whether predictive processing might offer a useful lens on the Buddhist account of dukkha.

My argument is not that neuroscience 'proves' Buddhism, or that Dharma can be reduced to brain theory. But in the spirit of the existing dialogue between Buddhism and science encouraged by the Dalai Lama amongst others, I do think this kind of bridge building can be valuable when it clarifies through a different cultural lens, rather than diminishes Buddhist insight.

As a clinician, I am especially interested in this because I encounter dukkha constantly in practice: suffering that is entangled with pain and pathology, but not reducible to either. I can't prescribe Buddhism however - yet the need to address Dukkha - is real.

Predictive processing suggests that we do not passively receive reality. We actively construct models of self and world through prediction, based on prior experience, beliefs, and expectations. Sensory data then either confirms those models or pressures us to revise them.

When placed alongside the Buddhist account of craving and aversion, this seems to offer an interesting way of thinking about suffering. Dukkha arises not simply because reality is painful, but because we cling to conditioned models of how self, world, and experience should be, and resist the demand to update them when reality refuses to conform.

Through this lens, craving and aversion are the ways the mind attempts to preserve preferred models of reality in the face of uncertainty and change. It's rooted in evolution and survival drive, but we amplify the issue through resistance - the 2nd dart.

In the essay, I explore this in more depth, including how this framework might help make ideas such as karma, self-construction, and liberation more intelligible through a contemporary cognitive-scientific lens, while still hopefully preserving their distinctly Buddhist meaning.

I’d be interested in how this lands with others here. Does it feel like a useful bridge, or do you think the synthesis breaks down somewhere important?

Full essay for anyone who wants to read further: https://open.substack.com/pub/liambaker677130/p/buddhism-x-predictive-processing?utm_source=share&utm_medium=android&r=6tdtsz