By Reef Karim

September 30, 2021


The deepest pain we will ever feel… is the pain of not living up to our abilities.


Of knowing there’s a purpose to our life that could fill us with meaning, passion and inspiration. Yet, most people don’t experience it.

Instead, they are left wanting…

And that leads to pain; a deep, gnawing, existential pain.

As a humanistic psychiatrist and addiction medicine physician, I’ve helped a lot of people in pain, and helped a lot of people overcome the wreckage that comes from attempting to remove or avoid their pain.

As a human being fascinated with the power of transformation, I’ve personally experienced a lot of pain, all three types of pain, including of course that deep gnawing existential pain.

The kind of pain you feel in the deep pit of your stomach; almost making you sick; not going away… remaining despite many attempts to temporarily soothe it. 



Hear this my friends… that pain is telling you something.

The problem is most people aren’t aware or trained to listen to it.

So let’s talk about our relationship to pain.

Yes I said “relationship”. 

Your pain is a part of you.

Pain and suffering is not optional… it’s mandatory. 

There are three different types of pain; physical, emotional and existential/spiritual.  

One of them is a guide, a signal, a source of direction, to help you lead a more inspired and fulfilled life. Take a guess which one!

Let’s start with physical pain.

We all know about physical pain. Broken bones. Lower back pain. Sports injuries.

Medical conditions that cause pain.

We often get prescribed medications for our physical pain and that’s okay (as long as you don’t abuse these medications) because who wants to feel a lot of physical pain while you’re injured and healing? The plan is the injury heals and you get off the pain medications.

There’s also emotional pain.



All of us in one way or another have experienced emotional or psychological pain. Shame. Rejection. Abandonment. Stress. Anger. Betrayal. Loss. Trauma. Mood instability. It can be very intense, and some people use medications to deal with this pain.

Emotional pain is the grey area; if it’s severe enough, medications may be needed.

But, even if medications are employed during the crisis phase, other treatments and techniques must be employed thereafter (stress management, mind-body techniques, mental clarity, attachment work, family of origin, different types of therapy, creativity work, etc.)

Now I’m not telling you to get off your medications (talk to your doctor about your medications).

If you’re in a crisis or have a chronic psychological/psychiatric illness, then of course you may need medication support to help you through it.

But, I am asking you to reconsider your relationship with pills. Not from an obvious pain perspective, but from an existential perspective.

When dealing with emotional pain that is long standing and not crisis based, the last thing you want to do is become dependent on pills to numb out your pain because then you won’t be motivated to make the necessary changes to transform your state; to a state that’s more connected, more courageous and more in sync with what you feel internally.

I believe we all have inner wisdom, inner guidance, that lets us know what we should be doing and what we’re most passionate about.

The problem is the noise of the world often drowns out this inner voice, this inner knowing.  

And that leads me to the third type of pain: spiritual or existential pain.

Spiritual pain is the pain that comes with feeling like you’re not aligned with what would bring you happiness and fulfillment. It’s a combination of decisions, fear, regret, holding back, limitations, conditioning and many other factors that move us away from our alignment.

This spiritual or existential pain may present as emotional pain, or in some cases even physical pain. When you’re not living up to your abilities and you end up in pain, the presentation is varied.

But the solution, at least in our country, seems to be pretty consistent.




We love to take pills to help us avoid our pain. It’s a philosophy here in the U.S.

“You’re in pain… pop a pill”. 

This may work for physical pain. It may even work for emotional pain 

But it definitely doesn’t work for existential pain.

Popping pills only takes you further away from the person you want to be.

The pills become a barrier, an obstacle, in the search for you; in your exploration. 

Why do I bring up this whole concept of medicating with pills?

Because it seems Americans don’t want to feel pain.

We pop pills at alarming rates. Some studies reveal 80% of the world’s supply of hydrocodone gets used up in the United States.

Why is that?  Are Americans in that much more pain than the rest of the world?



Or is our solution to pain immediately to numb it, avoid it or remove it; thereby numbing, avoiding or removing the information our pain is giving us about our life.

Regarding “American Pain” and the use of pills, there is definitely a deep-rooted internal system here between pharma, insurance companies and the doctors prescribing and diagnosing habits (well, some doctors), and of course, there’s also consumer marketing.

I laugh when I see pharma commercials. Most are so cheesy.

There is a deeper issue here.

Especially with existential (spiritual pain).

We have been conditioned to wipe away our pain; whether it’s consumer marketing for drugs, or doctor’s prescribing habits or something else, we’re losing valuable information.

We need to feel our spiritual pain, for it will direct us to the changes we need to make in our life.

 It signals us when we aren’t aligned. It lets us know when we need to reinvent, transform, make some changes.

I didn’t listen to my pain for a long time. It started with emotional pain, then became physical pain (back) and then the spiritual pain hit and hit hard.

Eventually I listened. 

When the pain of not living up to your abilities gets too intense, you have to take action.



For me, it was a wake-up call for transformation.

And after that experience, I felt it was important to share these thoughts about the subtext of our pain.

Yes, I love subtext…

We need to learn from our pain. Our spiritual pain is a self-improvement signal.

As more and more Americans complain of feeling unhappy (ahem, can you say Covid?) today than they’ve been in over 50 years, according to the COVID Response Tracking Study (University of Chicago), we will undoubtedly see more numbing, more escaping and potentially more pills. 

Americans are unfulfilled, uninspired and many are unhappy. Covid is a part of that.

But this trend was happening long before Covid.

Pain and suffering is not the problem. It will happen to all of us. It’s part of being human.

Masking the pain and the suffering and ignoring the clues and signals that let us know something is off IS the problem.

We need to develop an awareness of the signals given to us by our existential pain; what is it telling us and are we courageous enough to listen to it and do something about it?

Most people are not.

I hope speaking in the “subtext” changes that.


To creativity, courage and connection,


- Reef



If you know someone who really needs this information, please share this article with them. 




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