The triad of pain, suffering, and misery is inextricable from the human condition. Understanding it is essential to the effective pursuit of happiness.
Pain
Think of pain as a warning light on a car’s dashboard.
Q: Why does a dashboard warning light turn on? A: Because cars are designed that way.
We feel pain for the same reason — it is in our design. Pain is not an aberration; it is in our makeup.
The obvious follow-up question is, ‘Why are cars designed that way?’ The answer has to do with the evolution of cars: The first cars didn’t have warning lights. Over the years, designers realized that occasionally the driver’s attention may need to shift from the road to the car itself.
Under normal driving conditions, the driver’s attention should be on the road and the surrounding vehicles. But occasionally it needs to shift to the car itself. For example, when the engine overheats, attention must shift to the cooling system; when oil pressure drops, to the oil reservoir.
Therein lies the purpose of pain. Pain tugs at the coattail of consciousness, forcing a shift in attention to a problem that requires it.
Car designers make warning signals unsettling — red and orange lights at the bottom of the driver’s visual field, often accompanied by annoying tones. A different design is possible: the scent of roses when oil runs low, lilacs when the engine overheats. Such a system would be more pleasant but less functional. Unpleasant sensations are more effective than pleasant ones at forcing a shift in attention. That’s why pain is inherently noxious — difficult, if not impossible, to ignore, maximizing the alarm system’s efficiency.
The key point here is that (acute) pain itself is not a problem; it points to a problem. It is a harsh teacher, but not an enemy. The correct approach to pain is to decipher its message and implement a corrective action. Relief from pain usually confirms the action was effective.
This applies to acute pain. Acute pain carries a message that needs to be deciphered. Stable chronic pain doesn’t carry new information – its story has been told; it doesn’t have anything new to teach. Therefore, the management of chronic pain differs significantly from that of acute pain.
Pain System States
Pain systems are alarm systems that can be in one of three states: underactive, overactive, or well-calibrated.
For example, an underactive warning system is one where a wire connecting the battery to the light bulb is broken. If the oil pressure warning light is disconnected from the battery, the system will not trigger an alert to low oil pressure – a dangerous state for the car and its passengers. A system that can’t offer a warning is an invitation for trouble.
The same principle applies to pain. There are numerous pathological states in which a pain system is underactive. The most common example is diabetic peripheral neuropathy – a progressive loss of pain sensation in the lower extremities resulting from damage to peripheral nerves (i.e., the wires that conduct pain signals from the feet to the brain).
The consequences of peripheral neuropathy can be dire. Without the pain signal, patients ignore minor trauma, nicks, or small cuts to their feet. A small cut can develop into a localized infection that can easily progress into a serious problem. It is not uncommon for patients with diabetes to experience horrific complications – amputations or even death from systemic infections. Such catastrophic events can stem from problems that could have been resolved with minimal intervention, had the warning system been functioning well.
A low oil pressure warning light turning on is unwelcome news for the driver. But it’s far better to learn of the problem from a dashboard light than from smoke pouring out of the engine. Similarly, the pain of a cut is not good news, but it’s much better to feel this pain early — when intervention is simple — than not feel it and discover the problem only after it has become serious.
Another example illustrating our dependence on a functioning pain system is congenital insensitivity to pain with anhidrosis (CIPA), a rare neurological disease. Patients with CIPA are born without the ability to feel pain. In our analogy, this is like a car built without wires connecting the engine to the dashboard’s warning system. CIPA is extremely serious — approximately 20% of afflicted patients die before age three (Rosemberg et al., 1994). This underscores the fact that we depend on pain to survive. Pain is not the enemy.
This applies to mental pain as well. Guilt, for example, is a mental pain — a signal designed to bring attention to an interpersonal problem (specifically, a problem in one’s intent). Like patients with CIPA who cannot feel physical pain, some people have a markedly diminished capacity to feel the pain of guilt, a feature of antisocial personality disorder (Black et al., 2010). As a consequence, they typically either die violently at a young age or are removed from society and placed in prison, or both.
The other problematic state is an overactive alarm system. Imagine a car where the insulation between two wires leading to the oil pressure warning light has eroded. Driving over a bump brings the wires into contact, triggering the warning signal even though nothing is wrong with the oil system.
Imagine starting a cross-country trip in this car. Just as you leave town, the oil pressure warning light comes on. You curse and pull over. You check the oil level – it’s perfectly fine. Relieved to find the light off when you restart, you get back on the road. A few minutes later, the light comes on again. You repeat the check. By the third time, you can’t deny you have a problem, and it’s not in the oil system itself. Do you keep going, tuning out the warning light? Not only annoying, but also, more seriously, it risks ignoring a genuine problem and catastrophic engine damage. Cancel the trip? A difficult choice given that nothing seems wrong with the car. Pull into a service station? When are you going to find one, and if you do, do you trust an unknown mechanic in the middle of nowhere? None of your options is attractive. Dealing with an overactive warning system is inevitably frustrating and often leads to derailment of the journey.
Any of our pain systems can be overactive. Pain generated when attention isn’t really needed anywhere is called phantom pain – purposeless and carrying no message. The archetypal phantom pain is pain felt in an extremity following its amputation, coming from a limb that is no longer there. It can be excruciating, and it is certainly real. It forces directing attention to a part of the body that doesn’t exist. The problem is in the signal-carrying wires (i.e., the nerves that once extended to where the limb once was). Living with phantom pain can be debilitating and, invariably, is extremely frustrating.
A common example of an overactive mental pain system involves anxiety (which, like guilt, is a mental pain). Anxiety is a pain designed to redirect attention to potential threats. For example, an unexpected sound of footsteps in the middle of the night instantly triggers sharp anxiety designed to turn on and direct your attention to where it’s needed to ensure your safety. Feeling the same anxiety without a trigger, i.e., when there’s no sound of footsteps, is not uncommon. This is phantom anxiety. A full-blown episode of phantom anxiety is a panic attack.
A well-calibrated pain system remains silent until attention is needed to address a problem, responds with intensity appropriate to the severity of the problem, and becomes silent again once the problem is addressed.
Types of Pain
The different types of pain humans experience can be organized into four categories: physical, psychological, interpersonal, and spiritual. The first concerns the body; the last three are mental pains.
[Sidebar: This organizational scheme aligns with a broader model of consciousness. The material in consciousness falls into one of three categories: ‘Self’, ‘Other’ — all that is not of the ‘Self’, and ‘Process’ — where changes in the ‘Self’ and the ‘Other’ register. Physical and psychological pains bring attention to the ‘Self’ category. Pain originating in the ‘Other’ category is interpersonal pain. Pain pertaining to the ‘Process’ is spiritual pain.]
Physical pains include several pain types (e.g., crushing, cutting, overstretching) originating in specific body parts as well as generalized noxious sensations (e.g., shortness of breath, nausea, fatigue, dizziness). Physical pain is a signal that draws attention to a problem in a particular part or system of the body.
The first of the three mental pain categories is the psychological level, which by definition involves only the ‘Self’. Think of psychological pains as signals that can be experienced in a universe where nothing other than the consciousness of the ‘Self’ exists. The archetypal psychological pains are:
- Doubt — The notion that the Self (i.e., that lonely consciousness) is inadequate or not good enough to continue to exist
- Disappointment — The notion that the Self has failed to meet expectations (which can intensify into self-disgust and self-hatred).
- Anxiety — Essentially, the threat of a loss of control. (Most fundamentally, in a universe that holds nothing other than one’s consciousness, it is the threat of losing control over one’s own mind.)
The second mental pain category requires the existence of an ‘Other,’ thus creating an interpersonal environment. Interpersonal pains require the participation of a second ‘actor’ — someone other than the ‘Self’ (who may exist only in memory or imagination). The archetypal interpersonal pains come in pairs — because they involve both the ‘Self’ and an ‘Other’:
- Guilt and Unfairness: Both signal the violation of a contract. Guilt is the pain one experiences when breaking a contract with another; unfairness is the pain experienced when one is on the receiving end of a broken contract.
- Shame and Disappointment: Both arise from exposure of inadequacy. Shame is the pain one experiences when exposed as inadequate and unable to fulfill one’s promises; disappointment is the pain experienced when one realizes they are on the receiving end of an unfounded promise.
- Loss of Autonomy and Abandonment: Both arise from problems with distance in a relationship. The pain of loss of autonomy is experienced when one is consumed or dominated by another; the pain of abandonment is experienced when the distance in a relationship is so great that the connection is threatened or severed.
Each pair represents two perspectives on the same type of interpersonal violation. For example, guilt arises when one acts (or considers acting) with unfair intent toward another; unfairness arises when one is subjected to a behavior interpreted as driven by an unfair intent. At the fundamental level, both stem from the same pain – the violation of a relational contract. The narrative context (whether one is the violator or the violated) shapes how that pain is experienced and named. Similarly, shame and disappointment both arise from exposure of inadequacy, and loss of autonomy and abandonment both arise from distance problems in relationships. The pairing reflects this dual nature: one can experience the pain of an interpersonal violation either as actor (guilt, shame, loss of autonomy) or as recipient (unfairness, disappointment, abandonment).
The third mental pain category concerns the ‘Process’ — the journey of life itself. These pains are spiritual (or existential, if ‘spiritual’ rubs you the wrong way) pains. The archetypal spiritual pains are:
- Hopelessness and Pessimism
- Regret
- Meaninglessness and Purposelessness (the pain of perceiving the journey itself – one’s life – as lacking aim or direction)
[Sidebar: The term ‘archetypal’ refers to fundamental pains that appear across human experience. These categories form a hierarchical structure: simpler pains often serve as components in more complex ones. For example, doubt about the Self (psychological) can contribute to guilt and unfairness (interpersonal) and to hopelessness (spiritual). Similarly, self-disappointment feeds into shame, which feeds into regret. This progression reflects a developmental trajectory: the purely self-focused pains emerge earliest in development, relationally-embedded pains require sufficient social-cognitive maturity, and existentially-oriented pains require the capacity for abstract thinking about life’s meaning and direction.]
Pain functions by pointing to a specific problem and demanding that attention be directed there. Unfortunately, the four pain categories are poorly insulated from one another, making it difficult to localize the pain’s origin.
“Poor insulation” means that unaddressed pain can spread to adjacent categories, triggering additional pains that obscure the original source. The cascade follows a predictable pattern: unresolved physical pain triggers psychological pain, which spreads to interpersonal pain, which ultimately manifests as spiritual pain. This cascade can also run in reverse: unresolved spiritual pain can manifest as interpersonal, then psychological, then physical pain.
An additional complexity of pain management stems from the fact that not all pains “hurt” and not everything that hurts is a pain. Pains that don’t hurt are sensations that function to draw attention to a problem that needs it, but aren’t typically recognized as pains (physical examples include blurry vision, lethargy, shortness of breath, and loss of appetite; mental examples include apathy, loss of interest, and boredom). Because these sensations don’t “hurt” like most pains, they may fail to trigger the attention shift and corrective action they’re designed to prompt.
Examples of hurtful physical sensations that aren’t (functionally) pains include teething pain and musculoskeletal growing pains. These experiences hurt, but they don’t point to a problem requiring correction. They’re triggered by normal, healthy developmental processes that require no corrective action.
The primary example of a hurtful emotion that is not functionally a pain is the sadness felt in response to a loss. This sadness “hurts”, but it differs fundamentally from functional pain in its causal sequence. The sequence is reversed: sadness (and the grief it triggers) forms as a result of attention to (and registration of) an irreversible loss; i.e., it arises when the brain realizes that there is no correction of the problem. (Grief and its relationship to depression are discussed in detail in the Depression chapter.)
Pain Management
There are three fundamental approaches to a dashboard warning light. The first is denial (the Homer Simpson approach): A warning light comes on, the driver has an emotional response (“Doh!”), then quickly covers the dashboard with something, turns the radio up, and (“whoo hoo”) problem solved! This approach brings momentary relief, but in the long run inevitably leads to more serious problems that are costlier and more difficult to solve.
An example of this method of dealing with physical pain is the overweight, out-of-shape man experiencing chest pressure when climbing a flight of stairs (“Doh”!). The denial-based management of this pain may amount to a couple of antacid or analgesic pills. The discomfort (medically referred to as angina) may well resolve spontaneously (“whoo hoo”), especially early on in the course of coronary artery disease, but of course, this denial does not address the problem. This unfortunately all-too-common management style of chest pain is just about guaranteed to lead to serious, potentially catastrophic, cardiac problems.
The approach at the other end of the spectrum is catastrophizing (the Chicken Little approach). A warning light comes on, and the driver has an over-the-top response (“the sky is falling!”), interpreting it to mean the engine is about to explode and that a disaster is inevitable. This overreactive response is equally ineffective at dealing with the signal.
The catastrophizer is analogous to a person suffering from an illness anxiety disorder (formally, hypochondriasis). These patients interpret trivial pains as life-threatening symptoms: a cough from a cold means lung cancer; a headache signals a brain tumor. Mental pain can be similarly catastrophized: a pang of self-doubt signals guaranteed failure; a twinge of guilt means one is unforgivable. The catastrophizer overreacts: demanding a chest CT for a cough, demanding an MRI for a headache, abandoning a project at the first sign of self-doubt, or seeking excessive reassurance that they’re not unforgivable.
The prudent approach treats the warning signal as a message requiring thoughtful interpretation. When the prudent driver notices that a warning light turned on, she pulls over, checks the owner’s manual, deciphers the message, and follows the recommended corrective action. The prudent approach to pain is the same: attend to the pain signal, analyze it systematically, decipher its message, and implement the appropriate corrective action.
The key point is that pain carries a message. To reveal the message, the pain needs to be studied. Ignoring it or jumping to conclusions is pain mismanagement. Sometimes the message is straightforward – for example, waking up in the middle of the night with abdominal pain after consuming a large pizza and a pitcher of beer; the most likely message is that you are eating like “a baby with money” (to quote Bob Odenkirk). Other times, the message may be complex or veiled, and revealing it may require consulting an expert (analogous to bringing the car to a mechanic) — a physician, therapist, or clergy.
The evolutionary role of pain is to protect survival. When survival is at stake, quick reflexive responses to pain are optimal. However, the optimal management of even the same pain (e.g., anxiety) requires a different approach in the pursuit of happiness. Optimally managing pain in this context depends on calm and tolerance. Calm — the state of observing without reacting — promotes learning (and pain is a teacher). Tolerance — the ability and willingness to experience pain without reacting to it — promotes thoughtful actions (over reflexive reaction). Calm and tolerance are inherently at odds with pain’s survival-protecting design, which explains why prudent pain management in the pursuit of happiness can be so challenging. It also explains why spiritual practices devoted to the pursuit of happiness emphasize cultivating calm and tolerance. (For a detailed discussion of calm and the practice of cultivating it, see the Calm chapter in the Theory section and the Cultivating Calm chapter in the Practice section.)
Suffering
Suffering is readily conflated with intense or prolonged pain, which is a common mistake. Suffering is the meaning of pain.
Normal human bodies have pain receptors that inevitably activate, hence pain is unavoidable. The working human brain requires meaning for everything that registers in consciousness. Our brains either discover or manufacture meaning for all we perceive as real. The perception of pain is no exception. Hence, suffering is unavoidable.
To illustrate: Imagine two pregnant women in labor in adjacent rooms. The first woman is nine months pregnant, and labor is starting on her due date. The second is only five months pregnant. Their labor pain will be essentially identical. Their suffering will be radically different.
To the first woman, the pain means she will soon meet her child — considerable pain but minimal suffering. To the second, the same pain means she is at risk of losing her child — unimaginable suffering.
The women in these imaginary scenarios cannot avoid experiencing some degree of suffering, but each can either amplify their suffering or refrain from making it worse than it has to be. For example, the woman at term may doubt her ability to endure the pain without analgesics, which, in turn, she may interpret to mean she doesn’t have what it takes to be a good parent.
The woman at five months may conclude that her pregnancy is lost, even though early labor can often be stopped.
Attributing the wrong meaning to pain tends to worsen suffering.
In the human condition, the question is not whether or not we will suffer — we will; as mentioned above, it is unavoidable. The question is how we will suffer.
When we face pain, will we find its correct meaning, or will we attribute the wrong meaning and make our suffering worse?
According to Buddhist tradition, Siddhartha Gautama began his quest when he first left the royal palace and witnessed the prevalence of human suffering. Unable to accept that such suffering was purposeless, he searched for its cause and purpose — a search that led to his enlightenment and teachings as the Buddha.
The Buddha’s teachings begin with the Four Noble Truths: First, life and suffering are inseparable. Second, attachments are the cause of all suffering. Third, there is a way out of suffering. Fourth, the path out of suffering is a mental practice — the Eightfold Path. (For a detailed examination of attachment and its alternatives, see the Attachment and Commitment chapter.)
As mentioned above, suffering is the meaning of pain. Meaning stems from the appreciation of causality — the cause-and-effect, i.e., the before-and-after sequence of events. The discovery of meaning is therefore inseparable from the perception of Time. Consistently, understanding suffering can be organized against the backdrop of how we relate to time: our attitudes toward the past, the present, and the future. (For a detailed discussion of meaning, see the Meaning chapter in the Theory section.)
Dealing with a pain that originates from a past experience, it is easy (if not automatic) to imagine a better past — one without the traumatic experience. Grasping onto an image of a better past invariably inflates the meaning of that pain, thereby increasing the associated suffering. Forgiveness — the willingness to give up all hope for a better past — relieves the attachment to it and is therefore an effective (and, in my opinion, necessary) antidote to suffering stemming from past trauma.
Attachment to the present comes in two varieties. The first is attachment to a notion of how the present should be. It is grasping onto an imagined better present, and perceiving the actual present as depriving one of the reality they are entitled to. The second is an attachment to the actual present, leading to suffering stemming from the dread of inevitable change. Both types of attachment to the present are offset by acceptance: acceptance of the present as it is, and acceptance of impermanence. (For a detailed discussion of impermanence, see The Laws chapter in the Theory section.)
Attachment to the future is grasping onto an imagined specific way reality should materialize — an insistence on a desired outcome. Since the future is unknowable and uncertain, insisting on a specific future scenario is irrational and futile. It amounts to the wish to control the future, which (consciously or subconsciously) adults recognize as a non-option. Hence, it elicits the pain of anxiety and the suffering that stems from dreading the future. Attachments to a specific future can be offset by hope. Hope, defined as the conviction that the future has the potential to be better than the present, requires uncertainty (where there is certainty, there is no hope). The deliberate inclusion of hope in thinking about the future is an antidote to the seductive appeal of the illusion of certainty, thereby neutralizing the tendency to attach to a specific future. (For a detailed discussion of hope, see the Hope chapter in the Theory section.)
The importance of this triad — forgiveness, acceptance, and hope — in managing suffering cannot be overstated (nonetheless, I’ll keep trying). The state of mind that emerges from simultaneously incorporating forgiveness of the past, acceptance of the present, and hope for the future is Compassion. (For a detailed discussion of compassion and its role in the pursuit of happiness, see the Happiness chapter.) This explains the efficacy of Compassion in containing suffering and, consequently, the supreme importance it is given by all spiritual practices.
Another Buddhist insight: all human suffering falls into one of two scenarios. In the first, suffering results when a person wants something they cannot obtain. In the second, suffering results when a person obtains what they want (and then faces the inevitable loss of it through impermanence). Does this mean we are doomed to suffer? Not necessarily. The Third Noble Truth states there is a way to end suffering.
One way out of the trap is to stop wanting — to develop a mind free of desire. This is difficult, possibly impossible. The idea may be paradoxical: developing a mind free of desires is, in and of itself, a desire. It makes practical sense when we consider desire as a spectrum rather than a binary phenomenon: the more burdened by desires a mind is, the more suffering its owner will experience. The less desirous one’s mind is, the less they will suffer.
The second way out of the trap is to develop a mind that finds the process of pursuing what one desires inherently satisfying, regardless of the outcome. A mind that finds pursuing the prize as satisfying as obtaining it (or even more satisfying) will be immunized from the suffering inherent in both getting and not getting it. The key is to replace the value of the outcome with the value of the pursuit itself — the value inherent in moving in the right direction. This approach emphasizes the journey, the effective pursuit of happiness, over the imaginable but unattainable destination — the state of being happy.
The importance of moving in the right direction — pursuing happiness effectively — is consistent with the idea that suffering has a purpose. Though obviously undesired, suffering can be rewarding. The potential reward of suffering comes down to a single thing: learning. If one learns something worth knowing through suffering, the experience has inherent value.
Learning something worth knowing is synonymous with moving toward the Truth and away from ignorance; in Buddhist terms, it means moving toward enlightenment. Correspondingly, the completely enlightened has abolished ignorance and is therefore free of suffering. This underscores the importance of maintaining a calm mind (particularly in the face of pain and suffering): as mentioned above, a calm mind is better suited for learning than any alternative state.
Misery
The human brain is meaning-dependent: Normally, all that registers consciousness has meaning (in contrast, data without meaning can appear as part of the process of dreaming or as part of the psychotic process). Think of ‘meaning’ as a frame around the data in consciousness. The brain requires one frame; a second frame around the first one (and a third around the second, and so on) may be added, but only one is required.
Suffering, the meaning of a pain that registers in consciousness, is the required frame. Misery can be thought of as a second frame — the meaning of suffering. As such, misery is not required or obligatory; it is a choice, an elective option (under normal conditions; conceivably, psychopathological states may render misery a non-option).
More specifically, misery is a self-centered meaning of suffering. It follows two thematic categories: in one, the emphasis is on the ‘Self’ as a victim (e.g., “my suffering is so unfair”); in the other, the emphasis is on the Self’s helplessness (e.g., “there’s nothing I can do about my suffering”).
The attribution of these meanings to suffering is not only unnecessary, but it is also factually wrong: Firstly, Life (or Nature) is neither fair nor unfair (see the definition of fairness), and secondly, there is always something one can do to influence their circumstances.
Assuming your permission, I’ll elaborate: The notion of being treated unfairly by Life is rationally unfounded because fairness does not apply to Life or Nature. Fairness requires either deliberate allocation of resources according to need, or fulfillment of a contractual obligation. Life is not a deliberate agent allocating resources, nor have we entered into a contract with it. Personifying Life or Nature as an entity that can treat us fairly or unfairly is irrational. Consequently, misery stemming from the belief that one’s life is unfair is not grounded in reality.
The notion of complete helplessness is similarly incompatible with physical reality — it is simply impossible to avoid influencing what we encounter. The mere ability to generate a thought (such as “there is nothing I can do”) demonstrates that influencing one’s circumstances is unavoidable — at minimum, influencing one’s perception of those circumstances. Conscious awareness of a situation carries some influence over it, at least over how it registers in consciousness. The mere act of breathing (thus moving air molecules) is no less influential than the butterfly starting a storm with its wing flutter. One’s influence may be immeasurably small, but it is greater than zero. The belief of complete helplessness is, therefore, factually incorrect. Whether approached from a spiritual point of view (from which prayer is a form of influence), the psychotherapeutic point of view (from which visualization is a form of influence), or the scientific point of view (from which observing the experiment is influencing it), living beings do not have the option of exerting zero influence on their surroundings.
In conclusion, pain and suffering are unavoidable; misery is optional. By scanning one’s stream of consciousness, it is possible to detect thoughts that represent either one of the misery themes. Examining these thoughts rationally exposes them as invalid, thereby rendering acceptance or rejection a volitional choice.
The Opposites of Pain, Suffering, and Misery
The opposite of pain is pleasure. Pleasure is an innocuous neurological event designed to increase the frequency of the behavior that causes it.
Since the brain is meaning-dependent, pleasure requires meaning just as pain does. The meaning of pleasure is satisfaction. In this sense, satisfaction is the opposite of suffering. Satisfaction, like suffering, varies in depth and intensity. The depth of meaning determines the degree of satisfaction: Preparing a meal yields minimal satisfaction when it’s a routine chore, but it becomes deeply satisfying as an expression of caring and creativity. Similarly, the pleasure of orgasm yields minimal satisfaction as a solitary masturbatory act, but becomes deeply satisfying when experienced in the context of a loving relationship.
As discussed earlier, the brain tends to generate layers of meaning beyond the required first one. As such, it often gives a layer of meaning to satisfaction. When that attributed meaning is self-centered, it is hubris. Hence, hubris is the mirror image, the opposite, of misery.
Hubris (like its mirror image, misery) follows two thematic patterns. In the first, the Self is considered so special as to be entitled to experiencing pleasure. In the second, the Self is considered so powerful as to be able to force its will on reality so that its desires are fulfilled. Both themes rest on irrational beliefs, rendering hubris erroneous. Since only one layer of meaning is required, hubris, like misery, is a choice. Given its irrational foundation, it is incompatible with the effective pursuit of happiness.
REFERENCES
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Rosemberg, S., Marie, S. K., & Kliemann, S. (1994). Congenital insensitivity to pain with anhidrosis (hereditary sensory and autonomic neuropathy type IV). Pediatric Neurology, 11, 50–56. https://doi.org/10.1016/0887-8994(94)90091-4