Gratitude (Hakarat Ha-Tov)

I’ve spoken before about charity (tzedakah), and giving is certainly important. But there’s another side to that coin — receiving.

Allowing yourself to receive help from others can be unsettling. Pride gets in the way, and the very word charity carries its own stigma. But once you’re past that initial hurdle, the real work begins: cultivating gratitude. This applies to the one in need and the one who is not. Judaism gives us a perfect term here — הַכָּרַת הַטּוֹב (hakarat ha-ṭov), literally “recognizing the good.”

Gratitude is about far more than a polite “thank you.” It’s the humility that comes with receiving someone else’s sacrifice. Every gift — large or small — costs the giver something. We’re owed nothing in this life, not by other people and not by the universe itself. So when something is given to us, the only fitting response is to accept it humbly, receive it graciously, and remember it with the seriousness it deserves.

As many know, I received a heart transplant at the end of 2024. It’s an event that sharply slices your life into “before” and “after.” I am, of course, grateful beyond measure for this gift of life. I would not be here writing these words were it not for the kindness of my donor and his family.

But gratitude doesn’t cancel out the complexity. To get here, I endured trauma of the deepest kind. Every fear I’ve ever carried about the end of my life came to fruition in those months in the hospital. I’ve never been afraid of death itself — it’s the dying part that I dread. Far too often, death comes at the end of suffering, not the end of a peaceful life. There’s a reason we speak longingly of a “quick and painless death.”

Once the initial crisis passed — the procedures, the blood sticks, the countless shocks from what I lovingly call the industrial bug zapper, and finally the surgery itself — there was the long, exhausting trudge of recovery. Being a transplant recipient is its own kind of gauntlet: follow-up procedures and tests, daily medications that are both lifesaving and toxic, regular doctor visits, medical bills, insurance battles, unpredictable complications, physical limitations… it’s a lot.

And yet, through all of this, I remain grateful. But that gratitude lives right alongside a tangle of emotions and contradictions. As I’ve said before: I never feared death itself. And after everything I’ve seen, I no longer need “proof” that something exists beyond this life. In many ways though, I’ve simply traded one set of medical challenges for another — daily poisons, a different kind of suffering, and a future that remains uncertain.

So I turn, as I always have, to the ancient texts. How does one hold gratitude while wrestling with all this psychic weight?

Gratitude Across the Ancient Traditions

The Abrahamic traditions are simple enough on this point — the value of gratitude is woven throughout Jewish, Christian, and Islamic literature so thoroughly that citing them individually feels unnecessary.

But what about the rest of the world?

Cicero — Gratitude as the Foundation of Virtue

Cicero wrote that “gratitude is the mother of all virtues,” and warned that civilization collapses when people forget how to recognize mutual benefit.

Buddhism — Gratitude as a Daily Discipline

Buddhist practice embeds gratitude into ordinary life:
• The Five Remembrances train the mind to acknowledge impermanence, interdependence, and the gifts inherent in daily existence.
• Gratitude toward food, laborers, teachers, and even adversaries is standard mindfulness practice.
• Kṣānti (क्षान्ति), forbearance, is often paired with gratitude to dissolve ego: nothing in life is owed to you, therefore everything is received with humility.

Hinduism — Sacred Debts and Divine Gifts

Hindu thought teaches that every person is born under three sacred debts (ṛṇa, ऋण):
• to the gods,
• to the sages,
• to one’s ancestors.

Life is about fulfilling these obligations. The principle of prasāda (प्रसाद) reinforces the point: everything received — food, blessings, life itself — is considered a gift from the Divine. Gratitude is simply the appropriate stance toward reality.

Indigenous Traditions — Gratitude as Harmony

Indigenous traditions may express this most beautifully:
• The Haudenosaunee (Iroquois) Thanksgiving Address is a daily communal recitation thanking each element of creation.
• The Navajo (Diné) concept of hózhó — beauty, balance, harmony — depends on acknowledging the good in all things. Gratitude is not a feeling but a restoring force.

And Beyond: Confucianism, Sufism, Stoicism

Whether it’s Confucius emphasizing reciprocity, Sufi masters teaching shukr (شُكْر) as a pillar of the spiritual path, or the Stoics insisting that gratitude anchors a disciplined life, the message remains the same:

Gratitude is foundational.
It is indispensable.
It is never to be minimized.

Can Gratitude and Suffering Coexist?

This brings us to the question at hand:

Can someone feel profound gratitude while suffering, and even at times wondering whether fighting to survive was the right choice?

I believe the answer is unequivocally yes.

Trauma changes you. It scrambles the emotional circuitry. It creates contradictions and tensions that don’t tidy themselves up on command. None of this diminishes gratitude. None of it reduces the weight or value of the gift you’ve been given. What it means is that you’re human, and the work of healing is messy.

Above all, don’t let the well-meaning but shallow “you should be grateful” platitudes drown out your very real emotions. Gratitude and struggle can coexist. They often do. The task isn’t to silence one in favor of the other, but to navigate both with honesty, humility, and a steadfast commitment to recognizing the good — הַכָּרַת הַטּוֹב, hakarat ha-ṭov — even when the road ahead is hard.

Closing Reflection….

As we approach the holidays, this becomes even more apparent. Gratitude isn’t something reserved for the moments when life feels orderly or generous. It has to live alongside the harder truths — the trauma, the uncertainty, the quiet seasons, and the limits we’re still learning to navigate. Whether our tables are overflowing or simple, whether we’re surrounded by others or walking a lonelier path this year, the call is the same: recognize the good that is present. Every gift, large or small, deserves to be received with humility and a clear mind. Gratitude doesn’t cancel suffering, but it does give us the strength and clarity to see what remains worthwhile.