Stoic Medicine: A Guide to Rational and Ethical Practice by Vadim Korkhov

When I began embracing the philosophy of Stoicism two years ago, it came at a time in my life when I needed a way to deal with a myriad of issues facing my life that seemed too many to address all at once.  In applying this philosophy, I have realized its usefulness in application to the practice of medicine.  Stoicism has allowed me to be a more thoughtful, conscientious, and better skilled physician by putting the right priorities into perspective, and reminding me of my role in the process of a patient’s treatment.

It is altogether too easy to forget that my motivation is the patient’s best interest, and no one else’s.  While this may seem a natural conclusion, modern American medical practice is beset with distractions, such as financial performance benchmarks, impressing the patient in order to gain a favorable review, or dealing with political pressures within a healthcare organization.  Here, I hope to share some of the insights I’ve gained from Stoicism that I hope other physicians can use to improve their practices, and relieve from them needless burdens that they often impose on themselves by demanding of themselves more than what is possible or necessary.

I cannot deny that my background has greatly shaped my opinions and applications of Stoicism.  I am an intensivist, which is a physician that practices medicine in the Intensive Care Unit (ICU) of a hospital, where the critically ill are managed.  These are the sickest patients in a hospital who require constant and meticulous attention.  Patients admitted to the ICU have a diverse range of illnesses or injuries, or may require the ICU to manage after major surgery.  Some patients admitted to the ICU unfortunately are suffering terminal illness, and spend the last weeks of their lives in fruitless efforts to prolong death in the misguided hope of prolonging life.  

Critical care medicine requires a collaborative effort where the intensivist must rely on other physicians to complement his management in all but the most simple illnesses.  One would imagine that, in such a context, everyone would recognize an urgency to work together for the benefit of the patient.  And yet, over the years, this is not what I observed.  Instead, I discovered contentiousness between physicians, often to the point of pettiness over the most trivial matters.  I discovered politics earning greater place of consideration over a patient’s management than medicine.  I also discovered incompetence on the part of some doctors, which made it frustrating to be forced to work with them, as they often didn’t understand either what they were doing or what I was trying to do.  So frustrated was I at these impediments that I became bitter, and came to assume that when my plan was being thwarted, it was for personal reasons, slights against me!

Unless they leave the practice of clinical medicine altogether, and pursue research, administration, or academics, most physicians face problems like mine.  Like me, they face distractions to simply practicing medicine, as they learned in medical school and in their postgraduate training.  Medical training does not prepare them to deal with these issues, leaving it up to each individual to handle these problems for themselves.  Having no basis or preparation, they often succumb to maladaptive means, and due to the pressures of the career, have little time or energy to devote to correct them.  In this essay, I’ll share some insights I’ve had both in personal faults, but also in observing the faults of others.  In this way, I hope to be as comprehensive as I can of a wide range of experience, so that this advice can be applicable to all.

Stoic Medical Management: Applying Reason and the Right Use of Impressions, and the View to Providence

With all the pressure upon the physician to perform, medicine can be a stressful environment.  Besides the expectation of the patient to treat illness, there is also a pressure to treat quickly when the illness is severe and life-threatening.  Doctors, especially early in their careers when they have little experience, also worry whether they even have the skills to face the challenge of managing illness.  I myself remember those first few weeks at my first job, where I trembled wondering if I was going to be found out as a fraud because I might demonstrate too much hesitation in my decisions.  

It is thus easy to forget one’s faculty of reason in the face of stress, and resort to emotions as a substitute means for deduction.  Despite their training, doctors often do not apply what they were trained to do – to use deduction through objective evidence, arrive at a list of possibilities (differential diagnosis), and eliminate all possibilities until one of those possibilities is most likely.  Instead, they resort to instinct or gut feelings.  They “feel” that they know what the problem is and “know” the solution simply because their feelings confirm it.  

The ancient Stoics warned against succumbing to a false impression, and then acting too quickly on a whim.  Epictetus mentions it repeatedly in the Discourses, under many different conditions.  The excessive reliance on instinct over reason can lead to dangerous outcomes.  It can lead to the pursuit of unfounded suspicions while ignoring glaring problems.  Problems that are ignored often get worse over time, to the point where, once they are realized, become too late to correct.  

I can recall many cases where a doctor would forget to perform the physical examination — a basic tool of assessment.  Simply performing the physical examination saved hours of idle goose-chasing with pointless tests.  In another case, a physician consulted me for a patient who had shortness of breath, but never bothered to look at the chest x-ray he himself had ordered, which showed a glaring abnormality.  In another instance, a cardiologist was so perplexed by the nature of a patient’s heart disease that he simply walked away from the patient without doing anything at all.

Even early in my career, I recognized that the worst thing I could do was to panic.  As advised by the ancient philosophers, when you are overcome with a strong feeling – a passion – it is easy to succumb to a false impression about a subject.  The best thing to do is to do exactly the opposite of what many believe and not act quickly and rashly, but to pause for a moment to allow your passions to cool, and only then calmly assess the situation with the faculty of reason.  Then, it becomes far easier and clearer to pursue the correct course of action.  

Once you have repeated this process many times, it becomes ingrained as a habit, and less necessary to perform consciously.  This is ideally suited to medical practice, which is just a series of repeated presentations of mostly the same disease states in varied forms.  Without realizing it, I had acclimated myself to eliminating my passions by seeing the same thing over and over again, thereby gaining the proper use of impressions – those devoid of emotive pollution.  Such advice seems to run counter to medical glamor, which praises rapid decisions and remorseless confidence.  And some would prefer to be wrong and appear confident, than right and appear doubted.  

Exuberance of that kind has a tendency to lead to regret.  Once again, the ancient Stoics were right when they pointed out that acting out of passion inevitably leads to regret later.  By then, the faculty of reason has taken over in place of passion, and has discovered that earlier actions were foolhardy.  Seneca has a whole book about the dangers of anger, and how easily destructive it is, but it seems almost any passion shares this risk.  Many physicians have a tendency to retrospectively regret their actions after their heads have cooled.  They play Monday Morning Quarterback, wondering “if only I had done this… or that….”  It is easy to lapse into regret when a patient suffers a poor outcome.  I myself have not been immune to this.  Some patients simply do not fare well, even when managed entirely correctly.  In such circumstances, I have found it helpful to remember two things.  

  1. There are some things that lie within our control and outside our control.  We can only discover things from sufficient information, without which we are powerless to arrive at any conclusion without guessing.  We also cannot treat every illness.  Some diseases have no treatments.
  2. The Providence that everything eventually unfolds just as it was bound to unfold.  Some things are inevitable no matter what we do.  To the ancients, it was the Logos, which committed every action to the best course possible.  To us in the modern world, we must understand from science that there is a cause and effect to every event.    

By reminding myself periodically of these two factors, I can understand that my actions do not bear responsibility for absolutely everything that happens, and so I do not face regret.  I am then free of the burden of yet another passion, and so can pursue reason for the next task.  Even if I lapse in my judgement, or am simply incorrect in my conclusion within good judgement, it is better that I consider my error rationally, without regret, so I do not repeat it.  I still know that I did as much as my rational faculty was able.  I did not arrive to medical school knowing everything about medicine.  And I certainly have not learned everything about medicine since graduating from medical school.

Getting Along with Others: The Stoic Medical Community

In medical school, you are instructed to act as if you are the sole physician in the world, upon which everyone depends.  Every problem is up to you to solve, without counsel or support.  In the past, every physician was regarded as an independent practitioner, and his patients were his own as if they were his own children.  Nowadays, this is largely impossible.  There is too much to medicine for any one practitioner to know by himself, or to have skill in performing entirely on his own.  Therefore, the collaborative model of practice has emerged in recent years as the standard.  Where physicians in the past rarely had to work together, now they must work together to achieve even the minimum standard of care.  

At the beginning of my career, I was very frustrated by a lack of collaborative effort by other physicians.  My management was constantly second-guessed and scrutinized, and often not taken seriously.  Meanwhile, I felt that the older physicians were practicing poor and often outdated medicine.  There was always contention over who had the final say on a patient’s management decisions.  The older generation did not necessarily embrace the concept of collaboration, especially not with the young upstart they saw in me.  In truth, I was no less dismissive, as I also came to regard them with the same derision, just for different reasons.  In the end, it was the patients who suffered.  We, the physicians, only suffered our tender pride.  

There is a concept in Stoicism called “oikeiosis”, which can roughly be translated as “community.”  It is the idea that virtue is most useful when it involves society, and not just a single person.  Consideration for a virtuous act should follow what is best for everyone as a whole, and not what favors one or another.  In medicine, we are called upon for one chief aim – to better the patient.  Therefore, what is best for everyone involved in a patient’s care is what is best for the patient.  And what is best when many are involved, each of whom have the ability to make management decisions, is to work jointly so that the patient gains the greatest advantage from the expertise of all.  

Every doctor does for the patient what they believe to be right, but some may disagree with others on what that should be.  What always troubled me was when I judged a physician to be incompetent, and yet was forced to accept his plan, because he was the attending physician (the one who had traditional “ownership” of the patient as his own).  Sometimes, I would question, under my breath, the attending physician’s integrity, wondering if he was practicing for financial gain.  Instead of trying to reconcile with my rival for the sake of the patient, I’d ignore his plan, formulating my own, which would often be at odds with his.  It was a petty and sometimes passive-aggressive form of confrontation.  I was doing the same to them as they had done to me – dismissing them due to my perception of their incompetence.  Each time this would happen, nothing would be gained but bitterness on both sides.  

It is indeed true that some physicians are incompetent or worse, unscrupulous.  Some are outright fools, whereas others are ignorant, either willfully or accidentally.  Some may indeed be motivated by extraneous factors, such as money, pettiness, or pomposity.  But whatever their motivation, it is not always within my power to contend with everyone who crosses my path, since my proper goal is the care of the patient, not the education or morality of my colleagues.  My colleagues will have to fend for themselves in that.  Thus, I act within my power, limited such as it is, to act for the patient’s well-being.  

Whatever the disagreement is with another, regardless of the reasons for that disagreement, the situation remains the same.  Furthermore, my virtue has no bearing on the lack of virtue in others.  I would often seethe in anger that a colleague had ruined a patient with poor management, which I would then be forced to correct after the patient was handed over to my care.  As I came to realize my virtue was not affected by another’s vice, I ceased to be angry.  I could address the patient’s needs as I saw fit, doing as much as was within my power, now that the patient was mine.  Even if the patient was ruined later by another’s poor management, it was not up to me any more than my improvement of his care up to another.  

I tried many times to explain to colleagues why their actions were incorrect, but in retrospect, this probably sounded like a sermon more than a lesson.  The best way to teach someone the righteousness of your way was to live it, and demonstrate it with your own actions, because people learn best from example.  So I stopped going out of my way to teach, unless it was asked of me.  I concentrate on doing the best I can with the power and tools I’m given, without considering anyone else’s deficiency.  I follow, as a model, doctors that I’ve known whom I saw demonstrating exemplary skill and demeanor.  Now, people come to me to ask for guidance who would have ignored me in the past.  Perhaps, in time, others will take me as a model for proper decorum and skill.

Stoic Ethics: Care at the End of Life

It would seem that medicine would be a place where ethical concerns weigh strongly with every decision.  Medicine calls upon the physician to act always in the patient’s best interest, and so demand compassion and beneficence.  For most instances, it is clear what the physician’s duty is to the patient, when the goals of treatment are obvious.  And they are nearly always obvious because they are nearly always the same – to treat the patient’s disease without reservation.  At times, however, when goals of treatment are unclear, so are the ethical goals.

Patients enduring the end of their lives have different concerns than others.  Their conditions are no longer amenable to treatment, so that the ethical role of the physician is less clear than it would be if treatment had a clear path.  Patients usually are unaware of a terminal illness unless a physician apprises them, and so often rely on a physician’s counsel to make appropriate medical decisions.  Although it is a doctor’s responsibility to inform a patient when it is time for them to make plans for the end of their life, many do not do so, instead imposing their own brand of ethics upon the patient, without their consent, often without realizing it themselves.  They do this subtly, such as minimizing the severity of illness, or do not divulge options that the patients may have, such as hospice or other forms of limited care.  

It has seemed clear to me, in observation over the years, that their reluctance to raise these topics comes from their fear of their own personal mortality.  And if a physician cannot accept his own mortality, how can he discuss mortality dispassionately with anyone else about theirs?  Whatever the source of their reluctance, the doctor’s reluctance to discuss end-of-life gives the patient the impression that it is not worthy of consideration.  They are thus led on a futile path of treatment, while they suffer needlessly with pain, agony, and disability, until they finally mercifully perish.

Where there are problems in end-of-life care, it is usually because the patient with the terminal illness has goals of care that fly in the face of the severity of their illness, which causes prolonged hospitalizations through which patients suffer needlessly.  The confusion arises either because the patient, or their surrogate decision-maker, is ignorant about the advanced stage of disease (possibly because they have been steered wrong, as I mentioned earlier), or because the patient applies emotive reasoning to their decision, irrationally denying the illness.  Healthcare workers are then compelled to provide worthless “treatment” to such patients that they know will have no efficacy.  Thus, both patient and provider become demoralized.  

Patients at the end of life have the option to pursue palliative care.  They would be given medications to treat their pain and suffering, in place of definitive treatment for a disease state.  They would thus be free of suffering but, since their underlying disease is untreated, may also die sooner.  They may also die sooner due to the adverse effects of these same medications.  Unfortunately, because of the barriers mentioned, they do not do this until the very advanced stage of illness, often in the last days to weeks of life!  

The ICU is often the last place where such patients come to die, so that it often fell upon me to consider such weighty issues.  In time, I came to realize several principles that made my role less frustrating.  

  1. I never pussyfoot around the issue of end-of-life or palliative care.  Many doctors are squeamish about it and so never bring it up, waiting for the surrogate to do their job for them.  Despite the grimness, families usually appreciate the honesty, and do not become angry, as many would believe.  I do this because I know that virtue is the most important thing to do, in Stoicism, and I am not dismayed if the families do not demonstrate the same level of virtue as I do, because their virtue is not my concern.
  2. I recognize that I cannot change the opinions of others.  Most often, I must accept the decision of the family not to pursue palliation even when it is the right course of action.  I understand that it will ultimately be the patient who suffers for this, and not my frustration in dealing with it.  I will still be showing up to work no matter what the decision.
  3. I recognize that, the majority of the time, families do come around and agree to palliative care.  They go through Kubler-Ross’ stages of grief eventually (denial, anger, bargaining, depression, acceptance), and will come to acceptance inevitably.  All I need do is wait.  

When it comes to discussions of terminal illness, the most important Stoic principle arises – the pursuit of virtue.  The cardinal virtues of courage and justice take a leading role here.  So when I have meetings with families to discuss end-of-life goals of care, I do it honestly and without fear.  I state quite plainly what condition the patient is in, what the options are and why the palliative option is the best option.  I do all this dispassionately, without affecting any air of false affection or friendship for a patient who is a stranger to me.  I leave the loving tenderness to the family.  I have found that honesty is greatly appreciated, and that some families will surprise you with their insights if they are offered the opportunity to separate their dramatic emotions from their reason by sitting calmly in a conference room.  

The practices of Stoicism have helped me to be a better physician by putting into perspective what are the most important principles that I should follow.  By adhering to Stoic ethics in pursuit of virtue, I can make a patient’s final days on this world be free of suffering.  By adhering to logic and providence, I can deduce appropriate medical decisions free of hesitation or guilt.  And through the understanding that I am part of a greater medical community, working towards common goals, however imperfectly they may be achieved, I understand my role in helping to foster a good working environment for all.  

 

Dr. Vadim Korkhov is a critical care physician who works in the ICU of a major urban hospital in the US.  He developed an interest in ancient Greece and Rome from an early age, and earned a BA in Classical Civilization from NYU.  He developed an interest in philosophy from a colleague, in more recent years, which led to his immersion in Stoicism.  

Sati & Prosoche: Buddhist vs. Stoic “Mindfulness” Compared by Greg Lopez

Mindfulness is all the rage nowadays. But what is it, exactly? If you try to define it yourself, what do you come up with? If you compare your answer with the answers of others, you might find quite a bit of heterogeneity. That wouldn’t surprise me; while mindfulness is of interest to many, it’s hard to pin down exactly what different people mean by the term.

One definition that’s been put forth is from Jon Kabat-Zinn, the researcher behind Mindfulness-Based Stress Reduction (MBSR). He defines mindfulness as “paying attention in a particular way; on purpose, in the present moment, and non-judgmentally”. (Kabat-Zinn, 1994, p.4) This “modern” definition may capture some or even most of many people’s definition of mindfulness.

Kabat-Zinn’s form of mindfulness is derived from Buddhist mindfulness, with heavy influence from one particular lineage of Buddhism known as Theravada. This lineage gets its teachings from one of the earliest sets of scriptures in Buddhism known as the Pali Canon. The Pali Canon inherited its name from the language in which it is written: Pali, which is related to Sanskrit.

In Pali, the word we translate as “mindfulness” is sati. While MBSR and our modern conception of mindfulness may be derived from the ancient Buddhists texts, how much does our modern “mindfulness” resemble sati as described in the Pali Canon? And do either of these concepts resemble anything found in ancient Stoic writings? Can some form of “mindfulness” be found in the writings of Epictetus and Marcus Aurelius?

The goal of this essay, based on my workshop from Stoicon 2016, is to answer these questions.

Sati

To begin tackling this question, a good place to start would be looking for explicit definitions of sati in the Pali Canon. Unfortunately, little came up when I tried this approach. This is possibly because the term sati was well-understood and in common use during the time the Pali Canon was written. After all, I didn’t have to define “common” or “term” in the previous sentence, did I? But fortunately, we can still get some grasp on what sati means by looking at the etymology of sati and some similes the Buddha gives for sati.

Let’s start with the etymology. Sati is a noun derived from the Sanskrit term smrti, which means recollection or calling to mind. The verb form of sati is sarati, meaning “to remember”. So it seems that sati has something to do with memory, at least from an etymological viewpoint. However, etymology can sometimes lead one astray. So let’s turn to some similes for sati the Buddha gave in the Pali Canon to see if we can triangulate its meaning.

One such simile is found in Theragata 6.12:

If your mind runs loose
after sensual pleasures
and states of becoming,
quickly restrain it with mindfulness (sati)
as you would a bad ox
eating grain.

Another simile comes to us from the Sutta Nipata 5.4:

Whatever streams
there are in the world:
their blocking is
mindfulness, mindfulness (sati)
is their restraint — I tell you —
with discernment
they’re finally stopped.

These two similes seem to indicate that mindfulness can act as a kind of restraint on the mind and “streams in the world” (which may be taken to mean sense data and the mind, as defined in Samyutta Nikaya 35.82). Note that this is pretty different from “mindfulness” as we defined it in the previous section; there it seemed relatively passive. Here it’s not.

Sati also seems to have another major quality seen through similes in the Pali Canon. Let’s take a look at a couple of more similes to see what they’re pointing to. In the Anguttara Nikaya 6.43, we see mindfulness being compared to the neck of an elephant, with the head being wisdom. Also, in Sutta Nipata 1.4, we see mindfulness being compared to the goad and plowshare of the farmer, suggesting guidance. Both of these metaphors seem to indicate that sati has a guiding quality to it. The elephant metaphor illuminates what it is exactly that sati is guiding: the cultivation of wisdom.

How sati could lead to wisdom is clarified through a few other similes. Anguttara Nikaya 7.63 compares sati to a gatekeeper:

Just as the royal frontier fortress has a gate-keeper — wise, experienced, intelligent — to keep out those he doesn’t know and to let in those he does, for the protection of those within and to ward off those without; in the same way a disciple of the noble ones is mindful, highly meticulous, remembering & able to call to mind even things that were done & said long ago. With mindfulness (sati) as his gate-keeper, the disciple of the [noble] ones abandons what is unskillful, develops what is skillful, abandons what is blameworthy, develops what is blameless, and looks after himself with purity.

And in Majjhima Nikaya 105, the Buddha compares sati to a surgeon’s probe which is used to find the arrow of craving poisoned with ignorance. Together, these seem to point at how sati is thought to develop wisdom: through deeply and actively attending to one’s internal phenomenon, and noting what is harmful (or “unskillful”) and how it is so, along with what is helpful, or “skillful”.

The faculty of sati requires attending to four specific areas, described briefly in Samyutta Nikaya 48.10:

And what is the faculty of mindfulness (sati)? There is the case where a monk, a disciple of the noble ones, is mindful, highly meticulous, remembering & able to call to mind even things that were done & said long ago. He remains focused on the body in & of itself — ardent, alert, & mindful — putting aside greed & distress with reference to the world. He remains focused on feelings in & of themselves… the mind in & of itself… mental qualities in & of themselves — ardent, alert, & mindful — putting aside greed & distress with reference to the world. This is called the faculty of mindfulness.

The several practices to develop the faculty of sati within each of these four domains are laid out in more detail in Majjhima Nikaya 10, known as the Satipatthana (“foundations of mindfulness”) Sutta. Going into the details of these practices is beyond the scope of this essay. But a refrain throughout that sutta tells us of some similar qualities used throughout all four areas:

In this way he remains focused internally on the body/feelings/mind/mental qualities in & of itself, or externally…, or both internally & externally…. Or he remains focused on the phenomenon of origination with regard to the body/feelings/mind/mental qualities, on the phenomenon of passing away…, or on the phenomenon of origination & passing away with regard to the body/feelings/mind/mental qualities. Or his mindfulness that ‘There is a body/feelings/mind/mental qualities’ is maintained to the extent of knowledge & remembrance. And he remains independent, unsustained by (not clinging to) anything in the world.

In short, one watches these four areas to see how they arise and pass away, maintaining enough attention for the sake of “knowledge & remembrance” while putting aside worldly concerns.

The above seems to indicate to me that sati has many of the same qualities of mind that a student has when studying a subject they’re engrossed in. This is indicated through the allusions to memory and knowledge mentioned several times. But instead of studying textbooks, the practitioner is studying their phenomenological experience. There is also a judgmental aspect of sati that is not present in Jon Kabat-Zinn’s definition of a more modern form of mindfulness, as indicated by the simile of the gatekeeper and the metaphors of blocking streams and restraining an ox. One does not seem to simply observe passively, but instead one takes note of what phenomena are helpful or hurtful, how they are so, and what makes them arise and cease. In short, sati seems to be the careful self-study of one’s physical and mental experiences.

Prosoche

Now that we’ve laid out one definition of modern mindfulness and gotten a sense of what ancient Buddhist sati is like, let’s turn our attention to Stoicism and ask if something similar to either of these notions be found in the ancient Stoic texts. Many people think there is, and that it can be found in the notion of prosoche.

For instance, Donald Robertson seems to indicate that prosoche is similar to “mindfulness” when he writes: “Stoicism is a ‘here and now’ (hic et nunc) philosophy that centres upon the concept of prosoché, ‘attention to oneself’, which can also be translated as ‘mindfulness’ or ‘self awareness’.” (Robertson, 2010, p.153). He also suggests that “[t]he closest thing the Stoics have to a technical term for ‘mindfulness’ is prosoche, or ‘attention’, which refers to the continual self-monitoring of one’s thoughts and actions, as they happen, in the here and now.” (Robertson, 2013, p.189)

Other modern writers have suggested that prosoche plays a central role in ancient Stoic spiritual practice. For instance, Pierre Hadot calls prosoche “the fundamental Stoic spiritual attitude.” (Hadot, 1995, p.84) And Christopher Fisher writes that “Prosochē is essential for the prokoptōn to practice the three Stoic disciplines prescribed by Epictetus (Discourse 3.2.1-5). Constant attention is necessary to live according to Nature. Once one embarks on the path of the prokoptōn, the attitude of prosochē serves as an ever-present, vigilant watchman to ensure one continues to make forward progress.”

Putting the above together, modern writers have painted the following picture of prosoche:

  • It is a sort of attention to oneself that is similar to “mindfulness”
  • It was a fundamental part of Stoic practice

I disagree with both of these claims to at least some extent.

To start with, let’s tackle the first claim, that prosoche is a kind of self-awareness that is similar to mindfulness, by examining what this Greek term means and how it was used in the ancient texts.

For instance, Marcus Aurelius, when speaking of his father, states in Meditations 1.16 that:

…he cared for his body with due moderation without valuing his life at too high a rate or being concerned about his outward appearance, but also without neglecting it, and in such a way that, because of his own attentions, he rarely had need of a doctor’s help, or medicines, or external treatment.” (Hard, 2011)

The word “attentions” here is the accusative form of prosoche. And in 11.16, Marcus states reminds himself

“…that we shall have to attend to these [indifferent, external] matters for only a short while, and then our life shall be over.” (Hard, 2011)

“Attend” here is prosoche. Finally, in De Stoicorum Repugnantiis 1045e, Plutarch reports that Chrysippus said that there “…are some things not worthy of much study or attention.” “Attention” here is the genitive form of prosoche.

These three instances of the use of ‘prosoche” seem to indicate that the term has a pretty straightforward translation into English: “attention”. These examples do not seem to have any connotations of “mindfulness” that we’ve seen thus far. In Marcus’ first quote above, it simply seems to mean that his father “paid attention to ” or “took care of” himself. In the second quote, he is simply using it as “paying attention” just as we would in modern English. In the last example, we see a similar use; it seems to simply mean “attention” – not a kind of mindful self-study of one’s phenomenological experience and behavior. There are plenty of Greek terms that I think are best left untranslated since they don’t loan themselves to easy, English translations (e.g., eudaimonia, arete, hegemonikon). But prosoche is not one of them.

While the term “prosoche” is just used to mean “attention” in many instances, it does play a role as a Stoic practice in Epictetus’ teachings, which he expounds upon in Discourses 4.12 (“On Attention”). There, he explicitly explains what a practicing Stoic should pay attention to:

To what things should I pay attention, then?

In the first place to those general principles that you should always have at hand, so as not to go to sleep, or get up, or drink or eat, or converse with others, without them, namely, that no one is master over another person’s choice, and that it is in choice alone that our good and evil lie. …

And next, we must remember who we are, and what name we bear, and strive to direct our appropriate actions according to the demands of our social relationships, remembering what is the proper time to sing, the proper time to play, and in whose company, and what will be out of place, and how we may make sure that our companions don’t despise us, and that we don’t despise ourselves; when we should joke, and whom we should laugh at, and to what end we should associate with others, and with whom, and finally, how we should preserve our proper character when doing so. (Hard, 2014)

In short, one pays constant attention to one’s general philosophical “at-hand” precepts (especially the dichotomy of control) and one’s appropriate social role in all circumstances. This bears some faint resemblance to mindfulness of thoughts and actions, but is quite different from sati’s four areas of mindfulness practices and Kabat-Zinn’s mindfulness of the present moment.

What about the claim that prosoche is a fundamental Stoic spiritual attitude or practice? It is hard to answer this question since the large majority of Stoic texts are lost. However, we can take a stab at guessing how fundamental prosoche was to ancient Stoic practice by looking at how often the term was used and how widespread it was.

One way prosoche could be considered fundamental is if it is mentioned by multiple authors writing about Stoicism. However, this isn’t something we witness in the extant texts. For instance, Diogenes Laertius does not use the term at all in his description of Stoic philosophy in Book VII of his Lives of the Eminent Philosophers. Marcus uses the term only three times, to my knowledge, in Meditations; two of the times were mentioned above, and the third time he quotes Epictetus as saying that we “must find an art of assent, and in the sphere of our impulses, take good care [prosektikon – “attentive”] that they are exercised subject to reservation….” (Hard, 2011) Seneca wrote in Latin, so it’s a little harder to tell if he was referring to this specific term. However, the Latin translation of Epictetus’ writings often translateprosoche” as “animadversio”. Seneca uses this word less than 10 times throughout all his writings, and it never seems to indicate anything close to a Stoic practice.

But that alone doesn’t rule out prosoche being an essential Stoic practice. Perhaps it was essential in Epictetus’ Stoicism, as something either he himself emphasized or something he acquired from writings lost to us? However, this doesn’t seem to be the case, either. Epictetus himself seems to only use the term three times outside of Discourses 4.12: twice in 1.20.9-10 (where it seems to just mean “attention” in the normal sense) and once in Enchiridion 33.6 where it could refer either to the exercise of prosoche as described in Discourses 4.12 or simply “attention”. Within Discourses 4.12 he only uses the term 4 more times.

Let’s compare this with some other practice-related terms that are seen more frequently in his writings. For instance, logikos (logic) appears over 30 times in his writings, along with sullogismos (syllogism – related to logical reasoning); this seems to indicate that these practices were important to Epictetus, especially when one looks at uses of these terms in their context. Also, the practice of having “at-hand” rules, which one says to oneself, also seems of major importance; “procheiros” (having phrases or thoughts “at hand”) appears over 60 times, “epilege “ (“say to yourself”) appears 14 times, and “dokimazo” (rules which one compares impressions or value judgements to) appears 28 times. Compared to these concepts, it seems that Epictetus does not emphasize prosoche as something central to Stoic practice. It would be easy to miss it in a casual read of his works.

Overall, it looks like the two claims made about prosoche (that it is a fundamental part of Stoic practice and that is about self-examination of one’s thoughts and actions) do not quite reflect what is written in ancient Stoic texts. The term, when used as a practice, is specific to Epictetus, and he uses it relatively rarely and in a somewhat different way from what some modern authors claim.

The spirit of “mindfulness” in Stoic Practice

While it doesn’t appear that prosoche as used in the ancient texts is quite “mindfulness” as we construe the term nowadays, there are several aspects of Stoic practice that do reflect aspects of both modern mindfulness as well as sati. These similarities exists in ancient Stoic literature; they’re just not explicitly connected with prosoche.

One similarity between Buddhist practice and Stoic practice can be seen in Discourses 3.3:

It is in accordance with this plan of action above all that one should train oneself. As soon as you leave the house at break of day, examine everyone whom you see, everyone whom you hear, and answer as if under questioning. What did you see? A handsome man or beautiful woman? Apply the rule. Does this lie within the sphere of choice, or outside it? Outside. Throw it away. What did you see? Someone grieving over the death of his child? Apply the rule. Death is something that lies outside the sphere of choice. Away with it. You met a consul? Apply the rule. What kind of thing is a consulship? One that lies outside the sphere of choice, or inside? Outside. Throw that away too, it doesn’t stand the test. Away with it; it is nothing to you. If we acted in such a way and practised this exercise from morning until night, we would then have achieved something, by the gods. (Hard, 2014)

While the term “prosoche” is not explicitly used here, it does seem to be an application of it, in that Epictetus is advocating paying constant attention to “the rule” of the dichotomy of control in all that one does at every moment. A similar kind of rule application can also be seen in Buddhist practice, although this is also not explicitly connected to sati:

“What do you think, Rahula: What is a mirror for?”

“For reflection, sir.”

“In the same way, Rahula, bodily actions, verbal actions, & mental actions are to be done with repeated reflection.

“Whenever you want to do a bodily/verbal/mental action, you should reflect on it: ‘This … action I want to do — would it lead to self-affliction, to the affliction of others, or to both? Would it be an unskillful … action, with painful consequences, painful results?’ If, on reflection, you know that it would lead to self-affliction, to the affliction of others, or to both; it would be an unskillful … action with painful consequences, painful results, then any … action of that sort is absolutely unfit for you to do. But if on reflection you know that it would not cause affliction… it would be a skillful … action with pleasant consequences, pleasant results, then any … action of that sort is fit for you to do.

Instead of control, the rule here is focused on the harm to oneself or others. And, while sati is not explicitly mentioned, the “judgemental” aspect of sussing out what’s helpful and harmful does also appear in the concept of sati as I described earlier. A similar theme with regard to impulses to action can be seen in Meditations 8.7:

Every nature is contented when things go well for it; and things go well for a rational nature when it never gives its assent to a false or doubtful impression, and directs its impulses only to actions that further the common good, and limits its desires and aversions only to things that are within its power, and welcomes all that is assigned to it by universal nature. (Hard, 2011)

Thus, while these practices aren’t explicitly related to sati or prosoche, they do still have an aspect of “mindfulness” to them in that they’re both focused on the quality of thoughts and deeds in the present moment.

Indeed, a major similarity between modern “mindfulness” and Stoic practice can be seen in Marcus’ explicit focus on the present moment, which he mentions in several places throughout the Meditations. For instance, in 3.10, he writes: “Cast everything else aside, then, and hold to these few truths alone; and remember, furthermore, that each of us lives only in the present, this fleeting moment of time, and that the rest of one’s life has either already been lived or lies in an unknowable future.” And in 12.26, he states that “the life of every one of us is confined to the present moment and this is all that we have.” This is similar to some statements about the present moment in ancient Buddhism. For instance, we see in Majjhima Nikaya 131:

You shouldn’t chase after the past
or place expectations on the future.
What is past
is left behind.
The future
is as yet unreached.
Whatever quality is present
you clearly see right there,
right there.
Not taken in,
unshaken,
that’s how you develop the heart.
Ardently doing
what should be done     today,
for — who knows? — tomorrow
death.
There is no bargaining
with Mortality & his mighty horde.

As a brief aside, I should note that it’s not clear to me that “the present moment” is mentioned quite as often in the oldest Buddhist texts as many believe it to be, and when it is, it seems to be for a quite different purpose than what modern mindfulness focuses on. We can see a hint of that in the quote above, but going more deeply into the role of sati in Buddhist practice is beyond the scope of this essay. For more information, see Ronald Purser’s The Myth of the Present Moment.

As a final example, of something that could be reasonably construed as “mindfulness” in Stoic practice, let us take a look at what I call “decomposition” or “stripping” exercises, a practice which is advocated in one form or another by Epictetus, Marcus, and Seneca. One of several versions of it can be found in Meditations 6.13:

When you have savouries and fine dishes set before you, you will gain an idea of their nature if you tell yourself that this is the corpse of a fish, and that the corpse of a bird or a pig; or again, that fine Falernian wine is merely grape-juice, and this purple robe some sheep’s wool dipped in the blood of a shellfish; and as for sexual intercourse, it is the friction of a piece of gut and, following a sort of convulsion, the expulsion of some mucus. Thoughts such as these reach through to the things themselves and strike to the heart of them, allowing us to see them as they truly are. So follow this practice throughout your life, and where things seem most worthy of your approval, lay them naked, and see how cheap they are, and strip them of the pretences of which they are so vain. (Hard, 2011)

Here, Marcus strips descriptions of external things of their value judgements, describing their component parts in order to reign in desire. Compare this to one of the mindfulness of body practices laid out by the Buddha in Majjhima Nikaya 10:

Furthermore…just as if a sack with openings at both ends were full of various kinds of grain — wheat, rice, mung beans, kidney beans, sesame seeds, husked rice — and a man with good eyesight, pouring it out, were to reflect, ‘This is wheat. This is rice. These are mung beans. These are kidney beans. These are sesame seeds. This is husked rice,’ in the same way, monks, a monk reflects on this very body from the soles of the feet on up, from the crown of the head on down, surrounded by skin and full of various kinds of unclean things: ‘In this body there are head hairs, body hairs, nails, teeth, skin, flesh, tendons, bones, bone marrow, kidneys, heart, liver, pleura, spleen, lungs, large intestines, small intestines, gorge, feces, bile, phlegm, pus, blood, sweat, fat, tears, skin-oil, saliva, mucus, fluid in the joints, urine.’

In this way he remains focused internally on the body in & of itself, or focused externally… unsustained by anything in the world. This is how a monk remains focused on the body in & of itself.

Here, the Buddha is advocating breaking both one’s own body (“internally”) and possibly the body of others (“externally”, although this is not the only interpretation of these terms) down to its component parts, possibly for a similar purpose.

So, while prosoche is not explicitly connected to much of what we could relate to our concept of “mindfulness”, it is still fair to say that some similarities between Stoic practices and the concept exist.

Conclusion

The concept of prosoche is said to be a fundamental part of ancient Stoic practice involving mindfulness of one’s thoughts and deeds in the present moment. I hope I made a credible case for why this doesn’t seem to be entirely accurate. “Prosoche” is not mentioned very frequently in the ancient texts we have. When it is, it often just means “attention” in the common sense of the word. Only Epictetus (or Marcus quoting Epictetus) seems to mention it as an exercise, and even then it only bears a cursory resemblance to sati or modern mindfulness. While the “four foundations” of sati to which one pays careful attention are body, feeling tone, mind, and mental qualities, Epictetus defines the “two foundations” of prosoche as basic Stoic precepts and social role. While one pays attention to phenomenological experience in sati, one pays attention to more abstract concepts in prosoche. And while both touch on aspects of one’s present moment, neither sati nor prosoche are as explicitly tied up in that concept as modern definitions of mindfulness are.

However, as modern Stoics, we’re not compelled to exclusively follow the ancient texts. The fact is that mindfulness is a concept that has become embedded in our language and culture, and it is a useful concept. So, as modern Stoic practitioners, we should be free to co-opt the term “prosoche” to suit our own needs. After all, we do see a few aspects of “mindfulness” in Stoic practice, even if they’re not explicitly tied to prosoche proper in the ancient texts.

Patrick Ussher expresses similar views in his essay “Was There a ‘Stoic Mindfulness’?” There, he states that “although it is not strictly accurate to call prosoche ‘Stoic ‘mindfulness’, historically speaking, it is probably a helpful term to use as prosoche, like mindfulness meditation, clearly does involve developing a kind of attention: Stoic mindfulness is about bringing the two-fold distinction discussed above with you, in the various situations in which you find yourself, throughout the day…. In fact, all Stoic ‘mindfulness’, or prosoche, is really about is remembering the key precepts of Stoic ethics and putting them into practice.” (Ussher, 2014)

I completely agree. We should feel free to adapt and change terms for our modern time as long as our words are clear and useful. The goal of this essay was to simply clarify the roots of what it is exactly that we’re adapting.

 

(Non-internet) references

Goodwin, WW (ed.). (1874) Plutarch’s Morals. Boston: Little, Brown, and Company.

Hadot, P. (1995). Philosophy as a way of life. London: Blackwell.

Hard, R (trans.). (2011). Meditations: With Selected Correspondence. Oxford: Oxford University Press.

Hard, R (trans.). (2014). Discourses, Fragments, Handbook. Oxford: Oxford University Press.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.

Robertson, D. (2010). The philosophy of Cognitive-Behavioural Therapy (CBT): Stoic philosophy as rational and cognitive psychotherapy. London: Karnac.

Robertson, D. (2013). Stoicism and the Art of Happiness. London: Hodder & Stoughton.

Ussher, P. (2014). Was there a ‘Stoic mindfulness’? In P. Ussher (Ed.), Stoicism today: Selected writings vol. 1. CreateSpace/Stoicism Today.

 

Greg Lopez is a practicing secular Buddhist and Stoic, founder and facilitator of the New York City Stoics meetup, co-host of Stoic Camp New York, Director of Membership for The Stoic Fellowship, and co-organizer of Stoicon 2016. He also runs a nonprofit that uses cognitive behavioral therapy, which is what led to his interest in Stoicism. His professional and academic background is in pharmacy and basic science. His other interests include psychology, statistics, philosophy, and swing dancing.

What Does “In Accordance With Nature” Mean? by Greg Sadler

One guiding ideal for Stoics is living “in accordance with nature”. But what does this phrase really mean? To judge by the many questions and comments one sees in Stoicism-oriented social media, blogs and websites, this doctrine seems to be a perennial source of confusion. I get asked about it frequently when I teach online classes, lead seminars, give talks, or even post lecture videos.

When you first hear or read it, “in accordance with nature” sounds like a helpful criterion we could use to guide and measure our choices, beliefs, reasonings, desires, and actions. But then confusions and worries arise. For, without some clear conception in mind of what “nature” and “in accordance with” mean, it appears we might be just playing around with generalities, and thereby fooling ourselves with words that lack any definite meaning but do appeal to us on some merely emotional level. And that – if it really is the case – should be very troubling to a Stoic (pun intended)!

Given the uncertainties and confusions raised by this issue, it is quite natural to ask: Is there a simple and straightforward answer to this question – What does “in accordance with nature” mean? Well, I have some good news and some bad news for you.

The good news is that if it is a simple answer you’re looking for, you’re in luck! For there isn’t just one, but a whole slew of answers meeting that criterion. Then there’s the bad news: they all tend to be more or less wrong. Simple answers about complex matters abound, since there are multiple ways to go wrong through oversimplification.

There is, fortunately, a set of consistent answers contained within classic literature of (or about) Stoic philosophy. Unfortunately for us in the present, a significant portion of Stoic writings are lost (as is the case with many of the schools and thinkers of antiquity). Perhaps one of the greatest loss in this respect is the work that Zeno reportedly wrote, titled “On Life According To Nature” (Peri to kata phuisin biou). Wouldn’t it be wonderful to have that book in our hands?  Nevertheless, the texts that we do still possess provide a fairly clear, though necessarily complex, account of this key Stoic concept and doctrine.

Which texts should we turn to, if our goal is to better understand what “in accordance with nature” means for the Stoics? In my view, we should start with several works not authored by Stoics themselves, but that do provide us with invaluable information about key doctrines (and sometimes disagreements) of the Early and Middle Stoics. The first of these sources is Diogenes Laertes’ Lives of the Philosophers, the 7th book of which is devoted entirely to the Stoic school.  Another key source is the eclectic philosopher and statesman, Marcus Tullius Cicero.  To understand Stoic thought on this matter, it is particularly helpful to look at his On The Ends and On Duties.

Given the recurrently expressed worries about this key idea, I thought it might be useful to write a short piece here setting out and explaining classic Stoic teachings on the topic. The idea was to provide a resource those expressing confusions about the matter might be referred to – along with Eric Scott’s and Michel Daw’s earlier (and shorter) pieces on the same subject – not a complete answer on the matter, but at least enough to clear up a few misunderstandings and give readers a sense of where they might look for fuller discussions of the issue.

What Do We Mean By “Nature”?

One completely understandable – and avoidable – source generating confusions on the parts of modern readers is reading decidedly non-Stoic conceptions of “nature” into passages where the Stoics talk about being, living, or acting in accordance with nature. The result of this is typically that other key doctrines of the Stoics then appear out of harmony with, or even contradictory to “living in accordance with nature” interpreted along those lines. A great example of this is provided by a frequently-posted criticism made by Friedrich Nietzsche, from Beyond Good and Evil:

You desire to live “according to Nature”? Oh, you noble Stoics, what fraud of words! Imagine to yourselves a being like Nature, boundlessly extravagant, boundlessly indifferent, without purpose or consideration, without pity or justice, at once fruitful and barren and uncertain: imagine to yourselves indifference as a power – how could you live in accordance with such indifference? To live – is not that just endeavoring to be otherwise than this Nature? Is not living valuing, preferring, being unjust, being limited, endeavoring to be different? And granted that your imperative, “living according to Nature,” means actually the same as “living according to life”- how could you do differently?

Nietzsche goes on to argue that the Stoics have imposed their own viewpoint of “Nature ‘according to the Stoa,’” upon the totality of nature, and that Stoicism, as a form of “self-tyranny,” attempts to extend this domination to all the rest of nature, of which the Stoic is merely a part. What it comes down to, however, is that Nietzsche has worked out a very different conception of nature than that of the Stoics, and essentially faults them for relying upon their conception, rather than the one he prefers. This difference applies not only to “nature” in the sense of the entire cosmos and its processes, but also to “nature” as living things, and particularly to “nature” as human nature.

Setting aside Nietzsche as a particular example of, there is a broader problem. We do live in an era in which the sciences have made significant leaps forward, and within a culture in which some small measure of scientific literacy can be assumed on the part of the general public. But it is also safe to say that there are differing conceptions of “nature” floating around in our broader culture.  Understandably enough, when newcomers to Stoicism try to make sense of “living in accordance with nature,” some read in one or another conception of “nature” adopted either from the sciences – or more often from popular accounts of the sciences and science journalism – or from alternative sources.

The Stoics themselves did articulate an account of nature, understood as the totality of the cosmos, its differing degrees of being, its processes, and so on. We lack full access to that account, of course, since a good portion of Stoic literature has been lost, but we do at least have some outlines, with certain portions of that more or less filled in. What we can reconstruct is an account that is not entirely at odds with those set out by contemporary sciences. In fact, where through modern science we now possess better explanations of matters such as the nature of the universe, or what individual things are and how they causally interact, a Stoic might well want to consider how the philosophical doctrine might be harmonized with more modern conceptions of “nature”.

There do remain, admittedly, some doctrines central to classical Stoicism that will inevitably present significant challenges for the modern Stoic, for instance the conception of the cosmos itself as the divine, or the strong conception of providence for which Stoics argued against rival schools in antiquity. Those tensions, or problems, are very interesting and worth discussion, but I pass over them here.

A more serious conflict – one that that is highly relevant here – arises when we consider what would be in accordance with nature not just as referring to the totality of the cosmos, but more specifically in terms of our rational, i.e. distinctively human nature. According to Diogenes Laertes, some disagreement occurred in the early Stoa precisely over this matter:

By the nature with which our life ought to be in accord, Chrysippus understands both the common nature of the universe and the specific nature of human being, whereas Cleanthes takes the nature of the universe alone as that which should be followed, without adding the nature of the part [of the universe]. (7.89)

Chrysippus’ approach prevailed, as becomes apparent when examining later discussions of this key Stoic idea. In this domain not just of nature itself, but specifically human nature, clarity about what understanding of (or assumptions about) “nature” we have in mind becomes imperative. We need to be particularly on our guard towards uncritically substituting conceptions of “nature” drawn from non-Stoic sources when we attempt to think out what “in accordance with nature” means. Instead, we ought to look to the Stoic sources we do possess, and elaborate the conception of nature (particularly human nature) along those lines.

Stoics on Human Nature in Diogenes Laertes

One discussion that helps significantly toward understanding the “nature” Stoics advocate living in accordance with, begins by generalizing about all animal life:

An animal’s first impulse, say the Stoics, is to self-preservation, because nature from the outset endears it to itself, as Chrysippus affirms in the first book of his work On Ends. (7.85)

Being “endeared to itself” translates the Greek term oikeiouses, a cognate of which is the later oikeiosis, discussed at length by Hierocles in his Elements of Ethics, a concept many modern Stoics have become familiar with. Diogenes goes on to note that the Stoics apply this feature of self-preservation still more widely, extending it to all living things.

And nature, they say, made no difference originally between plants and animals, for she regulates the life of plants too, in their case without impulse and sensation, just as also certain processes go on of a vegetative kind in us. But when in the case of animals impulse has been superadded, whereby they are enabled to go in quest of their proper aliment, for them, say the Stoics, Nature’s rule is to follow the direction of impulse. (7.86)

Notice the turn the discussion now takes:

But when reason by way of a more perfect leadership has been bestowed on the beings we call rational, for them life according to reason rightly becomes the natural life. For reason supervenes to shape impulse scientifically. (7.86)

Nature, in one sense of the term – the totality of things that are – gives to these different orders of living things varied manners of preserving their existence, and indeed of growth, enjoyment, and flourishing.   The higher order does not lack what the lower order possesses, but adds to it. Human beings and the other animals possess what plants have, and add on impulse to it. Human beings also have impulse like other animals, but add the rational faculty on to that. This will have very important implications for what “in accordance with nature” means specifically for human beings.

Zeno was the first (in his treatise On the Nature of Man) to designate as the end “life in agreement with nature,” which is the same as a virtuous life, virtue being the goal towards which nature guides us. (7.87)

Already here, we see the interconnection, or even equivalence, between two central features of Stoic moral theory: living in accordance with nature, on the one hand, and the cultivation and practice of the virtues, on the other. This was a consistent doctrine, and Diogenes points out Cleanthes and Posidonius as having taught it. Chrysippus also emphasizes another side to this:

[L]iving virtuously is equivalent to living in accordance with experience of the actual course of nature. . . . for our individual natures are parts of the nature of the whole universe. And this is why the end may be defined as life in accordance with nature, or, in other words, in accordance with our own human nature as well as that of the universe, a life in which we refrain from every action forbidden by the law common to all things, that is to say, the right reason which pervades all things. . . . And this very thing constitutes the virtue of the happy man and the smooth current of life, when all actions promote the harmony of the spirit dwelling in the individual man with the will of him who orders the universe. (7.87-88)

Understood in this way, “living in accordance with nature” does not mean merely maintaining one’s existence through following impulse. Nor does it mean merely adapting oneself to the course of life, to things that happen, to the circumstances one finds oneself in. It means participating in our small portion, or role, within the totality of the universe, and doing so in a distinctively human way. That is what is in accordance with our specific nature. Rationality is essential to that nature. The capacity for virtue is too, and so is the possibility of recognizing and voluntarily following that common law or right reason.

Several other later Stoics added to Chrysippus’ explanation, as Laertes tells us. His successor as scholarch, Diogenes of Babylon “expressly declares the end to be to act with good reason in the selection of what is in accordance with nature.” Archedemus of Tarsus extends this to “the performance of all befitting actions.”  Notice that in these two formulas, what we see is an emphasis on reasoning out more practically – in particular cases as well as in general – what “in accordance with nature” means. Diogenes emphasizes the need to competently decide (and act upon), upon one out of a range of possible things in accordance with nature, that is, which one to prudently select. Archedemus emphasizes the whole domain of actual duties (in Greek, kathekonta, in Latin, officia) as part and parcel of living in accordance with nature.

Human Nature In Cicero’s Presentations of Stoicism

Although (as noted earlier) not himself a member of the Stoic school, Cicero’s works provide us very useful presentations of Stoic doctrines. On this matter in particular, a good bit of what he has to tell us is already there in Diogenes’ Laertes. That seeming redundancy is not entirely without value, since it confirms those points as long-established, and perhaps even commonplace, Stoic understandings of “in accordance with nature”. But on some points, Cicero also adds some additional depth to the picture outlined so far. 

On The Ends contains passages specifically focused on the issue of what is in accordance with nature. In book 3 of this work (which is set up as a series of dialogues), Cicero places the presentation of Stoic teachings into the mouth of his fellow philosopher and statesman (and later ally in the civil wars), Cato the Younger, who proposes that he “expound. . . the whole system of Zeno and the Stoics.” (3.4. 14) As a side-note, it should be pointed out that in book 4, Cicero actually claims that the notion of “living in accordance with nature” is not a feature unique to the Stoic school of philosophy. More specifically, he maintains that Zeno took over this notion from one of his teachers, the Academic Platonist Polemo. (4.6.15)

In book 3, Cicero clarifies the relationships between human nature, rationality, intrinsic moral value, duty, and choice. What is itself in accordance with nature, or are productive of those things in accordance with nature, possesses genuine moral value, and is worth choosing.   This leads to a duty of “retain[ing] those things which are in accordance with nature, and to repel those that are contrary.” This in its turn involves choice (selectio) on the person’s part along those lines, i.e. following that basic duty. And then, with time, that choice develops into something reliable (perpetua), and eventually attains the state of being entirely in agreement with nature. There is a process of development for the human being, by which he or she can more fully come into agreement with nature. That process of development both involves and refines the distinctively human faculties of reason and of choice.

He emphasizes another key aspect to the Stoic doctrine:

The human being’s first attraction is towards the things in accordance with nature; but as soon as he or she has attained to understanding, or rather to conscious intelligence. . . and has discerned the order and so to speak harmony that should govern conduct, he then esteems this harmony far more highly than all the things for which he originally felt an affection, and by exercise of intelligence and reason infers the conclusion that in this order resides the main good for human beings. . . (3.6. 21)

In the human being developing into a fuller agreement with nature, the basis from which one starts is just that, a starting point. There is a rational process that leads from the basic impulse for self-preservation into rationality and sociability.

A later discussion reaffirms this. When considering duties, or “appropriate actions” (officia), one example that he says both the wise and the foolish will choose, is that of self-preservation, since this is in accordance with nature (secundum naturam, 3.18.59). But, for a rational person, there may be occasions when it becomes appropriate to for that person to depart from life. It depends, Cicero tells us, on where the “preponderance of things in accordance with nature” (in quo enim plura sunt quae secundum naturam sunt) happens to fall in the specific case. A bit later, after noting that happiness (beate vivere) means “living in accordance with nature” (convenienter naturae vivere), he points out that this involves “grasping the right occasion” (opportunatis esse, 3.18.61)

In On Duties, Cicero elaborates upon what nature provides us with as human beings, that is, what distinctively human nature we possess:

Nature likewise by the power of reason associates human being with human being in the common bonds of speech and life; she implants in him above all, I may say a strangely tender love for his offspring; she also prompts human beings to meet in companies, to form public assemblies and to take part in them themselves; and she further dictates, as a consequence of this, the effort on man’s part to provide a store of things to minister to his comfort and wants – and not only for himself alone, but for his wife and children and for the others whom he holds dear and four whom he ought to provide. (1. 4.12)

This is particularly interesting, because not only does it asserts that sociability, affection, and association with other human beings are integral to rational human nature, but that this very tendency towards associating with others requires that rationality be effectively exercised. This in turn means that fully realizing our human nature requires that we develop and exercise the virtue of prudence or wisdom.

Cicero also points out several other sides to the natural human inclination towards acquiring wisdom, towards becoming more rational.

Above all, the search after truth and its eager pursuit are peculiar to human being. . . . We are eager to see, to hear, to learn something new, and we esteem is desired to know the secrets are wonders of creation is indispensable to a happy life. Thus we come to understand that what is true, simple, and genuine appeals most strongly to a human being’s nature. (1. 4.13)

And yet another:

To this passion for discovering truth there is added a hunger, as it were for independence, So that a mind while molded by nature is unwilling to be subject to anybody save one who gives rules of conduct or is a teacher of truth or who, for the general good, rules according to justice and law. (1. 4.13)

In going on and discussing the virtue and the duties associated with justice, Cicero also tells us:

As the Stoics hold, everything that the earth produces is created for human use; and as human beings too, are born for the sake of human beings, that they maybe able mutually to help one another; in this direction we are to follow nature as our guide, to contribute to the general good by an interchange of acts of kindness, by giving and receiving, and thus by our skill, our industry, and our talents to cement human society more closely together, human being to human being. (1.7.22)

Similar references to nature and reason in the discussion of the other cardinal virtues, courage and temperance (which I skip over here), further fill out this picture of what fully developed human nature – and thus living in accordance with nature – involves and requires of the human being.

On Duties also contains a relevant distinction and discussion of “four characters” (personae), each individual possesses by virtue of their human being. One of these is a universal character bestowed upon all of us by nature:

Arising from the fact of her being all alike and endowed with reason and with that superiority which lifts us above the brute. From this all morals of the impropriety are derived, and upon it depends the rational method of ascertaining our duty. (1.30.107)

The second is a character that is assigned to individuals as such. This assigns us our particular characteristics, “the bent of our own particular nature” (1.31.110), which might be better or worse, in some respects, than those of other persons. Cicero stresses that we cannot simply copy the traits of others and suppress those that express our own proclivities. But we must also find ways to adapt our own individual character to the greater whole.

There are two other “characters” as well. The third is imposed by “chance or circumstance” upon particular persons. Cicero cites as examples: “regal powers and military commands, nobility of birth and political office, wealth and influence, and their opposites.” In our own day, we might think of what countries and cultures we are born into or emigrate to, what organizations or institutions we are involved in, what opportunities we are afforded, and the like. The fourth depends upon our own deliberate choice (judicio nostro), that is, what we make of all of the rest of our circumstances and nature by our own will or choice (nostrae voluntatae).

How does this doctrine of the four characters impact the ideal of living “in accordance with nature”? The first character expresses a considerable amount of what “living in accordance with nature” would look like for all human beings. But there is also what is distinctive to us as individual persons, and we ought to cultivate that “nature” and live in accordance with it as well, provided of course that it really is “proper to us and not vicious,” or put in another way, “not against universal human nature” (1.33.110).

The fourth is particularly interesting, since it bears upon what we actually choose to do with and from those other three characters. It is where human agency not only expresses human nature but also deliberately shapes our own selves in relation to it. Whether or not we live in accordance with nature or not is something up to us. Even how we live “in accordance with nature” is up to us as well. Cicero points out a person’s choice about which virtues to excel in as one example of what lies within  this fourth character’s scope.

A Few Conclusions

After examining several of these interesting discussions of classical Stoic doctrine on “living in accordance with nature” and about specifically human nature, found in Diogenes Laertes and Cicero, what clear conclusions can we set out on the matter? Here are a few:

First, the Stoic ideal of “living in accordance with nature” does involve adapting oneself to “nature” in the sense of the cosmos, of which any given person is merely one part of a much greater whole. Just as important, however, is realizing distinctively human, rational nature in oneself.

Second, as living beings, humans are driven by the same natural impulse for self-preservation as are other non-rational living beings. Our rationality may often be used in the service of this impulse, but that is not its only function. Integral to that rationality, as it develops, is a capacity and desire for living together harmoniously with other people. Rational human nature involves sociability.

Third, human rationality affords us the capacity to be to some extent self-determining. We can rationally reshape what it is that nature has bestowed upon us, for instance our impulses.   We not only have capacities for responding to and modifying our natural environment, but also for working upon our own selves, as well as for taking part in complex human communities.

Fourth, living in accordance with nature involves the cultivation of the virtues – specifically prudence, justice, courage, and temperance – since virtue is the end to which nature orients rational beings. Doing so follows out and refines desires and impulses that we possess as human beings, for example for understanding truth, or for realizing justice.

Fifth, recognizing and fulfilling our duties is a main way in which we live in accordance with nature. This is not just a matter of blind or mechanical obedience to demands imposed upon us from outside, but rather ways in which we apply our human rationality to ourselves, others, and the situations in which we live together.

As I mentioned earlier, this short piece is not meant to provide a fully comprehensive account of what “living in accordance with nature” means for the Stoics. Instead, the goal was to flesh out that notion enough so that those who find it vague, confusing, or vacuous might have something more substantive to wrap their heads around. Here I have just drawn upon Diogenes Laertes and Cicero, but there is a good bit more said on the topic in the works of the Late Stoics that we fortunately still possess. My intention is to write a follow-up piece (later this year) focused on passages further developing this notion of “according to nature” in Musonius Rufus, Seneca, Marcus Aurelius, and especially in the works of Epictetus.

Gregory Sadler is the Editor of the Stoicism Today blog.  He is also the president and founder of ReasonIO, a company established to put philosophy into practice, providing tutoring, coaching, and philosophical counseling services, and producing educational resources.  He works as an executive coach and ethics trainer for Priority Thinking, produces the Half Hour Hegel series, and is a team member of (Slow) Philosophies.

Life After Pain Interviews – Irvine, Robertson, and Sadler

The website Life After Pain recently interviewed three of the members of the Modern Stoicism project – William Irvine, Donald Robertson, and Greg Sadler – on what resources and insights Stoic philosophy and practices offer in dealing with chronic pain.

You can find each of the interviews, carried out by Naomi Kuttner – in transcript and mp3 podcast form – by following these links:

Learn How to Deal with Negative Emotions – Professor William B Irvine

Coping With Pain Using the Stoic Philosophy – Donald Robertson

Using Stoic Principles in Everyday Life – Gregory  Sadler

The Life Without Pain website was created by Dr. Jonathan Kuttner, after his recovery from a hang-gliding accident spurred a very interest on his part in treatment of chronic muscle and joint pain.  Understanding pain – and all that goes with it – is key to his approach.

Stoic philosophy and practices provide a number of resources, exercises, and an over-all approach that can be helpful for people suffering from chronic pain.  Give a listen to these three interviews, and you’ll hear more than two-and-a-half hours of Irvine, Robertson, and Sadler unpacking insights from Stoicism and applying them to dealing with pain (and a number of other connected issues – beliefs, emotions, relationships, decisions, and lifestyles).

Musonius Rufus’ Nurturing Stoic Family or Plato’s Guardian Automatons? by Leah Goldrick

In Book V of The Republic, Plato describes a commonwealth devoid of biological nurturing. Mothers and fathers of the philosophical Guardian class are not allowed to be married and are excluded from the raising of their own children, who are instead entrusted to wet nurses and substitute caregivers at the whim of the Rulers.

We have to wonder if such an arrangement as Plato describes would actually undermine the structure of the commonwealth by producing a race of maladjusted automatons rather than philosophical Guardians for which it was designed. In removing a loving marriage bond, warm nurturing from a consistent caregiver and philosophical education within the nexus of the family, Plato effectively eliminates the primary basis from which virtue, intelligence and sociability develop.

In stark contrast to the cold, bureaucratic child rearing described in Plato’s Republic, the Stoic Musonius Rufus’ envisioned a different ideal, one consisting of warm nurturing along with modeling of virtuous behavior in the context of a Stoic marriage and family. Musonius seems to have gotten things right in light of much of the modern scholarship on infant attachment, empathy, and brain development. Ironically, it is Musonius’ type of care which is more likely to create good, sociable, reasonable people – Plato’s ideal for his Guardians – to begin with.

Let’s consider Plato’s method of caring for young children first:

The proper officers will take the offspring of the good parents to the pen or fold, and they will deposit them with certain nurses who dwell in a separate quarter; but the offspring of the inferior, or of the better when they chance to be deformed, will be put away in some mysterious, unknown place, as they should be… that must be done if the breed of the guardians is to be kept pure.

They will provide for their nurture, and will bring the mothers to the fold when they are full of milk, taking the greatest possible care that no mother recognize her own child; and other wet-nurses may be engaged if more are required. Care will also be taken that the process of sucking shall not be protracted too long; and the mothers will have no getting up at night or other trouble, but will hand over all this sort of thing to the nurses and attendants.[1]

Plato’s ideal of infant care, where babies are raised mostly by a rotating stream of surrogate wet-nurses and state-appointed caregivers without parental love, runs contrary to human evolutionary biology and as such might have undesirable effects. While I won’t argue that we are strict slaves to our biology, there is a general scientific consensus as to the type of early childhood nurturing and environment which promotes brain development and produces empathetic individuals. It is not consistent with Plato’s approach. Rotating bureaucratic caregivers, lack of consistent moral role models and the specter of an environment which is not emotionally responsive (or at least not as nurturing as care provided by people who have a loving interest in their own progeny) is particularly worrisome.

Loving relationships are essential to brain development in the early years, and these interactions have consequences for future emotional and physical health. Babies get distressed when caregivers are emotionally unresponsive.[2] Having a stream of changing caregivers who are unrelated to the child is more likely to result in care that is emotionally unresponsive.

Rotating caregivers, even if warm, are less likely to read the cues appropriately or to know what the babies likes and dislikes are, causing the babies stress levels to rise, likely to a state of near permanent anxiety in absence of a permanent attachment figure. The motherless babies in The Republic are not allowed the one comfort of suckling too long at the breast! The family-less arrangement as described in The Republic also ostensibly lacks the necessary dimension of moral role-modeling that the family traditionally provides children.

Another problem is that Plato’s ideal proceeds from the assumption that taking care of babies and young children is an inconvenience to be put aside in favor of more important matters. Plato clearly feels that the affairs of young children should be relegated to the ontological basement in order of importance. However, in designating parenting as an activity unimportant enough to be mostly foisted off on wet nurses and similar people of lesser social status than the Guardian class, Plato presupposes that the commonwealth can actually sustain itself in the absence of biological nurturing and parental modeling of virtue.

Plato errs in viewing the care of young children as an unimportant activity which hinders or detracts from philosophy and the good of the state, rather than one which is good and philosophical in and of itself. Raising virtuous and empathetic children is a most important matter, maybe even the most important philosophical matter, because it is the cornerstone on which a good society is built to begin with. The one is an antecedent cause necessary for the other.

By contrast, Musonius Rufus’ Stoic family described in his Lectures and Sayings, stands in stark contrast to the cold, bureaucratic child rearing described in The Republic. Both Plato and Musonius were looking to develop empathetic, virtuous people, but only Musonius recognized that the family is the place where concern for others is originally learned. (According to the Stoic Hierocles, oikeoisis, or empathy, originally begins in the family and progresses outward as a person matures until it applies to everyone in the cosmopolis.)[3]

Musonius begins by describing the ideal Stoic marriage as a partnership of mutual care which allows the spouses to grow in virtue. Such a loving marriage is (implicitly) more likely to produce good, empathetic children when prosoche and virtue are mirrored by the parents. He states:

When this mutual care is complete and those who live together provide it to each other completely, each competes to surpass the other in giving such care. Such a marriage is admirable and deserves emulation; such a partnership is beautiful.[4]

Musonius goes on to argue that marriage and the raising of children are not a handicap in the pursuit of philosophy and is in accord with nature, as is raising many children. A Stoic mother and father will naturally cohabitate (as opposed to the parents in The Republic, who are prevented from doing so), and being philosophical, they will model virtue for their children:

Now the philosopher is indeed the teacher and leader of men in all the things which are appropriate for men according to nature, and marriage, if anything, is manifestly in accord with nature. For, to what other purpose did the creator of mankind first divide our human race into two sexes, male and female, then implant in each a strong desire for association and union with the other, instilling in both a powerful longing each for the other, the male for the female and the female for the male? Is it not then plain that he wished the two to be united and live together, and by their joint efforts to devise a way of life in common, and to produce and rear children together, so that the race might never die?[5]

The Greek Stoics may not have universally sanctioned marriage and children. Zeno in particular held views that were somewhat embarrassing to later Roman Stoics, including the proposal that women should be held in common. The notion that a Stoic sage should marry and have children appears to have triumphed by the time of Cicero, however. Musonius, writing slightly after Cicero in the early Imperial period, held that both marriage and having many children were natural duties for a sage. Musonius espouses the idea that children can facilitate an individual’s moral development via an exchange of virtue and mutual appreciation.[6] He states:

[T]hat raising many children is an honorable and profitable thing one may gather from the fact that a man who has many children is honored in the city, that he has the respect of his neighbors, that he has more influence than his equals if they are not equally blessed with children. I need not argue that a man with many friends is more powerful than one who has no friends, and so a man who has many children is more powerful than one without any or with only a few children, or rather much more so, since a son is closer than a friend. One may remark what a fine sight it is to see a man or woman surrounded by their children. Surely one could not witness a procession arrayed in honor of the gods so beautiful nor a choral dance performed in order at a religious celebration so well worth seeing as a chorus of children forming a guard of honor for their father or mother in the city of their birth, leading their parents by the hand or dutifully caring for them in some other way. What is more beautiful than this sight? What is more enviable than these parents, especially if they are good people? For whom would one more gladly join in praying for blessings from the gods, or whom would one be more willing to assist in need?[7]

Furthermore, Musonius envisioned a Stoic mother as an energetic, nurturing woman well versed in philosophy. This Stoic mother’s behavior is much more consistent with what we are wired for in terms of evolutionary biology than the caregivers described in The Republic:

Who better than she would love her children more than life itself? What woman would be more just than such a one?.. For in fact she has schooled herself to be high-minded and to  think of death not as an evil and life not as a good, and likewise not to shun hardship and never for a moment to seek ease and indolence. So it is that such a woman is likely to be energetic, strong to endure pain, prepared to nourish her children at her own breast, and to serve her husband with her own hands, and willing to do things which some would consider no better than slaves’ work. Would not such a woman be a great help to the man who married her, an ornament to her relatives, and a good example for all who know her?  [8]

For Plato (and for Roman women of Musonius’ class) obligations such as breastfeeding and getting up at night to tend to children were considered hardships rather than as virtue enhancing activities. But there is nothing virtuous or philosophical about “not getting up at night,” from the Stoic perspective. Love of work is an attribute of andreia, usually translated as “courage” but which might also be thought of as “determination.” The work of raising children doesn’t end when the sun sets, and a Stoic mother is not soft and helpless when confronted with the important work of child rearing. She is a virtuous, loving role model for her children.

Upon examination, one would imagine that a nurturing Stoic family as we find it described in Musonius’ fragments is vastly more likely to produce the ideal which Plato was trying to achieve in The Republic – a community of people who possess virtue, reason and concern for others.

 

References:

  1. Plato (1908). The Republic. London: MacMillan. Book V, 168.

  2. Dewar, G. (2015). Stress in babies: An evidence-based guide to keeping babies calm and healthy. Retrieved March 20,     2017, from http://www.parentingscience.com/stress-in-babies.html

  3. Inwood, B. (2007). Seneca: Selected Philosophical Letters. Oxford: New York: Oxford University Press. 170.

  4. King, C. (2011). Musonius Rufus Lectures and Sayings. Create Space. Lecture 13.

  5. Lecture 14.

6. Gloyn, E. (2011). The Ethics of the Family in Seneca. Rutgers University. https://rucore.libraries.rutgers.edu/rutgers-lib/33668/ 125-6.

  1. Lecture 15.

  2. C. (1947). Musonius Rufus, the Roman Socrates. New Haven: Yale University Press.

 

Leah Goldrick became a practicing Stoic as a result of her ongoing inquiry into the Western wisdom traditions. She holds a Bachelor’s Degree in Philosophy and a Masters in Library and Information Science from Rutgers University. She used to be an archivist for the Presbyterian Church, and is now a part-time children’s librarian and blogger. She lives in the United States with her husband and infant son.  Her website is Common Sense Ethics.

Stoicon Workshop: Negative Visualisation And The Possibility of a President Trump by Tim LeBon

Introduction

Negative Visualisation is “the single most valuable technique in the Stoics’ psychological tool kit” according to William Irvine, author of A Guide to the Good Life: The Ancient Art of Stoic Joy. Seneca, Marcus Aurelius and Epictetus all recommend and practised Negative Visualisation[1]. You too can practice it if you wish by routinely imagining adversities that may befall you and then rehearsing the ways in which Stoicism can help you respond to these events wisely and virtuously. These adversities can range from encountering irritating people at the baths (Marcus Aurelius, Meditations, Book 2) to, controversially, the death of your own child (Epictetus, Enchiridion, 3) and your own death (Seneca, On Earthquakes).

There are two significant advantages to this seemingly counterintuitive practice. Firstly you will be less shocked if and when bad things happen. As Seneca put it – “Whatever has long been anticipated comes as a lighter blow” (Letters 78)

Equally, you are more likely to respond wisely if have anticipated a problem – like an actor rehearsing their lines before a performance. Again Seneca puts it eloquently when he writes

“Everyone approaches a danger with more courage if he has prepared in advance how to confront it. Anyone can endure difficulties better if he has previously practised how to deal with them.” Seneca Letters III 225

In this article I will describe a workshop I gave at the New York Stoicon in October 2016, where we practised a Negative Visualisation of Donald Trump becoming the next President of the United States. Its interest lies partly in this political context and also in the format. To my knowledge this is the first recorded instance of performing Negative Visualisation in a group. I will describe a format for group Negative Visualisation, then summarise what happened at the New York workshop, and conclude with suggestions for future developments.

Stoic Remedies for Troubled Times

“2016 has been the worst year in my political life”, a friend commented – and that was before the US Presidential election. He was not alone. After the unexpected vote for Brexit in the UK referendum on Europe on June 23rd, 2016, many felt a gamut of difficult emotions including anxiety, sadness, embarrassment and anger. It was easy enough to see parallels between Brexit and Trump. In the UK and US alike, many people felt let down by mainstream politicians and threatened by immigration, globalisation and technological change. For these people, a return to the nationalism and nostalgia offered by Brexit and Trump was very appealing. For liberal cosmopolitans like my friend and I, it was extremely worrisome.

In early 2016 my Google search history included several occurrences of “Odds of both Brexit and Trump.” The chances were considered small by those whose job it was to know about such things – about one in twenty. I felt temporarily reassured. However seeking reassurance and hoping for the best are decidedly un-Stoic and unwise strategies. Sure enough, they did nothing to prepare me for the shock of Brexit. When I eventually turned to Stoic Remedies for Brexit instead, they helped. But what would enable us all to prepare for the possibility that Trump might become President?

A Case Study: Visualising Trump as President

Could Negative Visualisation help? The Stoicon conference in New York in October 2016, the month before the Presidential election, offered the chance to find out. The challenge was to adapt Negative Visualisation so it could be effective in a group setting likely to include some novice Stoics and conceivably some Trump supporters.. Here is the plan I created for a five step version of Negative Visualisation. I reproduce it in some detail below to enable readers to adapt it, should they so wish, to facilitate their own group negative visualisations on an adversity of their choice.

Step 1: Preliminaries: Clarify the adversity to be considered in this workshop and give people the chance to leave should they not wish to do a negative visualisation about this. Begin with a brief group negative visualisation practice on a relatively minor adversity, such as breaking your phone or tablet.

Step 2: Visualising disaster: With eyes closed, vividly imagine that the feared event is happening. You hear the TV presenter announce “Hillary has conceded”. You see the newspaper headline “Trump President!” alongside a picture of a triumphant Donald Trump. Notice the thoughts and feelings that pop into your mind as you imagine that this is really happening. At this stage, do not try to apply Stoic principles. Observe what you feel like doing. Spend two or three minutes on this. Then open your eyes and make some notes on your experience.

Step 3: Group discussion of a wise Stoic response: Facilitate a group discussion about how to handle the adversity Stoically. Reflect first on Stoic wisdom, and then in turn the other Stoic virtues including self-control, justice, courage and practical wisdom. Summarise and write down key features of the Stoic response on a board or screen for all participants to see.

Step 4 Finding a wise Stoic alternative to each participant’s initial thoughts:  With these Stoic principles in mind, ask people to spend a few minutes working on Stoic responses to their initial thoughts that they wrote down at step 2. After a few minutes ask for sample answers so that participants can learn from the more confident and experienced Stoics in the group. Finally ask participants to spend a few more minutes in pairs or on their own developing their appropriate Stoic alternatives to their initial step 2 reactions. Ask them to write down their wise Stoic responses.

Step 5 Facing the fear again this time rehearsing the Stoic Response:  Each participant is asked to read to themselves their initial thoughts and their Stoic response which they have just been working on. Then, with eyes closed, they should vividly remind themselves of the adversity, their original non-Stoic reaction and then they should rehearse their Stoic response. They should repeat this several times. As they rehearse the Stoic response participants should particularly attend to what they feel like doing and what emotions they experience. Finally participants are requested to open their eyes and come back into the room.

The session concludes with participant feedback.

The New York Negative Visualisation Experience

So what happened when we tried this in New York?

Step 1: Preliminaries: It turned out no-one in the room supported Trump, or at least no-one admitted they did. Some people weren’t so sure about Hillary, either, though. There were a number of anti-Trump Republicans.

The practice of imagining one’s phone or ipad had broken worked well, allowing us to recall as a group the Stoic virtues and how they would help us deal with such an adversity.

What I hadn’t planned was a series of problems with the equipment – the lead to the projector did not fit my computer and when an alternative computer was provided, it could not read my presentation on my memory stick! That I managed to stay comparatively calm I put down to my having practised negative visualisation on something like this happening!

Step 2 : Visualising disaster: Table 1 below shows some of the thoughts, feelings and impulses participants experienced during the first part of the visualisation.

Emotion          Thoughts Impulse to
 

 

 

Anxiety

 

“Frozen like a deer in headlights”

“Women, minorities & immigrants will be marginalised & oppressed”

“Other countries will have a very negative view of America.”

“It will make us vulnerable to our enemies.”

“The Stock Market will plummet, economic depression with follow”

“Supreme Court Justices will be appointed who will destroy our American values and democracy”

 

Get tranquilizers

 

 

Drink

 

Distract self

Anger “How can so many people not see the truth?” Argue with everyone

Go on a tirade

Depression

 

Despair

 

“Trump represents everything I disagree with”

Hide in Bed

Give up

Emigrate!

Table 1: Pre-Stoic Reactions to visualising Trump being elected President

Anxiety was the most common emotion, it manifesting viscerally as being “frozen like a deer in headlights”.   Participants imagined themselves handling their anxiety by using distraction, drink and medication. Anger, depression and despair were also present in the room as we imagined Trump winning, with people thinking they might go on a tirade if angry and hide in bed in despair. It appeared that we had plenty of material to work with …

Step 3: Group Discussion of a wise Stoic Response: What would be the wise Stoic response to Trump being elected? I have increasingly found it helpful to present Stoicism in a somewhat simplified form as a distinct form of virtue ethics with a set of associated practices. The most distinctly Stoic virtue, “Serenity Prayer Wisdom” is stated by Epictetus at the very beginning of the Enchridion

Some things are in our control and others not. Things in our control are opinion, pursuit, desire, aversion, and, in a word, whatever are our own actions. Things not in our control are body, property, reputation, command, and, in one word, whatever are not our own actions.

The cardinal virtues of wisdom, self-control, justice and courage sum up how we should think and what we should do in the domains of knowledge, desire, other people and fear respectively. For completeness, I include love of humanity as part of justice and persistence as part of courage.

Looking at how to respond to an adversity through the lens of each virtue provides a very practical framework to determine a wise Stoic reaction. Table 2 below summarises how this framework can help us think about a Stoic response to Trump becoming President.

Stoic Virtue Meaning Application
“Serenity Prayer” Wisdom Focus on what you can control and accept what you cannot control. Unless you can legally challenge it, you have to accept the result You can however change how you respond to it, and the challenge is to respond virtuously.
Self-control

 

Knowing how to act and feel well in situations arousing emotions such as desire, appetite, lust & blame Self-control may be needed to manage impulses associated with anger and despair, such as feeling like going on a tirade or staying in bed and giving up.,
Justice & Love of humanity

 

Knowing how to act and feel well in our relationships with other people, at individual, family or communal level, knowing how to act generously and with positive benevolence, with friendship and affection.

 

Most obviously justice and love of humanity entail thinking about those likely to be negatively impacted by Trump how you can help them.

At the same time justice impies considering how to be just to democracy itself and to those who felt so disenchanted that they voted for Trump

Courage & Persistence Knowing how to act and feel correctly in situations of danger, in facing things seen as fearful (above all, death and other ‘disasters’) or in the face of setbacks. Overcome the impulse to give-up – the values are still worth standing and fighting for, all the more so.

Reflect on this might be a time for putting pleasure to one side and campaigning for what is right.

Practical Wisdom

 

Given the situation I find myself in, what would the Stoic sage do? What virtues can help, and how can I best aim to achieve what matters?

 

What in practice do can I do? What I need to do? What resources and skills have I got that will be useful? What would I need to do? How could I do it?

Which virtues will I need to employ given my specific thoughts I had in step 2 of this Negative Visualisation?

Table 2: The Stoic Virtues, their meaning and application

A key point that emerges is that Stoicism is not a passive philosophy. Whilst an Epicurean response might be along the lines of “there is nothing I can do, so let’s work on how I can be tranquil”, justice and love of humanity entail that the Stoic engages with the world and its problems, practical wisdom gives us the wherewithal to think up good solutions and courage provides the means to overcome fears related to doing the right thing.

Step 4: Finding a Stoic reframe for your specific initial thoughts: We were now in a position for participants to review their original thoughts and reframe them, given what they had just learnt about Stoic virtue. Epictetus famously said that “It is not events that upset you but how you interpret them”. Would we find this to be the case here?

Emotion Pre-Stoic Thought Stoic Alternative Thought Resulting Stoic Emotion
Anxiety

“Frozen like a deer in headlights”

“Women, minorities & immigrants will be marginalised & oppressed”

“Other countries will have a very negative view of America.”

It will make us vulnerable to our enemies.”

“The Stock Market will plummet, economic depression with follow”

“Supreme Court Justices will be appointed who will destroy our American values and democracy”

“It may not be as bad as I imagine. I may be overestimating how much difference a President can make. I can make a difference – I can be a grassroots activist for causes I care about – I need courage & wisdom”

 

Feeling more tranquil

 

Anger “How can so many people not see the truth?” People have their reasons & concerns which I need to understand. I also need to work at helping more people understand my view More understanding

Feeling calm acceptance

Depression and Despair Trump represents everything I disagree with” I accept the fact that he is President, I will do what I can to mitigate the damage Strength that I can handle the situation”

Table 3: Finding Alternative Stoic Wise Rational and Virtuous Responses

Table 3 above shows that Stoicism can indeed lead to more constructive thinking and less turbulent emotions.

Instead of being so anxious like a deer frozen in headlights, the Stoic response, “It may not be as bad as I imagine. I may be overestimating how much difference a President can make. I can make a difference – I can be a grassroots activist for causes I care about – I need courage & wisdom”, led to participants feeling much more tranquil.

Anger was replaced by some empathy with those who voted for Trump and a determination to work harder at making one’s views understood.

Strength supplanted depression and despair, as soon as people applied Serenity Prayer wisdom and accepted that Trump was President and determined to do what they could to mitigate the damage.

Discussion

Many participants told me that they had been helped by this Negative Visualisation exercise. I repeated it later at the London Stoic event, with similarly positive results. This is hardly surprising, since we have the positive testimony of Seneca, Epictetus, Marcus Aurelius and others. Moreover Negative Visualisation combines features of two evidence-based modern psychological techniques, exposure and mental contrasting.

Exposure is the “gold standard” for tackling anxiety. If you are frightened of dogs, for example, to overcome the fear you need to expose yourself to the dogs in a suitable manner[2]. A similar principle applies in some treatments for worry The first part of Negative Visualisation, where you think vividly about the feared object, clearly involves exposure and so should be expected to reduce the anxiety and the shock if and when the adversity occurs.

Mental Contrasting is a recent technique advocated by Oettingen as an alternative to positive thinking. Suppose you have an important interview next week. Whilst positive thinking might entail you imagining the interview going well, mental contrasting involves imagining likely difficulties and then mentally rehearsing what you need to do to overcome potential problems. Mental contrasting has been shown to help people achieve their goals, for example in weight loss and stopping smoking. Clearly the second part of negative visualisation resembles mental contrasting, so once again one would anticipate that negative visualisation would be beneficial. The key difference is that Negative Visualisation has a broader scope than mental contrasting, pertaining not just to goals and achievements but to adversities in general and living virtuously in spite of them.

There is good reason then to expect Negative Visualisation both to reduce anxiety, shock and worry and to develop character and virtue. The feedback from the New York and London workshops was certainly encouraging. However for this to constitute serious research further investigation is required. For example, each participant could be given a questionnaire before the workshop detailing their emotions and likely actions relating to a specified adversity. The same questionnaire could be completed at the end of the workshop by each participant.. If the adversity relates to a shared real life concern (such as Trump being elected) participants could then be contacted again and asked to fill in the questionnaire. The results compared to a control group who did not attend such a workshop. Future Stoic Weeks could provide an opportunity to engaging in research about the benefits of Negative Visualisation.

This experience of doing two Negative Visualisations in a group setting has also led me to conjecture that there may be significant advantages in doing negative visualisations as a group exercise. In the first place, each participant gets a sense that they are not alone, that their concern is shared by others. More importantly perhaps, the group, guided by the facilitator, can help participants learn wise Stoic responses to specific adversities. Table 3 (above) certainly helped me cope when Trump actually was elected President! So perhaps more Negative Visualisation workshops could be held, on a variety of human concerns, in person or potentially virtually through the internet.

One thing Negative Visualisation clearly could not do was stop Trump being elected President. But that, as Epictetus would remind us, is the point. We cannot control events, but we can control our response to them.

[1] although they do not give it that name

[2] To do exposure successfully it should be repeated, at an appropriate level and you should not leave the situation until the anxiety comes down.

Tim LeBon can be contacted via email on tim@timlebon.com. His website is http://www.timlebon.com

Interview: Walter Matweychuk

Walter Matweychuk will be one of the speakers at the Stoicon 2017 Stoicism Conference in Toronto, on October 14th.

Q: How would you introduce yourself and your work to our readers?

I am a clinical psychologist who has the good fortune of having work I love. I conduct around thirty-five adult outpatient individual and couples psychotherapy sessions a week at the University of Pennsylvania and in my private practice in Center City Philadelphia. The problems of everyday living I help people with range from coping with emotional problems such as depression, anxiety, anger, and phobias to behavioral disorders like addictions, to resuming one’s life in the aftermath of rape, serious accidents, medical illness, and failing to obtain tenure.

I also train and supervise doctoral level externs in Rational Emotive Behavior Therapy (REBT), the pioneering form of Cognitive Behavior Therapy, as well as teach a graduate course in Cognitive Behavior Therapy Theory and Applications at New York University in New York City. I maintain the website, REBTDoctor.com, which contains a great deal of freely accessible audio and video on Rational Emotive Behavior Therapy and do professional writing as well. I just completed, along with Dr. Windy Dryden, a book for professionals entitled Rational Emotive Behavior Therapy: A Newcomer’s Guide. In short I am a practicing psychologist who also trains and teaches psychologists, writes on and disseminates Rational Emotive Behavior Therapy.

Q: How do you currently make use of Stoicism in your work?

I use Stoic ideas and Stoic quotations to teach people how to effectively manage their emotional and behavioral responses to both relatively small to immensely challenging adversities. I use Stoic ideas to potentiate my interventions as an REBT psychotherapist. Stoicism works hand in hand with Rational Emotive Behavior Therapy because Dr. Albert Ellis, the originator of this distinct form of cognitive behavior therapy, heavily borrowed from Stoicism to create Rational Emotive Behavior Therapy. Although I primarily recommend to my patients REBT self-help books for homework, I have also recommended Bill Irvine’s book A Guide to the Good Life: The Ancient Art of Stoic Joy as a homework assignment to my patients.

Q: When and how did you first become interested in Stoicism?

I am continually striving to enhance my skills as a REBT psychotherapist and self-actualize as an individual. I want to have the happiest and most meaningful life possible with the only life I assume I will ever have to live. I also especially want to share Rational Emotive Behavior Therapy with the widest possible audience. Knowing Ellis borrowed heavily from Stoicism I assumed that by retracing the steps he took through reading the Stoics I might make further headway in accomplishing my previously stated personal goals. I am continually searching for ways to deepen my understanding of REBT and studying Stoicism seemed like a way of doing this.

Q: What’s the most important aspect of Stoicism to you?

The emphasis on identifying and focusing my effort on what is well within my domain of control and more or less being indifferent to those aspects of life and any given set of circumstances I cannot control. This single concept offers me incredible emotional leverage as I face personal adversity and as I teach and help my patients how to more effectively respond to their adversities. Secondly, when doing psychotherapy it is important to find language that resonates with patients in order to facilitate deep level emotional change. Although REBT has very powerful language associated with it, I judiciously sprinkle in Stoic quotes and ideas in order to keep the therapeutic dialogue fresh and interesting. Language and words in psychotherapy are like keys on a keychain. It is sometimes hard to know in advance which key will open a particular lock. By knowing and studying Stoicism I have some philosophical keys to try in my effort to open the emotional locks I am trying to pick, if you will.

Q: In what ways do you think Stoicism still matters today?

Despite our great scientific and technological advances since the time of Epictetus people continue to struggle to manage their emotions, find meaning and happiness, and have difficulty coping with losses, deaths, medical illnesses, defeats, failures, and injustices. In my view Stoicism and Rational Emotive Behavior Therapy are efficient, powerful, and self-liberating tools I want to share with my fellow citizens of the world. Life is hard enough without needlessly making it harder by trying to control that which is outside our domain of control, while overlooking what is well within our sphere of control.

Q: How has Stoicism affected the way you live your life?

Stoicism and Rational Emotive Behavior Therapy have immensely affected the way I live and the quality of life I enjoy. I no longer experience depression, anxiety, anger, envy and shame as I once did going way back to high school and even before that. When I do have a flash of one of these very self-defeating and unhealthy negative emotions I quickly swap them out for healthy negative emotions. I do this by examining my philosophy and any rigid and extreme attitudes operating at the moment so that I am better able to do what I can do, if anything, to favorably influence the situation I am facing. Let me explain.

In high school I began to see that my perceptions of reality impacted my painful emotions. As a college student at the University of Pennsylvania I worked closely with Dr. Aaron Beck who originated (about five years after Ellis had created Rational Emotive Behavior Therapy) the second and a somewhat different form of cognitive behavior therapy. Beck’s Cognitive Therapy emphasizes and focuses on the inferences we make about reality and showed me how to check these inferences for erroneous assumptions and distortions in order to make certain these inferences are accurate and consistent with the available empirical data. This helps one’s emotions quite nicely when in fact our inferences about a given situation are distorted.

For example, if I have a medical symptom and think, “I have cancer and will die in the near future”, slowing down and checking to see if this is an accurate inference by consulting a physician will help alleviate my panic. However, what if in fact my inference is unfortunately correct and I do in fact learn the empirical data suggests I have an aggressive form of cancer and will likely die in a year or at most two. This is where Beck’s Cognitive Therapy begins to have some difficulty and where Stoicism and Rational Emotive Behavior Therapy shine.

These two closely related philosophies will enable me to face this existential adversity and cope with it. By having deep conviction in the liberating overlapping philosophes of Stoicism and REBT I do not have to panic or despair. I can choose my emotional destiny and still can have some degree of happiness right up to the end of my life. Although helpful in less dire situations, Stoicism and REBT are the philosophies to turn to when your worst nightmare is your reality. Since learning REBT and Stoicism I no longer fear the worst case scenario in my life when I think of things that might go wrong. I also am better able to have some happiness when things go wrong despite their presence in my life. In essence now that I know REBT and Stoicism I change what I can change and move on when I cannot change anything and still find a way to have some pleasure in my life despite the presence of adversity.

Q: What’s one of your favorite Stoic quotations and why?

There are so many great Stoic quotations, so this is a very challenging question for me to answer. It used to be Seneca’s “Bring the mind to bear upon your problems” but it no longer is my favorite. I will select another by Seneca which is “Anger, if not restrained, is frequently more hurtful to us than the injury that provokes it.” I have selected this one simply because so much self-inflicted and other-inflicted damage and pain results from this unhealthy negative emotion whether one is angry at another person, himself, or in response to the situation in which he finds himself. This emotion is so seductive and yet so destructive that mastering the ability to not yield to anger at the tempting moment is an essential life skill if a person wants to be his best. Whether you hold anger in or let it out, anger significantly diminishes your creativity and problem-solving ability and can, paradoxically, undermine the persistence you bring to bear to solve the problem you face. I have also seen how anger corrodes or can suddenly end relationships, and the resulting pain that ensues from a moment of anger can be enormous and lifelong. I often silently say to myself as a way of preventing getting angry “Anger defeats me. Do not yield to it.”

Q: What advice would you give someone who wanted to learn more about Stoicism?

My guess is that if you are interested in Stoicism you are also interested in applying this liberating philosophy to your life. With that in mind I have two recommendations. I would read books on both Stoicism and REBT because there can be a synergy created by doing this. I would start with Bill Irvine’s book titled A Guide to the Good Life: The Ancient Art of Stoic Joy as it is so very accessible. Then I would go onto Epictetus’s Discourses. To me he is the hub of Stoicism. I would attend Stoicon on a regular basis to see and hear how Stoicism can be applied in different ways and meet fellow Stoics. I would regularly read Massimo Pigliucci’s website How to Be a Stoic as he seems to be quite the Stoic scholar.

I would also study the many self-help books written by Albert Ellis and Windy Dryden on Rational-Emotive Behavior Therapy. I sometimes think of REBT as the Cliff Notes of Stoicism or as a distilled, highly concentrated form of Stoicism. You will see how REBT efficiently teaches you how to implement the wisdom of Stoicism. You might even go and study the freely available audio and video found on my website REBTDoctor.com to facilitate your understanding of REBT. Finally, I would read a Stoic Quote every morning and write it on an index card. Carry it with you and try to find opportunity to apply that insight to any adversities you encounter during the day. Ryan Holiday’s book The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living would be a good source of useful Stoic quotations along with daily commentary Holiday makes on the meaning and implementation of each quotation. Most importantly attempt to use Stoicism (and REBT) to learn Stoicism! As Epictetus said “Learning that does not lead to action is useless.”

Q: Do you have anything else that you wanted to mention while we have the chance?

Life is hard for all of us. Stoicism and REBT can help you more effectively respond to life’s adversities and to self-actualize. These philosophies can help you either quickly terminate or entirely side-step needless suffering. Learn these powerful philosophies and then be a good model of them to others. When they display curiosity about how you maintain such equanimity in the face of adversity then introduce them to both Stoicism and REBT. Let them know your secret!