'Is Stoicism for the Mentally Ill, too?' by Ian Guthrie

Is Stoicism for the Mentally Ill, Too?

A Reflection on the Clinical Use of Marcus Aurelius’ Mediationsmental-illness-unemployment

Ian Guthrie, BA

In my own studies of Stoicism, I had come to recognize some similarities between the subject matter and certain counseling perspectives such as Rational Emotive Behavioral Therapy (REBT), founded by Albert Ellis, and Cognitive Behavioral Therapy (CBT), pioneered by Aaron Beck. The population I work with consists of individuals with a wide age range from young adult to elderly, who are considered to be seriously and persistently mentally ill (SPMI). The majority of these clients are diagnosed with bipolar disorder or a type of schizophrenia, and a smaller percentage experiencing other mental illnesses including anxiety disorders or traumatic brain injuries. Considering the benefits that individuals receive from CBT and REBT, I thought they might also benefit from understanding the ancient philosophies, so I began considering how to educate them in stoic philosophy.

I selected Marcus Aurelius’ Meditations because it provided short passages that could be broken up more easily and discussed within the time constraints of the sessions. The challenge hinged on my ability to translate Mediations into something accessible to this population of SPMI adults. I decided to keep the audience small: a weekly men’s group I had recently begun facilitating became the forum because it allowed more opportunity for each member to explore his thoughts as needed.

Our sessions progressed slowly. After each passage, the group would take time to explore where the information was coming from historically as well as how it could be applied to their contemporary lives. Early on, none of the members showed either great enthusiasm or an overwhelmingly negative response. Clients were quietly receptive but offering only occasional remarks. However, after we finished the first book and began the second, a new client joined the group. I asked if any of the more seasoned clients would like to explain what we were discussing. One of the clients, “John,” who suffered a traumatic brain injury, with resulting memory issues, spoke up. He described Meditations and recalled the brief biographical information about Aurelius I had given the very first day, with a minor embellishment. “And this Marcus Aurelius guy is one badass dude.” At that point, it was obvious that these clients had developed some personal investment.

Our sessions continued and they are currently ongoing. We are entering the ninth month and have only covered up through half of the fifth book. Different topics received varying levels of reception. For the purposes of brevity, I will highlight three topics, in no particular order, which seemed to resonate most with my clients.

The first of these topics is personal productivity and following through with natural duty. Meditations v.1 reads, “At day’s first light have in readiness, against disinclination to leave your bed, the thought that ‘I am rising for the work of man’.” The passage goes on to discuss that to love one’s self, one would “love your nature, and nature’s will.” This was a fairly long passage. The clients usually have difficulty comprehending what the longer passages are about, but this one resonated to such an extent that many of them needed no interpretation. They understood, and they summarized the message perfectly. One client, “Peter”, diagnosed bipolar I, spoke about how he had always struggled with motivation, but he always felt better after being able to work on something and be productive. Most of my clients have been judged unable to maintain employment and receive government support. However, each noted having the desire to contribute to society. So, we spent time discussing how each member could satisfy his natural duty. Some have since begun taking steps to follow through on their ideas, such as volunteering or pursuing hobbies.

The second Stoic topic that resonated with the group is self-regulation by rational thought. This is a topic that is mentioned frequently in Mediations and is a key concept in Stoicism. Several passages prompted lengthy discussions on the topic, such as the suggestion to “put from you the belief that ‘I have been wronged’, and with it will go the feeling. Reject your sense of injury, and the injury itself disappears” (iv.7).

Following this reading, there was a brief discussion that beliefs prompt emotions which can affect how we carry ourselves through our daily lives, when all that need be done to control the emotions is to regulate those beliefs with rational thoughts. The men began sharing previous experiences where they had been successful in practicing this, such as being able to control themselves when confronted with aggressive and irritating drivers, or unsuccessful and envisioning how they ought to have acted differently.

One client in particular, “Bruce”, diagnosed with paranoid schizophrenia, struggles greatly with paranoid delusions. When I read one of the passages relating to self-regulation, he immediately referenced his thought disorders, describing how hard it is to cope with from time to time. I encouraged him, in moments of particular paranoia, to consider his emotions and the thoughts that prompted those emotions and to embrace as reality only what he knew empirically. He has subsequently reported some small success in the management of his paranoia. As I have encouraged him to process his thoughts, he has begun to practice this on his own.

The third topic is that of understanding natural events, not as good or evil, but as indifferent. Having a mental disorder is something that I point to specifically when this comes up. Stoicism encourages us to view events, like having a mental illness, toward which some in the group have harbored resentment for limiting their opportunities, as a thing that does “neither elevate nor degrade; and therefore they are no more good than they are evil” (ii.11). Rather, they should hold the perspective of the headland being constantly assaulted by waves, to adopt the view, “not, ‘This is a misfortune,’ but ‘To bear this worthily is good fortune’” (iv.49).

When considering natural events, the idea of death is brought up, by both Aurelius and my clients alike. This is observably more difficult for some to accept than it is for others as a non-evil, natural indifferent. When mentioned as “no more than a process of nature” (ii.12), some clients did express some difficulty accepting this view. They described their experiences of friends dying at young ages and even some of their own brushes with death. In the Stoic sense, seeking death prematurely, such as is entertained in suicidal ideation, is in conflict with our natural duty to be productive members of society. However, in instances of a seemingly premature death (such as when a non-group member, female fellow client died suddenly of natural causes), Stoic philosophy would question the very idea of prematurity, “for the sole thing of which man can be deprived is the present” (ii.14). This usually prompts contemplation among the clients, and something I expect to discuss more as the topic is brought up in future sessions.

The following can be gleaned from these sessions. First, my clients seemed to have benefited, not just from the topics presented in Meditations, but also from the philosophical depth of ideas. They have been challenged intellectually and engaged in healthy thought. Second, Stoicism provides a blend of both simple guidelines and complex concepts which have allowed the men the opportunity to engage Stoicism at their own level. Third, Stoicism, in its embrace of the rational, has the potential to provide SPMI clients with intellectual tools to aid them in addressing a world which may appear, by virtue of their respective delusions, overly irrational. Take for instance, the example of Bruce and his paranoid thoughts that cause him to view the world in emotional context. He has been developing the tools necessary to separate his emotions from his view of reality. Further, individuals with bipolar diagnoses suffer mood swings which affect their approach to life. Through encouraging a thoughtful and rational approach, they may learn to lessen the impact that their moods swings have.

I admit to having some reservations before electing to share Stoic philosophy in the form of Marcus Aurelius’ Mediations with my clients. This was not because I doubted the worth of Stoic philosophy itself, but because my clients, individuals diagnosed SPMI, have somewhat impaired functioning and reasoning. This entire endeavor might have proven to be an exercise in futility. Even if the clients could comprehend Stoic teachings, they may have had no interest in them. However, in light of our sessions and to supplement conventional psychotherapies like REBT and CBT, I fully intend to continue on with Meditations and beyond as long as my clients will listen, because they have reported Stoicism has had a beneficial effect on their lives.

About the author:

Ian Guthrie, BA, is a graduate student pursuing licensure as a professional counselor. He is a psychosocial rehabilitation worker for a community mental health center in Kansas City, Missouri.

10 thoughts on 'Is Stoicism for the Mentally Ill, too?' by Ian Guthrie

  1. 3dbloke says:

    Oh no! Not another “head clutching” picture.
    There’s a campaign underway in the UK at present, aiming to encourage the use of images that are less stereotypical and narrow in their interpretation of what it means to have a mental illness.
    See http://www.time-to-change.org.uk/getthepicture

  2. Ronald Pies MD says:

    Hi, Mr. Guthrie,
    As a psychiatrist with a strong interest in CBT/REBT, and Stoicism, I found your comments extremely interesting, though not surprising. I do think there are profound connections between Stoicism and CBT/REBT (it is an oversimplification to lump these together, but for shorthand purposes, I am doing so). I discuss many of these connections in the book Patrick Ussher kindly referenced in one of his postings (Everything Has Two Handles). You may also be interested in this paper, below.–Best regards, Ron Pies MD
    World Psychiatry. 2014 Oct;13(3):244-50. doi: 10.1002/wps.20149.
    The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments.
    Thase ME1, Kingdon D, Turkington D.
    “In summary, CBT for psychosis is a very promising and evolving development
    (24). The evidence is clear that it reduces suffering, but it is offered to
    very few people in very few countries. Psychiatrists (25), mental health
    nurses (26) and case managers (27) have all been demonstrated to be able
    to effectively and safely use CBT in working with their patients with
    schizophrenia. Training is available, and there are many mental health
    workers – and their patients – who could benefit from using more
    effective and acceptable recovery-focused ways of working.
    National psychiatric associations and governments need to address
    problems with dissemination of CBT as a matter of urgency.”

  3. Jeffrey Allen says:

    It is gratifying to see how beautifully this ancient wisdom tradition lines up with modern therapeutic modalities such as CBT. It is also encouraging to see how effective these methods can be even for people with profound psychological challenges. In truth, we are all “mentally ill” to some extent. Even the most “well adjusted” people in our society habitually look to externalities for happiness and fulfillment–certainly a symptom of deep delusion–and the neurotic and persistent pursuit of things that do not serve their purpose can only be seen as a kind of collective insanity, more pernicious for being unrecognized and untreated.

  4. Ted Pomeroy says:

    Thank you, Ian. This is a good opening for all of us, ill or not. I do appreciate your caring and intelligent use of “Meditations” with your clients. Well chosen examples in this article, too.

  5. Ian Guthrie says:

    @ Dr. Pies, I rather enjoyed the article you linked to. Thank you. I have ordered a copy of your book. I am in the midst of my practicum at the moment, but look forward to reading it as time permits.
    @Jeffrey Allen and Ted Pomeroy, thank you for your thoughtful and encouraging remarks.

  6. royalmaverick says:

    Hi Ian,
    As someone with an SPMI, I found the question you ask in the title rather insulting, as if the mentally ill were too mentally challenged to understand philosophy. Plenty of people with SPMIs follow a philosophy, a belief system, or a religion, and the vast majority of us know right from wrong. Just because a person is sometimes too distracted by moods, delusions, or hallucinations to fully participate in mainstream society does not necessarily mean that they cannot figure out a way to cope with their illness, provided they have the insight to do so — and a lot of us do.
    I’ve been fortunate. I work full-time and have a relatively normal life by mental health professionals’ standards. I’ve worked very hard to get here, and it turns out that many Stoicism-influenced therapies helped me to get where I am: REBT, CBT, Logotherapy (I own _Man’s Search for Meaning_), some forms of meditation practices I do, and so on. I am looking into Stoicism because it seems to be the inspiration for a lot of things that led me to the road of recovery, so I expect to get a lot out of it.
    My hope is that your patients get the strength they need to at least partially recover from Stoicism and Stoicism influenced therapies. It’s obviously not a cure-all, but it can’t hurt.
    It’s just frustrating when therapy practitioners like you — and I’d say it’s the majority of you — don’t see any chance of people like me recovering. The fact that you believe such is very obvious to us, and I think practitioners/experts, are, at least in part, to blame for our lack of recovery. People tend to meet expectations, and you don’t have any, so people give up.
    I suppose it’s up to defiant people like me to show you, in a positive way, that many of us are capable of being productive members of society.

    • Patrick Ussher says:

      This is the blog’s editor. I appreciate your comments on the piece’s title, which I must admit I had thought of changing. I left it as it was, however, because the answer Ian provides to his own question is such a resounding and overwhelming ‘yes!’. For this reason, I believe the title of his piece should be read in the context of his argument as a whole. With kind regards, Patrick

  7. Michael Wilkinson says:

    yes , but it has been around for a very long time

  8. Ian Guthrie says:

    Thank you for fielding that comment, Patrick.
    @royalmaverick, I certainly agree with your criticism of the typical treatment of SPMI populations, which is the very reason why I have been bringing Stoicism into my work as a psychosocial rehabilitation worker.

  9. Andrea says:

    Excellent article! Thank you for sharing. I’m 24 years old and in recovery of anorexia nervosa, depression and anxiety disorders. My doctor is not sure, but I might have cyclothymia. So I read this to see if stoicism can help my therapy, and after your text, I’m now going to buy Meditations by Marcus Aurelius and discuss it with my psychotherapist.
    So truly, thank you.

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