“Stoicism and Illness” and “Stoic Resilience versus Stoic Virtue” by Carmelo Di Maria

This post provides a summary of Carmelo Di Maria’s presentations at the London STOICON-X 2017 conference.  This is the second in our series of posts drawn from Stoicon and the Stoicon-X conferences this year.
For over a year now I have been running a Stoicism group in London called “London Stoics” (you can find us on Facebook) and I am also a member of the Resources Committee within the Stoic Fellowship. About three years ago I came across Stoicism after a sentimental crisis. I was taken by the whole philosophy but two of the things which most struck me were: one, the idea that you create your own reality (“People are not upset by things but by the judgements they have about things” is the famous maxim by Epictetus) and two, the concept of the ‘indifferents’.
The first aspect was familiar to me. I was already a fan of Cognitive Behaviour Therapy and pretty much skilled at most cognitive distortions: over-generalizations, black and white thinking, jumping to conclusions, mind reading. I also loved the idea of ‘reframing’, trying to look at something from a different perspective in order to change your ensuing feelings and behaviour. The second aspect that took my fancy, illness seen as an indifferent, constituted in a way yet another example of reframing, but this time one of Herculean proportions, I thought.
As a person living with a chronic condition, it was in particular the idea of illness as an indifferent that struck a chord with me. In Italy when you’re being affected by a major problem, in common parlance people will tell you: “As long as you’re healthy, you’re ok”, in order to cheer you up. As if health was the supreme good. But the Stoics were telling me another story – the supreme good in life is ‘virtue’ and that was definitely within my reach, unlike health. Illness stopped being this bogeyman that weighed me down and made me feel less than ‘healthy’ people. I immediately felt liberated and self-empowered, I was not a ‘victim’ of personal circumstances anymore.
So I decided to write an article about my experience of Stoicism and the relationship between the philosophy and illness and I sent it to Patrick Usher, who was at the time the editor of the Stoicism Today blog. Patrick went on to publish it on the blog (you can find it as “Stoic Resilience in the Face of Illness“) and also told me my piece would be included in a collection of articles from both academics and non-academics called Stoicism Today: Selected writings, vol. 2.
Fast forward two years.  I decided to make a presentation highlighting the same relationship between Stoicism and illness, this time with the intent of sharing my experience with other people living with chronic conditions (PLCC), to see whether anyone could gain any benefit out of the philosophy, just like I did. I also thought that the London Stoicon X 2017 event would be a brilliant opportunity for a test run and for some feedback from a knowledgeable audience.
Hopefully there is a bit for everyone in this presentation regardless of health status, even for those who are not living with a chronic condition like HIV, cancer, diabetes, MS… you name it. With the exception of a few quotes from the Stoic literature which specifically refer to illness, the rest can be easily interchangeable with any major difficulty people find themselves in – big financial loss, severe injury, disability, loss of a partner/child/relative.
In the overview I have identified all those aspects of Stoicism which can offer a person with a chronic condition a fresh perspective on life and a renewed sense of self-esteem, strength, resilience and pride, not to mention what is the ultimate goal for a Stoic, ‘Virtue’.
Overview of my presentation:

• Stoicism as a philosophy of resilience
•  Illness as an Indifferent
• Death as an indifferent
• Shortness of Life as an Indifferent
• Post-Traumatic Growth
• Excellence of Character

The first item in the presentation points to the CBT aspect of Stoicism, if you like – the way that the philosophy shifts the focus from one aspect of reality to another, creating a whole different ball game. It does not define the philosophy in its entirety – and it would be a reductionist approach and a disservice to a whole philosophical system such as Stoicism to say otherwise – but it’s nonetheless one of the popular and characteristic aspects of it.
“Illness as an indifferent” – according to Stoicism a person is not confined or constricted by her health condition, i.e. her health condition does not define her as a person, but rather it is only one aspect of it and an ‘indifferent’ one at that. To paraphrase Epictetus, her illness affects her body, but not her ‘choice’, not her ability to pursue ‘virtue’.
“Death as an Indifferent” and “Shortness of Life as an Indifferent” follow the same Stoic reasoning around our locus of control and the central if not superlative quality of ‘virtue’. They are both relevant to PLCC in that the latter may have a keener sense of the transiency of life and of their own mortality.
“Post-Traumatic Growth” (PTG) is the idea that after a trauma like acquiring an illness or going through some other major crisis (especially if it entails a brush with mortality), it’s not all loss or doom and gloom, but you can actually gain something out of it – the person experiences some sort of growth, in terms of psychological strength (“what doesn’t kill me, makes me stronger”, as the saying goes), of confidence, maturity, spirituality, a keener sense of gratitude and an ability to enjoy life more.
The Stoics didn’t define it like that obviously, this is a modern coinage, but often refer to this concept, sometimes through the use of beautiful metaphors. Hercules is also referenced, within the Stoic literature, as an epitome of strength and resilience in the face of adverse circumstances. It was important for me to talk about PTG because even when I attended in the past workshops specifically aimed at PLCC and whose goal was to help people manage their condition, this was a concept that was never explored.
In a presentation about Stoicism, I could not help but mention the ultimate goal for Stoics – pursuing “virtue” or “excellence of character”. I reckon that a chronic condition may act as a spur to pursue virtue thanks to that heightened sense of mortality I referred to earlier. Especially if a person living with a chronic condition embraces a philosophy of life like Stoicism, he will be more keen to make every day count, to get his priorities right, to lead a life of purpose and strive for excellence of character.
Finally, I should mention that I was also given the opportunity to lead a workshop in the afternoon which I entitled “Stoic Resilience versus Stoic Virtue”. The reason I picked that title is that I found many quotes within the Stoic literature which express the idea that a person who endures or overcomes a difficult situation displays virtue, and also that challenges are seen as an opportunity to achieve virtue (“Calamitas virtutis occasio est”, Seneca says in his essay On Providence).
The problem is that it’s a virtue that is talked about mainly in terms of patience, resilience, strength, endurance (generally qualities which we would list under the cardinal virtue of courage). And of course this is only one aspect of the multi-faceted notion of “virtue” which also includes temperance, wisdom, and justice. So during the afternoon discussion, my idea was to elicit the difference between these two different aspects of the Stoic virtue, unravel the links between them, and perhaps find out ways in which life challenges can not only lead a person to display virtue in the sense of resilience but also lead to virtue intended in its more complex meaning.
Just to give you a few examples of what I mean, PLCC may have used all sorts of support services in their lives, ranging from medical care to psychosocial support, complementary therapies and friends & family, therefore chances are that they become aware of the great help they received in the way of competence, professionalism, empathy, patience, understanding etc. They understand the value of this help and may be inclined to help other people themselves in any way they can, developing this way the virtue of justice. Some PLCC, for example, often speak of wanting to get into volunteering as a way to “give back”.
PLCC may be likely to internalise the Serenity Prayer and make a difference between the things they can’t control (like their health status) and those they can (like their diet, level of fitness, their mental health etc), thus developing ‘wisdom’. They may have learnt to curb their irrational desire to be other than what they are and learnt to accept their health condition, coming to terms with the fact that they are ill (temperance).
The same way a notion of health which is not holistic and is purely based on the integrity of the body is fragmentary and insufficient, glorifying the aspect of fortitude, in isolation, and to the detriment of the other virtues, especially justice (when we talk about illness or any other sphere of human life for that matter) may be misleading and a fallacy. Even Marcus Aurelius, himself struggling with a chronic illness all his life, was aware that he owed much to relatives and mentors for the shaping of his character but at the same time contributed much to the education of future generations through his own reflections and the example of his own life.
At the end of the day one of the best ways to bring about self-healing, whether it’s an illness or some other problem, is to break free from the shackles of our self-absorption, elevate ourselves and have a good look around, finally integrating ourselves into a much bigger picture both in terms of time and space, just like we do in the “view from above”. It’s a brilliant practice which encourages to abandon the illusory idea of a being a discreet entity and become part of the whole instead. After all “to heal” means “to make whole”.
Carmelo Di Maria lives in London where he works as a TV listings writer. He’s interested in LGBT/human rights, secularism, stress management and mindfulness. For the past year he has been running the London Stoics group. One day he hopes to be able to offer a blend of mindfulness and Stoic reflective meditations to people with chronic health conditions.