The Stoic Nurse: Philosophy at the Frontline of Mental Health Crisis — by Paul Sutton

I work as a Registered Mental Health Nurse in an NHS Crisis Team in the UK. My role brings me face-to-face with people at their lowest points—when life has collapsed so completely that the future feels inconceivable, and death appears to be the only escape. Often, my task is to stand at that fragile threshold where despair meets survival, helping to create a safe space where, together, we can begin to understand what has brought them to this moment.

My training covered diagnosis, medication, rating scales, and a range of psychotherapeutic interventions. Yet little was said about the essence of being human. The role itself remains difficult to define, and no one seems able to fully agree on what a mental health nurse actually is. The best description of my work comes not from nursing textbooks but from philosophy. The Hellenistic schools often spoke of the philosopher as a “physician of the soul,” with philosophy itself acting as a kind of psychological medicine. The Stoics even referred to their teaching as therapeia—therapy for the psyche. In many ways, I see my role in the modern world as continuing this tradition: helping people discover what it means to live a good life, or as the Stoics would put it, to pursue eudaimonia.

Working with people in crisis, I often observe what I call the “unholy trinity” of human suffering: anger, fear, and sadness. These emotions overwhelm the senses, distort perspective, and trap people in regrets about the past or fear about the future. Yet these are the very emotions Stoicism addresses most directly. For me, Stoicism is not a bookish philosophy, or an abstract concept but a set of practical tools that confront psychological distress more effectively than many modern, overly academic, psychotherapeutic approaches.

Over time, I’ve seen how Stoicism overlaps with modern therapy, particularly Aaron Beck’s “Cognitive Behavioural Therapy “(CBT) and Albert Ellis’s “Rational Emotive Behaviour Therapy” (REBT), as synthesised in Donald Robertson’s The Philosophy of Cognitive-Behavioural Therapy. Both modalities encourage people to examine their thoughts differently, regulate their emotions, and focus on what they can realistically control.

What follows are three Stoic skills I use in my own life and in my work with people in acute mental health crisis. They come from Epictetus, Seneca, and Marcus Aurelius, and remain as relevant today as they were two thousand years ago.

Dichotomy of Control

“Some things are up to us and some are not.” Epictetus, Enchiridion, 1.1

When people are in crisis, they often feel powerless. Everything seems out of control—much like Zeno, the founder of Stoicism, when his ship was wrecked near Athens and he lost everything. From that loss, he turned to philosophy as a framework for endurance and direction, a reminder that from profound setbacks can come new ways of living.

This sense of entrapment drives despair, often leading to ‘paralysis by analysis’. Epictetus begins his Enchiridion with a simple division: some things are within our control, others are not. It sounds obvious, but in a crisis it can be transformative.

When I work with someone, I help them sort through the differences. For example:

Within our control: whether they answer the phone, take a short walk, use grounding or breathing techniques, reach out to a trusted friend, follow their safety plan, or accept medication offered.

Outside our control: how others respond, whether a partner returns, what professionals decide, waiting times for services, or how quickly life circumstances change.

This simple distinction changes everything. Instead of being trapped in “I can’t cope, it’s all too much,” people begin to see small, realistic steps. The impossible becomes smaller; the unmanageable becomes practical.

This way of thinking also echoes the principles of biomedical ethics that guide nursing practice. Respect for autonomy is about helping a person recognise what remains within their control and supporting their right to act on it. Beneficence and non-maleficence remind us to use that awareness with compassion, encouraging steps that foster safety and growth whilst guarding against harm. Justice calls us to see each person not as a problem to be solved, but as a human being of equal worth. Both Stoicism and medical ethics return us to the same point: focus on what belongs to the person, protect it, and build from there.

Fact or Opinion

“We suffer more often in imagination than in reality.” Seneca, Letters from a Stoic, 13

Seneca highlights something modern psychology confirms: much of our suffering does not come from events themselves, but from how we imagine them. Anxiety thrives on “what if” thinking—What if I lose my job? What if I never get better? What if something terrible happens? Albert Ellis, the founder of REBT, warned against the tyranny of “shoulds and musts.” Thoughts such as “The world should treat me better” or “I must get better or I’m a failure” only deepen suffering.

In a crisis assessment, I often slow the conversation down with one key question: “Is that fact, or is that opinion?”

For example, the facts might be: “I’m safe right now. I’m reaching out for help. I have people who support me.” The opinions might be: “Things will never get better. Everyone thinks I’m useless. Nobody would care if I were gone.” We often call this ‘checking your thinking.’ It can be done with friends, family, or mental health professionals. Here, the Socratic method adds even more value. Someone might say, “Life is terrible—it will never get better!” The response is to gently ask: “What do you mean by ‘life’—every part of it, or just this moment? What do you mean by ‘terrible’—unbearable, or simply hard? And how do you know it will never change?”

Defining terms breaks down vague, global statements into specifics that can be explored and challenged. This simple distinction—fact or opinion, definition or assumption—helps people separate what is real from what is imagined. Often, what once felt overwhelming begins to shrink once it is named.  Seneca’s warning remains true: imagination often makes things worse than reality. And Ellis’s reminder is just as sharp—our “shoulds and musts” chain us to demands life never promised to meet. Naming them helps break the chain. Fact anchors us; opinion can drown us.

Cognitive Distancing and the View from Above

“To see them from above: the thousands of animal herds, the rituals, the voyages on calm or stormy seas, the different ways we come into the world, share it with one another, and leave it.”

Marcus Aurelius, Meditations, 9.30

Marcus Aurelius speaks of the ‘view from above’—a way of stepping back from the deluge of daily problems and demands to see life with greater clarity and perspective. The philosopher Pierre Hadot called this an “oceanic feeling”: a sense of belonging to something larger, where personal pain is put into proportion by the vastness of human life.

In mental health crisis, thoughts feel absolute. A person might say, “I’m worthless” or “I can’t take this anymore.” These thoughts are powerful because they are experienced as truth. But the Stoic view from above invites perspective. It creates distance, reminding us that we are part of a bigger picture. From that higher vantage point, problems lose their agonising grip. They don’t disappear, but they no longer define everything.

This has clear parallels with modern mindfulness, which teaches us to notice thoughts and feelings without being swept away by them—to step back, observe, and allow them to pass. In practice, I’ll often encourage people to reframe with a question like: “What would you tell yourself, if you were sat where I am?” That small shift creates distance between the person and their situation. It is a mindful pause that loosens distress and opens space for choice.

From the position of ‘oceanic feeling’ suffering is still there, but it is not everything. It becomes one wave in a wider sea.

Ancient Tools for Modern Crisis

As a Mental Health Nurse working with people in acute crisis, I’ve seen how Stoicism can bring calm, composure, and direction into the all-consuming and potentially fatal grip of mental illness. What strikes me most about Stoicism is its practicality. These ideas were never meant to remain in lecture halls or as abstract theory, they were designed for living. They are tools for those moments when anger, fear, or sadness overwhelm us, and nothing seems possible.

Teaching people to focus on what they can control, to separate fact from fiction, and to take a wider perspective can make the difference between spiralling further into crisis or taking the first step toward recovery.

For me, this is not a clinical theory but a lived philosophy. I use these skills to stay resilient in the face of challenges, and I share them with service users who feel hopeless and adrift. They offer guidance and direction when little else seems available. The overlap between Stoicism and modern therapy is no accident. Both rest on the same keystone: we cannot always control what happens, but we can control how we respond.

In crisis care, that lesson is not just philosophical—it can be lifesaving.

References

Beck, A. T. (1979). Cognitive therapy and the emotional disorders. Penguin.

Dryden, W., & Neenan, M. (2007). Rational emotive behaviour therapy: 100 key points and techniques. Routledge.

Ellis, A., & MacLaren, C. (2005). Rational emotive behavior therapy: A therapist’s guide (2nd ed.). Impact Publishers.

Epictetus. (2024). Selected discourses: The wisdom of Epictetus: The Stoic classic. Capstone Classics.

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

Marcus Aurelius. (2002). Meditations: A new translation (G. Hays, Trans.). Modern Library.

Robertson, D. (2010). The philosophy of cognitive-behavioural therapy (CBT): Stoic philosophy as rational and cognitive psychotherapy. Karnac.

Seneca. (2021). Letters from a Stoic: The ancient classic (D. Robertson, Intro.). Capstone Classics.

About the author

Paul Sutton is a former frontline Police Officer and now a Registered Mental Health Nurse within the NHS, working as part of a Crisis and Home Treatment Team in the UK. He is particularly interested in how Stoic philosophy can be integrated into modern clinical therapeutic practice to respond to the growing prevalence of mental health challenges in today’s society. His work focuses on adapting ancient wisdom for use in crisis intervention, with an emphasis on resilience, recovery, and reflection as pathways to practical philosophy for everyday life. Paul is also keen to connect with others who are applying Stoicism in clinical practice.