Stoicism and Suffering

May 29th, 2023

Emperor Marcus Aurelius on his horse (175 AD, Rome)

Let’s start our series on suffering and spiritual paths by asking, “Can stoicism can help a terminal patient?”

A month ago, a friend called to say he admired how I live with cancer: “You’re a stoic.” The Stoics were a school of philosophers and statesmen in Ancient Greece and Rome. I asked him to explain, and he said,

From my point of view, it looks like you treat tough situations and terrifying developments as opportunities to deepen your knowledge and build your strength of character.

Kind words, but he’s wrong.

The best-known stoic writer is Marcus Aurelius Antoninus (121-180 AD), Emperor of Rome from 138 to 161 AD. He became Emperor not through birth or coup d'état but by adoption. Marcus was born during the reign of Hadrian (78-138 AD), to the latter’s nephew. Hadrian adopted Antoninus Pius as his new heir, and Antoninus, in turn, adopted Marcus. When Hadrian died in 138, Antoninus succeeded him; when Antoninus died in 161, it was Marcus. Adoption allowed Emperors to select and anoint talented successors from within the ruling class.

Edward Gibbon (1737-1794) called him the last of the Five Good Emperors (Nerva, Trajan, Hadrian, Pius Antonius, and Marcus). Niccolò Machiavelli (1469-1527) viewed him as wise and just (albeit weak). The historian Cassius Dio (155-238), Marcus’s near contemporary, called him the last Emperor of the Pax Romana, an age of relative peace and stability from 27 BC to 180 AD.

If that era was peaceful, I’d hate to see chaos. The Empire suffered a plague that killed millions. Marcus led his legions in wars on the Empire’s Northern and Eastern frontiers–modern Germany and Iran–for his entire reign. We should have no illusions about Roman warfare. The Emperor has a column in Rome celebrating his triumphs, depicting massacred soldiers, burned villages, and enslaved women and children.

Detail of the Column of Marcus Aurelius, Piazza Colonna, Rome (195 AD)

Marcus dedicated himself to the stoic way of life. His book, Meditations, does not report philosophical research. It’s a diary, the earliest such document that we possess. Marcus was not writing for publication; he wrote to improve his character and his life by applying Stoic principles.

On suffering, Marcus asserted that,

If anything external distresses you, the pain is not because of the thing itself, but to your estimate of it; and this you have the power to revoke at any moment. (Meditations, viii, 47)

Marcus argued that our thoughts, beliefs, and actions are the only things we control. Everything else—including the external world and others' actions—we cannot control. Regretting the effect of what we cannot control is futile, and complaining is ignoble. Worse, we suffer from incorrect beliefs or judgments about these external things. Some beliefs are incorrect because what we experience as harm–for example, loss of reputation–only appears to harm us.

So, when adversity happens, Marcus urges you to examine why you think it harmed you. Does the outcome matter? If it doesn’t matter, you should disconnect the event from your emotional response. You become indifferent to and thereby protected from what happens.

It’s enough if one’s current belief is true, if one’s current action has the common good as its objective, and if one’s current state of mind is the willing acceptance of every externally caused thing that happens. (ix, 6)

However, be aware that you can’t pretend something doesn’t matter; you must work to internalize this belief. You need inner strength to succeed in this work, so Marcus cultivated self-mastery. Using a military metaphor, he urged himself to build an interior ‘command centre’ free of false beliefs.

Clear your mind; control your impulses; extinguish desire; see that your command center retains its self-mastery. (ix, 7)

The Aurelius scholar Pierre Hadot translated ‘command centre’ as ‘Inner Citadel’ and summarized it as: “Withdraw into yourself. It’s natural for the Inner Citadel to be content with its actions' justice and the tranquility it will have as a result.” Tranquility happens when the citadel is impregnable.

Marcus was all in:

You must always consider, with Roman and masculine doggedness, how to tackle any matter that arises… That will happen if you treat every act as though it were the last of your life—which is to say, if you’re free from all stray thoughts and any deviation under the influence of passion, from the principles established by reason, and if you’re free from hypocrisy, self-love, and dissatisfaction with your lot. (emphasis added; ii, 5)

In brief, Marcus aimed to cultivate virtue and wisdom, including understanding what is under our control and what is not, and thus aligning our beliefs, judgments and desires. This requires the disciplined practice of understanding and managing our reactions, expectations, and judgments. He argued that this path led to peace, freedom, and happiness. Our goal is to maintain tranquillity and emotional balance, regardless of external circumstances.

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Marcus is popular in the tech industry; it’s easy to see why. The Emperor was an intellectual and a man of action. Schools that teach virtue require a saint whose life we want to emulate.

Jack Dorsey, founder of Twitter and Square, and a Stoic.

Stoicism fits our disenchanted secular world. The philosophers who inspired Marcus were rationalists and materialists. They held cosmopolitan views, seeing humanity as if we were all citizens of one large city, and our goal was to prosper and live in peace.

It’s easy to miss the most important thing about Marcus. Plato reported Socrates as saying that “the unexamined life is not worth living.” I’ve never heard anyone disagree. But have you examined your life today, and if so, what did you do?

Imagine Marcus hearing a sycophant on his military staff quote Plato on Socrates. He writes an acid note in his journal: “This fool flatters himself that he has examined his life.” Marcus not only preached self-examination but also did it rigorously, cultivating virtues–above all, self-mastery–and purging vices, including hypocrisy, narcissism, and resentment. His journaling practice would help anyone build character.

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I wonder, however, whether Silicon Valley stoics grasp that Marcus’s rationalism differs from theirs. Stoics were theists: they believed in the Logos, or universal reason, a divine rational principle that governs the cosmos.

The gods’ works are filled with providence; the works of fortune aren’t independent of nature or the interlacing and intertwining of things under providence’s direction. It is the source of everything, including necessity and the well-being of the universe, the whole of which you are a part. What is good for every part of nature is what is supplied by the nature of the whole and what preserves the whole; (ii, 3)

The Logos was the source of all laws of nature and our capacities for reason and virtue. Marcus believed he could conform his conduct and values to what nature demanded because nature was ordered to advance a benevolent purpose. His highest goal was serving the Logos.

It’s time now for you to recognize what kind of universe you’re a part of, and what kind of universal directing power you’re an emanation of, and that a limit has been set on your time, and if you don’t use it to dispel the mists, it will pass. You will pass, and the opportunity won’t come again. (ii, 4)

The Stoics held that the cosmos was a living coherent system whose rational beings comprised one community. What happened in that community was, therefore, a matter of divine providence. The universal community was not an abstraction or utopia; the best of all possible worlds was the Roman Empire. The one that Marcus ruled with fire and sword.

I do not share this view of providence. Our world is broken at its moral and social foundations. The philosopher Alasdair MacIntyre could have been describing me when he wrote,

A crucial turning point in [the] earlier history [of the West] occurred when men and women of good will turned aside from the task of shoring up the Roman imperium and ceased to identify the continuation of civility and moral community with the maintenance of that imperium.

The Pantheon, Rome (126 AD). Or is it the Jefferson Memorial, Washington, DC (1943)?

I was educated at Andover and Harvard, schools that select and anoint you to rule. Many classmates ascended to roles in government or finance; I stepped away. The Pax Americana is greater than Rome’s and superior to its totalitarian rivals, but it’s not my moral home.

A secular person might respond that she can practice Marcus’s self-reflection while rejecting his metaphysical commitments. She needn’t worship a divine Logos animating an imperial order. That’s correct. Yet Marcus’s faith in providence must have helped power his will. Can a secular build an impregnable Inner Citadel without his faith that his efforts align with the Will moving the cosmos?

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But our primary question is,

Can stoicism help a terminal cancer patient endure suffering?

It could. If you know about Cognitive Behaviour Therapy–the psychotherapy with the most robust evidence base–I invite you to compare Marcus’s practice against that technique.

However, imagine you have a tumour in the column of your cervical spine. It presses against your spinal cord, causing intense pain. Worse, the surgeons can’t operate. The tumour will kill you, but first, it will make you quadriplegic.

What would Marcus have you do? I take it you believe that control of your limbs affects your happiness. Is it credible that you could persuade yourself otherwise? Perhaps. Stephen Hawking proved that someone can live as if their happiness did not depend on mobility. But how many possess his strength, clarity, and resources?

And what would motivate such a profound self-transformation? Is building an impregnable Inner Citadel sufficient to power your will? Can you transform yourself just by reasoning about it? Wouldn’t that conversion require a change of heart, a revolution in cognition and emotion?

Marcus is the only character onstage in the Meditations. To be fair, he begins the book with heartfelt gratitude toward his family and his teachers. After that, others appear only when he scorns their faults. He doesn’t report a conversation that changed him; he’s not moved by love. The Emperor was a solitary hero, standing on the wall of the Inner Citadel, on the watch for hypocrisy and illusion.

Stoicism won’t get me through what I see ahead. The path must be emotional and cognitive, and I can’t traverse it alone.