S. writes: “I am a physician in Northeast Mexico. Recently I’ve been working at a small rural clinic, and I’ve been confronted with mistakes by other doctors working here, to which I don’t know how to properly react, I’ve pointed them out to the hospital administrators (so they won’t happen again, not looking for punishment for those who made them). Though I try to control my emotions as best as I can, I find myself constantly angry and complaining about this, which is not under my control, but I would like to know if there’s any Stoic advice to deal with this kind of situations, because I cannot remain silent, for these mistakes could cost someone’s life at worst, and a lot of money at least; yet administrators ignore my comments while this kind of things keep happening, and they even give us more work load (as some sort of punishment). To what extent should one keep complaining about things that are wrong? Even though they are not under our control, pointing them out so they don’t happen again is under our control.”
This is a really though situation, testing the limits of Stoicism as a practical philosophy. You obviously know the dichotomy of control, so there is no point in quoting Epictetus (though for people who want the reference, check Enchiridion 1.1). But something from Cicero will, I think, help put things in perspective. In De Finibus Bonorum et Malorum (About the Ends of Goods and Evils), written around 45BCE, he discusses Epicureanism, Stoicism and Academicism. In book III he imagines a dialogue with Cato the Younger, the Stoic role model, in order to present a number of Stoics doctrines. Here is what he says at 22:
“If a man were to make it his purpose to take a true aim with a spear or arrow at some mark, his ultimate end, corresponding to the ultimate good as we pronounce it, would be to do all he could to aim straight: the man in this illustration would have to do everything to aim straight, yet, although he did everything to attain his purpose, his ‘ultimate End,’ so to speak, would be what corresponded to what we call the Chief Good in the conduct of life, whereas the actual hitting of the mark would be in our phrase ‘to be chosen’ but not ‘to be desired.'”
The metaphor of the archer here stands for what Bill Irvine, in his A Guide to the Good Life describes as the Stoic internalization of our goals: to actually hit the target is not in our power, because it is affected by external factors, such as a sudden gust of wind, or perhaps the fact that the target itself moves (which is likely, if it is an enemy’s soldier). What is under our control, instead, is to do our best to hit the target, which includes practicing to improve our aim, taking care of the bow, making or acquiring well balanced arrows, and so forth.
While this is superficially similar to Epictetus’ dichotomy of control, it more explicitly concerns actions, and not just judgments, as the Epictetan version clearly refers to. In your case, your goal is to do the best you can to make your administrators listen and take action, but the outcome, whether they do, in fact, listen and take action, is just as outside of your control as Cato’s arrow.
It doesn’t follow, however, that you should cease your efforts. You have already been practicing the virtues of justice — because you want the patients to be treated fairly and their life not to be imperiled — and that of courage — by standing up to the administrators for what is right. It may, however, be time to flex the muscle of a third virtue, prudence, or practical wisdom, which tells you how to morally navigate complex situations. For instance, are there any of your colleagues who share your concern, and with whom perhaps you can join forces to gain the ear of the administration? Failing that, can you escalate the fight to higher levels of the administration, perhaps not at the place where you work, but at whatever higher structure from which it depends? If that too fails, maybe you can go to the authorities and denounce your administrators for willful negligence? Or you can contact a local paper to see if they are willing to run a story about the situation? Indeed, all the above mentioned courses of action could be pursued in parallel, or at least in rapid sequence.
In terms of your anger, it is certainly understandable, given the circumstances. But it isn’t useful, either for you or for your cause. As Seneca reminds us:
“In the first place, it is easier to banish dangerous passions than to rule them … There are certain things whose beginnings lie in our own power, but which, when developed, drag us along by their own force and leave us no retreat.” (On Anger, I.7)
The practical implication of this is clear: you need to nip your anger in the bud, not letting it develop and fester. To do this, use some simple cognitive distancing techniques: as soon as you feel anger begin to boil inside you, disengage from the situation by going outside for a walk, or retiring to the washroom for a few deep breadth. (In terms of breathing, in these cases do it using your diaphragm, not your chest, as it is more effective toward calming you down.)
You can also practice some negative visualization before beginning your shift: actually visualize one of your colleagues making a mistake, yourself taking control of the situation to repair the damage, and then talking to your colleague about it, not judgmentally, but with understanding and compassion. Or visualize your next encounter with a stubborn administrator, imagining yourself confronting him with the facts while maintaining a calm demeanor. Calm and deliberateness are most effective when talking to people, far more so than being agitated and raising one’s voice.
Your general attitude should be that of Marcus Aurelius when he was in the field, battling the Marcomanni:
“Begin the morning by saying to yourself, I shall meet with the busybody, the ungrateful, arrogant, deceitful, envious, unsocial. All these things happen to them by reason of their ignorance of what is good and evil. … I can neither be injured by any of them, for no one can fix on me what is ugly, nor can I be angry with my kinsman, nor hate him.” (Meditations II.1)
Of course, none of the above may work. You may fail to address the problem effectively despite your best efforts. At that point you have one last choice: either you keep working at the clinic with the chief goal of countering and minimizing your colleagues’ mistakes, or you quit in order to find work at another place, where you can help people more effectively. There are many people needing medical assistance, and one needs to balance the moral tradeoff inherent in these last two options: which one is better for both you and your patients? Where will you do the most good? If this is to be traded off for your own serenity, how much and for how long is it worth it? As always in virtue ethics, there are never simple answers to complex questions, but it is precisely through this sort of trying circumstances that we learn to practice our virtues and become better prokoptontes. It is worth recalling what Musonius Rufus, Epictetus’ teacher, wrote in Lectures I.6:
“Only by exhibiting actions in harmony with the sound words which he has received will anyone be helped by philosophy.”