Stoic advice: I have cancer, people tell me to be positive

[Feel free to submit a question for this column, but please consider that it has become very popular and there now is a backlog, it may take me some time to get to yours.]

P. writes: “I am 46 occupational therapist (and Masters student) with a 15 and 13 yo and husband. My parents are Dutch and I’d say I was raised as a Stoic, from what little I know so far. Interestingly my husband appears to be also — he’s an adopted Canadian Aboriginal. I have been living with metastatic (or stage 4) breast cancer for 6 years now. Having stoic tendencies, my husband and I have run with the idea of expect the worst, hope for the best. However, there is pressure in cancerland to be positive all the time and believe your experience has been a blessing. It ain’t btw. I sometimes catch myself wondering if thinking about my death will hasten it. And people get angry and defensive with me when I speak of having a terminal illness ‘you’re going to get old and grey, don’t say that!’ But it is — I’m 3 yrs past median life expectancy. Don’t bring up the hit by a bus thing — in 2010, 4100 Americans died as pedestrians hit by vehicles and over 40,000 died of mbc. I’d hedge my bets on the bus. To date I’m an outlier but I deal with tremendous anxiety and depression. Please could you suggest how to communicate authentically with people putting this pressure on me and remind me that thinking about death will not make it happen sooner. And how to deal with the anxiety and grief living terminally brings. I try to keep living — studying, running, volunteering, advocating.”

This is arguably the toughest situation I’ve encountered in this column, and I’m going to tell you up front that there isn’t going to be any magic bullet coming later. But you know that, of course. I am terribly sorry for what you are going through. The ancient Stoics would have actually been more comforting than I’m going to be, since they believed in an interesting kind of Providence. Not the Christian variety, of course, since their God was Nature, which doesn’t answer prayers and is not concerned with individual human beings. But since the universe itself was thought of as a living organism, then every single one of us was, in a sense, a functional part of that large organism. That meant that whatever happens to us is actually for the best of the entire Cosmos, even though we don’t realize it.

Epictetus put it poetically in Discourses II.10.3-4 (the bits in square brackets are my commentary):

“You are a citizen of the cosmos, and a part of it, and not a subordinate part, but a principal part of it [because you are a rational being, not a rock]. For you are capable of understanding the divine administration, and of reasoning on what follows from that. What then is the profession [the job, right behavior] of a citizen of the world? To have no private gain, never to deliberate as though detached from the whole, but to be like the hand or the foot, which, if they had reason and understood the constitution of nature, would never exercise impulse or desire, except by reference to the whole.”

Or consider this, from Discourses II.6.9-10:

“So Chrysippus did well to say, ‘As long as the consequences remain unclear to me, I always hold to what is best fitted to secure such things as are in accordance with nature; for God himself [i.e., Nature, the Cosmos], in creating me, granted me the freedom to choose them. But if I in fact knew that illness had been decreed for me at this moment by destiny, I would welcome even that; for the foot, too, if it had understanding, would be eager to get spattered with mud.'”

The problem is, if you are not a pantheist, then the above quotes aren’t going to be much more than poetry. Beautiful, but not helpful.

So let’s try to get to the helpful parts. I’ll address two different issues: the attitude toward your disease, and the attitude toward those people who relentlessly put pressure on you to be optimistic no matter what.

In terms of the cancer itself, then, you say that you “try to keep living — studying, running, volunteering, advocating.” Exactly. That is the only good thing you can do, until you will be able to do it. And it’s a lot, and of high value.

As Seneca puts it: “The good in life does not depend upon life’s length, but upon the use we make of it; also, that it is possible, or rather usual, for someone who has lived long to have lived too little.” (Letters, XLIX. On the Shortness of Life, 10)

And of course, as he and Marcus tell us several times, we have no idea how long we are allotted by the universe. Indeed, the very idea of someone dying “prematurely” is bizarre, as if we knew the workings of the cosmos well enough to figure out that someone died “before their time.” Come to think of it, for a Stoic or anyone else who subscribes to the existence of a universal web of cause-and-effect, there is no such thing as “before their time.” Things happen when they happen, and they happen because of whatever took place before.

Seneca also wrote about the preciousness of time: “What man can you show me who places any value on his time, who reckons the worth of each day, who understands that he is dying daily?” (Letters, I. On Saving Time, 2)

So it isn’t about length, it’s about quality. Yes, of course we would all like to live longer, nobody actually looks forward to dying (except under extreme circumstances of duress), but there are plenty of people who live far longer than others and yet arrive at the end of their existence and can’t point to anything worthwhile they have been doing with all that time. This semester I am teaching an intro philosophy class at City College, and when we got to David Hume I told my students: “so, the guy had come up with most of his brilliant ideas — for which we study him two and a half century after his death — by the time he was 25… What have you been up to, lately?” They laughed, but they got the point.

So do like Seneca advices: “Hold every hour in your grasp. Lay hold of to-day’s task, and you will not need to depend so much upon to-morrow’s. While we are postponing, life speeds by.” (Letters, I. On Saving Time, 2)

Which means keep doing precisely what you are doing: keep living — studying, running, volunteering, advocating. And keep loving your children and your husband, enjoying every minute you spend with them even more because you know the time is limited. Of course, the time is always limited, and I discovered to my own chagrin that I took the existence of both my parents for granted for far too long, postponing a visit here, shortening another one there, until they were both gone forever.

None of the above will spare you “the anxiety and grief living terminally brings,” as you put it. Stoicism isn’t a magic wand, and you would not be human if you didn’t feel anxiety and grief. But the general philosophical framework that is Stoicism will help you both accepting what is happening (since it is not in your control) and making the very best of every hour you have (because you have your priorities right, and a heightened sense of urgency).

If I were in your place I would also worry about how the last act of your disease will unfold, and about retaining my dignity as a human being until the end. Be sure you and your husband make whatever preparations you feel appropriate for that time, it will help alleviate your anxiety, knowing that you have planned whatever is possible to plan.

Along similar lines, I can give you a piece of advice that is helping me. While not suffering (fate permitting) of a terminal disease right now, I have always been anxious about contemplating my own death. And indeed this is one of the reasons I eventually turned to Stoicism. I found that a major way of alleviating my anxiety about the demise of my consciousness is to prepare (and from time to time revise) an ethical testament. This is a Judeo-Christian, not a Stoic tradition, but as Seneca often says to his friend Lucilius, I borrow the truth wherever I find it. Some people write an actual document to pass to their friends and family after they die, containing a summary of their views on life, references to things they found meaningful or important, advice to the next generation, and the like. For my part, I’m working on a slide presentation, which allows me to include graphics to enhance my message to whoever is important to me and will survive me. I find the activity to be both anxiety-relieving and a surprising exercise in self-discovery.

Now to the second issue: how to deal with those well intentioned people in “cancerland,” as you say, that want you to be positive all the time, and believe that your experience has been a blessing.

To begin with, you could try some dose of evidence-based medicine. Like this beautiful article by Barbara Ehrenreich, who went exactly through your same situation. I know cancer survivors who absolutely love Ehrenreich for telling it like it is, and for countering that relentless artificial optimism that is bothering you. I would also send those same well intentioned people this article by Jane Brody, about what not to say to a cancer patient. There are several others like these that may be helpful. Who knows, someone might get the message, or at least think twice before coming back for more.

The second approach I would try may surprise you, and perhaps you will feel uncomfortable about it, in which case don’t try it. You know how some religious people get offended when you point out anything that doesn’t go well with their particular faith? And they go on to say that you should respect their choices, no matter how much you disagree with them? Well, learn something from that playbook. Stoicism is not a religion (though some people disagree with me on this point), it’s a philosophy. Nevertheless, nothing stops you from answering the next optimist you run across with something like: “Look, I really appreciate your concern, but it goes against my chosen philosophy of life, and I would ask you to please respect that, just as you would a religious faith.” Who knows, they may become curious and ask you about Stoicism, thereby giving you a chance to teach them some Epictetus!

But remember, for a Stoic people don’t actually do bad things on purpose, they are simply mistaken about what is good, they suffer from amathia, or lack of wisdom (here is an essay on that topic). Which for us Stoic means we need to remember the words of Marcus:

“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)

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Categories: Stoic Advice

8 replies

  1. I once used Ehrenreich’s book Bright-Sided (https://www.amazon.com/Bright-sided-Relentless-Promotion-Positive-Undermined-ebook/dp/B002SKDGQ0/ref=sr_1_1?ie=UTF8&qid=1492267481&sr=8-1&keywords=bright-sided) as a text in a composition class. She shows how this relentless emphasis on positive thinking for cancer patients makes them feel guilty if, in fact, they don’t recover (as if they would have if they had only been more positive). Positive thinking is insidious, in this case and many others, but it is so ingrained in the American psyche that people will defend it nevertheless–at least, my class did.

    Liked by 3 people

  2. Thanks for writing in with this question P as you’ve helped all of us learn about a subject – death – that many find challenging. Contemplating our own death is a hard prospect but if huge benefit as it will come to us all. All the very best!

    Liked by 2 people

  3. Professor Pigliucci thank you for posting on this topic which is relevant to my life. Professor at age 15 in 1971 I was diagnosed with a malignant thymoma. I underwent surgery, systemic chemotherapy and radiation therapy.

    By all medical criteria I was cured of my malignant thymoma.

    Unfortunately professor, in 2014 I was diagnosed with my second cancer, a Myelodysplastic Disorder. Myelodysplastic Disorder may have been to damage to my bone marrow due to my prior radiation therapy and systemic chemotherapy for my prior Malignant Thymoma, or it have occurred simply because I have an increased genetic susceptibility due to my prior Malignant Thymoma.

    Professor, although I have studied Stoicism since age 15, and I am now 60 years old, I still consider myself to be a novice Stoic.

    Stoicism has helped me greatly in my life, but the issue raised by the original poster is an issue that for me causes cognitive dissonance and makes me question the completeness of Stoicism.

    The issue professor is does Stoicism ask us to attempt to achieve an ideal that is not possible.

    In the Enchiridion III, Epictetus admonishes us to remind ourselves of the impermanence of things.

    Professor Pigliucci, I acknowledge my impermanence, and even acknowledge that my mortality and potential upcoming death due to my Myelodysplastic Disorder is something that is beyond my control, but professor I still feel an emptiness.

    I am not afraid of death. I subscribe to Epicurus’s argument that it is irrational to fear death.

    But, even accepting and understanding Epictetus’ ‘dichotomy of control” I still feel negative emotions as I face a medical condition that may result in my death.

    Please accept my apology in advance if I have not been clear in expressing the thoughts that I am trying to convey to you.

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  4. As a terminal cancer patient myself and fierce advocate for Medical Aid In Dying laws, I found this blog post very enlightening. I appreciate P (a friend of mine) asking you these questions and how you answered. Your perspective will help me when I am faced with these questions again.

    I also appreciated that you considered end of life and what that would look like if you were in our position. This is a topic very few are comfortable talking about, let alone death in general. I’m currently working to help bring Aid-in-Dying laws to NYS as I do not want to go through the dying process that awaits me. I much prefer being able to take a medication that will allow me to go to sleep and skip the suffocating or starving or seizures that may happen. I don’t feel its necessary to have to go thru pain and trauma during the dying process and I certainly don’t subscribe to the notion that helping my death come sooner will have a negative impact on my spiritual energy.

    Again…thank you. Many will benefit from your thoughts and words of advice.

    Liked by 2 people

  5. As someone who is also a facing potentially terminal illness, I would like to recommend Dr. Irvin D. Yalom’s “Staring at the Sun: Overcoming the Terror of Death”.

    He discusses Epicurus’s argument that it is irrational to feature death.

    Epicurus’s argument has given me comfort since age 15 when I faced my first cancer.

    Dr. Yalom does not specifically discuss death and Stoic approaches to death, but he does allude to active and passive euthanasia which the Stoics commented upon.

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  6. Ronald,

    No apologies are necessary. The problem you run into isn’t, I think, an issue of the incompleteness of Stoicism. It’s that we are human beings, and Stoicism is a (powerful) philosophy of life, not a magic wand. It is meant to be helpful, and you yourself acknowledge that it has been in your life. But it is perfectly human to feel the way you do, and it would be stunning if you didn’t. There is no cure for the human condition.

    Stickit,

    Thanks for your comments. In the book that is coming out on May 9th, How to Be a Stoic (yes, same title as this blog…) I actually talk in detail about Epictetus’ “open door” policy and how it relates to assisted suicide, referring in particular to a recent case in California, which just passed a law allowing for the practice. I’m hoping New York will too, soon, and I thank you for your efforts in that direction!

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  7. The thing about the onslaught of positive thinking is a lot of those people are being selfish whether they know it or not. That reaction typically comes from a place of not liking how your problem is making them feel. This isn’t always true of course but in general it’s a very selfish way to handle someone trusting you with their ffeelings/problems. They probably don’t know how to handle it or what to say too. You have a chronic illness- you’re allowed to have anxiety and grief and be unhappy about it sometimes. If you are a constant ball of misery I can kind of understand them but from what I’ve seen as a chronically ill person myself and from friends with cancer, people tend to react to any expression that’s less than positive with this type of response even if you rarely talk about it.
    If I were you, next time one of your friends/family starts in on that I would just tell them, “hey -I am not depressed and I’m not going to be constantly worrying about this but it’s on my mind right now and talking to you helps. When you say things like that (the relentless optimism) it makes me feel like I can’t talk about this.”
    You probably listen to them venting about their bad days and personal arguments with their partner or whatever and I bet you try to listen and be as supportive as you can, right? They need to just allow you to express/process your feelings in this situition, even if those feelings make them uncomfortable sometimes.

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