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)