M. writes, “I consider myself to be a very unfortunate person. I have been afflicted with disease since the age of 15 (I am now 30) and went through war (Libyan civil war in 2011) during which my family and I lost relatives and friends, and also most of our material possessions; we now live as refugees. I managed to cope with all these misfortunes and more until a couple of years ago I was hit by the worst adversity I have ever had, a psychotic episode because of which I lost my mind in complete madness (delusions, hallucinations, etc.) for a few months. I was hospitalized against my will and forced to take antipsychotic medications.”
“I did however recover later on and gradually started gaining my self back. The doctors later told me about my condition and the worst news was that the likelihood of relapse is very high, just 15-20% of patients have only a one-off episode while the majority relapse and go on to develop a full-blown schizophrenia. So far through my reading of Stoic philosophers I find myself faced with a troubling issue. My problem is not with externalities that won’t affect my ability to lead a virtuous life. My problem is with the constant threat of losing my own mind on which the ability to exercise virtue depends. I fear losing the very thing that Stoics say is all you need to be self-sufficient. I feel hopeless in preparing for such an event as I will not have the means by which Stoicism (or anything else) would help me. I feel that my situation is beyond hope and that nothing can help me and see that the only way out of this is death. However, I can’t even kill myself because of my family and how hard it would be on them if I did. I am just trapped in this horrible nightmare. Please advise me on this as it is not something that I find ancient Stoics have dealt with.”
I truly feel awful about your situation, M.. I can hardly imagine what it would be like to experience one of the things you have endured, let alone the full set. Seems to me you have already demonstrated to be a Stoic in the best sense of the word. I will not address the war and consequent loss of friends and relatives, or your current status as a refugee, because those aren’t really the main question you are asking. And by comparison with the main question, they are actually easy, so to speak. The real issue is your mental condition, so let’s talk about that one.
The Stoics don’t refer to situations like yours, partly, I assume, because mental illness was of course far less understood then than it is now. But partly also because you are correct: mental illness strikes at the heart of the very thing that makes it possible to practice Stoicism — or any philosophy of life, really: what Marcus calls the ruling faculty.
“Different things delight different people. But it is my delight to keep the ruling faculty sound without turning away either from any man or from any of the things that happen to men, but looking at and receiving all with welcoming eyes and using everything according to its value.” (Meditations, VIII.43)
Indeed, Marcus famously said that the mind is an impregnable citadel, within which one can always retreat and bar the rest of the world, with its turmoil and lack of serenity:
“The mind that is free from passions is a citadel, for man has nothing more secure to which he can fly for refuge and repel every attack.” (Meditations, VIII.48)
But in your case the attack is from within, not from without, demonstrating that when Epictetus said that what is “up to us” includes our “opinion, motivation, desire, aversion, and, in a word, whatever is of our own doing” (Enchiridion, 1.1) he was being a bit optimistic, as there are situations when there is little that is our own doing, including some opinions, motivations, desires, and aversions.
I won’t lie to you. Stoicism is not a cure for mental illness. Indeed, it isn’t a cure for anything, it is a philosophy of life, not psychotherapy, and even less so, of course, psychiatry. My colleague Lou Marinoff, author of Plato, not Prozac!, a book about philosophical counseling, wrote in the Introduction to it that, despite the title, sometimes you do need Prozac, i.e., medication, in order to bring your mind back to more or less normal functioning. But once you manage that, you will still be faced by life’s problems, and that’s where philosophy kicks in.
This means that your initial preoccupation should be medical: get the best care you can, given the circumstances. I did a bit of research on this (which I’m sure you have too, so this is really for the benefit of other readers), and the first line of attack are antipsychotic drugs, probably of the kind you have already been administered. While they do have side effects, they commonly go away or are reduced significantly after a few days, and your doctor can work on finding the right dose.
After that, psychosocial treatments are helpful and often successful in order to learn coping skills and arrive at as normal a life as possible. People with schizophrenia can still manage to hold jobs and pursue a more or less normal life, with a combination of medications and learned skills. I hope you can achieve that much, your situation is not hopeless, even though it is very difficult.
What about Stoicism? Well, I think it enters the equation at two different levels: one is right now, the second one in case you really should develop full blown schizophrenia but will be able to manage the disease as sketched above.
First, the here and now. You are facing a situation that is clearly outside of your control. There is good reason to think that schizophrenia is actually a family of conditions sharing similar symptoms, not necessarily a single disease. There is evidence that suggests a genetic basis (which is obviously outside of your control), but people without a family history may develop it as well. Among the environmental causes listed by the NIHM web site are: exposure to a virus, malnutrition before birth, problems during birth, and a rather generic category labeled “psychosocial factors.” Again, hardly something under your control.
The Stoic practitioner, then, has to focus on how to handle the condition, both with regard to himself and to his loved ones. Seneca said:
“The wise man is sufficient unto himself for a happy existence, but not for mere existence. For he needs many helps towards mere existence; but for a happy existence he needs only a sound and upright soul, one that despises Fortune.” (Letter IX. On Philosophy and Friendship, 13)
Despising Fortune is something that is easy for someone like me to say, given the privileged life that I’ve lived so far, but your conditions — both what you have experienced in term of externals and your disease — really put your resolve to the test. Nobody is a Sage, but you should take comfort in the fact that you have been able to deal with your situation so far, and that your thoughts still go out to your family, clearly showing that your character is a good one, despite the incredible amount of “dispreferred indifferents” you have experienced thus far.
Indeed, I know few other people to whom this quote by Marcus clearly applies:
“The art of life is more like the wrestler’s art than the dancer’s, in respect of this, that it should stand ready and firm to meet onsets that are sudden and unexpected.” (Meditations, VII.61)
You have certainly met more than a fair share of sudden and unexpected onsets. And yet what you should do know, from a Stoic perspective, is clear: remind yourself that the universe isn’t after you, it is just that Fortune has dealt you a series of bad hands, not through malice, but by chance. It isn’t anyone’s fault, and certainly not your own. What is up to you is to play those hands to the best of your abilities, which means with integrity, concern for others (especially your family, who has been going through really hard times anyway), and by fighting the disease insofar as you can.
Which brings me to phase two, what happens if, in fact, the condition comes back. I have already mentioned that there are practical steps you can take, depending on what access you have to medical facilities (which I’m sure is limited, given your current life situation). You may also want to prepare yourself by reading a number of testimonies of Stoic practitioners who have dealt with mental illness, of a variety of kinds.
For instance: here is an article by Andrew Overby on depression; two articles (here and here) by Chris Peden on autism; and one by Zachary Augustine on diverse issues, including anxiety, obsession, depression, and chronic conditions. It may also help to talk to other prokoptontes afflicted by the same problem. For instance, here is a forum at PsychCentral initiated by someone who has schizophrenia and is interested in Stoicism. I’m sure there are others around, and you could probably find more people either with your same condition or who have something helpful to say about it at the now very large Facebook Stoicism community.
Let me stress again, that none of the above is a cure. Stoicism is a philosophy of life, not a kind of therapy or medical procedure. And yes, beyond a certain point, if our inner citadel has been severely damaged from within, then there is no talk of Stoicism or any other philosophy of life. However, I sincerely hope you will be able to fortify your defenses in such a manner that you will hold your citadel and live a life worth living within the human family.