Stoic advice: I decided for the wrong surgery, now I regret it

[Feel free to submit a question for this column, addressing it at massimo at howtobeastoic dot org. However, please consider that the column has become very popular and there is a backlog, it may take me some time to get to your question.]

M. writes: I’m struggling with the notion of regret. I’ve turned to the Stoics before in difficult times because their attitude can get us through a lot. But I’m stuck with this one. I understand on an intellectual level that it doesn’t make any sense to be wrapped up in tumults about a past event. But, like worry, I find it difficult to stop. Some specifics: I opted for a surgery that half of my doctors told me wasn’t necessary and the other half thought should have been done months ago. The surgery didn’t go well, and now I may be faced with a permanent disability. Had I not opted for the surgery, I would quite likely be perfectly fine. That slays me. I can’t get over that i did this to myself. I try to keep in mind how much worse others have it, and I try to focus on the here and now, and on what I have to be grateful for, but the regret rises up to ruin everything. How were the Stoics so able to get on top of these types of thoughts so well, or were they? To what extent are our own thoughts and feelings actually within our control?

The answer to your last questions are, respectively: practice; some were able to, some less so; and it depends on what one means by “thoughts and feelings.” Let’s take a closer look.

First off, it sounds to me like you have understood all the basic precepts. You know about the dichotomy of control, so you know that the past is not up to you. Which means that indulging in regret is — as you are experiencing all too clearly — a waste of your emotional resources. That is not to say you shouldn’t learn from your experience, of course, and in this case the lessons seem to be: (i) if your doctors are equally split in their opinions, seek the advice of more doctors, until some sort of pattern emerges; (ii) medicine is as much art as it is science, hence the disparate opinions of your doctors; and (iii) given that a lot of medical research is flawed, if something like this happens again you are probably better off taking the conservative route and not do surgery, unless a clear majority of your doctors thinks it’s obviously a good idea.

In terms of having to live the rest of your life with a permanent disability, you don’t specify what sort of disability, but this is obviously not a preferred indifferent. However, you may find strength and inspiration in reading the extraordinary story of a modern Stoic, Larry Becker (the author of A New Stoicism), as it is recounted, for instance, in chapter 10 of my How to Be a Stoic. Larry has been confined to a wheelchair for most of his adult life, but managed to flourish anyway. As he wryly puts it, “doing without a wheelchair is not a basic life goal.” (You can listen to a four-part interview I did with him here.)

In general, what you are running into is the common problem that one thing is to understand the theory, and an altogether different challenge it is to put it into practice. As Epictetus says:

“If you didn’t learn these things in order to demonstrate them in practice, what did you learn them for?” (Discourses I, 29.35)

And he also tells you what it means to practice:

“If from the moment they get up in the morning they adhere to their ideals, eating and bathing like a person of integrity, putting their principles into practice in every situation they face — the way a runner does when he applies the principles of running, or a singer those of musicianship — that is where you will see true progress embodied, and find someone who has not wasted their time making the journey here from home.” (Discourses I, 4.20)

Or consider this:

“If a man gets the habit of writing ungrammatically, his art is bound to be destroyed and perish. In the same way the modest man is made by modest acts and ruined by immodest acts, the man of honor keeps his character by honest acts and loses it by dishonest. … That is why philosophers enjoin upon us ‘not to be content with learning only, but to add practice as well and then training’. For we have acquired wrong habits in course of years and have adopted for our use conceptions opposite to the true, and therefore if we do not adopt true conceptions for our use we shall be nothing else but interpreters of judgements which are not our own.” (Discourses II, 9)

This is, of course, the same idea behind rational emotive behavior therapy, or cognitive behavioral therapy, both of which were initially inspired by Stoic practice.

Epictetus clearly recognizes that practice is much more difficult than theory, and that it requires years, because one has to undo the sort of bad habits of mind one develops during one’s upbringing as a non-Stoic. In your case, regret is considered by most to be a natural response to that sort of situation, so you have probably regretted all sorts of other things before, from very small and inconsequential ones to the one we are talking about now.

For you, then, “practice” may mean to start small, pick some minor regret you have, then analyze it — perhaps in writing, in a personal diary, or discoursing with a close friend about the issue. At the end of each round of analysis, tell yourself — loudly if it helps — that that was “nothing to me.” Then move to consider past events that are a bit more important to you, and finally come back to the surgery issue. Should this not be enough, then you may want to consider seeing a therapist (either REBT or CBT), focusing on this specific issue, and see whether that helps.

At the same time, please remember that neither therapy nor philosophy are panaceas for all maladies. As Seneca puts it:

“You must not think that our human virtue transcends nature; the wise man will tremble, will feel pain, will turn pale, for all these are sensations of the body. … It is a mistake on our part to make the same demands upon the wise man and upon the learner. I still exhort myself to do that which I recommend; but my exhortations are not yet followed.” (LXXI. On the Supreme Good, 29-30)

Which means that the prokopton, who is not a wise person, but only a student in training, will feel regret, anger, and all the other negative human emotions. The idea, however, is that she will make progress, and will be able to shift her emotional spectrum from negative to positive. If you are struggling, you are in good company, including Seneca himself!

That’s pretty much the answer to your first two combined questions: how were the Stoics so able to get on top of these types of thoughts so well, or were they? Some of them did better than others, but all were imperfect, from the above mentioned Seneca to Marcus Aurelius (who, in the Meditations, his personal diary, keeps coming back over and over to the same topics, presumably because he had slipped in his practice and was reminding himself of where the right path was).

Let me now get to your last question: to what extent are our own thoughts and feelings actually within our control?

As I explained in this post, modern cognitive science backs up a lot of Stoic intuitions about how the human mind works. In particular, research by Joseph LeDoux (author of Anxious: Using the Brain to Understand and Treat Fear and Anxiety, a book you may want to check out) confirms the Stoic distinction between propathos (the pre-reflective, instinctive reactions we have) and the mature, post-reflective emotions that the ancients then subdivided into pathē (negative, disruptive) and eupatheiai (positive, nurturing).

That’s the sort of distinction the led Epictetus to advice his students in this way:

“So make a practice at once of saying to every strong impression: ‘An impression is all you are, not the source of the impression.’ Then test and assess it with your criteria, but one primarily: ask, ‘Is this something that is, or is not, in my control?’” (Enchiridion 1.5).

It takes time, mindful effort, and patience to retrain our propathos away from the path of pathē and onto that of eupatheiai. That’s arguably the most difficult part of being a practitioner of Stoicism. But the result, if you succeed, is well worth the effort:

“If you have the right idea about what really belongs to you and what does not, you will never be subject to force or hindrance, you will never blame or criticize anyone, and everything you do will be done willingly.” (Enchiridion I.3)

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4 replies

  1. Perfect timing! I had surgery four years ago and realized that if I didn’t have this surgery (which I was told was necessary) I would have avoided four other surgeries, including a surgery to implant a medical device to help me relieve pain that the first surgery should have fixed. I am having real problems with regret and am mourning my loss of mobility. I am working hard to realize that this is what I have been delt, and I need to accept it and work around it. I am not quite there yet. Thank you for this piece and helping me along my journey.

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  2. Thank you so much for your thoughtful and provocative words here. In mulling it all over I realized my biggest problem with practicing is that I want it to all be better TODAY. It’s an effort to convince ourselves to continue working on something when the drive to have it finished makes it appear finished enough. I trick myself into thinking I already have practiced this attitude sufficiently, but I’m so clearly mistaken on that one! I wrote at length on this for anyone interested (brevity, like patience, is not my forté): https://apuffofabsurdity.blogspot.ca/2017/07/on-regret.html

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  3. I really sympathize with M’s difficult position. Epictetus, of course, also struggled with a disability. And I remember somewhere in his discourses he is asked (or he rhetorically asks himself) if he considers himself free, and he responds that he wishes that were so, but that he still overvalues his body and its health. It’s relieving (or daunting?) to know that even someone as proficient as Epictetus had difficulty with this.

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  4. Massimo, as a physician who all-too-well knows both the unreliable nature of much of our evidence-base, and the artistry involved in medical decision-making, I am deeply impressed by your compassionate, balanced response to this sufferer. You continue to serve as a model for many of your fellow students of Stoicism. (Also, as someone who struggles with anxiety, I’ll definitely check out LeDoux’s book!)

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