Stoicism, stoicism, and mental health

You can tell Stoicism is getting popular when anyone who disagrees with me on Twitter resorts to the “argument” (I’m using the word very loosely): “but what you said is un-Stoic!,” pretty much regardless of what I actually said, or of its logical connection to Stoicism. Anyway, another sign of popularity is the fact that mental health professionals are beginning to take an interest, wishing to empirically assess the effects of practicing Stoicism on people’s psychology.

Since Stoicism itself has from the beginning been a philosophy that included the study of psychology (under the field of “logic”), and moreover has always been explicitly open to revision, this is welcome news. What is not so welcome is when people, predictably, claim that they are studying Stoicism, while in fact they are studying stoicism (for this crucial, and not even that subtle distinction, see this article by Don Robertson).

Which is why a paper published last year in BMJ Open and entitled “Stoic beliefs and health: development and preliminary validation of the Pathak-Wieten Stoicism ideology scale” was a missed opportunity. Authored by Elizabeth Pathak, Sarah Wieten, and Christopher Wheldon, it purports to develop a scale with which to measure, as the title says, Stoic “ideology,” with the purpose of beginning to explore the mental health effects of practicing such ideology. Unfortunately, the paper hopelessly mixes Stoicism and stoicism, with a strong lean toward the latter.

The authors identify four “key domains” of Stoicism: imperviousness to strong emotions, indifference to death, taciturnity, and self-sufficiency. It is on the basis of these domains that they build their scale, which they then test on 390 subjects, most of whom are young students (aged less than 25), mostly white (though somewhat gender balanced), almost all American born.

Setting aside the usual problems with the sampling of subjects used in this sort of study, which there is very little reason to think is representative even of the American population, let alone beyond, let me begin with the four domains just mentioned. I will then move to a brief examination of additional problematic statements made by Pathak and collaborators in the paper.

I. Imperviousness to strong emotions: it is absolutely not the case that this is a Stoic value (although it certainly is a stoic one). Consider, for instance, what Seneca says to his friend Marcia in his letter of consolation to her:

“‘But,’ say you, ‘sorrow for the loss of one’s own children is natural.’ Who denies it? Provided it be reasonable? For we cannot help feeling a pang, and the stoutest-hearted of us are cast down not only at the death of those dearest to us, but even when they leave us on a journey.” (VII)

A bit earlier he writes to her:

“I am not soothing you or making light of your misfortune: if fate can be overcome by tears, let us bring tears to bear upon it: let every day be passed in mourning, every night be spent in sorrow instead of sleep.” (VI)

Does that sound to you like someone who is trying to be impervious to emotions? Or consider just how explicit on the subject Epictetus, notoriously the most stern of the ancient Stoics, really is:

“I must not be without feeling like a statue, but must maintain my natural and acquired relations, as a religious man, as son, brother, father, citizen.” (Discourses III.2)

And here is what modern scholar Margaret Graver, who wrote a whole book on Stoicism and Emotion, says: “If the psychic sensations [i.e., feelings] we experience in emotion are not simply identical with the pathē [i.e., negative emotions], then the norm of apatheia [i.e., lack of negative emotions] does not have to be cashed out as an injunction against every human feeling. One might be impassive in the Stoic sense and still remain subject to other categories of affective experience.”

So, no, the Stoics do not seek to be impervious to emotions. Rather, they work toward improving their judgments about externals, in order to re-align their emotional spectrum, de-emphasizing unhealthy emotions and nurturing and developing healthy ones.

II. Indifference to Death: one can see how people may develop a misconception here, for instance while reading what Seneca writes to Marcia:

“Reflect that the dead suffer no evils, that all those stories which make us dread the nether world are mere fables, that he who dies need fear no darkness, no prison, no blazing streams of fire, no river of Lethe, no judgment seat before which he must appear, and that death is such utter freedom that he need fear no more despots. All that is a phantasy of the poets, who have terrified us without a cause.” (XIX)

This, however, is an explanation of why we should not be afraid of what will happen after we die (because there won’t be any “us” to be concerned by things), it is hardly a council not to care about dying.

True, death — like everything that is not virtue — is categorized within the “indifferents,” either preferred or, in this case, dispreferred. But that word has a very clear technical meaning in Stoic philosophy: it doesn’t mean that one shouldn’t care about dying, but rather that death itself is irrelevant to virtue, in the sense that dying or staying alive, per se, doesn’t make you a better person.

Not convinced? Here is how Epictetus reacts to the news that a friend of his has decided to commit suicide for the hell of it:

“If your decision is justified, look, here we are at your side and ready to help you on your way; but if your decision is unreasonable, you ought to change it. ‘We ought to hold to our decisions.’ — What are you up to, man?” (Discourses II.15.6-7)

Again, does this sound like indifference (in the ordinary sense of the word) to death? I should think not.

III. Taciturnity: stoicism appeals to men, according to the authors, and goes well with the ideal (myth, really) of the solitary man who speaks by his actions. Think Clint Eastwood in The Good, the Bad and the Ugly, or in any of his other movies, for that matter. But Stoicism (the philosophy) advocates nothing of the sort. True, Epictetus famously advises his students to talk little and of important things:

“When you’re called upon to speak, then speak, but never about banalities like gladiators, horses, sports, food and drink — common-place stuff. Above all don’t gossip about people, praising, blaming or comparing them.” (Enchiridion 33.2)

Immediately below, Epictetus adds:

“In your conversation, don’t dwell at excessive length on your own deeds or adventures. Just because you enjoy recounting your exploits doesn’t mean that others derive the same pleasure from hearing about them.” (Enchiridion 33.14)

It’s obvious that this an injunction not to annoy people, and to engage others in meaningful, as opposed to idle, conversation. After all, the Stoics we know of were teachers, senators, generals, and emperors. Hardly the kind of individual who spends his life in a taciturn mood.

IV. Self-sufficiency: here too, stoicism (the attitude) seems to rely on the myth of the solitary hero who depends on no one. But Stoicism (the philosophy) is quintessentially cosmopolitan, and teaches that our primary concern should be to do good on behalf of the human polis. Sure, Marcus is often cited as saying:

“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)

But that’s simply an honest analysis of his expectations about other people qua emperor. He also tells himself in his personal diary:

“Have I been made for this, to lie under the blankets and keep myself warm? But this is more pleasant. Do you exist then to take your pleasure, and not at all for action or exertion?” (Meditations V.1)

And what action and exertion is he referring to, other than the obviously military one (he was encamped on the Danube fighting the Marcomanni tribes when he wrote the above)?

“Do what is necessary, and whatever the reason of a social animal naturally requires, and as it requires.” (Meditations IV.24)

Seneca says something interesting about this matter:

“The wise man is self-sufficient. Nevertheless, he desires friends, neighbours, and associates, no matter how much he is sufficient unto himself.” (IX. On Philosophy and Friendship, 3)

It is clear in context that by “self-sufficient” he means capable of maintaining virtue. And at any rate he is talking about the Sage, which is as rare as the mythical phoenix. He immediately adds that even the Sage desires friends, neighbors, and associates. So, no, there is no basis in Stoicism for the idea of self-sufficiency as understood within the context of stoicism.

This brief analysis should make clear that there is a huge difference between Stoicism and stoicism. Unfortunately, Pathak et al.’s article completely mixes the two, with a far stronger dose of stoicism than Stoicism. The result is a scale that measures something, but definitely not the effects of adopting a Stoic philosophy.

Let us take a look at some quotes from the paper itself, to make sure I am not misinterpreting what the authors are doing. “Stoicism has also been invoked as a defining characteristic of masculinity and as a key explanatory factor for certain health behaviors and outcomes among men” (p. 2 of the online version). This very clearly refers to the stiff upper lip attitude, not the philosophy. Indeed, on the very same page there is mention of the Liverpool Stoicism Scale, which includes “three items that are ideological, for example, ‘one should keep a stiff upper lip.’” Precisely, but no Stoic ever advocated that, so the scale should be renamed the Liverpool stoicism Scale…

Pathak et al. “attempt to articulate an explicitly theory of stoicism [the fact that they are using the lowercase here and elsewhere is not indicative of a distinction being made between the philosophy and common parlance] and its potential impact on health. … stoicism is an ideology … we theorize that people who strongly endorse a personal ideology of stoicism may be more likely to avoid or delay seeking professional medical intervention for serious signs and symptoms of disease” (p. 3)

This can be extremely misleading, if it will lead to adoption of the scale developed in the study for social health research that focuses on stoicism but makes claims about the medical unsoundness of Stoicism.

The results are also difficult to interpret, again because of the complete confounding of stoicism and Stoicism. For instance: “men were more than two times as likely as women to fall into the top quartile of responses” (p. 5), meaning that men agreed more readily with a self-description as “stoic.” “Scores for stoic taciturnity were strongly correlated with scores for both stoic endurance and stoic serenity, but stoic endurance and stoic serenity were not highly correlated with each other. Stoic death indifference … was least correlated with the other three domains” (p. 4). Moreover: “In this study population, respondents were least likely to endorse stoic serenity and most likely to endorse stoic death indifference” (p. 5).

It is hard to know what to make of these findings, since it isn’t clear at all to what mixture of stoicism and Stoicism they refer. Please note, of course, that so far as we know likely none of the participants to the study actually had any training in, or exposure to, Stoic philosophy. Based on that, I’m inclined to say that the relevance of the study to Stoicism is close to zero, while it may tell us a lot about stoicism.

The authors draw some conclusions that seem to me to be rather unsubstantiated, or at least, again, ambiguous as to their referent: “Ironically, a personal ideology of stoicism almost guarantees failure to live up to one’s ideals. … An ideology of stoicism creates an internal resistance to external objective needs, which can lead to negative consequences. … a study of major strain among family caretakers of elderly patients with dementia found those who used stoicism as a coping strategy suffered burnout, while those who sought social support did not” (pp. 6-7).

Right, but that sounds a lot like stoicism, not Stoicism. Now one could perhaps argue that Pathak et al. never actually intended to address Stoic philosophy, only the stiff upper lip modern attitude. But that is clearly not the case from the opening line of the paper: “Stoicism is a school of philosophy which originated in ancient Greece” (p. 1).

Which makes some of their conclusions particularly troublesome, especially for people who are trying to practice the philosophy: “We hypothesise that illness behaviors may become ‘noncompliant’ or ‘irrational’ or ‘self-harming’ when specific courses of action would create an internal conflict with patients’ ideas of who they are. … This internal conflict will lead to delays in or avoidance of help seeking, with potentially life-threatening consequences. For example, empirical studies of male suicide in rural Australia have identified hegemonic masculine norms of stoicism as an important causal factor in the context of severe economic stress” (p. 8).

The situation of rural men in Australia subject to economic stress and committing suicide at high rates is horrible, but it does not seem to have anything to do with Seneca, Epictetus, and Marcus Aurelius, names that are very likely entirely unknown to the people in question. It is therefore highly misleading, dangerous, and — I’m sorry to say — irresponsible to so casually mix stoicism and Stoicism.

Of course, as Don Robertson points out in his article on the matter, the same problem applies to other philosophies. I can easily see a study of “epicureanism” showing that if people indulge frequently in large meals, a lot of drinking, and unprotected sex with multiple patterns, they will incur health risks. But to blame Epicurus — who argued for restrain in or abstention from all the just mentioned activities — would be bizarre.

So I urge Elizabeth Pathak, Sarah Wieten, and Christopher Wheldon to scrap the whole exercise, ideally retracting their paper, and writing up their findings again while making crystal clear what they mean by “stoicism.” Better yet, since there is a philosophy that has carried that name for the past 23 centuries, avoid to use the term altogether and write a paper on how to measure the potentially negative health consequences of trying to live like Clint Eastwood in a Western movie. The underlying problem — that an image of extreme self-reliance is bad for one’s health — is likely real and deserves attention. But the relevant research ought to be carried out properly.