How to Think Like a Roman Emperor: The Stoic Philosophy of Marcus Aurelius

5. GRASPING THE NETTLE

Marcus Aurelius was known for his physical frailty, due to chronic health problems, but he was also known for his exceptional resilience. For instance, the historian Cassius Dio wrote:

To be sure, he could not display many feats of physical prowess; yet he had developed his body from a very weak one to one capable of the greatest endurance.¹

How do we explain this seeming paradox? How did a man so weak and sickly become known for toughness and endurance? Perhaps the answer lies in his attitude toward pain and illness, and the Stoic techniques he used to cope with them.

Marcus was nearly fifty, an old man by Roman standards, at the outbreak of the First Marcomannic War. Nevertheless, he donned the military cape and boots, rode forth from Rome, and stationed himself on the front line. He spent much of his time at the legionary fortress of Carnuntum, on the other side of the Alps, by the banks of the Danube in modern-day Austria. Cassius Dio tells us that at first Marcus was too frail to endure the frigid northern climate and address the legions assembled before him. It was a dangerous and physically grueling environment, even for an emperor. To make things worse, with large numbers of men living in close proximity, the military camps were especially vulnerable to outbreaks of the plague. Nevertheless, Marcus typically shrugged off the hardships of life on the northern frontier by quoting the poet Euripides: “Such things accursed war brings in its train.” They were to be expected, in other words.

Despite his health problems and the inhospitable environment, Marcus would spend over a decade commanding the legions along the Danube. In The Meditations, he thanks the gods that his body held out for such a long time under such physical duress.² He survived the two Marcomannic Wars and the Antonine Plague, nearly making it to the age of sixty at a time when the odds of doing so were poor. Indeed, although he suffered from recurring health problems, he managed to live longer than most of his contemporaries. Still, the sudden transition to military life must have been a tremendous physical challenge for him. It’s therefore no surprise that his writings frequently reveal evidence of his psychological struggle to cope with physical problems.

He’d been preparing himself to face this inner battle for most of his life, though. Over the years, Marcus had gradually learned to endure pain and illness by utilizing the psychological strategies of ancient Stoicism. During the war, in writing The Meditations, he reflected on these techniques as part of his ongoing practice. These notes reflect a state of mind attained from more than three decades of rigorous Stoic training. In other words, his attitude toward pain and illness during the northern campaign didn’t come naturally to him; he had to learn it.

The Meditations isn’t our only insight into Marcus’s thinking, though. In the early nineteenth century, the Italian scholar Angelo Mai uncovered a treasure trove of ancient letters between the Latin rhetorician Marcus Cornelius Fronto and several other notable individuals, including his student Marcus Aurelius. We can’t date the individual letters precisely, but they appear to span the whole period of Marcus and Fronto’s friendship, until the latter’s death around 167 AD at the height of the Antonine Plague.

Their correspondence is remarkable for several reasons. For the first time, scholars could peek into Marcus’s private life and witness his true personality. Far from the popular caricature of a Stoic as someone coldly austere, Marcus shows remarkable warmth and affection toward Fronto and his family. His style of writing is casual and good-humored. He tells Fronto, for instance, of the time he was riding in the countryside, dressed as a regular citizen, when a shepherd rudely accused his companions of being a band of common rogues. Marcus rode laughing into the flock, playfully scattering the sheep to break up the argument. However, the shepherd wasn’t amused and threw his cudgel at them, yelling as the young men fled the scene. It’s difficult to imagine that twenty years later the author of these affable and easygoing letters would find himself gravely noting down Stoic meditations upon seeing the severed body parts littering the frigid battlefields of Pannonia.

There’s something else, though, about these letters that stands in marked contrast to The Meditations: the amount of small talk, and sometimes even griping, that goes on about various health conditions. Fronto was roughly twenty years Marcus’s senior and was particularly fond of complaining to him about his assorted aches and pains. In one instance, Fronto lists the regions of his body most afflicted during the night by widespread pain—“my shoulder, elbow, knee, and ankle”—which he says prevented him from writing to Marcus in his own hand.³

In another letter he writes,

After your departure I was seized by a pain in the knee, mild enough, it is true, for me to be able to walk with due caution and use a carriage. Tonight the pain has set in more violently, but not so badly that I cannot easily bear it when lying down, if it does not get any worse.⁴

Sometimes Marcus gets drawn into gossiping with Fronto about his own health problems.

As to my present state of health, you will be able to judge that easily enough from my shaky handwriting. It is true that as regards my strength, that is beginning to come back, and nothing remains, besides, of the pain in my chest; but the ulcer is working on my windpipe.⁵

This particular letter was written before Marcus was acclaimed emperor. It shows that by the age of forty, perhaps much earlier, he was already suffering from the kind of symptoms that would afflict him throughout his reign. In these letters, though, there’s no evidence of the Stoic techniques for coping that we find a decade or more later in The Meditations.

As a youth, Marcus was fit and enjoyed physical activity, as we’ve seen. While at Rome, he was trained to fight in armor, probably by gladiators, using blunted weapons for practice. He also enjoyed hunting and particularly loved to spear wild boar from horseback. He went fowling as well, hunting birds with nets and spears.

So our overall picture of Marcus in his youth is one of a strong, athletic young man. As he aged into his forties and fifties, though, he became physically frail, and that seems to be how subsequent generations remembered him. Writing in the fourth century, for instance, the Emperor Julian imagines Marcus’s skin looked diaphanous and translucent. Marcus even referred to himself in a speech as a weak old man, unable to take food without pain or sleep without disturbance. The Meditations also mentions him obtaining remedies for coughing up blood and spells of giddiness.⁶ He particularly suffered from chronic chest and stomach pains. He could manage only small amounts of food, taken late at night. Scholars have offered different diagnoses, the most common being chronic stomach ulcers, although he probably suffered from multiple health problems.

After the initial plague outbreak at Rome, Marcus’s court physician, Galen, prescribed him the ancient compound known as theriac, a mysterious concoction made from dozens of exotic ingredients, everything from bitter myrrh to fermented viper’s flesh and a small quantity of opium. Marcus believed that regular doses of theriac helped him endure the pain in his stomach and chest as well as his other symptoms. He stopped using it for a time because it was making him too drowsy, but he resumed taking a modified version with a reduced quantity of opium. He therefore seems to have taken theriac judiciously and in a mild form.

In any case, the medicine clearly didn’t eliminate the pain and discomfort Marcus felt. Like many people who suffer from chronic pain, he had to develop other ways of coping. Over the years, therefore, Marcus came to depend on the psychological techniques of Stoicism as a way of living with health problems, especially as things became tougher for him after joining the army on the Danube. During the misery of the Antonine Plague and the carnage of the Marcomannic Wars, he must have witnessed countless people dealing with their own suffering, some better than others. Over the course of his life, he learned a great deal by studying how a handful of exemplary individuals endured severe pain and illness. He interpreted that wisdom through the lens of Stoicism and then distilled it into The Meditations.

In marked contrast to the Marcus of Fronto’s letters, he states very bluntly in The Meditations that the wise man neither strikes a tragic attitude nor whines about what befalls him. He’s certainly not referring to his rhetoric teachers, Fronto and Herodes Atticus. However, when he wrote these words, he probably had their rivals in mind: his philosophy teachers, the men who trained him in Stoicism and provided him with a living example of mental resilience. For example, the way Apollonius of Chalcedon endured severe pain and several long illnesses made a lifelong impression on Marcus. Apollonius had maintained his equanimity through it all, never allowing any setback to knock him off course, always remaining committed to his life’s goal of acquiring wisdom and sharing it with others.⁷

However, Claudius Maximus, another one of Marcus’s Stoic tutors, seems to have left an even more powerful impression on him. Marcus mentions Maximus’s illness and death three times in The Meditations. Like Apollonius, Maximus was completely resolute in his commitment to the pursuit of wisdom despite severe illness. He wasn’t a Stoic professor, like Apollonius, but a high-ranking Roman statesman and accomplished military commander. He was also a tough and profoundly self-reliant individual, renowned for his commitment to Stoicism—the sort of man who stood upright of his own accord, as Marcus liked to put it, rather than having to be set upright by anyone else. He remained unwavering in his resolve and cheerful in the face of any predicament.⁸ It seems likely that Maximus became ill and died not long after the Senate appointed him proconsul of Africa in 158 AD, and his loss seems to have affected Marcus quite deeply.

Indeed, Marcus appears to compare Maximus to the Emperor Antoninus. Both men showed impeccable strength of character, self-discipline, and endurance in the face of pain and illness. Antoninus took good care of his health, so that throughout most of his long life he seldom required the aid of physicians. However, he did suffer from severe headaches, and as he grew older, he became so doubled over that wooden splints were required to keep his torso upright. Marcus noticed that while recovering from a severe headache, his adoptive father would simply get right back to his duties as emperor with renewed determination. He didn’t waste time worrying about his ailments or allow the pain to stop him for long. As Marcus was writing The Meditations, he found himself looking back on the peaceful manner in which Antoninus had passed away over a decade earlier, at the venerable age of seventy-four.⁹ Like Maximus, Antoninus was always contented, always cheerful. It’s said that even as he lay dying, with his last breath he whispered the word equanimity to his guard, which was emblematic both of his character and of his reign. We can clearly see that Marcus’s attitude toward pain and illness was shaped by studying the characters of these men. Perhaps he also wanted to become less like Fronto and the other Sophists, whose love of high-flown rhetoric risked amplifying their complaints by turning common misfortunes into personal tragedies.

Although Marcus was a Stoic, he also drew inspiration from another, more surprising source when it came to coping with pain and illness: the rival philosophical school of Epicurus. The Epicureans believed that the goal of life was pleasure (hedone). They described pleasure, though, in a notoriously paradoxical manner, as consisting mainly of a state of freedom from pain and suffering (ataraxia). Minimizing the emotional distress caused by pain and illness was therefore extremely important to them.

Marcus quotes from a letter purportedly written by Epicurus nearly five hundred years earlier. We know from another source that Epicurus was afflicted by severe kidney stones and dysentery, which eventually caused his death:

When I was ill, my conversation was not devoted to the sufferings of my body, nor did I chatter about such matters to those who visited me but I continued to discuss the main elements of natural philosophy as before, and this point especially, how it is that the mind, while being aware of the agitations in our poor flesh, is unperturbed and preserves its specific good. Nor did I allow the doctors to assume grand airs, as though they were engaged in something important, but my life proceeded as well and happily as ever.¹⁰

Marcus must have been struck by the contrast between this letter and the sort of correspondence he had been having decades earlier with Fronto. Just as most of us do, Marcus had engaged in precisely the sort of chatter and complaints about the “sufferings of the body” that Epicurus had warned against. Although he was in poor health, Epicurus didn’t complain or dwell on his symptoms. In fact, he used his illness as an opportunity to converse in a dispassionate manner about how the mind can remain contented while the body suffers terrible pain and discomfort. He simply carried on doing what he loved: discussing philosophy with his friends.

Marcus quotes this letter and then exhorts himself always to act as Epicurus did: remain focused on the pursuit of wisdom even in the face of illness, pain, or any other hardship. This advice, he says, is common not only to Epicureanism and Stoicism but to all other schools of philosophy. Our main concern should always remain the use we are making right now, from moment to moment, of our own mind.¹¹

Marcus returns to the teachings of Epicurus concerning pain and illness several times in The Meditations. He’s particularly interested in one of Epicurus’s famous maxims, or Principal Doctrines, which contains advice for coping with pain. We should remind ourselves, Epicurus said, that pain is always bearable because it is either acute or chronic but never both. The Church Father Tertullian neatly summed up the same idea by saying that Epicurus coined the maxim “a little pain is contemptible, and a great one is not lasting.” You can therefore learn to cope by telling yourself that the pain won’t last long if it’s severe or that you’re capable of enduring much worse if the pain is chronic. People often object to this by saying that their pain is both chronic and severe. However, earlier in The Meditations, Marcus paraphrased the same quote from Epicurus as follows: “On pain: if it is unbearable, it carries us off, if it persists, it can be endured.”¹² The point is that chronic pain beyond our ability to endure would have killed us, so the fact we’re still standing proves that we’re capable of enduring much worse. Although this can be hard for some people to accept, participants in my online courses who have suffered for many years with chronic pain have reported that this Epicurean maxim has been a great help to them, just as it was for many people throughout previous centuries. We have to practice to keep looking at things this way, though, just as we must practice to overcome unhealthy habits and cravings.

Why exactly did the ancients find this particular strategy so helpful as a way of coping with pain? When people are really struggling, they focus on their inability to cope and the feeling that the problem is spiraling out of control: “I just can’t bear this any longer!” This is a form of catastrophizing: focusing too much on the worst-case scenario and feeling overwhelmed. However, Epicurus meant that by focusing instead on the limits of your pain, whether in terms of duration or severity, you can develop a mind-set that’s more oriented toward coping and less overwhelmed by worry or negative emotions about your condition.

Marcus also found it helpful to think of his pain as confined to a particular part of the body rather than allowing himself to become consumed by imagining it as more pervasive. Pain wants to dominate your mind and become the whole story. However, people who handle pain well usually view it objectively, as something more limited in nature, which makes it easier for them to see themselves coping with it in various ways. Indeed, elsewhere in The Meditations, Marcus adds a Stoic twist to Epicurus’s saying. “Pain is neither unendurable nor everlasting, if you keep its limits in mind and do not add to it through your own imagination.”¹³ The Stoics were typically happy to assimilate aspects of Epicureanism and other philosophical teachings, but they tweaked them to be more compatible with their own core doctrines. Marcus meant that pain is tolerable if we remember that our attitude toward it is what really determines how upset we become. It’s not our pains or illnesses that upset us but our judgments about them, as the Stoics would put it. This is one of the main therapeutic tools in the armamentarium of Stoic pain management.

Marcus also noted that most other forms of physical discomfort can be dealt with in essentially the same manner. He compares coping with pain to coping with difficulty eating and drowsiness, two problems we know he suffered from personally. He also mentions oppressive heat, bringing to mind the Cynic notion of learning to endure intense heat and cold. When faced with any of these discomforts, Marcus would simply warn himself, “You are giving way to pain.”¹⁴ Then he’d apply the same coping skills, whether he was struggling in a blizzard along the Danube or suffering fatigue from riding for days from his base at Aquileia in northern Italy to the legionary fortress of Carnuntum. Pain, discomfort, fatigue—they’re all just unpleasant sensations.

He was right. The skills people use to cope with pain—even very severe pain—are similar to ones that can be used to deal with other uncomfortable sensations. For instance, during ordinary forms of physical exercise, such as jogging or yoga, there are opportunities to practice essentially the same coping strategies. We can learn to tolerate the harmless sensations of fatigue and discomfort experienced while doing these sorts of activities. Taking cold showers also allows us to practice the same techniques. If we learn these strategies well enough, then we may be able to call upon them to cope with severe pain or serious physical injury in a crisis, even if we’re caught off guard. Everyday tolerance of minor physical discomforts can help us build lasting psychological resilience, in other words. You could call this a form of stress inoculation: you learn to build up resistance to a bigger problem by voluntarily exposing yourself repeatedly to something similar, albeit in smaller doses or a milder form.

Over time, Marcus observed many people around him afflicted by different illnesses and facing death in various ways. He also learned specific coping strategies and techniques from his Stoic teachers. Indeed, Marcus described several different Stoic strategies for dealing with pain and illness in The Meditations. The most important thing he observed in those individuals who coped well was their ability to “withdraw” or “separate” their mind from bodily sensations. We’ve already introduced this Stoic technique, which I’ve called cognitive distancing. It requires learning to withhold value judgments from unpleasant feelings, viewing them as morally indifferent, neither good nor bad in themselves, and ultimately harmless. This takes practice, of course, and an understanding of the underlying concepts.

It was mainly through the Stoic teachings of Epictetus that Marcus found a way to conceptualize this powerful technique. One of the most famous stories about Stoic endurance happens to be about Epictetus. He was originally a slave and came to be owned by Epaphroditus, a secretary to Emperor Nero. According to the Church Father Origen, Epaphroditus took hold of Epictetus in anger one day and cruelly twisted his leg. Epictetus didn’t react but remained completely composed. He merely warned his master that the bone was about to snap. Epaphroditus continued twisting it, and that’s exactly what happened. Rather than complain, Epictetus responded matter-of-factly: “There, did I not tell you that it would break?”

Epictetus alludes to his being lame in the Discourses but never mentions the cause. Instead, he uses his disability as an example to teach his students about coping with illness. Disease is an impediment to our body, he tells them, but not to our freedom of will unless we make it so. Lameness, he says, is an impediment to the leg but not to the mind.¹⁵ Epictetus was no more perturbed by his crippled leg than he was by his inability to grow wings and fly—he simply accepted it as one of the many things in life that were beyond his control. He viewed his lameness as an opportunity to exercise wisdom and strength of character. Later in life he gained his freedom and began teaching philosophy. Perhaps his master felt remorse. In any case, this story powerfully illustrates the famous indifference of Stoics to physical pain. If this story is true, Marcus would certainly have heard about it. HOW TO TOLERATE PAIN

It may seem natural to assume that pain is intrinsically bad, but the Stoics employ a barrage of arguments to persuade their followers that pain and pleasure are neither good nor bad. For instance, one way of illustrating the indifference of pain would be to point out that, like other externals, pain can be used either wisely or foolishly, for good or for bad. An athlete might learn to endure the pain and discomfort of extreme physical exertion. In that case, deliberately exposing themselves through hard exercise to painful, or at least uncomfortable, sensations might be something beneficial insofar as it helps them to build endurance. Of course, someone who avoids discomfort is probably going to avoid strenuous exercise. Pain and discomfort can become advantages in life if they provide opportunities for us to develop our strengths. It’s also true that many ordinary people, at certain times, exhibit indifference to pain—such as when they’re injured while saving their own life. Some people, of course, such as masochists, even enjoy the sensation of pain. Pain is just a sensation, in other words; what matters is how we choose to respond to it.

Epictetus tells his students how to cope with pain and illness several times in the Discourses. Like Epicurus before him, he believed that complaining and chattering too much about our problems just makes them worse, and, more importantly, it harms our character. Marcus agreed that collective whining is bad for the soul: “No joining others in their wailing, no violent emotion.”¹⁶ Modern cognitive therapists likewise find that distress escalates when people tell themselves “I can’t cope!” Their distress lessens when they begin looking at things more rationally and objectively and acknowledge various ways they can potentially cope now or have coped in a similar situation in the past. In part, this is an observation about the rhetoric of pain. We should be wary of telling ourselves “This is unbearable!” and so on, because that’s usually just hyperbole that adds to our sense of despair.

Epictetus tells his students that it’s one thing to have a pain in the head or in the ear, but they should not go a step further and say, “I have a pain in the head—alas!” They shouldn’t imply that the pain is some kind of catastrophe. He explained that he wasn’t denying them the right to groan, just that they shouldn’t do so inwardly by actually buying into the notion that they’ve been harmed. Just because a slave is slow in bringing them a bandage they shouldn’t cry aloud and torment themselves, complaining “Everyone hates me!” (“For who would not hate such a man?” he adds sardonically.) He summed up his practical advice by telling his students to respond to troubling events or unpleasant sensations by literally saying This is nothing to me. This perhaps overstates things. Stoics can still “prefer” to avoid pain and illness when possible. Once it’s already happening, though, they try to accept the fact with indifference.

In addition to the maxim of Epicurus, Marcus mentions many Stoic strategies for bearing pain and illness by viewing them with studied indifference. Most of these strategies were influenced by the Discourses of Epictetus.

1. Separate your mind from the sensation, which I call “cognitive distancing,” by reminding yourself that it is not things, or sensations, that upset us but our judgments about them.

2. Remember that the fear of pain does more harm than pain itself, or use other forms of functional analysis to weigh up the consequences for you of fearing versus accepting pain.

3. View bodily sensations objectively (objective representation, or phantasia kataleptike) instead of describing them in emotive terms. (“There’s a feeling of pressure around my forehead” versus “It feels like I’m dying—an elephant might as well be stamping over and over on my head!”)

4. Analyze the sensations into their elements and limit them as precisely as possible to their specific site on the body, thereby using the same depreciation by analysis that we used in the previous chapter to neutralize unhealthy desires and cravings. (“There’s a sharp throbbing sensation in my ear that comes and goes,” not “I’m in total agony.”)

5. View the sensation as limited in time, changeable, and transient, or “contemplate impermanence.” (“This sensation only peaks for a few seconds at a time and then fades away; it will probably be gone in a couple of days.”) If you have an acute problem like toothache, you’ll have forgotten what it felt like years from now. If you have a long-term problem such as chronic sciatica, you’ll know it sometimes gets worse and so at other times it must be less severe. It makes a difference if you can focus on the notion that this shall pass.

6. Let go of your struggle against the sensation and accept it as natural and indifferent, what is called “Stoic acceptance.” That doesn’t mean you shouldn’t take practical steps to deal with it, such as using medication to reduce pain, but you must learn to live with the pain without resentment or an emotional struggle.

7. Remind yourself that Nature has given you both the capacity to exercise courage and the endurance to rise above pain and that we admire these virtues in other people, which we discussed in relation to contemplating and modeling virtue.

We’ll look at each of these strategies in turn. COGNITIVE DISTANCING

The most important pain-management strategy mentioned by Epictetus and Marcus is the one we’ve called “cognitive distancing.” It’s summed up in a phrase that will already be familiar to you: “It’s not events that upset us but our judgments about events.”¹⁷ If we apply that to the concept of pain, it means that the pain isn’t what upsets us but rather our judgments about it. When we suspend the activity of assigning value judgments to the pain, our suffering is alleviated. It’s always within our power to do this in any situation—it’s up to us how much importance we choose to invest in bodily sensations.

Marcus describes the suspension of value judgments as the “withdrawal,” “separation,” or “purification” (katharsis) of the mind from, in this case, bodily sensations of pain and illness. He also likes to explain the suspension of judgment by saying that pain and pleasure should be left where they stand, in the parts of the body to which they belong. Even if the body, the closest companion of the mind, is “cut or burned, or festers or decays,” we can preserve our ruling faculty in a peaceful state as long as we don’t judge bodily sensations as being intrinsically good or bad.¹⁸

Marcus also calls this being “indifferent to indifferent things.”¹⁹ There’s a particularly important passage where he spells out the subtleties of Stoic psychology in this regard.²⁰ We should keep our ruling faculty undisturbed by external things, including bodily sensations of pain and pleasure. He says this means not allowing it to unite with them but rather drawing a line around the mind, marking its boundaries, with bodily sensations on the other side, as if viewed from a distance—over there. On the other hand, when we allow ourselves to make strong value judgments about external sensations such as pain, we merge our minds with them and lose ourselves in the experience of suffering.

It’s important to note that Marcus isn’t asking us to deny that pain (or pleasure, for that matter) is part of life, even for the Stoic wise man. He notes that sensations of pain and pleasure will inevitably find their way into our consciousness because of the natural sympathy that exists between the mind and the body. He stresses that you should not try to suppress the sensations, because they are natural, and you should not assign judgments to them as good or bad, helpful or harmful. This delicate balance is central to modern mindfulness and acceptance-based cognitive therapy, which teaches clients neither to suppress unpleasant feelings nor to worry about them. Instead, you should learn to accept them while remaining detached from them.

For Marcus, what matters is that we stop looking at pain and illness through the lens of harm. Those judgments originate within us. They are projected outward onto bodily sensations and other external events. It’s important to remember that whether we view something as helpful or harmful depends entirely upon our goals. Most people take for granted assumptions they have about their goals in life, so much so that they are rarely aware of them. If my goal is to look handsome, then if I break my nose, I’m bound to view it as harmful rather than helpful. But if my most cherished goal is survival and I break my nose while narrowly escaping certain death, I’d probably view it with relative indifference. The Stoics want us to go through a radical upheaval in our underlying values so that our supreme goal is to live with wisdom and its accompanying virtues. They want us to treat physical pain and injuries with indifference. In fact, these misfortunes can even provide an opportunity for us to exercise greater wisdom and strength of character. Marcus tells himself:

Do away with the judgment, and the notion “I have been harmed” is done away with; do away with that notion, and the harm itself is gone.²¹

So do the Stoics not care at all about physical health? Yes, they do. They classify it as a preferred indifferent. It’s natural and reasonable for us to prefer health to sickness. Physical health provides us with more opportunity to exercise our will and influence external events in life. In itself, health is not really good or bad. It’s more like an opportunity. A foolish person may squander the advantages good health provides by indulging in his vices. A wise and good person, by contrast, may use both health and illness as opportunities to exercise virtue. Was Epictetus “harmed” when his leg was broken if we suppose that this was one of the events that set him on the path to becoming a great philosopher? He would say that what matters, ultimately, is the harm we do to our own character. By comparison, a mangled leg is trivial.

If we can learn to withhold our judgment that pain is terrible or harmful, then we can strip away its horrific mask, and it no longer appears so monstrous to us.²² We’re just left with the banal observation that our flesh is being stimulated “roughly,” as Epictetus liked to put it. It’s just a sensation. Through our judgment that it is intrinsically bad, unbearable, or catastrophic, though, we escalate the mere sensation of bodily pain into the inner turmoil of emotional suffering. For instance, Marcus elsewhere addresses (apostrophizes) his impressions and bodily sensations, saying,

Go away, I entreat you by the gods, as you did come, for I do not want you. But you have come according to the ancient fashion. I am not angry with you: only go away.²³

“I am not angry with you,” he says to the painful feeling, because he does not perceive it as bad or harmful. It enters the mind in the age-old manner, through sensation, a natural physiological process that humans share with animals. Ironically, you don’t need to try to suppress or resist unpleasant feelings as long as you abandon the belief that they are bad. If you accept them with indifference, then they do you no harm. When your conscious mind, your ruling faculty, invests too much importance in bodily sensations, it becomes “fused and blended” with them, and it is pulled around by the body like a puppet on strings.²⁴ However, you always have the potential within you to rise above physical sensations and view them with studied indifference. FUNCTIONAL ANALYSIS

Once you’ve gained cognitive distance, you’re in a better position to consider the consequences of your value judgments (“functional analysis”). Given that suffering arises from our negative value judgments, the Stoics say that the fear of pain does us far more harm than pain itself because it injures our very character. Pain, by contrast, is harmless if you learn to accept it with an attitude of indifference. Epictetus stated this very succinctly: “For death or pain is not fearsome, but rather the fear of pain or death.”²⁵ To live life fully, you have to get out of your comfort zone, as we say today. Fear of pain makes cowards out of us all and limits our sphere of life.

It’s important to have a firm grasp of a behavior’s negative consequences if we want to change it. For example, blood phobia might prevent someone from having medical tests they require—for some women it’s even an obstacle to giving birth. Indeed, most people are frightened of pain and illness to varying degrees. Realizing that fear of pain may be doing you more harm than the pain itself can motivate you to start regularly practicing the psychological skills required to overcome intolerance of pain and discomfort. OBJECTIVE REPRESENTATION

Marcus also learned to describe external events and bodily sensations to himself as natural processes, adopting the language of objective representation. As noted earlier, we can compare this to the neutral and detached way a physician might document the symptoms of illness in a patient. Epictetus and Marcus both do this when they describe painful and unpleasant sensations merely as “rough” movements, or agitations, occurring in the flesh.

Thoughts such as these reach through to the things themselves and strike to the heart of them, allowing us to see them as they truly are.²⁶

It’s as if we were describing the problems of another person: with greater objectivity and detachment. I might say to myself, for example, “The dentist is working on Donald’s teeth,” thereby thinking of it dispassionately from a third-person perspective. DEPRECIATION BY ANALYSIS

Marcus also tells himself to avoid overwhelming his mind by worrying about the future or ruminating about the past. When we focus our attention on the reality of the here and now it becomes easier to conquer. By viewing things objectively, isolating the present moment and dividing it into smaller parts, we can tackle them one at a time, using the method we’ve called depreciation by analysis. He says, for example, that we should ask of each present difficulty, “What is there in this that is unbearable or beyond endurance?”²⁷ Indeed, Marcus notes that the power of events to afflict us is greatly diminished if we set aside thoughts of the past and future and focus only on the present moment, the here and now, in isolation.

This divide-and-conquer strategy is still used in modern cognitive-behavioral therapy to combat unpleasant feelings; clients might be encouraged to focus on the present moment and deal with overwhelming experiences one step at a time. The Stoics move between this perspective and one that modern scholars call the “view from above,” which involves picturing your current situation from high above, as part of the whole of life on Earth, or even the whole of time and space. One strategy divides events up into smaller parts, and the other imagines the whole of existence and an event’s minuscule place within it. Both strategies can help us view external events, such as pain and illness, with greater indifference.²⁸ CONTEMPLATING FINITUDE AND IMPERMANENCE

Having described any painful sensations or symptoms of illness to ourselves in objective language and analyzed them into their component parts, we can usually also view them as being confined to a particular location in the body. Marcus consistently reminds himself to view pain and pleasure as belonging to the parts of the body where they’re located—in other words, to think of the smallness of the sensation in contrast with the expansiveness of his observing consciousness. He thereby taught himself to think of pain remaining “over there” at a distance.

Let the affected part of the body complain if it must, he says. The mind doesn’t need to agree and go along with it by judging the sensation to be very bad and harmful.²⁹ Think of the pain in your body as if it’s the barking of an angry dog; don’t start barking along with the dog by groaning about your own pain. It’s always within your power to consider the sensation as belonging to the body and limited to a specific location. You can choose to leave it there rather than becoming fused with it through worry and rumination.

The mind, too, can preserve its calm by withdrawing itself, and the ruling faculty comes to no harm; as for the parts that are harmed by pain, let them declare it, if they are able to.³⁰

Therapists today help their clients objectify pain in this way by attributing an arbitrary shape or color to it, such as a black circle. This technique, called “physicalizing” the feeling, can help you picture it in your mind’s eye, from a detached perspective, at a particular location in the body. You might even think of yourself as looking at physical pain or another symptom of illness through a glass window, separating the body from the mind, or imagining the pain as temporarily outside of the body on the other side of the room.

In addition to viewing unpleasant sensations as limited spatially to the affected part of the body, Marcus frequently reminds himself to consider their duration and to view them as limited in both time and space. He employs this strategy with externals in general but particularly with painful sensations and symptoms of illness. It resembles advice given by Epicurus, to focus on the fact that acute pain is temporary. You might be familiar with the Persian saying “This too shall pass,” quoted by Abraham Lincoln, which makes a similar point. We can also remind ourselves how many unpleasant sensations have already come and gone in the past as a way of highlighting their transience.

This approach is one of Marcus’s favorite strategies for encouraging an attitude of Stoic indifference. Viewing things as changeable, like a flowing river, can help weaken our emotional attachment to them. Sometimes he goes further and reminds himself of his own transience—his mortality. We will achieve indifference to painful feelings, he says, if we remember that the demands they place on our attention will only be for a limited time, because life is short and will soon be at an end.³¹ STOIC ACCEPTANCE

Epictetus also said that we should actively accept sickness and painful feelings if they befall us (“Stoic acceptance”). He said that our feet, if they had minds of their own, would willingly be driven into the mud with each footstep we take, accepting it as a necessary part of their natural function.³² This recalls the early Stoic metaphor of the dog following the cart. A dog tethered to a moving cart can either pull on his leash and be roughly dragged along or accept his fate and run along smoothly beside the cart. Indeed, one of the earliest Stoic definitions of man’s natural goal is that it consists in a “smoothly flowing” life, free from unnecessary struggle. The concept of radically accepting unpleasant feelings has likewise become central to modern cognitive-behavioral therapy (CBT). Pain becomes more painful when we struggle against it, but the burden is often lightened, paradoxically, if we can accept the sensation and relax into it or even welcome it. Struggling to suppress, control, or eliminate unpleasant feelings adds another layer to our misery and frequently backfires by making the original problem worse.

Marcus actually imagines Nature herself as a physician, like Asclepius, the god of medicine, prescribing hardships to him as if they were painful remedies.³³ To take Nature’s medicine properly, we must accept our fate and respond virtuously, with courage and self-discipline, thereby improving our character. So Marcus sees voluntarily accepting hardship as a psychotherapy of the passions. We must swallow the bitter pills of Fate and accept painful feelings and other unpleasant symptoms of illness when they befall us.

The Stoics were influenced in this regard by the older Cynic practice of voluntary hardship, as we’ve seen. They would deliberately expose themselves to discomfort, such as intense heat or cold, in order to develop psychological endurance. The paradox of accepting discomfort is that it often leads to less suffering. Diogenes the Cynic reputedly taught that we should treat painful sensations like wild dogs. They will bite and tear at our heels the more we try to flee in panic but will often back down if we have the courage to turn and face them calmly.

It is like the bite that one can get when one takes hold of a wild beast, says Bion [of Borysthenes]; if you grasp a snake by its middle, you will get bitten, but if you seize it by the head, nothing bad will happen to you. And likewise, he says, the pain that you may suffer as a result of things outside yourself depends on how you apprehend them, and if you apprehend them in the same way as Socrates, you will feel no pain, but if you take them in any other way, you will suffer, not on account of any of the things themselves, but of your own character and false opinions.³⁴

However, most ordinary people unwittingly invite the assaults of Fortune by turning their backs in flight rather than confronting her face to face.

Dio Chrysostom, a Sophist who studied under the great Stoic teacher Musonius Rufus, compared the Cynic to a boxer who fares better if he prepares himself to be struck and to accept it with indifference. If, on the other hand, he shrinks anxiously away from his opponent, he will expose himself to a worse beating. Chrysostom also compared enduring pain to trampling out a fire—if we do it gingerly, we’re more likely to be burned than if we stamp on it confidently. Children even make a game of quenching flames on their tongues, he says, by doing it quickly and confidently. Today, we speak of “grasping the nettle” to make the point that facing something and accepting it often leads to less injury than approaching it hesitantly and defensively. (If you brush against a nettle, you’ll get stung; if you hold the nettle tight in the right way, pressing the sharp spines flat, you’ll prevent it from stinging you.) By calmly grasping the nettle of pain rather than struggling against it, resenting it, or complaining about it, we can learn to suffer less from it.

The Cynics and Stoics were thousands of years ahead of their time in proposing voluntary acceptance as a way of coping with pain and other unpleasant feelings. This acceptance has long been part of modern behavior therapy protocols for pain management, and in recent decades it’s become the central focus of many therapists dealing with these issues. Distraction can sometimes work for very brief (acute) pain, such as surgical procedures or dentistry, but avoidance strategies tend to backfire when used for coping with chronic pain. Like the Stoic dog following the cart, we have no real choice but to face our pain. Nevertheless, you can choose whether to do so roughly, struggling and fighting against it, or smoothly, through calm acceptance. Most people find that accepting pain greatly diminishes the emotional suffering it causes. Struggling with pain, trying to suppress or avoid it, consumes your time and energy, limits your behavior, and stops you from getting on with other things—so acceptance can also improve your quality of life in this respect. Moreover, in some cases, accepting our bodily sensations can allow natural habituation to take place, so that we begin to notice our pain less, and painful sensations may even begin to diminish as a result.

It’s therefore important to avoid struggling too much against painful or uncomfortable bodily sensations because there’s considerable evidence from modern psychology that doing so can be counterproductive. Researchers call this urge to control or avoid unpleasant feelings “experiential avoidance,” and it has proven quite toxic to mental health. People who strongly believe that unpleasant feelings are bad and try to suppress them from their minds often become more tense and preoccupied with the very feelings they’re trying to avoid, trapping themselves in a vicious cycle. For the Stoics, pain is “indifferent” and not bad. It’s therefore accepted as a natural process. In one graphic passage, Marcus tells himself that complaining about events is as futile and unhelpful as the kicks and squeals that piglets make as they struggle to free themselves during a ritual sacrifice.³⁵ Struggling against things we can’t control does us more harm than good. CONTEMPLATING VIRTUE

Epictetus actually delivered a discourse titled “In What Manner We Ought to Bear Sickness.” In it he argues that pain and sickness are an inevitable part of life, and just as in any other part of life, there are relevant virtues, which are always within our power to exercise.

If you bear a fever well, you have all that belongs to a man in a fever. What is it to bear a fever well? Not to blame God or man; not to be afflicted at that which happens, to expect death well and nobly, to do what must be done: when the physician comes in, not to be frightened at what he says; nor if he says, “you are doing well,” to be overjoyed.³⁶

Epictetus liked to tell his students that in the face of everything that befalls them, they should get into the habit of asking themselves what capacity, or virtue, they possess for making good use of the event. Similarly, cognitive therapists ask their clients, “What resources do you have that might help you to cope better with pain?” For example, if we’re faced with severe pain, then we will find that Nature has equipped us with the potential for endurance, and if we get into the habit of exercising that virtue, then the painful sensations will no longer have mastery over us.³⁷

Another useful way to approach pain is to ask ourselves how someone experiencing the same kind of pain or illness we’re facing might cope with it more admirably (modeling virtue). What would we praise other people for doing in the same situation? Consider then to what extent we can do the same by emulating those strengths or virtues.

Like Epictetus, Marcus often stresses that many ordinary people show great courage and self-discipline in the service of worldly goals, such as greed or showing off to impress others.

Nothing happens to anyone that he is not fitted by Nature to bear. The same things happen to another, and either because he fails to realize that they have happened to him, or because he wants to display his strength of mind, he stands firm and remains unaffected. Is it not extraordinary that ignorance and self-conceit should prove more powerful than wisdom?³⁸

Marcus reminds himself, though, that we can render everything that befalls us in life bearable by suggesting to ourselves either that it is in our interest to do so or that our duty somehow demands it. When we have a reason to endure something, it becomes easier. As Nietzsche said, “He who has a why to live for can bear almost any how.”³⁹ It’s often easier to endure pain if we are confident that it’s doing us no harm or if we’re fixated on some goal. Boxers take punches without complaining to win matches. Their ability to do this puts philosophers to shame, even though the latter believe themselves to be motivated by something infinitely more important: the love of wisdom. Nevertheless, we can learn from observing others that anyone can endure great pain and hardship if they are sufficiently motivated to do so. STOICISM IN EARLY PSYCHOTHERAPY

You’ve learned how the Stoic techniques for coping with pain and illness described by Marcus resemble some of those employed in modern CBT. However, at the start of the twentieth century, long before CBT, there was another “rational” or “cognitive” approach to psychotherapy that competed with Freudian psychoanalysis but is now largely forgotten. The Swiss psychiatrist and neuropathologist Paul Dubois, author of The Psychoneuroses and Their Moral Treatment (1904), was the main proponent of what became known as “rational psychotherapy.” Dubois believed that psychological problems were due mainly to negative thinking, which worked like negative autosuggestion, and he favored a treatment based on the practice of “Socratic dialogue” through which he sought to rationally persuade patients to abandon the unhealthy ideas responsible for various neurotic and psychosomatic conditions. The influence of the ancient Stoics is clear from Dubois’s scattered references to them.

If we eliminate from ancient writings a few allusions that gave them local colour, we shall find the ideas of Socrates, Epictetus, Seneca, and Marcus Aurelius absolutely modern and applicable to our times.⁴⁰

Dubois was particularly interested in the way Stoicism could be used to help psychotherapy patients cope with chronic pain and other physical or psychosomatic symptoms.

The idea is not new; the stoics have pushed to the last degree this resistance to pain and misfortune. The following lines, written by Seneca, seem to be drawn from a modern treatise on psychotherapy: “Beware of aggravating your troubles yourself and of making your position worse by your complaints. Grief is light when opinion does not exaggerate it; and if one encourages one’s self by saying, ‘This is nothing,’ or, at least, ‘This is slight; let us try to endure it, for it will end,’ one makes one’s grief slight by reason of believing it such.” And, further: “One is only unfortunate in proportion as one believes one’s self so.” One could truly say concerning nervous pains that one only suffers when he thinks he does.⁴¹

Dubois quoted Seneca’s letters to illustrate the role of patience and acceptance, as opposed to worry, in helping us to cope with and avoid exacerbating physical illness. He also quoted Seneca’s remarks that the principles of Stoic philosophy consoled him during illness and acted upon him “like medicine,” strengthening the body by elevating the soul.

However, one of the most striking and memorable passages in Dubois concerns something that one of his patients said to him about the Stoics:

A young man into whom I tried to instil a few principles of stoicism towards ailments stopped me at the first words, saying, “I understand, doctor; let me show you.” And taking a pencil he drew a large black spot on a piece of paper.

“This,” said he, “is the disease, in its most general sense, the physical trouble—rheumatism, toothache, what you will—moral trouble, sadness, discouragement, melancholy. If I acknowledge it by fixing my attention upon it, I already trace a circle to the periphery of the black spot, and it has become larger. If I affirm it with acerbity the spot is increased by a new circle. There I am, busied with my pain, hunting for means to get rid of it, and the spot only becomes larger. If I preoccupy myself with it, if I fear the consequences, if I see the future gloomily, I have doubled or trebled the original spot.” And, showing me the central point of the circle, the trouble reduced to its simplest expression, he said with a smile, “Should I not have done better to leave it as it was?”

“One exaggerates, imagines, anticipates affliction,” wrote Seneca. For a long time, I have told my discouraged patients and have repeated to myself, “Do not let us build a second story to our sorrow by being sorry for our sorrow.”⁴²

This diagram, added Dubois, illustrates that “he who knows how to suffer suffers less.” The burden of physical pain or illness is light when we look at it objectively, without “drawing concentric circles” around it, which multiply our suffering by adding layers of fear and worry.

By the time he wrote The Meditations, Marcus had a different relationship with pain than he had when he exchanged complaints with Fronto. According to the Stoics, our initial reaction to pain or illness may be natural and reasonable, but amplifying or perpetuating our suffering by complaining about it over time is unnatural and unreasonable. Animals may cry out in pain and lick their wounds for a while, but they don’t ruminate about it for weeks afterward or write letters to their friends complaining about how badly they’ve been sleeping. Marcus had learned how to suffer properly and thereby to suffer less, as Dubois would have put it. This is how he must have coped with both chronic pain and illness throughout the course of the First Marcomannic War, in which he led Rome to victory.