The Stoic School

Bizarre that there is so much talking about Resiliency, up to Antifragility, concealing very old philosophical terms into new words: the same happened for Mindfulness, which is just a new brand linked to specific forms of Ancient Yoga which were always existing.  

Also, the definition of “Narrative Medicine” is a “new label” since medicine, sciences and health care have always been narrative among millenniums: nothing new under the sun. Perhaps, a few increases in methodology ad more sharing by its users, the health care professionals.

Now, to whom should we be grateful for the existence of Resiliency and Antifragility?  To the psychologists who exported this word from physicists? To Nicholas Thaleb, the author of a marvellous book I recommend to read- Antifragility?  Just partly, in deed they have been working on something which was already here, in our Participatory Universe.  However, we are tremendously in debts with some philosophers, in particular the Stoicists, in the Greek version to Zeno of Citium, in Athens in the early 3rd century BC. Stoicism is a philosophy of personal ethics, full of tension towards accepting the reality as it is, not allowing oneself to be controlled by the desire for pleasure or by the fear of pain. The human mind should be used to understand the world and to do one’s part in nature’s plan, and by working together and treating others fairly and justly.

The Stoicism mainstream boosted in Rome with Seneca, rising up to the Roman Emperor Marcus Aurelius, who, by the way, was also the Chief of the Roman Army, so, not a person detached from pragmatic decisions- making. This is probably the reason why stoicism found among the Romans a fertile soil for their materialistic culture, which did not leave too much room for phantasies and lingering souls in the sky.

Philosopher Lucius Anneus Seneca was born in Spain, suffered from severe asthma and experienced tuberculosis when he was young; thanks to his mother’s networks, he moved to Rome and became the Advisor of the Future Emperor, Nero. After different phases of his life when he became popular, then exiled to Corse, then called back again in Rome, he was accused by Nero to have taken part to a conspiracy against him, although it was very unlikely that Seneca was involved.  Nero, his “devoted” ex- disciple, ordered him to kill himself. Seneca obeyed, following the tradition by severing several veins, to bleed to death. 

Why, all of this story, while we, as western countries, are experiencing the worst global mental suffering after the Second World War? In his short essay, “De tranquillitate Animi “, on the tranquillity of the psyche”, a letter written to a friend who is feeling psychologically tormented, there are advices to “stay mental healthy”.  Seneca  gives to his friend “Serenus” (a nickname, definitely) and to all of us readers easy and wonderful suggestions for staying calm, whatever the reality might be.

 De Tranquillitate Animi is a wonderful therapeutic book on resiliency and antifragility:  in the opening Serenus asks Seneca for counsel since he feels agitated, and in a state of unstable immobility, “as if I were on a boat that doesn’t move forward and is tossed about.”  On one hand there is one force asking silence and isolation, on the other an opposite force which asks for active political engagement (while I’m writing these lines, today, in Italy, a government crisis is just open, a wound in the flesh of this battered country). The philosopher Seneca argues that the goal of a tranquil mind can be achieved by being flexible and seeking a middle way between the two extremes: a third way, not only the reiterated concept that in medio stat virtus, the good is in the middle: participate to the crisis, by critically analysing the pros and cons, put the crisis into the historical frame, but don’t let you so down, taking too much personally  “the crisis”.

If we want to achieve peace of mind, Seneca recommends a simple life, advises us to choose our companions carefully, since if we choose those that are corrupted by the vices, their vices will extend to us. As vices, nowadays, we can think to “rage”, a dominating pervasive emotion, everywhere on the social, on the media, in active political engagement: if anger, for a short-limited time might be a good energetic power for asking, demanding and giving also more to the world to  improving the current situation,  staying away from rage- poisoned people is beneficial, since this huge emotion is a self and other’s destructive force. Frugality is the main treatment for peace of mind: we have to learn to know how to contain ourselves, curb our desires, temper gluttony, mitigate anger, to look at poverty with good eyes and to revere self-control. 

Seneca introduces the figure of the Stoic sage, whose peace of mind (ataraxia) springs directly from a greater understanding of the world. Only reasoning, caution, and foresight- vision of the future, can create in someone the ideal atmosphere of peace. The philosopher, while preserving his peace of mind, does not hate humanity for its injustice, vileness, stupidity and corruption. The times we live in are no worse than the preceding ones, and it is not reasonable to waste time raging about these evils, it is more reasonable to smile at them, and they are no worse than in the future. 

The right treatment is to follow nature, find the right balance between sociability and solitude; here some of his quotes. 

Difficulties strengthen the mind, as labor does the body.” – Are we somehow talking about antifragility? Tempering and becoming antifragile, leaving vulnerability, is a very old commandment. 

As is a tale, so is life: not how long it is, but how good it is, is what matters.”  The secret is adding more quality of life to years, than length of life in a depressed person. “A tale”, Seneca calls in action each own personal narrative: such a modern concept, a useless longevity doesn’t matter, what matters is how these years have been wisely “enjoyed”. The “other” is there to help us in finding this goodness in life.

The time will come when diligent research over long periods will bring to light things which now lie hidden. A single lifetime, even though entirely devoted to the sky, would not be enough for the investigation of so vast a subject… And so, this knowledge will be unfolded only through long successive ages. There will come a time when our descendants will be amazed that we did not know things that are so plain to them… Many discoveries are reserved for ages still to come, when memory of us will have been effaced.”- and this is his legacy for the research in the posterities.  Human being is evolving seeing with logic and rational minds how nature works, and what can help for e better life; the three main qualities of the Humanities that Seneca endorses are “Openness” to what happens, that asks for a rational reaction, “Measure”, the dosing between laughing and crying, shouting and being silent, the active and reflective mind, the expression of oneself and the pure listening, and “Help” since the mere fact that he writes therapeutic books to Serenus (A friend? The emperor? And beyond, His Alter Ego?)  is a sign of an Aid professional.

What are humanities for health? These ones, at least, their roots are here. Seneca, already 2.000 years ago, shed lights through his essays, his reflective writing, his coping attitude, in his own life endured by the disease, by being a private tutor sentenced to death in the family whose destiny was tangled with murders by severing veins and poisons. 

As Seneca foresaw very well, neurosciences later would have been discovering the positive effect of tranquillity to foster a sharp mind, to unveil reality and to move on, despite whatever reality is around:  COVID-19 times, war times, normal and a new normal age, this last time being the one we are longing for; however, according to Seneca, we should not put such a great pathos.  Possibly, the new normal will come not only for ourselves in the future, but mainly for the next generations who will benefit the most. 

Maria Giulia Marini

Epidemiologist and counselor in transactional analysis, thirty years of professional life in health care. I have a classic humanistic background, including the knowledge of Ancient Greek and Latin, which opened me to study languages and arts, becoming an Art Coach. I followed afterward scientific academic studies, in clinical pharmacology with an academic specialization in Epidemiology (University of Milan and Pavia). Past international experiences at the Harvard Medical School and in a pharma company at Mainz in Germany. Currently Director of Innovation in the Health Care Area of Fondazione ISTUD a center for educational and social and health care research. I'm serving as president of EUNAMES- European Narrative Medicine Society, on the board of Italian Society of Narrative Medicine, a tenured professor of Narrative Medicine at La Sapienza, Roma, and teaching narrative medicine in other universities and institutions at a national and international level. In 2016 I was a referee for the World Health Organization- Europen for “Narrative Method of Research in Public Health.” Writer of the books; “Narrative medicine: Bridging the gap between Evidence-Based care and Medical Humanities,” and "Languages of care in Narrative Medicine" edited with Springer, and since 2021 main editor for Springer of the new series "New Paradigms in Health Care."

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