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Dialogues in Philosophy, Mental and Neuro Sciences ORIGINAL ARTICLE Crossing Dialogues Dialogues in Philosophy, Mental and Neuro Sciences ORIGINAL ARTICLE Crossing Dialogues Association Stoic philosophy and psychotherapy: Implications for neuropsychiatric conditions A E. C 1,2,3 1: Department of Neuropsychiatry, BSMHFT & University of Birmingham, Birmingham (United Kingdom); 2: School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, (United Kingdom); 3: Sobell Depart- ment of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, (United Kingdom). Hellenistic philosophy has multiple parallels with modern psychotherapy and provides several theories, strategies, and techniques of practical value in clinical care, with particular reference to patients with neuropsychiatric conditions. The ancient therapeutic practices of Socratic philosophy, especially Roman Stoicism, reached us through the surviving texts of the three best-known Stoic authors: Seneca, Epictetus, and Marcus Aurelius. Both Albert Ellis and Aaron Beck, often regarded as the founders of rational emotive behaviour therapy and cognitive behavioural therapy, respectively, explicitly acknowledged the role of Stoicism as the philosophical precursor of their treatment approaches. The main analogy between Stoicism and modern psychotherapy is the assumption that cognitive activity (reasoning) aff ects emotions and behaviours: “men are disturbed not by things, but by the views which they take of things”, in Epictetus’ words. From the observation that cognitive activity can be monitored and altered, it follows that desired emotional and behavioural changes may be achieved through cognitive changes. Moreover, aspects of the ‘third wave’ of modern psychotherapy (mindfulness) closely resemble the ancient Stoic practice of attention or ‘concentration on the present moment’. Stoicism-derived psychological techniques can prove useful in the clinical management of patients with neuropsychiatric disorders. For example, movement disorders are chronic neuropsychiatric conditions characterised by the presence of both motor and non-motor symptoms, which are often psychological and aff ect patients’ health-related quality of life more deeply than motor features. Recent fi ndings have shown that cognitive behavioural therapies can be eff ective interventions for patients with movement disorders, especially Tourette syndrome and Parkinson disease. The benefi cial eff ects are not limited to anxiety and aff ective symptoms and prompt further research, across diff erent modalities. After providing a background on Stoicism as a Socratic philosophy based on practical techniques of mind therapy, the present paper highlights parallelisms between Stoicism and modern psychotherapy. Analysis of the texts of the Roman Stoics suggests that several types of psychotherapeutic practice currently in use in neuropsychiatry can be traced back to the Stoic tradition of philosophical therapy. Specifi cally, it has been argued that Seneca’s ‘Letters from a Stoic’ can be read as a precursor of individual psychotherapy, Epictetus’ ‘Discourses’ and ‘Handbook’ resemble recordings of group therapy sessions and self-help manuals, and Marcus Aurelius’ ‘Meditations’ can be regarded as an early example of therapy journal. Keywords: cognitive behaviour therapy, Hellenistic philosophy, mindfulness, neuropsychiatry, psychotherapy, Stoicism. DIAL PHIL MENT NEURO SCI 2019; 12(1): 10-24 www.crossingdialogues.com/journal.htm 10 Cavanna, 2019 “When evening comes, I return home and enter my study; on the threshold I take off my workday clothes, covered with mud and dirt, and put on the garments of court and palace. Fitted out appropriately, I step inside the venerable courts of the ancients, where, solicitously received by them, I nourish myself on that food that alone is mine and for which I was born; where I am unashamed to converse with them and to question them about the motives for their actions, and they, out of their human kindness, answer me. And for four hours at a time I feel no boredom, I forget all my troubles, I do not dread poverty, and I am not terrifi ed by death […]” 1 Niccolò Machiavelli, Letter to Francesco Vettori (10 December 1513) THE RENAISSANCE OF STOICISM: PHILOSOPHY AS MEDICINE “It has not escaped our notice” (to borrow Mediterranean societies since Alexander the a famous incipit from world-class scientifi c Great (356-323 BCE) marked the end of the literature) that an unprecedented series of books stability of the Greek city-state (polis) and linking the ancient Greek philosophy of Stoicism exposed the citizens of his empire to diff erent with the modern science of well-being have cultures and worldviews. It was during the been published over the last decade. To quote Hellenistic age, an era of increasing uncertainty, but a few examples, the works of American that the main focus of philosophy shifted from philosophers William Irvine (‘A guide to the the study of universal nature to the understanding good life: The ancient art of Stoic joy’, 2009) of individual man (introspection). The rival and Massimo Pigliucci (‘How to be a Stoic’, Socratic schools of Stoicism, Epicureanism, 2017) have been widely read and discussed. Cynicism, and Skepticism started diff erent In the United Kingdom and Canada, Scottish traditions, and were indeed characterised psychologist Donald Robertson has focused his by inner debates and tensions, however it is excellent work on the key role of Stoicism as the important to note that they shared the view of conceptual foundation of modern psychotherapy the role of philosophy as practical guide for life (‘The philosophy of cognitive-behavioural and powerful therapy for psychological distress. therapy: Stoic philosophy as rational and In one of his surviving fragments (221 Usener), cognitive psychotherapy’, 2010; ‘Stoicism Epicurus (341-270 BCE) was quite clear about and the art of happiness’, 2013). During the the role of philosophy as medicine for the soul: last two decades of the XX Century, the late “A philosopher’s words are empty if they do not classics scholar Pierre Hadot in France and the heal the suff ering of mankind. For just as medicine infl uential philosopher Martha Nussbaum in is useless if it does not remove sickness from the United States paved the way for the present the body, so philosophy is useless if it does not Renaissance of applied philosophy based on the remove suff ering from the soul”2. Interestingly, Hellenistic tradition of philosophy as practical the surviving philosophical texts of the Roman wisdom providing psychological therapy or writers such as the eclectic Cicero (106-43 mind training (Hadot, 1981; Nussbaum, 1994). BCE) show evidence of medical terminology More recently, American philosopher Lawrence and suggest that the view of philosophy as Becker published the new edition of a daring therapy of the mind was widely endorsed. exposition of what Stoic philosophy would In his ‘Tusculanae disputationes’ (‘Tusculan look like today if it had enjoyed a continuous Disputations’), Cicero described philosophy as development from the Hellenistic age, through ‘Socratica medicina’ (‘Socratic medicine’) and the Renaissance, the Enlightenment, and modern ‘animi medicina’ (‘medicine for the soul’), and science, to the current trends of moral philosophy drew a compelling parallel between the role of (Becker, 2017). the philosopher in the treatment of mental disease The role of ancient philosophy as mind (‘animi morbum’) and the role of the physician therapy is acknowledged within the diverse in the treatment of physical disease. The traditions of Hellenistic philosophy, which therapeutic role of philosophy was particularly stemmed from the teaching of Socrates (470-399 evident within the Stoic tradition. Although it is BCE) in Athens, as recorded by Plato (428-347 appropriate to distinguish diff erent philosophical BCE), the founder of the Academy, and mediated movements and stages within Stoicism, it by his later disciples, especially Aristotle (384- appears that the analogy between philosophy 322 BCE), the founder of the Lyceum. The and medicine is a key theme across thinkers and Hellenistic philosophies fl ourished across the times. For example, in the fi fteenth letter of his 11 DIAL PHIL MENT NEURO SCI 2019; 12(1): 10-24 ‘Epistulae morales ad Lucilium’ (often translated transforms his vision of the world, and, fi nally, as ‘Letters from a Stoic’), Roman politician and his entire being. The analogy seems all the more philosopher Seneca (4 BCE - 65 CE) wrote self-evident in that the gymnasion, the place “Recte nos dicimus ‘si philosopharis, bene est’ where physical exercises were practiced, was […] Sine hoc aeger est animus” (“We rightly say the same place where philosophy lessons were ‘if you are studying philosophy, it is well’ […] given; in other words, it was also the place for Without wisdom the mind is sick”). Finally, the training in spiritual gymnastics”3 (Hadot, 1995). Socratic concept of philosophy as medicine for Crucially, Hadot showed that the Hellenistic the soul, that became commonplace throughout schools of philosophy shared the assumption the Hellenistic age, reverberated in the teaching that the consistent use of reason, combined with of another Stoic philosopher, Epictetus (50- eff ort and training, can allow human beings to 135 CE), as reported by his disciple Arrian at rise above their circumstances and conquer their the beginning of the II Century CE: “ἰατρεῖόν emotions and desires. This is hardly surprising, ἐστιν […] τὸ τοῦ φιλοσόφου σχολεῖον” (“the
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