April 2008

The central idea of the Stoics of ancient Greece-that by understanding our ideas we can modulate our emotions-is still relevant today, says Ronald Pies.

Psychotherapy, Stoic-style

Psychiatrist Ronald Pies says the philosophers from ancient Greece can teach us a thing or two about coping with life in 21st-century America

By Taylor McNeil

If you say someone is stoic, the first image that comes to mind is a stiff upper lip, a detached demeanor in the face of adversity. But that's not the approach that the Stoics-the ones who started a school of philosophy in ancient Greece-were teaching. They were arguing for a rational acceptance of life, says Ronald Pies, a longtime clinical professor of psychiatry at Tufts Medical School, and for the use of reasoning to overcome life's inevitable vicissitudes.

In his latest publication, Everything Has Two Handles: The Stoic's Guide to the Art of Living (Hamilton Books), a short self-help book based on Stoic philosophy, Pies argues that the Stoics are the intellectual forbears of today's cognitive behavioral therapists. That approach is markedly different from analytic therapy, in which the past is plumbed to understand the present.

In cognitive behavioral therapy, the focus is on using reason to understand the present and overcome emotional difficulties. What the Stoics said, according to Pies, is both helpful and relevant to us, here and now. "I encourage people to consider the view that by understanding our ideas, we can modulate our emotions," he says, "because in a lot of ways, it's a counterintuitive view for this culture and this society."

Tufts Journal: What is the Stoic view of life?

The fundamental point is to live according to nature and the way the universe actually is, as opposed to how you might hope it would be. What Stoics say is that bad things happen, people get sick, they die-and good things happen, too. But a lot of things that trouble us happen. You can make yourself miserable about that if you want, or you can realize that this is the way things are. You can try to change those things that are within your power to change, but you don't have to make yourself miserable over the things that are not.

In some ways, it's like that well-known saying that is something of a clichť, which you see posted in 12-step meetings: Lord, give me strength to change the things I can change, give me courage to accept things I cannot change, and grant me courage to know the difference. It may be a clichť, but it does sum up a lot of the Stoics' beliefs.

And what about emotions? Stoicism is a very rational philosophy.

Emotion is part of our behavior. The Stoics knew and recognized that, and in their more subtle moments, they understood that you cannot and probably should not try to exorcise all emotion. They deal with the more persistent kinds of negative emotions that we all experience from time to time, things like holding grudges, ruminating for hours, days, months or years: "Why did that guy do that to me? I deserve better. This is just the end of the world. I can't stand it."

These are the very same kinds of things that modern cognitive behavioral therapists look at as irrational ideas. In fact, you can almost draw a straight line from the Stoics to Aaron Beck and Albert Ellis, the people who originated cognitive behavioral therapy.

What the Stoics would say, and what the cognitive behavioral therapists say, is we really can do something about the festering negative emotions that we torment ourselves with. What we can do is think clearly and logically about them, where they come from, and how we can replace them with more constructive emotions. That's the idea of living in harmony with the way the universe is.

How did you come to know the Stoics and incorporate their approach in your work?

That's kind of a biographical question, in a sense. My late mother, Frances Pies Oliver, was a psychiatric social worker. When we were growing up, she came home and talked to us kids all the time about rational emotive therapy, the brainchild of Dr. Albert Ellis. That model is almost a direct descendent of the Stoics. Ellis frequently quoted Epictetus, who was a Greco-Roman Stoic philosopher, who lived around A.D. 55, and whose philosophy is part of the title of my book. The complete quote is "Everything has two handles: one by which it may be borne, another by which it cannot."

And it's your choice which handle you choose?

Exactly right. I think of it as an urn: one handle is nice and smooth, which you can grasp and pick up. The other is jagged, with sharp edges to it, and if you pick it up that way, you're going to get hurt. Say you lose your job-you can view that two ways: "Oh my God, this is the end of the world for me; this is the worst thing that ever happened; I'm finished." The other handle is: "Well, OK, it's a bad break, but who knows, maybe it's an opportunity, maybe there is something better out there for me." That's the handle you'd like to pick it up with.

All of this was something I grew up with, learning about rational emotive therapy. I didn't really look into the philosophy behind it until many years later, until after medical school.

And you found the Stoics at the end of trail?

I was interested in the philosophical foundations of what I was using in my psychotherapy, and just wanted to know where this came from. It turns out that really what the Stoics were saying is almost word for word what you will find in the book Cognitive Therapy and the Emotional Disorders by Aaron Beck, who in a sense was the co-founder with Albert Ellis of cognitive behavioral therapy, or in more popular books you can find on the market by Wayne Dyer.

What about dealing with injustice? What is the Stoic response?

If there is an injustice that we're confronting or concerned about, the Stoic view is not to say, "Oh well, that's fate; there's nothing you can do about it." There's nothing in stoicism that says you should do nothing.

What the Stoics probably would say, and certainly what the cognitive behavioral therapist says, is by all means see what you can do about it. But if you fail, you don't have the additional obligation to make yourself miserable about it. That's not part of the deal. So, again, the courage to change the things you can change, but the wisdom to recognize that there may be some things you can't change.

It's a complicated philosophy. It's not entirely logical, if you want to dissect it. Their basic view was: change what you can change. Do what's in your power, but there are going to be some things that are not in your power.

Why are you trying to popularize Stoic philosophy now? At first glance, it doesn't seem to be in sync with 21st-century America.

The term stoic has something of a bad reputation, especially for those of us who grew up in the 1960s, when "let it all hang out" was the philosophy, where expressing emotion was very highly valued. I think back to Arthur Janov and primal scream therapy, and the idea that we're all really unhappy because we haven't gotten our feelings out.

The Stoics, along with Albert Ellis and Aaron Beck and people like that, would basically say, nonsense-that's just complete nonsense. In fact, it's just the opposite of what you want to do. The more you express your anger, the angrier you get. There are in fact studies that bear this out, that having people beat up pillows or things of that sort actually just gets people's adrenaline going. It doesn't change anything at all.

What the Stoics and the cognitive behavioral therapy folks say is that, sure, you're going to have feelings, and you don't want to damp them down with an iron rod. You need to recognize they are there. But you can change them by thinking your way out of them. And thinking means looking at evidence, seeing how factually based your belief is.

What's an example of that?

Is it really the end of the world if I lose that job? Does it really mean if one person doesn't like me, that I'm a terrible, unlikable person? Examining those ideas beneath the feelings and changing the ideas-the premise is that if you change the idea, you will eventually change the feeling-takes a lot of work. Shakespeare said, "For there is nothing either good or bad, but thinking makes it so." That's really what the Stoic view is.

Does it work better for some people than others?

Probably. I used to have some patients who did very poorly with the cognitive behavioral approach. They were usually people with very severe personality disorders, so-called borderline personality disorders. In recent years, though, there has been some very interesting research on using cognitive behavioral approaches with people with schizophrenia, and finding it can work. It's not easy, though.

Taylor McNeil can be reached at taylor.mcneil@tufts.edu.

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