Sunday, October 2, 2011

Consolations of Philosophy

I first began seeing my current psychiatrist - let's call him Dr. Blum - in January. During my first visit, Dr. Blum analogized mental illness to having a nail embedded in one's foot. In both cases, medical treatment is indicated; simply telling a person to cope with the pain would be inadequate, and also malpractice, because with medical treatment the root source of the pain could be eliminated (or at least managed, in the case of a chronic biologically-based mental illness like bipolar disorder).

That evening, I went home and started flipping through one of my two copies of the Everyman Epictetus, which contains the Discourses, Fragments, and Handbook. In the Handbook, I found this aphorism:

As, when walking about, you take care not to tread upon a nail or twist your foot, so likewise take care not to harm your ruling faculty. and, if we guard against this in every action, we shall set to work more securely.

Almost an identical analogy, but with such a different intended interpretation! Instead of mental anguish being thought of as an unforeseeable accident of life - but an accident whose effects could be ameliorated through medical care - Epictetus sees harm to one's mental faculties as a preventable accident which everyone has a duty to be on the watch for. As in so much of Epictetus's writing, one's mind is one's chief possession, the only one which any human being has any hope of holding on to and controlling, and the most valuable possession any human being has, as it is the one true path to happiness and freedom, as all earthly, bodily things can be stripped from a person.

Epictetus knew a lot about misery. He was born a slave in Phrygia; while his Roman master allowed him to study philosophy, according to one story that same master also deliberately crippled him by breaking one of his legs as punishment for some transgression or other. While Epictetus eventually gained his freedom, throughout his philosophy several key themes are repeated: one's life, freedom, health, and possessions are ultimately beyond one's control, as they can be taken away at any time by accidents of fate or deliberate human cruelty; and therefore one must seek happiness through self-control and internal virtue, as one's mind and one's choices are one's only true possessions.

Epictetus thrilled me when I first read him, several months before I descended into my first depression. I was seventeen, and in my second year of college. At sixteen, when I began my college education, I had read no philosophy; the Greek and Roman philosophers I read over the next two years made an extraordinary impression on me. Plato taught me to love the Good and Beauty, and to seek both ideals with all the passion and energy of eroticism. Aristotle showed me the possibility that through moderation human beings could achieve virtue, and that the goal of a philosophic life was to create the habits which would lead to virtue. And Epictetus taught me that philosophy would allow me to create my own happiness regardless of what happened in the world around me by teaching me self-control and the proper attitude with which to approach all of life's vicissitudes.


I was already predisposed to be skeptical of the psychiatric or psychological approach to misery before my first exposure to philosophy. I had witnessed my mother's terrible, terrifying depression for all of my adolescence, and had left home for college at sixteen in part to escape the tyranny of her moods. No amount of treatment seemed to make her any easier to live with. My father spoke dismissively of psychology as a soft science full of mumbo jumbo.

Ancient Philosophy taught me to think of the mind and soul as entities essentially separate from the body, and to blame myself for any unhappiness I felt, as clearly it meant I wasn't virtuous enough, or strong enough, or wise enough. If I were better, I wouldn't be miserable.

My first exposure to therapy only confirmed my preconception that my misery was "all in my head" - I did a course of cognitive-behavioral therapy with a Licensed Clinical Social Worker. By the time I saw her, I was already on the upswing, as I always am during the summer; I still retained a great deal of my native optimism and work ethic, and loved the idea that I could prevent negative feelings my recognizing irrational patterns of thought and stopping them in their tracks.

I went back to school for my junior year that fall unmedicated and with no treatment plan or follow-up scheduled, no idea what to do if my depression returned. And it returned. With a vengeance. I read Pascal for the first time that fall, identified intensely with his experience of wretchedness, mentally diagnosed him with Major Depressive Disorder, and wondered (not for the first time) whether I would find consolation in Christianity. Atheist that I am and was, I tried very hard to believe in God, but never had the experience of grace which Augustine describes. I was left to deal with my own wretchedness alone: no God, no family, no therapist, and certainly no psychiatrist.

I will not detail the years it took to finally get adequate treatment and an appropriate diagnosis. I will say that I fought medical treatment tooth and nail. I hated the idea that I would have to take mood-altering medications in order to be a functional human being. It felt like a betrayal of philosophy, an unvirtuous, weak-willed, materialist shortcut. But within three weeks of starting lithium and lamotrigine, I was a human being again, able to work, to laugh, to be a loving daughter.

Of course, my path has not been straightforward. I have continued to experience cycling moods despite improved (not perfect) compliance with medication. I am now resigned to the fact that my misery is biological, that no amount of strength of will can cure it, that neither grace from God nor the consolations of philosophy will be sufficient.

So what is the role of philosophy? What can stoicism, or Aristotelean ethics, offer to a psychiatric patient keenly aware that her brain - the seat of her mind, and perhaps her soul - is outside of her control?


A few things. I still use the CBT I was taught four years ago. I use it every day right now. I have the insight to recognize the illogical patterns of thought my depression creates, and CBT helps me to work through the pain. I am able to sit through class, to attend lecture, because I am able to challenge the thoughts which produce intense feelings of shame, guilt, anxiety, and self-loathing. Medication can help the depression lift, but until then I need CBT to endure the depression.

And philosophy helps me think about what kind of a person I want to be, what kind of a life I want to lead, what actions I think are ethical. Epictetus's stoicism has been of great comfort to me when dealing with miseries whose sources are external. Stoicism has been just as much use to me as therapy in dealing with turmoil in my family and cruelties inflicted by others. Stoicism is marvelous if you want to sort out what is or is not in your control, and helping you learn to base your own happiness only on the things that you can control.

Stoicism, like psychiatry, seeks to end human suffering. One works on the brain, the other on the soul; and we are still all wondering what the connection between the two is.

1 comment:

  1. Medication helps but there are so many other things that will also help. You are on the right track with philosophy, CBT, and connecting with others. I am glad you are considering your soul as well as your mind. You will be okay, but you will probably need to remain vigilant for the rest of your life. As you get older, you will see that most people have something that they will struggle with for a lifetime. We are not alone in suffering.