A Compassionate Philosophy: Medical Ethics in the Hellenistic Tradition (Stoics, Epicureics and Skeptics)

Dana Jalobeanu

(Martha C. Nussbaum, The Therapy of Desire. Theory and Practice in Hellenistic Ethics, Princeton University Press, 1994)

nussbaumIt is a pleasure to revisit old favorites. I liked Marta Nussbaum’s book at the first reading. I like it even more today, more than two decades after it was published. It is a good introductory book; and I am sure many of you will agree with me that it is the perfect book to teach to students (whether you teach ethics, history of philosophy, or philosophy 101). Imagine what it is to teach the history of Hellenistic ethics in a way that makes it immediately relevant to our students of today. In fact, in many universities this model has caught up a while ago (partly precisely because of this book). But I am coming from a university where history of philosophy (ethics included) is still history of philosophy.

By contrast, The Therapy of Desire reconstructs Stoic, Epicurean and Skeptic ethical theories as immediately relevant to a student willing to learn something useful for her own life. Nussbaum introduces us to such a character, Nikidion. Nikidion is a young woman in search of herself. She has loved and suffered; she has mourned loved ones (and hence experienced grief). She is confused and a bit lost in a complicated world (aren’t we all?). She thinks philosophy can help her reconstruct herself. She thinks joining a philosophical school can bring her peace and happiness. And she sets out to investigate, one by one, all the ancient schools, in order to live like an Epicurean, tone her mind with the Stoics, understand with the Aristotelians and learn how to argue from the Skeptics.

Nussbaum’s fictional character is not historically accurate; but, as an imaginative device and a learning tool, she is illuminating. Her story helps the reader to picture the complex teaching-and-learning scenario so characteristic of the ancient schools of philosophy. What all these schools have in common is what Nussbaum calls the medical model of philosophizing. They advocate philosophical practice and claim that philosophical arguments have value mostly in so far as they are able to heal the intemperate mind. Epicureans, Stoics and Skeptics agree on some basic tenets. They agree, first and foremost, that philosophy is a “medicine of the mind.”

Epicurus (Us. 221): Empty is that philosopher’s argument by which no human suffering is therapeutically treated. For just as there is no use in a medical art that does not cast out the sickness of bodies, so too there is no use in philosophy, if it does not throw out suffering from the soul.

Sextus Empiricus, (PH 3.280-81) Being a lover of humanity, the Skeptic wishes to heal by argument, insofar as possible, the arrogant empty beliefs and the rashness of dogmatic people.

Cicero, (TD 3.6): There is, I assure you, a medical art for the soul. It is philosophy, whose aid need not be sought, as in bodily diseases, from outside ourselves. We must endeavor with all our resources and all our strength to become capable of doctoring ourselves.

Seneca (Ep. 48.8) There is no time for playing around [attacking philosophers who devote their career to logical puzzles]… You have promised to bring help to the shipwrecked, the imprisoned, the sick, the needy, to those whose heads are under the poised axe. Where are you deflecting your attention? What are you doing?

The fact that ancient philosophy is a medicine of the mind is not, in itself, a new idea; Pierre Hadot has taught us that much. What Nussbaum is doing in The Therapy of Desire is to explain, with details, how this medicine was supposed to work, and how much of it is still relevant today, for our contemporaries. The emphasis of the book is on the practical and therapeutic aspects of the philosophical teaching (in contrast with Hadot who still focuses on the cognitive import of the “spiritual exercises”). Nussbaum introduces us to the fundamental therapies of desire practiced by the Epicureans, by the Stoic and the Skeptic. And she emphasizes a particular aspect of these therapies which make Hellenistic philosophy a compassionate philosophy, a form of medical ethics.

The teaching program is summarized, by Nussbaum, in eight points. For all ancient Hellenistic schools, philosophy is about constructing arguments which: 1) have a practical goal (they are directed at making the pupil better), 2) are value-relative (to be assessed in accordance to their success in healing), 3) are responsive to the particular case, 4) are directed at the health of the individual (they do not regard the community). Moreover, arguments are constructed with several constraints, such that 5) the use of practical reason is instrumental, 6) the virtues of the argument (consistency, clarity etc.) have an instrumental value, 7) there is an asymmetry of roles between the master (doctor) and the pupil (patient) and 8) the sympathetic scrutiny of alternative views is strongly discouraged (46-47).

How do the three Hellenistic schools of philosophy fare in these respects? They share a number of characteristics. Epicureans, Skeptics and Stoics equally believe that philosophical arguments have a practical goal and must be value-relative and responsive to the particular case (in various degrees). They also make use of the same distinction: “natural” versus “human” (a strong opposition between nature and culture, inherited and acquired). They work upon belief formation and correcting beliefs. Meanwhile, they differ a lot in important details with respect to points 3-8.

What is interesting in Nussbaum’s construction is the use of Aristotelian ethics as a background for the entire discussion. She reconstructs the ethics of the Skeptics, Epicureans and Stoics by contrast with, and as developing points deriving from this Aristotelian background. Again, the perspective is that of Nikidion, the student who, going to Aristotle’s courses realizes that what she learns there is not case-sensitive enough. This is mainly because Aristotle – according to Nussbaum – is too optimistic with respect to the abilities of humans to rationalize and express their beliefs. By contrast, Epicureans and Stoics realize how much of our beliefs are emotional, unconscious, non-discursive; to the extent one needs quite different techniques of argumentation than the ‘simple’ Aristotelian dialectics in order to unveil, diagnose and cure. Epicureans and Stoics, in particular, view the soul

[…] as a spacious and deep place, a place with many lofty aspirations, but also many secrets, a place of both effort and evasion. Much that goes on in it escapes the notice not only of the world at large, not only, even, of the teacher, but also of the person himself or herself. Part of the sluggishness and carelessness of everyday life as it is normally lived is its failure completely to grasp its own experiences and deeds, and failure to recognize and take stock of itself. The Stoic idea of learning is an idea of increasing vigilance and wakefulness, as the mind, increasingly rapid and alive, learns to repossess its own experiences from the fog of habit, convention, and forgetfulness. (340)

If the general trend of Nussbaum’s argumentation is well-known to any student of Hellenistic philosophy, what I find particularly appealing in her book is the remarkable reconstruction of a Lucretian therapy. Nussbaum reads Lucretius’ De rerum natura not like a poem about Lucretius’ thoughts and feelings, as usually interpreted, but as a complex therapeutic program where the diseases are first vividly pictured, only to be further exposed and explained, together with their cure.

Equally valuable is the set of clear distinctions which allows the reader to understand the main differences between the Epicurean and the Stoic versions of these therapies of desire. First and foremost among these is the different attitude (and respect) for the inner powers of reasoning. The Stoics, according to Nussbaum,

[…] have enormous respect for the goodness of reason in each person. This commitment is not only part of the content of their teaching, it is also what organizes it at the deepest level. All their therapy is cognitive, and cognitive therapy is taken to be sufficient for the removal of human diseases. They really believe that prejudice, error, and bad conduct result from incorrect reasoning, not from original evil, or even original aggressiveness or lust or unruliness. And so they believe that philosophy, if it develops the right ways of approaching stubborn and prejudiced people, really can change the look of the world, the appearances these people see, removing the salience of morally irrelevant features and emphasizing those that good and consistent reasoning would endorse. The thing of cardinal importance is for reason to trust itself, to take charge of itself, to scrutinize the sloppy or inconsistent appearances through which a lax and corrupt society influences it. Daily life is not so much evil as flaccid and lazy. We get truth by toning up the muscles of the mind. (335)

How is this “toning the mind” supposed to work? Nussbaum summarizes clearly the Stoic complex program of teaching and learning, focusing on Seneca’s therapeutic strategy which, unlike the Epicurean therapy, presupposes a radical change of roles: the Stoic patient becomes her own doctor. For Seneca and the Stoics the “school” (of philosophy) is abstract and in many respects fictional. They have nothing like the Epicurean community to protect the individual from the outside world. The student has to work on her own to diagnose her illnesses (ill- conceived passions and desires who clouds one’s judgment) and she has to apply the general arguments of the masters to her own particular case. By analogy, she has to learn from the examples provided by the Stoic texts, learning how to generalize, particularize and extend the conclusions so that they gain value for her own life.

Like Epicureans, Stoics also believe in friendship. But their community of friends is an ideal brotherhood; a fraternity of humans, extending to the whole universe. Teaching Stoic therapies is not an easy matter. Like Lucretius, Seneca employs complex literary strategies to achieve this intricate scenario of teaching and learning. Nussbaum reads Seneca’s letters and dialogues much like she reads Lucretius epic poetry: as intricate therapeutic set-ups intended to persuade and illuminate the reader on the main points of this medical ethics. But where the Epicurean is persuasive, the Stoic is didactic; and the Stoic scenario of teaching and learning is again, much more complex. Because, as Seneca repeatedly say, it is not enough the teach the content and the form of a virtuous act; acting virtuously means acting in the same way in which the wise would act in a similar situation.

According to Nussbaum, Seneca’s letters are all part of one “long and rich exemplum, an open ended and highly complex story” which

[,,,] show us […] how the rightness of any act, any life, is in large part a function of the devotion to reason that inspires and infuses it – that we do not have two separate activities, virtuous action and philosophical reason, that much of what makes good action virtuous is the dedication to reason out of which it grows. In this sense, it should be impossible to give a really correct exemplum without showing, inside it, the work of philosophical argument. (340)

But learning from example is only the beginning of the therapy. Once the student realizes how to particularize the exemplum to her own case, once she understands what does it mean to act like a philosopher, a whole new avenue opens towards sharing this experience for the benefit of the others. Because, what is really peculiar to the Stoics is the belief in the fellowship of all humans. In this, Stoics go beyond any of the other ancient schools of philosophy, advocating what looks like an essentially optimistic view on humanity. A humanity “living in common” in the intrinsic bonds of reason and friendship, much like a coral in the ocean. Here is Seneca, again


I am not your friend, unless whatever is at issue concerning you is my concern also. Friendship makes a partnership of all things between us. Nothing is advantageous or disadvantageous for the individual: we live in common. And nobody can live happily who considers only himself and turns everything into a question of his own utility. You must live for another, if you wish to live for yourself. This fellowship, scrupulously and reverently preserved, which makes us mingle as a human being with human beings and which judges that there is a common law of right for the human race, also makes a big contribution to fostering that more intimate fellowship of friendship of which I was speaking. For he that has much in common with his fellow human being has everything in common with his friend. (Seneca, Epistle 48)

Understanding the bonds of friendship and the “partnership of all things between us” involves a serious cognitive leap; but it also involves going beyond medical ethics and the therapy of desire into a more substantial reformulation of metaphysics and theology. For this, however, the reader must turn elsewhere.[i]

[i] A minimal bibliography would include Pierre Hadot, Philosophy as a way of life, London, Blackwell, 1995, Richard Sorabji, Emotions and the peace of mind, OUP 2003 and, perhaps, Alexander Nehemas, The Art of Living. Stoic Reflections from Plato to Foucault, Princeton University press, 2000.

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Associate Professor in Philosophy, Department of Theoretical Philosophy, University of Bucharest.

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