When people think of pain, they often think of (lower-case) stoicism, or having a stiff upper-lip. However, ancient Stoic philosophy had a much more sophisticated approach to pain management than just “grin and bear it.” In fact, it was the original inspiration for modern cognitive-behavioural therapy (CBT), which first appeared in the 1950s. CBT is currently the dominant evidence-based form of psychotherapy, and provides some surprisingly robust techniques for coping psychologically with chronic pain and illness.

However, one of my favourite anecdotes about Stoicism and pain actually comes from an early 20th century psychotherapist called Paul Dubois. Dubois used to assign his patients homework that involved reading the letters of the Stoic philosopher Seneca. Once Dubois was explaining to a young patient how Stoic philosophy could help him cope better with illness. The man interrupted saying: “I understand, doctor; let me show you.”

And taking a pencil he drew a large black spot on a piece of paper. “This,” said he, “is the disease, in its most general sense, the physical trouble—rheumatism, toothache, what you will—moral trouble, sadness, discouragement, melancholy. If I acknowledge it by fixing my attention upon it, I already trace a circle to the periphery of the black spot, and it has become larger. If I affirm it with acerbity the spot is increased by a new circle. There I am, busied with my pain, hunting for means to get rid of it, and the spot only becomes larger. If I preoccupy myself with it, if I fear the consequences, if I see the future gloomily, I have doubled or trebled the original spot.” And, showing me the central point of the circle, the trouble reduced to its simplest expression, he said with a smile, “Should I not have done better to leave it as it was?”

The burden of physical pain is lightened when we are able to look at it objectively, without adding layers of fear.

Dubois adds:

“One exaggerates, imagines, anticipates affliction,” wrote Seneca. For a long time, I have told my discouraged patients and have repeated to myself, “Do not let us build a second storey to our sorrow by being sorry for our sorrow.”

He says this diagram illustrates the Stoic doctrine that “He who knows how to suffer, suffers less.” The burden of physical pain or illness is lightened when we are able to look at it objectively, without drawing concentric circles around it and multiplying our suffering by adding layers of fear.

Here are 5 related techniques that ancient Stoics, such as the Roman emperor Marcus Aurelius, used to cope with pain:

Tip #1: Distinguish What Is in Your Control, From What Isn’t

The Stoic philosopher Epictetus said: "What, then, is to be done? To make the best of what is in our power, and take the rest as it naturally happens." This became the basis of the Serenity Prayer made famous by Alcoholics Anonymous: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” Which aspects of being in pain or suffering from illness are up to you and which are not? Maybe some of the physical discomfort isn’t under your control but you could change the way you think about it or aspects of your behaviour.

Tip #2: What Are the Consequences of Struggling Versus Acceptance?

What would happen, over time, if you could learn to calmly accept the fact that some painful sensations are beyond your direct control? What if you took greater responsibility for learning healthier ways to think and act in response to pain? The Stoics liked to say that it’s not really pain that’s our problem but rather the fear of pain. Struggling against things we can’t change can add to our emotional suffering. The Stoics want us to learn a healthy and rational attitude of acceptance instead. Of course, if there are practical steps that could potentially help your condition, then take them.

Tip #3: L et Go of the Inner Struggle

The Stoics compared life to a dog tied to a moving cart. If the dog tries to struggle and resist, it will be pulled along roughly by the cart anyway. However, if it chooses to run behind at the same speed as the cart, things will go smoothly. If we struggle against unpleasant experiences such as pain and try to resist them or become frustrated or resentful toward them, then we often just make our lives worse.

Tip #4: Focus on the Bigger Picture

One of the most famous Stoic techniques is called the "View from Above" by modern scholars. It involves picturing events from high overhead, like Zeus looking down from Mount Olympus. Sometimes it goes further and involves imagining our current situation as a tiny part of the whole of space and time. When we become upset, on the other hand, we tend to focus on events very narrowly and that can magnify our pain and suffering.

––––––––––-

If you want to learn more about the life and Stoic philosophy of Marcus Aurelius, and how techniques from Stoicism and CBT can help you to deal with bad habits, manage anger, overcome worry and anxiety, cope with pain and illness, and even come to terms with your own mortality, check out How to Think Like a Roman Emperor.