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Stoic Philosophical Therapy Workshop (Supporting Papers) Session 1: Where we are now. University of Exeter project on ancient healthcare and modern wellbeing

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Stoic Philosophical Therapy Workshop (Supporting Papers)

Session 1: Where we are now.
University of Exeter project on ancient healthcare and modern wellbeing (including psychological healthcare), involving Christopher Gill, John Wilkins, Patrick Ussher and others.

Background to convergence between academic study of Stoicism and modern practical ethics/practical philosophy and psychotherapy (especially cognitive).
FOUCAULT, M. (1990). The Care of the Self: The History of Sexuality vol. 3, trans. R. Hurley (London).

FOUCAULT, M. (2005). Hermeneutics of the Subject: Lectures at the Collège de France (1981-2), trans. G. Burchell (New York).

HADOT, P. (1995), Philosophy as a Way of Life: Spiritual Exercises from Socrates to Foucault, trans. M. Chase (Oxford).

HADOT, P. (1998). The Inner Citadel: The Meditations of Marcus Aurelius, trans. M. Chase (Cambridge, Mass.).

NUSSBAUM, M. C. (1994). The Therapy of Desire: Theory and Practice in Hellenistic Ethics (Cambridge).

STOCKDALE, J. (1995), Thoughts of a Philosophical Fighter Pilot (Stanford).

NUSSBAUM, M. C. (2001). Upheavals of Thought: The Intelligence of Emotions. (Cambridge).

SORABJI, R. (2000). Emotion and Peace of Mind: From Stoic Agitation to Christian Temptation (Oxford).

LONG, A. A. (2002). Epictetus: A Stoic and Socratic Guide to Life. (Oxford).

SELLARS, J. (2003). The Art of Living: The Stoics on the Nature and Function of Philosophy (Aldershot).

SHERMAN, N. (2005). Stoic Warriors: The Ancient Philosophy behind the Military Mind (Oxford).

TSOUNA, V. (2007), The Ethics of Philodemus (Oxford), on Epicurean therapeutic works by Philodemus.

More recent works:

EVANS, J. (2012). Philosophy for Life and Other Dangerous Situations (London)

LEBON, T. (2003). Wise Therapy (London).

ROBERTSON, D. (2010) The Philosophy of Cognitive-Behavioural Therapy (CBT): Stoic Philosophy as Rational and Cognitive Psychotherapy (London).

Stoic Philosophical Therapy Workshop:

Session 2: Where do we go next?
Summary of interdisciplinary project application pending:
Mining the past for future wellbeing: Identifying psychological and behaviour change techniques in Classical texts. Proposed two-year research project (Jan 2013-Dec 14).
Overall plan: the project will develop in three phases. First, a content analysis of ancient texts (both those relating to ancient ‘preventive medicine’ and philosophical therapy) to identify psychological and behaviour change techniques. Second, a comparison of these ancient methods with modern approaches. Third, consultation with experts in cognitive therapy and behaviour change on how ancient methods relate to current practice in psychiatric and health-related interventions.
John Wilkins (ancient healthcare), Christopher Gill (ancient philosophical therapy),

Charles Abraham (behaviour change, Peninsula/Exeter Medical School), Edwards Watkins (cognitive therapy, Exeter Mood Disorders Centre), also postdoctoral fellow.

Core of project: systematic correlation of methods of promoting behaviour change (e.g. as regards healthy lifestyle) with methods of cognitive psychotherapy and, in turn, with methods recommended or described in ancient texts relating to healthcare and/or philosophical therapy. For instance, Abrahams (2001) offers a taxonomy of 40 behaviour-change techniques as a basis for implementation, e.g. ‘prompt identification’ as role model/position advocate’, ‘prompt mental rehearsal of successful performance’, provide instruction on resisting social pressure’, prompt guided imagery to change mood or psychological state’. Abraham 2009 is an analysis of modes of intervention designed to promote a healthy lifestyle; his findings include the conclusion self-monitoring (combined with other modes of intervention) significantly increases the effectiveness of any given set of interventions. Ancient philosophical therapy, in particular (rather more than ancient treatises on ‘regimen’ or healthcare) offer a rich range of - what could be described as – methods of behaviour change, which can be correlated with those currently applied, with a view to enhancing current practice.

Abraham, C. et al. (2009), ‘Effective Techniques in Healthy Eating and Physical Activity Interventions: A Meta-Regression’, Health Psychology 28.6: 690-701.

Abraham, C. (2011), ‘Mapping Change Mechanisms onto Behaviour Change Techniques: A Systematic Approach to Promoting Behaviour Change through Text’, in C. Abraham and M. Kools (eds.), Writing Health Communication: An Evidence-based Guide for Professionals (London).

Watkins, E. R (2008), ‘Constructive and Unconstructive Repetitive Thought’, Psychological Bulletin 134: 163-206.

Methodological issues raised by this project:

ambitious four-way correlation of methods of behaviour change (ancient healthcare texts, philosophical therapy; modern behaviour change, modern cognitive therapy);

detachment of shared or analogous themes from broader medical and philosophical frameworks with differing conceptual and cultural frameworks.
Alternative (Complementary) Project (two versions)
(1) An analysis of a range of ancient psychotherapeutic methods, with a view to defining key structural features and motifs, aimed at correlating with modern practice(s) and enhancing these. A study of the types of writings used to communicate these methods (see below) and of the forms of expression (e.g. modes of address or self-address) used to render the methods effective in written form. (The project would thus combine conceptual and literary/formal aspects.)
(2) A more practically focused reader or resource (possibly an ebook); combining illustrative readings of ancient psychotherapeutic works with advice or guidance about how this could be used, from a specific modern therapeutic standpoint. Robertson 2010, Appendix II does this with the ‘view from above’ motif in Marcus Aurelius; but this approach could be taken further, offering e.g. materials for a course of treatment or for addressing specific needs or concerns or objectives. To be effective, such a reader would have to be prepared collaboratively, by an academic plus therapist (or an academic who is also a therapist). This reader could draw on analysis (1) if available.
Some notes on materials which are potentially relevant for either version of this project (cf. C. Gill, ‘Philosophical Therapy as Preventive Psychological Medicine’ (unpublished, available on the Exeter ancient healthcare blog).
Works of ancient philosophical therapy:

Chrysippus (3rd cent. BC Stoic), ‘therapeutic book’ (Book 4 of On Passions).

Philodemus (1st cent. BC Epicurean), many works of this kind including books on avoiding fear of death and anger. Lucretius, Book 3 on fear of death.

Cicero (1st cent BC), Tusculan Disputations 3-4 (review of therapeutic strategies).

Seneca (1st cent AD Stoic) On Anger, On Peace of Mind, Letters.

Plutarch (1st cent. AD Platonist), various works including those on avoiding anger and on peace of mind (Feeling Good).

Galen (2nd cent, doctor): Avoiding Distress (Not Feeling Down).

Galen, The Diagnosis and Cure of Psychological Affections (and Errors)

Stoic writings in practical combining elements of protreptic, therapy and advice: Epictetus (1st cent. AD Stoic teacher), Discourses, Marcus Aurelius (2nd cent. AD emperor influenced by Stoicism), Meditations.
Common elements in these writings: claim that all or most human beings have, constitutively, the capacity to improve their way of life or state of mind by their own efforts; more broadly, to achieve happiness, as conceived in the theory; that (most or all) distress or psychological disturbance derives not from (unalterable) circumstances but from mistaken beliefs about what happiness consists in or requires. ‘Therapy’, as exemplified in these works, sets out to revise these beliefs and also to offer well-grounded advice about how to obtain happiness. These works focused especially either on enabling people to survive misfortune without losing peace of mind (emotional resilience) or (2) on providing people with an understanding of the purpose of their lives (which also enables them to confront misfortune without loss of peace of mind).
Common elements co-exist with variant accounts of key ideas:

e.g. happiness (as virtue, in Stoicism, as pleasure, in Epicureanism, as virtue plus ‘external goods’, in Platonic-Aristotelian framework);

or ethical development (depends on combination of inborn nature, upbringing and education in Platonic-Aristotelian framework, Stoic-Epicurean view stresses natural or universal capacity for ethical development);

or psychological make-up (reason/mind contrasted with emotions and desires – and body – in Platonic-Aristotelian framework, psychological and psychophysical holism, in which reason can reshape emotions and desires completely, in Stoic and Epicurean thought);

different views of the nature of the universe and its bearing on ethical life (e.g. contrast between providential and non-providential world-views).
Two examples, illustrating shared approach and variations: Galen, Avoiding Distress (Platonic-Aristotelian), Seneca, On Peace of Mind. (Stoic). Four key elements: conception of happiness, ethical/emotional development, persuasive stance by author, training method.

Galen, Avoiding Distress – how to build up emotional resilience.

Form of work: letter to someone wanting to know why Galen is not affected by the loss of valuable possessions (external goods) as other people are, and retains his equanimity even under difficult circumstances.

  1. what is needed for human happiness: physical and psychological well-being (of a kind that is dependent on one’s own efforts).

‘So as far as my bodily well-being is concerned, I pray continually for good health, not wanting a broken head in order to display courage, and even though I have thought it right to train my imagination to face every disaster with moderation, I would never pray to meet anything that could distress me, I am keenly aware that I depend on the quality of the state of both my body and my soul, and so I would not like anything to arise from any external cause that could destroy my health or any disaster that could overpower my soul. Not that I neglect their welfare, but I always try, as far as in my power, to endow them with sufficient strength to withstand whatever distresses them. Even if I do not expect my body to have the strength of Hercules or my soul to be like that which some attribute to the sages, I think it better not to abandon deliberately any form of training.’ Galen, Avoiding Distress, 74-6.

  1. Development as basis for happiness

Galen’s inborn nature plus family background, habituation and education:

‘So you may suppose that I am naturally like my forebears because I was born like this and moreover, because I had an identical upbringing, I have a similar psychological attitude to them [father and grandfather]’. (60)

  1. Persuasive stance: Galen as exemplar:

‘I have received your letter in which you invite me to show you what kind of training, what arguments or what considerations had prepared me never to be distressed …You also said that you had never seen me moved in the slightest, but that what has just happened surpasses everything that has gone before, since all that I have had stored in the warehouses by the Sacred Way was destroyed in the Great Fire [of 62 AD]’

  1. Training method for emotional resilience; conscious training and self-correction, effective for those who have (some measure) of the psychological conditions for proper development, once they see what is needed for human happiness:

‘And he, by careful self-monitoring, improved greatly in the course of a year. In your case, even if you are not capable of a great improvement, you should be satisfied even with some quite small progress in the right direction in the first year. If you continue to withstand the affection and to soften your rage, you will make substantial progress in the second year. And if you persevere with the process of self-monitoring, you will notice still greater progress towards a worthwhile life in the third, and then the fourth and fifth years, and beyond. It is a shameful thing that a man will make every effort for a period of many years to become a good doctor, orator, grammarian, or geometer, but that you should give up on ever becoming a good human being, because of the expenditure of time.’ Galen, Psychological Affections ch. 4.

Seneca, On Peace of Mind: how to achieve consistent purpose in life.
Form of work: dialogue between Seneca and Serenus (the latter suffering from internal conflict and vacillation about his aims in life), analysis of roots of his state of mind and advice about how to correct it. Focus on management of actions and pathway of life as vehicle for search for happiness but also implications for surviving disaster without loss of peace of mind.

  1. Nature of human happiness: virtue or excellence, to live a life which is shaped by the motive of progressing towards virtue/happiness: implicit throughout dialogue but explicit in idea of wise person as invulnerable to fortune (11, contrast Galen).

  2. Development: recognition that different people are better suited for different pathways in life (public/private, study/action) – but any given life can be used as the vehicle for ethical development.

  3. Persuasive stance: analysis of Serenus’ initial state of internal conflict and incoherence, and advice about how to use your life (whatever its outer form) as vehicle for journey towards expression of virtue/happiness. Persuasive use of exemplars: Socrates under 30 tyrants (5), Julius Canus calmly responding to condemnation to death by Caligula (14). Recurrent message: virtue/happiness up to us and does not depend on fortune/circumstances/external factors.

  4. Training method: formation of life-strategy that matches choice of role to natural talents and inclinations, but also sees life as means of achieving a larger ethical purpose- the attainment of that purpose is not dependent on success in the role chosen (public or private) but on internal agency and engagement in the larger project.

Stoic Philosophical Therapy Workshop: Session 3
Where the Meditations fit in.
Christopher Gill: Marcus Aurelius, Meditations 1-6: new translation with full introduction and commentary (Oxford University Press, Clarendon Later Ancient Philosophers, 2013)
Meditations: roughly 400 short reflections or entries: philosophical (guide to life) notebook, purely for personal use, by Stoic-influenced Roman emperor in about 168-80 (AD, M. campaigning in Germany).
Topics considered: (1) overall shape of framework of thought underpinning the mosaic of reflections; (2) how to read individual meditations (‘chapters’); (3) special contribution of Med. for therapy/guide to life uses.
(1) Overall framework of thought in Med.

Most influential approach to date that of Pierre Hadot (Philosophy as a Way of Life, 1995, Inner Citadel 1998): three disciplines (or ‘spiritual exercises’, cf. Ignatius of Loyola): shaping desire (goals or ends), impulse (motives and social practice), and assent (beliefs and understanding); linked with ‘lived’ versions of the three branches of Stoic philosophy: desire with physics, impulse with ethics, and assent with logic; based on schema of practical ethics found in Epictetus (1st cent. AD Stoic teacher) who greatly influenced Marcus.

Alternative approach (cf. some other recent accounts, esp. A. Giavatto, M. van Ackeren), seeing Med. as less schematic in this respect, and as based more broadly on Stoic theory as whole, not just Epictetus, though still with a strong practical focus.

Thumbnail sketch of Med:

What we find are repeated attempts to encapsulate, in a few, highly charged sentences, the broad vision of human life and its larger cosmic setting offered by Stoicism. Above all, the work communicates with remarkable power what it means to try to live one’s life – sincerely and urgently -- according to Stoic principles. At the heart of the Meditations, I think, is an idea central to Stoic ethics, though not perhaps unique to Stoicism. The key thought is that, over and above the biological or physical and purely external or formal dimensions of our existence, we should aim to shape our lives as the expression of an ongoing journey towards an ideal state of character, understanding, and mode of interpersonal relationship, which should constitute our target even though we will never achieve it fully. In the light of this larger project, Marcus addresses challenges of which he is especially conscious but which are also universal human concerns. These are, above all, facing the looming presence of our own death, and recognizing the significance of our communal roles and personal relationships in spite of our shared mortality and transience. Marcus also addresses in his own distinctive way broader topics in the interface between ethics and logic or the study of nature that were crucial for Stoicism. He looks for reassurance, despite some uncertainties, that the capacities of human psychology and the nature of the universe support the kind of ethical vision that Stoicism offers.

In outline, 4 main themes or strands in Med:

(1) Core ethical project of on-going (life-long) self-improvement, deliberate movement towards goal (character, understanding, mode of interpersonal relationship); underpinning engagement in more localised roles (man, Roman, emperor); project shapes response to any given situation and is presented as possible in any situation, however challenging or seemingly disastrous. Underlying key Stoic theories: happiness constituted by virtue (life according to nature/reason/virtue); life as process of development or ‘appropriation’/’familiarisation’, making yourself ‘at home’ with your nature, humanity, world; two interrelated strands, individual (focused on ethical motivation), and interpersonal/communal. Recurrent images include ethical life as ‘path’, ‘way’, ‘journey’; overriding priority of project conveyed by stress on urgency, ‘now’, by repeated dismissal of other values and concerns. Most pervasive theme in Med.

(2) Human (or cosmic) transience, death (esp. one’s own) as a looming presence, (purely) physical or material aspects of life; recurrent theme (about 60 ‘chapters’); taken in isolation suggests pessimism, futility even cynicism (or Cynicism). Juxtaposition to theme 1 (core ethical project), sometimes implied, sometimes explicit, carries different significance: such things are ‘matters of indifference’ compared with virtue (goal of ethical project); more specifically facing and confronting prospect of death, transience, loss, is a central part of the ethical project.

(3) First two themes fall, in different way, within Stoic ethics, second two on interface of ethics with ‘logic’ and ‘physics’ (both broadly conceived). First, distinctive features of human psychology (esp. rational agency) make us (all) fundamentally capable of undertaking the kind of ethical project or journey implied in the first theme; cf. Epictetus, linked with distinction with what is and is not ‘up to us’ (within our power). Marcus recurrently appeals to – or urges himself to exercise – this human capacity: characterised in terms of primacy of ‘ruling centre’ (mind) or (inner) divinity (daimōn), guardian spirit. Some versions of this appeal thought by some scholars to express non-Stoic or Platonic psychology, implying sharp mind-body or reason-emotion distinction; but in fact M. assumes Stoic psychophysical and psychological holism, but couches this in terms that reflect centrality of rational agency (‘ruling centre’, ‘guardian spirit’).

(4) Second (interface of ethics and physics): complex of motifs: M. seeing himself as part of a larger (social and cosmic) ‘whole’; recognising that he forms part of the universal ‘web’ of causation or fate and that he should accept – gladly – what happens as a result, even if seemingly bad; seeing the exercise of rational agency as the proper expression of his human role within nature as a whole. Recurrent images: seeing oneself as part of the whole, adopting the ‘view from above’; harmonising oneself (one’s guardian spirit) with the rationality directing the universe as a whole. M.’s treatment of this area involves some rather puzzling and seemingly non-standard ideas (notably his repeated use of the alternative ‘providence or atoms’, seeming to call into question the providential world-view he normally assumes), and he has sometimes been seen as ‘eclectic’, rather than Stoic in this respect. M. admits his limitations in study of Stoic physics (and logic) and his handling of this topic shows him pressing the boundaries of his understanding of Stoic theory. On the whole, however, and even in this respect, his thinking reflects a distinctively Stoic stance on the interface of ethics and physics and of its role in supporting an ethical basis for life.

(2) Reading Med. (a rather unexplored topic)

Entries (‘chapters’) in Med. vary from short, single-theme passages to longer and more complex or interwoven ones. But in both cases it is important both to try to make sense of the sequence of thought in a given passage and to locate the passage in the broader, Stoic-inspired framework to get the benefit of the passage. My commentary aims to do this for each of the chapters in Books 1-6 (about 200).

Some examples of Med., mostly linked with the four strands just noted, with short comments.
M. himself seeming to reflect on the overall aim of Med.:
[4.3(1)] People look for retreats for themselves, in the country, by the coast, or in the hills; and you too are especially inclined to feel this desire. [2] But this is altogether un-philosophical, when it is possible for you to retreat into yourself at any time you want. There is nowhere that a person can find a more peaceful and trouble-free retreat than in his own mind, especially if he has within himself the kind of thoughts that let him dip into them and so gain ease of mind; and by ease of mind, I mean nothing but having one’s own mind in good order. [3] So constantly give yourself this retreat and renew yourself. You should have to hand concise and fundamental principles, which will be enough, as soon as you encounter them, to cleanse you from all distress and send you back without resentment at the activities to which you return.
So each meditation an occasion for self-addressed reflection on fundamental features of Stoic philosophy (esp. ethics) on which M. can shape his thinking about his life as a whole, and so renew himself and his state of mind in preparation for addressing his daily tasks again ‘without resentment’.
Four examples showing M.’s core project of ethical self-improvement:
[4.17] Do not act as if you were going to live for a thousand years. The inescapable is hanging over your head; while you are alive, while it is still possible, become a good person.
[2.5] (1) At every hour, give your full concentration, as a Roman and a man, to carrying out the task in hand with a scrupulous and unaffected dignity and affectionate concern for others and freedom and justice, and give yourself space from all other concerns. (2) You will give yourself this if you carry out each act as if it were the last of your life, freed from all randomness and passionate deviation from the rule of reason and from pretence and self-love and dissatisfaction with what has been allotted to you. (3) You see how few things you need to master to be able to live a smoothly flowing and god-fearing life; the gods will ask no more from someone who maintains these principles.
[2.1] (1) Say to yourself first thing in the morning: I shall meet with people who are meddling, ungrateful, violent, treacherous, envious, and unsociable. (2) They are subject to these faults because of their ignorance of what is good and bad. (3) But I have recognized the nature of the good and seen that it is the right, and the nature of the bad and seen that it is the wrong, and the nature of the wrongdoer himself, and seen that he is related to me, not because he has the same blood or seed, but because he shares in the same mind and portion of divinity. So I cannot be harmed by any of them, as no one will involve me in what is wrong. Nor can I be angry with my relative or hate him. (4) We were born for cooperation, like feet, like hands, like eyelids, like the rows of upper and lower teeth. (5) So to work against each other is contrary to nature; and resentment and rejection count as working against someone.
These passages illustrate in different ways the core project of on-going ethical self-improvement directed at an ideal state of character, understanding and mode of relationship – a project whose urgency M underlines forcefully in 4.17. M. presupposes the distinctive feature of Stoic ethics, that virtue (doing what is right) is the only good, in comparison with which other so-called goods are ‘matters of indifference’. He also assumes the Stoic view of ethical development as an interrelated, two-strand process, involving both a progressive understanding of the absolute priority of virtue and a progressive deepening of one’s relations with other people in the light of this development of ethical understanding. As in Stoic theory generally, social development can lead both to well-motivated engagement in conventional family and communal relationships and to regarding other people as fellow-members of a single (cosmic) family or city.
2.5 shows M. making every effort to enable this project of self-improvement to inform both his tasks and role (‘as a Roman and a man’) and his treatment of others (‘affectionate concern for others’); as well as his own broader view of his life as a whole (‘carry out each act as if it were the last of your life’). In 2.1, M. refers to the goal of seeing other people as fellow-members of the brotherhood of humanity or as fellow-citizens in the universe (we are ‘relatives’ who share ‘in the same mind and portion of divinity’ (2.1.3). M. also brings out here the –rather complex and in some way asymmetric – interpersonal stance implied in the process of social development (which we might compare with some ideas of Peter Strawson about the contrast between ‘reactive’ and ‘objective’ attitudes to other people). We need to allow our sense of people as ‘members of the brotherhood of humankind’ to negate the misguided emotions such as anger and resentment that are the product of our own incomplete ethical development. We also need to allow for the possibility that those other people are operating with a value-system very different from the one being taken as our goal – but without hating or being angry with them for this, since we see that ‘we were born for cooperation’, i.e. part of one human family.
[4. 49] (1) Be like the headland, on which the waves break constantly, which still stands firm, while the foaming waters are put to rest around it. (2) ‘It is my bad luck that this has happened to me.’ On the contrary, say, ‘It is my good luck that, although this has happened to me, I can bear it without getting upset, neither crushed by the present nor afraid of the future.’ (3) This kind of event could have happened to anyone, but not everyone would have borne it without getting upset. Why is that case one of bad luck rather than this case one of good? (4) In general, do you describe as bad luck for a person what is not a failure in human nature? And do you think anything can be a failure in human nature which is not out of line with the intention of that nature? (5) Well then, you have learnt what that intention is. Surely, what has happened cannot prevent you from being just, high-minded, self-controlled, thoughtful, deliberate, truthful, self-respecting, free, and the other qualities whose presence enables human nature to maintain its character. (6) So in future in every event that might lead you to get upset, remember to adopt this principle: this is not bad luck, but bearing it nobly is good luck.
In brief, here, M. uses his recognition of his core project (trying to live a human life that expresses the virtues, 4.49.5) to counteract the sense he might otherwise have that he is experiencing bad luck or misfortune. He urges himself to be ‘like the headland’ with waves around it, and free of the (misguided) emotions that would otherwise affect him.
Facing death and transience:
[2.17] (1) In a human life, one’s time is an instant, one’s existence is flux, perception is dim, the composition of the body as a whole is subject to decay, the mind wandering, fortune unpredictable, fame precarious. (2) To sum this up: everything belonging to the body is a river, and everything belonging to the mind is a dream and a delusion; (3) life is a war and a brief stay in a foreign land, and fame after death is oblivion.

(4) What then can guide us on our way? One thing and one thing only – philosophy. This consists in keeping the guardian spirit within us unviolated and unharmed, master of pleasure and pain, doing nothing in a random manner and nothing with falseness or pretence, not needing someone else to do or not to do something. Also, in accepting what happens and what is allotted to one as coming from the source from which one came oneself; and above all, waiting for death with a confident mind, since it is nothing but the dissolution of the elements of which every living creature is composed. (5) If for the elements themselves there is nothing to be feared in their continuous change from one into another, why should we fear the change and dissolution of all of them? It is in accordance with nature, and nothing bad can be in accordance with nature.

This passage illustrates the second main strand in Med., the recognition of imminent death and transience as ever-present facts of human existence (and of that of the universe as a whole (2.17.1-3); but also of setting against that our constitutive human capacity to engage in the ethical project of self-improvement – here presented as the function of his ‘escort and guide’, namely philosophy (4). This passage also indicates one aspect of the ethics-physics interface in Med: the recognition of our death (or dissolution of elements) as an ineluctable corollary of our nature as physical parts of the universe, and one we should accept – gladly, even joyfully, as he stresses elsewhere – in recognition of the overall goodness of the universe and of our nature as integral parts of this. Hence, the ‘pessimistic’ note of the first part of the passage is counteracted by the positive ethical stance (and physics-based considerations) that follow.
Third strand: human psychology capable of core project:
[5.26] (1) Make sure that the ruling and sovereign part of your soul is unaffected by the movement, rough or smooth, in the flesh and that it does not combine with that, but circumscribes itself and restricts those experiences to the parts affected. (2) Whenever they communicate themselves to the mind by virtue of that other sympathy, as is bound to happen in a unified body, then you should not attempt to resist the sensation which is a natural one; but your ruling centre should not add its own further judgement, that it is good or bad.
One of many passages in which M. assures himself that he is fundamentally capable of the kind of rational agency involved in his core ethical project. The passage seems at first sight to imply a sharp mind-body and reason-emotion split; but closer inspection shows that all these functions form part of ‘a unified body’ in which experiences move in two directions, to and from the ruling centre (mind); none the less, he is essentially able to control the judgements he makes about his experiences (about whether they are good or bad), and in this way to determine how he reacts overall as well as how he behaves.
Fourth strand: M. as part of the universe.
[2.3] (1) The works of the gods are full of providence and the works of fortune are not separate from nature or the interweaving and intertwining of the things governed by providence. Everything flows from there. (2) Further factors are necessity and the benefit of the whole universe, of which you are a part. What is brought by the nature of the whole and what maintains that nature is good for each part of nature. Just as the changes in the elements maintain the universe so too do the changes in the compounds. (3) Let these things satisfy you; let these always be your doctrines. Give up your thirst for books, so that you do not die grumbling on, but positively, genuinely, full-heartedly grateful to the gods.
Recurrent theme in Med.: M. (and everyone) an integral part of the whole (universe) and so should accept the events that follow from the interwoven causal web that makes up the universe ‘of which you are a part’, including ‘changes in the compounds’ (e.g. M.’s own death and dissolution of the elements). Hence, he should convert the likely response to oncoming death (‘grumbling on’) with a different one, being ‘positively, full-heartedly grateful to the gods’.
Distinctive Features of Med. , special contribution to guide-to-life writings or psychotherapy.
Philosophy of Med. (on this view) largely mainstream Stoicism, presentation adapted to practical ethics (cf. Seneca’s Letters, Epictetus’ teachings). All four strands figure (in varying degrees) in those works too: M. accentuates strand 2 and 4.

Distinctive features of form of Med. (potentially advantageous or problematic from this standpoint):

Compressed, pungent, often oracular statement, imagistic, near-poetic formulation, lack of systematic exposition or organisation of topics;

Intense, urgent tone, self-addressed, sustained self-encouragement to adopt a certain view of life; a personal ‘voice’ despite the abstract nature of the subject matter;

Concentrated form brings out interconnections and internal links in Stoicism, both within ethics (e.g. between value-system and conception of development, between value-system and modes of interpersonal relationship or emotions) and between ethics, logic and physics, and thus between value-system and psychology or view of cosmos;

Need for explanatory material to bring out conceptual framework and nature of form – and so to bring out the inherent power of the individual passages.

These features could make Med. especially useful for practical ethics/therapeutic purposes, either for individual use or as part of a therapeutic scheme:
Short intense passages to work with individually or with a therapist;

Reflective tone promotes ‘mindfulness’, detachment from daily concerns;

View of ethical life as journey, quest, way, towards ideal – one that can inform social relationships but that does not depend on them being ‘successful’ (conventionally);

Self-urging style helpful for promoting self-monitoring and self-scrutiny;

Compressed, concentrated style brings out key connections in Stoicism that are potentially helpful, e.g. linkage between strands 1 and 2 (core ethical project and death/transience) or 1 and 3: appeal to psychological agency as fundamental part of human nature and as a resource for all of us.
Potential problems in Med. for this purpose:

M. writes only for himself (contrast Seneca, Epictetus) so takes a lot for granted;

Brief allusive passages need explanation as regards form and content;

M.’s appeal to cosmic context of ethical and emotional life may be unfamiliar or unconvincing to many modern readers/users.

Broader questions raised by use of Stoicism for these purposes;

‘how much is enough?’: how much Stoicism does one need to accept to gain benefit from any one aspect of Stoic thought? Question applies both at theoretical and practical level.

Do we need to accept Stoic value-system (virtue as only good) to gain potential advantages of therapeutic treatment of emotions?

Do we need to accept Stoic psychology (psychophysical and psychological holism) to be assured we have the agency to confront our problems in life?

Do we need to accept Stoic providential view of cosmos, fate, to gain benefit of resignation at disaster, death?

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