Sick Stoics: Asthmatic Seneca, Lame Epictetus, and Marcus Aurelius in Pain
Introduction
The three great Roman Stoics lived with health problems. From his youth, Seneca suffered from a respiratory illness that he describes in his letters as recurring suffocation. Epictetus walked with a limp, and ancient sources debate whether it came from an illness or abuse by a master. Marcus Aurelius, according to historians of his time, had fragile health, with stomach and chest troubles, and wrote his Meditations in the middle of exhausting military campaigns.
They did not write about pain from a place of comfort. They wrote from inside it.
Philosophy does not cure an illness. It can change the way you inhabit it.
This article gathers what these three authors said about illness and pain, what that perspective can offer, and what it cannot. It does not replace any medical treatment: if you have persistent pain or an illness, the first task is medical care. The blog also has a guide on chronic pain.
Seneca and His "Rehearsal for Death"
In Letter 54, Seneca tells Lucilius that he has just come through an attack of his respiratory illness. He describes the episodes as brief but terrifying, like a short-lived squall, and says doctors called them a "rehearsal for death." In the middle of suffocating, he recounts, he kept comforting himself with brave and cheerful thoughts.
In another letter, Letter 78, he writes to Lucilius, who is sick, and speaks from his own experience. He recounts that in his youth his illness led him to think about ending his life, and that what stopped him was thinking of his elderly father, who would not have borne the loss. He adds that what sustained him most were his studies and his friends.
In that same letter, Seneca distinguishes three burdens that illness brings: fear of death, bodily pain, and the interruption of pleasures. And he proposes considering each one separately, rather than letting yourself be crushed by their sum.
Pain According to Marcus Aurelius
Marcus Aurelius takes up an idea he attributes to Epicurus, the founder of the rival school: intense pain is brief, and long-lasting pain is bearable. In other words, either it ends soon or it can be endured.
The line can sound overly optimistic to someone living with chronic pain, and it should never be used to minimize another person's suffering. Yet it holds a useful core: pain experienced moment by moment is usually more manageable than pain imagined added up across an entire lifetime. Marcus Aurelius advised himself not to be overwhelmed by the picture of the whole future, and to ask instead what is unbearable in the present moment.
In another note, he distinguishes bodily pain from the judgment the mind adds to it. Let the body complain if it can, he says; the mind can keep its calm if it does not judge that pain to be an evil.
Epictetus and His Leg
Two versions circulate about Epictetus's limp. One, handed down by the Christian philosopher Origen, recounts that his master twisted his leg for amusement, and that Epictetus calmly warned him it was going to break; when the leg snapped, he merely remarked: "Didn't I tell you?" The other version, from a later author named Simplicius, attributes the limp to an illness. The story about the master is probably a legend, but it reflects the image his contemporaries had of him.
What does appear consistently in his texts is a clear idea: illness is an impediment to the body, not to the will, unless the will itself chooses to make it one. Lameness hinders walking, not choosing how to act. Epictetus applied this distinction to everything that happens: the body may be bound; judgment is not.
What the Stoic Perspective Can Offer
Without promising cures, Stoicism offers several tools for anyone living with illness or pain:
- Separate the burdens. As Seneca proposed, distinguish physical pain, fear, and the loss of activities, and work on each one separately.
- Live the day, not the whole life. Ask what is unbearable right now, not over the next twenty years.
- Examine added judgments. Thoughts like "this will never end" or "I'm useless now" amplify suffering and deserve careful review.
- Look for what is still up to you. Even with limitations, possible actions almost always remain: tending to relationships, learning something, helping others in your own way.
- Lean on others. Seneca acknowledges that his friends and family kept him going.
Some of these ideas are related to psychological approaches used today in chronic pain treatment, such as cognitive behavioral therapy and Acceptance and Commitment Therapy, which seek not to eliminate pain but to reduce added suffering and help people reclaim meaningful activities.
What It Cannot Do
- It does not replace medical treatment. No philosophical exercise substitutes for a diagnosis or treatment plan.
- It does not require suffering in silence. The popular caricature of the "Stoic who endures everything without complaining" has been linked in studies to delays in seeking help and undertreated pain. Telling a doctor what hurts is part of taking care of yourself.
- It does not justify minimizing someone else's pain. The ideas in this article are for personal use.
Common Mistakes
- Waiting too long to see a doctor. Toughing out new or worsening pain is not fortitude.
- Blaming yourself for suffering. Feeling pain is not a philosophical failure.
- Isolating yourself. Illness tends to close us in; the Stoics leaned on their relationships.
- Using quotes as formulas. "Pain is brief or bearable" may comfort some and hurt others. Use judgment.
Conclusion
Seneca, Epictetus, and Marcus Aurelius did not write about pain from theory, but from their own bodies. Their lesson is not that we must endure everything in silence, but that we can separate pain from what the mind adds to it. If you live with an illness or pain, try this for a week: each night, write down Seneca's three burdens separately (what hurt in your body, what you feared, and what you missed doing) and, underneath, a single thing you were able to do that day. And if the pain is new, intense, or persistent, see a doctor.
References
- Seneca. Letters to Lucilius, 54 and 78.
- Marcus Aurelius. Meditations, VII.33, VII.64, and VIII.36.
- Epictetus. Enchiridion, 9.
- Origen. Against Celsus, VII.53.
- Pathak, E. B., Wieten, S. E., & Wheldon, C. W. (2017). Stoic beliefs and health: Development and preliminary validation of the Pathak-Wieten Stoicism Ideology Scale. BMJ Open, 7(11), e015137.
- Williams, A. C. de C., Fisher, E., Hearn, L., & Eccleston, C. (2020). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews, 8, CD007407.