Stoic philosophy and psychotherapy: Implications for neuropsychiatric conditions

Hellenistic philosophy has multiple parallels with modern psychotherapy and provides several theories, strategies, and techniques of practical value in clinical care, with particular reference to patients with neuropsychiatric conditions. The ancient therapeutic practices of Socratic philosophy, especially Roman Stoicism, reached us through the surviving texts of the three best-known Stoic authors: Seneca, Epictetus, and Marcus Aurelius. Both Albert Ellis and Aaron Beck, often regarded as the founders of rational emotive behaviour therapy and cognitive behavioural therapy, respectively, explicitly acknowledged the role of Stoicism as the philosophical precursor of their treatment approaches. The main analogy between Stoicism and modern psychotherapy is the assumption that cognitive activity (reasoning) affects emotions and behaviours: "men are disturbed not by things, but by the views which they take of things", in Epictetus' words. From the observation that cognitive activity can be monitored and altered, it follows that desired emotional and behavioural changes may be achieved through cognitive changes. Moreover, aspects of the 'third wave' of modern psychotherapy (mindfulness) closely resemble the ancient Stoic practice of attention or 'concentration on the present moment'. Stoicism-derived psychological techniques can prove useful in the clinical management of patients with neuropsychiatric disorders. For example, movement disorders are chronic neuropsychiatric conditions characterised by the presence of both motor and non-motor symptoms, which are often psychological and affect patients' health-related quality of life more deeply than motor features. Recent findings have shown that cognitive behavioural therapies can be effective interventions for patients with movement disorders, especially Tourette syndrome and Parkinson disease. The beneficial effects are not limited to anxiety and affective symptoms and prompt further research, across different modalities. After providing a background on Stoicism as a Socratic philosophy based on practical techniques of mind therapy, the present paper highlights parallelisms between Stoicism and modern psychotherapy. Analysis of the texts of the Roman Stoics suggests that several types of psychotherapeutic practice currently in use in neuropsychiatry can be traced back to the Stoic tradition of philosophical therapy. Specifically, it has been argued that Seneca 'Letters from a Stoic' can be read as a precursor of individual psychotherapy, Epictetus' Discourses' and 'Handbook' resemble recordings of group therapy sessions and self-help manuals, and Marcus Aurelius 'Meditations' can be regarded as an early example of therapy journal.