Stoicism and Early 20th Century Psychotherapy

Dubois and Baudouin

The earliest modern school of psychological therapy was arguably hypnotism, or “hypnotic therapeutics”, founded by the Scottish surgeon, James Braid, in 1841. Hypnotism spread to France after Braid’s death in 1860, where it gained popularity and the term “psychotherapy” was coined to describe hypnotic therapy and related methods. Hippolyte Bernheim, at Nancy, and Jean-Martin Charcot at the Salpêtrière hospital in Paris, set up rival schools of hypnotic psychotherapy, which flourished in the 1880s. Prior to developing psychoanalysis, Sigmund Freud studied hypnotism, attending both Bernheim and Charcot’s lectures. Freud’s first book on psychotherapy, Studies in Hysteria (1895), described his hypnotic “catharsis” method, the precursor of psychoanalysis proper, which was essentially founded with his publication of The Interpretation of Dreams (1900). Psychoanalytic approaches, derived from Freud and his followers, largely supplanted hypnotism and dominated the field of psychotherapy until the late 1950s, when “humanistic” and “behavioral” approaches to therapy began to be developed.

There’s not much evidence of Stoicism having influenced psychoanalysis. However, the fame achieved by Freud has often obscured the fact that rival approaches to psychotherapy existed in the early 20^th century. One of the most important of these was the “rational psychotherapy” or “rational persuasion” approach of the Swiss psychiatrist and neuropathologist Paul Dubois, author of The Psychoneuroses and Their Moral Treatment (1904).  Dubois was an important pioneer of modern psychotherapy and treated several famous clients, including the novelist Marcel Proust.

The impact of Stoicism during this period was mainly upon Dubois and those inspired, in turn, by his “rational” approach to psychotherapy. Dubois believed that psychological problems were due mainly to negative autosuggestion but rejected the technique of hypnotism in favor of a treatment based on the practice of “Socratic dialogue”, with the goal of rationally persuading patients to abandon the unhealthy ideas responsible for various neurotic and psychosomatic conditions. The influence of the ancient Stoics is clear from Dubois’ scattered references to them. He even prescribed reading Seneca’s letters to one of his patients as therapeutic homework (Dubois, 1904, p. 433).

If we eliminate from ancient writings a few allusions that gave them local colour, we shall find the ideas of Socrates, Epictetus, Seneca, and Marcus Aurelius absolutely modern and applicable to our times. (Dubois, 1909, pp. 108-109)

With practice, we can learn to monitor our thoughts and challenge the irrational ideas that cause unhealthy emotions and psychosomatic symptoms (Dubois & Gallatin, 1908, p. 56). Dubois therefore often speaks of his rational psychotherapy as involving a form of “stoicism” (with a small “s”) but he closely relates this to “Stoicism” (with a big “S”), especially as he found it in the writings of Seneca.

The idea is not new; the stoics have pushed to the last degree this resistance to pain and misfortune. The following lines, written by Seneca, seem to be drawn from a modern treatise on psychotherapy: “Beware of aggravating your troubles yourself and of making your position worse by your complaints. Grief is light when opinion does not exaggerate it; and if one encourages one’s self by saying, ‘This is nothing,’ or, at least, ‘This is slight; let us try to endure it, for it will end,’ one makes one’s grief slight by reason of believing it such.” And, further: “One is only unfortunate in proportion as one believes one’s self so.” One could truly say concerning nervous pains that one only suffers when he thinks he does. (Dubois, 1904, pp. 394-395)

Dubois also quotes Seneca’s letters to illustrate the role of patience and acceptance, as opposed to worry, in helping us to cope with and avoid exacerbating physical illness.

We must turn here to the ancients in order to recover the idea of patience towards disease, that stoical philosophy which not only helps to support us in evils, but diminishes or cures them. (Dubois, 1909, pp. 224-225)

He quotes Seneca’s remarks that the principles of Stoic philosophy served him as a consolation during illness and “act upon me like medicine”, strengthening the body by elevating the soul. It’s this ancient Stoic claim that by altering our judgments we can alleviate emotional suffering, and related physical symptoms, that most interested Dubois and he illustrates it with the following anecdote:

A young man into whom I tried to instil a few principles of stoicism towards ailments stopped me at the first words, 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?”

“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 story to our sorrow by being sorry for our sorrow.” (Dubois, 1909, pp. 235-236)

He adds that this diagram illustrates that “He who knows how to suffer suffers less.” The burden of physical pain or illness is light when we are able to look at it objectively, without drawing “concentric circles” around it, which multiply our suffering by adding layers of fear.

Moreover, Dubois was in broad agreement with the Stoic theory of universal causal determinism, and held such a firm conviction in its therapeutic value, as a means of moderating unhealthy emotions, that he dedicated an entire chapter of his textbook on psychotherapy to this subject. Although most of his patients were initially hostile to the idea of determinism, Dubois found that they could be persuaded, on reflection, to accept universal determinism as a common sense view and to adopt patient fatalism as the only rational response concerning inevitable events (Dubois, 1904, p. 47).

The idea of necessity is enough for the philosopher. We are all in the same situation towards things as they are, and towards things that we cannot change. The advantage will always lie with him who, for some reason or other, knows how to resign himself tranquilly. (Dubois, 1909, pp. 240-241)

Dubois felt that, in psychotherapy, the Stoic concept of determinism was particularly valuable as a way of viewing the behavior of other people. The influence of Stoic determinism upon his psychotherapy, in this regard, is particularly well-illustrated by the following passage:

I know of no idea more fertile in happy suggestion than that which consists in taking people as they are, and admitting at the time when one observes them that they are never otherwise than what they can be.

This idea alone leads us logically to true indulgence, to that which forgives, and, while shutting our eyes to the past, looks forward to the future. When one has succeeded in fixing this enlightening idea in one’s mind, one is no more irritated by the whims of an hysterical patient than by the meanness of a selfish person.

Without doubt one does not attain such healthy stoicism with very great ease, for it is not, we must understand, merely the toleration of the presence of evil, but a stoicism in the presence of the culprit. We react, first of all, under the influence of our sensibility; it is that which determines the first movement, it is that which makes our blood boil and calls forth a noble rage.

But one ought to calm one’s emotion and stop to reflect. This does not mean that we are to sink back into indifference, but, with a better knowledge of the mental mechanism of the will, we can get back to a state of calmness. We see the threads which pull the human puppets, and we can consider the only possible plan of useful action – that of cutting off the possibility of any renewal of wrong deeds, and of sheltering those who might suffer from them, and making the future more certain by the uplifting of the wrong-doer. (Dubois, 1904, p. 56)

However, the most explicit appeal to Stoicism in modern psychotherapy is probably contained in a self-help book called The Inner Discipline, co-authored by the psychotherapist and academic, Charles Baudouin. This combined elements of Dubois’ “rational persuasion” method with an eclectic mixture of other influences, including Coué’s “conscious autosuggestion”, psychoanalysis, Christianity, and Buddhism. Following Dubois’ example, Baudouin dedicated a whole chapter to the relevance of ancient Stoicism for modern psychotherapy and self-help. He concluded Stoicism was the school of ancient Western philosophy most-obviously relevant to the goals of personal improvement and selected it for special consideration because of the emphasis it placed upon self-discipline and the “education of the character” (Baudouin & Lestchinsky, 1924, p. 89). He noted that both rational psychotherapy and Stoic practice rest upon “the law of habit, and the need for training”, prescribing exercises to be “assiduously practised, daily if possible” (Baudouin & Lestchinsky, 1924, p. 216). Baudouin’s enthusiasm for Stoicism was tempered by his own Christian faith but he cited both Epictetus and Marcus Aurelius repeatedly, and in more detail than any other psychotherapist of the period.

The founders of CBT would later emphasize the quotation from Epictetus that says: “Men are disturbed not by things but by the views which they take of them” (Enchiridion, 5). However, Baudouin focused on the opening sentence of the Enchiridion, which arguably expresses a more fundamental principle of Stoicism: “One of the first of these philosophers’ precepts is that we must thoroughly grasp the distinction between the things which are in our power and the things which are not in our power” (Baudouin & Lestchinsky, 1924, p. 40). Following Dubois, he also espoused the psychotherapeutic value of Stoic determinism, and their attitude of acceptance and resignation toward the countless things in life that are outside our control (Baudouin & Lestchinsky, 1924, pp. 217-218). Likewise, as Baudouin notes, the Stoics advise us to focus on our locus of control, in the “here and now”, rather than dwelling on the past or distant future.

Imagination and opinion are pre-eminently to be classed among the things which are within our power. There is a familiar adage: If we can’t get what we like, we must like what we have. The Stoics held the same view, though on a somewhat higher plane. Instead of lamenting because we cannot change our lot, let us learn to love it. Happiness and unhappiness are, to a great extent, matters of imagination and opinion. (Baudouin & Lestchinsky, 1924, p. 45)

He also recognized the importance of the “pitiless analysis” through which Stoicism shows us the ultimate worthlessness of these external (“indifferent”) things, despite their being valued by the majority of ordinary people. Baudouin was also influenced by the Stoic practice that Hadot later dubbed “physical definition”, in which events giving rise to strong desires or emotions (“passions”) are patiently analyzed into their material constituents as if from the detached, objective perspective of natural philosophy (Stoic “Physics”).

The principle that underlies the [Stoic] method may be described as depreciation by analysis. When we decompose into its constituent parts the object which has been of so much concern to us, we shall realise that it is a matter of no moment (much as a child which has pulled a toy to pieces is disillusioned, and says, “Is that all it is?”). (Baudouin & Lestchinsky, 1924, p. 48)

Baudouin was perhaps the only modern psychotherapist to recommend the Stoic routine of morning meditation, described by Marcus Aurelius, apparently inspired by the Pythagorean tradition. Mastery over the mind and body can only be acquired by daily training in rational precepts, he says, and “the first hour especially demands our attention, for the attitude we adopt at this time sets the course for the day” (Baudouin & Lestchinsky, 1924, p. 58).