Book Review: Backbone by Karen Duffy

Karen DuffyKaren Duffy, or “Duff”, was kind enough to send me a review copy of her new book Backbone: Living With Chronic Pain Without Turning Into One (2017) because it contains a chapter on Stoicism. It’s a book about developing a backbone, and a sense of humour, and not allowing chronic pain or illness to get you down.

I wish I could write like Duff. Her style is witty banter and yet there’s a profound message of hope in there as well as the wisdom of experience. I postponed reading Backbone for about eight months because I was “too busy”. When I finally got round to it, I read it in a single evening and thoroughly enjoyed it. (I’ve already sneaked the PDF to some of my friends!) Duff has an autoimmune disorder called sarcoidosis of the central nervous system. It’s not very nice.  She’s had to learn to cope with a lot of health issues, as well as severe chronic pain. She talks about how it was as though “old age” hit her in her early thirties in the form of chronic illness. She’s tough, though, and full of gratitude for life. Duff’s pretty into Stoicism already, and maybe I’m biased, but I reckon she could be even more Stoic than she realizes.

Her basic attitude that “happiness is a byproduct of being useful”, that it comes from what we give rather than what we get, is pure Stoicism. It’s our own actions that lead to personal fulfilment not just the chance events that happen to befall us in life. She’s of the “you make your own luck” school of thought, which is totally derived from Stoicism as well. “What is bad fortune? Opinion.” (Epictetus, Discourses, 3.3). Duff says that it seems to her that things turn out for the best when we try to make the best of our situation. Epictetus calls this philosophy of life the magic wand of Hermes.  According to legend, it has the power to turn anything it touches into gold. What he means is that if we have the right attitude we can flourish even in adversity, by showing our resilience, and turning bad fortune into good. “I believe”, says Duff, “that when we face obstacles and adversity in our lives we have an opportunity to strengthen our courage.” She’s clearly talking from experience so I think we should listen…

One of the many unexpected things I learned from this book is that hockey may be the most Stoic game. Apparently there’s an “embellishment penalty” for players who take a dive and fake injuries on the ice. If there’s one thing the Stoics like to tell us it’s that we only make things worse by complaining too much about our suffering. It just adds another layer to our misery. As Paul Dubois, a famous Stoic-influenced psychotherapist everyone’s now forgotten about, liked to say: “He who knows how to suffer suffers less.” (Obscure therapy reference #1.) That could pretty much be Duff’s slogan as well. She describes her illness as, in some ways, a gift. Not a gift she’d have picked out for herself but she’s found an upside in discovering her own backbone, or inner resilience. Her advice that pain is inevitable but suffering is optional is (you guessed it) also pure Stoic.

When I read Duff’s remark “I believe that we are never too sick or too old to set another goal”, for some reason it reminded me of one of my favourite passages from ancient philosophy, found at the very start of Plato’s Republic. It’s a conversation between Socrates and a venerable old man, a wealthy immigrant living in Athens, called Cephalus. I first read it as a teenager and it just stuck in my mind. Socrates says that as life is a journey, he thinks it’s only sensible to ask those who have gone before us what the territory ahead is like: is it rough or smooth going? Cephalus gives him a surprising answer. First he explains that just as birds of a feather flock together so, he finds, old men like each other’s company. He hears all his friends complaining about old age, and their various aches and pains on a regular basis, and if you listened to them you’d think it’s a terrible curse. But Cephalus says they’re all wrong.

He says that what matters is your attitude and that if you’re the sort of person who complains about old age then he reckons you probably complained almost as much in your youth when the going was easier anyway. He looks on the positive side of things. As he gets older he’s lost his sex drive but that’s okay because it’s one less thing to worry about. He quotes Sophocles’ saying that it’s like being unshackled from a madman. In fact, Cephalus says that as he’s grown older he feels like he’s been gradually unshackled from several madmen. He looks at young people and feels that they spend a lot of time and energy chasing after things that just don’t matter to him anymore and worrying about superficial concerns that one day they’ll forget about. He can’t travel much anymore because he’s frail but he finds that he obtains more pleasure from conversation than he ever did in the past.

This is all prelude to the Stoics. Epictetus said “It’s not things that upset us but our judgements about them” and not a lot of people know this but he immediately follows it by saying that death can’t be terrible because if it were everyone would be scared of it whereas Socrates viewed it with noble indifference. Epictetus probably learned this strategy from reading about Socrates. Does something upset you? (Yes!) Does everyone else feel upset about it or do some people view it differently and cope better? (I guess so.) Well, in that case, could it be that it’s not the thing itself that’s upsetting but your way of looking at it?

In the conversation in the Republic the roles are reversed for some reason and it’s Socrates who’s learning this from Cephalus. What’s nice about this discussion is that he’s not entirely convinced, though. You see Cephalus owned a huge factory producing weapons and armour and so he was a wealthy businessman. Come now, says Socrates, surely people will think that’s easy for you to say because you’ve got loads of cash. Cephalus is very relaxed. He replies with a story. The Athenian general Themistocles, who had accomplished great things and won tremendous acclaim, once met a rude man from the relatively small and undistinguished Greek Island of Seriphos, who wanted to take him down a peg or two. The Seraphean remarked rather cynically that Themistocles was only famous because he had the good fortune to be born in Athens (the big smoke) and so he had a head start in life. “True,” replied Themistocles, “but if I had been born in Seriphos and you in Athens, neither of us would have achieved anything.” Touche! Cephalus brought up this anecdote to make the analogous point that wealth, though an advantage, only goes so far in making life more comfortable. At the end of the day, you need the right attitude as well. He’s already implied the same thing earlier when talking about the advantages of youth and good health. Someone with a negative attitude often won’t be happy even with all the advantages money, youth, and health bring. Cephalus admits that poverty, old age, and sickness are obviously disadvantages. However, even when faced with these challenges, a truly wise man, with the right attitude toward life, can perhaps flourish in his own way and find a degree of happiness. As I was reading Backbone, it occured to me that Duff might like that story too.  (So that’s my feeble excuse for a massive digression!)

Anyway, how did she actually get into Stoicism in the first place? Well, one of her friends pointed out a bust of Marcus Aurelius to her in the garden of Sylvester Manor, an 18th century house on Shelter Island, in New York. Not to be outdone, Duff decided she better find out who this guy was and brushed up on her knowledge of ancient Greece and Rome, including Stoic philosophy. Now she carries a copy of The Meditations of Marcus Aurelius in her purse and reads from it every day. As she puts it, it was actually her competitiveness and a kind of intellectual envy that inspired her to get into Stoicism. As she learned more about Stoicism, though, she realized that, ironically, it’s a philosophy that teaches us to value improvements in our own character (virtue) and indifference toward these sort of comparisons with other people (externals).  She plunged into Stoicism in any case because it was obviously very relevant to the challenges she was facing in life.

She went from reading Marcus to Epictetus whose endurance of chronic pain and disability she admired. Epictetus was lame and according to one account this was because, as a slave, his master cruelly snapped his leg. It’s surprising how many people find Epictetus relatable because of his gammy leg – it may explain why he comes over a bit cranky sometimes. Duff took from him the doctrine that none of us are free unless we master ourselves. She’d already taken up the challenge of mastering herself, particularly how she coped with pain and illness. Stoicism added some validation perhaps and she says it gave her a way to rise above the suffering of her body while focusing instead on the care of her soul.

Duff says she was very receptive to the core idea of Stoic philosophy, which she correctly sees as being that happiness, or fulfilment, comes largely from within, from our own way of thinking. Epictetus actually attributes this maxim to none other than Zeus himself: “If you want any good, get it from yourself.”  Duff rightly views Stoicism as a practical philosophy emphasizing discipline and duty, something which complements her own values. She says, “The Stoics inspired me to meet the everyday challenges of my life and showed me how to deal with inevitable losses, disappointments, and grief… I find Stoicism a great resource that fills me with resilience and vigour.” Chronic pain can become a teacher and she learned that trying to control her pain, when she couldn’t, sometimes just backfired by making it more intense. A certain type of acceptance can be a pathway to emotional resilience in coping with chronic pain and illness, as the Stoics taught. She therefore follows Marcus Aurelius’ advice to reject any sense of injury to herself, despite the physical limitations imposed by her illness. There are a whole repertoire of pain management techniques tucked away in Marcus Aurelius’ Meditations, from special ways of accepting the sensation to learning to forego unnecessary complaining, which the Stoics believed often only made things worse. One of the most fundamental things Stoicism teaches, though, is a particular way of looking at pain as being neither good nor bad but “indifferent”, which can help us accept that it’s there and get on with our lives. When we’re able to stop hating our pain and struggling with it internally, we often suffer less, which is a kind of paradox really.

Today we talk about grasping a nettle – if you do it confidently, without hesitating, you’re less likely to get stung. The Cynic philosophers, who were the forerunners of the Stoics, had a whole barrage of similar metaphors for accepting pain and hardship. They talk about our pain being like a pack of wild dogs threatening us. If we panic and try to run they’ll just chase us down and we’ll literally end up a dog’s breakfast – that’s just what they’re waiting for us to do. The wise man turns to face them, looking at them calmly and confidently, which hopefully causes them to back away. (At least according to the Cynics!) They also compare it to grabbing a snake. The nervous person who tries to pick it up by the tip of its tail or the middle will get himself bitten. An ancient snake handler would go straight for the scary end, grabbing it confidently behind its head to avoid being bitten. Their point is that if we voluntarily face our pain, and accept it, we’ll often suffer less than if we try to struggle or avoid it. Someone who tries to stamp out a fire gingerly is more likely to get burned, they say, than someone who just tramples on it confidently. And then they’ve got another one about a timid boxer who backs away and ends up getting more of a beating than if he’d moved toward his opponent, and had the confidence to fight more aggressively. Therapists today often say that coping with pain is like standing up to a bully. We have to stop running away and trying to hide from him, although that might seem scary at first. We might get hurt, it might be painful at first, but in the long-run we’ll often suffer less by standing our ground and facing what’s threatening us, actively accepting the reality of things like pain and illness.  That seems to be what Duff is saying in Backbone as well.

She also says that her appreciation of Stoicism led her to develop a “pantheon of heroes”, individuals whose resilience in the face of adversity she’s inspired by and who have become her role models in life. She says they’re carved into her own personal Mount Rushmore. They include Peg Leg Bates, a one-legged tap dancer from the 1920s.  Studying role-models who exemplify strength of character and resilience is a major technique in (wait for it) Stoic philosophy as well.

She emphasizes the importance of friendship which is not only good psychology, for building resilience, but it’s also a major theme in Greek philosophy. Socrates loved nothing more than bragging about his skill as a matchmaker of friends and he was adept at reconciling friends and family members who’d fallen out after a quarrel. He said some really cool things about friendship. The son of one of his wealthy companions was worried about making friends and he knew that Socrates had loads of friends from all walks of life so I think he was sneakily trying to get himself introduced to some of them. Socrates, in his usual style, gets a dialogue going about what qualities we should look for in our ideal friends. Seems pretty banal at first. But in typical Socrates-style he’s got a hidden agenda, and he plans to turn the whole conversation on its head. He explains that he’d be delighted to introduce the lad to all the best people in Athens and he knows the secret – he’ll just heap praise on him in their presence. There’s a catch, though, Socrates wants him to promise he’ll actually do all the things he’s just described the ideal friend doing because then he won’t be lying when praising him as someone who would make a great friend. That makes the boy hesitate. Socrates says there are only two parts to this process. Introducing him around Athens is the easy part and anyone should be delighted to do that once they see he’s such a great guy. That’s the only part the boy’s worried about but he needn’t be. The real problem is actually making himself a good friend to begin with, the sort anyone would want to have, and he admits that’s something he’s not really thought about enough. So he goes off to work on himself a bit more. Like most people facing most problems, he’d kind of got the whole thing back to front.  Socrates is also trying to get him to realize that his goal shouldn’t just be appearing like a good friend but actually being one.

Duff quotes Aristotle’s saying “A friend is a second self”, literally an alter ego. (Alter ego est amicus.)  That saying was also attributed to Zeno, the founder of Stoicism – maybe something the Stoics and Aristotle agreed on. Many of the other quotes and sayings are consistent with Stoicism even if that’s not where they came from. Duff quotes C.S. Lewis saying “Don’t let your happiness depend on something you may lose.” That’s Stoicism central. Epictetus said we should avoid becoming overly-attached to external things and let nothing cleave to us or grow on us that might cause us emotional pain when it is torn away (Discourses, 4.1). That doesn’t mean that Stoics don’t love just that they’re prepared in advance to endure the losses inevitable in life. Duff also talks about how people say things like “I’m not good at this. I’m so upset about your illness, I can’t handle it.” That jumped out at me incidentally because there’s a Discourse of Epictetus where he grills some poor guy who’s been talking just like that about his sick daughter. Epictetus shows him how absurd this is. I’ve been wondering how many people actually say things like that but it sounds like Duff’s met a few so they do exist.

As you can tell, Duff’s a connoisseur of fine quotes. I’ve never heard this one from Mark Twain: “The fear of death follows the fear of life. A man who lives fully is prepared to die at any time.” That really resonated with me, though. Duff’s learned not to be cowed by suffering and her book reminded me of Vespasian’s saying that an emperor should die standing, i.e., never give in. (“Die with your boots on”, I think, is the American version.) She’s also a bit of an etymology geek, noting that the word “disaster” comes from Greek, via Latin, and originally meant “bad star”, or as Shakespeare would say “ill-starred”. It’s a stroke of bad luck. Well I’ll see her “disaster” and raise her one “tragedy”, which comes from the Greek meaning “goat song”. We’re not sure if it was originally a song about a goat with a particularly tragic life or if the highly-contested prize for the most tragic song at Greek festivals was originally a splendid goat. Anyway, when wallowing in tragedy, I find it helps to remember this fact because it’s puzzling enough to serve as a convenient distraction.

Duff says that what matters isn’t that you live, or survive another day, but rather it’s how you live. The Stoics would say that the goal isn’t just to live but to live well, i.e., wisely.  I think her book will probably help a lot of people who are suffering to live through it a bit more wisely. Her voice really comes through loud and clear. It’s easy to write books that everyone sort of likes because they’re bland and inoffensive. This book’s a lot more in your face, and that’s a good thing. It reminded me a little bit of Andrew Salter, the guy who invented assertiveness training. (Obscure therapy reference #2.) Duff concludes the whole thing by saying: “I have a serious illness, but I don’t have to take it seriously. I have found an upside in having my life turned upside down. I have learned acceptance and resilience and have created a whole new life. In short, I grew a backbone.”

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