Marcus Aurelius in Therapy

How to do psychotherapy with a Roman Emperor

How to do psychotherapy with a Roman Emperor

The idea of a Roman emperor undergoing a course of psychotherapy probably sounds like historical fiction, right? Well, it’s not. The Roman emperor, Marcus Aurelius, was famously a lifelong follower of the ancient Greek philosophy of Stoicism. Stoic philosophers employed an early form of cognitive psychotherapy, and Marcus had a therapist.

Indeed, the word Marcus uses here in Greek is therapeia — there’s no question that it means therapy.

How do we know this? Because he tells us so, right at the beginning of his personal notebook, known to us today as The Meditations. Marcus is looking back on the things he learned from his family and teachers. We know from the Roman histories that the Stoic philosopher and Roman statesman, Junius Rusticus, was his favourite tutor. Speaking of him, Marcus says:

From Rusticus I received the impression that my character required improvement and therapy… — Meditations, 1.7

The word Marcus uses here in Greek is therapeia — there’s no question that it means therapy. Indeed, we know that the ancient Stoics, and other philosophers, wrote entire books on the subject of psychopathology and psychotherapy, the cause and cure of emotional problems. One of the most influential was the Therapeutics of Chrysippus, the third head of the Stoic school. Although it’s sadly lost, it’s one of the key influences on a surviving text called On the Diagnosis and Cure of the Soul’s Passions by Galen, the court physician of Marcus Aurelius.

As it happens, Stoicism was the philosophical inspiration for cognitive-behavioural therapy (CBT).

I’m a psychotherapist by profession, and write books about Stoic philosophy. As it happens, Stoicism was the philosophical inspiration for cognitive-behavioural therapy (CBT), the leading evidence-based form of modern psychotherapy. I’ve written about the relationship between them at length elsewhere. (See my recent book How to Think Like a Roman Emperor for a detailed discussion of how Marcus put Stoicism into practice in daily life, and its links with modern psychotherapy.)

Some of you are probably thinking that psychotherapy is a modern concept, right? Many people believe that it first started with Sigmund Freud. Well, even that part’s not true. Freud himself actually trained in psychotherapy, in France, under both Charcot and Bernheim. Modern psychotherapy had been up and running for at least half a century before Freud got onboard.

More importantly for us, though, the concept of psychotherapy was actually very familiar to ancient Greeks and Romans. Although they don’t use this word, as far as I know, they do come extremely close to doing so. It was common to refer to philosophy itself as a medicine or therapy (therapeia) for the psyche, the soul or mind.

Pythagorean & Socratic Therapy

We don’t know exactly how this began but, for instance, the pre Socratic philosopher, Pythagoras of Samos, combined the teaching of moral wisdom with music therapy and contemplative practices as far back as the 6th century BC. The Pythagoreans definitely believed that such practices could heal the soul of unhealthy desires and emotions, particularly anger.

We know that, centuries later, the Stoics were particularly influenced by Pythagoreanism. Zeno of Citium, the founder of Stoicism wrote a (lost) book titled Pythagorean Questions. Marcus himself mentions how the Pythagoreans would contemplate the heavens and sunrise in order to remind themselves of the idea of purity (Meditations, 11.27).

It’s designed, Socrates said, as a cure for a special kind of arrogance or conceit.

However, Socrates was the main influence on the Stoics. One ancient author described the Stoics as a “Socratic sect” and we can see Epictetus, the most famous Stoic teacher of ancient Rome, repeatedly telling his students to take Socrates as their supreme role model in life.

Socrates introduced a trademark style of questioning to philosophy, known today as the Socratic Method or Socratic Questioning. It was also called the elenchus or method of “refutation”, the name given to the cross-examination of witnesses in an Athenian law court. That’s because the method consists primarily in exposing contradictions in the statements of the individual being questioned. It’s designed, Socrates said, as a cure for a special kind of arrogance or conceit. This consists in believing that we know something, which in fact we do not know, about the most important things in life. By that he means exposing contradictions in our moral values, such as our definition of virtues like “justice”, “courage”, “piety”, “wisdom”, and so on.

This isn’t an “academic” exercise, though. Socrates makes it crystal clear that he thinks of it as a cure for illness in the soul, which works by talking rather than taking medicinal drugs. It’s what we call a “psychotherapy” and indeed that’s how later authors would describe it.

Stoic Therapy

The Stoics employed the Socratic Method of questioning. That’s the main reason that we think of Stoicism as a philosophy rather than a religion. In particular, we can see Epictetus employing the Socratic Method with his students. In one striking instance, Epictetus questions a magistrate about the beliefs that cause him to anxiously flee his sick daughter’s bedside. This man says, paradoxically, that he loved his little girl so much that he simply couldn’t bear to watch over her, while she was extremely ill and perhaps dying.

Epictetus examines whether this father’s views about what it’s natural and appropriate to do in such a situation are contradictory. Among other things, he asks the man whether he was acting toward his own daughter in the same way that he’d wish others to act toward him if he became sick.

Come then, if you were sick, would you wish your relations to be so affectionate, and all the rest, children and wife, as to leave you alone and deserted? By no means. — Discourses, 1.11

In modern cognitive therapy, we often do the same thing. It’s called the “Double Standards” strategy. Often, if not always, people begin to change their beliefs when they are forced to realize that they’re incompatible with one another, and that they’re contradicting themselves. Of course, consistency is a necessary but not sufficient condition of the truth. We can be free from contradictions and yet still wrong. However, one thing is for sure, we cannot be completely in the right while holding contradictory beliefs. So it’s a good enough starting point for moral self-examination and psychotherapy.

Marcus in Therapy

Socrates, and the Stoics, believed that the wise man was free of such contradictions. His mind had been purified by questioning, or self-examination, so that his values and judgments are totally consistent with one another. He doesn’t say one thing and do another, like a hypocrite. He doesn’t say one thing one day, and another thing the next. The Stoic Sage is pretty clear about what’s right and wrong. He’s not “all over the place” with his morals.

At one point, Marcus appears to describe the goal of Stoic therapy (Meditations, 3.8). He says that in the mind of one who has been critiqued (“chastened”, the word also means “pruned”) and purified (the word katharsis, cleansed) there is nothing corrupt or impure, or even any wound remaining beneath the surface. This is the radical ideal, toward which Stoic therapy works. Having attained wisdom, his life seems complete, and fulfilled. There is no longer anything servile about such a man, he says, nothing phoney. He’s neither overly-attached to anything in life, nor completely detached from things. There’s nothing blameworthy, or shameful within him, and therefore no more does he feel compelled to hide anything about himself.

The word therapeia also referred to the care exhibited to temples and gods by the pious. For Stoics, though, all men have a divine spark or spirit within them, called the daemon. So the religious and psychological uses of the word therapeia become fused into one. We can see this clearly in The Meditations, where Marcus says that men fall into a wretched state when they busy themselves about everything under the sun without grasping that what we should really be doing is paying attention to the daemon within ourselves.

And reverence [therapeia] of the daemon consists in keeping it pure from passion and thoughtlessness, and dissatisfaction with what comes from gods and men. For the things from the gods merit veneration for their excellence, and the things from men should be dear to us by reason of kinship. — Meditations, 2.13

In practice, the methods of Stoic therapy required giving another person, the therapist, permission to speak very frankly (parrhesia). Socrates’ companions found that his questions often left them feeling a sort of confusion (aporia). Some enjoyed the experience and found it liberating; others became angry and defensive.

Epictetus describes what it felt like to be morally cross-examined by his own teacher, the famous Stoic knight Musonius Rufus:

Rufus used to say: “If you have leisure to praise me, I am speaking to no purpose.” Accordingly he used to speak in such a way that every one of us who were sitting there supposed that someone had accused him before Rufus: he so touched on what was doing, he so placed before the eyes every man’s faults. The philosopher’s school, ye men, is a surgery: you ought not to go out of it with pleasure, but with pain. — Discourses, 3.29

This might explain why Marcus says that, although he loved him dearly, he sometimes also found Rusticus, his Stoic mentor, provoked his anger. He gives thanks that:

Though I was often irritated with Rusticus, I never did anything of which I needed to repent. — Meditations, 1.17

We can perhaps infer some of the things Rusticus questioned Marcus about from the remarks he makes about him. The first thing Marcus says, though, is that having convinced him that he needed Stoic therapy, Rusticus persuaded him not to be led astray by the Sophists, or by his love of writing theoretical works. Rusticus also told Marcus to abandon writing moralizing speeches, like the Sophists, in which he poses as man of virtue. He was to stop pretending to be someone self-disciplined or making a big display of acts of benevolence, where this was being done to impress others. He was to focus on actually becoming a good man rather than just appearing to be one.

Rusticus also taught Marcus to communicate simply and honestly, without embellishing his words using rhetoric like, once again, a Sophist. Indeed, he largely quit writing fancy speeches and poetry. Marcus also stopped walking around the palace in his ceremonial robes, the purple of imperial office (toga picta), and began to dress more plainly, like an ordinary Roman citizen. These were all challenges to the young Caesar’s natural vanity.

Marcus was also prone, he says, to read books superficially, and too hastily to give his assent to people who had a way with words, perhaps the Sophists yet again. Rusticus was the one who got him out of these habits, teaching him to read patiently and carefully, and to think more deeply about the things he heard others say.

Intriguingly, Marcus adds that Rusticus got him reading certain notes instead about the lectures of Epictetus, “from his own personal collection.” I won’t review the evidence here, but it’s generally agreed this was probably a copy of The Discourses of Epictetus we know today. Of the original eight volumes, though, only four survive — Marcus appears to have also read the missing volumes.

As an aside, Arrian, who transcribed these discourses, wrote that he had originally intended them only for private circulation among friends. Arrian was appointed military governor of the Roman province of Cappadocia. A later author states that Junius Rusticus had served under Arrian in the Roman army, probably around 135 CE in the war against the Alani. So it’s possible that Marcus, as a young man, received a copy of The Discourses previously owned by Arrian, before these writings were widely-known or circulated in public. He got a sneak preview of what’s arguably the most important text ever written on Stoicism.

However, perhaps even more intriguingly, having told us that Rusticus sometimes provoked his anger, Marcus also says that it was this teacher who showed him how to conquer anger.

[From Rusticus, I learned] with respect to those who have offended me by words, or done me wrong, to be easily disposed to be pacified and reconciled, as soon as they have shown a readiness to be reconciled. — Meditations, 1.7

Rusticus perhaps had to provoke Marcus sometimes in order to really show him how to manage his temper. Indeed, The Meditations contains many references to Stoic techniques for overcoming anger. One passage even provides a master-list, which Marcus calls “Ten Gifts from Apollo and his Muses” (Meditations, 11.18). They draw upon the writings of Epictetus. It’s tempting to imagine that Marcus may have been taught them by Rusticus, his Stoic therapist.


We know that Rusticus died around 170 CE, at Rome, not long after Marcus had left to fight the First Marcomannic War, while he was probably stationed at Carnuntum, in modern-day Austria. As it happens, that’s around the time scholars believe Marcus began writing The Meditations.

We can safely assume that Marcus wrote many letters to his Stoic mentor and therapist, while he was away from Rome. We know that the death of Rusticus was experienced by him as a great loss. Perhaps at that point, he was forced to take over the role of becoming his own Stoic therapist. Instead of writing to Rusticus, he now wrote to himself. Indeed, The Meditations is a title chosen by modern editors. The earliest Greek manuscript of the text was titled simply To Himself.

Perhaps, the whole of Marcus Aurelius’ Meditations can, therefore, be viewed as a continuation of the lifelong process of self-improvement and self-therapy that he began under the Stoic Junius Rusticus.

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