Discourses and Selected Writings

The readers of Anesthesiology facing adversity or aiming to progress their practice and career may find useful advice in the book Discourses and Selected Writings of Epictetus. In the current times, when the prevalence of burnout is on the rise, the readers’ attention may be directed at apparently more urgent matters.1 However, the one who chooses to explore this book should find advice that facilitates peace of mind in all areas of life.This book is a principal text on stoic philosophy, but it is far from a dense read. The book begins with a short biography of Epictetus, the stoic slave-turned-teacher. Next, the book is organized as short lecture notes recorded by Arrian (86 to 160 AD), a student of Epictetus, with engaging titles, such as “Concerning what is in our power and what is not,” “On freedom,” and “Don’t be angry with wrongdoers.” Finally, the book ends with Epictetus’s most popular text, the Enchiridion.The English word “stoic” is often associated with a cold and apathetic demeanor, but in actuality, stoic philosophy is supremely warm and compassionate because its aim is to serve fellow humans, be it the patient, the scientific community, or something grander. Through altruistic service, the stoic lives the good life, often referred to as “a life in accordance with Nature.” In a nutshell, living in accordance with Nature means that the stoic embraces his or her role in the system in which one finds oneself, be it healthcare or academia; ultimately, the system comprises the entire universe.How exactly does this book advise the anesthesiologist to face adversity or progress their career? Epictetus does so by, among other teachings, repeatedly reminding us of what is good and what is bad, how to handle the opinions of others, and by emphasizing the importance of action over theory. I have found great value in this book and wish to share some of my own experiences in applying stoic philosophy as an anesthesiology clinician and researcher.Circumstances often unfold contrary to my wishes; my patient may suffer an adverse outcome or my manuscript may be rejected. I am often quick to label these events as bad. Fortunately, a central theme in the book is the embracement of so-called adversity. To better understand how to embrace adversity, we must begin with what the stoics consider good and what they consider bad. Contrary to Western consequentialism, the stoics do not consider the results or outcomes of one’s actions as good or bad. Instead, the only thing they consider good or bad is the process behind one’s actions, a key concept called virtue. Undesired results that appeared as adversity are not bad if the process was otherwise morally just. Furthermore, apparent adversity can even be good, because it serves as material for continuous improvement. Indeed, the ability to face adversity is in itself a skill worth learning, and what better way to practice this skill than through direct experience? To quote Epictetus: “For as wood is the material of the carpenter [. . .] so the subject matter of the art of life is life itself.” However, Epictetus also states that virtue is rare: “Show me one person who cares how they act, someone for whom success is less important than the manner in which it is achieved.” Although virtue is rare and difficult, the paradox that comes to our aid is that the practice of conducting life with virtue—i.e., trying to be an honest and decent person—is by itself virtuous and thus the good life, irrespective of the outcome. Thus, virtue is within our control, and therefore the good life is available to everyone.Related to what is good and bad, the book contains helpful advice on handling the opinions of others. As a junior clinician and researcher, I constantly arrest myself daydreaming of fame and acknowledgment, but chasing fame is foolish according to Epictetus, and I completely agree. People’s opinion does not define the good, only virtue does: “If you decide to do something, don’t shrink from being seen doing it, even if the majority of people disapprove. If you’re wrong to do it, then you should shrink from doing it altogether; but if you’re right, then why worry how people will judge you?” Thus, to surpass one’s need for the approval of others is essential for progress because the deliberate practitioner does not need the validation of the spectators: “A musician has no consideration for anyone who mistakes the highest string on the lyre for the lowest.” Ultimately, the good life consists of doing the right things irrespective of other’s opinion.Lastly, the book repeatedly emphasizes the value of actions, applications, and practice over knowledge, theory, and discussions. For instance, I can easily recognize that honesty and decency in clinical practice and research is good. However, this knowledge is mostly valuable if I can apply it in my everyday life. Equally true is the application of physiology and evidence-based medicine into clinical practice. Epictetus continuously emphasizes the value of applying the stoic theory of virtue to the conduct of everyday life. However, Epictetus also recognizes that this is literally easier said than done: “In the classroom we’re fierce and fluent, quick to answer any little question on these topics, and adept at drawing the right conclusion. But force us to put the principles into practice and we’re as good as lost.” Still, trying to put theory into practice is in line with the practice of conducting life with virtue. After all, Epictetus asks, “If you didn’t learn these things in order to demonstrate them in practice, what did you learn them for?”In summary, the Discourses and Selected Writings of Epictetus is an engaging encounter with stoic philosophy and can be useful for the clinician and researcher alike. I believe this book is more relevant than ever in our current times when burnout among anesthesiologists is on the rise.1The author declares no competing interests.