Rethinking Therapeutic Reading. Kelda Green

model of the emotions, which is at the heart of CBT: we experience an event (A), then interpret it (B), and then feel an emotional response in line with our interpretation (C). Ellis, following the Stoics, suggested that we change our emotions by changing our thoughts or opinions about events.¹

The belief that ‘we change our emotions by changing our thoughts or opinions about events’ is fundamental to CBT and it is an idea of self-control that comes directly from Stoic philosophy. The most extensive surviving evidence that we have of ancient Stoic philosophy is provided by Lucius Annaeus Seneca, the Roman philosopher (4 BC–AD 65) described by Jules Evans as the author of ‘one of the first works of anger management in Western culture’.² Within the 124 surviving philosophical letters in which many of the general principles of Stoicism are set out, Seneca outlines how by changing our thoughts or opinions about events, we can transform our emotions: ‘It is according to opinion that we suffer. A man is as wretched as he has convinced himself that he is.’³

In the 40 years since CBT was first developed by Ellis and Beck, its popularity and prevalence has dramatically increased. Bestselling CBT self-help books such as Mind over Mood have translated Stoic philosophy into practical manuals for modern living, and today CBT is the most commonly prescribed evidence-based psychological therapy in the United Kingdom. Between 2016 and 2017, 31 per cent of the 567,000 programmes that were completed under the government’s ‘Increasing Access to Psychological Therapies Scheme’ (IAPT) were in CBT, while a similar number of guided self-help programmes were completed – a low-intensity therapy which is based on the principles of CBT.⁴

A large number of studies have identified the benefits of CBT and shown it to be as effective – and in some cases more effective – than medication, particularly when used to treat depression and anxiety: ‘Researchers have found that a 16 week course of CBT helps around 75 per cent of patients to recover from social anxiety, 65 per cent to recover from PTSD and as much as 80 per cent from panic disorders.’⁵ Yet there are concerns – not least from among practising clinical psychologists – about the apparent dominance of CBT and its rigid, top-down and often overly manualised approach. A survey carried out in 2010 by the charity Mind found that only 8 per cent of patients deemed to require psychological therapy were offered any choice as to what that therapy might be: invariably patients were simply prescribed a course of CBT.⁶ As the clinical psychologist Joanna Cates writes, ‘There are a large number of people whose symptoms of anxiety and depression are caused by a myriad of other factors and for whom CBT is not necessarily the panacea it is sometimes promised to be. For this reason I question IAPT’s over-dependence on this model as a means of conceptualising and “treating” a person’s emotional distress.’⁷

In response to some of the concerns surrounding CBT, a ‘third-wave’ of psychodynamic therapies have been developed, including Cognitive Analytic Therapy (CAT) and Acceptance and Commitment Therapy (ACT). These new therapies address some of the perceived limitations of CBT by incorporating elements of psychoanalysis, mindfulness and acceptance strategies.⁸ However, while rooted in Greek and Roman philosophy, CBT and its new variants still offer, I will argue, only second-order versions of the original, ancient models of therapy of those philosophies. Evans himself acknowledges that they are fragmented over-simplifications of much more complicated thought-systems:

It is inevitable that, in turning ancient philosophy into a sixteen-week course of CBT, cognitive therapists had to truncate it and narrow its scope, and the result is a rather atomised and instrumental form of self-help, which focuses narrowly on an individual’s thinking style and ignores ethical, cultural and political factors […] Self-help in the ancient world was far more ambitious and expansive than modern self-help. It linked the psychological to the ethical, the political and the cosmic.⁹

      By turning back to the classical antecedents of modern psychology, this chapter aims to rediscover the ‘ambitious’ and ‘expansive’ model of therapy that was originally developed by the Stoics. It will attempt to restore an understanding of Stoicism as a whole, rather than the ‘truncated’ version of it that has been co-opted by the discipline of psychology. In After Virtue, Alasdair MacIntyre writes of the broader threat of moral incoherence posed by the truncation or fragmentation of ideas into isolated disciples:

What we possess, if this view is true, are the fragments of a conceptual scheme, parts which now lack those contexts from which their significance derived. We possess indeed simulacra of morality, we continue to use many of the key expressions. But we have – very largely, if not entirely – lost our comprehension, both theoretical and practical, of morality.¹⁰

      By retaining only the vocabulary of self-mastery, regularity and moderation or only the surface appearance of Stoic strategies while rejecting the core of the ‘conceptual scheme’ that holds together and provides the motivation for those strategies, we are left with only a shadow of the original thought. Psychology is smaller than cosmology and secondary to cosmology and necessarily so because psychology seeks to fulfil the second-order need for a smaller, private, personal space in the midst of the great all or nothing extremes of the tragedies. But equally, I am arguing that a psychology that has stripped Stoicism of its cosmology is depleted and must seek to reformulate that core cosmology if it is to offer more expansive forms of therapy.

Seneca’s surviving body of work consists of eight tragedies, a series of moral treatises, three consolations and one hundred and twenty-four letters to his friend Lucilius. The tragedies were written first and contain a degree of brutality and violence that does not sit comfortably alongside either the restraint of his later letters or our conventional understanding of Stoicism. In the centuries after Seneca’s death the tragedies and letters were deemed to be so incompatible that the misconception developed that there must have been more than one Roman philosopher named Seneca. The fifth-century orator Sidonius Apollinaris and later Renaissance thinkers Erasmus and Diderot are among those who believed there were multiple Senecas.¹¹

While the philosophical letters have been celebrated and absorbed by the discipline of psychology, Seneca’s tragedies have been largely ignored in recent scholarship despite their noted influence on Shakespeare and other Renaissance dramatists.¹² Professor of Classical Philosophy Brad Inwood makes no mention of the tragedies in his collection of essays Reading Seneca: Stoic Philosophy at Rome, other than to explain his omission in the introduction:

I have not said a word about Seneca’s poetic works, his dramas […] My decision rests partly on a sense of my own limitations and partly on the conviction that any philosophical influence probably runs from the prose works to the plays rather than the other way around […] For the purpose of this collection, Seneca the philosopher writes in prose.¹³

Within the philosophical letters themselves, Seneca argues against the kind of scholarship which focuses on fragments of a body of work at the expense of the whole. He admonishes his friend Lucilius for attempting to subdivide the complex philosophical ideas that they are studying together: ‘Look into their wisdom as a whole; study it as a whole. They are working out a plan and weaving together, line upon line, a masterpiece, from which nothing can be taken away without injury to the