“I am going to die, and I don’t know what to do”? The Answer of Enchiridion 17

Philosophy, according to Socrates (as told in Plato’s Phaedo) is a kind of “training for dying” (Wesley, 2022) Montaigne began his essay To Philosophize Is to Learn to Die, with “Cicero says that to philosophize is nothing more than to prepare for death” (1958 [1580], Book 1, 20). More recently, Dastur (2012) wrote that philosophy teaches us to embrace death and mortality as the defining essence of our humanity. Many articles on palliative care resort to philosophy as a resource for helping patients with the approaching end of life (Buetow et al. 2009). However, philosophy is a deep and wide sea, often with contradictory currents, and it is unclear which ideas to choose and how, and when to use them. Also, not all patients are interested in intellectual and abstract reasoning, and not all physicians and therapists have the time to delve into “old writings.”

If a physician or therapist had to choose only 1 philosophical idea to help a person in the final stage of life to cope optimally with his or her fate, what would it be? It is suggested here that Epicteus’ Enchiridion paragraph 17, would be a good choice. It is simple, useful, and powerful. It relieves feelings of guilt, enhances acceptance, and changes the situation from a passive experience to an active one. The use of Epictetus’ words with a patient and the author’s application of the same to his fear of death is presented, with almost word-for-word narration of the first of 2 sessions with Sarah (not a real name), a colleague of the author who came for consultation.

For the last few years, Sarah was treated for ovarian cancer, which recently recurred a third time. Her physician informed her that there was nothing that could be done anymore by way of therapy and that she had about 3 months left to live. She asked, “What should I do, how do I cope with the situation?” I asked whether she was familiar with stoic philosophy and Epictetus in particular. She knew what “stoic” meant, but never heard about him (like most psychologists, who do not learn about him in their studies). I told her that he was a slave in Rome during the reign of Nero the evil and murderous Emperor (about 50 CE). His master maimed him but also sent him to study philosophy. Later he was freed, started to teach, and was eventually deported from Rome, to open a school of his own in Greece. Like Socrates, he did not write anything himself. Still, Arian a pupil of his wrote down his lessons, which remain in Discourses and as a summary of the lessons in a short about 14 pages long manual, Enchiridion in Greek, which can be easily found on the web. This short introduction conveyed the message that Epictetus was not a philosopher who dealt with theoretical abstractions, but rather a person who learned about life the hard way. It was then pointed out that Paragraph 17 (out of 52) is especially relevant to Sara’s concern now, which was quoted from memory:

Remember that you are an actor in a play, which will be as the author chooses, short if he wants it to be short, and long if he wants it to be long. If he wants you to play the part of a beggar, act even that part with all your skill; likewise, if you are playing a cripple, an official, or a private citizen. For that is your business, to act the role that is assigned to you as well as you can; but it is another’s part to select that role. (Epictetus 2013)

Being a psychologist, Sarah was aware of the common theory that people get cancer due to prolonged periods of living under stress, or because they repressed their feelings. Thus, guilt and regret are added to the fear of death. Epictetus’ words helped her realize that she was not responsible for her condition and that it was more a matter of genetics and chance or fate. What is her role? To play a person knowing that she will die in a few months. How do you play this role? Just by raising this question, we moved from passivity (being a victim of a disease) to activity (managing the situation). To find an answer, we then turned the question around and asked, what would it be like to play her (undesired and not chosen) role badly?

Bad acting would be to stop living and bewail her fate. Bad acting would be complaining about her pain and being miserable, saying that “it is not fair” being angry at her doctors for not saving her life, demanding attention from her family, and making it hard for them too. We then could better answer the question of how to play the role well. Sarah said that she would have to enjoy as much as possible what she always enjoyed (reading, music, cooking, and film). Because everyone and her family too, are afraid of death, she must become a model and show them how not to be panicked and accept it as a natural part of life. She should prepare them for her death and help them continue to live well after she is gone.

There are no written scripts for playing one’s role. All one must do, is ask these 2 questions: How to act a given role well, and how to act it badly, and then choose. The answers are already inside us. Driving to my office, Sarah listened to the radio. A man, a holocaust survivor was interviewed. He was one of many children who remained an orphan, the sole survivor of a large family. How could he survive? He answered that his mother and siblings were killed earlier by the Nazis, and he was standing in Auschwitz in the notorious selection line, where people’s fate to be sent to work or to be gassed in the crematorium was determined. His father (who was indeed killed) told him that whatever would happen, he would always be close by and protect him. He survived because he always felt his father’s presence.

Seeing that a medication works for others, psychologists will often take it themselves. About 2 years later, I was diagnosed with cancer of the colon. Fortunately, after a successful operation and follow-up, I am fine. Then, fearing for my life and living with uncertainty, Epictetus and Sarah came to my help. I asked myself what is my role. How to play it badly and how to play it well. I made my choice.