The Roman Emperor Marcus Aurelius, named at birth Marcus Annius Verus, is now remembered primarily as the author of what have become known as the Meditations. These reflections were written on campaign in the later years of Marcus’ life. The title Meditations is a later addition – the title on the manuscripts that survive is Tά εỉς έαυτόν, transliterated to Ta eis heauton (‘to himself’). In this paper, I will examine the Meditations and Marcus’ reflections on his role as Emperor as an exemplar of reflective practice. This is in the context of Stoic philosophy, and a wider concern in the ancient world with self‐cultivation by means of reflection and diary keeping – I also wish to provide a historical context for reflective practice work. I will use this to reflect on practices in my own profession of medicine and suggest that Marcus Aurelius is a useful role model for reflective practice.
Before discussing the Meditations as a prototypical reflective practice text, I will discuss reflective practice from my own perspective. I am from a medical background, at time of writing a Special Lecturer and Senior Registrar in Psychiatry. Reflective practice has become popular within the professions; one could argue that reflective practice is something that has always been implicit in them, as an extension of the duty to ‘keep up to date.’ Another view would see it as being imposed by regulatory and other agencies, representing a public distrust of professional authority.
A key text in reflective practice in its modern incarnation is Schön’s
1987 book
Educating the Reflective Practitioner. In the book, Schön quotes the sociologist Everett Hughes:
In return for access to their [the professions’] extraordinary knowledge in matters of great human importance, society has granted them a mandate for social control in their fields of specialization, a high degree of autonomy in their practice, and a license to determine who shall assume the mantle of professional authority. But in the current climate of criticism, controversy, and dissatisfaction, the bargain is coming unstuck. When the professions’ claim to extraordinary knowledge is so much in question, why should we continue to grant them extraordinary rights and privileges? (Schön,
1987, p.7)
The power of the professions and the power of the academy are continually questioned in modern society. Medicine in particular has lost much of its privileged status. Scandals such as the Bristol, Alder Hey and Shipman cases in the UK, the Michael Neary case in the Republic of Ireland, and contaminated blood products in a number of jurisdictions, have led to a much greater public expectation of external scrutiny of medical authority. Reflective practice may offer an answer to Hughes’ question.
Various models of reflective practice are influential in biomedicine. One is that described by Raw, Brigden, and Gupta (
2005) consisting of:
This approach has been incorporated within professional education in the establishment of formal mentoring and supervision schemes, and the formal use of reflective practice diaries. Reflective practices are increasingly built into both undergraduate medical education and postgraduate training. This reflects a concern in medical education with fostering deeper, lifelong learning patterns. Medical students were, traditionally, seen as particularly prone to exam‐focused, ‘just in time’ learning.
Concern has arisen within medical educational research about the possible effects of embedding reflective practice in work and the framework of regulatory supervision. This concern is well articulated by Tight (
1998). Can this lead to a joylessness and rote approach to reflection, a sense that rather than being something that can lead to professional and personal growth and development, it is simply a means of control by external agencies? With this question in mind, I wish to return to discussing the philosophical background to the
Meditations.
Cicero, the Roman orator and political figure of the first century BC, whose philosophical writings are sympathetic to Stoicism, described philosophy in his Tusculan Disputations as
animi medicina, or ‘medicine for the soul’ (Nordenfelt,
1997). Ancient Philosophers saw their role as discerning and teaching the right way to live, in a way that modern academic philosophy, ethics apart, does not.
The
Meditations are often described as a text of Stoic philosophy. ‘Stoic’ in modern contemporary usage is synonymous with ‘repressed’ and has pejorative connotations. This was very different from what the Stoics actually taught. Zeno of Citium (334 BC–262 BC) started the Stoic school of philosophy around 301 BC, teaching in the
stoa poikile or ‘painted porch’ of his house in Athens, from whence the word ‘Stoic’ derived. Stoic thought (Sellars,
1996) provided a holistic, unified worldview, with a threefold approach of formal logic, materialist physics and naturalistic ethics. It is for their ethical writings and teachings that the Stoics are now primarily remembered, but an equal emphasis was placed in Stoic teaching on a view of logic which held that certainty in knowledge could be achieved through the use of reason, and a cosmology which posited the universe as a material substance capable of reason and known as ‘God’ or ‘Nature.’
As mentioned above, it is in the ethical field that the Stoics are most remembered and most misunderstood. Rather than encouraging an emotion‐free approach to life, enduring for the sake of enduring, they proposed an approach based on απαθεια (apatheia) which is generally translated as ‘apathy’ – something very different from modern use of the word.Apatheia implies clarity of thought and judgement rather than indifference. They argued that we should attempt to focus on what is under our control, and what is not under our control is ‘indifferent.’ It is possible to have ‘preferred indifferents’, things not under our control but desirable, such as health or good reputation. Stoic thought postulated an ideal ‘sage’ to which we could aspire, although no one had actually achieved that level of apatheia and indifference to indifferents.
The Meditations are not straightforwardly ‘Stoic’, and incorporate elements of Platonism and Epicureanism as well. They generally avoid technical discussion of Stoic or other approaches to questions such as the nature of being. They have been divided, traditionally, into 12 ‘books’, although the structure of the original manuscript is considerably looser. The first of these books is quite different from the rest, consisting of a catalogue of significant people in Marcus’ life and what he has learned or derived from each. The other books compile his own reflections in various ‘sections’, not organised with any evident over‐riding scheme or argument. They are generalised, rather than dealing with specific instances. Many allude to quotations and historical incidents, some of which are unknown to us.
The Meditations, I argue, reflect a key argument of Stoic thought – that apatheia, the characteristic of the wise man or sage, could be cultivated and developed. The Ancient Greeks had a concept of meditation or practice from early in their cultural history. The original Muses (female personifications of various attributes) were three – Mneme (memory), Aoite (song) and Melete (meditation/practice) – before later becoming the more familiar nine. The first identifiable philosophers of Ancient Greece, the Pre‐Socratices and the Sophists, also discussed the importance of practice and reflection. The Sophist Isocrates stated that the exercise of philosophy (philosophias askesis) is for the soul what medical attention is for the body. The word ‘ascetic’ is derived from askesis, and in a now familiar pattern had a broader meaning than the current sense of the abjuration of physical comfort.
The French philosopher and classicist Pierre Hadot described how Ancient Philosophical traditions distinguished between philosophy as
philo Sophia (‘the love of Wisdom’) and discourse about philosophy as practice (Hadot,
1990,
1995,
2001). The Stoics, for Hadot, exemplified the ancient tendency to focus on practice rather than speculation, or debate. Practice leads to the cultivation of wisdom and the development of a spiritual life. Epictetus writes ‘the lecture room of the philosopher is a hospital ward’ (Epictetus,
1928, 3.23.27) and the Stoics, like other Ancient Philosophers, saw their work as being the cure of souls. As mentioned above, the Stoics did have a cosmological and metaphysical system, which loomed as large in their work as the ethical one – but the writings of Stoics such as Seneca, Cicero and Marcus Aurelius (all primarily public figures rather than philosophers) focused on practical ethics.
Another French thinker who particularly attended to Stoic thought (and has been highly influential) was Michel Foucault. In his later works, Foucault explored the creation of ‘a technology of the self’ (Foucault,
1984) and, while his starting point was Socrates’ injunction that one should ‘take care of oneself’, he mainly focused on the Stoics as the Ancient Philosophers who developed techniques for actually doing this. ‘Technology of the self’, discussed in the third volume of Foucault’s unfinished
magnum opus The History of Sexuality (Foucault,
1984), referred to the techniques through which human beings constitute themselves. Foucault argues that, as subjects, we are perpetually engaged in defining and producing our own ethical self‐understanding. Foucault discusses at length the υποµνηµα –
or Hypomnema – a Greek term that can be translated in many ways – as a reminder, a note, a copy, a public record, and other terms. Foucault uses the word in the sense of a note, and discusses it in the context of Seneca’s discipline of self‐knowledge.
Foucault’s and Hadot’s view of Stoicism as being concerned with ‘practice’ brings us to the actual practices that were involved in developing
apatheia. Epictetus advised his adherents ‘to exercise daily to meet the impressions of our senses’ (Epictetus,
1928, 3.8.1). In his writings, we find question‐and‐answer pairs that serve to limit the perceived consequences of any particular occurrence. For instance, ‘His ship is lost. What happened? His ship is lost. He was carried off to prison. What happened? He was carried off to prison.’
Meditations (all citations to this text that follow are from the Oxford World’s Classics Edition of Rutherford, 1990) was written as a form of practice of Stoic discipline, with the headings of individual parts of the manuscript indicating that entries were written at particular stages of a military campaign. Rutherford observes that they
are not predominately reflections,
pensées, or miniature essays; Marcus tends to be talking to and at himself. The aim of the
Meditations is therapeutic: to revive and bring home to himself, in suitably striking and memorable form, the moral truths that the author has accepted in the past. (Rutherford,
1989a, 13)
Who was Marcus Aurelius? Marcus Annius Verus was born in 121 AD. His father, Verus, died when Marcus was young, and he was raised primarily by his grandfather, also Marcus Annius Verus, who was an influential figure related to the Emperor Hadrian. Hadrian punningly nicknamed Marcus verisissimus – ‘the truest’ – and regarded him as something of a favourite, prevailing upon his heir Antoninus Pius to adopt the boy in 138.
On the death of Hadrian, Marcus was betrothed to Antoninus’ daughter (and his own cousin) Faustina. On his accession as Emperor, Marcus requested that the Senate install his adoptive brother Lucius as Co‐Emperor. Lucius took the name Verus as Emperor and would earn a reputation as a playboy in later literature, partly as a rhetorical foil to the serious Marcus. However, Marcus’ diaries and correspondence reveal affection and respect for his Co‐Emperor, who pre‐deceased Marcus in 169.
The five emperors up to and including Marcus became later known as the Five Good Emperors. This phrase is derived from Machiavelli’s
Discourses, as an illustration of the superiority of succession by adoption (implying a degree of judgement and merit) over succession purely based on birth (Machiavelli,
1983). Edward Gibbon, in his
History of the Decline and Fall of the Roman Empire, wrote that
If a man were called to fix the period in the history of the world during which the condition of the human race was most happy and prosperous, he would, without hesitation, name that which elapsed from the death of
Domitianto the accession of
Commodus [Marcus’ son and heir]. (Gibbon,
2000, I:70)
During his reign, the Empire was more or less constantly beset by wars. From the 160s, Germanic tribes began launching incursions into Gaul and across the Danube. After Verus’ death, the rest of Marcus’ reign was spent on campaign. The main tribal antagonists of the Romans were the Marcomanni and Quadi, and the term ‘Marcomannic Wars’ has been given to the overall conflict. Although a Roman victory in 176 AD saw a triumph for Marcus, the respite was brief and in 177 AD a second Marcomannic war began. Over the course of this campaign, Marcus Aurelius fell ill with chickenpox and died in Vindobona (modern Vienna) on 17 March 180.
The
Meditations were unknown during his lifetime and until the fourth century. Brunt (
1974) argues that as the
Meditations can often be cryptic and allude to what are presumably personal events, as well as repetitive and unsystematic in their treatment of various themes, it is nearly certain that they were written for Marcus himself rather than an external readership.
A Medical Education 