Stoicism and Testicular Cancer (Part 1)

This multi-part post is going to act as a catharsis for me more than anything, but I think there will still be some value in sharing it with others. Last November I was diagnosed with testicular cancer. In these next few posts I am going to attempt to document what I went through the past few months, along with how I used Stoicism to help and guide me through the ordeal.

This all started roughly in October, the week before Halloween. While I was washing myself in the shower I noticed that something felt strange. My right testicle felt harder than usual. It was fairly easy to tell something was off since I did indeed have two testicles to compare against. One testicle was squishy, the other was not so squishy anymore.

Now thankfully I had a pretty decent health class in high school where we talked about these kinds of things, so the idea of testicular cancer did flash into my mind for a moment. At that point though, I figured there was no reason to jump to conclusions right away. Perhaps I had somehow hurt myself while rolling around in my sleep or during some other activity. I was not in any real pain, so I decided that I would keep an eye on it for a week to see what happened and go from there.

After waiting for a week it had not gotten better. The hardness was still there, and now I was starting to get minor shooting pains in my testicles as well. At this point I had a bit of an internal struggle, a decision to make. Do I wait longer to see if this goes away on its own? Or do I go see a doctor? Going to see a doctor was not a very appealing option at the time. After moving the Brooklyn I had not found a new Primary Care Physician (PCP), and since I am relatively healthy, I had actually not been to the doctors once in over four years.

This meant that I would have to go through the process of finding a new doctor in NYC that accepted my insurance, he would have to check me out downstairs, and it would hopefully not be awful. I decided to ask the two people who I knew had a lot of experience with finding doctors, my parents. They were able to give me some good advice on where to look, and I was able to schedule an appointment for a physical.

Surprisingly enough, this was probably one of the most difficult and critical steps of the entire process. I could of very easily ignored what was going on, blown it off, and moved on. Health is a preferred indifferent after all right? It doesn’t really matter whether I get sick or not, I can still live a good life, at least, according to the Stoics. But I also remembered that while my health and my body are a preferred indifferent, the use of my body, and the choices I make about it are not an indifferent. How I use what I have is what matters, that is where virtue comes, from your choices. I figured the wise choice would be to get checked.

I am also fond of Immanuel Kant and some of his ideas. For those of you that are not familiar, Kant is all about Dentology (rules and duties). You have duties to others that you must morally fulfill, but, you also have duties to yourself as an individual. I felt that if I just ignored this issue, I would be neglecting a duty that I owed myself.

So I went and got my physical. The doctor examined me and agreed that something felt off. He immediately mentioned that testicular cancer was a possibility, and if that was the case, that I would probably need my testicle removed. He said that I needed to get a sonogram of my testicles to check and make sure. He also made sure to mention that even if it was testicular cancer, that the vast majority of people went on to live normal lives afterwards. He recommended a couple of places where I could get a sonogram, and said that it wasn’t urgent, but that I should get one sooner rather then later.

At this point, I was just glad that I had made the right decision to get checked out, that something was indeed off as I had suspected. I told myself again, just like before, at this point it was too soon to say anything for sure, that there was no reason to freak out  or think I had an issue yet.

I recalled a quote from Seneca

Yet what could be more senseless than suffering over what had not yet happened? Rather than awaiting future trials, you are summoning them to your side! Better you should delay them if you cannot dispel them altogether. – Seneca, Letter 74.33

Even though this was my primary mode of thought at the time, I knew it was important to not push testicular cancer off the table as an option entirely. If I rejected that as a possibility, if I said that there was no way it could happen to me, and then it did, I would be far worse off than if I accepted that fact that it was a real possibility.

Yield not to adversity, trust not to prosperity. Fix your eyes on fortune’s privilege, thinking that whatever can happen to you will indeed happen. What has been long expected is easier when it comes. – Seneca, Letter 78.28

You might feel like Seneca is contradicting himself in these two passages, but he isn’t really. In the first passage, he is saying that there is no point in suffering now over something that hasn’t happened yet, that it actually makes no sense because you just end up suffering twice. In the second passage he is suggesting that you do a premeditation of adversity. To realize that anything can happen to you, that nothing is truly off the table. And that when you accept this, then, if some trouble really does come your way, you will be better prepared for it.

Seneca combines these two ideas into one in a later letter:

Wisdom lies in combining the two: you should neither hope without doubting nor doubt without hoping. – Letter 104.12

This is some of the best advice out there in dealing with unknown events that may happen in the future. It helped me a great deal during these early stages.

So I scheduled my sonogram at a Radiology Clinic in Brooklyn for the next week. It was a bit of a trip to get there from my apartment. A 40 minute subway ride into a part of Brooklyn I had never visited before. Little did I realize that the clinic I had scheduled an appointment with was in one of the worst parts of Brooklyn. I realized as soon as I got out of the subway station that I stuck out like a sore thumb in that area.

My first reaction was “uh oh, maybe I shouldn’t be here”. But then I thought about it for a little and remembered that the Stoics always had a cosmopolitan outlook, that these were human beings just like me, and that at this moment, they didn’t deserve any of  the judgement that I was about to pass on them.

If he did wrong, the ill lies with him; but perhaps he did not. – Meditations 9.38

The above passage is saying that if someone does wrong, that choice lies with them, but also, it is possible that they did not do anything wrong at all. It is difficult to know the actions, intentions, and circumstances of other people, so we should not be so quick to judge others.

Another relevant passage that came to mind is as follows:

But I, who have observed the nature of the good, and seen that it is right; and of the bad, and seen that it is wrong; and of the wrongdoer himself, and seen that his nature is akin to my own – not because he is of the same blood and seed, but because he shares as I do in mind and this in a portion of the divine – I, then, can neither be harmed by these people, nor become angry with one who is akin to me, nor can I hate him, for we have come into being to work together, like feet, hands, eyelid, or the two rows of teeth in our upper and lower jaws. To work against one another is therefore contrary to nature; and to be angry with another person and turn away form him is surely to work against him. – Meditations 2.1

One technique that I have picked up from these ideas, which has been suggested and mentioned elsewhere, is that in awkward situations like this, that we should call other people our “brothers and sisters” (internally in our heads at least, not out loud). It makes it much more difficult to have any sort of negative or apprehensive thoughts towards other people when you think of them in this way. It is also true in a sense like Marcus says, we may not be related by blood, but we still have a shared humanity with one another. As social animals we were made to work together, so, lets work together.

I made it to the radiology clinic without any issues, and, still sticking out like a sore thumb, filled out the required paperwork, waited, and was eventually called in for my sonogram. This, I can tell you, was probably one of the most awkward parts of the ordeal. I got to lay down in a chair with my testicles exposed, while a guy with a bunch of goopy gel and a plastic wand got to rub my testicles for 30 minutes in-order to scan them. I was periodically told to clench like I was going to the bathroom, probably so that the technician could get a better scan of the testicles in different raised and lowered states, but for the most part, I was just lying there still the whole time.

I don’t know if there are any Stoic exercises that apply to this situation in particular, but I can say that doing simple mindfulness meditation, and counting my breath, was very helpful. It allowed the time pass by more quickly and also kept me relatively relaxed.

After the scan was finished, I was told that they would send the results to their radiologist to be checked, and that I could get my own copy of the results on a CD, which I did. Their radiologist would call my doctor with the final results, which would happen within a few days.

That was all done on a Saturday. I figured it would take a little while to get the results, probably not till Wednesday. I ended up getting a phone call from my doctor that Monday morning while I was at work. I was busy at the time and didn’t have the doctor added as a contact, so he had left a message on my cell phone. The message went something like this “Hi, we got your results back. It isn’t very good news…but it could be worse…I guess…call me back when you have the chance”.

At that point my heart-rate skyrocketed and I probably went into high octane adrenaline mode for about 30 seconds. I thought to myself, ok, this is officially happening, I probably have cancer. After calming down a bit I called the doctor back, he wasn’t available and I was told he would call me back when he had a chance. Great, more waiting. I tried to go back to work and keep myself occupied for the meantime, probably not getting too much work done in the process.

I got a phone call back from the doctor withing an hour or so. He confirmed what I had thought. Yes, I had a tumor, it was most likely testicular cancer, I very likely needed to have my testicle removed, and I needed to schedule an appointment with a specialist now. Ok, time to get busy.

What should a philosopher say then, in the face of each of the hardships of life? ‘It is for this that I’ve been training myself; it is for this that I was practicing.’ – Epictetus, Discourses 3.10.7



On Virtue

So last time we talked about Eudaimonia and how it essentially means having the best possible life that a human can have, full of happiness, contentment, and fulfillment. We also mentioned  that the Stoics believe that the best way to obtain Eudaimonia was to be virtuous.

The Stoics believed that virtue was both necessary and sufficient for a life of Eudaimonia. This differentiated them from many other Greek philosophical schools at the time who believed that virtue was necessary for a life of Eudaimonia. Other schools, such as the Peripatetics, believed that virtue was necessary for a good life, but that you also needed other things as well, such as friends, family, money, good food, etc…

So what did the Stoics mean by virtue? And how could virtue alone be sufficient for a good life?

What the Stoics really meant by virtue, aretewas something like excellence of character. There were four cardinal virtues that were required for excellence of character. These virtues were temperance, courage, justice, and practical wisdom. These virtues are very broad, and encompass a variety of sub virtues. Here is a general break down of the four cardinal virtues.

Practical wisdom – Understanding how to act and feel correctly. Includes good judgment, discretion, and resourcefulness. It is the all encompassing virtue, the other virtues are really just specific manifestations of practical wisdom.

Temperance – Knowing how to act and feel well in situations arousing other emotions such as desire, appetite, and lust. Includes propriety, sense of honor, and self-control. It is wisdom applied to matters of choice.

Courage – Knowing how to act and feel correctly in situations of danger, in facing things seen as fearful, especially death and disaster. Includes perseverance, confidence, and magnanimity. It is wisdom applied to endurance.

Justice – Knowing how to act and feel well in our relationships with other people, at individual, family or communal level. Knowing how to act generously and with positive benevolence, with friendship and affection. Includes piety, kindness, and sociability. It is wisdom applied to social living.

So essentially, if you have all of these virtues, and act on them correctly, you will live a good life. Sounds pretty good to me right?

But what about money, friends, family, pleasure, etc…?

Well, the Stoics thought that it would be nice to have these things, but they didn’t really think that they were necessary for a life of Eudaimonia, the good life. Why is this the case? This is because the Stoics classified these things as being outside of our control. The only thing that is fully within our control is how we act, essentially our character and our actions (they were compatibilists). If we allow ourselves to depend on externals for our happiness (money, pleasure, etc…), we will at some point become disappointed, or as Epictetus liked to say, we will become wretched. We will become anxious when we try to obtain these externals, and depressed when we fail. You should not rely on these externals for your happiness. Instead, you already have everything you need to live a good life full of joyfulness and tranquility, and that is a life of Virtue.

It is important to note that the Stoics did not forbid people from having money, friends, family, small pleasures, etc… they were not ascetics like the early Cynics were. They separated these things into what they called preferred and dispreferred indifferents. It is ok to have and pursue these things (money, family, friends) as long as they do not detract from your ability to pursue a life of virtue. In pursuing these externals you must not turn to vice, the opposites of the virtues.

This is not an easy task to accomplish. The only one to fully accomplish this goal is considered to be a Stoic sage, and we are not even sure if such a person ever existed. Perhaps Socrates, Zeno, or Cato the younger are examples of sages, but we are not really sure. Consistently achieving these virtues is something that must be worked on every day, perhaps, for the rest of your life. And that is why we should all be prokoton, one who makes progress towards virtue.

And then, because I’m not naturally gifted, shall I therefore abandon all effort to do my best? Heaven forbid. Epictetus won’t be better than Socrates; but even if I’m not too bad, that is good enough for me.

– Epictetus, Discourses 1.2.35

For additional reading on Stoicism and virtue, I encourage you to read the r/Stoicism FAQ, the IEP entry on Stoicism,  and this blog post by Christopher Gill about the virtues. Much of the information in this particular blog post was pulled from these resources.

This will be my final post for 2016, so I wish all of you happy holidays and a eudaimonic new year!