What the Stoics meant by ‘indifferent’, seen from an intensive care unit

A colleague once found me reading Epictetus during a quiet hour on a night shift and asked, half joking, whether the Stoics would tell our patients' families that their father's life was "indifferent". I laughed, but the question stayed with me, because the honest answer is yes, in a technical sense, they would. And the technical sense is almost the opposite of what the English word suggests. This essay is my attempt to explain what Stoic indifferents really are, why the doctrine is harder than its modern popularisers admit, and why I still find it useful at work.

The doctrine

The early Stoics, from Zeno of Citium and Chrysippus onwards, held that only virtue is good and only vice is bad. Everything else, health and sickness, wealth and poverty, reputation, even life and death, is indifferent (adiaphoron). That sounds brutal. But "indifferent" here means something precise: these things make no difference to whether a life is good, because a good life consists in virtue, and virtue can be exercised whether one is healthy or sick, rich or poor.

It does not mean one should not care about them. The Stoics divided indifferents into the preferred (health, life, wealth, the wellbeing of one's family) and the dispreferred (illness, poverty, pain, death). Preferred indifferents have a real kind of value, and it is natural and reasonable to select them. A Stoic should look after her health, work to heal the sick and feel what is fitting at a loss, provided her reason is not overturned. What she should not do is treat these things as if her own goodness depended on getting them.

The distinction the Stoics drew is between choosing the good and selecting the preferred. In Cicero's On Ends, where the Stoic position is presented by Cato, the wise person is compared to an archer. The archer does everything in his power to hit the target, and that effort is his real aim; hitting the mark is something to be selected, not the measure of whether he shot well.

Epictetus gave the practical form of the same idea at the very start of the Handbook: some things are up to us, our judgements, intentions and desires, and some are not, our bodies, possessions and reputations. Our freedom lies in the first.

The objections, old and new

The doctrine was attacked from the beginning. The Peripatetics, followers of Aristotle, argued that external goods such as health and friends really are goods, part of a flourishing life, and that a person on the rack is not living happily, however virtuous. Aristotle had said that it is impossible, or at least not easy, to act finely without resources. From the other side, the Stoic Ariston of Chios argued that if indifferents are truly indifferent, then the distinction between preferred and dispreferred is a mistake: there is no reason to prefer health to sickness at all. Mainstream Stoicism rejected Ariston, but critics then and since have asked whether "preferred indifferent" is a coherent idea or a way of having it both ways.

The hardest case is the death of a child. On Stoic principles it is not, strictly, an evil for the parent. The Stoics accepted this. Modern readers who adopt Stoic techniques usually drop it quietly, along with the providential cosmos that made it intelligible: the belief that the universe is rationally ordered, so that whatever happens belongs to a whole that is as it should be. Without that belief, I think, the claim that only virtue is good loses most of its support, and the advice to accept what you cannot control becomes a coping method rather than a claim about reality. The method may still help. It is no longer quite Stoicism.

A comparison from another tradition

It helps to set the doctrine beside a teaching I met through a colleague from Kerala: the Bhagavad Gītā's counsel to act without attachment to the fruits of action. Krishna tells Arjuna, in a verse many readers know, that his concern is with the action alone and never with its results. The resemblance to the Stoic archer is clear, and I have found it helpful.

But the two should not be run together. The Gītā's teaching sits within an account of duty, the self and liberation, and its aim is freedom from the bondage of action through action offered without self-interest. The Stoic teaching rests on a theory of value in which virtue alone is good, and its aim is a life in agreement with nature and reason. They agree that the agent's real work lies in the acting, not the outcome. They disagree about why.

What I take to the bedside

Here is my argument. The strict doctrine, that a patient's death is not an evil, I cannot accept, and I do not think the Stoics gave a good enough reason for it once their cosmology is set aside. The Peripatetics were right that a life cut short, or broken by pain, is worse, not merely dispreferred.

But the structure of the doctrine, the distinction between what we select and what we are, has been invaluable to me. On a ward we work hard for outcomes, recovery, comfort, a peaceful death, and many of those outcomes are not up to us. Without some version of the archer's distinction, every death becomes a personal failure, and that leads either to burnout or to a defensive coldness I have watched take hold of good colleagues. The Stoic distinction lets me give everything to the shot and still accept that the target sometimes moves.

So my answer to my colleague would be this. The Stoics would call their father's life a preferred indifferent. They would mean that it was right to fight for it with all our skill, and that whether we succeeded would not decide whether we had done well by him. I think the second half is true and humane. The first half needs a better word than "indifferent", and the Stoics never quite found one.