One of the most powerful Stoic practices is premeditatio malorum—the pre-visualization of hardships and the deliberate rehearsal of life’s worst-case scenarios. Stoic courage is not mere bravado or charging ahead despite fear—it’s the deeper courage to stare fear in the eye and erase its roots entirely.

First, let’s examine Seneca’s instructions for the exercise:

“Lucilius, I know you’re not weak. Even before you trained your mind with Stoic exercises, you already had guts. Still, brother, let me give you a few extra weapons.

Here’s the first thing to consider: There are more imaginary fears than real dangers. We suffer way more in our minds than in reality.

So here’s my first rule: Do not suffer before you have to. What you’re afraid of probably won’t happen. And if it does—well, deal with it then. Not now. 

 There are three kinds of worry:

1. We exaggerate the problem before it arrives.
2. We suffer from it before it happens.
3. We suffer from things that were never even real in the first place.

Sometimes we inflate the danger. Sometimes we invent the danger. Sometimes there was never any danger at all.

Ask yourself: "Am I actually suffering? Or am I just imagining the worst?"

You say, "But something bad might happen."

Sure. But first ask: Is there real evidence? Most of the time, you’re just working off rumour. Your brain is making up bad news.

So: investigate. Even if it seems likely that something bad is coming, that doesn’t mean it will. So many things we feared never happened. So many things we never saw coming hit us out of nowhere. So even if the worst is coming—why suffer early?

When the pain comes, you’ll deal with it. In the meantime, give yourself a break. There’s no glory in living in fear. At best, you waste time. At worst, you make your life miserable for nothing.

There’s no life at all if you fear everything that could happen. If you go down that road, there’s no end to your misery.

So what should you do?

Use your mind. Use your courage. Even if the fear is real, crush it with mental toughness.

Most people panic over nothing. They’re lost in anxiety. They have no real reason to fear, and no guarantee that anything bad will happen. But they burn anyway. Once the panic starts, they don’t stop. They never say: "Wait a minute… Who told me this? Is it even true?"

But Lucilius, you deserve real medicine, not surface treatments. Let others say: "Maybe it won’t happen."

You yourself must say: "So what if it does?"

This is the Stoic path. This is premeditatio malorum.

Imagine the worst-case scenario. Look it in the eye. And say: "Let’s see who wins." Maybe it even happens for you.

Double down on your strength. Refine your courage. This is your path, brother. The path of Stoic mental toughness.” - Seneca, Moral Letters, 13

I used to feel that same stress Seneca describes whenever I managed critical patients. Premeditatio malorum changed that for me. By facing and rehearsing the worst in advance, I could erase the panic and keep my head clear when it mattered most. Let me share how I personally used this exercise in the emergency room—hoping it might also help fellow Stoics apply it to their own high-pressure situations.

When a critical patient needs intubation, fear itself can be the biggest danger. Stress makes your hands shake, clouds your thinking, and puts the patient at risk. Premeditatio malorum helps erase that stress.

For example, here’s my self-talk in that exact moment when the first intubation attempt isn’t working: The tube isn’t passing. This is the very first step of the algorithm, and I know it by heart. The room is tense, everyone feels the pressure. But this is exactly when I must stay calm—the patient’s life depends on it. If the first attempt fails, I stop, re-oxygenate, and reposition. If it still fails, I adjust technique: different blade, bougie, or video scope. If I still can’t secure the airway, I’ll call a colleague and keep the patient ventilated. If bag-mask fails, I’ll place a supraglottic airway. And if all else fails, I’ll move to cricothyrotomy. I’ve trained for each step. The path is clear.

Often we panic only because we haven’t clearly visualized and faced the fear. We imagine collapse when in fact the steps are manageable. Once you rehearse the worstcase scenario, the fear loses its grip.

Philippe Belanger MD is a practicing physician with a passion for Stoicism. He is a translator of Stoic Classics, including the Best-Seller Seneca – Letters from a Stoic Master: Complete Letters to Lucilius Adapted for Modern Readers

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