Abstract
In his large output, Galen (AD 129–c. 216) tackles the topic of mental illness both as an expert physician and as a competent philosopher. The vantage point of medical expertise sets him apart from most of the ancient philosophical authors, and, equally importantly, the medical knowledge he had access to was hugely advanced as compared with that available to Plato or Aristotle, for example. For Galen, medical mental disorders are disorders of the brain. This chapter explores his views on melancholy, mania and phrenitis and their treatment. Moreover, I discuss Galen’s views on passions and errors of the soul, and the differences and similarities between medical and non-medical disturbances of the mind.
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Notes
- 1.
For a detailed account of Galen’s life, see Hankinson (2008b).
- 2.
His philosophical hero being Plato. Galen’s On the Opinions of Hippocrates and Plato, in which he seeks to vindicate the medical and philosophical theories of his idols and demonstrate their compatibility, neatly crystallises his anthropological thought and philosophical style.
- 3.
This ideal is expressed in the small treatise Quod optimus medicus sit quoque philosophus (“That the best doctor is also a philosopher”), edited in Kühn 1, 53–63.
- 4.
After all, the tripartition features only in some of Plato’s dialogues, and the psycho-physiological theory propounded in the Timaeus is rather vague and obscured by the dialogue’s quasi-mythical stylistic pretensions.
- 5.
On Galen’s eclecticism, see Hankinson (1991, 198–208).
- 6.
Cf., e.g., De usu partium 4, 142 Kühn. Galen’s physiological theory comes forth in several of his writings, with slight variations. For a concise summary, see the introduction to M. May’s translation of this work (1968), and Debru (2008).
- 7.
Cf. Hankinson (2008b, 12–13).
- 8.
See, e.g., PHP 4, 7, 35 and 5, 6, 18.
- 9.
E.g., PHP 3, 7, 11–12.
- 10.
PHP 6, 8, 57. Translation de Lacy. The past tense is due to the fact that Galen is commenting on Hippocrates’ formulation.
- 11.
Cf. Siegel (1973, 108–109).
- 12.
Ars medica 1, 319 Kühn. See also de Lacy (1988). Elsewhere, Galen suggests that the ultimate goal of the appetitive soul is the preservation of life, and that this is the common denominator of all its desires, e.g., for food and sex; see Hankinson (2008b, 3).
- 13.
E.g., PHP 7, 3, 21.
- 14.
There is an English translation of the work in Johnston (2006, 203–301).
- 15.
There is obviously something wrong with the Kühn text here. It should probably read eis heteran idean ektropē.
- 16.
However, Galen notes that not all instances of fever delirium are to be considered phrenitis. On phrenitis, cf. below, pp. 156–158.
- 17.
Cf. De methodo medendi 10, 82 Kühn. On Galen’s ideas on the difference between symptoms and diseases, see Johnston (2006, 21–31).
- 18.
This work has also been translated into English in Johnston (2006, 180–202).
- 19.
De atra bile 5, 132 Kühn. Galen refers to the mythological story of Proetus’ daughters, cured of their madness by the seer Melampus.
- 20.
This association between the spleen and melancholy is still reflected in the way the word “spleen” is used in the sense of “peevishness”.
- 21.
Cf. De alimentorum facultatibus 6, 662 Kühn: “the condition properly (idiōs) called melancholy”.
- 22.
Cf. De atra bile 5, 105 Kühn.
- 23.
The fragments have been edited, with an English translation and commentary, in Pormann (2008). I refer to Rufus’ melancholy fragments according to the system used in this work.
- 24.
De locis affectis, Book III, Chap. 10. Cf. De locis affectis 8, 192 Kühn, in which Galen appears to suggest that the third type is not true melankholia, but a gastric condition with melancholic symptoms. This threefold division was perhaps taken from Rufus, who, however, was mostly concerned with the “hypochondriac” variety of melancholy; cf. fr. 1.
- 25.
The special sympathetic relation between the stomach and the brain is attributed to the numerous large veins that connect these parts; cf. De locis affectis 8, 179 Kühn.
- 26.
De locis affectis 8, 182–185 Kühn.
- 27.
E.g., De symptomatum causis 7,202 Kühn. There are abundant references to this pair of symptoms in Galen.
- 28.
Cf. Hippocrates, Aphorisms 6, 23.
- 29.
De locis affectis 8, 190 Kühn, and De symptomatum causis 7, 203 Kühn.
- 30.
De locis affectis 8, 185 Kühn. Bloodletting was a therapeutic as well as a diagnostic measure in this type of melancholy.
- 31.
Melancholy is mentioned at Quaestiones medicinales 4 (Gärtner).
- 32.
Some comments on how to assess the patient’s mental state from his general behaviour, speech and acts are offered at In Hippocratis librum primum epidemiarum 17a, 213–214 Kühn.
- 33.
Cf. In Hippocratis aphorismos 18a, 35 Kühn.
- 34.
De symptomatum causis 7, 203 Kühn.
- 35.
De locis affectis 8, 173–175 Kühn.
- 36.
Cf. De utilitate respirationis 4, 507 Kühn.
- 37.
De symptomatum causis 7, 203 Kühn; cf. De locis affectis 8, 191 Kühn.
- 38.
De locis affectis 8, 190 Kühn, and In Hippocratis librum primum epidemiarum 17a, 213 Kühn. It is questionable whether the patient really was Galen’s own, as the example appears to be traditional. In the version related by Alexander of Tralles, the man imagines he himself is Atlas (Therapeutica 1, 605), while in the Arabic physician Ishaq ibn Imran’s version the man fears that heaven will fall upon his head should the god grow tired while he is outside, and therefore dislikes walking under the open sky; see Jackson (1986, 57). For a more obvious ancient description of agoraphobia, see Aretaeus, De causis et signis diuturnorum morborum 1, 6, 6.
- 39.
However, in the commentary on Hippocrates’ Epidemiae VI, Book VIII (p. 487), Galen suggests that the man’s melancholy actually developed because of his fixation on the idea that the world would soon come to an end. On this work, see note 122 below.
- 40.
In Hippocratis librum vi epidemiarum 17b, 30 Kühn.
- 41.
Or a snail, in R. Siegel’s English translation of the work.
- 42.
De locis affectis 8, 190 Kühn. Rufus discusses a wider range of melancholic symptoms, such as abnormal desires and aversions, and specific phobias.
- 43.
These questions are discussed most fully in the De temperamentis (“On Mixtures”). The textbook-like Ars medica also contains discussion of the psychophysical temperaments.
- 44.
Cf. De temperamentis 1, 643 Kühn.
- 45.
In Hippocratis librum vi epidemiarum 17b, 29 Kühn. Cf. Rufus, fr. 11, 22, where Rufus makes the Aristotelian distinction between the naturally melancholic and those who get an excess of black bile from their diet. On Rufus’ ideas on melancholy and genius, see below.
- 46.
In Hippocratis prorrheticum i 16, 525 Kühn.
- 47.
Aetius, Iatrica 6, 9 = Rufus, fr. 11.
- 48.
Unlike Galen, Rufus was fond of the Aristotelian/Dioclean idea that melancholic patients are abnormally replete of pneuma. Alexander of Tralles appears to refer to the same patient: the man believed he had been beheaded, and was cured by being persuaded to believe that his head had been replaced (Therapeutica 1, 607). For this cure, cf. Rufus, fr. 12.
- 49.
Πάνυ δὲ ἐμαυτὸν πείθω κατὰ τοὺς χυμοὺς τοὺς ἐν τῷ σώματι δόξας ἐνυπνίων ἐγγίγνεσθαι σημαινούσας καὶ ἀγαθὰ καὶ κακὰ τῷ ἀνθρώπῳ, ὧν κατάληψις ἄλλη οὐκ ἔστι μὴ ἀκούσαντι (Ed. Gärtner).
- 50.
The text appears in volume 6 of the Kühn edition, pp. 832–835. It is not known whether the treatise was part of some lost work by Galen or perhaps a paraphrase of his lengthier writing on the subject. There is, however, no reason to doubt that the ideas expressed in the text are indeed Galen’s own; for similar ideas, cf. In Hippocratis librum primum epidemiarum 17a, 214–215 Kühn.
- 51.
Galen evidently believed in god-sent dreams, and his own choice of career was ultimately due to a dream his father had had. See Hankinson (2008b, 3–4).
- 52.
Such claims should not be taken too seriously. As V. Nutton notes, “as [Galen] grew older, the boundary between what he had once read and what he himself had done became blurred”; Nutton (2004, 226).
- 53.
Gregory’s “Galenism” is most pronounced in the final chapter (30) of the On the Creation of Man, in which he offers a medical account of the construction of the human body. He never names his medical sources explicitly, and he could well have been using sources more contemporary than Galen; cf. Cherniss (1930, 60).
- 54.
Cf. also Galen, De symptomatum causis 7, 142–143 Kühn.
- 55.
Along with the Platonic tripartition, Gregory advocates the Aristotelian model of the nutritive, perceptive and rational soul. See, for example, his treatise On the Soul and the Resurrection, pp. 48–61 (Migne). Yet Gregory is unwilling to locate the immaterial and immortal rational soul in any bodily organ. He acknowledges that derangement occurs when the brain and its membranes are affected, but notes that similar symptoms also occur when the middle area of the body is affected in phrenitis, which indicates that the rational soul is present in the whole of the body (On the Creation of Man, p. 157 Migne). The whole body is the instrument of the rational soul, and the soul is unable to use bodily parts that are in an unnatural state.
- 56.
Cf. Galen, De dignotione ex insomniis 6, 835 Kühn: dreaming of faeces indicates either putrid bodily humours or an actual excess of faeces in the intestines.
- 57.
According to Rufus, the melancholic patients are sexually lustful (fr. 60), and sexual intercourse is beneficial to them, as it calms them down (fr. 59). This idea is evidently based on the Aristotelian claim that ejaculation relieves the melancholic of excess pneuma; cf. Problems IV. 30, 880a30–33.
- 58.
Cf. Aristotle, NE I. 13, 1102b3–11, and DL 10, 121b (on Epicurus).
- 59.
Cf. In Hippocratis librum primum epidemiarum 17a, 213 Kühn.
- 60.
This similarity does not mean that the madmen are dreaming their delusions (an idea Galen considers and leaves open at In Hippocratis prorrheticum i 16, 524–525 Kühn), merely that both arise in a similar way and perhaps involve the sub-rational soul’s attempt to express something of the physical condition.
- 61.
On the interpretation of these fragments, see Swain (2008).
- 62.
In Hippocratis aphorismos 18a, 79–80 Kühn.
- 63.
De locis affectis 8, 185 Kühn.
- 64.
De locis affectis 8, 192 Kühn.
- 65.
De compositione medicamentorum secundum locos 12, 382 Kühn. Hiera, the formula for which varied from author to author, was a compound of several ingredients, such as aloe and cinnamon.
- 66.
Cf. note 48 above.
- 67.
However, since Galen notes that gladness (thymēdia) can cause “moist” diseases, it probably also alleviates dry conditions; De causis morborum 7, 19 Kühn.
- 68.
Cf. De locis affectis 8, 178 Kühn.
- 69.
Cf. also De symptomatum causis 7, 202 Kühn.
- 70.
De locis affectis 8, 330–331 Kühn.
- 71.
In Hippocratis prorrheticum i 16, 566–567 Kühn. Cf. Nutton (2004, 235).
- 72.
Celsus also makes the distinction between “hallucinatory” and “delusional” types of madness; see Chap. 2, p. 18.
- 73.
According to R.J. Hankinson (2008b, 2), “wool-worker” was Galen’s derisive expression for a (passive) homosexual, and he takes the boy in the story to be the man’s lover (probably a slave or a prostitute).
- 74.
The story is also related in Nemesius of Emesa, De natura hominis 13, 70–72. Nemesius elaborates it by explaining how the different functions are located in the brain, the faculty of phantasia being at the front, reason in the middle, and memory at the back. This is a later development of Galen’s theory (cf. note 77 below).
- 75.
For a similar hallucination, see In Hippocratis prorrheticum i 16, 565 Kühn.
- 76.
De locis affectis 8, 178 Kühn. “Bestial” derangement renders the patient violent and dangerous; cf. In Hippocratis prorrheticum i 16, 780 Kühn.
- 77.
In Hippocratis prorrheticum i 16, 565 Kühn. It should be noted that Galen, unlike some of his followers, did not try to localise the various functions of the rational soul in the brain; see Rocca (2003, 245–247).
- 78.
De locis affectis 8, 227–228 Kühn.
- 79.
Acoustic, olfactory and tactile hallucinations are mentioned at In Hippocratis prorrheticum i 16, 566 Kühn. For Galen’s explanations of these phenomena, cf. Siegel (1973, 162).
- 80.
In Hippocratis prorrheticum i 16, 524–525 Kühn.
- 81.
Cf. De methodo medendi 10, 929–931Kühn.
- 82.
De symptomatum causis 7, 202 Kühn.
- 83.
Cf. De locis affectis 8, 166 Kühn, in which the feverish counterparts of mania and melancholy are said to be phrenitis and lethargy, and In Hippocratis librum iii epidemiarum 17a, 699 Kühn.
- 84.
In Hippocratis aphorismos 18a, 35 Kühn.
- 85.
De victu attenuante 93–96 (ed. K. Kalbfleisch in CMG 5, 4, 2).
- 86.
De purgantium medicamentorum facultate 11, 341, 5–7 Kühn.
- 87.
For a concise summary of these disorders, see Jackson (1969, 376–378).
- 88.
Cf. De locis affectis 8, 163–164 Kühn.
- 89.
De symptomatum causis 7, 201 Kühn. The reference is to Thucydides 2, 49–50.
- 90.
De locis affectis 8, 162 Kühn.
- 91.
De locis affectis 8, 166 Kühn.
- 92.
De locis affectis 8, 194 Kühn.
- 93.
Pro puero epileptico consilium (“Advice for an Epileptic Boy), edited in Kühn 11, 357–378.
- 94.
Cf. Plato, Timaeus 91b. For a vivid description of the “wandering womb”, see Aretaeus, De causis et signis acutorum morborum 2, 11. On hysteria in ancient medical thought, see Lefkowitz (1981, 12–26), Simon (1978, 238–270), and Veith (1965, 9–39).
- 95.
De praenotione 14, 630–635 Kühn. The On Prognosis is mostly concerned with recounting Galen’s medical triumphs, and includes some interesting descriptions of his employment in the imperial court. There is an English translation, with a commentary, in V. Nutton’s edition of the work (CMG 5, 8, 1). On the cases of the lovesick woman and the anxious slave, see also Wack (1990, 9), and Ballester (1988, 139). On Galen’s case histories in general, see Mattern (2008).
- 96.
The husband is mentioned on page 626, but not in the story itself. He was possibly of senatorial rank; see Nutton (1979, 186–187). It is curious that Galen evidently saw nothing inappropriate in revealing the identity of his patients, even when their complaints were of a somewhat embarrassing nature. Cf. the Hippocratic Oath, which forbids the physician to divulge not only the things he sees or hears when plying his trade, but also knowledge he acquires through his private life.
- 97.
The story is most fully told in Plutarch’s Life of Demetrius (Chap. 38). According to the story, Erasistratus persuaded the king to give his wife in marriage to his son and thus “cured” his patient. Galen points out the similarity himself, noting that making the correct diagnosis was easier for Erasistratus because the patient could see his beloved on a regular basis, so that the physician was better able to monitor his reactions (p. 635). On different versions of the story, see Nutton (1979, 194–196).
- 98.
On Galen’s general treatment of lovesickness, comprising, rather traditionally, various distractions, see Wack (1990, 8). It is doubtful whether this kind of advice was applicable to women as well.
- 99.
This belief is most eloquently expressed in the De usu partium. Cf., e.g., the opening chapter on the functionality of human hands.
- 100.
Cf., e.g., In Hippocratis librum vi epidemiarum 17b, 248 Kühn: “I think that those who have made definite statements about these matters surpass me rather in rashness than in wisdom.” Galen’s agnosticism is expressed in several works; see Donini (2008).
- 101.
Cf., e.g., De usu partium 3, 238 Kühn.
- 102.
Cf. Plato, Timaeus 87b.
- 103.
PHP 5, 5, 34.
- 104.
PHP 5, 5, 30.
- 105.
Passions of the Soul 5, 39 Kühn.
- 106.
Medea, being both highly passionate and highly intelligent, was a rare exception (PHP 3, 4, 23–27), and so was the philosopher Anacharsis the Scythian (QAM 4, 822 Kühn).
- 107.
Cf. QAM 4, 804 Kühn, and Ars medica 1, 332 Kühn. On the relation between hair growth and internal heat, cf. De temperamentis 1, 619 Kühn.
- 108.
The issue is thoroughly discussed in PHP 6, 1.
- 109.
Passions of the Soul 5, 7 Kühn.
- 110.
It is questionable how accurate Galen’s account of Posidonius’ theory of the emotions is. For an assessment, see Cooper (1998), and Gill (1998).
- 111.
Galen’s example of an erroneous value judgement that is not a passion is Epicurus’ belief that pleasure is the highest good (PHP 4, 4, 29). He is aware of Chrysippus’ further qualification of passions as “fresh” value judgements (e.g., PHP 4, 7, 3), something Epicurus’ belief evidently was not.
- 112.
Passions of the Soul 5, 3 Kühn. For a thorough comparison of Chrysippus’ and Galen’s takes on the therapy of emotions, see Gill (2010, 243–329).
- 113.
Galen uses the word only at Passions of the Soul 5, 11 Kühn. Although his ideal resembles metriopatheia more than the Stoic apatheia, all movements of the lower souls ranking as pathos are to be eradicated. Hence apatheia is an apt word to describe the goal of the therapy.
- 114.
Cf. Plato, Laws 731e.
- 115.
De symptomatum causis 7, 203 Kühn.
- 116.
In Hippocratis prorrheticum i 16, 565 Kühn.
- 117.
Cf. Rufus of Ephesus, Quaestiones medicinales 2 (Gärtner).
- 118.
Cf. Passions of the Soul 5, 24 Kühn. The occurrence of the expression psykhikē nosos in the sense of “mental illness” is Wenkebach’s (obviously unfortunate) conjecture at In Hippocratis librum vi epidemiarum 17b, 249 Kühn.
- 119.
De locis affectis 8, 163 Kühn.
- 120.
Cf. the story of how Galen found out that Boethus’ son was hiding food he was not allowed to have by taking the boy’s pulse, which betrayed his guilt and fear; De praenotione 14, 635–641 Kühn.
- 121.
Cf. De locis affectis 8, 301–302 Kühn, where Galen attributes death from pain, pleasure and fear to weakness of the “vital tonos” of the heart, and to the strength of such passions in the “uneducated”.
- 122.
Galen describes his own equanimity after experiencing a similar loss in the recently discovered work Peri alypias, edited by V. Boudon-Millot (2007b). The stories of Maiander and Callistus are related in Book VIII of Galen’s commentary on Hippocrates’ Epidemiae VI, p. 485–487. The text is extant only in Arabic, and a German translation (by F. Pfaff) is to be found in CMG 5, 10, 2, 2.
- 123.
In Hippocratis aphorismos 18a, 35–36 Kühn: καὶ γὰρ καὶ μανία πολλοῖς ἤδη φαίνεται γεγενημένη, διὰ θυμὸν ἢ ὀργὴν ἢ λύπην ἀρξαμένη, αὐτοῦ τοῦ σώματος δηλονότι πρὸς τὸ παθεῖν τὰ παθήματα ταῦτα κατὰ τὸν καιρὸν ἐκεῖνον ἐπιτηδείως ἔχοντος (Ed. Kühn).
- 124.
E.g., In Hippocratis librum vi epidemiarum 17b, 259 Kühn. In the same passage, there is an interesting allusion to a kind of “reverse psychotherapy”: Galen recommends that patients whose krasis is abnormally cold should be provoked to anger, as the passion serves to warm the body, especially the head.
- 125.
Cf. In Hippocratis aphorismos 18a, 35 Kühn.
- 126.
On this treatise in general, see Lloyd (1988).
- 127.
As far as Galen was concerned, the “Aristotelian” position implied that the rational soul was mortal, which is not Aristotle’s view as expressed in the De anima.
- 128.
Translation P.N. Singer (1997). τινας τῶν Πλατωνικοὺς μὲν ἑαυτοὺς ὀνομαζόντων, ἡγουμένους δ’ ἐμποδίζεσθαι < μὲν > ἐν ταῖς νόσοις τὴν ψυχὴν ὑπὸ τοῦ σώματος, ὑγιαίνοντος δὲ τὰς ἰδίας ἐνεργείας ἐνεργεῖν οὔτ’ ὠφελουμένην οὔτε βλαπτομένην ὑπ’ αὐτοῦ (Ed. Müller in SM 2).
- 129.
Galen notes that certain drugs can also induce madness (mania), for example, henbane (hyoskyamos) and thorn-apple/jimson weed (strykhnon manikon); De simplicium medicamentorum facultatibus 11, 767; 12, 145; 12, 147 Kühn. The latter was perhaps used deliberately to induce pleasant hallucinations; cf. Dioscorides, De materia medica 4, 73, and Siegel (1973, 268–269).
- 130.
Translation Singer. ἄχρι μὲν γὰρ τοῦ λήθην ἢ ἄνοιαν ἢ ἀκινησίαν ἢ ἀναισθησίαν ἕπεσθαι τοῖς εἰρημένοις, ἐμποδίζεσθαι φαίη τις ἂν αὐτὴν ἐνεργεῖν αἶς ἔχει φύσει δυνάμεσιν· ὅταν δέ < τις > οἴηται βλέπειν τὰ μὴ βλεπόμενα καὶ ἀκούειν ἃ μηδεὶς ἐφθέγξατο, καὶ φθέγγηταί τι τῶν αἰσχρῶν ἢ ἀπορρήτων ἢ ὅλως ἀδιανοήτων, οὐ μόνον ἀπωλείας ἐστὶ τεκμήριον ὧν εἶχε δυνάμεων ἡ ψυχὴ συμφύτων ἀλλὰ καὶ τῆς τῶν ἐναντίων ἐπεισόδου (Ed. Müller in SM 2).
- 131.
The treatise on errors is entitled De animi cuiuslibet peccatorum dignotione et curatione (“On diagnosing and curing the errors present in every soul”, here “Errors of the Soul”). There are some major difficulties in the text. I use the edition of W. de Boer (CMG 5, 4, 1, 1).
- 132.
Errors of the Soul 1, 2 de Boer, and Passions of the Soul 5, 7 Kühn.
- 133.
PHP 4, 2, 39.
- 134.
Errors of the Soul 3, 26 de Boer.
- 135.
On the relation of passions and beliefs in Galen, see Hankinson (1993, especially pp. 200–202).
- 136.
Making these distinctions is difficult, because valid and invalid inferences closely resemble each other. The subject is more thoroughly tackled in Galen’s work on linguistic fallacies, De sophismatis penes dictionem, based on Aristotle’s Sophistical Refutations. This work was apparently intended as a textbook for beginners; see the introduction to R.B. Edlow’s edition and translation of the work (1977).
- 137.
Errors of the Soul 3, 18 de Boer.
- 138.
Errors of the Soul 6, 11 de Boer.
- 139.
Cf. Hankinson (2008c, 162–165).
- 140.
De simplicium medicamentorum facultatibus 11, 462 Kühn.
- 141.
Cf. Heraclitus, DK B 118: “A dry soul is the wisest and the best.” In DK B 117 the same idea is associated with drunkenness’ being both a moist and stupid condition. Galen refers to Heraclitus at 786. Cf. also Hippocrates, On Regimen 1, 35, 56–61, where a watery soul is said to be slow, stupid and “mad”.
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Ahonen, M. (2014). Galen on the Diseases of the Mind and Soul. In: Mental Disorders in Ancient Philosophy. Studies in the History of Philosophy of Mind, vol 13. Springer, Cham. https://doi.org/10.1007/978-3-319-03431-7_6
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