Balance of the Mind.complete

© Copyright by Patricia Ann Clark 1993

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The Balance of the Mind: The Experience and Perception of Mental Illness in Antiquity by Patricia Ann Clark

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 1993

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University of Washington Abstract The Balance of the Mind: The Experience and Perception of Mental Illness in Antiquity by Patricia Ann Clark Chairperson of the Supervisory Committee: Professor Lawrence J. Bliquez Department of Classics The goal of this dissertation is to examine the concept of mental illness in Greek literary and historical sources, to generate an empirically based assessment of the ways in which people in antiquity thought about and responded to mentally ill or dysfunctional individuals, and to analyze these perceptions and individual experiences within the broader context of ancient Greek society. To this end a comprehensive collection of biographical, historical, and medical descriptions of mentally aberrant individuals has been made using a wide diversity of sources ranging from the Archaic period through to the late Roman Imperial period, with particular emphasis on biographical, historical, and medical works from the fifth century BCE through the second century CE. The starting point is language; the analysis of primary sources is based on a thorough collection of Greek words and phrases used to identify mentally aberrant behaviour and this material forms a substantial appendix. The study concludes that in the absence of an institutional framework (legal, medical or ecclesiastical) for labelling, classifying and segregating the mentally dysfunctional, and in the light of the underdeveloped and divergent character of medical knowledge and its limited accessibility, the way was open for people to develop a wide variety of conceptions of and responses to mental illness. In the “face to face” society of the ancient polis people responded

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to aberrant individuals on a continuing and immediate level and sought explanations and cures in a flexible, individual and pragmatic manner. Madness was conceived of as a disease, but in contrast to our own society, its treatment and management involved not merely the realm of medicine, but of religion and magic and everyday ‘common sense’. The spectrum of both lay and medical responses to aberrant individuals was determined more by the behaviour exhibited than by any preconceived concept of madness and, in the case of physicians, by what was in their power to alter. Although there were commonly recognized signals operative in identifying mentally disturbed individuals, no unified concept of madness is visible in Greek society, but rather a diversity of conceptions which allowed for multifarious responses.

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TABLE OF CONTENTS Note on pagination: the pages of the original dissertation hard copy are given followed by the pages of the online verion (where they differ) in brackets. PART ONE: Introduction - Aims, Methods and Approach Chapter One: Introductory Statement

1

A. Approach and Methods

3

B. The Vocabulary of Mental Illness

5

C. Methodological Considerations

6

I. Aberrant Behaviour and Metaphor how is insanity identified?

6

II. Madness as a Cultural Phenomenon - to what extent is madness a culturally relative term?

9

i. The Social Labelling Approach

11

ii. The Bio-Medical Approach

13

iii. The Two-Tiered Model

14

Chapter Two: Review of Previous Work

18

A. Early works

18

B. Later developments

20

I. Medical History

20

II. Literary Studies

22

III. Socio-literary Approaches

23

IV. Religion and Magic

24

V. Legal Studies

25

VI. Socio-historical Approaches

25 (26)

C. Summary Remarks

27

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PART TWO: Evidence from Historical Narrative Chapter Three: Descriptive Cases

30

A. The Single Figure

30

I. Permanent States

30

II. Temporary or Recurrent States

37

B. Group Instances

41

I. Permanent States

41

II. Temporary States

45

C. Summary Remarks Chapter Four: Physical Manifestations, Clues and Signals

47 50

A. Feigned Madness

50

B. Dramatic Madness

56

C. Generally Recognized Characteristic

57

I. Historically Observed Physical Traits and Gestures

57

III. Actions and Behavioural Signs

60 (59)

III. Emotional and Mental States as Signs

62 (61)

Chapter Five: The Popular Causes of Mental Disorders

71 (69)

A. Age - Old Age and Youth

71 (69)

B. Mental Deficiency, Extreme Stupidity, Brain Damage

75 (73)

C. Heredity and Congenital Considerations

78 (76)

D. Disease - Epilepsy

79 (77)

E. Ingested Substances: Wine, Drugs and Poisons

83 (81)

I. Wines

83 (81)

II. Drugs and Poisons

88 (86)

III. Madness From Other Substances

90 (88)

F. Emotions

92 (90)

G. Divine Possession and Divine Punishment

99 (97)

I. Madness as Punishment

100 (98)

II. Madness and Possession

103 (101)

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i. Ritual Possession

104 (102)

ii. Madness and Prophecy

110 (107)

ii. Madness as Possession - other evidence

115 (113)

Chapter Six: Attitudes and Care; Treatment and Cures A. Treatment and Cures

123 (121) 123 (121)

I. Treatment by Physicians

123 (122)

II. Popular and Magical Cures

126 (124)

III. Religious Cures

128 (127)

i. Oracular Consultation

129 (127)

ii. Temple Prayers and Dedications

129 (128)

iii. Purification Rituals

130 (129)

iv. Religious Healing Rituals

132 (131)

v. Music

136 (134)

vi. Dreams and Incubation

138 (136)

IV. Other Cures B. Care and Attitudes I. Public Attitudes

143 (141) 144 (142) 144 (142)

i. Spitting

145 (143)

ii. Avoidance

146 (144)

iii. Stoning

147 (145)

iv. Ridicule

147 (145)

v. Dismissal, Banishment, Escape

150 (148)

vi. Tolerance and Humouring

151 (149)

II. Family Care

152 (150)

III. Caring Attitudes

153 (151)

IV. Protection and Prevention

156 (153)

C. Responsibility and Limits - Public Concerns and the Law

156 (154)

I. Restrictions and Political Participation

157 (155)

II. Legal Restrictions: Insanity and the Courts

158 (156)

i. Γραφὴ Παρανοίας (Graphe Paranoias)

159 (157)

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ii. Contracts: Wills and Testaments; Adoptions

161 (159)

iii. Marriage and Betrothal

162 (160)

iv. Sale of Slaves

163 (161)

v. Cases

164 (162)

vi. Diminished Responsibility

168 (166)

vii. Restrictions on Freedom of Movement

171 (169)

C. Summary Remarks

174 (171)

PART THREE: Evidence from the Medical Sources Chapter Seven: Syndromes, Symptoms and Cases

175 (173)

A. The Hippocratic Corpus

176 (174)

B. Celsus

188 (187)

C. Caelius Aurelianus (Soranus)

193 (191)

I. Acute Diseases

194 (192)

i. Phrenitis

194 (192)

ii. Lethargy

202 (201)

iii. Hydrophobia

204 (203)

II. Chronic Diseases

206 (205)

i. Incubus

206 (205)

ii. Epilepsy

207 (206)

iii. Madness, Insanity, Mania

208 (207)

iv. Melancholy

212 (211)

v. Effeminate Men or Pathics

213 (212)

D. Aretaeus of Cappadocia

215 (214)

I. Epilepsy

215 (214)

II. Melancholy

217 (216)

III. Mania

219 (218)

E. Rufus of Ephesus

226 (225)

I. Hydrophobia

227 (226)

II. Love-Madness

228 (226)

III.Loss of Memory

228 (226)

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IV. Epilepsy

228 (227)

V. Melancholy

229 (228)

F. Galen

236 (234)

I. Phrenitis

243 (241)

II. Mania

246 (243)

III. Melancholy

246 (244)

IV. Loss of Memory, Dementia, Morosis

250 (248)

V. Epilepsy

252 (249)

VI. Senility

255 (252)

VII. Diseases of the Soul (Passions and Errors)

255 (253)

G. Other Aberrant States in Later Compilators

256 (253)

I. Lykanthropy

256 (253)

II. Love-Sickness

257 (255)

H. Summary Remarks Chapter Eight: The Medical Causes of Mental Dysfunction

259 (257) 261 (259)

A. Humors and Temperaments

261 (259)

B. Causes of Abnormal Mental States in Medical Sources

266 (264)

I. Humoral Explanations

267 (265)

i. Bile: Black and Yellow; Blood and Phlegm

267 (265)

ii. Vapours and the Brain

275 (274)

II. Heredity and Temperament

277 (275)

III. Qualities and States

280 (278)

IV. Seasonal and Climatic Influences

284 (282)

V. Age and Gender

287 (286)

i. Epilepsy

288 (287)

ii. Melancholy and Black Bile Disorders

289 (288)

iii. Mania and Insania

290 (289)

iv. Phrenitis

291 (290)

v. Mental Disorders of Old Age

291 (290)

VI. Emotions

292 (291)

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VII. Strain, Stress, Overwork, Fatigue, Hunger

295 (294)

VIII. Ingestion of Substance

296 (294)

i. Milk

296 (294)

ii. Wine

296 (295)

iii. Drugs

298 (297)

iv. Bad Food, Bad Eating Habits, Indigestion

299 (298)

IX. Other Physical Causes

301 (300)

X. Diseases, Defects, Wounds and Medical Procedures

302 (301)

XI. Contagion

313 (312)

XII. Divine Causes, Superstition and Folk Tales

314 (313)

C. Summary Remarks

317 (316)

Chapter Nine: The Treatment of Mental Dysfunction

321 (320)

A. Is There an Illness?

321 (320)

B. Is There a Cure?

326

C. Spontaneous Cures

331 (330)

D. Physical Treatments

333 (332)

I. The Physical Surroundings

333 (332)

II. Supplying Deficiencies, Building Up Strength

338 (337)

i. Sleep as a Remedy

338 (337)

ii. Attempts to Rouse and Restore

340

iii. Aromatherapy

342

iv. Massage, Rub-Downs, Anointing

343

v. Exercise

345

vi. Sexual Activity and Pregnancy

348 (347)

vii. Food and Wine - the Dietary Regimen

353

III. Removing Harmful Elements and Eliminating Excess

357

i. Bleeding, Cupping, Scarification

357

ii. Purging the Head: Sternutatives, Shaving, Fomentations and Plasters iii. Emetics

358 360

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iv. Purgatives and Cathartics: clysters, suppositories and diuretics IV. Treating by Opposites, Restoring Equilibrium

360 361 (362)

i. Heating: Kataplasms, Fomentations and Plasters

363

ii. Cooling Remedies

364

V. Surgical Methods

364

VI. Folk Remedies in Medical Contexts

366

E. Attitudes and Handling of the Mentally Disturbed

372 (373)

I. Physical Restraint, Threats and Coercion

373

II. Allaying Fears, Soothing, Calming

378

III. Humouring and Deceiving the Patient

380

IV. Redirecting Thoughts. Awakening Interests, Changes of Scene

382

V. Cheering Up: Friend, Music, Entertainment, Stories, Games F. Summary Remarks Chapter Ten: Summary and Conclusion

385 387 (388) 390

A. Aims and Evidence

390

B. Perceptions of the Mentally Ill

391

I. What is Madness? Manifestations, Clues and Signals

392

II Cultural Specifics

399

III. Terms and Labels

400

IV. Who Goes Mad?

404 (405)

V. Perceived Causes

406 (407)

C. Experiences of the Mentally Ill

410

I. Responsibility for Care

410

II. The Physician’s Role

411

III. Cures and Treatments

413

i. Popular Cures

413 (414)

ii. Medical Cures

414 (415)

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IV. Attitudes and Handling D. Ancient Society and the Mentally Ill

416 (417) 417 (418)

Bibliography

421 (422)

Appendix A. The Vocabulary of Abnormal Mental States

447 (440)

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ACKNOWLEDGEMENTS The author wishes to thank principally Professor Lawrence J. Bliquez, Advisor optimus, for his tactful assistance and heartening enthusiasm. Thanks too are due to Professors Michael J. Halleran and Mary Whitlock Blundell for their careful attention to the preparatory stages of this manuscript. I am particularly grateful to my colleague and friend, Professor Keith R. Bradley, who originally started me thinking about the experience of the mentally ill in ancient society, and whose support and advice have always been immeasurably valuable.

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To my family – Peter, Douglas, Catherine and heather with love and gratitude.

PART ONE: INTRODUCTION - AIMS, METHODS AND APPROACH CHAPTER ONE There is no psychology; there is only biography and autobiography. Thomas Szasz, The Second Sin. Introductory Statement Philostratus recounts that the sophist Herodes Atticus was once summoned by the Emperor Marcus Aurelius to his headquarters at Sirmium in Pannonia, to respond to charges put forward by his fellow Athenians that he was a tyrant. Herodes lodged in the town's suburbs in a building with a high tower, and, during the night lightning struck the tower killing the two young women accompanying him, twin girls he had raised from childhood and loved as his own daughters. Herodes came to the Emperor's court driven frantic by the disaster, out of his mind and longing for death. He seemed to onlookers to have no control over his rage and one singular indication of his crazed condition, expressly noted, was that in the ensuing barrage of invective he poured over the court, he did not even use figures of speech! (HN1) ὑπὸ τοὐτου δὴ τοῦ πἀθους ἔκφρων ὁ Ἡρώδης ἐγένετο καὶ παρῆλθεν εἰς τὸ βασίλειον δικαστήριον οὔτε ἔννους καὶ θανατοῦ ἐρῶν. παρελθὼν γὰρ καθίστατο ἐς διαβολὰς τοῦ αὐτοκράτορος οὐδὲ σχηματίσας τὸν λόγον, ὡς εἰκὸς ἦν ἄνδρα γεγυμνασμένον τῆς τοιᾶσδε ἰδέας μεταχειρίσασθαι τὴν ἑαυτοῦ χολήν, ἀλλ' ἀπηγκωνισμένῃ τῃ γλώττῃ καὶ γυμνῇ διετείνετο ... . 1 It is from brief glimpses such as this that we may glean evidence for some of the automatic assumptions prevalent in antiquity about madness in daily life. Many questions arise when one reads about Herodes, for example: Was it unusual in antiquity for a man to become ἔκρων upon the death of a family member? Did people commonly expect madness to result from grief and loss? Or, were other forces thought to be involved which precipitated Herodes into a state of mental derangement? Did he show any prior signs of mental instability, for example, and what might they have been? Was the fact that he was an old man of any significance in people's perceptions of his behaviour? And then, what did people think of him after such a display, and how did they treat him? Were they compassionate or punitive -- or did they perhaps avoid him as one polluted? More generally, was there a link in people's thinking between an unbalanced mind and a longing for death? Was there a connection assumed between sanity and emotional control in public life? The anecdote invites too a host of more speculative questions - what if Herodes had 1 Philostr. VS 560-561: “Herodes was driven frantic by this misfortune, and when he came before the Emperor's tribunal he was not in his right mind but longed for death. For when he came forward to speak he launched into invectives against the Emperor, and did not even use figures of speech in his oration, though it might have been expected that a man who had been trained in this type of oratory would have had his own anger under control. But with aggressive and unguarded tongue he persisted in his attack....” (Trans. Loeb). The testimonia throughout this dissertation are numbered for convenient reference, HN for those from historical narrative sources and MT for those from the medical sources.

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been a woman, the girls' mother perhaps? Would she, exhibiting the same behaviour, have been described as “out of her mind”? One is even tempted to wonder (idly) whether, if the distressed Herodes had employed figures of speech, his sanity would ever have been questioned. What if he had been a slave - or an uneducated man - what clues then would have signalled to onlookers that his mind was unbalanced? The fact is that we know very little about the ways in which people thought about and reacted to those who were mentally disturbed in antiquity. This study may not be able to furnish precise answers to all questions of the kind posed above; its aim is, however, to generate to the extent possible a comprehensive picture of mental illness or aberration as it was popularly perceived and experienced in the Greek and Greco-Roman societies of classical antiquity. The great mad figures of Attic tragedy, Orestes, Ajax, Heracles, are familiar to us all, as are various other figures who exhibited disturbed mental states - Cassandra, Phaedra, Medea. But because so much scholarly attention has been directed toward madness as it was depicted in myth and drama, this study sets out to redress the balance somewhat - or at the very least to complement such works - by emphasizing primarily the evidence for aberrant mental states found in descriptions of and references to historical individuals. To this end the study examines Greek prose literature- primarily biographical, historical, legal and oratorical works and the works of Greek medical writers - and assembles descriptions as full and specific as possible of individuals labelled insane or mentally disturbed and of how people thought about and treated them. From these accounts a picture emerges of the different kinds of mental abnormality commonly recognized in antiquity, and of what signals triggered labels such as “insane” to contemporaries, what causes were thought to be operative, what groups susceptible, and, most particularly, what was the spectrum of responses on the part of individuals and the community toward these individuals. A. Approach and Methods The primary sources for the study are primarily Greek authors from the fifth century BCE through the second century CE. Two medical sources, Celsus and Caelius Aurelianus, are in Latin, but in each case the work is either a translation or heavily derivative of earlier Greek medical writings. With respect to narrative history, Plutarch in particular is an extremely valuable source for personal anecdotes - many of which concern Roman historical figures in addition to Greek. This bi-cultural aspect of his historical and biographical works may be thought to present a problem for the social historian - is he reflecting Roman or Greek attitudes and values? Plutarch’s world-view is, in many aspects, a Greek one - at the very most he can be described as Greco-Roman in outlook, particularly when it comes to issues of public life and political stability.2 In ordinary, everyday matters - relationships with friends and family, the customs and traditions of daily life - his writings exhibit a Greek sensibility. His descriptions of and attitudes toward the mental conditions of the people he writes about are assumed here largely to reflect his own personal and cultural assumptions about the manner in which the human mind and character work - whether Greek or Roman. If at any point in the examination of the Greek sources discernible differences become visible between

2 See Jones 1971, 122-130 for a discussion of the attitudes of Plutarch and other educated Greek towards Rome and Roman values; “Plutarch’s attitude to Rome is in a sense both Greek and Roman” (125). See also Russell 1972, esp. ch.5, on Plutarch the Hellenic tradition, morals and men; cf. Wardman 1974, 236.

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the ways in which Greeks and Romans thought about and treated the mentally disturbed, they will be articulated and discussed. It should be noted at the outset that parameters of time and space have here been kept deliberately broad, and that the body of source material is correspondingly wide and diverse.3 There are several reasons for this: first, the subject of insane or mentally incompetent individuals was of only peripheral interest to ancient historians and biographers (and even to medical writers) and a wide net is therefore required to obtain even a modest amount of evidence. Secondly, the nature of this evidence, sparse, elliptical and diffuse, suggests that a useful approach might be to look not merely to Classical Athens for traces of “popular thought”, but to a variety of ancient civic communities. This approach is problematical if we require detailed and valid conclusions about the place of the insane person within a specific city-state and at a more or less precise historical moment. If, however, we can be satisfied with some significant inferences about popular attitudes from diverse communities over a longer period of time, the difficulties are not as great as they may initially appear. An ancient civic community, whether it was Athens, Corinth, Sparta, or Pergamon, may be characterized very broadly as a traditional, relatively static society with a closed citizenry whose civic life emphasized family and personal connections, competition, and for men, visibility, and active participation in public affairs - political, religious and military. In societies of this kind, behavioural norms of public (and private) conduct tended to be relatively uniform, whether they were held explicitly or implicitly, and any aberrant, deviant or exceptional behaviour was quickly identified.4 Primarily in democracies, oligarchies and republics, but even to some extent under tyrants, competence for office was the subject of public debate (or semi-public gossip), public praise and public scorn. And at some level competence and incompetence included an assessment of an individual's mental ability and/or stability. Given a social matrix of this kind some very general questions arise: what kinds of mentally aberrant behaviour were identified? What was thought about individuals so labelled and what was done about them? What did it mean for them, and for their families, to be so labelled? The wide time-frame adopted here is justified by the fragmentary nature of the available evidence. Such evidence as survives can, it is true, permit some knowledge of the variations and continuities among popular attitudes. But, in the absence of statistical data, it is difficult, if not impossible to identify significant and widespread societal shifts and trends.5 In view of these constraints and in view too of the traditional, conservative nature of ancient pre-

3 Most sources, as noted above, fall between the fifth century B.C.E. through the second century C.E.; however some later material, particularly from the medical authors, is necessarily included. 4 Crone 1989, 114-115. For an excellent general discussion of expectations for citizens in such societies see ch.6, “Society and the Individual”. Such a civic community has been characterized by Paul Cartledge, among others, as a “face-to-face society”; cf. the concluding chapter of Jane Gardner’s 1993 book on the Roman citizen,”The Face to Face Society”. Themistocles, for example, was said to have learned by heart the names of all his fellow citizens. Cic. Sen. 21. For the ancient city state and its ethos see Fustel de Coulanges [1864] 1980; Sinclair 1989. 5 For an illustration of the lack of change in basic societal attitudes see Treggiari 1991, esp. 108; for the difficulty in assessing change see K.R. Bradley's reviews of Wiedemann CP 86 (1991): 258-260, and of Saller and Kertzer, CP

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industrial societies, it is a working hypothesis of this study that there was a wide range of behaviours and attitudes visibly associated with mentally aberrant individuals in antiquity; but that this range itself did not alter perceptibly over the centuries under consideration. Perhaps only with the entrenchment of Neoplatonic and Christian daemonological doctrines can a coalescence of prevalent attitudes toward the insane be seen.6 The emphasis of this study is upon popular perceptions and personal experiences, and in this it reflects the increasing desire among contemporary social historians to understand more of the private and ordinary aspects of the daily lives of people in antiquity; of how, in the words of Lawrence Stone, “individuals thought about, treated and used each other, and how they regarded themselves ... .”7. Over the past two decades scholarly attention has turned increasingly to the experiences of previously silenced and submerged elements of society such as slaves, peasants, women and children.8 In a manner similar, socially deviant individuals - the mad, the criminal, the mentally deficient - have traditionally been ignored by ancient historians, but their stories hold intrinsic interest. It is the object of this study to provide an increased awareness of how people thought about, talked about and reacted to their own and others' mental afflictions, so that significant nuances will be added to the complex images of social interaction we seek to construct for ancient societies. B. The Vocabulary of Mental Illness The starting point for the study is language. It is assumed that the first step toward understanding mental illness in antiquity is to isolate as many words and phrases as possible which served to identify the spectrum of behaviours associated with mental aberration, and then to view this within the framework of ancient Greek society.9 The emphasis here is on personal behaviour in a social context and the ultimate aim is to achieve a “fit” between the behavioural spectrum and its historical context - the ancient city and its ethos. A collection, as exhaustive as possible, has been made of Greek words and phrases which refer to aberrant or disturbed states of mind. They form the basis for the search of selected primary sources. There are, of course, some words - for example ὑπομαργότερος - which were used infrequently, and others, like μανία and παράνοια, much more often. Some words are problematical - ἄνοια is a good example - for although it has a core meaning of mental dysfunction it seems most frequently to have been used in a much ‘softer’ context - where simply silliness or foolishness was implied. Some editorial judgement is required and in general passages have been selected for inclusion in which the context made it clear that the vocabulary of madness was being used to describe people,

(forthcoming July 1993). Changes of public attitude as reflected in the legal or political realm are somewhat more accessible, but even there interpretation is not without problems. 6 Smith 1965; Rosen 1969, 92; Jackson 1972, 292; Mora and Brown 1978. 7 Stone 1979, 21. 8 For example, Bradley 1989, Wiedemann 1989, Boswell 1988, Golden 1990, Pomeroy 1991. 9 For the collection of terms which formed the basis of this study see Appendix 1

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behaviour, and situations which were thought to be aberrant, in some way dysfunctional, and notably out of the ordinary. C. Methodological Considerations: I. Aberrant Behaviour and Metaphor - how is insanity identified? In our own culture the zone of comfortable normality is vague, ambiguous, and difficult to delimit; how much more difficult it is, inevitably, for us to comprehend the 'normal' of the ancient world. Normality, or for our purposes sanity, tends in all cultures to be assumed and unexpressed, whereas insanity, both actual and metaphorical, was a concept of very real interest for ancient writers, and attempts were made by various medical writers and, among philosophers, notably by Plato, to define and differentiate between certain types of “mad” states.10 Yet in the words of this century's leading historian of ancient medicine, “Great philosopher as Plato was, his writings do not suffice to tell the historian what the Athenian people of his time thought insanity to be”, and this stricture too can be applied to the specialized writings of the physicians of antiquity.11 How then are we to approach the question of “what people thought”? The safest assumption from the outset is that a variety of people thought a variety of things about the insane and about insanity.12. It is only by tracing some of this diversity of attitude and behaviour, by comparing, looking for consistencies or contradictions, and above all by examining each piece of evidence in context, that we can achieve any measure of understanding mental disturbance in an ancient society. In our society a continuum of mental aberration seems to operate, with the outright bizarre and inexplicable at one end, behaviour which is in everyone's view clearly ‘insane’, moving through actions mildly aberrant - the behaviour of persons considered harmlessly odd or eccentric.13 Further along is the occasionally strange behaviour which even ‘normal’ people may exhibit; this is usually regarded as temporary and, above all, explicable. Normality - at the other end of the continuum - consists of the kinds of behaviour which are within the realm of the expected and which largely go unnoticed. But even when we describe actions within the vague zones of acceptable normality we at times resort to the language of insanity: a person may be “crazy” about someone, or “out of his mind” with terror or grief; people are said to “lose it” or “go over the edge”, perhaps when angered or perhaps during the “frenzy of war” when “battle-crazed”. The frequent use and rich variety of such everyday phrases indicates a continual, albeit unarticulated, recognition of categories of behaviour which approach and yet to us are not quite coextensive with

10 Pl. Phdr. 244a-245. 11. Temkin 1971, 14. 12 See G.E.R. Lloyd,1990, 135-145, esp. 142, on the necessity of recognizing diversity and context when examining “what people thought” in a particular culture. 13 Even at the extreme end of the continuum, however, categories are not easily demarcated; the concepts “clinically” and “legally” insane operate in medico-legal and pseudo-medico-legal contexts to mark some sort of boundary - one which is a subject of constant doubts and courtroom debate. See, for example, the discussion of the difficulties in evolving a legal definition for insanity in the precedent setting 19th century M'Naghten case in Britain. The 'M'Naghten Rules' have never been superseded but difficulties in defining insanity recur. For a succinct summary of the case and later (1973) relevant discussion in the Court of Appeals see Porter 1991, 190-194.

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‘real’ or ‘certifiable’ insanity. Regularly, in daily usage we make a tacit distinction between literal and metaphorical instances of insane behaviour, and it seems to be one of the functions of metaphorical language to indicate when behaviour is approaching the border between the normal and the abnormal. By employing the same, or a very similar, vocabulary for these two somewhat different fields of reference, the metaphorical and the literal, we underscore the ill-defined, even fluid nature of their boundaries, and we emphasize too the delicate balance involved and the clearly consensual nature of what it is to be called ‘mad’ or ‘sane’. One of the first problems which arises when we look at descriptions of mentally aberrant behaviour from another culture is this fluid boundary. How do we decide whether an individual was ‘really’ considered by his peers to be ‘insane’ or only metaphorically so? Was Herodes, for example, thought ‘really’ to be out of his mind? This problem is, I think, at least for the purposes of this study, more apparent than real. The use of the vocabulary of madness, whatever the range of behaviours to which it is applied, suggests that certain fundamental and common elements are perceptible and have triggered an imaginative response in the person describing the behaviour. There was something about - for example - the way Herodes rolled his eyes or stammered in his speech which signalled to the onlookers ‘madness’ - or - ‘like madness’. To take an example from our own society, when we hear a phrase, such as the one included in a recent news report from the Bosnian city of Srebrenica, that the terrified inhabitants of the besieged town were “near madness” as the Serbian army approached, do we wonder whether they are “really” insane?14 Or do we perhaps find images in our minds of people disoriented, talking wildly, randomly and compulsively performing apparently meaningless tasks, or else paralysed, withdrawn, - or driven to self-destruction and even the murder.of loved ones? In short, many of the behavioural manifestations which to us commonly signal some degree of mental disorder will tend to emerge. And so, rather than addressing the issue of the differences between real and metaphorical madness, it is the analysis of these common elements, the kinds of behaviours thought to signal madness, and the responses to them by other members of society, which is the primary focus of this dissertation. Moreover, it seems probable that the difference between one who is ‘really’ mad or only ‘metaphorically’ mad was considered in ancient Greek culture to be only be a matter of degree. In connection with Greek perceptions of mental health and mental illness, K.J. Dover has suggested that “the distinction between emotion, thoughtlessness and shamelessness, all of which we tend to think one ought to control, and insanity, which we know one cannot control, was generally treated by the Greeks as quantitative.”15 If this was so, Greek thinking was not unlike our own sense that a continuum of behaviours is operative in society, ranging from normal and acceptable to abnormal and unacceptable.

14 CBC news report, April 17, 1993. 15 Dover 1974, 126-7.

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In summary, it is difficult for us to comprehend the extent to which terms in antiquity were used metaphorically or literally.16 The dichotomy is, however, very much a part of our own way of conceptualizing language and, however much we may try, it is difficult to eradicate. It seems best, therefore, to proceed in full acknowledgement that we do not know (unless they tell us) the extent to which Greeks used the vocabulary of madness literally or metaphorically, and then to examine each instance of its use in as full a context as possible in an effort to gauge the layers of meaning implicated when individuals and their behaviour are described as ‘mad’, and to extract from these descriptions key elements of the Greek perception of madness. II. Madness as a Cultural Phenomenon - to what extent is madness a culturally relative term? καθαίρονται δ' ἄλλως αἵματι μιαινόμενοι οἵον εἴ τις εἰς πηλὸν ἐμβὰς πηλῷ ἀπονίζοιτο. μαίνεσθαι δ' ἂν δοκοίη, εἴ τις αὐτὸν ἀνθρώπων ἐπιφράσαιτο οὕτω ποιέοντα. “They vainly purify themselves of blood-guilt by defiling themselves with blood as though one who had stepped into mud were to wash with mud; he would seem to be mad, if any of men noticed him doing this”.17 When Heraclitus made this remark he was not only stepping outside to view the religious world of his contemporaries, he was at the same time making an observation about the culturally bound nature of what people call sane and insane. In an important respect behaviour only becomes “mad” when we notice it and term it so. For Heraclitus such an observation was not central, but for our purposes it is, for a significant question we can ask about any society is, what is it that people notice and term “mad” and what do they, by consensus, take more or less for granted as “normal”, everyday behaviour.18 Somewhere there may be a society in which the categories of ‘mad’ and ‘sane’ (however translated) are undifferentiated, but it is a society yet to be discovered. The cultures of ancient Greece and Rome were unexceptional in this respect; an abundance of Greek and Latin terms for impaired or disturbed mental activity suggests that these societies were very much aware of forms of behaviour and patterns of thought and mood which for them constituted the ‘normal’ and the ‘abnormal’. When comparisons are made with other cultures on the basis 16 Some scholars have even suggested that the literal/metaphorical polarity is an inappropriate construct to use with languages of other cultures. See Padel 1992, 33-40 for a perceptive discussion of the physicality of Greek expressions of feeling and thinking and the difficulties in meaningfully applying contemporary western concepts such as “concrete/abstract” and “metaphorical use” to these. The difficulty in drawing the line between when the vocabulary of madness is being applied literally and when metaphorically is a recurring one. One useful, if rather arbitrary, distinction which is made in the present study is the decision to limit the cases examined to ones in which an individual's personal behaviour is described as “mad”. Descriptions of a person's thinking and decisions on public matters (military or political) as “mad” have been set aside for separate study. 17 Heracl. Fr. 5, DK 1.151-152; Trans. Kirk, Raven, and Schofield [1957] 1983, 209. Emphasis mine. 18 See Simon 1968, 31-42 for a good discussion of the problem of definition.

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of vocabulary , our own perhaps, or more strikingly, various non-Western societies such as those of late Imperial China, the Yupik Eskimos, or the Egba Yorubas, it has been shown that within each of these societies categories of normal and abnormal mental function, madness and sanity, are inevitably recognized and named, but that such categories are severally differentiated and delineated to greater and lesser extents by each society.19 For if the idea of insanity is universally present in all societies, it does not necessarily follow that in every culture the same kinds of behaviour are labelled as insane. Since mental disorders are the product to some degree of cultural definition, even within the same society, at various points in time, different kinds of behaviour have been identified by both lay and professional people as pathological.20 In our own society some mental disorders which were once commonly identified - ‘hysteria’ for example - are now found to be extremely rare, and new, and sometimes controversial, syndromes are being incorporated into the canon of psychiatric medicine. Currently debate is raging over the contents of the soon to be released new edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry’s bible. Described as “an indispensable diagnostic tool”, DSM is also acknowledged to be “a powerful social weapon that determines who is and who isn’t mentally ill.”21 Some of the more disputed entries from earlier editions of the DSM are in the realm of ‘personality disorders’; these have included in the past such ‘illnesses’ as homosexuality, a “self-defeating personality disorder”, “premenstrual dysphoric disorder” and a disease said to make men commit rape, “paraphilic coercive disorder”. Some of these, in response to societal changes in attitude and intraprofesssional pressure, are now being dropped; others will remain listed in DSM-IV, an index of disputed mental conditions.22 What this debate does, primarily, is point once again to the fluid boundaries and changeable nature of the normal and the aberrant. In our society, there are not only disagreements about what constitutes a mental disorder, but, in addition, significant variation among the psychological experts in the manner in which such disorders are viewed. One critical distinction (put here in its simplest form), is that some experts in their diagnoses, aetiologies, and treatment methods emphasize

19 Murphy 1976, 1019;Ng 1990, 25-28. 20 Two recent news items underscore the ways in which cultural definitions can shift: (1) the British Psychological Society at its annual meeting has declared premenstrual syndrome (PMS) a “myth”, whereas the American Psychiatric Association has recently classified premenstrual dysphoria as a “depressive disorder”. Globe and Mail, 22 June 1993, sec. A pl 18. (2)”Dr. Richard Bentall of the University of Liverpool recently sparked off a controversy in British psychiatry by asserting that happiness is so rare that it should really be classified as a mental disorder.” Globe and Mail, 18 June, 1993 sec. A p.20. 21 “Who gets to decide who’s normal?”Globe and Mail, 18 May 1993, sec. A p. 17. 22 “Who gets to decide who’s normal?” Globe and Mail, 18 May 1993, sec. A p.17; in an effort “to correct the perceived sexist imbalance of the DSM, and psychiatric diagnosis generally” two Canadian psychologists have submitted a properly scientific and scholarly proposal for a new syndrome to be included in the DSM : a disorder called “delusional dominating personality disorder”- “a category that describes aggressively male behaviour as pathological”. The proposal has inevitably met with a mixed reception,but is thought to have raised awareness of previously unacknowledged political issues in psychiatric diagnosis. The Globe and Mail review concludes, “... it should force us to remember that the line between normal and pathological is far from firm. Given that, it is a good idea to know who draws it, and how.”

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more the cultural aspects of mental disorders, while others stress the physiological. The following brief discussion is designed to generate an approach to mental disorders in antiquity which takes into account both cultural and biological factors. i. The Social Labelling Approach It is demonstrably true that certain unusual behaviours, hearing voices for example, may be variously viewed in different societies - or even within the same society - and meet with differing degrees of social acceptance. Such phenomena may on occasion be seen as symptoms of incipient mental illness, yet in another context be viewed as a positive sign, perhaps designating the capacity for spiritual healing.23 Observations of this kind have led some proponents of what has been called social labelling theory to view insanity as a purely culturally specific, relative term applied to one form of social deviation - drunkenness and crime for example are others.24 From this perspective there are no objectively measurable criteria for insanity. Instead, in the view of one extreme proponent of this approach, behaviour which is termed “mad” is merely “a residual category of diverse kinds of deviations which constitute an affront to the unconscious definition of decency and reality uniquely characteristic of each culture”.25 True, many mentally disturbed people very often do violate these (and other) social codes, but the concept of social deviance alone is insufficient to explain insanity. Athenian Old Comedy, for example, regularly and deliberately presented deviant - e.g. indecent, outrageous, unrealistic behaviour - for the delectation of the citizenry, but for such behaviour to be called “insane” it would have had to have been exhibited spontaneously by a real person in an unpredictable (i.e. not socially prescribed or permitted) context.26 The two situations differ significantly in that in the former, key elements are present which lend meaning to behaviour: social ritual and individual motivation and control. In instances of actual insane behaviour it is precisely these elements which are not readily perceptible to the observer. Social ritual, and the meaning of behaviour in terms of social ritual, is what labelling theory sets out to delimit; its focus is upon “what is made of an act socially”.27 Schur's definition of deviance elucidates this focus: “Human behaviour is deviant to the extent that it comes to be viewed as involving a personally discreditable departure from a

23 Or again, in the same society, the two attitudes may co-exist Simon 1968, 31 & 34; Kiev 1972, 20. 24 Murphy 1976, 1019-1029 citing Scheff 1966, 33 & 82. In the sixties the British psychiatrist R.D. Laing and the American Thomas Szasz became influential and widely known proponents of the social labelling theory as applied to mental disorders. See Laing and Esterson 1964 and Szasz 1961. 25 Murphy 1976 1020 citing Scheff 1966, 33,82. 26 See Silk in Pelling 1990, 171 on Aristophanic characters and norms. 27 Schur 1971, 16.

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group's normative expectation, and it elicits interpersonal or collective reactions that serve to ‘isolate,’ ‘treat,’ ‘correct,’ or ‘punish’ individuals engaging in such behaviour.”28 Labelling theory is not, however, particularly interested in exploring the meaning of an act in terms of an individual's motivation, or indeed, in examining the factors which might help to account for the initial act which is then consequently labeled deviant.29 Its focus is less upon this 'primary deviance' and more upon the selfperpetuating behaviour which results when such actions are stigmatized by society. To a great extent in labelling theory, “the primary deviations of mental illness are held to be for the most part insignificant, and societal reactions become the main etiological factor.”30. A key objection to the relativist approach of labelling theory lies, however, in the area of 'primary deviance' and the question of the individual's motivation and control. Ari Kiev, a leading researcher in cross-cultural psychiatry, objects to the suggestion, implicit in social labelling, that mental disorders are “acts of norm breaking, rather than ... products of underlying biological reactions, which remain outside the individual's control.”31 ii. The Bio-Medical Approach Kiev's focus is characteristic of the medical/psychiatric model of mental illness in which types of mental disorders are thought to be rooted in the biological nature of humans, and seen to be fairly constant throughout time and place.32 This model is particularly useful for some of the more severe forms of mental illness such as schizophrenia or manic-depressive psychoses for which clear evidence of bio-chemical disorder has been indicated.33 It is noteworthy that cross-cultural psychiatric studies have found, in contrast to the relativism of labelling theory, that among a variety of societies there are fundamental similarities in the symptoms which form the basis for judging a person to be mentally ill.34 From her study of several non-western cultures, Jane Murphy concludes that, “almost everywhere a pattern composed of hallucinations, delusions, disorientations, and behavioural aberrations appears to identify the idea of ‘losing one's mind,’ even though the content of these manifestations is colored by cultural

28E.Schur 1971, 24, original emphasis. 29 Schur 1971, 16. 30 Murphy 1976, 1020; who provides in her introduction a succinct summary and critique of social labelling models. 31 Kiev 1972, 3. 32 Kiev 1972, 1. 33 In the treatment of schizophrenia, for example, although it is not known whether the causes are chemical, structural or both, anti-psychotic drug therapy predominates. Much attention is currently being given in Canada to a new drug, Risperidone, which appears to restore brain activity “to something closer to a natural balance”; see “Hopes high for new anti-schizophrenia drug,” The Globe and Mail, 13 May 1993, sec. A p.6. 34 Kiev 1972, 22.

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beliefs.”35 Such researchers conclude then, that the underlying processes of insanity, the disorders of memory, perception, and feeling, have some biological and chemical basis and are everywhere essentially the same.36 Yet problems lie in the more hazy realms of mental distress, with what North Americans might term neurotic behaviour, for here the question of bio-chemical involvement is problematical, the line between normal and abnormal elusive, and here especially we encounter cultural differences in categorizing and responding to mental abnormalities. Even within our own culture, Madness is not always easily distinguished from other categories of thought and behaviour ... problems occur in separating madness from states of disturbance that occur in connection with particular life events or stages of life: sickness, separation, death, adolescence, old age, and so on. Generally speaking, each culture has rough limits of expectable behavior in these situations, but when does profound grief become pathological mourning? Where does adolescent turmoil end and schizophrenia begin?37 Fortunately the social labelling and the bio-medical modes of explanation are neither antithetical nor mutually exclusive in their application. Each is in some way insufficient: social labelling theory ignores certain universal biologically based symptoms of mental disease, and neither the bio-medical nor the social labelling approach alone can explain the varying definitions of deviant (including mentally aberrant) behaviour among different societies. 38 A synthetic approach is required, therefore, to account for the fact that forms of madness are omnipresent yet multifariously delineated. iii. The Two-Tiered Model Ari Kiev has proposed a two-tiered model for explaining psychiatric disorders. His approach is designed to incorporate both an account of the universal elements of mental disorders and an explanation for cultural variations and he takes an interactive view of the person and the environment. In brief, with respect to the evolution of mental illness, biological and constitutional factors predispose some individuals to develop one or another kind of psychological disorder, whereas “non-specific environmental stresses” in their impact upon the individual influence whether or not an identifiable mental disorder will result. Individuals vary in their susceptibility to such life stresses, as do, naturally, the kinds, frequency, and intensity of stresses to which their cultures expose them.39 The relationship between the individual and the environment is seen to be reciprocal, in that “shifts in one tend to be

35 Murphy , 1027. 36 Murphy, 1023, Kiev, 1, 22. 37 Simon 1978, 31. 38 Schur 1971, 18-19, citing Gibbs 1966, 12. 39 Kiev 1972, 3,4.

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accompanied by corresponding changes in the other” - biological factors may alter a person’s perception of the environment just as environmental changes may alter an individual’s physical and psychological responses.40 Once “insanity” has developed, although the behavioural patterns which signal it vary from culture to culture, there are, according to Kiev “certain basic or pathogenic psychiatric processes that are invariant. Loosening of associations, diurnal variation of mood, and clouding of consciousness, for example, do not appear to be influenced by culture or by individual motivation.”41 Such disordered processes of mood and thought provide the basic forms of mental illness found the world over, but the content of the disorder, the kinds of delusions or hallucinations, the specific nature of the aberrant behaviour, is primarily a product of cultural responses to and influences upon the individual.42 It is at this level, where culture and the individual interact and impact upon one another, that the concept of social labelling becomes useful. Different societies tolerate different kinds and degrees of dysfunction in individuals, dysfunctions for which they may or may not have precise terms.43 They also have differing expectations with regard to mental disturbances arising in connections with life events, for example, sickness, loss, adolescence, childbirth, menopause, or old age.44 They can assign different roles to the abnormal individual, for example a mentally disturbed person may be seen to be ill, criminal, or dangerous, a prophet, a healer, possessed by demons or a god - or several of these may be combined. Members of society may respond to such individuals in a variety of ways depending upon the role assigned and the kinds of behaviour exhibited; they may exclude, restrain, care for, sanctify, reward, revere, vilify or laugh at them - or again some of these responses may be combined.45. Some research indicates that the way in which a society labels - or does not label - individuals who display aberrant behaviour can affect the frequency, severity, and duration of incidences of mental illnesses within that society and can also influence the rate and likelihood of an individual's recovery from the disorder and reintegration into society.46 Although such a statistical assessment is not possible here, generally perceptible patterns of response to insane and mentally aberrant individuals will be noted and their wider social implications considered. If, for example, an episode of madness has been labeled in Greek society as a case of supernatural possession, does this 40 Kiev 1972, 7. 41 Kiev 1972, 22. 42 Murphy, 1027; Kiev 1972, 1, 7, and ch.2. 43 Murphy 1976, 1024 points to the lack of a word for senility among the Yoruba, yet all were aware “that some old people become incapable of taking care of themselves, talk to themselves, are agitated, wander away and get lost. In such cases they are watched, fed, and protected .... The lack of a specific label seems to make little difference in how they are treated.” 44 Kiev 1972, 20; see quote above, Simon 1868, 31. 45 Murphy 1976, 1025 cites an example of simultaneous compassion, ridicule and rejection in the case of an insane man in Gambia living on an abandoned anthill 500 yards outside the village. The villagers laughed at his odd way of moving, yet put food out for him and annually forcibly bathed him and put new clothes on him. 46 Waxler, Murphy, Kiev, 7, 64.

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mean, as has been shown for other societies, that the individual can then “shed the sick role easily” - in other words be cured?47 Finally, it has been suggested that any culture, partly as a result of its own definition of and treatment of mental abnormalities, and partly as a result of the kinds of stress and conflicts contained within itself, will develop “cultural stress points”, that is vulnerable groups may be discernible within the population, groups whose individual members are perceived to exhibit a higher rate of deviance, maladjustment or mental distress than others.48 The identification of such groups depends upon the availability of sufficient data for defining both them and their symptoms; unfortunately here again such statistical manipulations for ancient societies are impossible. However such a study may partially be approximated by noting categories of people popularly identified in antiquity as prone to mental instability - slaves or pre-pubertal girls are possibilities. Some of these second level questions will probably remain unanswerable, not only because of lack of evidence but because of the other constantly limiting factor in writing ancient history: the inescapable fact that the view from ancient sources is overwhelmingly biased toward the outlook of the elite educated male. In summary, this study addresses the experience and perception of the mentally ill in antiquity, and for that purpose it is the social definition of the various forms of mental deviance which will be its primary focus.49 Although it is recognized that some conditions may have a biological, chemical or even genetic aetiology, and that key symptoms can be isolated that are universally observable in some severe psychoses, it is assumed that socio-cultural elements play a major role in defining and influencing mentally aberrant behaviour. Accordingly, it is considered irrelevant for our purposes to attempt to classify ancient examples of mental illnesses in line with contemporary syndromes and no effort will be made here to assign modern diagnoses to them.

47 Waxler, 1974, 379; I am grateful to Mary Blundell for suggesting the possibility that primarily those individuals who exhibited brief and intermittent delusional periods were the ones singled out and labelled as supernaturally possessed. This is entirely possible, just as it is possible, as Vaughan has suggested, that only those disturbed individuals whose demeanour and bearing “seemed filled with a kind of inspired madness” were the ones regarded as sacred and prophetic (1919, 30). 48 Kiev xi. 49 An exception is the case of mental retardation, although this condition too admits of gradations. Evidence for cases of mental retardation in antiquity is exiguous in the extreme. See discussion below, ch. 5.

CHAPTER TWO Review of Previous Work Although an interest in madness in the ancient world is hardly new, this dissertation approaches the material from a somewhat different perspective and, it must be reiterated, is designed primarily to complement work already undertaken by others. In order to assess its contribution therefore, a brief review of the major currents in the field will be useful. A. Early works By the mid-nineteenth and early twentieth century several studies specifically concerning insanity in antiquity had appeared, each of them approaching the subject with a different emphasis: medical-historical, religious or mythological, philosophical or literary, and sociological. Five significant early works collectively inaugurated major streams of research that others were to follow and develop.50 I.H. Thomée's medical-historical approach surveyed a wide body of classical literature to demonstrate his belief that because madness was a common literary theme, insanity was widely prevalent in Greek society. He included general observations of some of the kinds of and treatments for insanity recognized by Greek medical and philosophical writers and brief discussion of Greek (Platonic) legislation, concluding that care of the insane was of no real social concern for the Greeks. Naive, and criticized for its superficiality and incoherence, Thomée's work nonetheless opened doors for future medical and social historians.51

D.R. Semelaigne, anthropologist and medical director to the asylum of Saint-James (Neuilly), published in more organized detail an account of ancient medical categories of mental illness and methods of treatment by period: Hippocratic, Alexandrian (Erasistratus and Herophilus) and Greco-Roman (Asclepiades, Celsus, Aretaeus, Caelius Aurelianus and Galen). His final chapter outlined aspects of Roman legislation pertaining to the insane; Greek legislation was assumed by the author to have been the basis for and therefore similar to Roman (216). Greek, and especially Christian, conceptions of daemonic possession and its treatment were the subjects of the 1909 dissertation of J. Tambornino. The lengthy first chapter consisted in a substantial and valuable collection of testimonia which form the basis of the subsequent discussion. Of particular interest is Tambornino's attempt in his depiction of the possessed to classify the kinds of persons popularly referred to as mad: 1) epileptics; 2) those undergoing illnesses involving feverish delirium; 3)those under the influence of Pan; 4) participants in orgiastic

50 I.H. Thomée, Historia Insanorum apud Graecos (Bonn: 1830); D. R. Semelaigne, Études historiques sur l'aliénation mentale dans l'antiquité (Paris: 1869); Julius Tambornino, De Antiquorum Daemonismo (Giessen: 1909); Agnes Carr Vaughan, Madness in Greek Thought and Custom. (Baltimore:1919); Ainsworth O'Brien-Moore, Madness in Ancient Literature (Weimar: 1924). 51 Vaughan 1919, 10-13.

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religious celebrations such as the rites of Dionysus or the Great Mother; 5) Prophets; 6) Poets; and 7) any other individuals noticeably deviant in their behaviour.52. This last loosely defined category is the one to which the current study is designed to give some substance. Detailed discussion and criticism of the works of Thomée, Semelaigne and Tambornino constituted the first chapter of the earliest attempt at a sociological approach to madness in Greek society. A.C. Vaughan's focus was upon “the popular conception of insanity and the popular methods of dealing with it as shown in the general literature of ancient Greece” (17). Citing parallel customs in modern folklore, Vaughan collected evidence from a wide range of sources, including some from vase painting, for popular beliefs about causes of madness and religious beliefs concerning madmen as sacred and possibly as sacrificial beings. She discussed the treatment of the insane by society at large (placation of the gods, purification and/or expulsion of the affected individual), surveyed popular beliefs about cures for insanity, and in a final chapter looked at madness and the laws, concluding that the insane were regarded as “waste-material” (74) by the state, that the laws took note of them only to the extent of protecting others from them, and that “the whole question of madness in ancient Greece ...seems to have been dealt with, largely, by popular custom, except in cases where the madman was of positive value, through his connection with religion, or a positive menace to the state through his irresponsibility” (74). Although it is a slim volume, her work provides a cornerstone for subsequent investigations into the societal aspects of insanity in the Greek world. O'Brien-Moore, dismissing historical instances of madness as numerically negligible, wrote the first study of madness which focused on purely literary depictions of mad individuals, examining selected authors from Homer through Seneca. He accompanied a brief discussion of the popular conception of madness (here assumed to be daemonic possession), and of humoral explanations and treatments for madness with a survey of literary references to medical concepts such as black bile and hellebore treatment. Attitudes toward madness in comedy, including some discussion of legal and social aspects of madness, complete a rather cursory background to what was the main focus of his work: “elevated representations of madness in literature of the grand manner”: Homer, Greek and Roman tragedy, Vergil, Quintus Smyrnaeus and Nonnus. Special attention was given to the motif of the Fury, to mantic madness and to Seneca's Hercules Furens.53 B. Later Developments I. Medical History With its beginnings in the work of Thomée and Semelaigne, what might be called the medical history branch of research on insanity emerged strong and persistent. It is characterized by an interest in the history of diagnosis and treatment of madness among proponents of the various ancient medical schools and in identifying and describing specific mental illnesses prevalent in antiquity.54 Some researchers examine ancient diseases within a context of

52 Tambornino 1909,55-62. 53 O'Brien-Moore 1922, 7. 54 For example Heiberg 1927 - a still useful survey of the medical sources; Weinreich 1933.

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modern diagnostic concepts, with retrospective diagnosis, classification, and (to the extent possible) quantification as goals.55 Certain of the more easily definable and defined aberrant mental states have received scholarly attention in greater depth of detail, epilepsy for example, and melancholia, hysteria, and mania.56 Psychological aspects in the works of various medical writers have been examined and specific therapeutic methods in the ancient world have been singled out for attention.57 Some years ago the noted medical historian I.E. Drabkin called for a “modern unified treatment, on a large scale, of the broad field of ancient psychopathology” and set forth a tentative proposal for a “group effort” which would involve biologists, psychologists, and specialists in medicine, magic, religion, law, art and literature.58 The call has not been answered, but many of the issues raised in Drabkins's schedule have been separately addressed. In particular his request for “a preliminary discussion of the problem of mind and mind-body in Greek philosophy and science”, has now been met by J. Pigeaud’s La Maladie de L'Ame. Etude sur les relation de l'âme et du corps dans la tradition médico-philosophique antique.59 Psychoanalytic theory (both Freudian and Jungian) with its emphasis upon dreams and myth, family dynamics and verbal therapeutic techniques, found in classical literature a fertile field.60 George Devereux for example, applied an ethno-psychiatric approach to dreams in Greek tragedy and to characters historical (Sappho) and literary (Euripides' Hippolytus).61 Bennett Simon too, a psychoanalyst interested in the history of psychiatry, in Mind and Madness in Ancient Greece. The Classical Roots of Modern Psychiatry, explores Greek literary, philosophical and medical conceptualizations of the mind and its disturbances.62 Simon constructs three models of mind operative in ancient Greek culture: the poetic, drawn from the Homeric epics and selected dramatic works; the philosophical, here primarily Platonic; and the medical model which he presents in essays on the Hippocratic Corpus, pseudo-

55 Drabkin 1955, Jackson 1969, Gourevitch 1983, Gill 1985, Veith 1957, Flashar 1966, Simon 1978 (and forthcoming), Grmek 1989. General histories with sections relevant to mental illness in classical antiquity include: Zilboorg and Henry 1941, 36-92; Leibbrand and Wettley 1961; Alexander & Selesnick 1966; Moss in Brothwell and Sandison 1967, 709-722; Rosen 1969; Roccatagliata 1973; Ducey and Simon in Howells 1974. 56 Epilepsy: Temkin: 1971; Schneble: 1987. Melancholy: Müri 1953; Klibansky, Saxl and Panofsky 1964; Flashar 1966; Jackson: 1986; Pigeaud: 1984; Toohey: 1990. Hysteria: Veith: 1965; Simon 1978; Trillat: 1986; Rousseau and Porter (forthcoming). Hallucinations: Pigeaud: 1983; Mania: Pigeaud: 1987; 57 Medical writers and psychology: Galen in Veith: 1961; Jackson:1969; Ballester 1974; Manuli and Vegetti 1988; Hippocrates in Simon: 1978, 215-227; Lloyd 1987, 21-37; Aretaeus in Rothkopf 1974. Pigeaud 1981 studies the body-soul relationship in the ancient medico-philosophic tradition. Therapies: Linforth 1946; Jeanmaire 1949; Pivnicki 1969; Laín Entralgo 1970; Meier 1985; Pigeaud 1987; Gill 1985. 58 Drabkin 1955, 223. 59 Pigeaud 1981. 60 See Klein 1975. For a perceptive discussion of recent work in “psycho-history”, and in applying psychoanalytic theories to studies of myth, ancient psychology and therapy, and ancient social psychology, see Lloyd-Jones 1985. 61 Devereux 1976; 1970. 62 Simon 1978.

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Aristotle's remarks on melancholy in Problemata 30, and hysteria as a medical phenomenon and a social issue. 63 “Model” is used by Simon in preference to theory in order to encompass the explicit and implicit assumptions made when a writer talks about mental activity.64 The models are constructed from four points of view: “(1) the representation of mind and of ordinary mental activity, (2) the representation of disturbance of mind, (3) the treatment of disturbance of mind, and (4) the relations between the craft of the practitioner (poet, philosopher, or doctor) and the theories of mind and mental disturbance”; that is epic, tragedy and Platonic philosophy each considered in its therapeutic aspects with respect to the individual and to society.65 Simon's book has been praised for its open and sensitive readings of the sources, but is open to criticism for the serious limitations inherent in its reliance upon a small number of canonical texts.66 The thoughts of daily life, ordinary people (especially women), popular culture and folk-beliefs are elements which a study of this kind tends to leave unexplored, elements which a more eclectic approach such as the current one attempts to restore but may still, because of the lack of records, find elusive. Methodologically too the formulation of discrete models tends to underestimate the enormous degree to which different modes of thinking interpenetrated one another in the ancient world; G.E.R. Lloyd in particular has explicated the very large role played by traditional and popular thought in the medical and life sciences of ancient Greece.67 In a forthcoming study of the history of psychiatry in Greek and Roman antiquity Simon plans to add a fourth model, that of folk-healing and folk-belief, to his previous approach and thus overcome some of its limitations.68 II. Literary Studies In the wake of of O'Brien-Moore, other studies of madness in ancient literature have attempted composite socioliterary depictions by compiling examples from epic, lyric, myth, drama, including some medical references, but with little attempt at analysis.69 Some useful work was begun in the area of terminology, but a more systematic and comprehensive study of the vocabulary of madness is still required.70 Among more recent literary studies of madness in antiquity, J. Mattes’, Der Wahnsinn im griechischen Mythos und in der Dichtung bis zum Drama des

63 Here Simon includes, unusually, group “hysteria”, i.e. Dionysiac ecstatic possession, drawing physical analogies between Bacchantes and women suffering individually from hysterical suffocation. 64 Simon 1978, 47. 65 Simon 1978, 47. 66 Winkler 1981. Criticism of Simon's psychoanalytic approach to Plato, Lloyd-Jones 1985, 157, 160-161. 67 Lloyd, 1979, see esp. p.49; 1983,1, 204-217; 1987 esp. ch.1; Padel 1992, esp. ch.3 . Rosen 1969, 93 suggests the process was reversed too and that medical thinking and terminology trickled down into popular discourse. 68 Bennett Simon, Preface to forthcoming book (personal correspondence, December 27, 1990). 69 For example Heiberg 1927; Köhm 1927/28. 70 Jones 1923, lix-lx; Rénier 1956; Paschall 1966; Mattes 1970, 100-113; Padel 1992, passim. Appendix 1 of this dissertation provides a comprehensive list of words associated with mental aberration.

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fünften Jahrhunderts, is a comprehensive analysis, including a useful tabular summary, of all the Greek mythological and dramatic stories in which madness plays a significant role.71 The second chapter of Lillian Feder’s Madness in Literature, examines ancient prototypes of madness which prefigure themes recurring in later western literature: Dionysiac frenzy in the Bacchae (sparagmos and omophagia), the prophetic madness of Cassandra, the Erinyes and Orestes, and Sophocles' Ajax - which Feder calls “the first literary work in which madness is treated as essentially individual, a personal alienation from accepted social and political conduct”.72. In view of the fact that the material from primary sources emphasized in this dissertation is historically descriptive rather than literary, Feder's monitory remarks about the portrayal of insanity in literature are worth noting: The madman of literature is, to some extent, modelled on the actual one, but his differences from such a model are at least as important as are his resemblances to it: he is rooted in a mythical or literary tradition in which distortion is a generally accepted mode of expression; furthermore, the inherent aesthetic order by which his existence is limited also gives his madness intrinsic value and meaning. A mad literary character must thus be approached on his own terms .... .73 III. Socio-Literary Approaches Ruth Padel's work, which centers around madness in fifth century Athenian tragedy, includes first, a discussion of how tragic depictions of madness offered the audience “a way of reflecting on aspects of their own psychology”.74 Padel sees the dramatic metaphor of madness as a crystallization of two common concerns underlying tragic theatre: double determinism, which locates causality both inside and outside the person, and the essentially fragile nature of human life, body, and soul.75 Most recently Padel's In and Out of the Mind. Greek Images of the Tragic Self is a subtle exploration of the mentalité of fifth-century Athenians and of Athenian tragedy particularly as it revolved around “representations of consciousness and divinity”.76 Resonances from bio-medical discourse and daemonological modes of thinking enrich her analyses of the human psyche as it emerges in tragedy. Padel constructs a polarized mind-world in which all that is associated with the inner - bodily interiors, disease, darkness, blood and divination, our emotions, sleep, dreaming, death, and above all madness - is “other”, and is distinguished 71 Mattes 1970. Mattes also includes a discussion of the vocabulary of madness with particular emphasis on metaphorical and poetic expressions. 72 Feder 1980, 90. Unacccountably Heracles is omitted from her discussion. 73 Feder, 1980, 9. 74 Padel 1981, 105. 75 Double determinism: Padel 1981, 105, citing Dodds 1951, ch. 1 and Lloyd-Jones 1971, 10. Fragility: Padel 1981, 118. 76 Padel 1992, ix.

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from a world directed outward, a world of clarity and light, rationality, sanity - and maleness. In this schema the human mind is gendered and Greek tragedy, reflecting an exclusively male Athenian outlook, is portraying in its mad individuals a state of intense inner violence essentially female and '“other” in form and source.77 Padel's poetic insights into the language of the mind and emotions are illuminating and she insists that “tragedy does reflect important patterns in the imaginative world of its audience”; that is in some way the madness and the responses to madness seen on stage holds significance for the audience, but the nature of this signification remains complex and diffuse.78 It will be interesting to note whether Padel’s observations on the gendering of the disturbed human mind are reflected to any degree in the ways people viewed and talked about mentally disturbed individuals in everyday life. Were women more than men thought to be prone to mental illnesses? Were men afflicted with mental disorders considered in some way ‘womanish’ or weak? IV. Religion and Magic Padel's analysis here, and a previous study of women as models for daemonic possession in fifth century Athenian thought, contribute innovatively to a large and diverse body of works concerning connections between the Greek perceptions of madness and Greek ideas about the divine, the magical, the daemonic and the irrational.79 Of these the most influential has been E.R. Dodds’, The Greeks and the Irrational, in which the four Platonic types of divine madness (prophetic, telestic, poetic and erotic), are discussed in their social context, and in particular two more positive, socially institutionalized manifestations of mental aberration, ecstatic prophecy and maenadism.80 Although by the fifth century writers were distinguishing between natural and supernatural causes for madness, in popular thought, according to Dodds, the insane were not only feared but “also regarded ... with a respect amounting to awe; for they were in contact with the supernatural world, and could on occasion display powers denied to common men.”81 “Popular thought”, however, is not easily discernible; it undoubtedly did (and in places still does) include a large component of religious and daemonic causal explanations. But it is unlikely that supernatural explanations exhausted the array of responses available to individuals in antiquity. The purpose of this dissertation is to clarify what else people thought or actually did when confronted with mental illness in their lives. V. Legal Studies

77 Padel 1992, 162. 78 Padel 1992, 170, see also 6-7. 79 Padel 1983; Tambornino 1909; J. Rohde [1903] 1925; Edelstein 1937; Linforth:1946; Jeanmaire 1949; Dodds 1951; Pieper 1964; Linforth 1971; Devereux 1976; see also Parker 1983, esp. ch. 7. 80 Pl. Phdr. 244A; Dodds 1951, 64-101; 270-282. 81 Dodds 1951, 65,66; quote 68.

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Apart from the chapter in Semelaigne, the only detailed study of aspects of insanity and the law in antiquity is that of Roman law by O. Diliberto, Studi sulle origini dell cura furiosi.82 This work is comprehensive and still very useful. In A.C. Vaughan's 1919 study of madness in popular thought and custom, one chapter deals with the very small amount of Greek legal evidence available and this material was reviewed again by George Rosen in 1968 in conjunction with a brief survey of Roman legal practices and the insane. This rather slight body of works will soon enjoy the welcome addition of a forthcoming dissertation by Peter King, U. of N. Carolina, Chapel Hill , entitled The Definition and Status of the Insane in Roman Society.. VI. Socio-Historical Approaches After Vaughan's pioneering study of popular attitudes to insanity, no systematic sociological approach emerged again until the work of George Rosen in 1968.83 His chapter on Greece and Rome in Madness in Society. Chapters in the Historical Sociology of Mental Illness builds upon several topics introduced by Vaughan, adding additional case histories, some in considerable detail. Rosen addresses the same central questions as Vaughan under the headings, “What is Madness? Who is Mad?” and “Whose Responsibility is the Madman?”84 He notes the wide use of the basic terms μανία, μαίνεσθαι and insania, and discusses briefly some additional vocabulary for various states of mental aberration: κακοδαίμων, μελαγχολᾶν, and νθμφόληπτος.85 Madness admits of degrees, and definitions are slippery; Rosen offers examples of delusion, excessive and senseless cruelty, violence against fellow citizens and paranoid persecution as typifying behaviour called mad because its “orientation to reality [was] considered excessively divergent from socially accepted norms”.86 In addition to the reality criterion Rosen suggests others that were operative: proneness to violence and a propensity to “wander about”.87 Rosen also discusses borderline states, “individuals whose behaviour is not as extremely aberrant as that of the insane.”88 His interest here is in the psychologically impaired individual's ability to function in society and in the cultural systems which may have fostered this. He cites as an example the physician Menekrates Zeus, who called himself divine and surrounded himself with a circle of followers all of whom seem to have participated in what Rosen terms “a shared psychopathology”.89 A group such as this appears to have been identified as somewhat abnormal, but was largely socially tolerated. Again, the sophist Aelius Aristides' career is examined at length as an example of another

82 Diliberto 1984. Two articles appear relevant, but have been unobtainable by me to date: 1) E. Rénier, “Observations sur la terminologie de l'aliénation mentale”. Revue internationale des droits de l'antiquité 3 (1950): 429-455; and 2) E. Nardi, Squilibrio e deficienza mentale in diritto romano. Milan:1983. 83 Rosen 1968 and 1969. 84 Rosen 1969,90-101 and 121-136. 85 Rosen 1969, 90-93. 86 Rosen 1969, 97. 87 Rosen 1969, 98. 88 Rosen 1969, 101. 89 Rosen 1969, 109.

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individual whose mental and emotional impairments were alleviated in part by participation in a therapeutic religious community. Rosen's wide-ranging overview and his emphasis on the social context of mental illness are both perceptive and compelling. But his discussion also highlights important areas which require further exploration and definition. In particular a broader survey of the different varieties of abnormal mental states recognized in antiquity needs to be carried out, starting with a more detailed exploration and delineation of the vocabulary used by both lay and medical people to refer to these. In addition, the array of responses by individuals and society at large to people exhibiting these disturbed states merits far more detailed examination, and to achieve each of these goals a strongly empirical approach is required. More specific information is needed about the degrees and kinds of mental incapacity people recognized, the behavioural cues they reacted to, what their responses in each specific case were, and the variety of contexts in which the vocabulary of madness was evoked. For example, with regard to popular expectation, does it seem that certain groups, categorized by age, class or gender, were thought to be particularly susceptible or resistant to mental instability? What were people's expectations about susceptibility, permanence or recovery and about the afflicted individual's subsequent participation in society? What was the range of causes generally thought to be operative in mental diseases? Or again, since Rosen cites some evidence for a compassionate attitude toward the mentally disordered, what specific forms of compassionate care can be demonstrated - and what other kinds of treatment and handling should also be considered?90 Rosen's summary assessment that “the problem of madness was handled primarily on the basis of custom”, rings profoundly true.91 But closer examination of the custom, indeed customs, concerned is now desirable. C. Summary Remarks To work toward answers to these and other questions this study proposes to expand the limits of the kinds of evidence customarily examined. It will emphasize primarily discussion of historical situations in which people were described as in some way mentally aberrant, using both historical narrative and medical sources. But it will include also material from literary descriptions of madness, from epigraphic, legal and archaeological sources, and, at times, from proverbs, aphorisms, jokes, oratory and philosophy - in short whatever may illuminate our understanding of how people thought about, treated and experienced mental illness.92 We have noted above that, as a preliminary, a clear necessity requires us to expand the vocabulary of madness to include a wider variety of terms and phrases which suggest some degree of mental abnormality or impairment - words and phrases such as ἄφρενος, δύσθυμος, 90 Rosen 1969, 89-90; Gill 1985 and 1992 has some useful observations on the element of compassion in psychotherapeutic approaches in antiquity. 91 Rosen 1969, 136; cf. Vaughan, 74. 92 Although literary descriptions of madness do not form the bulk of this study, they are useful to confirm or contrast with historical examples. It is assumed that the insane on stage, for example, would have exhibited some behaviours readily identifiable as such by the audience. A similar assumption applies in dealing with the possibility that insanity was, at times, a literary motif or topos in ancient historical and biographical writings. It is assumed that a core of conventional plausibility was present for the reader in the incidents described.

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ἐκστατικὸς τῶν λογισμῶν /τοῦ νοῦ, ἔκφρων, ὐπομαργότερος, φρενοβλαβής (and many more) must be included.93 It is hoped that the resultant increased body of material, particularly when it is compared with the additional descriptive material gathered from the legal and medical realms, may then allow informed speculation about further social questions. This brings the current study into the category of sociological or perhaps more accurately socio-historical approaches to insanity in antiquity. Broadly speaking this type of study is one which considers the social context of mental illness to be of primary interest; it is concerned with social labelling, with beliefs about, attitudes and responses to, and provisions for the mentally ill and also with the social factors which play a role in determining these. Where the evidence allows, a socio-historical study can include demographic considerations such as incidence of illness and recovery, or analyses of perceived vulnerable groups by age, class, and gender. For antiquity, unfortunately limitations of evidence preclude this level of analysis. But although hard, statistically significant evidence is beyond the reach of the social historian of ancient cultures, nevertheless it is anticipated that some suitably cautious observations may be made about the place of mentally disturbed people in antiquity. The chapters that follow are heavily, but necessarily, descriptive in order to provide the detailed body of evidence required for an understanding of the perceptions and experiences of mentally aberrant individuals in Greek society. In the first section of this study, narrative historical material is examined; specific cases of madness are described and popular ideas about mental aberration, its manifestations and causes are identified. But the various ways in which mentally disturbed individuals were treated and managed are also explored - and here some discussion of the insane and the law is included. In the second section, anecdotal material from specific cases described in the medical sources is examined, and, in addition, general medical observations about identifying symptoms, causes and treatment of mentally disturbed individuals. The final chapter compares the bodies of material presented in the foregoing sections and suggests some general conclusions to be drawn about the ways in which insane and mentally disordered individuals were perceived in antiquity and the kinds of experiences they could expect to undergo.

93 See Appendix 1, “The Vocabulary of Abnormal Mental States”.

PART TWO: EVIDENCE FROM HISTORICAL NARRATIVE CHAPTER THREE Descriptive Cases This chapter is designed to show how “madness” (or a term equivalent) is invoked when Greek prose writers describe certain kinds of odd or irrational behaviour. The evidence is drawn from a broad chronological range of sources, from works of the early classical period to Greek literature of the Roman Empire. These writers envisage different kinds of mad states and, without imposing a modern classificatory system upon them, it is possible to make some useful basic distinctions. As a preliminary we can say that some of the states described involve individuals, others groups; some states seem to have been permanent, others temporary or episodic. The first chapter of this section presents descriptive examples roughly grouped according to these four categories of mental aberration: solitary states, both temporary and permanent, and instances of group madness, permanent and temporary.94 It concludes with an analysis of recurring elements common to the examples presented. This body of evidence will be supplemented in the subsequent chapters with further material from primary sources. Chapter four outlines key physical and behavioural manifestations thought to signal madness in its broad sense and chapter five discusses the various causes of mental aberration as they were popularly perceived. Chapter six presents popular methods of curing and managing the care of those afflicted, and concludes with a consideration of attitudes toward the mentally ill, both private and public, and a discussion of relevant legal issues. A. The Single Figure

I. Permanent states - here defined as states for which no cure or spontaneous recovery is noted. Examples of solitary madness clearly so labelled by contemporaries and passed down in traditional accounts occur early in Greek literature. If we exclude Homeric and mythological stories of madness - even those that form the stuff of tragedy - a good beginning can be made where myth first merges into historic prose narrative, with “the father of history”. According to Herodotus there were two notable people in historical times who were quite definitely mad.95 Herodotus, incidentally, is fully prepared to take into account cultural relativism in matters of everyday behaviour, but the behaviour of these individuals was not merely inexplicable and unusual, it was also designated insane by their own peers.96

94 This mode of categorization is arbitrary; inevitably some examples will overlap or be difficult to place because of lack of information. 95 On Herodotus as medical diagnostician see Dawson 1986, for insanity esp. 94-96. 96 Other cultures, other customs see Herod. 3.38.

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Herodotus describes the madness of King Cambyses (HN2) and the progress of his disease over time in some detail.97 The king's incipient mad condition is signalled early on in the account by the fact that he sets off in fury to attack Ethiopia with no consideration for the length of the journey and without ordering supplies for his troops, but οἷα δὲ ἐµµανής τε ἐὼν καὶ οὐ φρενήρης.98 While his troops starved and died Cambyses paid no attention but pressed on until some of them upon reaching the desert, resorted to formalized cannibalism. At this point Cambyses, δείσας τὴν ἀλληλοφαγίην, and with significantly fewer troops, decided to turn back. His return to Memphis, however, happened to coincide with an Egyptian festival celebrating the appearance among the populace of the god Apis, an event which Cambyses became convinced was really a celebration of his own defeat. Accordingly he first had the “lying” officials and priests executed and then, drawing his dagger attacked the Apis calf itself as though half-mad, οἷα ἐὼν ὑπομαργότερος. This, according to Herodotus, was the turning point for Cambyses; and his subsequent conspicuous insanity was explicable in a variety of ways. For the Egyptians, he went mad as a direct result of his crime against the god, but for Herodotus himself Cambyses' madness was clearly progressive and the seeds of it were apparent in the king's earlier actions: Καμβύσης δέ, ὡς λέγουσι Αἰγύπτιοι, αὐτίκα διὰ τοῦτο τὸ ἀδίκημα ἐμάνη, ἐὼν οὐδὲ πρότερον φρενήρης.99 Herodotus then lists Cambyses' subsequent outrageous acts as further proof of his insanity.100 First, those toward members of his own family, which included the murder of his brother because of a disturbing dream, and then of his sister, who was also his wife. For Cambyses, ingeniously circumventing Persian law and custom, had contrived to marry two of his sisters, and it was the second and younger one who was pregnant and whom, according to one account, he kicked in a rage causing her to miscarry and die. The double family murders were seen by Herodotus (and possibly his sources too) as something more than the tragic results of a violent quarrel or acts of pure power politics - deaths of that kind would have been comprehensible, if reprehensible. But for Herodotus, whether the ultimate explanation was the attack on Apis, the effects of life-long epilepsy on Cambyses' mind, or some other cause altogether, these two acts were clearly the acts of a madman, ταῦτα μὲν ἐς τοὺς οἰκηιοτάτους ὁ Καμβύσης ἐξεμάνη.101 Further evidence of madness is adduced from Cambyses' actions toward other Persians whom he is said to have treated with lunatic savagery (ἐξεμάνη).102 Increasingly sensitive to criticism, Cambyses on one occasion chose to interpret an opinion about himself which he had extracted from his cupbearer, Prexaspes, that “the Persians praised him highly but thought him too fond of wine,” as really meaning “the Persians say excessive drinking has driven me 97 Herod. 3.25-3.38; 3.61-3.66. 98 Herod. 3.25.2, “He lost his wits completely, and, like the madman he was ....” (Trans. de Sélincourt). 99 Herod. 3.30.1, “Even before this Cambyses had been far from sound in his mind; but the Egyptians are convinced that the complete loss of his reason was the direct result of this crime.” (Trans. de Sélincourt). 100 Cambyses' outrages on his kin: Herod. 3.30-3.33. On Herodotus’ misperceptions about Persian marriage customs see Hall 1989, 190. 101 Herod. 3.33.1, “These two crimes were committed against his own kin; both were the acts of a madman ....” (Trans. de Sélincourt). 102 Cambyses' outrages on other Persians : Herod. 3.34-3.38.1.

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mad!” Νῦν ἄρα µέ φασι Πέρσαι οἴνῳ προσκείµενον παραφρονέειν καὶ οὐκ εἶναι νοήµονα.103 And so to prove his sanity Cambyses insisted on a bizarre wager with the hapless cupbearer: if Cambyses could shoot Prexaspes' son through the heart he would have proved himself sane and the Persians crazy (παραφρονέουσι); if he missed, the Persians would be sane and he himself devoid of wits (μὴ σωφρονεέιν). Needless to say Cambyses hit the target, the boy died, and the terrified father, realizing that Cambyses' mind was unbalanced, ὀρῶντα ἄνδρα οὐ φρενήρεα, complimented him on his marksmanship.104 Other evidence of insanity to be found in Cambyses' public behaviour includes: arresting twelve Persian nobles on trifling charges and burying them alive head downward, breaking into ancient tombs at Memphis to examine bodies, breaking into sacred temples to ridicule and jeer at the images of the Gods, and ultimately to violate them. Herodotus concludes definitively: πανταχῇ ὦν μοι δῆλά ἐστι ὅτι ἐμάνη μεγάλως ὁ Καμβύσης.105 In a second clear case of insanity Herodotus gives an account of the strange behaviour of King Cleomenes of Sparta (HN3).106 Here again he implies that the descent into madness which Cleomenes experienced on his return to Sparta was not unexpected: κατελθόντα δὲ [αὐτὸν] αὐτίκα ὑπέλαβε μανίη νοῦσος, ἐόντα καὶ πρότερον ὑπομαργότερον.107 From this incipient state (whatever it may have consisted in - Herodotus does not specify), Cleomenes suddenly became violent, and because he began to go up to citizens on the street and strike them with his sceptre, his relatives restrained him in stocks as a madman (παραφρονήσαντα).108 Whereupon, having procured a knife by guile, he slowly and methodically hacked himself to death, progressing from the feet up. Again, the cause of the madness is unclear, but Herodotus reports theories held variously by the Argives, the Athenians and “most other Greeks”, each one of which related to divine retribution for some treacherous and sacrilegious offence committed by the king. The Spartans however, had their own version: ἐκ δαιμονίου μὲν οὐδενὸς μανῆναι Κλεομένεα, Σκύθῃσι δὲ ὁμιλήσαντά μιν ἀκρητοπότην γενέσθαι καὶ ἐκ τούτου μανῆναι.109 But Herodotus himself comes down on the side of divine vengeance (τίσις) which, he thinks, visited madness on Cleomenes because he had subverted the Pythia in a plot against his co-regent Demaratos.110 103 Herod. 3.34.3. 104 Herod. 3.35. 105 Behaviour: Herod. 3.36-3.37; Verdict: 3.38.1. According to Herodotus' account of Cambyses' death (3.64), the king, shortly before his prophesied end was brought back to some level of sanity by the double shock of the revolt of the Magi and a fatal wound incurred by a fall from his horse, ἐκπεπληγμένος ... ἐσωφρόνησε. Yet although his madness was not literally permanent, it was life-long and is included here with other similar cases. 106 Herod. 6.75-6.84; cf. also Plut. Mor. 223 B; Ael.VH 2.41; Athen. Deip. 427c. 107 Hist. 6.75.1; cf also 5.42 of the young Cleomenes, who succeeded his father, King Anaxandrides, despite early evidence of mental instability: ὁ μὲν δὴ Κλεομένης, ὡς λέγεται, ἦν τε οὐ φρενήρης ἀκρομανής τε. 108 Herod. 6.75.2, ἔδησαν οἱ προσήκοντες ἐν ξύλῳ. 109 Herod. 6.84.1. 110 Herod. 6.84.3. For the story of Demaratos and Cleomenes: Herod. 6.61-6.67.

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These two accounts of mad kings have a somewhat legendary quality to them, but it is important to note that they are legends concerning insanity. Other kings, larger than life, may do things equally memorable, cruel, even unGreek. Xerxes, for example, in a rage lashed and branded the Hellespont, or at another time cut the son of Pythias in two and marched his army between the halves. Darius with macabre word play slit the throats of the sons of his friend Oeobazos . And the Persian custom of burying people alive as a propitiatory sacrifice is handled elsewhere in the objective manner of Herodotus the anthropologist. Nowhere in the reports of any of these cases is the vocabulary of madness used.111 Cambyses and Cleomenes, according to Herodotus and the tradition he was writing from, became, quite simply, mad. Why did they receive this appellation? Elements of irrationality, excessive rage,? Unpredictable behaviour? Attacks on family, fellow citizens, one's self or the gods? None of these in itself is sufficient to draw the charge of madness. We may hypothesize that it is only when several or all of these factors occur in combination, in some kind of critical mass, that the boundaries between sane and insane or between halfmad and completely mad are explicitly crossed. But to sketch these boundaries and their surrounding territory even lightly it is necessary to sift through many more accounts of madness and mental aberration; some are dramatic or involve famous men, others concern anonymous individuals and have a more prosaic, everyday colouring. In addition to the two kings, Herodotus mentions Charileos (HN4), a brother of the despot Maiandrios, who was called insane (ὑπομαργότερος) and kept bound in a dungeon, for some apparent but unnamed offence.112 His mad behaviour, however, may have been considered to be somewhat episodic, or at the least malleable, since Maiandrios (albeit as a last resort) was persuaded by Charileos to release him to lead a defensive force of Samians against the Persian invaders. The despot recognized that the madman could be sacrificed; and better yet, his crafty guile and violently aggressive qualities could be useful. King Cotys of Thrace (HN5) and Dionysios, Tyrant of Syracuse (HN6) provide further notorious examples of powerful historical figures prone to acts of madness.113 Among the more memorable excesses of King Cotys was an occasion upon which he held a banquet to celebrate his alleged marriage with Athena. Drunk to the point of madness (ἔκφρων γενόμενος) he sent one of his bodyguards to see if Athena had yet arrived. On his return with a negative report Cotys shot him dead, then repeated the performance with a second servant. Finally a third messenger returned to report (more wisely) that Athena had arrived some time ago and was awaiting the King - this man, it seems, survived. To this anecdote Athenaeus has appended a second, briefer one which serves to confirm King

111 Xerxes: Hist. 7.35 and 7.39; Darius: 4.84; burying alive: 7.114. Only much later in the tradition does Plutarch (Mor. 342E.8) remark on Xerxes “mad” (μανικά) act of branding the Hellespont. 112 Herod. 3.145-146. 113 And, much later, the Roman Emperor Gaius Caligula, cf. Suet. Cal. 50.2-3.

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Cotys' madness: he reports that the king in a fit of jealousy (ζηλοτυπήσας) cut up his own wife, beginning with the genitals.114 If King Cotys was unstable with respect to his wives, the tyrant Dionysios I of Syracuse seems to have been particularly vulnerable when it came to his tragic poetry. Indeed, when he thought it was being received badly he became melancholic (that he was plunged into madness (μανιώδης διάθεσις κατέσχε τὴν ψυχὴν αὐτοῦ). Growing jealous and suspicious of his friends, he exiled some and killed others in an insane rage (λύττης καὶ παρακοπῆς).115 Some plunges into insanity were orchestrated by others. The elder son of Aratus (HN7), it is said, was given poisons by Philip V which did not kill but crazed (οὐ θανασίμοις, ἀλλὰ, μανικοῖς ἐξέστησε τοῦ λογισμοῦ φαρμάκοις).116 The effects are rather vaguely summarized by Plutarch: the boy turned to “strange and dreadful impulses under which he grasped at absurd activities and experiences not only shameful but destructive”. His death, which came “in the flower of his young manhood” is described not as a calamity but an ἀπόλυσις κακῶν καὶ σωτηρία. Another young man who underwent a similar sort of fate was Arrhidaius (HN8), the son of Philip II of Macedonia and Philinna of Larissa, a woman ἄδοξος καὶ κοινή.117 As a boy he was said to have shown a gifted and noble disposition, (χάριεν ἦθος καὶ οὐκ ἀγεννές) but as he grew up Olympias gave him drugs which injured his body and ruined his mind (διαφθαρῆναι τὴν διάνοιαν). As a result he became mentally deficient (ἀτελῆς ... τὸ φρονεῖν ὤν). The purposeful damaging of a mind by charms or potions admitted of a variety of degrees, some less drastic than the case of Arrhidaius. One could simply make a person behave very foolishly - perhaps to the point of craziness - as did Aretaphila who, to free her city and avenge herself on a cruel husband, the despot Nikokrates, used charms and potions on his brother Leander (HN9) in order to upset his reason (διαφθεῖραι ... τὸν λογισμόν).118 She then persuaded him to murder Nikokrates and take his place. Unfortunately for Aretaphila's plans - or perhaps because of her methods - Leander too began to rule in a crazy and foolish way (ἐμπλήκτως καὶ ἀνοήτως). As his behaviour became more and more like that of his brother, further plots had to be evolved to get rid of him in turn. The great general Lucullus (HN10) is reported to have lost his mind in old age: λέγεται νοσῆσαι τὴν διάνοιαν αὐτῷ κατὰ μικρὸν ἀπομαραινομένην.119 He had entrusted himself to the care and nursing of one of his freedmen, Callisthenes, and, according to one account, his mind was disabled neither by old age nor disease but by this 114 Athen. Deip. 12.531f - 532a. 115 DS. 15.7; but see textual note ad loc., Schäfer: λύπης. 116 Plut. Arat. 54. 117 Plut. Alex. 77. 118 Plut. Mor. 256.E - F. 119 Plut. Luc. 43, citing Nepos (not extant); cf. Plut. Mor. 792.B-C.

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freedman, who drugged him with potions in order to win more of his affections. The drugs however, “drove him from his senses and overwhelmed his reason” (ἐκστῆσαι δὲ καὶ κατακλύσαι τὸν λογισμὸν) until Lucullus' brother Marcus, realized what was going on, drove Callisthenes away and himself took over the care of Lucullus, managing his property and tending him like a child (ἐπαιδαγώγει). Pausanias records a number of instances of madness with a legendary quality. In the first (HN11), two young men of ancient lineage, Astrabacus and Alopecus, sons of Irbus, son of Amphisthenes, son of Amphicles, son of Agis immediately went mad (αὐτίκα παρεφρόνησαν) when they discovered a wooden statue of the goddess Artemis. The statue, called Artemis Orthia, was reputedly stolen by Iphigenia and Orestes from the Tauric lands and brought back to Laconia.when Orestes was king; the madness is adduced as proof that the Laconian statue is the true one.120 Two other stories of madness in Pausanias concern Olympic athletes. In one, Timanthes of Cleonae (HN12), winner of the pancratium for men, upon retiring from athletics continued to test his strength every day by drawing his great bow. This practice was interrupted for a period while he was away from home and upon his return he found himself no longer able to bend the bow. Consequently he lit a fire and threw himself alive onto it. Pausanias comments: ὁπόσα δὲ ἤδη τοιαῦτα ἐγένετο ἐν ἀνθρώποις ἢ καὶ ὕστερόν ποτε ἔσται, μανία μᾶλλον ἢ ἀνδρία νομίζοιτο ἂν κατά γε ἐμὴν γνώμην.121 The second athlete, Cleomedes of Astypalaea (HN13), killed Iccus of Epidaurus during a boxing-match and was denied the prize because the umpires convicted him of foul play. Cleomedes went mad with grief (ἀφῃρημένος τὴν νίκην ἔκφρων ἐγένετο ὑπὸ τῆς λύπης). Returning to Astypalaea he attacked a school holding approximately sixty children and pulled down the pillar which supported the roof. The citizens pelted him with stones until he took refuge by hiding in a chest in the sanctuary of Athena.122 II. Temporary or recurrent states Categories such as episodic, discrete or recurrent, are liable to shades of interpretation. Here we include accounts of those states specified in the sources as episodic, intervening in an otherwise sane mode of life, or as temporary and cured. Refreshingly there are a few stories about people who were neither legendary leaders nor of royal blood. One ordinary Athenian citizen of the fourth century, Thrasyllos (HN14), son of Pythodoros of the deme Aexone, fell into “a strange, new kind of madness” (παράδοξον καὶ καινὴν ἐνόσησε μανίαν).123 Leaving his home in the city, Thrasyllos went to live in the Piraeus, seized by the belief that all the ships putting in to harbour belonged to him. He registered them in his accounts, managed them, despatched them, welcomed their returns with joy, but showed 120 Paus. 3.16.9. 121 Paus. 6.8.4. 122 Paus. 6.9.6-8 cf. Plut. Rom. 28.4-6; The story goes on to tell of his mysterious disappearance from within the chest and the Delphic pronouncement that he was to become the last of the heroes. See Knox 1964, 56-57. 123 Ael. VH 4.25. The anecdote, attributed to Heraclides of Pontus, is repeated in Athen. Deip. 12.554e-f, where the madness is said to be the result of luxurious living.

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no interest or distress if they became lost at sea. This agreeably fantastic life came to an end when Thrasyllos' brother Crito returned from Sicily, seized his deluded relative and handed him over to a physician who successfully cured him of his madness - somewhat to Thrasyllos' regret. ἐμέμνητο δὲ πολλάκις τῆς ἐν μανία διατριβῆς καὶ ἔλεγε μηδέποτε ἡσθῆναι τοσοῦτον ὅσσον τότε ἥδετο ἐπὶ ταῖς μηδὲν αὐτῷ προσηκούσαις ναυσὶν ἀποσωζομέναις.124 A similar story occurs in the Pseudo-Aristotelian Θαυμάσια Ἀκούσματα in which a man of Abydos (HN15), out of his mind (παρακόψας τῇ διανοίᾳ) used to go to the empty theatre and watch as though there were performers, applauding them and approving the play. He too upon regaining sanity (ὡς κατέστη τῆς παρακοπῆς) mourned the loss of his happy fantasy world. In Horace's version of the same story he stresses that in all other respects the man was sane.125 A brief anecdote, again in the Θαυμάσια, describes another kind of discrete or episodic madness. It concerns a wine merchant (HN16) who by day carried on his trade quite normally but by night went mad (μαίνεσθαι). Remarkably, he kept the key to his business on his belt throughout and despite many attempts on it by thieves while he was deranged, never lost it.126 A bout of extreme raving madness could be visited temporarily upon an ordinary person, often it seems as the outcome of drugs or potions. The effect might be purposeful, as we have seen above in the cases of Arrhidaius and the son of Aratus, or unintended and accidental as in the case of Leander. Accidentally induced madness appears to have been a peculiar property of aphrodisiacs.127 One vivid literary picture of such a case occurs in Achilles Tatius Τὰ κατὰ Λευκίππην καὶ Κλειτοφῶντα, when the girl Leukippe (HN17) was secretly given a love philtre in a too concentrated dose.128 Although the source is a romance novel, it is useful for our purposes in that it provides a detailed account of the course of a mental disturbance which must have seemed plausible to the audience of its day. The account begins dramatically; while out walking one day Leukippe suddenly fell to the ground, her eyes rolling. When friends ran up to her in concern with bloodshot eyes (ὕφαιμον βλέπουσα) she struck one in the face and 124 Ael VH 4.25. 125 Ps. Arist. Mir. 832b; Hor. Ep. 2.2,128-140, the same story here told of a nobleman of Argos. fuit haud ignobilis Argis, qui se credebat miros audire tragoedos in vacuo laetus sessor plausorque theatro; cetera qui vitae servaret munia recto more, bonus sane vicinus, amabilis hospes, comis in uxorem, posset qui ignoscere servis et signo laeso non insanire lagoenae, posset qui rupem et puteum vitare patentem. hic ubi cognatorum opibus curisque refectus expulit elleboro morbum bilemque meraco, et redit ad sese: “pol, me occidistis, amici, non servastis,” ait, “cui sic extorta voluptas et demptus per vim mentis gratissimus error.” 126 Ps. Arist. Mir. 832b. 127 For aphrodisiacs see Winkler 1990, 71-98; Faraone 1990, 219-243, madness 243 n.51; and Faraone forthcoming. 128 Ach. Tat. 4.9, 10, 15-17.

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kicked another who was trying to constrain her. Her friends, Kleitophon and Menelaus realizing that she was afflicted with some kind of madness (μανία τις) tried forcibly to restrain her while Leukippe struggled violently -not even “caring to conceal what a woman doesn't want to be seen, οὐδὲν φροντίζουσα κρύπτειν ὅσα γυνὴ μὴ ὁρᾶσθαι θέλει.129 With pity and regret they bound her with ropes and sent for a physician for, it was said, “such seizures were not a permanent disability but were in many cases a normal side effect of youthful exuberance (ἡλικίας ζεούσης): young blood seething in its own strength may boil over the veins and rise inside the head, where by flooding it impedes the circuits of rational thought.130 The doctor prescribed a drug to be dissolved in oil and rubbed on her head to make her sleep - the first stage of the cure. Leukippe slept soundly but when she awoke she was still not cured and again cried out some meaningless words (πάλιν ἄσημα ἐβόα), so the doctor, still at hand, gave her a second, purgative medicine. For ten days there was no improvement in her illness; by day she raved madly but at night gradually seemed to become less disturbed and more sensible, for, muttering in her dreams one night, she gave a clue to the cause of her madness. “It is through you that I have lost my senses Gorgias” - the name of the man who had bribed a servant to administer his love philtre to Leukippe. Mistakenly it was given to her undiluted and caused the madness. The guilty servant was found, paid to prepare an antidote and to drink it along with Leukippe, just to be sure, and in the morning the girl awoke freed from her madness, with no memory of it at all. Even without the intervention of drugs and poisons an otherwise strong, healthy and sane individual might yet be prone to a discrete period of madness of a kind which was though to have mental or emotional pressure as its basis. A clear example of this is the case of Timoleon of Corinth (HN18), who was afflicted with a long period of mental disturbance but eventually recovered.131 This wise and just general had a headstrong (possibly even mentally unbalanced) brother (ἔμπληκτον καὶ διεφθαρμενὸν ἔρωτι μοναρχίας) who declared himself tyrant of Corinth and whom Timoleon repeatedly tried to dissuade form this “mad”, unfortunate ambition (τὴν μανίαν καὶ δυστυχίαν ἐπιθυμίας ἐκείνης). Meeting with no success Timoleon plotted with a kinsman and a friend to save Corinth from despotism and, according to one account, stood by weeping, yet acquiescent while they drew swords and killed his brother. For this act, whether it was an offense committed by omission or commission (accounts vary), Timoleon was to pay with a twenty-year period of mental derangement (συνταραχθεὶς τὴν διάνοιαν).132 Having put love of country above love of family, Timoleon now found that many of his undemocratically inclined fellow-citizens abused him as the perpetrator of an impious and abominable deed. On top of this his own mother reproached and cursed him and refused him entry to her house when he went to plead his case. “Then indeed he became altogether a prey to grief and disordered in mind, and determined to starve himself to death.”133 He gave up public life, left the 129 Ach. Tat. 4.9.1-3. 130 Ach. Tat. 4.9.3-4; 4.10.1-2. (Trans. Reardon). 131 Plut.,Tim. 4, 5, 7, 25; cf. Plut. Mor. 102C.2. 132 Plut. Tim. 5.3; omission: Plut. Tim. 4.5; Nepos Tim. i,4; commission: DS 16.65.4. 133 Plut. Tim. 5.3 (Trans. Loeb).

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city and wandered in great distress of mind in the most desolate areas of the country (ἀδημονῶν καὶ πλανώμενος ἐν τοῖς ἐρημοτάτοις τῶν ἀγρῶν δίετριβεν).134 Shattered and confounded in his mental powers (κατέκλασε καὶ συνέτριψεν αὐτοῦ τὴν διάνοιαν) Timoleon for almost twenty years refused to undertake any conspicuous enterprise or participate in public life.135 But the story does not end here and Timoleon unlike many other aged exempla did not end his life in a disordered mental state. Fortuitously, toward the end of the twenty distraught years the Corinthians embarked on an enterprise to liberate their colonists in Sicily and Timoleon, to his surprise, was nominated general and enthusiastically endorsed by the votes of the populace. This seemed to give him the needed impetus to move out of depression and reclusiveness and toward a restoration of self-esteem. The foremost man of Corinth at that time, Telekleides, publicly urged Timoleon to take on the task bravely and nobly, for, he said, “if you fight successfully we shall think of you as a tyrannicide - if badly, a fratricide”.136 From this point on Timoleon's military and public career rose to exemplary heights and with sanity restored he died in old age, cherished and honoured by his fellow citizens “like a father to all”.137 B. Group Instances Madness on a mass scale, or at least as involving a group of persons, was noted in a variety of contexts. Again, some can be classified as permanent states, in that no cure (except death) is observable, others seem to have been viewed as temporary or episodic manifestations. I. Permanent States Accidental poisoning is given as the reason for two historical episodes of group dementia. One was temporary, the other permanent with a more tragic outcome.138 When Antony was in command of the Roman army in Parthia (HN19), conditions were extremely hard and they were finally reduced to foraging for vegetables and roots. Compelled by starvation to try some strange and unfamiliar kinds, they discovered that one type of plant produced a madness leading to death (ἐπὶ θάνατον διὰ μανίας). The men who ate it lost their memories and could think of nothing other than turning over or moving every stone as if accomplishing some task of great importance. “The plain was full of men stooping to the ground and digging around the stones or removing them; and finally they would vomit bile and die since the only remedy, wine, was not to be had.”.139

134 Plut. Tim. 5.4. 135 Plut. Tim. 7.1. 136 Plut. Tim. 7.2, Ἂν μὲν φάρ, ἔφη, καλῶς ἀγωνίσῃ, τύραννον ἀνῃρηκέναι δόξομεν, ἂν δὲ φαύλως, ἀδελφόν. 137 Plut. Tim. 39.1, Ἐν τοιαύτῃ δὲ γηροτροφούμενος τιμῇ μετ' εὐνοίας, ὥσπερ πατὴρ κοινός. 138 For Xenophon's account of a temporary mass mania, see below HN25. 139 Plut., Ant. 45.5. (Trans. Loeb); see Pelling ad loc; the story is told by Dellius (cf. Arr. Parth. Fr. 30 R) and is similar to one in Xen. Anab. 4.8.20-21. Pelling suggests the symptoms may have been caused by either ergotism or a metallic poisoning such as magnesium affecting the plants grown in that district. For wine as a cure for disease cf. Plut. Caes. 41.

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In the following examples of groups which seem to have permanently exhibited noticeably odd behaviour, it is recognized that some forms of mental aberration are especially difficult for the twentieth-century observer to conceptualize clearly. Where, for example did such apparent anomalies as Menekrates “Zeus”, Alexarchos “Helios” and their respective followers fit into the Greeks' perceptions about the sane and the insane? Or what were the various verdicts upon Eunus, the leader of the first Sicilian slave revolt? Menekrates (HN20), a doctor with an excellent reputation for treating epilepsy, was so conceited about his skill that he bestowed upon himself the title of Zeus. He figures in several outrageous stories.140 In one he is said to have sent a letter to King Philip of Macedon that began: Φιλίππῳ Μενεκράτης ὁ Ζεῦς εὖ πράττειν. To this Philip replied: Φίλιππος Μενεκράτει ὑγιαίνειν, and advised him to betake himself to the regions around Anticyra, an area known for its production of hellebore - a herb commonly advised as a remedy for insanity.141 Philip is also credited with exposing Menekrates' foolishness (ἄνοια) in a direct and common-sense manner: he invited Menekrates Zeus to a particularly sumptuous dinner party but provided for him, away from the rest of the party, a couch to recline on and, instead of food, incense as befitting a God. Menekrates, initially elated by the honour, reclined in solitary splendour until insistent hunger ultimately brought him to the realization that “he was indeed a man and foolish”, whereupon he rose and departed, deeply indignant.142

140 Menekrates: Ael. VH 12.51; Athen. Deip. 7.289a - 299b; Clem Al. 4.48P; DS 16.44. For discussion of Menekrates and his followers see Rosen 1969, 104-109; and especially Weinreich 1933, a detailed psychological monograph on the cases of Menekrates Zeus and Salmoneus. 141 Aelian, VH 12, 51; For popular usage cf. Aristoph. V.. 1489; Soc. Ep. 8.1.13. Hellebore and Anticyra: Thphr.. HP 9.9.2; Aul Gell. 17.15.5; (see Rolfe's note ad loc.); Pliny NH 25.52; Paus. 10.36.7; Strabo 9.3.3. 142 Ael. VH 12.51 (Trans. Stanley); cf. Athen. 7.289e. The following excerpt from Advance, the magazine of the University of Michigan Medical School, Hospitals, and School of Nursing, quoted in The New Yorker, July 9, 1984, p.71 contains resonances of Menekrates. “LASER NIGHTSKY formerly David Rosensweet ('68M) of Mill Valley, California, is in private general practice and an attending physician at Marin General Hospital. He was recently hired by the New Mexico Health and Social Services Department to head health promotion and to write a paper on nutrition. 'I give workshops around the country in holistic medicine and health,' he writes. 'I have been, for the last five years, involved with the Total Integration Institute's multidimensional research and expansion, a program committed as medical school, from which I have had enormous personal and professional gains in knowledge, healing, love, joy and ecstasy. I am a powerful healer, my most recent success being with multiple sclerosis. I am pioneering on a frontier of medicine and healing that goes beyond what is commonly known, believed, or accomplished. I am healthy, alive, and in love, and I have changed my name to Laser NightSky.”

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Menekrates' name is associated with several other men who appear to have been regarded as in some way peculiar. Nikostratos the Argive (HN21) was a man good in counsel and in action (ἀγαθὸς καὶ πρᾶξαι καὶ βουλεύσασθαι), yet according to Diodorus there was madness mingled with his intelligence (μεμιγμένην δ' ἔχων τῇ φρονήσει μανίαν).143 The evidence he gives is that because Nikostratos excelled in bodily strength he went into battle dressed like Heracles, wearing a lionskin and carrying a club. Elsewhere Nikostratos is described as a patient of Menekrates Zeus by whom he had been successfully cured of “the sacred disease”; in gratitude Nikostratos became a follower of Menekrates, assuming the garb and title of Heracles.144 Another member of Menekrates' group was Nicagoras of Zeleia (HN22), who is said to have dressed and been addressed as Hermes.145 One other person is associated with these self-proclaimed divine individuals, but he is perhaps less clearly a suspect ‘case’. The scholar Alexarchos (HN23), son of Antipater, Alexander's general, was a contemporary of Menekrates and founder of a new colony on the Athos peninsula.146 Founding a colony was not in itself unusual, but this new colony was. It was called Uranopolis, the inhabitants called themselves Uranidae, and coins were minted for the city depicting Alexarchos as the son god Helios, a name which he apparently preferred. He tried too to establish a new language for his city and a letter demonstrating some of it is held up to ridicule in Athenaeus, τί δὲ ἡ ἐπιστολὴ αὕτη δηλοῖ νομίζω μηδὲ τὸν Πύθιον ἂν διαγνῶναι.147 Yet there is no evidence which helps us to understand just how such a personage was viewed by his contemporaries.148 Was he the butt of jests like Menekrates? Was there admiration for him tinged with rumours of madness, as there seems to have been for Nikostratos? In Athenaeus Alexarchos merely takes his place among a panoply of eccentric linguists and grammarians, prone to ridiculous mistakes and pretentious usage. Yet in another source it is his appropriation of a divine title which is emphasized and Alexarchos Helios is assigned his place alongside Menekrates Zeus, Nicagoras Hermes, and Nikostratos Heracles - a fellowship tainted certainly with allegations of madness.149

143 DS 16.44.The coinage of Alexander the Great depicts something similar; presumably a line was drawn between acceptable symbolic representation and actual behaviour which verged either upon hubris or madness. See e.g. Kraay 1963, Pl. I, #10; Pl. II, #11; Pl. III, 39. I am grateful to Richard Parker for providing me with a copy of his (unpublished) paper, “Nikostratos the Argive,” delivered at the Annual Meeting of the Classical Association of the Canadian West, Victoria, B.C., March 1993. P.’s explication of Nikostratos’ imitation of Heracles as Argive rhetoric is quite convincing; it does not, however, alter the fact which is important here - that in the traditional reports, Nikostratos is called “mad”. 144 Athen., Deip. 7.289. 145 For Nicagoras of Zelea see Athen. Deip. 289c and Clem. Al. 4.48P. 146Athen. Deip. 3.98d-99b; Clem. Al. 4.48P; Strabo 7.35. 147 Athen. Deip. 3.99b, “What all this means not Apollo himself could understand.” 148 G. Rosen 1969, 105, discusses the difficulties inherent in trying to understand Menekrates and his followers from the viewpoint of their contemporaries. Certainly believing oneself to be a divinity is, in our society, a recognized and common symptom of mental disturbance. Christ is a popular figure for such disturbed individuals, and the recent tragic events surrounding David Koresh and his cult provide a vivid example of the way in which groups can form around and share in the psychopathology of a leader. 149 Clem. Al. 4.48P.

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Another individual with divine pretensions and a courtly following is equally problematical. Diodorus Siculus provides a long and detailed description of a Sicilian slave, Eunus (HN24), who had an aptitude for magic and wonder-working and who claimed to be able to foretell the future by divine inspiration through dreams.150 He “pretended” to have waking visions and while in a state of divine possession used to produce fire and flame from his mouth and rave with oracular pronouncements. Diodorus is extremely sceptical of the man's gifts, even going so far as to explain how the fire and flame were produced.151 The slave was treated as a source of amusement by his master Antigenes, and exhibited at dinner parties where he used to announce that the Syrian goddess had told him he would one day be king, and he would answer questions from the guests about how he would treat each of them in the event. Among his fellow slaves, however, his prophetic powers held some credence and he was consulted about the prospects of a planned slave revolt in a neighbouring household. He prophesied success, even leading the revolt with the aid of his fire tricks, and upon its success was crowned king. His career prospered; he murdered his master, proclaimed his wife queen, giving her a diadem, appointed a royal council and, with a great slave army at his command, won many battles. When the tide of revolt eventually turned Eunus was found in a cave where he had taken refuge with four others: his cook, his baker, the man who massaged him at his bath and the slave whose duty it had been to amuse him at drinking parties. Diodorus speaks of him rather as imposter and trickster than madman; his fellow slaves appear to have believed him to be genuinely divinely inspired, yet his master seems to have exhibited him for amusement like a morio or harmless lunatic.152 Like Menekrates Zeus he remains a subject for speculation.

150 DS 12.34/35.2; Florus 2.7.4; Livy, Periocha 56; cf. Bradley 1989, 55-57;62. I am grateful to Keith R. Bradley for this reference. 151 For a similar sceptical account of false prophecy and wonder-working see Lucian, Alexander or the False Prophet, below ch. 4. 152 A morio was an idiot kept as a laughing stock or fool: Mart. 6.39.17; Plin. Ep. 17.1; Ulp. Dig. 21.1.4.3.

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II. Temporary States Group madness as a temporary phenomenon may be seen in the following examples. It is noteworthy that men have predominated in the cases discussed so far, the single exception being the literary heroine Leukippe. In several of the examples which follow, however, women as well as men are seen to be subject to certain kinds of mass frenzy. Xenophon gives an account of mass mania among his troops while they were camped near Trapezos in Colchis (HN25) that is similar in origin to the madness experienced by Antony's troops in Parthia, but ultimately less than fatal. It was caused by eating honey from the numerous swarms of local bees, for all the soldiers who ate it became physically ill and went off their heads (ἄφρονες ἐγίγνοντο).153 Those who had eaten a little were like people excessively drunk (σφόδρα μεθύουσιν ἐῴκεσαν); those who had eaten more were like crazy men (μαινομένοις) - or even dying men. In the event no-one died and after a few days all had recovered. Another episode of group aberration occurred in Telestes' time (c.400 B.C.E.), when a strange ἔκστασις afflicted the women in Southern Italy (HN26). Suddenly in the middle of dinner, as though hearing the call of a voice, they would leap up and uncontrollably (ἀκατασχέτους γινομένας) rush out of the city. When the Locrians and Rhegians consulted the oracle about deliverance from this misfortune, the God prescribed twelve Spring paeans to Apollo daily for 60 days.154 Another account which involves women relates an episode of mass hysteria occurring in Miletos (HN27) where a sudden passion for death, “an insane (περιμανής) impulse toward hanging” seized the young women (παρθένιοι) of the town, and many of them, circumventing their vigilant parents and friends, managed to steal away and kill themselves. As a last resort a certain citizen of great common-sense (νοῦν ἔχων) proposed a law that the women who had hanged themselves be carried naked through the agora before burial. The measure was passed and, it is reported, immediately put an end to the epidemic.155 It should be noted here in passing that the observations made by the bystanders about Leukippe's madness - that she was young, a virgin, and so subject to intense bodily stresses are relevant too for this 'suicide cluster' of young Milesian virgins.156 Evidence from the medical authors,

153 Xen. An. 4.8.20-21 cf. DS 14.30. For honey and madness see also Ps. Arist. Mir. 831.b. 154 Apollon. Mirab. 40, (p. 53 Keller), preserves the account by Aristoxenus in his Life of Telestes. On this now see M.L. West's textual note, “Ringing Welkins,”CQ 40 (i) (1990): 286-287. I am grateful to David A. Campbell for this reference. 155 Plut., Mor. 249 B-C. The story is traditional and no date can be assigned with any certainty to the incident. Coleman 1987, 9-11 cites this episode as one of the earliest recorded examples of a suicide cluster. See also Choron 1968, 46-47. 156 Ach. Tat. 4.8.3.

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discussed in more detail below suggests that young adolescent females were perceived by their own society to be vulnerable as a group to insanity and suicide.157

Women in the grip of mania, both singly and en masse, are a well-recognized ancient literary topos.158 The context is usually a religious one, for at an individual level something manic attends the sacred state of prophetic possession.159 In legend and drama oracular priestesses, preeminently, Cassandra, (HN27a) are frequently cited examples of women raving while in the grip of the god.160 At a group level terms such as μανία and ἔκστασις are normally employed to describe the behaviours accompanying the female worship of Dionysus, who incites women to frenzy, ὀρσιγύναικα μαινομέναις Διόνυσον.161 Euripides' Bacchae provides dramatic descriptions of this kind of experience from the point of view both of onlooker and participant.162 There are however, singularly few historical accounts of such episodes of group mania, although a description of the aftermath of one is provided by Plutarch (HN28).163 Some women of Thebes, devotees of Dionysus, wandering by night in a religious frenzy (ἐκμανεῖσαι καὶ περιπλανηθεῖσαι νυκτός) unwittingly arrived at the town of Amphissa. The women were exhausted and, as they had not yet recovered their full reason (μηδέπω τοῦ φρονεῖν παρόντος αὐταῖς) they simply flung themselves down around and about the agora and slept. Amphissa, however, had just recently becomes an ally of Phocis who was waging war (the Sacred war) against Thebes, and Phocian soldiers were at that very moment staying in the town. The women of Amphissa, fearful that the vulnerable sleeping Theban women might be badly treated, formed a defensive guard around them until they had wakened and regained their senses. Then they fed them and escorted them safely back to the frontier. C. Summary Remarks The foregoing body of anecdotes about mad individuals, although disparate, elliptical, even historically imprecise, does provide a representative survey of the kinds of actions that led contemporaries to question the mental competence of the people involved. The list of cases is by no means exhaustive; it is meant primarily to underscore 157 See below ch.8; King 1983, 113-115; van Hoof. 1991, 22-30, “Virgins as a Risk Group”; on the ritual ‘wildness’ of young women in ancient Greece cf. Seaford 1988. 158 Padel 1983 passim. 159 Dodds 1951, 64-101 is the classic discussion of this topic; see also Osterreich 1960. 160 Plutarch quotes Cassandra from a lost tragedy: καὶ πρὸς παθόντων κἀν κακοῖσι κειμένων / σοφὴ κέκλημαι, πρὶν παθεῖν δέ 'μαίνομαι', cf. Nauck, no. 414, 919. Cf. also Σίβυλλα δὲ μαινομένῳ στόματι, Heraclit. 92, Diels. Fr. i,172. For a graphic description of the madness which afflicted the Delphic priestess Phemonoe, a reluctant vessel for Apollo's oracular responses, see Lucan, Pharsalia 5.123-224 cf. Plut. Mor. 438B. 161 Plut. Mor. 398.B7 cf. Lyr. Adesp. 131. On festivals such as the Agriana involving ritualized wildness for young women, see Dowden 1989, 82-87; 199-202 and passim. 162 Dodds 1951, 270-282 discusses the historical probability of Maenadism. More recently see: Kraemer 1979; and esp. Bremmer 1984. On enthousiasmos generally: Burkert 1977. 109-111, notes and references 931. 163 Plut. Mor. 249.E-F.

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the wide variety mental states which were popularly recognized to be abnormal and to act as a starting point for delineating popular attitudes toward and treatment of mentally aberrant individuals. Can we identify any one common unifying thread in these accounts? At the beginning of this section, in the accounts of Cambyses and Cleomenes, it became clear that several factors in combination were often involved when people were labeled mad. From the ensuing descriptions, a number of aspects have emerged which require to be considered as part of the fabric of madness; whether any one of them can be identified as a key element in every case is problematical. First, apparently unmotivated violence toward oneself, family and kin, fellow-citizens, - or even simple random violence - are important identifying elements in some cases (King Cotys), not in others (the Locrian women). At times delusions or hallucinations are seen to accompany that violence, but these can also occur alone and to degrees that vary markedly (Menekrates, Eunius, Thrasyllus). Excessive emotions may be a part of some mad scenarios, for example Hyperides' uncontrollable rage or the debilitating depression of Timoleon. Thrasyllus, on the other hand, looked back on his period of happy madness with nostalgia. Markedly inappropriate behaviour too is often noteworthy: Antony's men obsessively turning over every stone, or those “strange and dreadful impulses” enigmatically referred to in the case of Aratus' son. An appropriate sense of shame and modesty was said to be lacking in the case of the mad Leukippe, on the other hand it was said to be unaffected by the madness of the young women of Miletus. Isolation, distress, and a severe loss of self-esteem, may be seen to result from mental impairment (Timoleon). But Menekrates Zeus, serene among his followers, appears to have suffered no lack of confidence. Inability to care for oneself may also be a factor (the women of Amphissa), but again some mad individuals were seen as uncannily self-reliant (the man from Abydos). Even the basic dichotomy of rational/irrational cannot be applied straightforwardly; for apart from his one basic delusory premise, Thrasyllus' careful accounting of profit and loss was highly rational. If there is one simple common thread linking each of the instances cited above it is that insane behaviour is viewed by the spectator as somehow incomprehensible, out of phase with everyday reality. Such an assessment, perhaps too reductive to be useful, may nevertheless be the only unifying factor for madness. Xenophon's Socrates implies such an absence of consonance when, in an analogy, he describes diverse attributes of madmen:

τῶν τε γὰρ μαινομένων τοὺς μὲν οὐδὲ τὰ δεινὰ δεδίεναι, τοὺς δὲ καὶ τὰ μὴ φοβερὰ φοβεῖσθαι· καὶ τοῖς μὲν οὐδ' ἐν ὄχλῳ δοκεῖν αἰσχρὸν εἶναι λέγειν ἦ πιοεῖν ὁτιοῦν, τοῖς δὲ οὐδ' ἐξιτητέον εἰς ἀνθρώπους εἶναι δοκεῖν. καὶ τοὺς μὲν οὔθ' ἱερὸν οὔτε βωμὸν οὔτ' ἄλλο τῶν θείων οὐδὲν τιμᾶν, τοὺς δὲ καὶ λίθους καὶ ξύλα τὰ τυχόντα καὶ θηρία σέβεσθαι.164

164 Xen. Mem. 1.1.14, “And some madmen have no fear of danger and others are afraid where there is nothing to be afraid of, as some will do or say anything in a crowd with no sense of shame, while others shrink even from going abroad among men, some respect neither temple nor altar nor any other sacred thing, others worship stocks and stones and beasts”. (Trans. Loeb).

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Scholars have traditionally considered behaviour, and by inference , orientation to reality, which diverges excessively from socially acceptable norms to have been an adequate criterion of insanity in the ancient world. The characteristics of mad behaviour which form part of this definition are the mad person's “habit of wandering about, and ... proneness to violence”.165 Such a definition appears incontrovertible, yet, in the light of the multifarious examples examined above, somehow insufficient. To understand fully what insanity and mental derangement meant in the ancient world it seems essential to appreciate the great variety of manifestations and the array of causes and responses associated with such states.

165 Rosen 1969, 97-98.

CHAPTER FOUR

Physical Manifestations, Clues and Signals ἐπεὶ καὶ οἱ μαινόμενοί γε ὑπὸ πάντων γιγνώσκονται.166 The public perception of the madman in his most extreme form can be reconstructed most accurately by examining three bodies of evidence: first, a group of accounts of individuals who feigned madness, secondly, descriptions of mad individuals from drama; and thirdly, the clues and signals explicitly noted in the historical accounts above. From these some general conclusion can be drawn about physical characteristics and behaviours which were thought in antiquity to signal madness. A. Feigned Madness The relatively frequent references in the sources to feigned acts of madness in antiquity have have fueled speculation among historians for many years.167 For the present purpose it is not so important to ask why the various individuals thought it to their advantage to appear to be mad. In general it seems to have been with the object of escaping some sort of responsibility or accountability.168 What is a more interesting question is what did these people do so as to achieve the label of "madman" (μαινόμενος)? For just as an actor portraying Orestes µαινόµενος must move and speak in a manner which the audience finds plausibly mad, so too the informal "actor" must give out clues which signal clearly to his "audience" of fellow citizens that he is to be considered insane. Several brief examples and two more detailed descriptions provide further illustration of the kinds of clues which signalled madness in popular thought. The mythological account of Odysseus' deceitful madness, which, had it worked, would have granted him exemption from participating in the Trojan war, may be seen as the prototype for the story of Meton, the Athenian astronomer (HN29).169 According to one version, Meton, fearful of the outcome of the ill-fated Sicilian expedition and wishing to avoid any part of it, feigned madness and set his own house on fire, (ἐσκήψατο μεμηνέναι, καὶ λαβὼν δᾷδα καιόµενην οἷος ἦν αὑτοῦ τὴν οἰκίαν ὑφάπτειν) - the plausible act, as a number of sources attest, of a real

166 Xen. Mem. 3.3.1. "Even madmen are known to everyone." (Trans. Loeb). 167 See esp.Vaughan 1919, 11; Rolfe's note ad Suet. Jul. 45 (Loeb ed.) on the feigning of epileptic attacks; cf. HN24, Eunus, leader of the first Sicilian slave revolt who feigned divine possession. 168 The question of accountability and real or feigned insanity continues to this day to tax the courts. For Roman concerns see Ulp. Dig. 1. 18, 13-14. 169 On feigned madness see Padel 1981; a lost play by Sophocles Odysseus Mainomenos probably was based on the myth. See also Mattes 1970, 72-73 and cf. Davies EGF, 27-45; Plut. Mor. 18A. Meton: Plut. Nic. 13.5; Alkib. 17.45.

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madman.170 A similar motive drove Anthia (HN30), a young woman in a story by Xenophon of Ephesus, to feign epilepsy in an attempt to avoid prostitution; in her case the attempt was successful.171 She was brought to the brothel, while the brothelkeeper sometimes tried to console her and sometimes threatened her. And when she arrived and was put up for hire, a crowd of admirers surged forward, most of them ready to pay money to satisfy their desires. She was in an impossible plight but found a means of escape. She fell to the ground, let herself go, and pretended to be afflicted with the divine disease. The bystanders felt pity and fear and no longer wanted to satisfy their desires but tried to attend to her. And the brothelkeeper, realizing the disaster that had befallen him, and thinking that the girl really was ill, brought her home, made her lie down, and looked after her, and when she seemed to have come to,he asked her the cause of the disease.172 A more elaborately described pretence of madness was executed by Nicias (HN31), a leading citizen of Engyium, a city in Sicily renowned for the epiphanies of the goddesses called "Mothers" (Ματέρες) 173 This city ardently favoured the Carthaginian cause and Nicias, having been an outspoken advocate for alliance with Rome, became aware of a plot being prepared against him by his political opponents. His counterstrategy was devious and well-planned. To his enemies delight he began to speak publicly and inappropriately, (λόγους ... ἀνεπιτηδείους) about the "Mothers", loudly decrying people's belief in them. As the day approached when, according to the plot, Nicias was to be arrested, he attended a meeting of the assembly and in the middle of his address there: ... ἐξαίφνης ἀφῆκεν εἰς τὴν γῆν τὸ σῶμα, καὶ μικφὸν διαλιπών, οἷον εἰκὸς ἡσυχίας σὺν ἐκπλήξει γενομένης, τὴν κεφαλὴν ἐπάρας καὶ περιενεγκὼν ὑποτρόμῳ φωνῇ καὶ βαρείᾳ, κατὰ μικρὸν συντείνων καὶ παροξύνων τὸν ἦχον, ὡς ἑώρα φρίκη καὶ σιωπῇ κατεχόμενον τὸ θέατρον, ἀπορρίψας τὸ ἱμάτιον καὶ περιρρηξάμενος τὸν χιτωνίσκον, ἡμίγυμνος ἀναπηδήσας ἔθεε πρὸς τὴν ἔξοδον τοῦ θεάτρου, βοῶν ὑπὸ τῶν Ματέρων ἐλαύνεσθαι ... .... he suddenly threw himself upon the ground, and after a little while, amid the silence and consternation which naturally prevailed, lifted his head, turned it about, and spoke in a low and trembling voice, little by little raising and sharpening its tones. And when he saw the whole audience struck dumb with horror, he tore off his mantle, rent his tunic, and leaping up half

170 For example, DS 16.64.2. 171 Xen.Eph. 5.7; see commentary by Schmeling, 1980, 70-71. 172 Xen. Eph. 5.7. (Trans. Reardon). 173 Plut. Marc. 20; cf. DS 4.79.5-7.

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naked, ran towards the exit from the theatre, crying out that he was pursued by the Mothers. (Trans. Loeb) No one dared try to catch him, but in superstitious fear shrank from any contact while he ran out through the city gates, "freely using all the cries and gestures that would become a man possessed and crazed" (πρεπούσης δαιμονῶντι καὶ πραφρονοῦντι). His wife, in on the strategy, taking her children with her, prostrated herself in supplication before the temples of all the gods and then, pretending to seek her husband, left the city too, without hindrance and in perfect safety, and fled with her husband to the Roman camp. Madness could be feigned not just for escape but also for more positive gains. Monimos of Syracuse (HN32), philosopher and student of Diogenes, was originally a slave in the household of a certain Corinthian banker to whom Xenïades, Diogenes' purchaser and master, made frequent visits.174 Excited by Xeniades' unstinting praise of Diogenes, Monimos became his passionate admirer and so: αὐτίκα γὰρ μανίαν προσποιηθεὶς τὸ τε κέρμα διερρίπτει καὶ πᾶν τὸ ἐπὶ τῆς τραπέζης ἀργύριον ἕως αὐτὸν ὁ δεσπότης παρῆτάσατο· καὶ ὅς εὐθέως Διογένους ἦν. ... he forthwith pretended to be mad and proceeded to fling away the small change and all the money on the banker's table, until at length his master dismissed him; and he then straightaway devoted himself to Diogenes.175 Lucian's account, Alexander or the False Prophet, tells in considerable detail the story of the religious charlatan Alexander Abonuteichos (HN33), who managed to establish himself as an oracular prophet in Asia Minor in the second century CE. Part of Alexander's technique was to play the part of a madman - albeit a prophetically inspired one - and Lucian reveals some of his methods: Εἰσβαλὼν οὖν ὁ Ἀλέχανδρος μετὰ τοιαύτης τραγῳδίας διὰ πολλοῦ εἰς τὴν πατρίδα περίβλεπτός τε καὶ λαμπτὸς ἦν, μεμηνέναι προσποιούμενος ἐνίοτε καὶ ἀφροῦ ὑποπιμπλάμενος τὸ στόμα· ῥᾳδίως δὲ τοῦτο ὑπῆρχεν αὐτῷ στρουθίου τῆς βαφικῆς βοτάνης τὴν ῥίζαν διαμασησαμένῳ· τοῖς δὲ θεῖον τι καὶ φοβερὸν ἐδόκει καὶ ὁ ἀφρός. ... ἕωθεν δὲ γυμνὸς εἰς τὴν ἀγορὰν προπηδήσας, διάζωμα περὶ τὸ αἰδοῖον ἔχων, κατάχρυσον καὶ τοῦτο, καὶ τὴν ἅρπην ἐκείνην φέρων, σείων ἅμα τὴν κόμην ἄνετον ὥσπερ οἱ τῇ μητρὶ ἀγείροντές τε καὶ ἐνθεαζόμενοι, ἐδημηγόρει ἐπὶ βωμόν τινα ὑψηλὸν ἀναβὰς ... οἱ παρόντες δέ - συνεδραμήκει γὰρ σχεδὸν ἅπασα ἡ πόλις ἅμα γυναιξὶ καὶ γέρουσι καὶ παιδίοις - ἐτεθήπεσαν καὶ εὔχοντο καὶ προσεκύνουν. ὁ δὲ φωνάς τινας ἀσήμους

174 DL 6.82. 175 Trans.Loeb. DL adds, "He often followed Crates the Cynic as well and embraced the like pursuits; whereupon his master, seeing him do this, was all the more persuaded that he was mad." (μαίνεσθαι).

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φθεγγόμενος, οἷαι γένοιντο ἂν Ἑβραίων ἢ Φοινίκων, ἐξέπληττε τοὺς ἀνθρώπους οὐκ εἰδότας ὅ τι καὶ λέγοι, πλὴν τοῦτο μόνον, ὅτι πᾶσιν ἐγκατεμίγνυ τὸν Ἀπόλλω καὶ τὸν Ἀσκληπιόν. Well, upon invading his native land after a long absence with all this pomp and circumstance, Alexander was a striking figure, putting on an occasional show of madness and foaming at the mouth. This came easily to him by chewing soapwort, a plant used in dyeing, but others thought the foam an awesome visitation. ... At daybreak he leaped out into the city-centre, naked except for a gilded loincloth, brandishing his great scimitar, and tossing his loose hair like the devotees of the Great Mother in ecstasy. He mounted a high altar and made a speech.... . They were awestruck, and went down on their knees in prayer. He made such unintelligible sounds, which might have been Hebrew or Phoenician, to impress an audience which had no notion what he was saying except that he kept bringing in the names of Apollo and Asclepius.176 But perhaps the most amusing and thought-provoking story about pseudo-insanity is the account given of the madness of the great Athenian law-giver Solon (HN34).177 Once, when the Athenians had become exhausted by their war with the Megarians over Salamis, they enacted a law that no one, on pain of death, should incite the city to take up arms again over Salamis. Solon, whose birthplace was Salamis, considered the law a disgrace and sensing that there was some support for the war among the Athenian youth, he retired to his house and had his family give out the report that he was showing signs of madness. Meanwhile he secretly composed and memorized an elegiac poem about the Salamis issue then suddenly sallied out into the agora, wearing an invalid's cap, and declaimed his verses to the curious throng. They were enthralled immediately and easily persuaded to repeal the law and launch another war against Megara - with Solon in command. One final description of a type of falsified madness can be included here. Like the previous tale it concerns a famous figure, the presocratic philosopher Democritus of Abdera (HN35), and the insanity to which he is allegedly subject turns out too in the end to be fictitious. The account is presented rather in the manner of an epistolary novel in the Pseudepigrapha of the Hippocratic collection.178 In a series of letters exchanged between the council and the people of Abdera with Hippocrates of Cos, the incipient madness of Democritus' is described and the physician's aid secured. As Temkin has recently pointed out, the issues involved in the exchange reveal themselves to be primarily philosophical, not medical, and "the whole diagnostic deliberation is related to the famous pseudo-Aristotelian problem ... of the relationship of genius and melancholy".179 Yet mindful that the philosopher's madness was meant to be comprehensible to the reader as indicative of a real medical and civic problem, and that his symptoms are listed in detail, the descriptions of insane behaviour included in these letters are useful for the purposes of this study. Democritus' symptoms are described:

176 Luc. Alex.. 13-14, (HN33). 177 # The story appears fully developed in Plut. Sol. 8.1-3; cf. DL 1.46. Dem. De falsa Leg. 420.281 hints obliquely at the feigned madness by mentioning the "invalid's cap" (πιλίδιον) worn by Solon in the agora. 178 Littre 9, 308-429; Smith 1990; Temkin 1985, 455-464. 179 Temkin 1985, 457.

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ἐκλαθόμενος γὰρ ἁπάντων καὶ ἑωυτοῦ καὶ πρότερον, ἐγρηγορὼς καὶ ἡμέρην καὶ νύκτα, γελῶν ἕκαστα σμικρὰ καὶ μεγάλα, καὶ μηδὲν οἰόμενος εἶναι τὸν βίον ὅλον διατελεῖ. γάμεῖ τις, ὁ δὲ ἐμπορεύεται, ὁ δὲ δημηγορεῖ, ἄλλος ἄρχει, πρεσβεύει, χεροτονεῖται, νοσεῖ, τέτρωται, | τέθνηκεν· ὁ δὲ πάντα γελᾷ, τοὺς μὲν κατηφεῖς τε καὶ σκυθρωπούς, τοὺς δὲ χαίροντας ὁρῶν. ζητεῖ δὲ ὁ ἀνὴρ καὶ περὶ τῶν ἐν Ἅιδου καὶ γράφει ταῦτα καὶ εἰδώλων φησὶ πλήρη τὸν ἠέρα εἶναι καὶ ὀρνέων φωνὰς ὠτακουστεῖ· καὶ πολλάκις νύκτωρ ἐξαναστὰς μόνος ἡσυχῇ ᾠδὰς ᾄδοντι ἔοικεν· καὶ ἀποδημεῖν ἐνίοτε λέγει ἐς τὴν ἀπειρίην καὶ Δημοκρίτους εἶναι ὁμοίους ἑωυτῷ ἀναριθμήτους· καὶ συνδιεφθορὼς τῇ γνωμῃ τὸ χρῶμα ζῇ. For, previously inattentive to everything, including himself, he is now constantly wakeful night and day, laughs at everything large and small, and thinks life in general is worth nothing. Someone marries, a man engages in trade, a man goes into politics, another takes an office, goes on an embassy, votes, falls ill, is wounded, dies. He laughs at every one of them, whether he sees them downcast and ill-tempered, or happy. The man is investigating things in Hades, and he writes about them, and he says that the air is full of images. He listens to birds' voices. Arising often alone at night he seems to be singing softly. He claims that he goes off sometimes into the boundless and that there are numberless Democrituses like himself. He lives with a complexion as ruined as his reason. 180

180 Ps. Hipp. Ep. 10 .1 (321-322) ed. Smith 1992, Trans. Smith (all excerpts are from this edition); cf. Temkin 1985, 455. and Pigeaud 1981, 462-64.

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Β. Dramatic Madness A description of the mad Heracles (HN36) in Philostratos' Imagines suggests the way in which full blown madness was theatrically depicted. The description is of a painting of Heracles slaying his wife and children, and both seem to have been drawn primarily from Euripides' play.181 Significantly it is Heracles' eyes which the writer first notes, eyes which stare elsewhere - to Argos and the children of Eurysthius: ἀπατηλὸν γάρ τι ἡ μανία καὶ δεινὸν ἐκ τῶν παρόντων ἀγαγεῖν εἰς τὰ μὴ παρόντα.

182 In the midst of a chamber with all its furniture kicked aside the frenzied Heracles stands, with his servants

struggling vainly to subdue and restrain him "like a bull that is running riot, surrounded by herdsmen". τῷ δὲ αἴσθησις μὲν αὐτῶν οὐδεμία, ἀναρριπτεῖ δὲ τοὺς προσιόντας καὶ συμπατεῖ, πολὺ μὲν τοῦ ἀφροῦ διαπτύων, μειδιῶν δὲ βλοσυρὸν καὶ ξένον καὶ τοῖς ὀφθαλμοῖς ἀτενίζων εἰς αὐτά, ἃ ὁρᾷ, τὴν δὲ τοῦ βλέμματος εὔνοιαν ἀπάγων εἰς ἃ ἐξηπάτηται. He, however, has no consciousness of them, but he tosses those who approach him and tramples on them, dribbling much foam from his mouth and smiling a grim and alien smile, and, while keeping his eyes intently fixed on what he is doing, yet letting the thought behind his glance stray away to the fancies that deceive him. The writer goes on to describe the bellowing throat and swelling neck with veins dilated as the disease of madness flows up through it to "the sovereign parts of the head. The Fury... has entered into Heracles himself and dances through his breast and leaps up inside him and muddles his mind."183 Several features of this description find echoes elsewhere in tragedy. It has long been noted that rolling eyes, a misdirected gaze or a bull-like glare were understood to be evidence of a severely disturbed mind.184 A foaming mouth too, with its overtones of animal exertion, signalled lunatic savagery.185 C. Generally Recognized Characteristics I. Historically Observed Physical Traits and Gestures General popular conceptions of the "madman" would clearly have included those of the dramatists, but in addition several other physical characteristics can be noted both from the examples above in chapter three and from others observed in the 181 Translator's note, Loeb edition. The translation which follows is from the Loeb edition. 182 Philostr. Imag. 377 F.5 "for madness is a deceptive thing and prone to draw one away from what is present to what is not present." (Trans. Loeb). 183 Philostr. Imag. 2.23 (Trans. Loeb); cf. Eur. Her. 931-935. 184 On eyes and sanity generally see now Padel 1992, 60 & n.31. Rolling eyes: Simon 1978 152; cf. Kamerbeek's ed. of Soph. OT ad 419 and 528ff. See also Jebb's discussion ad 1385 and cf. Ai. 447; Aesch. PV 882; Eur. Her. 931935; Med. 90-93 cf.187-8; Ba. 1122-3; Eustathius ad Il. 13.515, Aias' flashing eyes and clouded mind. Bloodshot eyes, as in the case of Leukippe (HN17) can also be a sign of madness. 185 Eur. Her. 934; Ba.. 1121; a foaming mouth is one of the universal indications of epilepsy among the medical writers in antiquity, but the symptom seems to have been popularly associated with madness too.

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literature. Disordered speech was one - perhaps disjointed or too rapid or, in some kinds of mania, versifying and nonsensical. In his madness, Ajax is said to have talked in a sinister language taught to him by a daemon.186 And Phaedra's strange words cause her nurse to remonstrate, "Child why do you rave so, there are others here. Cease tossing out these wild demented words whose driver is madness." 187 But the signals could be far less dramatic. The feigned madness of Nicias of Engyium had its onset in the middle of a speech, and it was signalled by sharp alterations in volume and tone.188 According to Diogenes Laertius, student orators were warned not to speak too rapidly lest they appear crazy: μὴ ταχὺ λάλει· μανίαν γὰρ ἐμφαίνει. And Plutarch remarks that a madman's ravings are usually in verse and song: τῶν τε μαινομένων ὀλίγους ἰδεῖν ἔστιν ἄνευ μέτρου καὶ ᾠδῆς ληροῦντας.189 Again, convulsive, too rapid, or inappropriate hand or bodily movements could indicate a state of mental unbalance. Another warning to orators in Diogenes Laertius enjoins them not to move their hands, μὴ κινεῖν τὴν χεῖρα· μανικὸν γὰρ. This advice is echoed by Quintilian, who warns against an over-use of gestures which might give an orator the appearance of a raving madman: Nam et clamant ubique et omnia levata, manu emugiunt, multo discursu, anhelitu, iantatione gestus, motu capitis furentes. Hand gestures are socially encoded to a high degree, and this seems to have been as true of Greek culture as any other.190 Diogenes of Sinope is said to have remarked on the significant difference between pointing with one finger rather than another: τοὺς πλείστους ἔλεγε παρὰ δάκτυλον μαίνεσθαι· ἐὰν οὖν τις τὸν μέσον προτείνας πορεύηται, δόξει μαίνεσθαι, ἐὰν δὲ τὸν λιχανόν, οὐκέτι.191

186 κακὰ δεννάζων ῥήμαθ' ἃ δαίμων κοὐδεὶς ἀνδρῶν ἐδίδαξεν. Soph. Aj. 243-4 ; on the belief that people in abnormal mental states speak a special language see Dodds 1951, 68 and 85 n.24. 187 Eur. Hipp. 212-214.(Trans. Grene) ὦ παῖ, τί θροεῖς; οὐ μἠ παρ' ὄχλῳ τάδε γηρύσει μανίας ἔποχον ῥίπτουσα λόγον; 188 Plut. Marc. 20, see above HN31. 189 Speech: DL Bias 1.88; cf.Apul. Flor. 9.29, stammering in disorderly and faulty phrases such as might rise to the lips of a madman: quis incondita et vitiosa verba temere quasi delirantibus oborientia permiserit blaterare? Verse: Plut. Mor. 623C; cf. Cic. 14.6, Catiline gives the answer of a madman (μανικήν), i.e. riddling and obscure. Se also Ael. VH 14.26 which suggests public verbal abuse was considered to be behaviour with overtones of madness; cf. also DL Chrysipp.7.182, too vehement public disputation. 190 Brown 1988, 10-14 is a brilliant evocation of the importance among the upper classes in the Roman world of bearing, voice, gesture and demeanour. Certainly many of his observations apply also, mutatis mutandis, to Greek public and private life. 191Gesture: DL Chil. 1.70; Quint., Inst. 2.12.9 – 10; DL Diog. 6.35. It is interesting to note that Alexander of Tralles, writing in late antiquity (6th C. CE) describes a case of a mentally disturbed (melancholic) woman who went about with one finger pointing because she thought that the world would collapse if she ben her finger, ἐγὼ δὲ γυναῖκα ἐθεασάμην οὕτο φανταζομένην καὶ πρεσφίγγουσαν ἑαυτῆς τὸν μέσον τῆς χειρὸς δάκτυλον, ὡς ἐν αὐτῷ τὸν ὅλον κόσμον βαστάζουσαν (1.605).

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Most people, he said, are so nearly mad that a finger makes all the difference. For, if you go along with your middle finger stretched out, someone will think you mad, but if it's the little finger, he will not think so. Dancing, but especially dancing in an unorthodox setting, could be taken as a sign of mental aberration: Charmides, who came upon Socrates dancing for exercise in the early morning air, claimed that his first reaction was to think that Socrates was going mad (μαίνοιο). And, according to Artemidorus, it is a bad sign for a sick man or woman to dream of dancing, for this signifies mental derangement and delirium because of the great movement of the dance.192 Even excessive or unusual walking and moving about might be a sign of madness; again Artemidorus states: "For madness induces men to move and walk about and not to lie prostrate in bed [and not to be at rest] as they do when they are sick [which is a symbol of health]." 193 In women especially, but men too, dishevelled hair signals madness. Sometimes this feature is part of a religious context, an inspired frenzy such as that of the Maenads. Eunus the prophetic leader of the first Sicilian slave revolt, in his demonstration of prophetic mania waved his dishevelled hair "in honour of the Syrian goddess".194 And in the Hippolytos (201-202), Phaedra under the weight of her mysterious "madness" tells the nurse to let her hair fall free over her shoulders. There is slight evidence that mad persons were thought, like Heracles and Ajax, to have exceptional strength. Plutarch speaks of "a madman strong in his frenzy".195 In the difficulties her friends had in restraining Leukippe and in the accounts of the athlete Timanthes and of Cleomedes, who pulled down the pillar supporting the school roof, there is some suggestion that in popular thought there was an association between uncontrollable madness and unconfinable strength. II Actions and Behavioural Signs

192 Dancing: Xen. Symp. 2.19.5; Artem. Oneir. 1.76; cf. 3.42, madness causes men to move and walk about. Plut. Mor. 704E writes disparagingly of a drunken company settling down after dancing and clapping "as though recovering from a fit of madness (ὥσπερ ἐκ μανίας)."In general, behaviour inappropriate to one's age and status could readily earn the epithet crazy; Hor. Sat. 2.3, 276-80 provides examples, e.g. if a bearded man played with toys he would be a lunatic. 193 Artem. Oneir. 3.42, κινεῖσθαι γὰρ καὶ περιπατεῖν ἡ μανὶα προάγεται καὶ μὴ κατερρῖφθαι [καὶ μὴ ἠρεμεῖν], ὥσπερ ἐν νόσῳ [ὅπερ ὑγιείας ἐστὶ σύμβολον]; cf. also Ps. Hipp. Ep. 18 (383). 194 Flor. 2.7.4. On the connection between head tossing in madness or ritual frenzy and ancient ideas about brain activity see Onians 1951, 104, n.5. 195 Plut. Mor. 693A.9-10, (comparing unmixed wine): 'ὅτι νὴ Δία πλέον ἰσχύει μὴ διηθούμενος'· καὶ γὰρ ἄνθρωπος, ὦ φίλε, φρενετίζων καῖ μαινόμενος.

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Public nudity, or at least a lack of shame in exposing oneself, may have been a sign of mental aberration. Nicias stripped off his clothes to show he was mad as he ran from the city of Engyium, and Leukippe, in her frenzy, didn't even bother to cover "what a woman doesn't want to be seen".196 Obsessive behaviour, particularly of actions with no bearing on reality, is another symptom of madness: Antony's men turning over stone after stone; Thrasyllus recording every boat entering and leaving the Piraeus. More violently, certain kinds of aggressive behaviour were associated with madness; in particular, stone-throwing at passersby, some kinds of indiscriminate physical violence, and the destruction of property (especially setting fire to one's own house and possessions).197 Indeed the latter action dramatized the status of the insane person so completely that it seems to have been used particularly by people wishing, for some personal, ulterior purpose, to be classified as insane.198Violence, particularly when unprovoked, unmotivated and directed toward one's self, one's family or friends, was also clear evidence of insanity.199 One example which combines several of these criteria is a report concerning the wife of a Phocian commander (HN37) whose house was set on fire by her eldest son in a fit of madness, and who was burned alive in it.200 Some behaviour labelled mad is sometimes euphemistically described as "strange and unnatural acts", leaving much to the imagination. Plutarch speaks of a painting of the feigned madness of Odysseus (HN38) which depicts one of the "unnatural acts" (πράξεις ἀτόπους) performed presumably to convince onloookers of his crazed status. Unfortunately the act is not

196 Plut. Marc. 20; Ach. Tat. 4.9; cf. DL 3.86; and DL 3.86, "that which has arisen out of custom (κατὰ ἔθη) is called unwritten law; for instance not to appear in the market-place undressed or in women's attire. There is no statute forbidding this, but nevertheless we abstain from such conduct because it is prohibited by an unwritten law." (Trans. Loeb). Note Plut. Artax. 5.5 , wearing women's trinkets earns the epithet of "madman". 197 Stone-throwing: Plut. Pomp. 36.6; Ages. 36.6; Xen. Cyr..8.3.29-30. Fire: DS 16.64.2; Paus. 6.8.4. Violence: Herod. 6.75; Plut., Per. 34.5; Anth. Pal. 9.141. Some random violence was perhaps recognized as symptomatic of illness and not simply misbehaviour, see for example, DL Diog. 6.38. The wanton slaughter of animals (akin to destruction of property but with delusional overtones too) is part of the portrait of madness in Soph. Aj. 51-67. Destruction of property: Paus. 6.9.6-8; DL 6.82, the slave Monimus who threw away his master's money; cf. Herod. 5.92, Thrasyboulus is described as παραπλῆγα τε καὶ τῶν ἑαυτοῦ σινάμωρον. Note Apul. Apol. 87, proof of Pudentilla's sanity is that she took care of the household affairs and the accounts intelligently and responsibly. 198 Notably Meton, the Athenian astronomer (HN29), Ael. VH 13.12; Plut., Nic. 13.7-8; cf. Alkib. 17.4-6. 199 Unprovoked family violence: Plut., Mor. 497D-E; DS 16.64.2; Herod. 3.30-32; cf. 1.109; Ps. Arist. Mir. 816b; Athen. Deip. 12.531f-532a; Plut. Per. 34.5; Luc. Bis Accusat. 3; 14; 16; 17; 30. The popular assumption is, of course, dramatic and thematic in Eur. HF. and Ba.. and the myth of Athamas; cf. Plut. Mor. 167.D. Violence toward self: Herod.6.75; cf. 3.155; Paus. 6.8.4; Plut. Mor. 249B-D; Dion 55.4; DL.4.3 (depression); Porphyr. Plot. 11; cf. Plut. Cat. 68.4-8, Cato accuses his son of judging him a madman, by removing his sword, not allowing him to use his own judgment, nor discussing his suicide decision with him. Note: Dio Cass. 59.9.3, the strange suicide of the slave Machaon strongly suggests madness, although it is not stated explicitly. Note that van Hoof 1991, 217, in his appendix of suicides lists Machaon's motive as furor. 200 DS 16.64.2.

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described.201 Again, Aratus' son , poisoned by Philip, engaged in absurd and shameful, but nameless, activities until his early, unlamented death, παρέτρεψεν εἰς δεινὰς καὶ ἀλλοκότους ἐπιφοράς, πράξεων ἀτόπων καὶ σὺν αἰσχύνῃ παθῶν ὀλεθρὶων ὀρεγόμενον. And the young despot whose reason had been destroyed by Aretaphila's drugs ruled in a crazy and foolish way (ἐμπλήκτος καὶ ἀνοήτος), but no details are given of his activities.202 Only Aristotle spells out some specific examples of horrifying behaviour carried out by people either in a brutish state (i.e. people with bad natures) or a morbid state ( i.e. people diseased with epilepsy or madness). As examples of the former he lists a kind of female said to rip open pregnant women and devour their foetuses, certain Black Sea tribes who practiced cannibalism and exchanged children to be eaten, and the tyrant Phalaris of brazen bull fame. Men said to be diseased by madness include one who sacrificed and ate his mother and a slave who ate the liver of his fellow slave (HN39 & HN40).203 Finally, behaviour which constituted an attack on the gods, while bringing with it the risk of divine retribution in the form of insanity, might also be seen as indicative of pre-existing madness or a propensity toward it. Herodotus implies several times that Cleomenes was already half-mad when he committed the several outrages which (as some said) catapulted him into his final deadly mania.204 Herodotus' views on the sacrilegious actions performed by Cambyses in Egypt are,however, quite definitive: πανταχῇ ὦν μοι δῆλα ἐστι ὅτι ἐμάνη μεφάλως ὁ Καμβύσης· οὐ γὰρ ἂν ἱροῖσί τε καὶ νομαίοισι ἐπεχείρησε καταγελᾶν.205 III. Emotional and Mental States as Signs Some specific emotional and mental symptoms suggested to observers that an individual was in a disturbed state of mind. An excessive desire for solitude, whether it was associated with dejection, shame and guilt, or a misanthropic outlook, was generally regarded by Greeks as strangely abnormal behaviour. Timoleon, we might recall, in one phase of his mental disorder shunned all human contact:

201 Plut. Mor. 18A; a description of one of the senseless activities of Odysseus is perhaps to be found in Hyginus Fab. 95.2 (c.f Tzetzes ad Lyc, 815): insaniam simulans pileum sumpsit et equum cum bove iunxit ad aratrum, "he put on a felt cap (pileus) and yoked an oxen together with a horse at the plow". For discussion of this passage see Mattes 1970, 72-73. It is noteworthy that both here and in the anecdote of Solon's feigned madness (HN34) the pileus, felt cap or invalid's cap, serves as a marker for mad or aberrant behaviour. The cap was commonly worn for medical purposes; probably to warm the head after after it had been shaved for treatments. See below ch. 9. 202 Plut. Arat. 54.1-3; Mor. 256E-F; cf. Mor. 417C-D, describing certain mystery rites which involve eating raw flesh, rending victims, fasting, breast-beating, scurrilous language at shrines, and mass frenzy and shouting , and which, according to Plutarch, placate insane and imperious passions (μανικοὺς καὶ τυραννικοὺς ἔρωτας) not able to be satisfied in natural and normal ways. 203 Arist. EN 1148b-1149a; he also cites a man whose madness caused him to fear a weasel; cf. Xen. Mem. 1.1.13 and examples of other irrational fears discussed by medical writers, below, ch. 7. 204 Herod. 5.42; 6.75; sacrilegious acts: 6.76-84. 205 Herod. 3.38.

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ἔγνω ζῆν καθ' ἑαυτὸν ἐκ μέσου γενόμενος, καὶ πολιτείαν μὲν ἅπασαν ἀφῆκε, τοὺς δὲ πρώτους χρόνους οὐδὲ κατιὼν εἰς πόλιν, ἀλλ' ἀδημονῶν καὶ πλανώμενος ἐν τοῖς ἐρημοτάτοις τῶν ἀγρῶν διέτριβεν. ... and finally he resolved to live by himself apart from the world. He withdrew completely from public life and for the first years of his retirement did not even return to the city, but spent his time wandering in great agony of mind in the most deserted parts of the country.206 Several anecdotes about Diogenes of Sinope (HN41) suggest that he was popularly thought to have suffered from melancholy and solitariness. In an anecdote in Aelian it is said that because Diogenes was so sour and morose (and poor) he drove away all companions and was reduced to such a state of loneliness and misanthropy that he ate the top leaves off trees. Elsewhere Aelian reports that Plato used to say of Diogenes, "This man is Socrates mad." (μαινόμενος οὗτος Σωκράτης ἐστίν).207 A certain degree of melancholy, it seems, according to some thinkers fell within the bounds of normality. This seems to have been felt to be true particularly with respect to men of powerful intelligence. Diogenes Laertius reports Zeno the Stoic as writing "on good men" (οἱ σπουδαῖοι) that they will not get drunk nor be liable to madness, although they will not be immune to the disturbing effects of melancholy or delirium: ἔτι δ' οὐδὲ μανήσεσθαι· προσπεσεῖσθαι μέντιο ποτὲ αὐτῷ φαντασίας ἀλλοκότους διὰ μελαγχολίαν ἢ λήρησιν, οὐ κατὰ τὸν τῶν αἱρετῶν λόγον, ἀλλὰ παρὰ φύσιν. ... they will not be liable to madness either; not but what there will at times occur to the good man strange impressions due to melancholy or delirium, ideas not determined by the principle of what is choiceworthy but contrary to nature.208 Other philosophers reported by Diogenes Laertius as having melancholic or misanthropic tendencies include Heraclitus (HN42), who became a misanthrope, wandering in the mountains and eating grass. His work is alleged to have suffered from his mental condition, "Theophrastus says that because of melancholy some of his [Heraclitus'] writings were half-finished and the rest confused".209 Pyrrho too (HN43) is said to have been misanthropic and to have talked to himself (αὑτῷ

206 Plut. Tim. 5.4 (Trans. Scott-Kilvert); cf. Schol. ad Aristoph. Plut. 903, ὥσπερ οἱ μαινόμενοι τὴν ἐν πλήθεσι διατριβὴν ἀπαναινόμενοι ἐν ἐρημίαις φέρονται. On this passage and the comic use of melancholan for madness associated with solitariness see O'Brien Moore 1924, 63f. 207 Ael. VH 13. 26 and 14.33 cf. DL 6.54 (bracketed). 208 DL 7.118 (Trans. Loeb); on the relationship between melancholy and greatness cf. Ps. Arist. Prob. 30.1, (below ch. 8) cited in Plut. Lys. 2.3, Ἀριστοτέλης δὲ τᾶς μεγάλας φύσεις ἀποφαίνων μελαγχολικάς, ὡς τὴν Σωκράτους καὶ Πλάτωνος καὶ Ἡρακλέους, ἱστορεῖ καὶ Λύσανδρον οὐκ εὐθύς, ἀλλὰ πρεσβύτερον ὄντα τῇ μελαγχολίᾳ περιπεσεῖν; on Aristotle and melancholy see Simon 1968, 228-237 and esp. Klibansky et al. 1964. 209 DL 9.3 and 9.6, Θεόφραστος δὲ φησιν ὑπὸ μελαγχολίας τὰ μὲν ἡμιτελῆ, τὰ δ' ἄλλοτε ἄλλως ἔχοντα γράψαι.

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λαλῶν).210 Although he suggests other reasons for preferring solitude and quiet, the author of the pseudo-Hippocratic letters does understand the Abderites' suspicion that Democritus' desire for solitude is symptomatic of a melancholy-madness: ... ἡμέρην δὲ καὶ εὐφρόνην πρὸς ἑωυτὸν καθεστεῶτος καὶ ἰδιάζοντος τὰ μὲν πολλὰ ἐν ἄντροιςι καὶ ἠρεμίῃσι ὑπὸ σκιάσεσι δενδρέων ἢ ἐν μαλακῇσι ποίῆσιν ἢ πᾶρ' ἡσύχοισιν ὑδάτων ῥείθροισι. συμβαἰνει μὲν οὖν τὰ πολλὰ τοῖσι μελαγχολικοῖσι τοιαῦτα· σίγηροί τε γὰρ ἐνίοτε εἰσιν καὶ μονήρεις καὶ φιλέρημοι τυγχάνουσι· ἀπανθρωπέονταί τε ξύμφυλον ὄψιν ἀλλοτρίην νομίζοντες. ... but day and night staying by himself and being mostly alone in caves and the quiet covering of trees or in soft grass, or by quiet streams of water. Such things are generally characteristic of melancholics. Sometimes they are quiet, solitary, and like deserted places. And they avoid people, considering the face of their own tribe alien. However, he adds: ... ποθέουσι δ' ἄντρα καὶ ἡσυχίην οὐ πάν | τως οἱ μανέντες, ἀλλὰ καὶ οἱ τῶν ἀνθρωπίνων πρηγμάτων ὑπερφρονήσαντες ἀταραξίης ἐπιθυμίῃ. It is not wholly madmen who want caves and quiet, but also those who scorn human affairs in their desire for freedom from perturbation.211 In the reply Democritus writes to Hippocrates at the end of the episode, he gives a clear picture of the sort of clues a physician - or even an ordinary person - might use to identify madness: ἐννοήθητι γάρ· εἰ μὴ κατειλήφεις με γράφοντα, ἀνακεκλιμένον δὲ ἢ σχέδην περιπατοῦντα καὶ πρσομιλέοντα ἐμαυτῷ ὁτὲ μὲν δυσχεραίνοντα, ὁτὲ δὲ μειδιῶντα ἐπὶ τοῖσιν ἐννοουμένοισιν ὑπ' ἐμεῖο καὶ τοῖσι μὲν προσομιλέουσι τῶν γνωρίμων οὐ προσέχοντα, ἐφιστάντα δὲ τὴν διάνοιαν καὶ σκεπτόμενον ἐκπάγλως, ᾠήθης ἂν Δημόκριτον κατά γε ὄψιος κρίσιν ἐκ τῶν ὁρεομένων μανίης εἰκόνι ἐοικέναι.

210 DL 9.64. Talking to oneself, perhaps common among many people in private, when indulged in publicly is today a clear sign of mental disturbance. This may have been true also in antiquity. Another solitary man (τὸν μονήρη) who talked to himself provides material for a witticism at DL 7 174 and one of the symptoms the Abderites describe of the mad Democritus was that he would often arise alone at night and sing softly to himself, Ps. Hipp. Ep. 10.1 (322) (HN35). 211 Ps. Hipp. Ep. 12. (331-332) (Trans. Smith). ἀταραξία is, of course, what Smith calls "the code word" which signals the goal of life for Epicureans. See also Eur. Hipp. 208-211, Phaedra is seized by a craving to lie on a grassy meadow and drink cool spring water - both the inappropriateness of such behaviour and its wild solitariness seem to signal to the nurse madness or delirium.

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Consider, if you had found me not writing, but reclining, or walking around slowly, communing with myself, sometimes exasperated, sometimes smiling at my inner thoughts, not attending to conversation of acquaintances, but with my mind entirely engaged in intense investigation, you would have thought that Democritus, by the eye's judgement from things seen, was the image of madness.212 Finally it should be noted that the author of the Hippocratic treatise on the Sacred Disease tells us that epileptic sufferers habitually sought solitude when they sensed that an attack was imminent - this, he explains, they did out of shame: Ὅσοι δὲ ἤδηδ ἐθάδες εἰσὶ τῇ νούσῳ, προγινώσκουσιν ὅταν μέλλωσι λήψεσθαι, καὶ φεύγουσιν ἐκ τῶν ἀνθρώπων, ἢν μὲν ἐγγὺς ᾖ αὐτῷ τὰ οἰκία, οἴκαδε, ἢν δὲ μή, ἐς τὸ ἐρημότατον, ὅπη μέλλουσιν αὐτὸν ἐλάχιστοι ὄψεσθαι πεσόντα, εὐθύς τε ἐγκαλύπτεται· τοῦτο δὲ ποιεῖ ὑπ' αἰσχύνης τοῦ πάθεος καὶ οὐχ ὑπὸ φόβου, ὡς οἱ πολλοὶ νομίζουσι. Such as are habituated to their disease have a presentiment when an attack is imminent, and run away from men, home, if their house be near, if not, to the most deserted spot, where the fewest people will see the fall, and immediately hide their heads. This is the result of shame at their malady, and not, as the many hold, of fear of the divine.213 Depression, a harsh disposition, and a habitually bad temper were also noted symptoms of mental abnormality. These kinds of symptoms may have been seen as due primarily to one's bodily condition, and to have been either preventable or curable. Xenophon's Socrates lists a number of conditions caused by bad bodily health which disturb an individual's ability to think properly: πολλοὶ μεγάλα σφάλλονται διὰ τὸ μὴ ὑγιαίνειν τὸ σῶμα; καὶ λήθη δὲ καὶ ἀθυμία καὶ δυσκολία καὶ μανία πολλάκις πολλοῖς διὰ τὴν τοῦ σώματος καχεξίαν εἰς τὴν διάνοιαν ἐμπίπτουσιν οὕτως, ὥστε καὶ τὰς ἐπιστήμας ἐκβάλλειν. ... it is a matter of common knowledge that grave mistakes may often be traced to bad health. And because the body is in a bad condition, loss of memory, depression, discontent, insanity often assail the mind so violently as to drive whatever knowledge it contains clean out of it.214

212 Ps. Hipp. Ep. 18 (383) (Trans. Smith). 213 Hipp. Morb. Sacr. 15; whereas little children, he adds, who do not yet know shame, run to their mothers or another familiar person, out of fear and terror at the experience. 214 Xen. Mem. 3.12.6 (Trans. Loeb).

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Lysander (HN44) is one example of a great natured man upon whom the effects of old age were markedly destructive; he became afflicted with melancholy in his later years and developed a harsh disposition which affected his political and military decisions.215 Strange and unusual behaviour has been discussed above, but strange and unusual thoughts, ideas and whims, inexplicable fears, and, it seems, inappropriate laughter, might each carry implications of mental imbalance. Herodotus' account of the multifarious activities of King Cambyses is a litany of bizarre misconceptions: he is suspicious that the Persians think him an alcoholic and madman, he forgets to provision his army for a major expedition, he suspects the Egyptians of celebrating his defeat, he laughs at the god Apis and jeers at sacred statues.216 The "mad" Democritus too seemed suspiciously prone to strange ideas and indiscriminate laughter: the air is full of images, he goes off into the boundless, there are many Democrituses - and he laughs at everything, large or small, fortunate or tragic.217 Inexplicable fears and loss of memory, as will become more apparent from our examination of the medical evidence, were viewed as clear symptoms of mental distress. Both Marius (HN45) and Alexander (HN46), before their deaths, became notably suspicious and fearful to excess, and both tried drinking heavily in an attempt to calm their turbulent minds.218 Loss of memory is one of the aberrant mental conditions preventible, according to Xenophon's Socrates, by good bodily health; it is recorded as one of the symptoms of the madness afflicting Antony's soldiers in Parthia.219 It was also one of the afflictions affecting those who survived the great plague at Athens in 430, and it is discussed by several medical writers as a form of mental disorder.220 Hallucinations, delusions, mistakes about reality - including misconceptions about one's own role or place in the order of things - all can be taken to indicate a marked level of madness. Xenophon's Socrates in his discussion of madness claims that most men use madness as the term for errors in matters of common knowledge, but not slight errors - major errors: τοὺς μέντοι πολλοὺς ἔφη ἃ μὲν οἱ πλεῖστοι ἀγνοοῦσι, τοὺς διημαρτηκότας τούτων οὐ φάσκειν μαίνεσθαι, τοὺς δὲ διημαρτηκότας ὧν οἱ πολλοὶ γιγνώσκουσι μαινομένους καλεῖν· ἐάν τε γάρ τις μέγας οὕτως οἴηται εἶναι, ὥστε κύπτειν τὰς πύλας τοῦ τείχους διεξιών, ἐάν τε οὕτως ἰσχυρός, ὥστ' ἐπιχειρεῖν οἰκίας αἴρεσθαι ἢ ἄλλῳ τῷ ἐπιτίθεσθαι τῶν πᾶσι δήλων ὅτι ἀδύνατά ἐστι, τοῦτον μαίνεσθαι, φάσκειν· τοὺς δὲ μικρῶν διαμαρτάνοντας οὐ δοκεῖν τοῖς πολλοῖς μαίνεσθαι, ἀλλ' 215 Plut. Lys. 2.3 and 28.1, Ἤδη δὲ παντάπασι χαλεπὸς ὢν ὀργὴν διὰ τὴν μελαγχολίαν ἐπιτείνουσαν εἰς γῆρας. See below ch. 5. 216 Herod. 3.35; 3.25;3.27, 28; 3.29; 3.37. 217 Ps. Hipp. Ep. 10.1 (321-322); cf. 14 (338), γελᾷ, φασίν, αἰεὶ καὶ οὐ παύεται γε |λῶν ἐπὶ παντὶ πρήγματι καὶ σημεῖον αὐτοῖσι μανίης τοῦτο δοκεῖ. (HN35). 218 Plut. Mar. 45; Alex. 75. 219 Xen. Mem. 3.12.6; Plut. Ant. 45.5 (HN19). 220 Thuc. 2.49; see below ch. 7.

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ὥσπερ τὴν ἰσχυρὰν ἐπιθυμίαν ἔρωτα καλοῦσιν, οὕτω καὶ τὴν μεγάλην παράνοιαν μανίαν αὐτοὺς καλεῖν. "Most men, however," he declared, "do not call those mad who err in matters that lie outside the knowledge of ordinary people: madness is the name they give to errors in matters of common knowledge. For instance, if a man imagines himself to be so tall as to stoop when he goes through the gateways in the Wall, or so strong as to try to lift houses or to perform any other feat that everybody knows to be impossible, they say he's mad. They don't think a slight error implies madness, but just as they call strong desire love, so they name a great delusion madness."221 Proof of one's mental soundness, on the other hand, was a demonstrable capacity to be realistic and competent in the decisions and administrations of every-day life. That this seems to have been key is implied in the passage cited from Xenophon and is evident in practical application in a passage in which Apuleius defends the sanity of his wife Pudentilla. Although this passage is of interest primarily in connection with details of the Roman laws of insanity, still Apuleius' common-sense appeal to the court that it judge Pudentilla's sanity on the basis of her continued responsible care, not only of the household but the household accounts, is an argument which would have held sway throughout the Greco-Roman world.222 From Diomedes on, it was always of special importance to a Greek not to be deluded in anything.223 Nevertheless a number of very interesting delusions are described in the medical literature, and even from the historical evidence above we discover a variety of examples. Democritus' "strange thoughts" and "many Democrituses" can be described also as delusions which resonate with the two suns and the double Thebes of Pentheus.224 A happy delusion possessed the man of Abydos, a spectator in an empty theatre; less innocuous were those of Antony's soldiers who were obsessed with the importance of turning over every stone. The delusions of Marius awarded him command of the Mithridatic war which he conducted from his bed. Cambyses seems to have been full of what we might term paranoid delusions of persecution, whereas Thrasyllus, who thought that he owned every ship in the harbour, was deluded by a form of megalomania - so too, at least in the eyes of some of their contemporaries, were Menekrates "Zeus" and his assorted company, King Cottys who expected to wed Athena, and Eunus the Sicilian slave leader.225

221 Xen. Mem. 3.9.6-7 (Trans. Loeb). 222 Apul. Apol. 80-87. 223 See the illuminating remarks on ἄτη in Dodds 1951, 5-8. 224 Eur. Ba. 918; cf. Plut. Mor. 1083F, where Pentheus' condition is described: οὐχ ὁρᾶν αὐτὸν ἀλλὰ παρορᾶν λέγομεν, ἐκτρεπόμενον καὶ παρακινοῦντα τοῖς λογισμοῖς. For descriptions of the terrible phantoms of madness, dreams and delirium see Plut. Mor. 1123B. 225 To these delusions of grandeur we might add Plutarch's judgement of King Xerxes' attempt to fetter and scourge the Hellespont as μανικά (Plut. Mor. 342 E) and Aelian's report of the Spartan response to Alexander's claim to be a god - they regarded it as an ἔμπληξις (VH 2.19).

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Some delusions were less dramatic. At times mad people seemed not recognize that they were ill, nor did they always recognize danger. Plutarch speaks of diseases of the body which are worse because they are attended by an inability to perceive one's own condition, and among these he includes μανία.226 Elsewhere he remarks that those who are ill with melancholy, frenzy or delirium often drive away physicians or run from them, not realizing that they are ill.227 Allied to this misperception is the legendary inability of the insane to recognize danger. In a discussion of courage in Xenophon, Euthydemus denies that those who are fearless because they are ignorant of dangers are therefore courageous, saying, Νὴ Δί' ... πολλοὶ γὰρ ἂν οὕτω γε τῶν τε μαινομένων καὶ τῶν δειλῶν ἀνδρεῖοι εἶεν. 228

226 He also lists λήθαργοι, κεφαλαλγίαι, ἐπιληψίαι, ἀποπληξίαι αὐτοί τε πυρετοὶ οἳ συντείναντες εἰς παρακοπὴν τὸ φλεγμαῖνον καὶ τὴν αἴσθησιν ὥσπερ ἐν ὀρφάνῳ διαταράξαντες ..., Mor. 501 A-B. 227 Plut. Mor. 81F, οἱ δ' εἰς μελαγχολίαν ἢ φρενῖτιν ἢ παρακοπὴν ἥκοντες cf. Per. 34.5. 228 Xen. Mem. 4.6.10, "So those who feel no fear of such thing because they are ignorant of them are not courageous?" "Of course not, for in that case many madmen and cowards would be courageous." (Trans. Loeb).

CHAPTER FIVE The Popular Causes of Mental Disorders In the following section the various causes of mental aberration which appear in popular narrative are discussed. Many have been mentioned in the anecdotal material above; further and more specific evidence is provided as each category of cause is discussed separately here. The causes of madness or of mental aberration include: age (senility and youth); inherited or congenital defects; physical disease or physiological imbalance (e.g. epilepsy); ingested substances and other external influences (wine, poisons and aphrodisiacs, magical springs and stones, seasons and climate); emotions (anger, grief, remorse, fear, love); and divine agency (possession and punishment). A. Age - Old Age and Youth αὐξομένῳ γὰρ τῷ σώματι συναύξονται καὶ αἱ φρένες, γηράσκοντι δὲ συγγηράσκουσι καὶ ἐς τὰ πρήγματα πάντα ἀπαμβλύνονται.229 This gnomic statement from Herodotus along with the popular Greek proverb, δὶς παῖδες οἱ γέροντες (old men are children again), indicate the extent to which mental incompetence in old age was anticipated.in Greek society.230 It was not, however, assumed to be inevitable: Aristoxenus admonishes, “Children should not behave like infants (νηπιάζοιεν), youths like children (παιδαριεύοιντο), adults like young men (νεανιεύοιντο), and old men should not become crazy”.231 And at a later period Diogenes of Oenoanda too protests (rather frequently) against the anticipation of senility. Two fragments give the tone: “[... since many] live to the last day of their lives with their faculties unimpaired”, and, “let us not forget that it is not from old age that derangement comes but from some other natural cause”.232 Yet old age and accompanying disease bring dangers even to a healthy individual's mind and the example cited above of the aged general Lucullus graphically illustrates the vulnerability of the aged.233 The problem of senility, or at any rate insanity among the elderly, appears to have been recognized in Athenian law, for provision was made for a son to confine his father if he could convince the jury that he was insane (κατὰ νόμον ἐξεῖναι παρανοίας ἑλόντι καὶ τὸν πατέρα δῆσαι).234

229 Herod. 3.134, “For as the body grows in strength, so does the mind; but as the years pass and the body weakens, the mind ages too and loses its edge.” (Trans. de Sélincourt) 230 For additional references and discussion of the proverb see Golden 1990, 6, 184 n.25. On old age in antiquity see: Richardson 1933; Kirk 1971; Byl 1977 and 1983; van Hoof 1983; Bremmer 1987; Falkner and deLuce 1989; Garland 1990; Ephraim 1991. 231 Aristox. Fr. 35, Wehrli cited in Golden, 1990, 10. 232 Frag. 56, Chilton; Frag. 63, Chilton; cf. commentary p. 121 citing Cic. De senect. 11.36, in which it is stated that not all old men are victims of ista senilis stultitia quae deliratio appellari solet. 233 HN10; Plutarch gives two accounts of Lucullus' mental deterioration, anonymous sources reported simply, νοσῆσαι τὴν διάνοιαν αὐτῷ κατὰ μικρὸν ἀπομαραινομένην. Cornelius Nepos (not extant) provided the report that his freedman drugged him. 234 Xen. Mem. 1.2.49, “the law allowed a son to put his father in prison if he convinced a jury that he was insane”; cf. AP 56.6 and Harrison i, 80-1; MacDowell, 92, 101. See the discussion of insanity and the law, below ch.6.

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Philocleon in Aristophanes Wasps , with his wandering, obsessions, and delusions, is the locus classicus for senility in Greek society.235 Some non-literary examples are however, available since occasionally ancient biographers concerned themselves with the difficulties of their subjects in old age. In addition to Lucullus, Plutarch's Lives contain descriptions of a number of great and able men whose minds became deranged toward the end of their lives: Aemilius Paulus, Timoleon, Marius, Arcesilaus, Hipponicus, and Lysander. In other sources even Sophocles in his extreme old age is said to have had to defend himself against a charge of insanity (δίκη παρανοίας) brought against him by his son. Some senile states seem to have been mercifully brief: Aemilius Paulus (HN47) suddenly became delirious and deranged in his mind and on the third day died.236 Others had symptoms perhaps less dramatic but still unusual enough to be noteworthy: Lysander was “prone to melancholia” in his later years and developed “a harsh disposition” owing to this propensity (παντάπασι χαλεπὸς ὢν ὀργὴν διὰ τὴν μελαγχολίαν ἐπιτείνουσαν εἰς γῆρας ).237 Speusippus (HN48) was crippled by paralysis and in his old age committed suicide because of despondency (ὑπὸ ἀθυμίας).238 And when the geometer Hipponicus' mind gave way (HN49) (παρακόψαντα), King Arcesilaus is said to have taken him into his house and nursed him until he was completely restored. Arcesilaus himself (HN50), however, died in the end at the age of seventy-five, mad (παρακόψας), reputedly because of a habit of drinking unmixed wine- a habit enshrined in verse by Diogenes Laertius: τί μοι τόσον οἶνον ἄκρητον ἀφειδῶς ἔσπασας, ὥστε φρενῶν ἐκτὸς ὄλισθες ἑῶν; 239 The decline of the aged Marius (HN45) is described by Plutarch in some detail. As he grew old he was plunged into anxieties, nightly terrors and wakefulness, and, in his attempt to escape from or cure this sleeplessness he indulged in drinking-bouts “at unseasonable hours and in a manner inappropriate to his years” (ἀώρους καὶ παρ᾽ ἡλικίαν). Before long he was in his final illness during which he entered a strange delusory world (εἰς ἄτοπον ἐξοκεῖλαι παρακοπήν) which, according to his friends, completely revealed his ambitious nature. He thought that he had

235 See also Nub. 844. On senility in Aristophanes see Dover 1974,19; for general studies on old age in antiquity see Richardson 1933; Kirk 1971, 123-158; van Hoof 1983; in Sparta, David 1991; in Plutarch, Byl 1977; for the lack of anecdotal data about senility and old age generally in antiquity see M.I. Finley's introductory remarks in Falkner and de Luce,1989. 236 Plut., Aem. Paul. 39. 237 HN44; Plut., Lys. 2; 28. Plutarch cites Aristotle's view that great natures, such as those of Socrates, Plato and Heracles, were subject to melancholy. For melancholy as a form of mental illness see discussion below, ch.7. 238 DL 4.3 Speusippus. 239 DL 4.44,45, “Why, tell me, Arcesilaus, did you gulp down so liberally unmixed wine so that you went out of your mind?” It is not clear what age Hipponicus was when his mind gave way; old age may not have been a factor here - or indeed in the case of Arcesilaus. Old age plus alcohol, however, probably combined their effects to hasten his deterioration.

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command of the Mithridatic war and, just as he had done in actual battles in the past, “he would indulge in all sorts of attitudes and gestures, accompanying them with shrill cries and frequent calls to battle”.240 Finally, a kindly antidote to the former sad accounts is the story, much repeated in antiquity, of Sophocles' old age (HN51). According to Cicero, Sophocles ad summam senectutem tragoedias fecit; quod propter studium cum rem neglegere familiarem videretur, filiis in iudicium vocatus est, ut, quem ad modum nostro more male rem gerentibus patribus bonis interdici solet, sic illum quasi desipientem a re familiari removerent iudices. Tum senex dicitur eam fabulam quam in manibus habebat et proxime scripserat, Oedipum Coloneum, recitasse iudicibus quaesisseque num illud carmen desipientis videretur, quo recitato sententiis iudicum est liberatus. Sophocles went on writing tragedies until he reached a very great age. His preoccupation with this literary work created the impression that he was neglecting his family's finances. So his sons took him to court, urging that he was weak-minded and should have the family property taken out of his control (like us they had laws empowering such action in cases of mismanagement). The story goes on, however, that the aged Sophocles read aloud to the magistrates from the play that he had just written and was still working on, the Oedipus at Colonus. Then he asked them if they would describe its author as weak -minded. After listening to his recitation they voted his acquittal.241 There is no specific term for senility in Greek but the regular words for old and ancient, γέρων, ἀρχαῖος, πρεσβυτικός, are sometimes used in a way which come close to ‘senile’ in meaning.242 Plato is said to have been taunted by Dionysios, λόγοι σου ... γεροντιῶσι (Loeb translation: “You talk like an old dotard”). And in Plutarch, Fabius' military tactics toward Hannibal are described by Cornelius Scipio as “antiquated and senile”, ἀρχαῖον ... λίαν καὶ πρεσβυτικόν. 243 Circumlocution seems to have been employed when referring to the people themselves. Aelian describes an old Kean custom in which the very old and useless (οἱ γεγηρακότες, ἄχρηστοι) are assembled and crowned with garlands as though for a feast and then given hemlock to drink. The victims are described as ὑποληρούσης ἤδη τι αὐτοῖς καὶ τῆς γνώμης διὰ τὸν ψρόνον.244 In similar vein he mentions a Sardinian custom 240 Plut., Mar. 45. 241 Cic. Sen. 7.22 (Trans Michael Grant) cf. FHG 3.162, Vit. Soph 13; Plut. Mor. 785 A; Apul. Apol. 37. Lefkowitz 1981, 84-85, in a view now widely accepted, disputes the authenticity of this anecdote, claiming its source to be a lost play about the family of Sophocles, possibly a comedy influenced by Sophocles' OC. 242 At times the pejorative use may simply mean ‘silly’ or ‘old-fashioned’, elsewhere it is translated more strongly. For γέρων see Dawe ad Soph. OT 402.. For ἀρχαῖος see Dover ad. Ar. Nub. 821. 243 Plut. Fab. 25.2 (Trans. Loeb). 244 Aelian, VH 3.37.

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dictating that the old must be killed by their sons with a club and buried: αἰσχρὸν ἡγούμενοι τὸν λίαν ὑπέργηρων ὄντα ζῆν ἔτι· ὡς πολλὰ ἁμαρτάνοντος τοῦ σώματος.245 There is some evidence that youth too was a vulnerable time and that young girls in particular were prone to attacks of mental derangement. Leukippe's age (which undoubtedly implied also her virginal status) is given by the physician in the story by Achilles Tatius as the reason that her system was overwhelmed with an attack of madness.246 The suicidal girls of Miletus too were described as young virgins. Young men appear not to have been quite so readily prone to suicidal impulses and the kinds of madness associated with them as young women in antiquity.247 B. Mental Deficiency, Extreme Stupidity, Brain Damage There are very few indications that there were people in antiquity who suffered from some degree of mental retardation, nevertheless it is safe to assume that they existed. Down's Syndrome, for example, is a genetically determined deformity whose incidence is thought not to have varied from antiquity to the present.248 The only influence on its frequency is the age of the mother at conception, women over thirty being at much greater risk. Statistical projections for ancient Greece which take into account the younger age of mothers suggest an incidence of Down's Syndrome of one in two thousand to two thousand five hundred newborns.249. Paleopathological evidence from skulls and spines indicates the existence in antiquity of other congenital problems which involve brain damage, for example, Klippel-Feil syndrome and spinal bifida. Iconographic representations also suggest hydrocephalus and other skull malformations, either congenital or resulting from birth trauma.250 Even if noticeably deformed babies would not have been raised, many types of mental retardation are not readily perceptible at birth, and brain damage in later life from chemical imbalances, fever or trauma was always possible.251 A variety of terms are used to signify a person or behaviour of notable stupidity, for example: ἀνόητος, μῶρος, (μῶρα φρονεῖν), ἠλίθιος, κωφός, ἀσύνετος, ἀφραδής, κενόφρων, ἀλόγιστος (παντάπασιν), νωθής, νωθρός, ἄφρων,

245 Aelian VH 4.1. In the same passage he informs us that the Berbiccans put to death all people over 70, the men sacrificed by the sword (καταθύοντες), the women hanged or strangled (ἀπάγχοντες). 246 Ach.Tat. 4.9.3-4; 10.1-2; HN 17. 247 van Hoof 1991, 22 - 26 and 26-30 discusses differences in gender, frequency and motive in suicides of young males and females in antiquity. 248 Grmek 1983, 9. 249 Grmek 1983, 9. Grmek, 75, & 377 n.110, mentions iconographic representations of several genetic deformities including Down's Syndrome, and a work in progress on Greco-Roman pathological iconography. 250 Grmek 1983, skeletal evidence 70-71, iconographic 75; hydrocephalus is a condition discussed by the early medical authors; cf. Adam's edition of Paulus of Aegina Bk. 6, Sec. 3 for an overview of the ancient sources. 251 Exposure of weak and deformed, Pl. Theat. 151C; Den Boer 1979, 98; Pomeroy 1983; 1986; Patterson 1985; Golden 1981; Boswell 1988.

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νήπιος.252 With these terms in mind, descriptions of individuals who may have been mentally deficient follow below, but it is difficult to comprehend the degree of mental incompetence involved in these examples. Only descriptions of people who seem to have been singled out as permanently and preeminently mentally incompetent are discussed here; what appears to have been casual criticism of stupid acts by otherwise ‘normal’ people has not been included.253 Individuals described by Herodotus had their physical and mental defects and capacities assessed as a matter of course, particularly if they were in any way exceptional. So the child Battus had weak and stammering speech (ἰσχόφωνος καὶ τραυλός), his grandson, Battus the Fortunate, was “lame and infirm on his feet” (χωλός τε ἐὼν καὶ οὐκ ἀρτίπους).254 The famous son of Croesus who was mute (ἄφωνος), was not, however, slow witted (τὰ μὲν ἄλλα ἐπιεικής).255 Others, whether by nature and birth or as a result of harmful drugs, were less fortunate. Periander gave up on his elder son (HN52) as a successor because he seemed to be slow-witted (νωθέστερος). 256 His sons are described later in the tradition by Diogenes Laertius: παῖδας ἐξ αὐτῆς ἐποίσε δύο, Κύψελον καὶ Λυκόφρονα· τὀν μἐν νεώτερον συνετόν, τὸν δὲ πρεσβύτερον ἄφρονα.257 Plutarch is the source of the story of Arrhidaeus, the son of Philip of Macedon by Philinna, an “obscure and common” woman. As noted above (HN8), this young man was gifted and noble as a boy (χάριεν ἦθος καὶ οὐκ ἀγεννές), but drugs were given to him by Olympias which injured his body and destroyed his mind, (διαφθαρῆναι τὴν διάνοιαν). He is further described as “deficient in intellect” (ἀτελῆ ... τὸ φρονεῖν) and “a fool” (οὐ φρενήρη).258 There are a number of brief, enigmatic references. Diogenes the Cynic is reported to have dedicated to Asclepius a “bruiser” or “brawler” (πλήκτην) (HN53) who, whenever people fell on their faces, used to run up to them and

252 See Appendix 1. 253 Plutarch's descriptions (Art. 5; 27-28) of Teribazus at the court of King Artaxerxes, for example, might indicate that he was at times something of a court fool. He is said to have been “rather light-headed and witless” (ὑπόκουφος καὶ παράφορος), and his disposition “not stable, but uneven and precipitate” (οὐδὲ ἄλλως στάσιμος ὢν τὸ ἦθος, ἀλλ᾽ ἀνώμαλος καὶ παράφορος). And, when contrary to specific orders he dressed up in the King's coat and women's trinkets, King Artaxerxes laughed at him saying, δίδωμι σοι καὶ τὰ χρυσία φορεῖν ὡς γυναικὶ καὶ τὴν στολὴν ὡς μαινομένῳ - “I permit you to wear the trinkets as a woman and the coat as a madman.” It is difficult, however, accurately to assess the shades of ridicule involved here as Teribazus seems also to have been part of highly influential circles. 254 Herod. 4.155; 161. 255 Herod. 1.85. 256 Herod. 3.53. 257 DL 1.94, “He produced two sons, Kypselus and Lykophron, the younger was intelligent, the elder weak in mind.” 258 Plut. Alex. 77; 10.2.

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attack them.259 For such a response the man may have seemed more in need of healing and protection than punishment and incarceration. Some kind of mental derangement or deficiency is probably indicated. A brief anecdote about Menedemus, the philosopher, includes another possible candidate for this category - a simpleton (HN54) who is relating something to him with no apparent object (τὸν ἀναίσθητον ἀναφέροντα τι αὐτῷ εἰκαίως). Menedemus, after a witty response, relegates the fellow to his farm to care for his cattle. 260 A similarly dim character appears in Theophrastus, the “stupid man” (ὁ ἀναισθητος) (HN55) who suffers from the dullness of a slow mind in word and deed ἡ ἀναισθησία βραδυτὴς ψυχῆς ἐν λόγοις καὶ πράξεσιν).261 Aelian has assembled a cryptic collection of people who were notoriously imbecilic (HN56), one tried to count the waves, another looked for a ladder in a jar: φασὶ παχύτατον γενέσθαι τὴν διάνοιαν οἱ τῆς κωμῳδίας ποιηταὶ τὸ δέρμα ἔχοντα ἀδιακόντιστον Πολύδωρόν τινα καὶ ἄλλον Κοικυλίωνα ὄνομα, ὅσπερ τὰ κύματα ἠρίθμει ὑπὸ τῆς ἄγαν μανίας. λόγος δέ τις καὶ Σαννυρίωνα τοιοῦτον γενέσθαι, ὃς ἐν τῇ ληκύθῳ τὴν κλίμακα ἐζὴτει. καὶ Κόροιβον δὲ καὶ Μελιτίδην καὶ ἐκείνους ἀνοήτους φασίν. 262 The comic poets say that a certain Polydorus had the thickest mind and a skin that was impenetrable; there was also another by the name of Coecylion who, in his excessive madness, tried to count the waves. There is a story too of a similar person, Sannyrion, who looked for a ladder in a jar. They also say that Coroebus and Melitides were very stupid. It is difficult to know how much of this is a garbled version of scenarios from comic plays with the foolishness attributed to the authors or actors, apocryphal accounts of amusing town clowns or village idiots, or a blend of them all. Mentally deficient people unwittingly provide a good deal of public amusement in some sectors of contemporary society, that this was also true in antiquity is attested by a series of ‘moron’ jokes in the Philogelos.263 C. Heredity and Congenital Considerations

259 DL Diog. 6.38. 260 DL 2.128. 261 Thphr. Char. 14. 262 Ael. VH 13.15. 263 Philogelos 109; 110-139; 251. Presumably there were proverbs too, such as the one cited at Epict. 2.15.13, "μωρὸν οὔτε πεῖσαι οὔτε ῥῆξαι ἔστιν" - “you can neither persuade nor break a moron”.

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The importance of breeding from sound and healthy stock was emphasized in the ancient world, as it is still today in some parts of the modern world, rural Greece for example. This emphasis was not restricted to questions of animal stock-breeding, but applied analogously in the human realm.264 In Sparta, Lycurgus is said to have been critical of men in other parts of Greece who demanded that their wives have children by no others regardless of how foolish, infirm or diseased they themselves were (κἂν ἄφρονες ὦσι, κἂν παρήλικες, κἂν νοσώδες). The famous Spartan marriage practices were deliberately designed to circumvent bad breeding.and the production of offspring ἀγεννὲς καὶ ἄµορφον.265 However the account by Herodotus of the birth of King Cleomenes suggests that the Spartan system was not flawless. Cleomenes seems to have been half-mad from very early on in his life, a fact which was known but regrettably ignored when the Spartans appointed him king, instead of his sane, healthy, but younger half-brother Dorieus.266 Cleomenes' crazed suicide, is presented as the final outcome of mental taint inherited from birth.

It was popularly thought inevitable that bad stock would show itself.267 Plutarch displays an interest in questions of heredity, and in particular in attempts to avert the consequences of what we might call genetic predispositions, both physical and mental. For children of epileptics, melancholics and gout sufferers, he prescribed a regime of exercise, diet and medicines designed to prevent them suffering as their fathers did, (mothers' hereditary traits are not here specifically considered).268 Moreover, according to Plutarch, children engendered by drunken fathers tended to become drunkards; an anecdote attributed to Diogenes goes further and suggests a proverbial belief that children conceived while their fathers were drunk could be mentally and/or emotionally unstable: καὶ Διογένης μειράκιον ἐκστατικὸν ἰδὼν καὶ παραφρονοῦν "νεανίσκε" ἔφησεν, "ὁ πατήρ σε μεθύων ἔσπειρε."269 D. Disease - Epilepsy

264 Although wide recognition was given to the influence of the family and training in forming the character; see discussion of heredity and environment in Dover 1974, 83-95, esp.93-94. 265 Plut. Lyc. 15-16; on Spartan marriage practices see Cartledge 1981. 266 Herod. 5.42, Ὁ μὲν δὴ Κλεομένης, ὡς λέγεται, ἦν τε οὐ φρενήρης ἀκρομανής τε, ὁ δὲ Δωριεὺς ἦν τῶν ἡλίκων πάντων πρῶτος, εὖ τε ἠπίστατο κατ᾽ ἀνδραγαθίην αὐτὸς σχήσων τὴν βασιληίην. Cf. Herod. 6.75, Cleomenes becomes violently insane, having been somewhat crazy even before – καὶ πρότερον ὑπομαργλοτερον. 267 Plut. Lyc. 15, “as though children of bad stock did not show their badness to those first who possessed and reared them , and children of good stock, contrariwise, their goodness", ὡς οὐχὶ πρώτοις τοῖς κεκτημένοις καὶ τρέφουσι τῶν παίδων γινομένων πονηρῶν, ἐὰν ἐκ πονηρῶν γένωνται, καῖ τοὐναντίον χρηστῶν, ἂν τοιαύτης τύχωσι γενέσεως. cf. Artemidorus Oneir.. 4.30: a man dreamed his own daughter was hunchbacked. After this his sister died. Artemidorus in interpreting the dream, says this was a fitting and logical outcome, “for his stock was not healthy” (Trans. White). 268 Plut. Mor. 561E. cf. ch. 9, Exercise and Food and wine, the Dietary Regimen. But on mothers see Artemidorus Oneir. 4.67, in which a pregnant woman dreams of a serpent. When the child is born, it becomes paralytic. Artemidorus adds that the woman was ill at the time of her dream and so it was natural “that the child that had been conceived and carried during a sickness would not maintain a healthy nervous system.” 269 Plut. Mor. 1D; 2A.

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One type of mental and somatic affliction, epilepsy, was clearly identified in antiquity, although with a variety of names: in Greek, ἡ ἐπιληψία, ἡ ἱερὰ νόσος, ἡ μεγάλη νόσος, τὸ μεγὰ νόσημα, νόσος παιδική ; in Latin, comitialis morbus, morbus sacer, maior morbus among many others.270 It should be noted that the popular common term for epilepsy, “the sacred disease”, was used rather loosely. First, it may have included mental and somatic disturbances which physicians both now and in the past would classify differently: eclampsia, encephalitis, and hysterical convulsions have all been suggested.271 Secondly, even in antiquity there appear to have been several diseases other than epilepsy, called 'sacred'.272 There is no doubt, however, that at the core of what were identified in antiquity as epileptic or sacred diseases, were cases of what is now termed grand mal epilepsy.273

Epilepsy has always been perceived to be a disease, whatever causative factors may have been assigned to it. 274 Plutarch lists epilepsy among the kinds of diseases of the body which are worse than diseases of the soul because they are attended by the inability to perceive the body's condition; others include, lethargies, migraine, apoplexies, fevers, and delirium or madness.275. Elsewhere, as we have noted above, he writes of epilepsy as a hereditary predisposition, like gout and melancholy, and prescribes a regime of exercise, diet and medicines for children of epileptics to follow in order to avoid familial transmission of this disease.276 . That epilepsy was widely believed to be a congenital weakness is attested by the Spartan practice of bathing newborn infants in unmixed wine in the belief that it would bring on epileptic seizures in those so predisposed.277 Epilepsy itself, however, will be discussed in greater depth of detail below in the chapter on medical syndromes (Chapter Seven). Here we are concerned primarily with epilepsy as it was popularly thought to be a precipitating cause for violent and destructive forms of madness. The best non-medical description of what it was to be an epileptic in the ancient world is Apuleius' account of an epileptic slave boy called Thallus (HN57).278 Although this account is by a Latin author, it is quite probable that 270 On epilepsy in antiquity Temkin [1945] 1971, 3-81 is essential; see also Grmek 1983, 40-41; 353-354; Schneble 1987, 6-53. For terms see Appendix 1; discussion, Schneble 1987, 17 - 18; 25-28; 34-38. 271 Grmek 1983, 40-41; Temkin [1945] 1971, 50 suggests that physicians earlier than Galen may have tended to use the words ‘epilepsy’ and ‘convulsions’ interchangeably. 272 Temkin [1945] 1971, 15-19 discusses the variety of syndromes subsumed under the term “sacred disease”. See discussion below, ch.7. 273 Temkin [1945] 1971, 17; cf. Grmek 1983, 41. 274 Temkin [1945] 1971, 3. 275 Plut. Mor. 501.A; cf. Plut. Mor. 755E, the sacred disease is like love, both are great and frenetic afflictions, one of the body and one of the mind, ἀμέλει καὶ σώματός τις ... νόσος ἔστιν ἣν ἱερὰν καλούσιν· οὐδὲν οὖν ἄτοπον, εἰ καὶ ψυχῆς τὸ μανικώτατον πάθος καὶ μέγιστον ἱερὸν καὶ θεῖον ἔνιοι προσαγορεὺουσιν. 276 Plut. Mor. 555E. 277 Plut. Lyc. 16.2. 278 Apuleius, Apol. , 43-44 (Trans. H.E. Butter). Evidence of epileptic tendencies, particularly important when buying a slave, could be obtained beforehand by a wary purchaser by various methods, for example by the burning

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Apuleius' description of the boy's symptoms and the reactions to him by his fellows could apply very easily to any epileptic slave boy in antiquity.279 The portrait is vivid and perhaps grotesquely exaggerated, for Apuleius was defending himself against accusations of witchcraft and was concerned here to portray Thallus as the very opposite of the sort of “healthy, unblemished, intelligent, handsome boy” who would be an appropriate vehicle for divine powers. Thallus, recounts Apuleius, has fits two or three time a day and “exhausts all his limbs with his convulsions. His face is ulcerous, his head bruised in front and behind, his eyes are dull, his nostrils distended, his feet stumbling... . ... He is continually lying down, either a seizure or mere weariness causing him to collapse.” His fellow slaves spit upon him and “no one ventures to eat from the same dish with him or drink from the same cup.” The boy had frequently been shown to doctors, evidently to no avail, for he was sent ultimately to a distant farm in the country, far from the sight of his fellow slaves “for fear he should infect the rest of the household”. All in all, says Apuleius, no one will deny “that this boy is of revolting appearance, that his body is rotten through and through with disease, that he is liable to fits, and is a barbarian and a clodhopper”. (Non negabunt turpissimum puerum, corpore putri et morbido, caducum, barbarum, rusticanum ). And moreover, were Thallus to have appeared in court, he would have rolled his eyes, foamed at the mouth, spat in the prosecutor's face, clenched his hands convulsively, shaken his head and at last fallen into a fit.280 An epileptic fit was an unequivocal instance of mental breakdown, a discrete episode (with a tendency to recur), characterized by a cluster of symptoms recognizable to everyone. Yet some of these symptoms were also thought to be physical signs typical, as we have seen, of other kinds of madness: rolling eyes, foaming mouth,convulsive hand or bodily movements.281 The implications are clear from Apuleius' description that some epileptics were feared and despised in much the same way that wandering madmen were at different periods in history. Such fear is often explained as a superstitious dread of the divine origin of the disease, but it seems from the following examples to have been compounded also with more practical fears - fear of contagion and also fear of what unpredictable things an epileptic might do. One of the earliest examples of an epileptic said to have gone mad is King Cambyses, whose bizarre and savage behaviour, according to Herodotus, may have been caused by a life of epileptic seizures.282 Herodotus concludes:

of a special stone, gagates (agate according to some translators, bitumen according to others), in the slave's presence, or alternatively, by observing his/her reactions while gazing at a spinning potter's wheel. It was thought that either of these tests would induce a falling fit in those susceptible and they were regularly employed, says Apuleius (44), in the slave markets. For further discussion of tests for epilepsy see below ch. 9. 279 The episodes described take place in Roman north Africa, Apuleius' birthplace. 280 Apul Apol. 44, ... si tu interrogares; iam in media quaestione hic ibidem pro tribunali oculos trucis in te invertisset, faciem tuam spumabundus conspuisset, manus contraxisset, caput succussisset, postremo in sinu tuo corruisset. 281 Simon 1978, 152; cf. above ch. 4. 282 Herod. 3.33; See Temkin [1945] 1971, 15; Brown 1982; Grmek 1983, 41; Dawson 1986 94.

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καὶ γάρ τινα καὶ ἐκ γενεῆς νοῦσον μεγάλην λέγεται ἔχειν ὁ Καμβύσης, τὴν ἱρὴν ὀνομάζουσι τινες. οὔ νύν τοι ἀεικὲς οὐδὲν ἦν τοῦ σώματος νοῦσον μεγάλην νοσέοντος μηδὲ τὰς φρένας ὑγιαίνειν. There is in fact a story that he had suffered from birth from the serious complaint which some call 'the sacred sickness'. There would then be nothing strange in the fact that a serious physical malady should have affected his brain.283 It is by no means certain the Cambyses' disease was epilepsy, but what is significant here is that people thought it was. At least one contemporary historian has noted however, in connection with Cambyses' symptoms, that instances of homicidal delirium among some epileptics have been confirmed by modern medicine.284 Further ancient evidence for links between madness and epilepsy is sparse and conflicted. Several other historical figures with characters as widely divergent as Julius Caesar and Caligula are alleged to have suffered from epilepsy, but the deleterious effects of the disease seem to have been distinctly different in each case.285 Caligula's mental soundness was questionable even to himself, yet epileptic attacks seem to have had no obviously detrimental effects on Caesar's career, despite an occasion, noted by Plutarch, when Caesar claimed his disease caused giddiness and prevented his rising to meet the senators.286 And there are other examples of competent, respected people who either suffered from epilepsy with little apparent handicap, or were successfully cured.287 At least five of the followers of Menekrates Zeus, among them a military leader, a statesman, and a scholar, were said to have been cured of the sacred disease by his exceptional skill and to have stayed with him for years, either out of gratitude or because they had sworn to do so if his treatment was successful.288 It is noteworthy however, that recurring suggestions of madness are attached to several of these in the later tradition.289 E. Ingested Substances: wine, drugs, and poisons

283 Herod. 3.33 (Trans. de Sélincourt). 284 Grmek 1983, 41, however he cites no specific studies. See also Milns 1990, 454. 285 Suet. Jul 45.1; Calig. 50.2; cf. Plut. Jul. Caes. 60.7. The reality of Caesar's epilepsy has been questioned by medical historians who find it difficult to believe that he could have achieved such demanding feats of physical endurance if he had suffered from epilepsy. 286 Plut. Caes. 60.7cf. Suet. Jul. 45.1. 287 Some kinds of epilepsy were apparently thought to allow one to lead an active, normal life, but then prove unexpectedly fatal. Aelian VH 9.31 tells of an anonymous victor in the wrestling who died of an epileptic fit while receiving the crown at the Olympic games. 288 Again, it is not certain that the sacred diseases referred to here were cases of epilepsy, see Temkin, 17 - 18. For identification of Menekrates' followers see Weinreich 1933, 10-16; cf.Rosen 1969, 104-109. 289 DS 16.44; Athen Deip. 7.289; and see discussion above, ch. 3.

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Numerous popular references attest to the danger of madness thought to be inherent in wine and drugs, both medicinal and magical. The anecdotes at the beginning of this chapter alone tell of a man's mind deranged by charms and magic, a woman's by an aphrodisiac, troops driven mad by poisonous natural substances, several men whose minds were destroyed by drugs or poisons, and a number of kings whose drinking led to madness.290 I. Wines A close relationship was thought to exist in antiquity between madness and the intoxication derived from wine or herbs, a dangerous boundary with resonances even in the animal kingdom. According to Aelian, “Every irrational creature naturally abhors wine, especially those who being over-fed with grapes become drunk. Crows if they eat the herb oenutta , as also dogs, run mad (βακχεύονται)”.291 The apotropaic eyes painted at the bottom of drinking cups used in symposia imply that Greeks were aware of how loss of control, irrational impulses, and the distorted perceptions of intoxication could cause them to approach or even cross the boundaries of madness.292 That crossing it seems, might be either temporary or permanent.

Greek literature abounds with phrases such as “drunk to the point of madness”.293 In a letter to Cyrus, Queen Tomyris accuses him of using the vine as a weapon to capture her son, saying that the Persians fill themselves with wine to the point of madness while shameful words rise up on the fumes: ἐμπιπλάμενοι μαίνεσθε οὕτως ὥστε κατιόντος τοῦ οἴνου ἐς τὸ σῶμα ἐπαναπλέειν ὑμῖν ἔπεα κακά.294 It is not always clear to what extent such statements are literal or metaphorical, for the line between the two was probably not so definitive in antiquity as it is today.295 When the Celts are described as so beside themselves with pleasure (ἔκφρονες) when they are first introduced to wine that they gather up their goods and chattels and emigrate to Italy, metaphor seems evident. But when one individual kills another, ἐκμανεὶς παντάπασιν ὑπὸ τοῦ θυμοῦ καὶ μέθης, it is not easily apparent where, or even if, ancient society perceived a boundary between this kind of action and ‘real’ madness.296 What becomes apparent is a nexus of ideas which include wine, drunkenness, violent emotion, madness, and death.

290 Plut. Mor. 256 E-F; Ach. Tat.4.9, 10, 15, 16, 17; Xen. An.4.8.20-21; Plut. Ant. 45.5; Plut. Arat. 54; Alex. 77; Luc. 43; Athen. Deip. 12.531f - 532a; Herod. 6.84 & 3.34. 291 Ael. VH 2.40; οἰνοῦττα - LSJ cites Arist.. Fr. 107 - a plant with intoxicating properties. 292 This awareness applies also to Roman drinkers to judge from the celebre dictum (Apul. Florida 20.96), prima...creterra ad sitim pertinet, secunda ad hilaritatem, tertia ad voluptatem, quarta ad insaniam. Cf. Pliny NH 14.137 on the allure of wine, quod hominem mentem mutet ac furorem gignat. 293 E.g. King Cotys of Thrace, ἔκφρων γενόμενος, Athen Deip. 12.531f.; cf. Archilochus 77, …ὡς Διωνύσοι ἄνακτος καλὸν ἐξάρξαι μέλος οἶδα διθύραμον οἴνῳ συγκεραυνωθεὶς φρένας. 294 Herod. 1.212.2. 295 Padel 1992, 35; on the Greek propensity to see madness as a quantitative matter see Dover 1974, 126-127. 296 Plut. Cam. 15.3; Plut. Mor. 251C.

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Plutarch has much to say about wine, drunkenness and madness. He relates an aetiological myth that vines and wine come from the blood of those who once battled the gods, died and went into the earth; so drunkenness drives men out of their senses and crazes them because they are filled with the blood of their ancestors (διὰ καὶ τὸ μεθύειν ἔκφρονας ποεῖν καὶ παραπλῆγας, ἅτε δὴ τῶν προγόνων τοῦ αἵματος ἐμπιπλαμένους).297 Elsewhere he asserts that ivy and wine do not cause intoxication, but a madness similar to that induced by henbane: ὅ γὰρ ἐμποιεῖ τοῖς πιοῦσι πάθος οὖ μέθην ἄν τις εἴποι, ταραχὴν δὲ καὶ παρφροσύνην, οἷον κύαμος ἐμποιεῖ καὶ πολλὰ τοιαῦτα κινοῦντα μανικῶς τὴν διάνοιαν.298 He makes another suggestive analogy with wine which is unfiltered and wine which has been clarified, saying that wine is stronger unfiltered just as a madman is stronger in his frenzy. But when he recovers, after a dose of hellebore or some other curative regime, his violence and tensions are gone and genuine strength and soundness of mind return to his system. In just this way clarifying removes the violent and insane element from wine (τὸ πληκτικὸν καὶ μανικὸν), bringing it to a gentle wholesome state.299 He gives further advice, noted above, citing Diogenes' observations on a youth “emotional and crack-brained” (ἐκστατικὸν ... καὶ παραφρονοῦν), and warning that children engendered by drunken fathers tend to be drunkards too, and by implication to inherit a predisposition to mental instability.300 As a way of making drinking less dangerous he advises that good conversation, by which Plutarch means speculative and instructional, when it accompanies wine removes the wild and manic element in it (τὸ ἄγριον καὶ μανικόν).301 Passages such as the above reinforce a connection which is stated unequivocally in other sources, that wine can be a cause of madness.302 Madness may depend upon the kind of wine drunk; Aelian tells of vines in Arcadia whose wine make women fertile (τεκνοποιοὺς τίθησιν) but takes away men's reason (ὁς τοῦ λογισμοῦ παράγει) and drives the Acadians mad (ἔκφρονας ... ποιεῖ).303 Madness was thought more likely, however, to come from excessive amounts of wine. The Persians seem to have suggested this as the reason for King Cambyses' madness: Νῦν ἄρα μέ φασι Πέρσαι οἴνῳ προσκείμενον παραφρονέειν καὶ οὐκ εἶναι νοήμονα.304 Aelian implies something similar in the case of a certain Apollodorus, who drank more wine than any man and neither concealed this vice nor endeavoured to hide his drunkenness and its evil consequences. Enflamed and enraged with wine he grew steadily more bloody and cruel

297 Plut. Mor. 353C. 298 Plut. Mor. 649A.10 - B1. 299 Plut. Mor. 693A 9-11 & 693B.3. 300 Plut. Mor. 1D-2A. 301 Plut. Mor. 717A. 302 There are several useful studies on alcoholism in classical antiquity: Rolleston 1927; McKinlay 1950 (see 230, n.1 for bibliography); Leibowitz, 1967; Preiser 1981; see also Dawson 1986, 94 & n.38. 303 Aelian VH, 13.6. Other wines were reputed to have different effects; in Thasos one gave deep, sweet sleep, but another wakefulness and disturbance, and in Achaea a certain kind of wine was said to cause women to miscarry. 304 Herod. 3.34.

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“increasing the cruelty of his nature by this corporeal vice.”305 Wine, as is apparent in other cases discussed below, can exacerbate an inherently defective nature to the point of aberration. Even in individuals whose nature is unexceptional, drink and strong emotion make a potent combination. According to one saying, “if anger lives next door to madness, ... drunkenness lives in the same house”.306 The case of Lucius (HN58), a mercenary of the despot of Aristotimus of Elis, is an instructive example. Full of lust and drink (μεταξὺ πίνων πρὸς ὀρφήν) he tried to force Micca, the daughter of a respectable citizen, to become his concubine. When she refused and begged her father to support her, Lucius, utterly crazed by rage and drink ἐκμανεὶς παντάπασιν ὑπὸ τοῦ θυμοῦ καὶ μέθης) stripped her, whipped her and finally slew her on her father's bosom.307 In antiquity, as now, heavy drinking and a disturbed mind ally in ways which are not always easy to disentangle: how much is cause, how much effect? Certainly people were aware of some relationship between the two, and there are occasional suggestions that not only was drinking thought to cause mental dysfunction, but the opposite could also be true. One version of the death of Alexander, for example, recounts how the King, with a mind already disturbed with fears and superstitions (ταραχώδης ... καὶ περίφοβος τὴν διάνοιαν), took to drinking heavily and was attacked with a fever. Raging with fever, he quenched his violent thirst with wine, fell into a delirium (φρενιτιᾶσαι) and died some days later.308 The last days of C. Marius too, as we have seen, were marked by disturbances of mind in which unseasonable and inappropriate bouts of drinking were implicated, although it is unclear from the extant accounts which came first.309 Too much wine was dangerous, but habitually drinking too strong a mixture of wine was a sure recipe for madness or even death.310: Alone and in moderation, wine may have been able to soothe cares and inspire dance, but undiluted wine combined with a hot temper was said to lead to savagery and madness.311 Undiluted wine was one

305 Ael. VH 14.41. 306 Plut. Mor. 503D-E. Cf. Antiphanes Fr. 295, Kock: λύπη μανίας ὁμότοιχος εἶναι μοι δοκεῖ 307 Plut. Mor. 251C. 308 Plut. Alex. 75; elsewhere (4,7) Plutarch describes Alexander as prone to drink (ποτικόν) and choleric (θυμοειδῆ) 309 Plut. Marius 45, HN51. 310 Death - Grmek 1983, 44, cites an inscription “whose topicality is not restricted to a single moment in Greek history: ‘Asclepiades, son of Anaxippos, an Ephesian. Twenty-two years of age, I drank in one gulp a large amount of unmixed wine and died, spitting blood.’ ” Bulletin épigraphique, no. 385 (1978). See C. Meillier, “Un cas médical dans une inscrition funéraire,” ZPE 38 (1980): 98. (Grmek, p. 44 and note 178 p.369). 311 Plut. Mor. 462B. The maddening power of undiluted wine was a topos in antiquity. Cf. Hipponax 67 (Campbell, 41); DS 4.2-4; Plutarch speaks of the insane God, Dionysus/wine, made sane and reasonable when chastened by a sober one, Poseidon/water. (Mor. 791.B-C). And in another figure of speech, he describes Cato's friend, M. Favonius, as one who was affected to the point of frenzy (μανικώτερον) by argument, as though it were unmixed

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of the reasons suggested for the madness of King Cleomenes.312 And the same verdict was reached on King Arcesilaus who died as the result of over-indulgence in unmixed wine which affected his reason.313 But Arcesilaus was seventy-five years of age when the wine finally overcame his reason, and the evidence seems to suggest that the effects of strong wine were thought to be most pernicious when a predisposing constitutional weakness was involved: Arcesilaus' old age, epilepsy in Cambyses case, or Cleomenes pre-existing tendency to madness.314 This assumption of an underlying physical defect exacerbated by unmixed wine is perhaps the basis for the legendary testing by the Spartans of newborns, as noted in the discussion above on hereditary factors. By bathing these infants in unmixed wine the Spartans assumed that any congenital weaknesses would thereby be exposed: λέγεται γὰρ ἐξίστασθαι τὰ ἐπιληπτικὰ καὶ νοσώδη πρὸς τὸν ἄκρατον ἀποσφακελίζοντα τὰ δ᾽ ὑγεινὰ μᾶλλον στομοῦσθαι καὶ κρατύνεσθαι τὴν ἕξιν.315 Finally wine may be implicated in madness and death by being witheld. Cornelius Nepos, (Dion 10.4 ) tells of Dion's son by Arete (HN59) who was kept drunk by Dionysios. When Dion returned and tried to cure him, appointing guardians to wean him from his bad habits, the son hurled himself from the roof and died. Plutarch's version is less specific, but suggests some kind of mental instability: Dion's son, in a fit over some trivial matter, threw himself off the roof and died, ὁ υἱὸς αὐτοῦ, σχεδὸν ἀντίπαις ὤν, ἔκ τινος λύπης καὶ ὀργῆς μικρὰν καὶ παιδικὴν ἀρχὴν λαβούσης ἔρριψεν ἑαυτὸν ἀπὸ τοῦ τέγους ἐπὶ τὴν κεφαλὴν καὶ διεφθάρη.316 Paradoxically, wine has been reported as a cure for the kind of madness which afflicted Antony's troops after eating the unfamiliar roots in Parthia. 317 Plutarch, who seems to have held a variety of opinions about wine and its effects, includes in the Quaestiones Conviviales a discussion of why those who are very drunk are less deranged (ἦττον παρακινητικοί) than those who are tipsy, and here he suggests parallels between the effect on the mind of wine and that of a dose of hellebore ( the drug commonly used as a cure for madness). Frenzy is the initial outcome,

wine. (Cato Minor) 46.2. M. Favonius appears several times in Plutarch's Lives, each time with a negative epithet, often an adjective indicating some kind of mental instability: Brut. 34 μανικῷ; Caes. 41.3, μανικῶς. 312 Herod. 6.84, αὐτοὶ δὲ Σπαρτιῆταί φασι ἐκ δαιμονίου μὲν οὐδενὸς μανἠναι Κλεομένεα, Σκύθῃσι δὲ ὁμιλήσαντά μιν ἀκρητοπότην γενέσθαι καὶ ἐκ τούτου μανῆναι. Cf. Athen. Deip. 427c and Aelian VH 2.41, a list of renowned drinkers in history. 313 DL 4.44, ἄκρατον ἐμφορηθεὶς πολὺν καὶ παρακόψας; cf. his elegy (4.45): τί μοι τόσον οἶνον ἄκρητον ἀφειδῶς ἔσπασας, ὥστε φρενῶν ἐκτὸς ὄλισθες ἑῶν; 314 Herod. 5.42. 315 Plut. Lyc. 16.2. 316 Dion 55.4. Although madness is not specifically stated here, it is assumed by van Hooff (1991, 97 & 98), perhaps because Roman law and several historical examples suggest that those killing themselves out of furor often threw themselves from a height. 317 Plut. Ant. 45.5 cf. Caes. 41. The medical writers seem divided about the use of wine in treating mental disturbances, see below ch. 9.

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but after comes calm and tranquillity.318 Clearly the relationship between wine and madness was not a simple one, either for the layman or, as will become apparent in the discussion below, among the medical writers. II. Drugs and Poisons The troops of both Antony and Xenophon experienced a deadly dementia as a result of accidental poisoning from natural substances, honey and roots. Other frenzy-inducing plants, ivy, henbane (ὑοσκύαµος) and (in the wrong dosage) hellebore have been noted.in passing.319 The latter two are medicinal plants whose dosage must be controlled. Henbane, a member of the nightshade family, was used to soothe, among other things, the pain of gout, swollen breasts at childbirth, and earache.320 However it was popularly thought to cause insanity, and in fact, just as with hellebore, a verb form meaning “to be raving mad” was constructed from it.321 Hellebore was used in a variety of purifying contexts, along with magical chants for example, to purify houses and flocks, but it was widely known as the medicinal cure commonly recommended for all forms of madness.322 If, however its quantity was not carefully controlled, convulsions, strangulation and death could result.323 There was a strong belief in the ability of folk medicines, coupled with magical charms and chants, to control the thoughts and feelings of another person.324 Such beliefs were entrenched in Athenian law, which recognized that a will or contract must be made without restraint, that is specifically without physical coercion or while under the influence of illness, madness, drugs or a woman. 325 Several examples given in the discussion at the beginning of this chapter demonstrate that it was popularly believed that controlling another person's mind could even extend to destroying it or driving them mad. Olympias gave drugs to Philip's son by another woman which injured his body and ruined his mind (διαφθαρῆναι τὴν διάνοιαν).326 A later Philip gave poisons to Aratus' son, which did not kill

318 Plut. Mor. 656B ff. 319 Mandragore was used for love potions, it could induce sleep or, in the wrong dose madness, Thphr. HP 9.8-9; Diosc. 4.76; Ivy: Plut. Mor. 291.A; 648B - 649F; Thphr. HP 3.18.6. 320 Henbane: Dioscorides 1.35; 4.69. 321 Henbane: Xen. Oe. 1.13, τὸν ὑοσκύαμον καλούμενον ... ὑφ᾽οὗ οἱ φαγόντες αὐτὸν παραπλῆγες γίγνονται. LSJ sv ὑοσκυαμάω and ἑλλεβοριάω. 322 Hellebore: Thphr. HP 9.9-10; Hipp. Salubr. 1.35; Diosc. 4.150-2. 323 O'Brien-Moore 1924, 34-35 for discussion; dangers of hellebore, Pliny, NH 25,51. 56-58, 61; Aul Gell. 17.15.5. For further discussion see below ch. 9. 324 E.g. Plut. Sol. 7.1 even virtue itself (ἄρετη), the most valuable and pleasing possession in all the world is often banished by sickness or drugs (ὑπὸ νόσων καὶ φαρμάκων). See Winkler 1990 esp. 79-82 on love potions; cf. also Luck 1985 and Faraone and Obbink 1991. Gager 1992 and Betz 1992 are valuable collections of magical charms and curses. 325 Plut. Sol. 21; cf. Harrison 1968-1971,i,152 n.5; MacDowell 1978, 101. See discussion below ch.6. 326 Plut. Alex. 77; cf. Philo, de Spec. Leg., 3.17, maladies caused by poisoning are difficult, sometimes impossible, to cure, with bodily afflictions less grievous than those of the soul: ἐκστάσεις γὰρ καὶ παραφροσύναι καὶ ἀφόρητοι μανίαι κατασκήπτουσι.

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him but deprived him of his reason (ὁ Φίλιππος οὐ θανασίμοις, ἀλλὰ μανικοῖς ἐξέστησε τοῦ λογισμοῦ φαρμάκοις). And Aretiphila of Cyrene, by charms and drugs which she pretended were love potions, destroyed the reason of her political enemy (διαφθεῖραι ... τὸν λογισμόν), making him crazy and foolish (ἐμπλήκτως καὶ ἀνοήτως). Not only was deliberate poisoning to be feared, but also the inadvertent danger to the mind of a potion gone wrong. Such popular fears are evident in the stories of Leukippe overdosed with aphrodisiac, and of Lucullus, whose freedman, in an effort to win more of his love, gave the aged general drugs so strong as to drive him from his senses and overwhelm his reason (ἐκστῆσαι δὲ καὶ κατακλῦσαι τὸν λογισμόν).327 Plutarch states that men caught by love potions and magic spells turn out to be dull-witted degenerate fools (ἐμπλὴκτοις καὶ ἀνοήτοις καὶ διεφθαρμένοις).328 It could be asked here, whether this was not rather the effect than the cause.

III. Madness from Other Substances: Certain peculiar examples of essentially natural substances were believed to cause madness in both animals and people: Pausanias tells of a well in Potnia whose waters caused the mares of the district to become mad.329 Springs, perhaps because of their associations with nymphs and nereids, were often thought to contain maddening properties which affected humans: one caused madness (τὸν γὰρ πιόντα φασὶν εἰς μανίαν ἐμπίπτειν), one made people drunk, another made them abstemious, one had a delayed reaction and harmed drinkers the next time they got drunk, and a spring on the island of Chios was said to make any who drank from it unawares stupid (fiunt insipientes), with a mind of stone (saxeos habiturum sensos; or, < ... ἀλλὰ νόῳ> πἐτρος ὁ τήνδε πιών).330 The story of Glaucus tells of some grasses growing near a spring which had the power to restore life to a hare Glaucus had caught; but when he himself tasted them he was driven mad and threw himself into the sea.331 A certain honey at Trapezus in Pontus had a heavy boxwood scent and was said to be a cure for epilepsy, but if eaten by healthy men sent them mad.332. Special stones too were believed to cause madness; two are named in the Pseudo-Aristotelian Mirabiles. One called σώφρων (by contradiction), if placed in an individual's lap, caused him to go mad and murder 327 Arat. 54; Mor. 256E-F; Ach. Tat. Leuk. 4.9, 10, 15-17; Plut. Luc. 43 cf. Mor. 792B. For literary examples of madness induced by aphrodisiacs see Faraone 1990, 243. 328 Plut. Mor.139A. 329 Paus. 9.8 cf. above, crows and dogs from οἰνοῦττα, Ael. VH 2.40; other instances of animals driven mad: cats by myrrh (Plut. Mor. 144D); horses by loco-weed (Theoc. Id. 2.48; Phot. s.v. Acts 26.24); horses from fear (Xen. Cyrop. 7.1); hare from fear (Xen. Cyrop. 6.40); mad dogs (Xen. Anab. 5.7 26, Mem. 4.1.3; Plut. Mor. 731A); mad wolves (Theoc. Id. 4.11); elephant ,from grief (Plut. Pyrr. 33.6); elephant, madness stopped by shock (Plut. Mor. 641B); tigers from perfume (Plut. Mor. 144D-E; 167C); madness in animal generally: tigers are maddened by drums,bulls by the colour red, and elephants are frightened by bright clothing (Plut. Mor. 963D-F: dogs, horses, cattle, foxes). 330 Rosen 1969, 81; DS 2.14; Vitruv.8.20-21; cf. Tac. Ann. 2.54; Pliny NH 2.231. Other springs were curative; Pausanias (8.19.2-3) tells of one called Alyssus, because if a rabid dog turned a man mad, or wounded or otherwise endangered him, its waters cured him. 331 Athen. Deip. 297a. 332 Ps. Arist. Mir. 831b; it is tempting to speculate that this is the same honey which figures in the accounts of Xenophon and Diodorus Siculus (HN25).

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a relative. Another, on Mount Berecynthus, was called μάχαιραν, and if anyone found it during the celebrations of the mysteries of Hecate, he became mad.333 In popular thought madness was associated with particular seasons of the year, and both literary references and medical opinion concur with this.334 Spring and fall were thought to be tumultuous times during which people's minds became precariously balanced. It was spring when the women in southern Italy were visited with the sudden mass mania causing them to jump up and run out of doors.335 Several sources concur that the fifth month of the Attic year, Μαιμακτηριών, when the weather changed frequently and the air was disturbed and gusty, madness was to be feared.336 Similarly, a strange condition of the air, it was suggested, was to blame for the outbreaks of suicidal madness which afflicted the young girls of Miletus: .... εἰκάζετο κρᾶσιν ἐκστατικὴν καὶ φαρμακώδη λαβὼν ὁ ἀὴρ τροπὴν αὐταῖς καὶ παραφρορὰν τῆς δανοίας ἐνεργάσασθαι.337 A belief in the power of astral bodies to influence the lives and fates of individuals was prevalent in Hellenistic and Roman times. It has been suggested that earlier beliefs in the powers of possession of lunar deities such as Hecate, Selene and Artemis became transformed with the rise of popular interest in the complex pseudo-science of astrology, into a belief that the heavenly bodies themselves were divinities.338 Whether this can be said of all levels of society is open to question; it seems, however, that among some circles, the position of the heavenly bodies were thought to dictate how susceptible an individual might be to mental disorders. A third century astronomical poem informs us that epilepsy, for example, is more to be feared when the moon is in conjunction with Mars. When the sun and moon are in opposition, and Saturn and Mars are sinking, people have visions of the dead and are prone to frenzy and madness. And when Saturn and Venus are in conjunction, slaves of the gods and custodians of the temples are subject to madness.339

333 Ps. Arist. Mir. 816b; 847a. 334 In his didactic poem Alexipharmaca (30), Nicander refers to a “maddening season”, ἀγριόεσσα ὀπώρη, the hot days of late summer. Something similar is suggested in Hes. Erg. 587, μαχλόνται δὲ γυναῖκες, ἀφαυρότατοι δ᾽τὸ ἄνδρες; cf. Alcaeus 347 and Campbell 1983, 30-31. Medical: Hipp. Epid. 1, 18 & 22, phrenitis with delirium, fears and depression was more common from the equinox until the setting of the Pleiades, Nov. 11; winter and spring too were hazardous up until the equinox; cf. Aretaeus, who warns of relapses in the spring (I 6, p. 59 Adams); Hipp. Aph. 3.20, “In spring occur melancholia, madness, epilepsy”; Aph. 3.22, “In autumn occur many summer diseases, ... epilepsy, madness, melancholia.” See discussion below ch. 8. 335 Appollon. Mir. 40 (Keller, 53). 336 Propitiatory sacrifices to Zeus Meilichios were consequently offered. Vaughan 1919, 19 cites Suidas s.v. Μαιμακτηριών; cf. Eustath. ad Od.., 22.481; Harpocrat. s.v. Μαιμακτηριών; for Zeus Meilichios see Farnell 18961909, i.64. 337 Plut. Mor. 249B. 338 Rosen 1969, 82-83. 339 Man. Apotelesmatica, 6.608 ff.; 1. (5) 229 ff.; 4.214 ff. cited in Vaughan 1919, 19 and Rosen 1969, 83.

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F. Emotions Severe emotional stress as a precipitating factor in temporary, or even enduring, mental impairment is specifically noted in a number of sources. The clearest example is the case of Timoleon, who, according to one account, became seriously mentally deranged after his reluctant complicity in the death of his tyrant brother.340 It is notable that his mental affliction is not described in terms of divine punishment for the murder of kin, rather it is explicitly stated that hatred on the part of some of his fellow citizens and outright rejection by his mother plunged Timoleon into severe ἀθυμία: τότε δὴ παντάπασι περίλυπος γενόμενος καὶ συνταραχθεὶς τὴν διάνοιαν, ὥρμησε μὲν ὡς διαφθερῶν ἑαυτὸν ἀπέχεσθαι τροφῆς· τῶν δὲ φίλων οὐ περιιδόντων, ἀλλὰ πᾶσαν δέησιν καὶ πᾶσαν ἀνάγκην προσενεγκαμένων, ἔγνω ζῆν καθ᾽ ἑαυτὸν ἐκ μέσου γενόμενος, καὶ πολιτείαν μὲν ἅπασαν ἀφῆκε, τοὺς δὲ πρώτους χρόνους οὐδὲ κατιὼν εἰς πόλιν, ἀλλ᾽ ἀδημονῶν καὶ πλανώμενος ἐν τοῖς ἐρημοτάτοις τῶν ἀγρῶν διέτριβεν ... Then indeed he became altogether a prey to grief and disordered in mind, and determined to starve himself to death; but his friends would not suffer this, and brought all manner of entreaty and constraint to bear upon him, so that he made up his mind to live by himself, apart from the world. So he gave up all public life, and for a long while did not even return to the city, but spent his time wandering in great distress of mind among the most desolate parts of the country. (Trans. Loeb) The unsettled mind was to last for twenty years before a turn of events brought about a recovery: Τὸ δὲ Τιμολέοντος ἐπὶ τοῖς πεπραγμένοις πάθος, εἴτ᾽οἶκτος ἦν τοῦ τεθνηκότος, εἴτε τῆς μητρὸς αἰδώς, οὗτω κατέκλασε κεὶ συνέτριψεν αὐτοῦ τὴν διάνοιαν, ὧστε εἴκοσι σχεδὸν ἐτῶν διαγενομένων μηδεμιᾶς ἐπιφανοῦς μηδὲ πολιτικῆς ἅψασθαι πράξεως 341 But the grief of Timoleon over what had been done, whether it was due to pity for his dead brother or to reverence for his mother, so shattered and confounded his mental powers that almost twenty years passed without his setting has hand to a single conspicuous or public enterprise. (Trans. Loeb) Whatever assumptions they may have had about the sources of such feelings, whether divine, anatomical and humoral, or a vague amalgam of the two, it is clear that for many people in antiquity a powerful emotional shock or

340 See above, HN 18. 341 Plut. Tim.. 5.3-4; 7.1.

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state could be a precipitating factor in mental breakdown. Rage, grief, pain, fear, despair, and love could each cause an individual (usually temporarily) to “go out of his mind”.342 Even stress and overwork, it seems, were states to be avoided. Herodotus reports some wise words of King Amassis of Egypt who likened human nature to a bow, which if kept constantly strung and taut, becomes useless. So too with man: εἰ ἐθέλοι κατεσπουδάσθαι αἰεὶ μηδὲ ἐς παιγνίην τὸ μέρος ἑωυτὸν ἀνιέναι, λάθοι ἂν ἤτοι μανεὶς ἢ ὅ γε ἀπόπληκτος γενόμενος.343 The shock of something unexpected or overwhelming, very often in a military context, could produce reactions which are described in terms of the vocabulary of madness. In defeat, for example, Pompeius (HN60) is described as speechless (ἄφθογγος) and like a man bereft of sense and crazed, μάλιστα δὲ ὅμοιος παράφρονι καὶ παραπλῆγι τὴν διάνοιαν. A similar reaction is recorded of his wife Cornelia, who fell to the ground ἔκφρων καὶ ἄναυδος, later regaining her senses (συννοήσασα).344 Fear, again usually in a military context, is an emotion whose extremes were seen to be very close to the borders of madness. Panic (ἔκπληξις) is a state of fear in which the mind has lost control and all normal calculations of action and consequence are suspended.345 A literary topos, descriptions of cities under attack frequently include some reference to citizens out of their minds with fear (ἔκφρων).346 The reality which underlay the use of what might seem to contemporary readers as a stock phrase may be seen in Plutarch's description of the mad mass frenzy of the Lycians (HN61), whose city was under siege by Brutus and his troops. The people were possessed by a terrible madness and a passion for death: Τοὺς δὲ Λυκίους δεινή τις ἐξαίφνης πρὸς ἀπόνοιαν ὁρμὴ καὶ λόγου κρείσσων κατέσχεν, ἥν τις ἔρωτι θανάτου μάλιστα προσεικάσειεν.347 A terrifying account follows in which the Lycians fed the fire that was consuming the city and then jumped into it themselves, men, women, slaves and children alike. Some threw themselves from the walls, children begged for their fathers to kill them, mothers slew their babies and

342 Rage: Lucius HN59; Grief: Timoleon HN18; Pain: a scorpion's sting, ἐπιτρίβει τοὺς ἀνθρώπους καὶ τοῦ φρονεῖν ἐξίστησι, Xen. Mem. 1.3.12; Fear: Plut. Dion 55.2, an apparition makes Dion παντάπασιν ἐκστατικῶς ἔχων καὶ δεδοικὼς; Despair: Thuc. 1.82.4; 7.81.5, ἀπονενοημένους; Love: Xen. Mem. 1.3.11. The medical writers concur with this popular belief that strong emotional shocks or experiences can cause mental disturbances. See below ch. 8. 343 Herod. 2.173, “anyone who was always serious, and never allowed himself a fair share of relaxation and amusement, would suddenly go off his head, or get a stroke.” (Trans. de Sélincourt). 344 Plut. Pomp. 72.1; 74.2; cf. Mor. 223B, Cleomenes, son of Anaxandridas, after defeat at Argos went out of his mind and slashed himself to death laughing and grinning (τῶν φρενῶν ἔξω γενόμενον); cf. Herod. 6.75 and 84; Athen. 427c. Shock can work the other way, however, and become a cure for madness (whether temporary or permanent is not specified), cf. Cambyses, Herod. 3.64. 345 DL 7.112; other instances of panic: Thuc. 2.94.1(2); 4.14.3(4); Herod. 4.203.3; 7.43.2; 8.38; cf. Dawson 1986, 94. On Pan and panic now see Borgeaud 1988. 346 Plut. Cato, 59.1-2; Ages. 31.4; Eumen. 15.4; cf. the recent news reports from inside the former Yugoslavia, e.g. the one cited in ch. 1. 347 Plut. Brut. 31.1-2, “But the Lycians were suddenly possessed by a dreadful and indescribable impulse to madness, which can be likened best to a passion for death.”

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hanged themselves, setting fire to their own houses. Even the Roman commander was so horrified at the spectacle that the fear of a repetition of it lingered with him on his next campaign.348 In a non-military context too, fear is seen to disturb the mind; Dion (HN62), for example, at the sight of an apparition was beside himself with fear (ἐκστατικῶς ἔχων).349 King Midas (HN63) became so depressed and disturbed in mind as the result of frightening dreams that he committed suicide by drinking bull’s blood.350 And Aristodemus, king of the Messenians (HN64), was so alarmed at the bad omens the seers saw that he lost heart and hope and killed himself.351 More often however, and especially among the medical writers, extreme and inexplicable fear is the sign of a disturbed mind; symptom rather than cause. But the poverty of detail in the brief anecdotes which form the bulk of our evidence often makes it difficult to tell whether fear is the source or outcome of a mental illness. As we have noted in the discussion of wine and madness, the descriptions of Alexander, who toward the end of his life became suspicious, fearful and superstitious as his mind grew perturbed and apprehensive (ταραχώδης ... καὶ περίφοβος τὴν διάνοιαν) demonstrate well this inherent difficulty with the sources.352 Anger is another emotion whose extreme forms can cross the border into madness. According to Plutarch, anger and μανία a are closely allied.353 He cites Cato the Elder as saying that a man who has lost his temper differs from one who has lost his mind only in duration of time.354 The case of Lucius, who killed Micca on her father's bosom, crazed with rage and drink is an object lesson on the disastrous outcome of rage swelling into madness.355 Anger again, in the form of jealousy, is said to have been the precipitating emotion for the insane attack by King Cotys of Thrace on his own wife.356

348 Plut. Brut. 32. 349 Plut. Dion 55.2. 350 Plut. Mor. 168F, ἀθυμῶν καὶ ταραττόμενος οὕτω κακῶς ἔσχε τὴν ψυχὴν. 351 Plut. Mor. 168F-169A, ἐξαθυμήσας καὶ κατασβεσθεὶς ταῖς ἐλπίσιν αὐτὸς ἑαυτὸν ἀπέσφαξεν. 352 Plut. Alex. 75.1. 353 Plut. Mor. 503D, μανία γὰρ ὁμότοιχος μὲν ἡ ὀργὴ; cf. 551A, anger and madness together cloud judgement. 354 Plut. Mor. 199A.5, Τὸν δ᾽ ὀργισζόμενον ἐνόμιζε τοῦ μαινομένου χρόνῳ διαφέρειν. Cf. Mor. 78C, some people are able to confront the world boldly only under the influence of anger or mental derangement (παραφροσύνη). 355 Plut. Mor. 251C; HN59. The phrase is also used less literally, e.g. Plut. Mor. 57E, “if criticized I go mad with anger” (μαίνομαι κακῶς ἀκούσας ὑπ᾽ ὀργῆς). 356 Athen. Deip. 12.532a cf. 296d. In Luc. Bis Accus. (HN64a) the young doctor predicts that his father’s angry rages will plummet him back into insanity (32) and in describing the incurable madness of his stepmother he stresses its emotional aetiology: it comes, he says from “some trouble of long ago, lurking in the soul” which has now broken out into the open ((6). He speaks of women as being especially prone to excessive passions - hatred, jealousy, grief, or anger - which can in time produce madness (30). There is even, he suggests, a special women’s form of insanity particularly noticeable in stepmothers (31).

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Grief alone, or anger together with grief, was also thought to be sufficient cause for mental derangement. Plutarch, citing Philemon, asserts that excessive grief, which he calls μανικά, can bring insanity, incurable ills, even suicide.357 Philostratos provides an exemplum, as we have seen, in his account of the trial of Herodes, in which, after the loss of his two foster daughters Herodes is described as out of his mind (ἔκφρων) with rage and grief. 358 In the accounts of Pausanias too, the Olympic victor Cleomedes, is said to have gone mad with grief when he was denied his crown, and Timanthes' fiery suicide when he found he could no longer string his bow, is clearly labelled μανία; whether it was from grief, rage, or a combination of the two.359 Allusions to passionate love and madness, another literary topos, are unavoidable in ancient literature.360 Love as a power which can derange both body and mind occurs early in Greek poetry and drama and was elaborated over the centuries, by Menander, in the Hellenistic romances, and then in the biographies and histories which were, in turn, influenced by them.361 Plato's fourth type of divine madness, erotic madness, inspired by Aphrodite and Eros is echoed and amplified by later writers by whom desire is often prefixed with an adjective suggesting madness: “ a mad desire born of love” – περιμανὴς ἐξ ἔρωτος ἐπιθυμία; men “insane with passion” – παρακινοῦσι καὶ μεμηνόσιν; the frenzied passion of adultery – λυσσῶντες; to love a woman or boy can be φαῦλα καὶ μανικά, in fact it can be called γυναικομανία or παιδομανία.362 Falling in love, according to Xenophon's Socrates, can make you worse than insane. 363 Examples of some ridiculous and extravagant passions (ἔρωτας) are enumerated by Aelian (HN65); among them Xerxes' love for a plane tree and in particular an Athenian youth who fell in love with a statue of Ἀγαθὴ Τύχη and killed himself when he was denied ownership of it, ἐκμανεὶς καὶ οἰστρηθεὶς ὑπὸ τοῦ πόθου.364

357 Plut. Mor. 609F; 102C, “διὰ λύπην γάρ,” φασί, “καὶ μανίαν γίγνεσθαι πολλοῖσι καὶ νοσήματ᾽οὐκ ἰάσμα”...; cf. Philemon 106, Kock, CAF II p. 512.. See also Antiphanes 295, Kock, λύπη μανίας ὁμότοιχος εἶναι μοι δοκεῖ. Livy 42.28.10-12, provides a Roman example in the suicide of Aemilius Papus who hanged himself overwhelmed by the death of one son and the dangerous illness of another: Obruit animum simul luctus metusque. 358 Philostrat. 560; HN1. 359 Paus. 6.9.6-8; 6.8.4; HN12 & 13. 360 According to Grmek 1983, 43-44, the almost clinical descriptions of the madness of love in Archilochus, Alcaeus, and Sappho are “the oldest detailed descriptions of a psychosomatic state perceived to be abnormal”. For bibliography see 368-9 n.175. 361 For example, Sappho 1; Ibycus 286; Eur, Hipp. 239-249; 503-507; 525-562 etc; Plato, Phaedr. 265B cf. Dodds 1951, 218. Especially useful is the historical introduction by Beecher and Ciavolella to the 1990 edition of Jaques Ferrand A Treatise on Lovesickness., 39-58, esp. 48. 362 Plut. Mor. 43D; Athen. Deip. 13.586; Plut. Mor. 655A; 769B; cf. also 623C & 654E and Fr. 136.39. Mor. 755E ff. Plutarch likens the disease of love to “the sacred disease” - of the mind rather than the body - and discusses Plato's doctrines of love and madness (Phaedr. 244A and Tim. 86E-87A). He does, however, distinguish between ‘real’ madness, τραχεῖα καὶ χαλεπὴ καὶ νοσώδης, and the divinely inspired frenzy of love., Mor. 758 D-E. 363 Xen. Mem. 1.3.11, “What do you think will happen to you through kissing a pretty face? Won't you ... be forced to concern yourself with things that no madman even would care about?” (σπουδάζειν δ᾽ ἀναγκασθῆναι ἐφ᾽ οἷς οὐδ᾽ ἂν μαινόμενος σπουδάσειεν;). 364 Ael. VH 2.14; 9.39.

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One of the first and most famous examples of what was reputed to be a historical case of love-sickness is attributed to the late fourth century B.C. physician Erasistratus, the story of Antiochus and Stratonice (HN66).365 Antiochus fell hopelessly in love with Stratonice, Queen of Upper Asia and young wife of his father Seleucus to whom she had borne a son. ... τὸν Ἀντίοχον ... διακεῖσθαι κακῶς καὶ πολλὰ ποιεῖν τῷ πάθει διαμαχόμενον, τέλος δ᾽ ἑαυτοῦ καταγνόντα δεινῶν μὲν ἐπιθυμεῖν, ἀνήκεστα δὲ νοσεῖν, κεκρατῆσθαι δὲ τῷ λογισμῷ, τρόπον ἀπαλλαγῆς τοῦ βίου ζητεῖν καὶ παραλύειν ἀτρέμα καὶ θεραπείας ἀμελείᾳ καὶ τροφῆς ἀποχῇ τὸ σῶμα, νοσεῖν τινα νόσον σκηπτόμενον. Antiochus was distressed, and resorted to many means of fighting down his passion, but at last, condemning himself for his inordinate desires, for his incurable malady, and for the subjugation of his reason, he determined to seek a way of escape from life, and to destroy himself gradually by neglecting his person and abstaining from food, under pretence of having some disease.366 The court physician, Erasistratus, easily recognized the symptoms of love sickness and by careful observation of the boys reactions to a variety of people, noted that whenever Stratonice came near the “tell-tale signs” increased. (Plutarch lists here Sappho's symptoms: “stammering speech, fiery flushes, darkened vision, sudden sweats, irregular palpitations of the heart,and ... helplessness, stupor, and pallor”.) Through diplomacy disingenuous in the extreme Erasistratus so arranged matters that Seleucus made his son King of Upper Asia and gave him Stratonice as his Queen. It should be noted that nowhere in this account is Antiochus described as mad, but reference is made to his reason being affected and to his determination to commit suicide, two clear.indications that the boundaries of madness are not far off.367 Love as madness and love as sickness are two ancient and recurring themes which arise out of the same problematic nexus of passions threatening to overwhelm reason and control.368 In a vein similar to the story of Antiochus and Stratonice a romance by Xenophon of Ephesus, with a plot full of Romeo and Juliet resonances, recounts how the young woman Anthia (HN67) came to her bridal chamber and drank poison, “either because she was mad or because she was in love with someone else.”369 Love again, but this time of a novel kind, is conjoined with jealousy and madness in Plutarch's description of the passion developed by Dionysios for Plato (HN68). He was said to be seized with a keen and even frenzied passion 365 Plut. Demet. 38; cf. Val.Max.Mem. 5.7.1. 366 Plut. Demet. 38.2 (Trans. Loeb). 367 Medical diagnoses and treatment of love-sickness is discussed in ch. 7, 8 & 9. Plutarch's account of Erasistratus' methods is said to have influenced Galen (ch.7) and much subsequent medical thought. (Ferrand 1990, 49-51). 368 Cf. Plut. Fr. 135, “To some love is a disease, to others a desire, ...friendship, ...a madness... a divine and demoniac change in the soul...a god outright....rightly its excess is a madness.(μανία).” 369 Xen. Eph. 3.9, εἴτε μανεῖσα εἴτε ἄλλου τινὸς ἐρῶσα

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for Plato's teaching and companionship (ἔρως ... ὀξὺς καὶ περιμανὴς) and is described as growing insanely jealous and acting like a moody lover (μαινομένου καθάπερ οἱ δυσέρωτες ὑπὸ ζηλοτυπίας).370

G. Divine Possession and Divine Punishment Madness in Greek myth and drama is almost universally visited upon mortals by divine forces. Sometimes it is the result of sacrilege, deliberate or accidental, and is a punishment; at other times chance and caprice play a role.371 Something of these assumptions about madness can be seen in the warning to philosophers by Xenophon's Socrates that to meddle with the secrets of the heavens means risking insanity (παραφρονῆσαι).372 There is historical evidence that this stratum of thought operated throughout antiquity especially with regard to causation in mythological cases of madness. Diodorus Siculus for example, tells the story of Boutes, son of Boreas (HN69), a Thracian exile who settled on Naxos from where he led raiding parties on sea and land. During an expedition to Thessaly, Boutes and his men came upon a group of female worshippers of Dionysus and tried to seize them. One woman, Coronis, was raped by Boutes; in anger she called upon Dionysus who struck Boutes with madness so that, out of his mind, he threw himself into a well to his death.373 Athenaeus too tells of the minor sea god Glaucus (HN70) who ate magical grasses growing round a spring, grasses which had revived a hare to life, and was afflicted with a divine madness so that when a storm arose by Zeus's decree he cast himself into the sea.374 However it is noteworthy that from the evidence we have examined above, divine causation in the form of direct intervention by the gods, although it is not entirely absent, appears not to have dominated explanations for insanity in everyday life. As we shall see, however, there was a pervasive belief that certain lesser supernatural forces, most notably daemons, could bring about all kinds of mental disturbances at will.375

370 Plut. Dion. 11; 16. 371 E.g. a forgotten sacrifice is suggested as a cause Soph. Aj. 172-86; Eur. Hipp. 141ff cf. Parker 246;252. On disease, including madness, and divine vengeance generally see Parker 1983, ch.8; other examples: Cassandra, Aesch. Ag; Orestes, Aesch. Choe.; Eur. Or. ; Io, Aesch Pr.; Pentheus, Eur.Ba.; the madness of the daughter of Proetus, Ael. VH 3.42; cf. also Soph. Ant. 955-962 (Dryas). Apollodorus recounts the major myths of madness, among them: the Proeteids (2.2.2 & 1.9.12, Loeb i, 147, 149 & 91); Acteon’s dogs (3.4.4, Loeb i, 323); Athamas (1.9.2 & 3.4.3, Loeb i, 77, 319); Lycurgus (3.5, Loeb i, 324-331); Alcmaeon (3.7.5, Loeb i, 380-385); See also Parker 1983, esp. ch. 7; 129; 218; 243-248; 288; 208, 215-16; 372. P. cites Arist. Fr. 58 (Austin) from the lost play Heroes; see discussion below. For the motif of madness and divine punishment in Greek tragedy see Padel 1981, passim; 1992, ch. 8. 372 Xen. Mem. 4.7.6. Anaxagoras and his insane pride in his explanations of divine machinery is held up as a dire warning. 373 DS 5.50.5, τὸν δὲ μανίαν ἐμβαλεῖν τῷ Βούτῃ, καὶ δὶα τοῦτο παρακόψαντα ῥῖψαι ἑαυτὸν εἴς τι φρέαρ καὶ τελευτῆσαι. The story of Boutes belongs to a group of legends centred around the refusal to accept the worship of Dionysus or the active opposition to it, cf. Homeric Hymn 7, To Dionysus and Rosen 1969, 78-80. 374 Athen. Deip. 297A, ἀναζωπυρήσαντος δὲ τοῦ λαγὼ τῇ βοτάνῃ ἐπιγνόντα τῆς βοτάνης τὴν δύναμιν ἀπογεύσασθαι καὶ ἔνθεον γενόμενον ἐπιγενομένου χειμῶνος κατὰ Διὸς βούλησιν εἰς τὴν θάλασσαν αὑτὸν ἐκρῖψαι. 375 Divine causation, in the sense that all of nature and man too are divinely directed, is another matter. See Hipp. Morb. Sacr. 21.

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I. Madness as Punishment There are a number of historical reports in which madness is said to have afflicted individuals as the direct outcome of violations of the boundaries between the human and the divine.376 Herodotus cites several examples: in one an Athenian trireme was despatched to Aegina to restore forcibly to Attica two sacred olive wood statues of Damia and Auxesia (HN71). The statues were difficult to move and while the Athenians were hauling on them with ropes a sudden thunderclap and earthquake occurred, upon which the entire ships crew suddenly went mad (ἀλλοφρονῆσαι) and began to kill one another; only one survivor remained to return alone to Phaleron.377 In the account Herodotus gives too of the multiple explanations for the madness of King Cleomenes, it is only his fellow countrymen who consider the king's madness to have a natural explanation - the effects of drinking undiluted wine Scythian style.(6.84). The rest of the Greeks, and Herodotus himself, each opt for one of several supernatural explanations which involve divine punishment: ... ὡς μὲν οἱ πολλοὶ λέγουσι Ἑλλήνων, ὅτι τὴν Πυθίην ἀνέγνωσε τὰ περὶ Δημαρήτου [γενόμενα] λέγειν, ὡς δὲ Ἀθηναῖοι [μοῦνοι] λέγουσι, διότι ἐς Ἐλευσῖνα ἐσβαλὼν ἔκειρε τὸ τἐμενος τῶν θεῶν, ὡς δὲ Ἀργεῖοι, ὅτι ἐξ ἱροῦ αὐτῶν τοῦ Ἄργου Ἀργείων τοὺς καταφυγόντας ἐκ τῆς μάχης καταγινέων κατέκοπτε καὶ αὐτὸ τὸ ἄλσος ἐν ἀλογίῃ ἔχων ἐνέπρησε. (6.75) Most people in Greece think that that was a punishment for having corrupted the Priestess at Delphi and inducing her to say what she did say about Demaratus; the Athenians, however, put it down to his devastating the sacred land of Demeter and Persephone, when he marched to Eleusis; while the Argives maintain that it was a punishment for his sacrilege when, after a battle, he fetched the Argive fugitives from the holy ground of Argos, and cut them to pieces, and then showed such contempt for the grove itself that he burned it down. ...ἐμοὶ δὲ δοκέει τίσιν ταύτην ὁ κΚλεομένης Δημαρήτῳ ἐκτεῖσαι. (6.84) ...my own opinion is that Cleomenes came to grief as a punishment for what he did to Demaratus. (Trans. de Sélincourt)

376 Madness was of course not the only affliction visited upon transgressors by divine vengeance: see for example Grmek 5.91, Heraclides died of apoplexy, the Pythia's revenge for a forged utterance. Milns 1990, 456 suggests that madness could be a punishment for merely human wrongdoing. He cites Aristoph.Fr. 58 (Austin) in which the chorus of heroes proclaims that they punish transgressors with all manner of diseases such as spleen, dropsy and madness On Heroes as bestowers of good and evil see Merkelbach 1967 and bibliography below ch. 6, n. 66. Both the Heroes and the Furies (who drove Orestes mad in punishment for his matricide), are personal and local divinities. 377 Herod. 5.82-88; madness 5.85.

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Again the multiple explanations offered by Herodotus for the madness of King Cambyses are not without a component of divine retribution. It is only after Cambyses has attacked the Apis calf (3.30), that he is described as plunging into total madness, Καμβύσης δὲ, ὡς λέγουσι Αἰγύπτιοι, αὐτίκα διὰ τοῦτο τὸ ἀδίκημα ἐμάνη, ἐὼν οὐδὲ πρότερον φρενήρης. But significantly in the case of Cambyses Herodotus distances himself from this line of thought. He characterizes Cambyses' subsequent vicious acts toward his family as the acts of a madman, but leaves the aetiology open: ταῦτα μὲν ἐς τοὺς οἰκηιοτάτους ὁ Καμβύσης ἐξεμάνη, εἴτε δὴ διὰ τὸν Ἆπιν εἴτε διὰ ἄλλως, οἷα πολλὰ ἔωθε ἀνθρώπους κακὰ καταλαμβάνειν· καὶ γάρ τινα καὶ ἐκ γενεῆς νοῦσον µεγάλην λέγεται ἔχειν ὁ Καµβύσης, τὴν ἱρὴν ὀνοµάζουσἰ τινες. οὔ νύν τοι ἀεικὲς οὐδὲν ἦν τοῦ σώµατος νοῦσον µεγάλην νοσέοντος µηδὲ τὰς φρένας ὑγιαίνειν.378 These two crimes were committed against his own kin; both were the acts of a madman - whether or not his madness was due to his treatment of Apis. It may, indeed, have been the result of any one of the many maladies which afflict mankind, and there is, in fact, a story that he had suffered from birth from the serious complaint which some call 'the sacred sickness'. There would then be nothing strange in the fact that a serious physical malady should have affected his brain. (Trans. de Sélincourt) Indeed Herodotus goes further in his final summary of Cambyses' character and, in a reversal of traditional explanation, cites the sacrilegious acts of Cambyses as certain evidence which demonstrates and even proves that he is insane - for no man in his right mind would so assault and mock all that law and custom had made sacred: “In view of all this, I have no doubt whatever that Cambyses was completely out of his mind; it is the only possible explanation of his assault upon, and mockery of, everything which ancient law and custom have made sacred in Egypt.”379 A link between madness and divine punishment persists into the later literature; the successful ruse of Nicias' feigned madness for example, depended entirely on the likelihood that the general public would immediately believe it plausible that his sacrilegious remarks about the Mothers would result in a divinely imposed madness.380 And

378 Herod. 3.33. Parker 1983, 243, asks a significant question about Herodotus' explanations for diseases - and here we may include madness - and that is to what extent do the diseases of ordinary people have the same causes as those of the great? It is worth bearing in mind with respect to the figures of both Herodotus and tragedy that, “the lives of kings who exercised a decisive influence on the course of history were easily absorbed into the schemata of crime and punishment characteristic of myth. Would Herodotus, smitten by a chronic disease, have believed his own affliction to be equally rich in significance?” 379 Herod. 3.38, (Trans. de Sélincourt): πανταχῇ ὦν μοι δῆλά ἐστι ὅτι ἐμάνη μεγάλως ὁ Καμβύσης· οὐ γὰρ ἂν ἱροῖσί τε καὶ νομαίοισι ἐπεχείρησε καταγελᾶν. 380 Plut. Marc. 20 HN31.

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the story in Diodorus Siculus about the wife of the Phocian commander burned alive in her house by her eldest son in a fit of madness, suggests that madness might be visited upon an individual one stage removed from the original transgression. For it was the wife who wore one of the gold necklaces taken from Delphi (said to be the fatal necklace of Eriphyle, wife of Amphiaraus).381 Several other accounts, like that of Herodotus 5.85, particularly concern the powers of cult statues to produce madness. Plutarch records an incident said to have taken place at Pellene during the Aetolian war (HN72). According to one version of the story, while the city was under attack by the invading Aetolians, the priestess of Artemis carried the image of the goddess out from the temple, an image said to be so powerful that none dared look upon it and even the trees past which it was carried would become barren and drop their fruit. The priestess held the image directly in the faces of the invaders, causing them to lose their reason and judgement, ἔκφρονας καταστῆσαι καὶ παρελέσθαι τὸν λογισμόν.382 Pausanias also tells of a wooden image sacred to Artemis Orthia at Limnaeum in Laconia. As proof that it was the authentic image stolen from the Tauric lands by Orestes and Iphigenia, Pausanias tells us that “Astrabacus and Alopecus, sons of Irbus, son of Amphisthenes, son of Amphicles, son of Agis, when they found the image straightway became insane” (αὐτίκα παρεφρόνησαν).383 II. Madness and Possession Apart from the above accounts which are concerned to show the power of the divine to inflict madness upon those who transgress certain boundaries, there are others in which the focus is upon the capacity of the gods to take possession of human faculties, whether it be in a specifically religious context, such as the enthusiasm of the Bacchic rites and the oracular states of seers and prophets, or in a more general seizure which onlookers may simply label divine or daemonic possession, conditions variously described as κακοδαίμων, νυμφόληπτος, or the “sacred disease” (ἱερὰ νοσός).384

381 DS 16.64.2 HN37. The necklace, of mythological fame, was the work of Hephaestus and the wedding gift of Cadmus to his bride Harmonia, daughter of Ares and Aphrodite. It was used by Polynices to bribe Eriphyle, wife of Amphiaraus to persuade Amphiaraus to take part in the ill-fated expedition of the Seven against Thebes. Other wives of the Phocian commanders who wore other necklaces (one from Helen of Troy) apparently suffered other forms of divine punishment. 382 Plut. Arat. 32.4. 383 Paus. 3.16.9 HN11 (Trans. Loeb). 384 Although the rites connected with the worship of Dionysus are widely recognized to have involved ecstatic possession, they were not unique. Artemis, for example, is described by Timotheus as μαινάδα θυιάδα φοιβάδα λυσσάδα (apud Plut. Mor. 22A and 170A); cf. Lyra Graeca iii, 620. For other ecstatic rituals, Cybele, the Mother, the Corybantes see below.ch. 6.

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i. Ritual Possession Bacchic revelry in the worship of Dionysus and the popular belief in its propensity to lead worshippers into madness is demonstrated clearly in Herodotus' descriptions of the Scythian's reactions to finding that their king, Scylas, was being initiated into these alien Greek rites (HN73). Σκύθαι δὲ τοῦ βακχεύειν πέρι Ἕλλησι ὀνειδίζουσι· οὐ γάρ φασι οἰκὸς εἶναι θεὸν ἐξευρίσκειν τοῦτον ὅστις μαίνεσθαι ἐνάγει ἀνθρώπους. Now the Greek custom of indulging in Dionysian orgies is, in Scythian eyes, a shameful thing; and no Scythian can see sense in imagining a god who drives people out of their wits. (4.79, Trans. de Sélincourt) One of the Greeks informed the Scythians outside the town that their king was celebrating in full Bacchic frenzy and persuaded them to come and see for themselves:

"Ἡμῖν γὰρ κατραγελᾶτε, ὦ Σκύθαι, ὅτι βακχεύομεν καὶ ἡμέας ὁ θεὸς λαμβάνει· νῦν οὗτος ὁ δαίμων καὶ τὸν ὑμέτερον βασιλέα λελάβηκε, καὶ βακχεύει τε καὶ ὑπὸ τοῦ θεοῦ μαίνεται." “You laugh at us,” he said, “for being possessed by the spirit of Dionysus when we celebrate his rites. Well, this same spirit has now taken hold of your own king; he is under its influence Dionysus has driven him mad.”(4.79, Trans. de Sélincourt)

Needless to say the outcome of this exotic indulgence was for Scylas both politically and personally disastrous.385 The divine madness of Dionysiac worship has a long tradition and here the theme has been conflated with another type of divine madness, divine punishment, in Aelian's jumbled miscellany of “certain women who fell mad” (HN74). Ἐλέγη καὶ Κελαινὴ Προίτου θυγατέρες. μάχλους δὲ αὐτὰς ἡ τῆς Κύπρου βασιλὶς εἰργάσατο. ἐπὶ μέρους δὲ τῆς Πελοποννήσου [καὶ] ἔδραμον, φασί, γυμναὶ μαινόμεναι, ἐξεφοίτησαν δὲ καὶ εἰς ἄλλας χώρας τῆς Ἑλλάδος, παράφοροι οὖσαι 385 Herod. 4.80.

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ὑπὸ τῆς νόσου. ἀκούω δὲ ὅτι καὶ ταῖς Λακεδαιμονίων γυναιξὶν ἐπέπεσέ τις οἶστρος βακχικὸς καὶ ταῖς τῶν χίων. καὶ αἱ τῶν Βοιωτῶν δὲ ὡς ἐνθεώτατα ἐμάνησαν καὶ ἡ τραγῳδία βοᾷ. μόνας δὲ ἀφηνιάσαι τῆς χορείας ταύτης λέγουσι τοῦ Διονύσου τὰς Μινύου θυγατέρας Λευκίππην καὶ Ἀρσίππην καὶ Ἀλκιθόην. αἴτον δὲ ὅτι ἐπόθουν τοὺς γαμέτας, καὶ διὰ τοῦτο οὐκ ἐγένοντο τῷ θεῷ μαινάδες. ὁ δὲ ὀργίζεται, καὶ αἱ μὲν περὶ τοὺς ἱστοὺς εἶχον καὶ ἐπονοῦντο περὶ τὴν Ἐργάνην εὖ μάλα φιλοτίμως· ἄφνω δὲ κιττοί τε καὶ ἄμπελοι τοὺς ἱστοὺς περεῖρπον, καὶ τοῖς ταλάροις ἐνεφώλευον δράκοντες, ἐκ δὲ τῶν ὀρόφων ἔσταζον οἴνου καὶ γάλακτος σταγόνες. τὰς δὲ οὐδὲ ταῦτα ἀνέπειθεν ἐλθεῖν εἰς τὴν λατρείαν τοῦ δαίμονος. ἐνταῦθά τοι καὶ πάθος εἰργάσαντο ἔξω Κιθαιρῶνος, οὐ μεῖον τοῦ ἐν Κιθαιρῶνι· τὸν γὰρ τῆς Λευκίππης παῖδα ἔτι ἁπαλὸν ὄντα καὶ νεαρὸν διεσπάσαντο οἷα νεβρὸν τῆς μανίας ἀρξάμεναι αἱ Μινυάδες, εἶτα εντεῦθεν ἐπὶ τὰς ἐξ ἀρχῆς ᾖξαν μαινάδας· αἱ δὲ ἐδίωκον αὐτὰς διὰ τὸ ἄγος. ἐκ δὴ τούτων ἐγένοντο ὄρνιθες, καὶ ἡ μὲν ἤμειψε τὸ εἶδος εἰς κορώνην, ἡ δὲ εἰς νυκτερίδα, ἡ δὲ εἰς γλαῦκα. Elege and Kelaine were daughters of Proetus. The Queen of Cyprus made them become lustful, for they say that they ran around parts of the Peloponnesus naked and raving and that, carried away with this disease, they wandered into other parts of Greece too. And I hear that a Dionysian frenzy fell also upon the Spartan women and the women of Chios - and τragedy tells us that the women of Boeotia too became transported with a divine madness. The say that only the daughters of Minos, Leukippe, Aristippe and Alkithoe, declined the dance of Dionysus, because they desired to have husbands and therefore refused to be Maenads to the God. At this Dionysus became enraged. The three women stayed busy at their looms and devoted themselves to their work. But suddenly branches of ivy and vines twined about their looms and serpents lurked in their baskets, and from the roof distilled drops of milk and wine. But these things did not persuade them to enter into the God's service. Then indeed they committed a deed no less than that in Cithaeron, for the Minyades, seized with madness, tore into pieces Leukippe's tender young infant, thinking it a kid. After

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that they turned eagerly to the original Maenads, but they persecuted them for this polluted act and because of this they became birds; one was changed into a crow, the other into a bat, and the third into an owl.386 The majority of anecdotes about the dangers of Dionysiac frenzy concern women, but not all: Herodotus' account of Scylas and particularly a comment in Pausanias make it clear that intoxication and violence could be anticipated from any celebrant: ἐνταῦθα καὶ Διονύσου ναός ἐστιν Αἰγοβόλου. θύοντες γὰρ τῷ θεῷ προήχθησἀν ποτε ὑπὸ μέθης ἐς ὕβριν. ὥστε καὶ τοῦ Δοινύσου τὸν ἱερέα ἀποκτείνουσιν· ἀποκτείναντας δὲ αὐτίκα ἐπέλαβε νόσος λοιµώδης, καὶ σφισιν ἀφίκετο ἴαµα ἐκ Δελφῶν τῷ Διονύσῷ θύειν παῖδα ὡραῖον· ἔτεσι δὲ οὐ πολλοῖς ὕστερον τὸν θεόν φασιν αἶγα ἱερεῖον ὑπαλλάξαι σφίσιν ἀντὶ τοῦ παιδός. Here there is also a temple of Dionysus Goat-shooter. For once, when they were sacrificing to the god, they grew so violent with wine that they actually killed the priest of Dionysus. Immediately after the murder they were visited by a pestilence, and the Delphic oracle said that to cure it they must sacrifice a boy in the bloom of youth. A few years afterwards, so they say, the god substituted a goat as a victim in place of their boy.387 Plutarch also tells of a ritual still performed at Orchomenos in his own day at the Agrionia, when women descended from the Minyades fled from the priest of Dionysus who pursued them, armed with a sword and was entitled to kill any of the women he caught, and, he says,”in my time the priest Zoilos killed one of them”.388 There were many perceived dangers attendant upon Bacchic frenzy, both to the individual and to society at large.389 Plutarch's account of the women of Phocis who unwittingly wandered into enemy territory while celebrating the Dionysian Mysteries, emphasizes the vulnerability of individuals in the grip of divine possession.

386 Ael. VH 3.42, (Trans. mine) Accounts of women maddened by the god for rejection of his cult include the story of Pentheus and Agave, preeminently presented in Eur. Ba.; cf. Apoll. Lib. 3.2 ; some versions of the three daughters of Proteus and the three daughters of Minyas, Plut. Mor. 299E-300A. On the genealogy of these myths see now Dowden 1989, 71-95. Men too could be similarly maddened: see for example, the stories of Boutes HN69, of Pentheus, and of Lycurgus, the Thracian king (HN75), who, having opposed the worship of Dionysus, was driven mad for his impiety and, imagining he was trimming a branch off a vine, killed his son with an axe (Apoll.. Lib. 3.5.1) cf. Plut. Mor. 15E. 387 Paus. 9.8.2, (Trans. Loeb); cf. the human sacrifice of three Persian youths alleged to have been offered by the Greeks to Dionysus the Devourer before the battle of Salamis, Plut. Them. 13.2-3, who cites Phanias the Lesbian, a philosopher and historian. On the historicity of this episode see now Henrichs 1981. 388 Plut. Mor. 299F, καὶ γίγνεται παρ᾽ ἐνιαυτὸν ἐν τοῖς Ἀγριωνίοις φυγὴ καὶ δίωξις αὐτῶν ὑπὸ τοῦ ἱερέως τοῦ Διονύσου ξίφος ἔχοντος. ἔξεστι δὲ τὴν καταληφθεῖσαν ἀνελεῖν, καὶ ἀνεῖλεν ἐφ᾽ ἡμῶν Ζωίλος ὁ ἱερεύς.

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... αἰ περὶ τὸν Διόνυσον γυναῖκες, ἅς Θυιάδας ὀνομάζουσιν, ἐκμανεῖσαι καὶ περπλανηθεῖσαι νυκτὸς ἔλαθον ἐν Ἀμφίσσῃ γενόμεναι· κατάκοποι δ᾽ οὖσαι καὶ μηδέπω τοῦ φρονεῖν παρόντος αὐταῖς ἐν τῇ ἀρορᾷ προέμεναι τὰ σώματα σποράδην ἔκειντο καθεύδουσαι. τῶν δ᾽ Ἀμφισσέων αἱ γυναῖκες, φοβηθεῖσαι μὴ διὰ τὸ σύμμαχον τὴν πόλιν Φωκέων γεγονέναι καὶ συχνοὺς στρατιώτας παρεῖναι τῶν τυράννων ἀγνωμονηθῶσιν αἱ Θυιάδες, ἐξέδραμον εἰς τὴν ἀγορὰν ἅπασαι καὶ κύκλῳ περιστᾶσαι σιωπῇ κοιμωμέναις μὲν οὐ προσῄεσαν, ἐπεὶ δ᾽ ἐξανέστησαν, ἄλλαι περὶ ἄλλας ἐγίνοντο θεραπεύουσαι καὶ τροφὴν προσφέρουσαι· τέλος δὲ πείσασσαι τοὺς ἄνδρας ἐπηκολούθησαν αὐταῖς ἄχρι τῶν ὅρων ἀσφαλῶς προπεμπομέναις. ...the women devotees of Dionysus, to whom they give the name of Thyads, in Bacchic frenzy wandering at night unwittingly arrived at Amphissa. As they were tired out, and sober reason had not yet returned to them, they flung themselves down in the market-place, and were lying asleep, some here, some there. The wives of the men of Amphissa, fearing, because their city had become allied with the Phocians, and numerous soldiers of the despots were present there, that the Thyads might be treated with indignity, all ran out into the market-place, and, taking their stand round about in silence, did not go up to them while they were sleeping, but when they arose from their slumber, one devoted herself to one of the strangers and another to another, bestowing attentions on them and offering them food. Finally, the women of Amphissa, after winning the consent of their husbands, accompanied the strangers, who were safely escorted as far as the frontier.390

On the other hand a comment by Artemidorus on the Mysteries of Dionysus suggests something of the underlying fear with which the ritually possessed were viewed and the danger they were felt to be to others. (HN76)391 Αἱ περιοχαὶ τῶν μυστηρίων ὅμοια τὰ ἀποτελέσματα ποιοῦσι καὶ ἐν χρόνῳ τοσούτῳ ὁρώμενα ἐν ὅσῳ τελεῖται τὰ μυστήρια. γυνὴ ἔδοξε χορεύειν τῷ Διονύσῷ μεθυσθείσα. τὸ ἑαυτῆς παιδίον ἀπέκτεινεν ὃν τριετές. καὶ γὰρ ὁ περὶ Πενθέα καὶ Ἀγαυὴν λόγος τοιοῦτος, καὶ τῷ θεῷ τριετηρίδες ἄγονται ἑορταί.

...the events that form the basis of the Mysteries come true in the same way in real life and the amount of time it takes to see the Mysteries determines the amount of 389 On ritual madness (Plato's telestic madness) see Phdr.. 244A-245A; 265B; Dodds 1951, 75-80 and Appendix 1, 270-282; Linforth 1946; Euripides Ba. is of course the locus classicus for the tension between the ecstatic worship of Dionysus and social order and control. 390 Plut. Mor. 249E-F HN28 above. Elsewhere Plutarch emphasizes the derangement and frenzy of worshippers: Mor. 362A-B; 389B. 391 See Padel 1983, esp 6 - 7; 12-14.

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time in which they will be accomplished. A woman dreamed that she was drunk and danced in a chorus to honor Dionysus. She killed her own child who was three years old. For such is the legend of Pentheus and Agave. And the festivals conducted in honour of the god are triennial.392 Artemidorus also notes that it is inauspicious to dream of dancing in the rites of Dionysus, waving a thyrsus, carrying trees in a procession, or doing anything else that is pleasing to the god - unless one is a slave. “For most men, it foretells folly and harm because of the ecstasis of the mental processes and the frenzy, but for slaves, it is a symbol of freedom”.393 Clearly the telestic madness connected with the worship of Dionysus was a powerful, enduring, and often problematical facet of social life in antiquity; a fact which is underscored by the outlawing of Bacchanalian celebrations in all of Italy in 186 BCE.394 ii. Madness and Prophecy The evolution of the associative link between madness and prophecy in Greek thought has been brilliantly discussed by Dodds and his work will not be duplicated here. As one of the four forms of divine madness, prophetic inspiration is distinguished by Plato and some instances of it are identifiable in several other sources.395 In the Timaeus (71-72) it is stated clearly that prophetic states are aberrant and the individuals who experience them insane.396 The power of prophecy is assigned to the liver, the baser, irrational part of humans, and divination is thus only possible for individuals when they are not in their right minds; it is thus the responsibility of the sane to decipher the prophetic message:

392 Artem. Oneir. 4.39 (Trans. R.J. White); see Eur. Ba. 1042-1164; On women as models for possession see Padel, 1983. 393 Artem Oneir. 2.37 (Trans. R.J. White), χορεύειν δὲ τῷ θεῷ ἢ θυρσοφορεῖν ἢ δενδροφορεῖν ἢ ἄλλο τι τῶν κεχαρισμένων τῷ θεῷ πράττειν πᾶσι πονηρὸν πλὴν δούλων· οἷς μὲν γὰρ διὰ τὴν ἔκστασιν τῶν φρενῶν καὶ τὴν παρακοπὴν ἀφροσύνην καὶ βλάβην προαγορεύει, οἷς δὲ διὰ τὸ ἀνεπίστρεπτον τῶν εντυγχανόντων καὶ διὰ τὴν τοῦ θεοῦ προσηγορίαν καὶ εὐχαριστίαν ἐλευθερίας ἐστὶ σημαντικόν. 394 Livy 39.8-19; cf. CIL I2 no. 581 (=ROL, IV, 254-59). Individual worship of Bacchus was tolerated; it was the mass participation by groups in orgiastic rites which were prohibited for religious, social, and political reasons. 395 Pl. Phdr. 244A-B; 265A and Tim. 71D-E; cf. Eur. Ba., 298-299. See also Dodds 1951, 68-75. A recurring, yet minor, motif among several of the medical writers (e.g. Cael Aur. Morb. Chron. 1.150) is the popular association of madness and prophecy - but it is an attribute only of some madmen; see below ch. 7. 396 Cf. also Pl. Phdr. 244d-e.

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ἱκανὸν δὲ σημεῖον ὡς μαντικὴν ἀφροσύνῃ θεὸς ἀνθρωπίνῃ δέδωκεν· οὐδεὶς γὰρ ἔννους ἐφάπτεται μαντικῆς ἐνθέου καὶ ἀληθοῦς, ἀλλ᾽ ἢ καθ᾽ ὕπνον τὴν τῆς φρονήσεως πεδηθεὶς δύναμιν ἢ διὰ νόσον ἢ διά τινα ἐνθουσιασμὸν παραλλάξας. ἀλλὰ ξυννοῆσαι μὲν ἔμφρονος τά τε ῥηθέντα ἀναμνησθέντα ὄναρ ἢ ὕπαρ ὑπὸ τῆς μαντικῆς τε καὶ ἐνθουσιαστικῆς φύσεως, καὶ ὅσα ἂν φαντάσματα ὀφθῇ, πάντα λογισμῷ διελέσθαι, ὅπῃ τι σημαίνει καὶ ὅτῳ μέλλοντος ἢ παρελθόντος ἢ παρόντος κακοῦ ἢ ἀγαθοῦ· τοῦ δὲ μανέντος ἔτι τε ἐν τούτῳ μένοντος οὐκ ἔργον τὰ φανέντα καὶ φωνηθέντα ὑφ᾽ ἑαυτοῦ κρίνειν, ἀλλ᾽ εὖ καὶ πάλαι λέγεται τὸ πράττειν καὶ γνῶναι τά τε αὑτοῦ καὶ ἑαυτὸν σώφρονι μόνῳ προσήκειν. ὅθεν δὴ καὶ τὸ τῶν προφητῶν γένος ἐπὶ ταῖς ἐνθέοις μαντείαις κριτὰς ἐπικαθιστάναι νόμος· οὕς μάντεις αὐτοὺς ὀνομάζουσί τινες, τὸ πᾶν ἠγνοηκότες ὅτι τῆς δι᾽ αἰνιγμών οὗτοι φὴμης καὶ φαντάσεως ὑποκριταί, καὶ οὔ τι μάντεις, πρφῆται δὲ μαντευομένων δικαιότατα ὀνομάζοιντ᾽ ἄν. And clear enough evidence that god gave this power to man's irrational part is to be found in our incapacity for inspired and true prophecy when in our right minds; we only achieve it when the power of our understanding is inhibited in sleep, or when we are in an abnormal condition owing to disease or divine inspiration. And it is the function of someone in his right mind to construe what is remembered of utterances made in dream or waking by those who have the gift of prophecy and divine inspiration, and to give a rational interpretation of their visions, saying what good or evil they portend and for whom, whether future, past, or present. It is not the business of any man, so long as he is in an abnormal state, to interpret his own visions and utterances; there is truth in the old saying that only a sane man can attend to his own concerns and know himself. Hence the custom of setting up spokesmen to pronounce judgement on inspired prophecies, they are sometimes called prophets by those who are ignorant that they are in fact not prophets, but expounders of riddling oracles and visions, and so most exactly called spokesmen of those who prophesy.397 397 P. Tim. 71-72 (Trans. Desmond Lee); cf. Phdr. 244b (Trans. Walter Hamilton): “in fact madness, provided it comes as the gift of heaven, is the channel by which we receive the greatest blessings. Take the prophetess at Delphi

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Plato's distinction between the 'mad' prophet unable to interpret the divinely inspired message and the sane onlooker and interpreter is one which does not finds resonances in Greek tragedy, for here very often the seer or prophet comprehends fully the significance of his or her supernatural vision - it is the ‘sane’ onlooker who calls them mad or seems unable to grasp the truth of their message.398 As Padel has noted, sometimes (although certainly not always) the tragic poets present the alternative reality of their mad figures as a truer vision of the world and events. “The mad see 'otherwise' and sometime more truly.”399 But there are problems in attempting to use either Plato or the tragedians as indications of popular attitudes toward prophets and prophetic states. Plato's observations on the aberration and insanity of the prophetess and priestess, and their inability rationally to expound their own visions may, at least in part, reflect a commonly held opinion. But Plato's own agenda very likely has a bearing on the expressed and it is probable that in the Timaeus Plato underlined and heightened any distinctions between rational and irrational states to enhance his argument for the tripartite division of the soul. We cannot assume Plato to have been a reliable reporter of popular thought, although one or two examples noted below do seem to support generally an association between prophecy and mental aberration. Similarly we must be cautious with the tragedians. The playwright's requirement of dramatic tension perhaps exaggerated the extent to which prophets were in actuality regarded as venial and/or insane. The dramatic function of such distrust and disbelief is apparent, for example, even in the Antigone; for when Creon comes at long last to accept Teiresias' vision of things (ll. 1091-1099), it is notably only after the dramatic requirements of doubt and hesitation have been fulfilled - in short when it is tragically too late.400

and the priestesses at Dodona, for example, and consider all the benefits which individuals and states in Greece have received from them when they were in a state of frenzy, though their usefulness in their sober senses amounts to little or nothing”; νῦν δὲ τὰ μέγιστα τῶν ἀγαθῶν ἡμῖν γίγνεται διὰ μανίας, θεᾴ μέντοι δόσει διδομένης. ἥ τε γὰρ δὴ ἐν Δελφοῖς προφῆτις αἵ τ᾽ ἐν Δωδώνῃ ἱέρειαι μανεῖσαι μὲν πολλὰ δὴ καὶ καλὰ ἰδίᾳ τε καὶ δημοσίᾳ τὴν Ἑλλάδα εἰργάσαντο, σωφρονοῦσαι δὲ βραχέα ἢ οὐδέν ... 398 Cassandra, Aesch. Ag. 1105; 1112-1113; 1211-1212; Eur. Tr. 406-407; Teiresias, Soph. OT 350-461; Ant. 10341064; Eur. Ba. 196; 298-369; cf. Euripides Fr. 973 (Nauck), μάντις δ᾽ ἄριστος ὅστις εἰκάζει καλῶς; “The best of seers is he that guesses well”. 399 Padel 1992, 73; cf. Padel 1981, 109; 126-129. 400 I owe this observation to Laurel Bowman, whose forthcoming dissertation on prophecy in Greek tragedy will contain a fuller discussion of the issue of credence.

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When they are not labelled as mad, seers and prophets are often called tricksters or charlatans sometimes both. And as we have seen in the case of the slave Eunus, who claimed to be able to predict the future, different audiences could have widely differing attitudes. Clearly Diodorus and later historians found him a wicked charlatan; on the other hand Eunus’ master and his associates evidently regarded him as an amusing and harmless madman or fool, useful as entertainment at dinner parties. His fellow-slaves, however, clearly believed in his divinely inspired prophetic gifts and chose him to lead their revolt.401 Specific Greek historical accounts which link prophecy with madness are few. Strabo writes of an Albanian custom which has suggested to some scholars a parallel connection in Greek popular thought between mad individuals and the sacred power of prophecy.402 Some have gone so far as to suggest that, at least in the earliest periods of Greek history, all madmen were regarded as sacred.403 However Vaughan's assertion seems more plausible, “it is probable that such a feeling was prevalent only toward those who seemed filled with a kind of inspired madness."404 Strabo reports of the Albanians (HN77) that their chief deity was Selene the moon goddess; the chief priest of Selene was held in honour second only to their king and had charge of the extensive and well populated sacred lands. Moreover: ... καὶ τῶν ἱεροδούλων, ὧν ἐνθουσιῶσι πολλοὶ καὶ προφητεύουσιν· ὃς δ᾽ ἂν αὐτῶν ἐπὶ πλέον κατάσχετος γενόμενος πλανᾶται κατὰ τὰς ὓλας μόνος, τοῦτον συλλαβὼν ὁ ἱερεὺς ἁλύσει δήσας ἱερᾷ τρέφει πολυτελῶς τὸν ἐνιαυτὸν ἐκεῖνον, ἔπειτα προαχθεὶς εἰς τὴν θυσίαν τῆς θεοῦ, σὺν ἄλλοις ἱερείοις θύεται μυρισθείς. τῆς δὲ θυσίας ὁ τρόπος οὑτος· ἔχων τις ἱερὰν λόγχην, ᾗπέρ ἐστι νομὸς ἀνθρωποθυτεῖν, παρελθὼν ἐκ τοὺ πλήθους, παίει διὰ τῆς πλευρᾶς εἰς καρδίαν,

401 DS 12.34/35.2; cf. Florus 2.7.4-8; Livy, Periocha 56 HN24. 402 Strabo 11,4,7, see below HN77; Vaughan 1919, 30; Rosen 1969, 84-86. 403 Tambornino 1909, 55; 59; Vaughan 1919, 25; 30; Köhm 1928; Rosen 1969, 82-86; Dodds 1951, 66-68. Dodds’ discussion of sacred madmen centres largely on examples of what he calls “psychic interference” (66) rather than possession in the sense of personality take-over by a supernatural being, although he does suggest that the ‘possessed’ state in antiquity could be related to a high incidence of what is commonly called multiple personality; on this phenomenon see Crabtree 1985. On the nature of the link between the sacred and the insane see Smith 1965. 404 Vaughan 1919, 30.

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οὐκ ἄπειρος τοιούτου· πεσόντος δὲ σημειοῦνται μαντεῖά τινα ἐκ τοῦ πτώματος δὲ τοῦ σώματος εἴς τι χωρίον, ἐπιβαίνουσιν ἅπαντες καθαρσίῳ χρώμενοι. ... he has charge ... also of the temple slaves, many of whom are subject to religious frenzy and utter prophecies. And any one of those who, becoming violently possessed, wanders alone in the forests, is by the priest arrested, bound with sacred fetters, and sumptuously maintained during that year, and then led forth to the sacrifice that is performed in honour of the goddess, and being anointed, is sacrificed along with other victims. The sacrifice is performed as follows: Some person holding a sacred lance, with which it is the custom to sacrifice human victims, comes forward out of the crowd and strikes the victim through the side into the heart, he being not without experience in such a task; and when the victim falls, they draw auguries from his fall and declare them before the public; and when the body is carried to a certain place, they all trample upon it, thus using it as a means of purification.405 It is important to note, however, that there is no evidence in early Greek society of rites of this sort which specifically involved mentally disturbed people. The account in Strabo is cited by scholars who posit a “primitive” level of magical thinking common to all societies, and who assume the likelihood that historical parallels existed between the ways in which Albanians and other peoples held mentally aberrant people to be in some way sacred and useful for purposes of ritual communal purification.406 Although ritual beliefs such as the one described by Strabo do not appear to have been a part of Greek life, several incidents do confirm what Plato suggested, that there was, in popular thought, a close connection between the power of prophecy and mental aberration. According to Lucian, the false prophet Alexander of Abonuteichos (HN33) in the early stages of his elaborate ruse established his credibility with the crowd by playing the part of a madman, foaming at the mouth and speaking in seemingly inspired but unintelligible words to the them from a high temple.407 And Plutarch tells of one incident in which an ordinary person, in this case Olbius, the paedagogos of 405 Strabo 11.4.7 (Trans. Loeb); cf. Vaughan 1919, 30 (who cites Frazer in connection with this passage), “In this custom, the prophet, or rather the maniac, was plainly supposed to be moon-struck in the most literal sense, that is possessed or inspired by the deity of the moon”. 406 Rosen 1969, 86 cites evidence for other scapegoat rituals in the Greek world but states clearly that there is no evidence that deranged persons were deliberately selected for this (contra Vaughan 1919, 35); For scapegoat rituals per se see Dodds 1951, 4344, and n.88 (bibliography); common primitive belief that all mental disturbances have supernatural source see Dodds 1951, 66. 407 Luc. Alex. 12-24.

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the children of Nicogenes (HN78), entered into a strange state of mind and began to prophesy in verse, ἔκφρων γενόμενος καὶ θεοφόρητος ἀνεφώνησεν ἐν μέτρῳ.408 Plutarch does not, however, inform us as to whether or not the prophetic paedagogue remained ἔκφρων. But he does in another another episode, this time concerning a priestess whose job it presumably was to enter into prophetic states (HN79). Yet on this occasion she was reluctant to go into the oracle; there had been unpropitious signs earlier during the sacrifice of the victim and the priestess was unwilling, half-hearted in her approach. During the first response a harshness in her voice showed that she was not responding properly “she was like a labouring ship and was filled with a mighty and baleful spirit (ἀλάλου καὶ κακοῦ πνεύματος). Then she became hysterical (παντάπασιν ἐκταραχθεῖσα), and with a frightful shriek threw herself down. When they picked her up she was still conscious but lived for only a few days more.”409 Obviously things could go very wrong when states of ecstatic prophecy were induced - in this case a mentally aberrant state of quite another kind seems to have ensued, yet one also described in terms of possession.

iii. Madness as Possession - other evidence In the parodos of Euripides' Hippolytus (141-169), the strange and incomprehensible behaviour of Phaedra prompts the chorus to try to diagnose her illness (HN80). They wonder if a supernatural power is involved, or alternatively, is her distraction caused by a family crisis - or is she perhaps pregnant? Their first guess involves them in further speculation about the identity of the divinity whose frenzy possesses her: - - - ἦ σὺ γ᾽ ἔνθεος, ὦ κούρα, εἴτ᾽ ἐκ Πανὸς εἴθ᾽ Ἑκάτας ἢ σεµνῶν Κορυβάντων φοι τᾳς ἢ µατρὸς ὀρείας; - - - σὺ δ᾽ ἀµφὶ τὰν πολύθηρον Δί – κτυνναν ἀμπλακίαις ἀνίε ρος ἀθύτων πελάνων τρύχῃ; Is it Pan's frenzy that possesses you 408 Plut. Them. 26, His prophecy - that that night would speak and instruct and give victory - was directed to Themistocles, who was in flight to Aegae and had taken refuge with Nicogenes, the wealthiest man in Aelia. On the propensity for prophets to speak in verse see Dodds 1951, 74 and n.70. Note also that madmen were popularly thought to speak in verse, Plut. Mor. 632C. 409 Plut. Mor. 438B (Trans. Loeb). See Dodds 1951, 70 - 74 esp.72; cf. also Plutarch's descriptions of the seer, Mor. 432D - E. The graphic description of the madness which afflicted the Delphic priestess Phemonoe, a reluctant vessel for Apollo's oracular responses, Lucan, Pharsalia 5.123-224, is perhaps based upon the same incident recorded by Plutarch, which can be dated between 57-62 CE, see J. Bayet, Mélanges Grat, I.53 ff. cited in Dodds 1951, 90 n. 59.

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or is Hecate's madness upon you, maid? Can it be the holy Corybantes, or the mighty Mother who rules the mountains? Are you wasted in suffering thus, for a sin against Dictynna, Queen of hunters? Are you perhaps unhallowed, having offered no sacrifice to her from taken victims?410 A similar speculative attempt on the part of onlookers to assign appropriate divine responsibility is evident in the Hippocratic treatise The Sacred Disease. Because of its polemical nature, this work provides us with significant information about popular beliefs and superstitions, primarily about epileptics, but indirectly too about people who were insane or delirious.411 The author distinguishes here between those who have the sacred disease and others who show equally strange behaviour: those who are mad and delirious (μαινομένους ἀνθρώπους καὶ παραφρονέοντας), and those subject to disturbances during their sleep such as groaning and shrieking, choking, jumping up and rushing outside. According to this source it is only the former disease, epilepsy, which is popularly regarded as 'sacred'. Such a distinction was clear probably only to the medical specialist in antiquity, in popular thought, as we have noted earlier, there were many 'sacred diseases' and even what was called epilepsy was sometimes something else.412 The author attributes the origination of the term 'sacred' for this disease to men whom he likens to the magicians, purifiers, charlatans and quacks of his own day (μάγοι τε καὶ καθάρται καὶ ἀγύρται καὶ ἁλαζόνες), men who use superstition as a cover for their own ignorance and inability.413 They even apportion responsibility to different gods for the various manifestations of the disease: (MT1a) καὶ ἢν μὲν γὰρ αἶγα μεμῶνται, καὶ ἢν βρύχωνται, ἢ τὰ δεξιὰ σπῶνται, μητέρα θεῶν φασὶν αἰτίην εἶναι. ἢν δὲ ὀξύτερον καὶ εὐτονώτερον φθέγγηται,ἵππῳ εἰκάζουσι, καὶ φασὶ Ποσειδῶνα αἴτιον εἶναι. ἢν δὲ καὶ τῆς κόπρου τι παρῇ, ὅσα πολλάκις γίνεται ὑπὸ τῆς νούσου βιαζομένοισιν, Ἐνοδίῃ πρόσκειται ἡ ἐπωνυμίη· ἢν δὲ πυκνότερον καὶ λεπτότερον, οἷον ὄρνιθες, Ἀπόλλων νόμιος. ἢν δὲ ἀφρὸν ἐκ τοῦ στόματος ἀφίῃ καὶ τοῖσι ποσὶ λακτίζῃ, Ἄρης τὴν αἰτίην ἔχει. οἷσι δὲ νυκτὸς δείματα παρίσταται καὶ φόβοι καὶ παράνοιαι καὶ ἀναπηδήσιες ἐκ τῆς κλίνης καὶ φεύξιες ἔξω, Ἑκάτης φασὶν εἶναι ἐπιβολὰς καὶ ἡρώων ἐφόδους.

410 Eur. Hipp. 141-147 (Trans. Grene). 411 All translations of this work are from the Loeb edition of W.H.S. Jones. As we have noted in prior discussion “epilepsy” in antiquity might include a variety of other psychiatric problems. This treatise is discussed in more detail below in the section on medical evidence, ch. 7-9. 412 Hipp. Morb. Sacr.1. Other diseases called sacred: Temkin 1971 [1945], 15-21. Note also that some diseases were personified and given the status of gods or daemons, Dodds 1951 41-42 who cites Semon. Amorg. 7.102 (famine); Soph. OT 28 (pestilence); see also Dodds, 84. n.14 (fever daemons). 413 Hipp. Mor. Sacr. 2.

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If the patient imitate a goat, if he roar, or suffer convulsions in the right side, they say that the Mother of the Gods is to blame. If he utter a piercing and loud cry, they liken him to a horse and blame Poseidon. Should he pass some excrement, as often happens under the stress of the disease, the surname Enodia is applied. If it be more frequent and thinner, like that of birds, it is Apollo Nomius. If he foam at the mouth and kick, Ares has the blame. When at night occur fears and terrors, delirium, jumping from the bed and rushing out of doors, they say that Hecate is attacking or that heroes are assaulting.414 The author here is concerned to show contradictions in the reasoning of those who treat the disease as sacred and yet employ purification and incantation in their attempts to heal it. For, he says, they treat those afflicted as though they were polluted, blood guilty, bewitched by men, or had committed some unholy act, ὥσπερ μίασμά τι ἔχοντας, ἢ ἀλάστορας, ἢ πεφαρμακευμένους ὑπὸ ἀνθρώπων, ἢ τι ἔργον ἀνόσιον εἰργασμένους ... . Instead, if the disease were truly divine, “they should have brought them to the sanctuaries, with sacrifices and prayers, in supplication to the gods."415 The aim of the author of the Hippocratic treatise is primarily to demonstrate the capacity for scientific medical approaches to comprehend the puzzling and recalcitrant diseases of the mind.416 The arguments which he presents do not address the problem that in popular thought the seizure of a person's mind and body was not only seen as divine punishment for some transgression, known or unknown, but alternatively, it might be the work of unpredictable malevolent spirits, of daemonic rather than divine forces.417. Terms such as κακοδαίμων, νυμφόληπτος, μητρόληπτος, θεόληπτος, μουσόληπτος, and others similar, all indicate a belief that diverse supernatural forces, in addition to the gods enumerated above, could take hold of an individual's mind. Ἐπίληπτος, by analogy contains the germ of this same concept, as even today in our own language the word ‘seizure’ implies that one is in the grip of an alien force.418 Evidence from Attic comedy suggests that explanations for madness in 414 Hipp. Mor. Sacr. 4. 21-33 (Trans. Loeb) see discussion below, ch. 8. (MT identifies this passage as one of the medical testimonia). The common belief that any one of a number of deities may be in possession is seen also in a passage from Menander, Thphr. 1-30 (Oxford text, p. 145), in which a flute test is proposed to see which divinity is in possession. cf. Padel 1983, 13.. On the heroes see Kearns 1989, esp. 13 and n. 148 above; on healing heroes see below ch.6. 415 Hipp. Mor. Sacr. 4.38-42, (Trans.Loeb). See also 4.43-48, the objects of purification too (καθαρμῶν - see textual note ad loc) should not be hidden, thrown into the sea or carried up into the mountains for fear of contamination; instead, if a god is the cause, they should be taken to the sanctuaries and offered to him. 416 See the illuminating discussion by Lloyd 1987, 26-28 of the ‘scientific’ alternative to magic offered by the Hippocratic treatise. 417 Dodds 1951, 40 makes this important distinction; see also Parker 1983. 245-248 on the opposition between “madness as punishment for ritual or moral offences, and madness as seizure by capricious, amoral spirits” (246). 418 For a discussion of daemons and the fifth century coinage of κακοδαίμων see Dodds 1951, ch. 1 and esp. p.42; for “seizures” by daemons see 66; for an early use of δαιμόνιοι (madmen!) see Hom. Hymn 7. 17 & 26.

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popular thought relied heavily on the idea of mischievous daemonic seizure without any suggestion of an offence against the gods.419 The use of the terms seizure and possession have led some scholars to make a distinction between the Greek concept of possession and later ones, especially the image found in the New Testament of demons inhabiting the body, as in Matthew 28, the incident of the Gadarene swine. Greek daemons seem to have been forces which torment and afflict an individual; they have to be warded off and constrained rather than actually expelled from within.420 One piece of archaeological evidence demonstrates the popular use of the term νυμφόληπτος to describe the experience of having one's mind disturbed by supernatural forces, an inscription from the cave of Pan and the nymphs at Vari on Mount Hymettos. Archedamos of Thera (HN81), who resided in Athens around 400 BCE, created a shrine for the nymphs in the grotto, planting a garden in front of it, erecting a dancing-floor for the nymphs and decorating and inscribing the walls with representations of the nymphs and a series of inscriptions, in one of which he describes himself as νυμφόληπτος.421 Epigraphic evidence indicates that the popular belief that some supernatural powers were concerned with justice and revenge led to attempts to direct and harness such forces in people's personal lives. A recent publication of a group of lead curse tablets from the ancient world provides examples of spells and curses designed to harm, among other areas, people's minds. A striking example, because of its explicitness, is an inscription from Chalcis by a certain Amphicles (HN82) dated in the second century CE, which was designed to protect a bath installation. The curse reads in part: “May god strike this person with trouble and fever and chills and itch and drought and insanity and blindness and mental fits; and may his possessions disappear, may he not walk on land or sail at sea; may he (produce) no offspring. ... May he have the Erinyes as watchers over him.”422 This inscription is somewhat unusual in that traces of paganism have been overlaid by Judaic influence, in particular allusions to the Septuagint are frequent and the opening address to the gods and heroes found in other parallel texts has been replaced by a singular god. Many such tablets, however, include a mixture of divinities and daemons from multiple traditions rather a ‘shot-gun’ approach to prevention. Another tablet, this one from Oxyrhyncus, and dated to the second 419 O'Brien Moore 1924, 10-11 notes a contrast between the genres of tragedy and comedy in their treatment of madness as divine punishment and madness as daemonic intervention and/or an excess of black bile. Barrett ad Eur. Hipp. 1362 notes that κακοδαίμων is used in tragedy only here, but “frequently in comedy ... as a term of pity shading over through contempt to abuse.” For parallel use of μελαγχολᾶν in comedy see Parker 1983, 246 and n. 61, “Black bile: often in Aristophanes (e.g. Nub. 833; Av. 14, Pax 66), and Menander. This is probably in origin a popular, not a scientific interpretation (see Kudlien, 77-88) and need not be later than the religious one”. 420 Smith 1965 is the classic discussion of “the non-literalness of Greek ideas of possession” (Simon, forthcoming); see also discussion in Milns 1986, 457. The curse tablets collected by Gager 1992 present compelling evidence for the popular perception of daemons as interfering and manipulative external powers. 421 IG I2 784; 785; 788; cf. C.H. Weller et al., “The Cave at Vari,” AJA 7 (1903): 263-349, esp. 297. See also Rosen 1969 who cites Nilsson 1949, 263 ff. and 1951, 72-78. See also Nilsson 1949, 112. 422 Gager 1992, 184-185 cf. IG 12, fasc. 9,955 and 1179. Gager notes (185 n.26) that the series of misfortunes in the first half of this sentence is taken from the Greek text (LXX) of Deuteronomy 28:22 and 28.

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century CE, carries a spell aimed at breaking up a marriage and obtaining the wife (HN83). Among other curses it says, “Lay Allous low with fever, with sickness unceasing, starvation - Allous - (and) madness! Allous”.423 That these spell were believed to have potency is attested by other inscriptional evidence. A second century CE inscribed marble stone from Asia Minor “narrates a sacral-legal proceeding against a woman, Tatia, who was suspected of having placed a curse on her son-in-law.” A portion of the inscription (HN84) reads: “Because Ioukoundos fell into a condition of insanity and it was noised abroad by all that he had been put under a spell by his mother-in-law Tatia, ...”.424 One final testimony, from late Antiquity, is in Jerome's Life of Saint Hilarion the Hermit (21). It relates an incident not unlike that of Leukippe and the aphrodisiac overdose. A young man of Gaza, who had fallen in love with a Christian virgin and been rejected, traveled to Egypt where he studied (probably) the magical arts (HN85). After a year of instruction with the prophets of Asclepius, who are trained not to heal souls but to destroy them, he returned home, excited by his dreams of debauchery; at the home of the young woman, under the threshold, he buried a metal tablet, made of bronze from Cyprus, engraved with various portentous words and potent figures. Immediately the young virgin went crazy.425 Gager has clearly demonstrated that the use of magical spells and curses was pervasive in all periods of classical antiquity, and among all strata of society. The Elder Pliny,who was himself a polemicist against what he called magici and the “fraudulent art”, nonetheless stated, “There is no one who does not fear to be spellbound by curse tablets.”426 Clearly in popular belief malevolent supernatural powers could be called upon as agents of vengeance to destroy another persons mind. - while others in turn could be called upon to protect it.427 The gap between the attitudes of educated and uneducated, ordinary people seems not to have been uniformly wide when it came to issues of the supernatural. As Simon emphasizes,

423 Gager 1992, 110-111, #35; c.f 104-5, #30. 424 Gager 1992, 246-7, #137. The details of a spell of this kind are given in one of the demotic magical papyri from Egypt: “[Spell to] make mad any man or woman: You should take the hair of the man whom you wish together with the hair of a dead man; you should tie them to each other; you should tie them to the body of the hawk; and you should release it alive. If you wish to do it for some days, you should put the hawk in a place, feeding it in your house.” Betz, [1986] 1982, PDM XIV. 1185 [v. col. xxix, 4], p. 249. 425 Gager 1992, 261, #163. 426 Pliny NH 28.4.19; quote, 28.30.1, defigi quidem diris deprecationibus nemo non metuit.; magici - 28.30.1-13; see Gager 1992, 253, #146. 427 Of course revenge was not the only motive for placing curses and spells on another - fear and competition in love, business, and the courts gave ample scope; cf. Gager 1992, 75, a spell in Latin dialect from Roman Gaul targeting a rival actor “May Sosio become delirious, may Sosio suffer from fevers, may Sosio suffer pain everyday. May Sosio not be able to speak”.

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It is important to keep in mind that throughout the centuries of antiquity, there was a more or less unspoken assumption that the universe is peopled with a great variety of agencies, personages, deities, and deity-like forces, some helpful, some malevolent, some both, and these agents and agencies played an important part in human welfare, illness, and also in severe emotional distress. Daimones, guardian spirits, Keres, Furies, Larvae are among the many names for particular agents. ... The assumption was “popular”, but not “vulgar” or only prevalent among the uneducated, but pervaded ancient cult, philosophy, religion, and healing practices.428 Socrates, for example, may have participated in the Corybantic rituals, and both Plato and Aristotle seem to have approved of their use for curing certain types of mental distress.429 And Plutarch, who adapted and elaborated upon Plato's basic distinction between the four divine forms of madness and those forms of madness which are caused by humoral imbalances in the body, even Plutarch seems at some level to have allowed for daemonic explanations for disturbed states of mind.430 For although in one work he scornfully speaks of the superstitious man who, rather than blaming man or luck (τυχή) for his lot, blames god (ὁ θεός) or ῥεῦµα δαιµόνιον ἄτης, he elsewhere expressly suggests there may be some truth in

that most extraordinary doctrine of the oldest times, that mean and malignant spirits, in envy of good men and opposition to their noble good deeds, try to confound and terrify them, causing their virtue to rock and totter, in order that they may not continue erect and inviolate in the path of honour and so attain a better portion after death than the spirits themselves. οὐκ οἶδα μὴ τῶν πάνυ παλαιῶν τὸν ἀτοπώτατον ἀναγκασθῶμεν προσδέχεσθαι λόγον, ὡς τὰ φαῦλα δαιμόνια καὶ βάσκανα, προσφθονοῦντα τοῖς ἀγαθοῖς ἀνδράσι καὶ ταῖς πράξεσιν

428 Simon (forthcoming), 15. 429 Dodds 1951, 79 citing Pl. Euthd, 277D and Linforth 1946, 124 f,also Pl. Leg. 791A; Arist. Pol. 1342a7ff, Linforth 1946, 162. 430 Plut. Mor. 758D-759B cf. Pl. Phdr. 265; Tim. 86-87A. Plutarch divides madness into 1) the somatically caused and 2) inspiration or divine possession. The latter includes prophetic, Bacchic, muse inspired, Ares inspired and erotic. On the passion and inspiration which Ares adds to reason to banish fear in battle see Mor. 452 B-C; 458E; and esp. 758F-759A; Pyrr. 22.11.

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ἐνιστάμενα, ταραχὰς καὶ φόβους ἐπάγει, σείοντα καὶ σφάλλοντα τὴν ἀρετήν, ὡς μὴ διαμείναντες ἀπτῶντες ἐν τῷ καλῷ καὶ ἀκέραιοι βελτίονος ἐκείνων μοίρας μετὰ τὴν τελευτὴν τύχωσιν.431

431 Plut. Mor. 168B; Dion 2.1-4; on this passage and Plutarch's rare expression of deisidaimonia see Wardman 1974, 91-96; cf. also Mor. 706E, P. notes without comment that sorcerers advise those possessed by demons (δαιμονιζόμενος) to recite and name over to themselves the Ephesian letters: οἱ μάγοι τοὺς δαιμονιζομένους κελεύουσι τὰ Ἐφέσια γράμματα πρὸς αὑτοὺς καταλέγειν καὶ ὀνοµάζειν.

CHAPTER SIX Treatment and Cures; Attitudes and Care A recurrent thread in many accounts of madness, whether of the episodic or more permanent variety, is the fact that many mad people require others to care for them, at least at some level. It may simply be by restraining them from harming themselves or others, by providing or acquiring some sort of therapeutic treatment, or by nursing them and ensuring that minimal bodily needs are met. In this section we will examine the evidence for the variety of ways in which people in antiquity responded to mentally distressed individuals. This will include a discussion of both physical responses - the ways in which individuals were handled- and of the attitudes which seem to have governed these. A. Treatment and Cures One of the first actions we in our society might take, when confronted with a friend or relative beginning to exhibit mental or emotional problems, would be to consult a medical expert. The expert would then decide upon a variety of courses of action depending upon the severity of the problem and the school of thought to which he or she belonged. Some form of therapy might be undertaken which could involve drugs, a “talking” approach , some attention to dreams, or a physical routine, and the disturbed individual might even be placed in a therapeutic centre under some degree of restraint. But there are other forms of recourse, and advice would be available from many quarters both inside and outside the family. Some might look to the types of food the person was in the habit of eating and suggest changes in the diet, others might extol the virtues of exercise or certain combinations of vitamins and patent preparations. Some might recommend massage or hypnotherapy, others rely on ‘common-sense’ approaches keeping the person occupied, making sure he or she is not too much alone, ‘cheering them up’, ‘calming them down’, letting them talk, and trusting in the passage of time. Others might find a group of similarly afflicted persons so that the individual could become part of a self-help group - and still others might resort to prayers or special religious ceremonies. Many options with some similarities to these appear to have been available too for people in antiquity.

I. Treatment by Physicians In cases of severe mental illness, doctors were available for consultation and, as we shall see when we examine the medical evidence, were occasionally sought out by disturbed people themselves, although perhaps more frequently by those close to them. In a number of the cases we have reviewed, doctors have appeared as consultants: the brother of Thrasyllus, when he returned to Athens took him to a doctor and had him cured. When Leukippe was overcome by the effects of the concentrated aphrodisiac a doctor was called - to very little effect. The people of Abdera, in despair over the madness of Democritus, wrote to the finest physician of their time, Hippocrates. And, according to Apuleius, the epileptic slave boy Thallus had been examined (again to little effect) by a number of

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physicians. The entourage surrounding the physician Menekrates “Zeus” consisted, according to some sources, of those whom he had healed successfully of the sacred disease.432 Clearly consultation with a doctor was one fairly obvious recourse for people who had to deal with insanity. Not everyone, however, would have had sufficient wealth to do so. It seems probable that only the higher levels of society were able to consult medical expertise and could afford the regimens prescribed. This did not mean, however, that treatment was reserved only for the rich.; as the case of Thallus shows, the slaves of the wealthy were treated by physicians too, although presumably only if their value economically justified it.433 The free poor may have had access to physicians' assistants, but for the most part they almost certainly had to make do with quick and inexpensive cures, “ a drug, a spell, a visit to a religious shrine”.434 The story of Aspasia, who was refused treatment by a physician because her father was not able to pay and who then dreamed her own (successful) cure is perhaps not atypical with respect to the financial difficulties confronted by poorer patients.435 Physicians were clearly not universally accessible - nor were they perhaps universally sought. It should be noted that among the several cures and treatments for his senile father pursued by the reasonably well to do Philocleon in Aristophanes Wasps , there was no attempt made to consult a doctor. 436 Some people preferred, perhaps in place of or perhaps seriatim, to consult other experts - religious healers at the temples and sanctuaries, purifiers, or specialists in spells, sometimes even oracles.437 Some cities appointed a public (δημόσιος) physician who was paid to reside in the city and be available for those afflicted with illnesses both of the body and the soul.438 A fee was customarily charged for their services, although several inscriptions for the second and first centuries B.C. praise certain public physicians for serving all sufferers alike, sometimes at their own personal expense.439 According to Aelian, the Spartans (HN86), who were reputed 432 Thrasyllus HN14; Leukippe HN17; Democritus HN35; Thallus HN57; and cf. Apul. Apol. 48, in which an epileptic woman comes to Apuleius' house to be cured by his “magic” and he calls a physician. 433 Sinclair 1951, 386-7 comments on a passages in Pl. Leg. (4.720 and 9.857), which suggests two classes of doctors, the physician proper who attended free patients and his assistant (slave or free), who attended slave patients. Sinclair suggests that, as a result, distinctly different ways of dealing with patients, attitudes toward medical science and professional standards were in existence. On slaves and Greek medicine generally see Kudlien 1968, who discusses the Platonic passage and rejects it as evidence for historical practice. 434 Rosen 1986, 115; cf. Milns, 1986, 456 citing Temkin [1945] 1971, 79 ff. 435 Ael. VH 12.1; cf. 12.63, a dream cures a young man of his passion for a courtesan he can't keep; on dreams and cures see discussion below. 436 Milns 1986, 456. 437 For example, DL 6.38 (Asclepius dedication); Hipp. Morb. Sacr. 2-3 (purifiers); Gager 1992, 234, #125 (amulet with spell); Aristox. apud Apoll. Hist. Mir. 40 (oracle). 438 An early example of a state or public physician was Democedes of Croton, Herod. 3. 125; 131-132. On public physicians see Sinclair 1951; Woodhead 1952; Cohn-Haft 1956; Hands 1968, ch. 9 discusses public health and hygiene, see esp. 133-140. 439 Temkin 1979, 10 and n.27.

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not to have valued learning as much as other Greeks, were in the position of having to call in expert foreign physicians when they required help with illnesses or madnesses which had achieved the dimensions of a public calamity: ... εἰ δέ ποτε ἐδεήθησαν τῆς ἐκ Μουσῶν ἐπικουρίας ἢ νοσήσαντες ἢ παραφρονήσαντες ἢ ἄλλο τι τοιοῦτον δημοσίᾳ παθόντες, μετεπέμποντο ξένους ἄνδρας οἷον ἰατροὺς ἢ κατὰ Πυθόχρηστον. ...if at any time they needed the help of learning, whether in sickness or madness, or some other public calamity, they sent for foreigner as physician [or purifiers] according to the oracle of Apollo. 440 In a subsequent chapter the attitudes and modes of treatment of the medical writers is examined in detail. It is sufficient here to note that physicians were understood by the laity to have devised simple tests for madness and their opinions, at least in later antiquity, might be offered as convincing proof that an individual was either mad, epileptic, or mentally sound.441 II. Popular and Magical Cures It is possible to get some sense of the variety of treatments popularly thought to be useful in cases of mental aberration. Medical regimens are discussed in greater detail below, but several aspects of these, in particular hellebore treatment, permeated lay discourse too.442 There are some peripheral literary references to popular cures for madness and a number of quasi-medical references in writers such as Dioscorides, Theophrastus and the Elder Pliny.443 Popularly conceived cures are of three kinds: those which involve the application or ingestion of substances - whether medicinal or magical; religious cures; and a residual category which includes curative agencies such as time, shock or emotional reactions.

440 Ael VH 12.50, Trans. Stanley. 441 Tests: Ps. Hipp. Ep. 17.3 (354 cf. 17,4 (358); Apul. Apol. 44-45; on tests for epilepsy see Vaughan 1919, 49-50; Temkin [1945] 1971, 10; 35; 47-49. Proof: Apul. Apol. 51 does cite the opinions of philosophers and medical men as evidence that his own actions were appropriate; see also discussion below ch. 9. There is no evidence that the opinions of physicians were a part of legal proceedings regarding insanity, Rosen 1969, 136. 442 Cf. O'Brien-Moore 1924, 36-47 for a detailed discussion of hellebore in comedy; for medical treatment with hellebore see below ch. 9. 443 Vaughan 1919, 48. As Vaughan has noted, many popular cures, with the exception of music, were directed against epilepsy; music was rarely, if ever directed against this disease. The present section examines the evidence for popular remedies both for madness and epilepsy.

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Wine, so often thought of as a cause of madness, was also a cure for certain illnesses and, in the case of the madness of Antony's soldiers in Parthia, it is specifically mentioned as the only cure.444 The waters of special springs could cure madness; the spring called Alyssus in Arcadia was said to be a cure for the madness caused by the bite of a rabid dog.445 Honey, another natural substance with ambivalent properties, could either cause or cure mental diseases. As noted previously, one heavy scented honey from boxwood at Trapezus in Pontus was said to cure epileptics but drive healthy men insane.446 Stones too, in the form of amulets or as naturally occurring sacred objects, could either drive men insane or, on the contrary, drive out their madness. A stone in the river Nile was said to have the power to help those possessed by an evil spirit (τοῖς δαίμονί τινι γενομένοις κατόχοις), for the daemonion left them as soon as they put their noses against it.447 One found in Samos could cure madness, as could the λίθος τοπάζιος ground to a powder and mixed with water. Powder or scrapings from two other stones, the λίθος σεληνίτης and the λίθος ἄσσοις were preventatives for epileptic attacks, the latter particularly recommended for children.448 Certain types of stones worn as amulets offered protection from madness and epilepsy.449 One variety of the Lapis Chelidonius was recommended to be worn in a calf or deer skin bag as an an amulet to prevent epileptic seizures; it consisted in two stones taken from the crop of a fledgling swallow secured at the time of the full moon.450 The Lapis Topazontes worn as an amulet cured the types of madness that were caused by drinking certain wines.451 And the Lapis Chrysolithus, when pierced through with the bristles of an ass and tied to the left arm was said to ward off daemons.452 Sacred stones whose powers were linked with great religious myths were apparently used in cathartic rituals. Orestes was said to have been cured of his madness by sitting on the stone of Zeus “Kappotas”, or in another legend, Orestes' purifiers were

444 HN19; for wine as a medicinally prescribed cure see below ch. 9; McKinlay 1950; as a popular cure cf. Theognis 2.211, οἶνόν τοι πίνειν πουλὺν κακόν· ἢν δέ τις αὐτὸν πίνῃ ἐπισταμένως, οὐ κακός, ἀλλ᾽ ἀγαθός - quoted by Galen, Mental Faculties Follow Bodily Constitutions, Brock, 234. 445 Pausanias 8.19.2-3. 446 Ps. Arist. Mir. 831b. 447 Ps. Arist. Mir. 816b. 448 Vaughan 1919, 53 cites Diosc. De Simpl. 21 and 18; see also 5.168, Akone (Naxian whetstone) when iron was rubbed on it produced scrapings which, when mixed with vinegar, cured epilepsy and other disorders; 5.146 Thrakias Lithos was said to cure like Gagates. (this was a mineral which burned with water and was quenched with oil - magnesium?). 449 For extensive enumeration of magical methods for preventing or expelling daemonic possession Tambornino 1909, 75-89 is still useful. I owe many of the examples of magical cures included here to Vaughan 1919, 48-58. 450 Vaughan 1919, 51 cites Diosc. De Simpl. 19; cf. Cass. Felix ad epilepsiam 71, p. 172 (Rose); Damig. p. 171.10. The moon was thought to have magical connections with epilepsy. 451 Vaughan 1919, 51 cites Orph. Lith. p. 143.ll.2 ff.; Damig. p. 185, 29. 452 Vaughan 1919, 51-52 cites Damig. p. 194, 47; cf. ibid. p. 187.32. Daphnea lapis, also Lydus De Mens. 4. p.54.4.

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seated on a sacred stone outside the temple of Artemis Λυκεία. 453 Pausanias tells of a stone at Thebes called λίθος σωφρονιστήρ, which received its name, according to local legend, because Athena threw it at the mad Heracles to cure him. According to Farnell this stone was used in a “ritual of purification from the 'miasma' of madness”.454 He also puts forward a theory concerning the Delphic omphalos: ...that the omphalos was a sacred stone fashioned to indicate the grave-mound of the earth-spirit, and that the suppliant who sat or knelt upon it, as Orestes does in a vase-representation in the British Museum, was availing himself of its cathartic virtue. Such an act would denote that the person was putting himself into communion with the chthonian divinities; but it is probable that the 'omphalos' had lost this significance before the Orestes story concerned Delphi, and had become a mere symbol of Apollo's power. However, the primary legends about these miraculous cathartic stones seem to belong to another stratum of religion than the Apolline. Curative properties too were available from animals; seals when caught were said to vomit a material which was good for epileptics.455 Vaughan lists a variety of folk recipes for treating epilepsy and madness which involve animal substances: the liver or heart of a vulture, various parts of a weasel, seal's flesh and horse tetter, the blood of an amphibious tortoise, the hooves of an ass, or a sea turtle's gall.456 The ingredients of the antidote which was prepared for Leukippe are unfortunately not given in Xenophon's story, but they might well have included such rare and intriguing items as the above. Homeopathic and allopathic remedies were sought to bring about a state of calm and sanity. According to Plutarch, who cites Aristotle and the Egyptians, the use of perfumes (especially myrrh) and flowers was thought to be conducive to health, to relax the brain and by their warmth and lightness to cure it of its cold and frigid nature. He also recommends an aromatic compound used by the devotees of Osiris to relax and loosen and cure, by homeopathic means, the irrational in the soul.457 III. Religious Cures

453 Farnell 1896-19094,302-3. 454 Eur. Her. 1003; Paus. 9.11.2. Sacred stones: West ad Hes. Theog. 498-500; Vaughan 1919, 52-53, quotes Farnell 1896-1909,4.302f. 455 Ps. Arist. Mir. 835b, the Loeb translation gives “vomits beestings” for ἐξεμεῖν τὴν πυτίαν, which seems unnecessarily fanciful; rennet is the more usual translation. On the numerous cures for epilepsy, many of which were in origin linked with magic and superstition, see Temkin [1945] 1971, 20-26; 77-80 and discussion below ch. 9 on folkloric elements in the medical texts. 456 Vaughan 1919, 48, citing Diosc. Simpl. 18; Lydus De Mens. 4, p. 96,65; c.f Tambornino 1909, 86-89 which lists a great variety of animal parts and substances thought to be remedies against daemonic possession (included here are epilepsy and madness). 457 Plut. Mor. 383D-384A; the editor's note ad loc. cites Aristoteles Pseudepigraphus, Rose, p.233.

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The power of the gods both to bring about and to cure madness was a belief fundamental in antiquity. The aid of divine forces was sought by sufferers in a variety of ways. Several of the popular cures discussed above include the use of sacred and magical objects to ward off or cure mental diseases. In addition to this usage we may also include the therapy of music (including the singing of Paeans to Apollo), ritual purification, temple dedications and prayers, and participation in those religious rites specifically thought to cure madness, those of Hecate, the Mother (Cybele), possibly Dionysus, and, most notably, the Corybantic rites. A particularly interesting religious cure, and one of which we have a patient's lengthy first-hand account, is that of incubation, or dream healing.458 : i. Oracular Consultation Consultation with the god through oracles could reveal a curative treatment, particularly if the problem had a civic dimension. In the case of the women of southern Italy afflicted with a type of contagious mania, the oracle, when consulted by the male citizenry, prescribed Spring Paeans to be sung by the women - twelve a day for sixty days - a very effective method of keeping the women focused and occupied, and responsible too, so we are told, for the great number of paean writers in Italy.459 Other requests for oracular assistance, however, show clearly that common, everyday questions were frequently asked; questions about crops, children’s paternity, career choices, lost objects, and which god or hero one should placate for good health.460 It is not unlikely then, that oracles were consulted about whom to propitiate in individual cases of madness.461In this context it should, however, be noted that the epigraphic evidence from the temple of Asclepius at Epidauros contains no thank-offering for a cure for insanity.462 ii. Temple Prayers and Dedications Visits to a temple or healing shrine were undoubtedly a common way to seek a cure for any form of illness, physical or mental. Direct placation and appeal to the gods was a method available to all who could afford to make even a minimal offering - or in some cases to travel to the appropriate shrine. And ceremonies of purification, placation and incubation would be undertaken by the person, their families or even someone else concerned on their behalf,.as we have seen in the anecdote in Diogenes Laertius in which Diogenes of Sinope dedicates to Asclepius a “bruiser” who was causing public mischief.463 It should be noted here that there is no evidence from any of the extant sacred laws that the diseased, including the insane and epileptic, were formally defined as polluting and were excluded from 458 Ael Arist. Sacred Discourses; for bibliography and a detailed examination of Aristides' illnesses and cure from a psychiatric point of view see Rosen 1969, 109-120; cf. Gill 1985, 312-313. 459 HN26; Apoll. Mirab. 40, p. 53 Keller cf. Aristoxenus Fr. 117 Wehrli. On the medical paean see Parker 1983, 212, n. 25 cf. 298, n. 84 citing Deubner 1919. 460 See for example the selections at C. Michel Recueil d’Inscriptions Grecques 843-851; on oracular consultation and healing see Parker 1983, 250. 461For oracular responses to medical questions see: Parke 1985, 147; 149-157; 161; (Claros); Fontenrose, 1978, 7879; 162; 251-252; 368; 396 (Delphi). 462 Milns 1986, 461 n. 8. Forty three cures are attested; see Edelstein and Edelstein 1945. 463 Rosen 1969, 135; DL 6.38, HN53.

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entering temples.464 A useful distinction has been made between two kinds of contagious conditions in Greek popular belief: On the one hand, there are pollutions such as those of birth, death, and blood-guilt that are communicable according to specified principles and demand the formal seclusion of affected persons. On the other, there are a series of undesirable qualities and conditions that can be 'wiped off' on people and with which one may be 'filled' - folly immorality, bad luck, and the like. ...It seems to be in this latter sense that polluting diseases were contagious. People threw stones at madmen and might spit at the sight of a madman or epileptic, but these were protections against something repugnant and frightening rather than against a medical infection or a formally defined pollution.465 This distinction is significant since it means that although some members of the community may have used apotropaic gestures to distance themselves from mentally disturbed individuals, no rigid social mechanisms were in place to exclude such people. The possibility of alternative attitudes and additional modes of treatment remained open. iii. Purification Rituals The agency of “purifiers” was sought to treat both physical and mental diseases. Parker's careful discussion of the differences and similarities between the archaic healer-seers and the later (and lesser) heirs to their traditions, the purifiers of the fifth and fourth centuries, tells us something of the kinds of disease popularly thought to be appropriate for their arts. Epilepsy and madness are singled out along with some physical diseases, notably skin diseases, impotence, and plagues.466 The legendary healer-seer Melampes (HN87) was said to have healed the Dionysian μανία of the Argive women μεθ᾽ ἀλαλαγμοῦ καί τινος ἐνθέου χορείας (with the help of ritual cries and a sort of possessed dancing).467 And the historical healer-seer Epimenides “professed to purify people by rite from any damaging influence whatever, physical or mental, and to state its cause.”468 Such healing individuals however, were much maligned by the fifth and fourth centuries, as the author of the Hippocratic treatise on the Sacred Disease makes very clear.469 The treatise is useful, however, for providing details of some of some rituals

464 Parker 1983, 219; indeed the temples seem to have been appropriate places for those whose ‘madness’ took the inspired, prophetic form. 465 Parker 1983, 219; on stone throwing and spitting see discussion below. 466 Parker 1983, ch. 7, esp. 208-210; on the healer seer see also Kudlien 1968, 305-310. 467 Dodds 1951, 77, cf. 95, n.85 citing [Apoll.] Bibl. 2.2.2; cf. Paus. 8.18.7, the Proetids 468 457 FGrH T 4e in Parker 1983, 210, n. 17 (original emphasis). For Melampus and Epimenides as healer-seers see Parker 1983, 209-210. 469 See discussion above ch. 5.

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of purification and incantation which were popularly thought to cure epilepsy.470 The approach here appears to have been eclectic: baths were forbidden and a great variety of foods, the sufferer was forbidden to wear black (a sign of death), must not lie on or wear goat-skin, nor “put foot on foot or hand on hand (all which conduct is inhibitive)”.471 The last phrase, πάντα γὰρ ταῦτα κωλύματα εἶναι, is thought to be a reference to “binding” by sorcery. This method of treatment is criticized by the author: καθαρμοῖσί τε χρέονται καὶ ἐπαοιδῇσι, καὶ ἀνοσιώτατόν τε καὶ ἀθεώτατον πρῆγμα ποιέουσιν, ὡς ἔμοιγε δοκεῖ· καθαίρουσι γὰρ τοὺς ἐχομένους τῇ νούσῳ αἵματί τε καὶ ἄλλοισι τοιούτοις ὥσπερ μίασμά τι ἔχοντας, ἢ ἀλάστορας, ἢ πεφαρμακευμένους ὑπὸ ἀνθρώπων, ἢ τι ἔργον ἀνόσιον εἰργασμένους, οὓς ἐχρῆν τἀναντία τούτων ποιεῖν, θύειν τε καὶ εὔχεσθαι καὶ ἐς τὰ ἱερὰ φέροντες ἱκετεύειν τοὺς θεούς· νῦν δὲ τούτων μὲν ποιέουσιν οὐδέν, καθαίρουσι δέ. καὶ τὰ μὲν τῶν καθαρμῶν γῇ κρύπτουσι, τὰ δὲ ἐς θάλασσαν ἐμβάλλουσι, τὰ δὲ ἐς τὰ ὄρεα ἀποφἐρουσιν, ὅπη μηδεὶς ἅψεται μηδὲ ἐμβήσεται· τὰ δ᾽ ἐχρῆν ἐς τὰ ἱερὰ φέροντας τῷ θεῷ ἀποδοῦναι, εἰ δὴ ὁ θεός ἐστιν αἴτιος ... In making use, too, of purifications and incantations they do what I think is a very unholy and irreligious thing. For the sufferers from the disease they purify with blood and such like, as though they were polluted, blood-guilty, bewitched by men, or had committed some unholy act. All such they ought to have treated in the opposite way; they should have brought them to the sanctuaries, with sacrifices and prayers, in supplication to the gods. As it is, however, they do nothing of the kind, but merely purify them. Of the purifying objects some they hide in the earth, others they throw into the sea, others they carry away to the mountains, where nobody can touch or tread on them. Yet, if a god is indeed the cause, they ought to have taken them to the sanctuaries and offered them to him.472

470 Hipp. Morb. Sacr. 2 and 4; καθαρμοὺς προσφέροντες καὶ ἀπαοιδάς. 471 On this passage and magical cures for epilepsy generally see Temkin [1945] 1971, 10-15; the significance of goats, 11-12. A rare type of goat currently in vogue among some goat breeding circles in North-America is 'the falling goat'. These animals fall to the ground -often mid-bounce - and are apparently unconscious for very brief intervals, then get up and carry on with no ill effects. This falling occurs repeatedly and regularly. Is it possible that similar strains of goats in the ancient Mediterranean world gave rise to a connection in popular thought between epilepsy and goats? The Hippocratic Morb. Sacr. 14 describes goats as common victims of epilepsy and folk and magical cures for epilepsy repeatedly involve goats in some way - e.g. avoidance of goat skins, eating goat's liver. 472 Hipp. Morb. Sacr. 4 (Trans. Loeb).

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iv. Religious Healing Rituals It was generally thought that rituals specifically associated with those divinities primarily thought to cause madness would be effective in curing it.473 In this connection mention is made particularly of the rites of Dionysus, Hecate, the Mother and the Corybantes.474 Little reliable is known about the rites of Hecate and the Mother in connection with cures for mental conditions but about the healing cult of the Corybantes slightly more is available.475 Their cult is not attested before the fifth century but their method of healing, by homeopathic ecstatic possession, was not new; the cult of Dionysus which preceded it is thought to have had a similar function and healing process.476 A passage in Plato's Laws (790c) speaks of “the women who cure Corybantic conditions”. They are mentioned in the same context as nurses of young children who understand the value of rhythmic movement and song for calming frantic children. Plato explains that the effects of rocking and singing to a child are similar to the effect the music of the pipes has upon frenzied Bacchic revellers. Here he seems to speak as though both Corybantic and Bacchic rituals had the same purpose and method.477 He goes on to explain: Δειμαίνειν ἐστί που ταῦτ᾽ ἀμφότερα τὰ πάθη, καὶ ἔστι δείματα δι᾽ ἕξιν φαύλην τῆς ψυχῆς τινά. ὅταν οὖν ἔξωθέν τις προσφέρῃ τοῖς τοιούτοις πάθεσι σεισμόν, ἡ τῶν ἔξωθεν κρατεῖ κίνησις προσφερομένη τὴν ἐντὸς φοβερὰν οὖσαν καὶ μανικὴν κίνησιν, κρατήσασα δὲ γαλήνην ἡσυχίαν τε ἐν τῇ ψυχῇ φαίνεται ἀπεργασαμένη τῆς περὶ τᾶ τῆς καρδίας χαλεπῆς γενομένης ἑκάστων πηδήσεως, παντάπασιν ἀγαπητόν τι· τοὺς μὲν ὕπνου λαγχάνειν ποίει. τοὺς δ᾽ ἐγρηγορότας ὀρχουμένους τε καὶ αὐλουμένους μετὰ θεῶν, οἷς ἂν καλλιεροῦντες ἕκαστοι θύωσι, κατειργάσατο

473 Vaughan 1919, 47 lists legendary cures attributed to gods: Zeus cures Io, Aesch. Pr. 848f. (cf. Lucian Dial. Mar. 7, it is Hermes); Hera with Artemis cures the Proetids, Bacchyl. 10.107f.(cf. Artemis alone; Paus. 8.18.8); Apollo cures Orestes, Aesch. Choe. 1021ff.; Athena cures Ajax, Quint. Smyr. 5.451 and Heracles, Eur. HF 1003f.; Cybele (or Rhea)cures Dionysus, Apoll.. 3.5; Julian 1.7.220c; Vaughan adds Medea curing Heracles, DS 4.55.4. 474 The scholia (ad Pi. Pyth. 3. 137ff.) call both Dionysus and the Mother “curers of madness”, καθαρτικὸς τῆς μανίας (Dionysus); καθάρτρια τὴς μανίας (Mother/Cybele); see also Dodds 77-80; he suggests (95, n.87) little evidence in the historical period for Dionysus as healer; cf. Parker 1983; 246-247, 288 and n. 36; See also Vaughan 1919,, 47-48; Tambornino 1909, 75-76. 475 Dodds 1951 96, n.91 on the annual teletÆ of Hekate at Aegina suggests that the inference drawn from Arist. V. 122, that the rites were directed to curing madness, is only a “plausible guess.”On Hekate now see Johnston 1990. On the connection and similarity in function of the rites of the Mother (Rhea-Cybele) and the Corybantic rites see Dodds 1951, 96 n.90. On the Corybantic rites see especially Linforth 1946a. 476 Dodds 1951, 77; Parker 1983, 247. 477 See Saunders 274,n.2 Penguin trans. of Pl. Laws. Plutarch too, when considering divine possession, indicates a similarity between the rituals of Dionysus and those of Pan, Cybele ,and the Corybantes. Ἐνθουσιασµοῦ δὲ τὸ µαντικὸν ἐξ Ἀπόλλωνος ἐπιπνοίας καὶ κατοχῆς, τὸ δὲ Βακχεῖον ἐκ Διονύσου, κἀπὶ Κυρβάντεσι χορεύσατε, φησὶ Σοφοκλῆς· τὰ γὰρ µητρῷα καὶ πανικὰ κοινωνεῖ τοῖς Βακχικοῖς ὀργιασµµοῖς. Plut. Mor. 758E-F; Soph. Fr. 778 (Nauck, TGF p. 313); “There are several kinds of enthusiasm: the prophetic comes from the inspiration and possession of Apollo; the Bacchic from Dionysus - Dance after the Corybantes, says Sophocles, for the festivals of Cybele and Pan have much in common with the Bacchic revels.” (Trans. Loeb)

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ἀντὶ μανικῶν ἡμῖν διαθέσεων ἕξεις ἔμφρονας ἔχειν. καὶ ταῦτα, ὡς διὰ βραχέων γε οὕτως εἰπεῖν, πιθανὸν λόγον ἔχει τινά. Both these conditions are a species of fear, and fear is the result of some inadequacy in the personality. When one treats such conditions by vigorous movement, this external motion, by cancelling out the internal agitation that gives rise to the fear and frenzy, induces a feeling of calm and peace in the soul, in spite of the painful thumping of the heart experienced by each patient. The result is very gratifying. Whereas the wakeful children are sent to sleep, the revellers (far from asleep!), by being set to dance to the music of the pipes, are restored to mental health after their derangement, with the assistance of the gods to whom they sacrifice so propitiously.478 The “Corybantic conditions” which Plato refers to seem to have included both forms of madness and anxiety states which were “cured homeopathically by the disciplined music and dancing of Corybantic ritual.”479 Plutarch too explains the therapeutic effect of such rites in a slightly different way; calm and tranquillity is induced with a shift in the kind of music which is played in the last stages of the rites, a shift in rhythm from the trochaic and a shift in mode from the Phrygian. He compares this effect with the relief from the madness of war a soldier feels when he lays down his arms and with the calm and tranquillity the Pythia experiences after she has left her tripod.480 The use of Corybantic initiation to cure mental conditions is further attested in Aristophanes' Wasps , where it is one of several methods tried on Philocleon's father.481 Here too we see the verb κορυβαντιάω used in a way similar to ἑλλεβοριάω, meaning to be in need of the Corybantic rites because of some mental disturbance.482 Elsewhere in Plato there seems to be the inference that it was a common practice even for elite Athenians to participate in these rites, and in a controversial passage he is thought to refer to the use of this kind of purification and initiation in curing madness which has afflicted certain families because of ancient sins. ἀλλὰ μὴν νόσων γε καὶ πόνων τῶν μεγίστων, ἃ δὴ παλαιῶν ἐκ μηνιμάτων ποθὲν ἔν τισι τῶν γενῶν, ἡ μανία ἐγγενομένη καὶ προφητεύσασα οἷς ἔδει ἀπαλλαγὴν εὕρετο. καταφυγοῦσα πρὸς θεῶν εὐχάς τε καὶ λατρείας, ὅθεν δὴ καθαρμῶν τε καὶ τελετῶν τυχοῦσα ἐξάντη ἐποίησε τὸν

478 Pl. Leg. 790E-791A (Trans. Saunders). 479 Saunders ad Pl Laws, 274, n.1. Saunders defines these conditions as “frenzied pathological states accompanied by a strong desire to dance, popularly supposed to be caused by the Corybantes, spirits in attendance on the goddess Cybele.” This is perhaps too limited a view of the disorders the ritual was used to cure. See Linforth 1946a and Dodds 1951, 77-80. 480 Plut. Mor. 759A-B; on this passage see Linforth 1946a, 126. 481 Schol ad loc.: τὰ τῶν Κορυβαντίων ἐποίει αὐτῷ μυστήρια, ἐπὶ καθαρμῷ τῆς μανίας. 482 Aristoph. V.. 8; but see Linforth 1946a, 152-154 who argues that the word means fundamentally and most frequently “to be in a state of Corybantic possession”.

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ἑαυτῆς ἔχοντα πρός τε τὸν παρόντα καὶ ἔπειτα χρόνον, λύσιν τῷ ὀρθῶς μανέντι τε καὶ κατασχομἐνῳ τῶν παρόντων κακῶν εὑρομένη. In the next place, when ancient sins have given rise to severe maladies and troubles, which have afflicted the members of certain families, madness has appeared among them and by breaking forth into prophecy has brought relief by the appropriate means: by recourse, that is to say, to prayer and worship. It has discovered in rites of purification and initiation a way to make the sufferer well and to keep him well thereafter, and has provided for the man whose madness and possession were of the right type a way of escape from the evils that beset him.483 Linforth has discussed various speculative attempts to identify the legendary families afflicted with madness referred to in this passage and has concluded convincingly that Plato had no specific family in mind. Rather, he says, Plato is providing an aetiological myth for the wild and unseemly disorder of institutionalized ritualistic frenzy (such as the Corybantic rites) and has attempted to dignify it, so that it may take its place beside other worthy forms of divine madness, especially those of the prophet and the poet. Madness herself was the discoverer, and to her he gives the glory. ...He has emphasized the divinity of Madness herself, and he has declared that her benevolent work was first displayed in cures which were effected, not among persons of unstable and fanatical temperament, but in the high circles of old aristocratic families.484 There is little detailed information about how the Corybantic rites were organized and carried out. Participation seems to have been available to all (women, men, and slaves are mentioned in connection with them), and they appear to have been particularly attractive to those suffering from irrational fears and anxieties. Participants it seems, could join in at regular intervals to find repeated relief from their symptoms.485 v. Music Several of the cures discussed above include music as part of their healing process, as for example the singing of a series of Paeans to Apollo. Dancing, singing, and instrument playing too was integral with the Bacchic and Corybantic rituals, and indeed music was probably used diagnostically in the Corybantic rites, the patient's reactions

483 Pl. Phdr.. 244e, Trans. Hamilton (Penguin); on participation Euthyd. 277d and see Dodds 1951,99, n.104 on the possibility that Socrates himself had participated. That the rites of purification and initiation were Bacchic/Corybantic see now Parker 1983, 288, cf. Linforth 1946a, 163-72. 484 Linforth 1946b, 170 -171. The entire article is a lucid explication of this passage. 485 See Gill 1985, 310-311 for an interesting comparison of Corybantism and some modern psychotherapeutic methods. More recently, a technique developed at the Sylvan Trust in England treats epileptic patients through music and dance, viewing “epileptic seizures as outbursts of bottled-up emotional energy rather than symptoms of a brain abnormality”; see Michael Kesterton, “Social Studies. Some notes on music,” Globe and Mail, 17 Sept. 1992, sec. A20.

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to the various kinds of music played indicating the kind of disorder he suffered from and the appropriate healing response.486 The ability of music both to soothe and to arouse means it has the potential to work both homeopathically and allopathically on the mind and both approaches seem to have been used by the Greeks to bring order to a disordered mind.. Whether by excited or more measured rhythms, “music patterns, and thereby opposes, is the antidote to, violent passion.”487 Music was an ancient therapy and legendary healers included music among their techniques: Thaletas the Cretan put an end to the plague attacking the Spartans by his music, and the healerseer (ἰατρόμαντις) Melampus, as we have seen, was said to have cured the women of Argos of their madness by a musical ceremony which involved ritual cries and possessed dancing.488 Later Theophrastus, like Plato suggested music as a cure for anxiety states. And Asclepiades followed by several other physicians in Roman times recommended music among their treatments for mental diseases; others, however, warned of its deleterious effect.489 The Pythagoreans are reported to have believed profoundly in the health-giving power of music, a subject which is discussed in connection with education and societal hygiene by subsequent philosophers, notably Plato and Aristotle.490 In the later tradition, Cleinias the Pythagorean is reputed to have used music as a cure for anger and the Pythagoreans generally were reputed to use lyre music before sleep to charm and cure the irrational in the soul.491 Not all instruments and forms of music, however, were considered conducive to mental health. Both philosophers and medical practitioners expressed reservations about flute music - too arousing - and the Phrygian mode - too frenzied. Yet it is precisely with the music of flutes, drums and Phrygian rhythms that the orgiastic religious rituals achieved their homeopathic cures. More usually however, deleterious effects could be expected on the rational mind and the emotions from these, whereas music from stringed instruments, such as the lyre, and music of the Dorian mode especially were thought to have a sobering and steadying effect on the listener.492 It is interesting to note parenthetically that in addition to suggestions for the use of music in curing mental problem, the medical literature

486 Pl. Ion 536C, see Dodds 1951, 79 and n.102; and cf. Men. Theophor.. 487 Padel 1992, 127. 488 Thaletas, Plut. Mor. 1146C; Parker 1983, 209, 212; Dodds 1951, 77; Melampes, HN 87. 489 Thphr.., Fr. 88 Wimmer (=Aristoxenus, Fr.. 6) cited in Dodds 1951, 99, n.108; Celsus 3.18; Cael Aur. (= Soranus) Morb. Chron. 1.5; Censorinus, de die natali 12.4 and see below ch. 9. 490 Pythagoreans: Dodds 1951, 79 and 99, n.107; see discussion Parker 1983, 297-8; Iambl. VP 110, 68; cf. Aristoxenus Fr. 26 Wehrli; Porph. VP 30, 32-3. Arist.. Pol. 8.7, 1341b 32-1342a16. For discussion of the cathartic effects of music see Lucas ed. Arist. Poet. Appendix II. 491 Ael VH 14.23 cf. Plut. Mor. 384A. 492 Aristotle Pol. 8.7; c.f Dio Chrys. 32.56-57; Pl. Rep. 398c-400c, Plato suggests (400b) that certain combinations of rhythms are suitable to express “meanness, insolence, madness (μανία), and other evil characteristics”.

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also contains several examples of individuals with psychological disturbances and irrational fears associated with the sound of flute players.493 vi. Dreams and Incubation The belief that helpful information may come from dreams is present in Greek thought from the earliest times. 494 Significant dreams might occur spontaneously bringing with them messages, advice, or clues to important problems - clues of varying degrees of opacity. Skilled interpreters were sometimes required to disentangle obscure dream language. Priests or seers would undertake such tasks and, in later antiquity, specialized dream interpreters and their books of dream signs were available.495 In the fourth century BCE some specialists in Hippocratic medicine used signs from dreams to assist in diagnosing physical diseases.496 In addition, advice from dreams was deliberately sought, and methods evolved to stimulate access to dream figures and experiences. One of these was the practice of sleeping in a sacred place, sometimes near a chasm which offered access to the world of the dead, and often near the tomb of a powerful figure from the past, a hero. Strabo (14.1.44) describes one such cave, the Charonium, above the sacred precinct of Pluto and Kore. The sick were often left there for days at a time to heed their own dreams or to consult with the priests who also slept there and prescribed from their own dreams. The heroes, like the gods, were thought capable of sending disease - including madness. This they could do either at whim or because they constantly intervened in human's affairs in a moral supervisory capacity. In a fragment from Aristophanes' Heroes, the chorus of heroes announce “We are the guardians of good things and ill; we watch out for the unjust, for robbers and footpads, and send them diseases - spleen, coughs, dropsy, catarrh, scab, gout, madness, lichens, swellings, ague, fever. That's what we give to thieves.”497 ἡµεῖς ἐσµεν οἱ ταµίαι τῶν κακῶν καὶ τῶν ἀγαθῶν, κἀναθροῦντες τοὺς ἀδίκους 493 See below ch.7, MT8; MT136; cf. MT107; and Dodds 1951, 97, n. 95. 494 On dreams and their patterns of use in Greek thought see Dover 1951, ch.4; on incubation esp. 110-116; dream oracles, Burkert [1977] 1985, 115; on the power dreams could have see e.g. Plut. Mor. 168F, Midas' suicide because of a dream. 495 One famous extant work is the second century CE Oneirocritica of Artemidorus of Dalda, which informs us, for example, that to dream of singing in the market place foretells disgrace and ridicule for a rich man, and insanity for a poor man (1.76). 496 See Dodds 1951, 119 and notes. Hipp. On Regimen (περὶ διαίτης) is particularly detailed in its use of dreams for diagnosis; dreams as significant signs elsewhere in the Hippocratic corpus: Epid. 1.10 (II.670 L); Hum. 4, (V 480L); Hebd. 45, IX 460L. Dodds notes(133 n. 102), “in particular, anxiety dreams are seen to be important symptoms of mental trouble, Morb. 2.72, VII 110L; Int. 48, VII 286L. Aristotle says the most accomplished physicians believe in taking serious account of dreams, div. p. somn. 463a 4.” The Quaestiones Medicinales of Rufus of Ephesus stress the important signs the physician may detect from the dreams of his patients (205-206). 497 Ar. Fr. 58 (Austin) cf. Merkelbach 1967. On the heroes both as moral supervisors of conduct and as general trouble-makers see Parker 1983, 243-44 (with bibliography); Burkert [1977] 1985, 203-208. On hero cults (Attica) see now Kearns 1989, healing heroes, 14-21; cf. also Simon (forthcoming) 19-22.

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καὶ κλέπτας καὶ λωποδύτας τούτοις μὲν νόσους δίδομεν σπληνιᾶν βήττειν ὑδερᾶν κορυζᾶν ψωρᾶν ποδαγρᾶν μαίνεσθαι λειχῆνας ἔχειν βουβῶνας ῥὶγος πυρετόν· ταῦ]τα [τοῖ]ς κλέπτα[ις] δίδομεν If the heroes could send disease, deservedly or undeservedly, they could, like the Olympian gods, also send cures. This they would do through the medium of dreams which they sent to the inquirer during the process of incubation.498 The ritual of incubation involved a preparatory sacrifice, followed by a stay overnight in the sacred area or temple. In the morning the inquirer's dreams would be interpreted, usually with the aid of attendant priests.499 Pausanias (1.34.5) describes the procedure at the dream oracle of Amphiaraus at Oropos: καὶ πρῶτον μὲν καθήρασθαι νομίζουσιν ὅστις ἦλθεν Ἀμφιαράῳ χρησόμενος· ἔστι δὲ καθάρσιον τῷ θεῷ θύειν, θύουσι δὲ καὶ αὐτῷ καὶ πᾶσιν ὅσοις ἐστιν έπὶ τῷ βωμῷ τὰ ὀνόματα· προεξειργασμένων δὲ τούτων κριὸν θύσαντες καὶ τὸ δέρμα ὑποστρωσάμενοι καθεύδουσιν ἀναμένοντες δήλωσιν ὀνείρατος. One who has come to consult Amphiaraus is wont first to purify himself. The mode of purification is to sacrifice to the god, and they sacrifice not only to him but also to all those whose names are on the altar. And when all these things have been first done, they sacrifice a ram, and, spreading the skin under them, go to sleep and await enlightenment in a dream. (Trans. Loeb) For those suffering from various intractable medical problems incubation was a popular option, and it was still used extensively even when incubation for other purposes seems to have declined at the end of the fifth century. 500 Among dream oracles associated with healing gods and heroes, the cult of Asclepius in particular assumed great stature as Asclepeia became important centres in the ancient world.501 There is some evidence that incubation was used in cases of mental disturbance. Philocleon for example, in Aristophanes' Wasps (121-123) was taken to the 498 The ancient practice of incubation survives in the modern Greek Christian practice of incubation in a church; see Dols 1984, 145; Ballas 1972; Papageorgiou 1975. 499 Burkert [1977] 1985, 115, citing Deubner De Incubatione, 1900 and Hamilton Incubation, 1906. 500 Dover 1951, 118; see also Kearns 1989 18-19. 501 Edelstein and Edelstein 1945 have published the inscriptions on votive tablets from the temple of Asclepius at Epidaurus, the most famous of the Asclepeia; see also Kerenyi [1942] 1945. Another important healing centre in mainland Greece was the Amphiaraion at Oropos, see Paus. 1.34.5; Kearns 1989, 147, 14-21 cites Petrakos, Ὁ Ὀρωπὸς καὶ τὸ ἱερὸν τοῦ Ἀμφιαράου, Athens 1968; A. Schachter Cults of Boeotia BICS Supp. 38. 1.19-26; Braithwaite 1925; Panayiotis 1968; see also Burkert [1977] 1985, 393 n.59.

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island of Aegina and lodged in the temple of Asclepius overnight in one of his son's vain attempts to cure him of his jury-mania. And although from Epidaurus, the major centre for healing in the Greek world, no votive tablets have been found which mention cures for mental illness, one at least does record the experience of an epileptic incubant (HN88): N.N from Argos, epileptic. This man during his sleep in the curative chamber saw a vision: he dreamed that the god approached him and pressed his ring ... upon his mouth, nostrils, and ears and recovered.502 We might reasonably speculate about the role of dreams in another case, that of Archedamos of Thera, who was νυμφόληπτος. A very common kind of “godsent” dream is one which instructs an individual to dedicate or build something for the deity.503 Epigraphical evidence confirms this for Greece, certainly for the Hellenistic and Roman period, but as Dover has shown, the practice was undoubtedly common earlier. He cites a passage from Plato's Laws (909E-910A) which states that dedications are made as a result of dreams or waking visions, “especially by women of all types, and by men who are sick or in some danger or difficulty, or else have had a special stroke of luck”.504 It seems entirely possible that the cave decorations (undertaken at the admonition of the nymphs), the gardens, and the dancing floor for the nymphs at the Vari sanctuary were created by Archedamos because of a series of dreams.which may have occurred either spontaneously or as a result of incubation.505 The paucity of references connecting incubation with mental disease is very likely a reflection of a more general scarcity of evidence. It is possible however, that incubation was a method of treatment not suited to deeply disturbed individuals, many of whom, it has been suggested, were not even aware that they were ill. It is a form of treatment which depends for results very much on what the inquirer brings to the process. As to those individuals suffering from the more marginal forms of mental disturbance such as melancholy, δυσθυμία, or love sickness, perhaps other forms of cure - moral suasion, magic, or a purgative - may have been seen to be more appropriate. One very valuable source for the process of medical incubation is the unique personal account of treatment by incubation by an individual whose medical problems puzzled the doctors of his time and even today evoke some

502 Temkin [1945] 1971, 14, citing Rudolph Herzog, Die Wunderheilungen von Epidauros. Philologus, Supplementband 22, Heft 3 (Leipzig: 1931), 33. Milns 1986, 461 n. 8 finds it remarkable that of the 43 epigraphically attested cures from Epidaurus, none is for insanity. 503. Dover 1951, 108; this is true in Greece (and elsewhere) still today. (I myself have contributed to the rebuilding of an ancient church in western Crete, undertaken by a young businesswoman friend because of a series of insistent dreams.) 504 ἔθος τε γυναιξί τε δὴ διαφερόντως πάσαις καὶ τοῖς ἀσθενοῦσι πάντῃ καὶ κινδυνεύουσι καὶ ἀποροῦσιν, ὅπῃ τις ἂν ἀπορῇ, καὶ τοὐναντίον ὅταν εὐπορίας τινὸς λάβωνται; Dover 1951, 108 and notes; cf. Pl. Epin. 985C. 505 Archedamos HN81.

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speculation, the second century CE orator and sophist, Aelius Aristides (HN89).506 The account is based on a diary which Aristides kept at Asclepius' command and consists in a detailed description of his lengthy illness and the dreams and cures he underwent during his sojourn at the shrine of Asclepius in Pergamon. His stay at the sanctuary lasted ten years, except for occasional trips to other healing centres, and during that time Aristides looked upon Asclepius as his physician, whose methods of treatment (often paradoxical) were revealed to him in a series of dreams. Over the years Aristides records a multiplicity of symptoms, all of which he describes in physical terms; there is no evidence at all that he (or anyone else) thought he was suffering from any form of mental disorder. 507 Attempts have been made by modern scholars to categorize Aristides as mentally disturbed - a neurotic, a hypochondriac, someone who did not want to be cured.508 Rosen in particular has provided a detailed psychoanalytic study of Aristides career as an invalid, but many of his observations are highly debatable.509 He does however make some useful observations about the probable social function of healing centres such as the Asclepeion at Pergamon which, whether or not they apply to Aristides, could apply to any mentally or emotionally impaired citizen of wealth and leisure. Rosen stresses the role played by therapeutic religious community such as those at the Asclepeion in enabling individuals to find solutions to their mental and emotional problems:510 The cult of Asclepius was ... a system in which faith in the god, the practices of incubation and dream interpretation, the rituals, and the therapies, together with the environment created by the priests and the other patients, combined to provide an institutional framework, which enabled patients like Aristides to behave in extravagant but culturally sanctioned ways, thus protecting them from the possibly disruptive consequences of their unconscious needs and private defensive manoeuvres.511 IV. Other Cures 506 See Behr 1968 and 1986; Aristides life and works see: Philostrat. VS 9; Rosen 1969, 110, n. 140 cites, among others, Festugiere 1954, ch. 6. 507 Gill 1985, 312, “Aelius himself does not regard his treatment as psychotherapy because he sees his illness as being physical and Asclepius as being a medical doctor in the usual sense (albeit a divine one).” 508 Rosen 1969, 118-120, esp. 119, “Aristides ... was a neurotic with functional symptoms localized most specifically in the respiratory and gastrointestinal tracts”.; and Aristides had “the iron constitution of the chronic invalid”; (citing Bonner 1937, 126 and Festugiere [1954] 1960, 86); Gill 1985, 312, is more cautious and implies that Aristides' diseases were at least partly psychosomatic. 509 For example, Rosen prefers Freudian explanations for Aristides' “fantasies” which involve his “deep-seated sense of guilt ... underlying severe anxiety ... and excessive...self-regard”. He also bases his explanation for Aristides' asthmatic condition on a putative disturbed mother-child relationship. 510 Rosen 1969, 110-111 cf. 109 and 120; Gill 1985, 312 makes a similar observation, “what is psychiatrically interesting about [Aristides'] account is that it shows how the temple of Asclepius provided a context in which a person could (with religious, medical and social support) explore his psycho-physical individuality, and could treat, with partial success, diseases which were at least partly psychosomatic.” 511 Rosen 1969, 120; the parallel with expensive sanatoria or spas is irresistible see Rosen 114, and Simon (forthcoming).

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An essentially experimental, ‘try anything’ approach was very likely the key in antiquity when it came to searching for cures for madness and mental disturbances of all kinds. Psychological problems are difficult to cure and by their very nature idiosyncratic. It has long been thought that the series of desperate attempts by Philocleon in Aristophanes Wasps to find some remedy for his father's wandering obsessiveness truly reflect the position of those who had a mentally afflicted individual in the family.512 ... in the actual life situation of people struggling with emotional distress and/or diagnosable mental illness, people would (as they still do) reach for any number of possible avenues of relief for their distress. To speak of what was the treatment for mental illness at a particular time or place already misses the point that as far as we can tell throughout antiquity there were a multiplicity of treatments available, and if one didn’t get better with method A, one tried method B, and all others humanly possible. Or, some tried several at once, and not necessarily seriatim.513 It is not surprising therefore, that some of the sudden cures for madness which have been reported in the literature have a rather post hoc quality. Cambyses, for example, is said to have suddenly become sane after a series of shocks: a political uprising followed by being wounded and falling from his horse.514 Somewhat akin to shock was the reported effect on the suicidal young women of Miletus of the threat to carry their naked bodies through the market place; they quickly reverted to their normal behaviour.515 More sinister is the suggestion implicit in an epigram in which a maniac (φρενοπλήξ) and a man in a coma (ληθαργικός) are put in bed together in order to cure them both. The madman (one assumes predictably), attacks the other, who is forced to wake up and gives him a sound beating in return and this effectively cures him.516 Another violent but novel cure is the one related in a story in Pausanias (8.34.2-3) about Orestes, who recovered from his madness after he bit off his own finger. Finally, time itself is understood to have worked a cure in some kinds of madness: after three days Xenophon's army, crazed by the honey of the bees of Colchis, had recovered.517 So too the women of Amphissa required time to rest from their Bacchanalian frenzy - plus some care and feeding - before they were sane enough to travel.518

512 Rosen 1969, 135; Milns 1986, 455-456; Gill 1985, 315-316. 513 Simon (forthcoming), 9. 514 Herod. 3.64 ἐκπεπληγμένος ... ἐσωφρόνησε. 515 Plut. Mor. 249B-D; HN 27. 516 Anth. Pal. 9.141 cf. Vaughan 1919, 53-54 who cites customs in other Indo-European culture which involve ritually whipping epileptics and madman to drive out evils. V. suggests that although there is no evidence for this custom in Greece, this epigram may contain a survival of that kind of thought. This interpretation does not seem congruent with the way in which daemons are perceived by Greeks as rather harassing than “possessing”. For expectations of violence on the part of the insane see above ch.4. 517 Xen. Anab. 4.8.19-21; HN 25. 518 Plut. Mor. 249E-F; HN 28.

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B. Care and Attitudes: I. Public Attitudes Apart from the search for a cure, other responses to the mentally disturbed are suggested by the anecdotal sources. It is to be expected that responses would vary depending upon the onlooker’s degree of closeness to the problem. Several different attitudes are visible in the reactions of people publicly encountering an obviously disturbed individual, a madman or an epileptic. Artemidorus (Oneir. 3.42) provides some information about public attitudes to the madman on the street. Μαίνεσθαι ἀγαθὸν τοῖς ἐπὶ τὸ πράττειν ὁρμῶσιν· ἀκώλυτοι γὰρ οἱ μαινόμενοι, ἐφ᾽ ὅ τι ἂν ὁρμήσωσι. μάλιστα δ᾽ ἂν εἴη ἀγαθὸν τοὶς δημαγωγεῖν καί ὄχλου ἄρχειν βουλομένοις καὶ τοῖς εἰς ὄχλον καθιεῖσιν ἑαυτούς· πλείονος γὰρ ἀποδοχῆς ἀξιωθήσονται. ἀγαθὸν δὲ καὶ τοῖς παιδεύειν βουλομένοις, ἐπειδὴ καὶ παῖδες τοῖς μαινομένοις ἀκολουθοῦσι. καὶ τοὺς πένητας εὐπορωτέρους ἔσεσθαι σημαίνει· παρὰ πάντων γὰρ ὁ μαινόμενος λαμβάνει. καὶ τῷ νοσοῦντι ὑγεῖαν προαγορεύει· κινεῖσθαι γὰρ καὶ περιπατεῖν μανία προάγεται καὶ μὴ κατερρῖφθαι [καὶ μὴ ἠρεμεῖν], ὥσπερ ἐν νόσῳ [ὅπερ ὑγιείας ἐστὶ σύμβολον]. To dream of being insane is auspicious for those who are undertaking a business venture. For madmen are not hindered in anything that they set their hearts on. It would be especially propitious for potential demagogues, for those who wish to rule the masses, and for those who ingratiate themselves with the crowd. For they will be considered worthy of greater acceptance. It is also auspicious for those who wish to teach, since children also follow the insane. It signifies, moreover, that poor men will become richer. For madmen receive something from everyone. It foretells health to a sick man. For madness induces men to move and walk about and not to lie prostrate in bed [and not to be at rest] as they do when they are sick [which is a symbol of health].519 This passage suggests that people may have given madmen a wide berth - tolerated strange behaviour and minor demands, even given things to them out of pity or superstitious fear. Taunting or ridicule are probably implied by the observation that children follow madmen - but also the simple fact that children are intrigued by and curious about anything out of the ordinary.520 Stories found in Philo Judaeus, Dio Chrysostom, and Bar-Hebraeus in which

519 Artem. Oneir. 3.42, (Trans. White 1975, emphasis mine). 520 Vaughan 1919 38 discusses the prevalence of stoning in antiquity, citing Hirzel, die Strafe der Steinigung, Abhand. d. kgl. sächs. Ges. d. Wiss., phil. hist. kl., vol. 27, 225ff.; Farnell 4.272.

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harmless madmen were the focus of attention of groups of small boys suggest that this phenomenon was one found in many cultures in antiquity (and later).521 i. Spitting It has been noted by a number of writers that some people spit upon sight of madmen and epileptics as they pass them in the street Theophrastus tells us that one characteristic of the superstitious man is, “when he sees a madman or an epileptic, he shudders and spits in his bosom”.

522 We cannot know whether this was a universal reaction;

family members, friends, and those who prided themselves, like Theophrastus, on being freed from superstitions, may or may not have felt impelled to follow this practice. Spitting was in all probability directed primarily toward that category of the mentally aberrant who were wandering or dispossessed. The fact that Apuleius' epileptic slave boy,Thallus, caused his fellow slaves to spit, confirms his lack of status, but also emphasizes the prevalence of superstitious fears in antiquity.523 The spitting reaction, however, probably did not exist in isolation. Superstitious people in contemporary Mediterranean countries often spit to avert the evil eye, but this usually is done as an automatic gesture and is part of a complex of responses. Certainly spitting to avert contagion does not preclude other attitudes being held simultaneously and other behaviour being exhibited toward an afflicted person. Avoidance or ridicule may have followed in one case, and in another, alms-giving.524 ii. Avoidance Direct contact with the insane was often something to be avoided. The citizens of Engyium shrank from Nicias in his feigned mad state, allowing him to make his escape unhindered from the city. Much the same response seems to have been true of contact with epileptics. The Hippocratic treatise On the Sacred Disease indicates that epileptics themselves fled from human contact at the first signs of an attack, but the process was often a two-way one: the fellow servants of Thallus in Apuleius' account, shunned him and avoided all contact. Even the usually stalwart Odysseus is shown to be reluctant to confront Ajax face to face, although, he says “Certainly if he were sane I

521 Ph. Jud. In Flacc. 6; Dio. Chrys. 35.7; Bar-Hebraeus The Laughable Stories (Trans. Budge) 160 is cited in Vaughan 1919, 38 n.141. 522 Thphr. Char. 16, μαινόμενόν τε ἰδὼν ἢ ἐπίληπτον φρίξας εἰς κόλπον πτύσαιi; the practice was common in the Roman world too, cf. Plaut. Cap. 3.4.550 ff., et illic isti qui insputatur morbus interdum venit. As Temkin notes, the context here suggests madness rather than epilepsy; the character referred to then asks, “insanum esse me?” See also Pliny NH 10.69, simulque comitialem propter morbum despui suetum; and 28.35, despuimus comitiales morbos, hoc est contagia regerimus, “in cases of epilepsy we spit, that is, we throw back the contagion”. On spitting see Parker 1983; 219, spitting and stone-throwing “were protections against something repugnant and frightening rather than against a medical infection or a formally defined pollution”; for the practice generally see Nicolson 1897; Bolkestein 1939, ch. 7; and for the practice in modern Greece, Blum and Blum 1965. 523 Apul. Apol. 44 HN 57; Parker 1983, 219. 524 On beggary see Bolkestein 1939, 200-213; Hands 1968, ch. 5 on begging and alms-giving; cf. also ch. 6 “Pity for the Destitute”, esp. p. 77.

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should never shrink from him (HN90).”525 In the story by Xenophon of Ephesus, the heroine Anthea feigns epilepsy in the hope that this would cause the customers in the brothel to lose interest in her; they experience a mixture of pity and fear, enough to lose their sexual interest in her, but significantly they are portrayed as also becoming concerned for her welfare.526 iii. Stoning Disturbed persons who were wandering, rootless, perhaps raving and disoriented, were very often the primary targets for stone-throwing and other forms of abuse. Such action may, like spitting, have had an apotropaic element in it, but in addition those disturbed individuals who were particularly threatening or annoying to passers-by were often driven away by pelting them with clods or stones.527 Comedy, both Greek and Roman, makes a great many references to violence and abuse - particularly stone throwing - on the part of mad individuals and those who encounter them. There is evidence too of concerted public stoning of an overtly dangerous madman in the anecdote in Pausanias (6.9.7) about Cleomedes of Astypalea who was chased and stoned by the townspeople after he had pulled down the roof of the school in a manic rage.528 iv. Ridicule Public ridicule of the insane was another feature of life in antiquity; it is implicit in the the statement by Artemidorus that madmen were followed or surrounded by children. The story of Carabbas of Alexandria (HN91) told by Philo Judaeus perhaps typifies the fate of many solitary mentally impaired individuals. There was a certain lunatic (τις μεμηνώς) named Carabas, whose madness was not of the fierce and savage kind (ἀγρίαν καὶ θηριώδη µανίαν), which is dangerous * both to the madmen themselves and those who approach them, but of the easy-going, gentler style. He spent day and night in the streets naked, shunning neither heat nor cold, made game of by the children, and the lads who were idling about. The poor fellow was driven into the gymnasium by a band of rioters who

525 Trans. Moore, Soph. Aj. 81-82, ΑΘ. μεμηνότ᾽ ἄνδρα περιφανῶς ὀκνεῖς; ΟΔ. φρονοῦντα γάρ νιν οὐκ ἂν ἐξέστην ὄκνῳ ; Nicias HN 31; Thallus HN 57. 526 Xen. Eph. 5.7, HN 30. 527 Many sources express fear of violence on the part of madmen; for madmen striking or throwing stones or clods at passers-by see above, ch.4 and Xen. Cyr. 8.3.29-30;Plut. Pomp. 36; [Pl.] Alcib. 2; 139d; Aristoph. V. 1482-1491; Av. 5; Plaut. Capt. 592-602; and see discussion in O'Brien-Moore 1924, 58-64; also cited in Rosen 1969, 88 n.67, Arist. Ra. 560-566; Plaut. Cas. 660-671, Lucian Bis Acc. 16. 528 Stone-throwing at madmen: Aristoph. Av. 524-5 ὥσπερ δ᾽ ἤδη τοὺς μαινομένους / βάλλουσ᾽ ὑμᾶς with scholia τοῖς λίθοις; for discussion of this and other passages see Vaughan 1919, 37 -39 and cf. Roman practices, e.g. Plaut. Poen. 527. On stoning for other reasons (religious offences) see Parker 194-5, n.20. On comic abuse and madness see Dover 1974, 28.

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... set him up on high to be seen by all and put on his head a sheet of byblus spread out wide for a diadem, clothed the rest of his body with a rug for a royal robe, while someone who had noticed a piece of the native papyrus thrown away in the road gave it to him for his sceptre. And when as in some theatrical farce he had received the insignia of kingship and had been tricked out as a kin, young men carrying rods on their shoulders as spearmen stood on either side of him in imitation of a body guard. Then others approached him, some pretending to salute him, others to sue for justice, others to consult him on state affairs. 529 But not only children ridiculed madmen. Laughter and ridicule appear to be a universal response to certain kinds of incongruous behaviour, behaviour which may be labelled to some degree mad. Euthyphro, for example, complained to Socrates that whenever he attempted to speak in the assembly about things divine the Athenians laughed at him as though he were a madman (HN92). And a story by the fabulist Phaedrus tells of an Athenian who, seeing Aesop playing a game of nuts with a group of boys, stopped and laughed at him as if he were crazy (HN93).530 Whether Aesop and Euthyphro were or were not thought to be mad is not the relevant point here; what is clear is that people found it perfectly normal to laugh at some mentally deranged individuals. It should be noted here that two individuals, Menekrates Zeus and Eunus the slave leader, whose roles are particularly difficult for us to assess, were each subject to a type of ridicule. Menekrates was the made the butt of an elaborate practical joke by Philip and taunted to “Get sane!”; and Eunus was exhibited by his master at dinner parties for the amusement of his guests. 531 An anecdote in Plutarch’s Cato demonstrates the propensity for people of all classes to mock those mentally or physically impaired: Τῶν δὲ Ῥωμαίων εἰς Βιθυνίαν τρεῖς ἑλομένων πρέσβεις, ὧν ὁ μὲν ποδαγρικὸς ἦν, ὁ δὲ τὴν κεφαλήν ἐξ ἀνατρήσεως καῖ περικοπῆς κοίλην εἶχεν, ὁ δὲ τρίτος ἐδόκει μωρὸς εἶναι, καταγελῶν ὁ Κάτων ἔλεγε πρεσβείαν ὑπὸ Ῥωμαίων ἀποστέλλεσθαι μήτε πόδας μήτε κεφαλὴν μήτε καρδῖαν ἔχουσαν. When the Romans chose as ambassadors to Bithynia three men of whom one was afflicted with gout, one had undergone an operation in which part of his skull was removed with a trepan and the

529 Philo Jud. In Flacc. 6 (Trans. Loeb); the word translated in the Loeb edition as “dangerous” is ἄσκηπτος; otherwise unknown, its meaning is given in LSJ as “that cannot be feigned”. This is not an appropriate translation here; see the Loeb editor's note ad loc. for some very tentative textual emendations. See also Vaughan 1919, 38-9 and Rosen 1969, 89. 530 Pl. Euth 3c; κατεγελῶσιν ὡς μαινομένου; Phaedr., 3.14.1-3; cf. Dio Chrys. 32.24, who suggests that if a sane man (σωφρονοῦντι) is followed and taunted repeatedly by urchins as crazy, he will, by constantly fending them off, reviling and chasing them, truly end up in a state of madness. 531 Menekrates, Aelian VH 12.51; Plut. Ages. 21.5;HN 20; Eunus,DS 12.34/35; HN24.

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third was considered mentally deficient, Cato made the derisive comment that the Roman state was dispatching an embassy that was missing feet, a head and a heart.532 It has been suggested that the wealthy would have used attendants to watch over disturbed family members to ensure that they were not publicly molested and harassed, and that as a consequence, “the madmen who wandered at large and roamed the streets belonged mostly to the lower classes.”533 This is at least a plausible assumption. Certainly it was the responsibility of the family to care for such individuals, a task more easily undertaken by those with large resources and staffs of slaves or servants.534 A variety of factors may, however, have contributed to disturbed persons becoming wanderers: the attitude of the family towards them; the kinds of behaviour they exhibited, and especially the difficulty of effectively restraining particularly persistent individuals over a long period of time. Again, Philocleon in Aristophanes' Wasps provides a glimpse of how difficult the task may sometimes have been even with the aid of servants. Several of the examples we have considered above were men of great public stature who nevertheless seemed to rove at large unencumbered by “keepers”. Timoleon, who haunted the deserted countryside and kept away from the city, had been rejected by his family - an experience which was probably not unique to him.535 Solon, who spread rumours of his own madness, seems to have wandered quite naturally into the agora to sing his subversive songs without attendants. And Nicias too, who ran from the city in a pantomime of madness, made his way to the Roman camp without serious attempts to follow and restrain him.536 Although it is impossible to estimate the numbers, it seems quite possible that wandering madmen could come from any walk of life. It is noteworthy, however, that the examples noted above are all male heads of households; their constraint would presumably have been far more difficult to manage than that of mentally disturbed women or children. v. Dismissal, Banishment, Escape According to Plutarch (Tim. 5.4), Timoleon's mental state was said to be so disturbed that he refused to take part in public life for a period of twenty years. That some degree of derangement was a considered sufficient reason to prevent people from carrying out responsibilities is a reasonable assumption and is suggested by the several stories of feigned madness above, in which people expected madness to allow them to escape from some undesirable prospect: Odysseus from the Trojan war, Meton to exempt his son from the Sicilian expedition, Nicias from 532 Plut. Cato 36 (9). Trans. Sansone. Cato evidently subscribed to the belief that the mind was located in the καρδία. 533 Rosen 1969, 89. The prototypical Orestes and Io certainly represent the aristocratic segment of society. 534 Family responsibility, see discussion below. 535 Plut. Tim. 5.4 HN18; for another example of family rejection (for reasons obscure) see DL 2.81, the philosopher Aristippus, accused of disowning his son as if he were not his own offspring (τὸν υἱὸν ἀπορριπτοῦντα ὥσπερ οὐκ ἐξ ἑαυτοῦ γεγονότα) is said to have replied, “Phlegm, too, and vermin we know to be of our own begetting, but for all that, because they are useless (ἀχρεῖα ὄντα), we cast them as far from us as possible.” Trans. Loeb, which strangely translates ἀπορριπτοῦντα (above) as “exposing”. This is an improbable use for the verb, particularly in connection with υἱόν; βρέφοςor something similar would normally be used of a newborn. . 536 Timoleon, HN 18; Solon, HN 34; Nicias, HN31.

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prosecution, and Anthia from prostitution.537 There are indications too that slaves who were devalued because of epilepsy or some other kind of mental impairment were discharged or, if they belonged to an urban household, were banished to the country.538 Menedemus sent the “blockhead” (ἀναίσθητον) to his farm to care for the cattle just as Apuleius sent his epileptic slave boy, Thallus, to a remote place in the country when cures had failed. And the banker who owned Monimus, when the latter pretended to be mad, immediately dismissed him from his service (παρῃτήσατο).539 vi. Tolerance and Humouring Not all mad people were treated with abuse and ridicule, or at least not all of the time. Sometimes their high status compelled others to tolerate and humour them. The servants and members of the court who surrounded Cambyses had certainly to respond with discretion to his many bizarre acts if they weren't themselves to become victims of his madness. 540 So too those who lived and worked in the vicinity of King Cotys had no recourse but to learn ways of humouring him.541 In fact a significant level of tolerance for characters who were harmless and eccentric possibly even amusing - is visible in a number of accounts. Certainly the problematical Menekrates and Eunus were allowed to indulge in their fantastic identities, the butt of jests, but otherwise suffering few negative consequences. Thrasyllus went to the Piraeus daily and pursued his fantasy life until his brother arrived to enforce treatment upon him. Similarly the story of the wine merchant who went mad by night suggests an ordinary life which functioned during the day, and one version of the story of the man who delighted in watching plays in an empty theatre emphasizes the fact that in all other respect the man was sane and led a normal life.542 Plutarch’s observation, which finds parallels in some of the recommendations of the medical writers seems to have held true in many cases:

537 Odysseus, HN 38, Plut. Mor. 18A; Meton HN 29, Plut. Nic. 13.7-8; Alc. 17.6; Solon HN 34; Nicias, HN 31, Plut. Marc. 20; Anthia, HN30, Xen. Eph. 5.7. 538 Pl. Leg. 11.934d makes the owner responsible for the custody of a mad slave. Such a law was designed primarily to combat rather than codify existing practice; see discussion below. In later Roman legislation, “those who have custody of the insane are not responsible only for seeing that they do not do themselves too much harm but also for seeing that they do not bring destruction on others. But if that should happen, it may deservedly be imputed to the fault of those who were too neglectful in performing their duties”, Macer apud Ulp. Dig. 1.18.14. In the case under discussion those responsible were family; it is not improbable, however, that slave-owners might be held responsible under certain conditions. On mentally disordered Roman citizens see now Gardner 1993, ch. 6 “The Handicapped Citizen”, “Mental disorder”, 167-178; slaves and mental disorder, 171-174. 539 Menedemus, HN 54, DL 2.128; Thallus, HN 57, Apul Apol. 44; Monimus, HN 32, DL 6.82. 540 Herod. 3.36; for the savage response when tact failed see e.g. 3.32 541 HN 5; significantly King Cleomenes, a Greek king, was physically restrained by his relatives from acting out his anti-social impulses. 542 Menekrates HN 20; Eunus HN 24; Thrasyllus, HN 14, Ael VH 4.25 cf. Heracleides of Pontus (Voss 36)apud Athen. Deip. 12.554e; wine merchant HN16; man of Abydos, HN15, [Ps.] Arist. Mir. 832b; Hor. Ep. 2.2,cetera qui vitae servaret munia recto more; , cf. [Ps.] Arist. 832b.

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Although when our friends are in their right minds it is best to show them their errors and correct them when they make a mistake, we usually do not struggle with them or contend against them when they are mentally deranged or delirious, but humour them and agree with them. Ὥσπερ γὰρ τοὺς φίλους ὑγιαίνοντας μέν, ἂν πλημμελῶσιν, ἐξελέγχειν καὶ νουθετεῖν κράτιστόν ἐστιν, ἐν δὲ ταῖς παρακοπαῖς καὶ τοῖς φρενιτισμοῖς εἰώθαμεν μὴ διαμάχεσθαι μηδ᾽ ἀντιτείνειν ἀλλὰ καὶ συμπρεριφέρεσθαι καὶ συνεπινεύειν. 543 II. Family Care Even if a mentally ill family member did not require restraint, they did require some level of care, and again it devolved upon the family - or surrogate family in the form of friends, slaves or freedmen and women - to undertake this.544 The wandering romantic heroine Leukippe, as we have seen was cared for by her lover and the friends with whom she was travelling. Anthea, after her epileptic attack was cared for quite compassionately by the brothel keeper who had bought her. The philosopher Arcesilaus is said to have taken into his own house his friend, the geometer Hipponicus, when the latter's mind gave way (παρακόψαντα) and nursed him until his recovery.545 And the accounts of the old age of the Roman general Lucullus tell how he was cared for by his freedman Callisthenes, who proceeded to further damage his enfeebled mind with drugs and potions, at which point Lucullus' brother Marcus intervened and, dismissing the freedman, managed his brothers affairs and “tended him like a child” (ἐπαιδαγώγει).546 Finally, Plutarch's account of the suicide preparations of Cato the Younger (HN94) provide an insight into the familial tensions and uncertainties which were the inevitable outcome of the family's role in assessing and protecting the mentally disturbed. Cato 's friends and family detected certain signs that he was contemplating suicide and Cato's son removed his father's sword in the hope of preventing this. Cato responded by accusing his son of judging him to be insane and treating him like a madman: ὁ δὲ Κάτων ἐξαναστὰς ἐνέβλεψέ τε δεινὸν καὶ "πότ᾽" εἶπεν "ἐγὼ καὶ ποῦ λέληθα παρανοίας ἡλωκώς, ὅτι διδάσκει μέν οὐδεὶς οὐδὲ μεταπείθει περὶ ὧν δοκῶ κακῶς βεβουλεῦσθαι, κωλύομαι δὲ χρῆσθαι τοῖς ἐμαυτοῦ λογισμοῖς καὶ παροπλίζομαι; ... " But Cato raising himself, and looking fiercely, “When,” said he, “and how did I become deranged and out of my senses, that thus no one tries to persuade me by reason, or show me what is better, if

543 Plut. Mor. Fr. 136.3,4 (Trans. Loeb). 544 Reliance on family support, whether or not codified in law, is pervasive throughout the Greek and Roman world; see e.g. Dover 1974, 273-278; Blundell 1989, 39-43; cf. Apul. Apol. 52; Cic. In Pis. 46-48. 545 HN 17;.HN 30; DL 4.32,HN 49. 546 Nepos apud Plut. Luc. 43; cf. Mor. 792B; HN 10.

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I am supposed to be ill-advised? Must I be disarmed, and hindered from using my own reason?”547 III. Caring Attitudes Scholars have become increasingly aware of the presence of compassionate attitudes in antiquity toward the insane and mentally aberrant by both medical and lay people.548 The passage from Plutarch cited earlier, which suggests humouring those who are deranged, displays a notable degree of empathy and tact on the part of those whose friends or family showed signs of mental disturbance. But Artemidorus suggests the presence of an even more general compassion when he says, “For a madman receives something from everyone” (Oneir. 3.42). In many of the cases we have been discussing sympathy and compassion for the mentally disturbed have been expressed in one form or another: Leukippe’s lover looked on her frenzy with pity and sorrow; Lucullus’ brother “tended him like a child”; Timoleon’s friends dissuaded him from suicide and supported him when his family repudiated him and later, together with his fellow citizens, encouraged him to resume an active civic role and blot out his guilt. The parents and friends of the young women of Miletus advised, remonstrated, and wept; the women of Amphissa formed a protective circle around the women of Phocis, then fed them and gently led them to the border. 549 Greek tragedy too portrays, par excellence, scenes in which an individual who has been overwhelmed by insanity is helped by onlookers either to recover from it or to come to terms with the consequences of his or her actions. 550 Agave, in Euripides' Bacchae, returns from the Dionysian rites still possessed by the ritual madness during which she killed her son. The scene which follows, in which her father, Cadmus, helps her to make the transition back into a normal state of mind, holds a particular fascination for psychologists, notably George Devereux, who has called it “the first surviving account of an insight-and-recall oriented psychotherapy, which sheds a light upon an aspect of Greek attempts to treat psychiatric illness, which is not otherwise attested.”551 Devereux’s interpretation of this scene has been criticized by Gill, among others, for importing into it a structure and significance which is not really visible. According to Gill, what is at the core of the scene is “a portrayal of one person helping another from

547 Plut. Cat. 68.6; Trans. Dryden, rev. Clough. Note that Plutarch's Cato here uses the technical legal term for having been judged insane, παρανοίας ἡλωκώς. 548 Rosen 1969, 89-90; Milns 1986, 459; Gill 1985, 313-316 cf. Gill 1992, 6; c.f Vaughan 1919 who makes no reference to compassionate popular attitudes. 549 Leukippe, HN 17; Lucullus, HN 10;Timoleon, HN 18; Miletus HN 27; Amphissa HN 28; cf. Lucian, Bis Acc. 2, in which a physician, unable to cure his insane stepmother “expresses his compassion for her as a worthy person deserving a better fate.” Rosen 1969, 90. 550 The following discussion is indebted to Gill’s thoughtful analysis (1985, 313-316)of the relevant passages in Eur. Ba, 1165-1301; HF, Soph. Aj. and Aristoph. V. 551 Devereux 1970, 35; but for criticism see Gill 1985, 315, “Devereux’s interpretation is not the most natural reading of the text.”

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madness to sanity, and then treating her gently as she reenters normal consciousness.”552 He points to comparable scenes in Euripides' Heracles and Sophocles' Ajax, in which the heroes, on emerging from their frenzy, find immediate support from those around them. In each instance the victim’s first impulse is to commit suicide out of shame - a decision strongly combatted by Theseus and Tecmessa respectively, both of whom refrain from criticism and leave the responsibility for the insane acts in the hands of the gods. Gill points to another instance of tactful, therapeutic handling of a madman in Aristophanes’ Wasps, when Bdelycleon arranges for his father to indulge in his obsessive law-court mania by setting up a dramatic facsimile at home, what Gill calls a “psycho-drama”. This approach - humouring, agreeing and “working on madness from within” - is clearly enunciated as we shall see by several of the more sympathetically inclined medical writers.553 The several stories which recount the happiness of the madman in his delusive state (Thrasyllus and his ships, the man of Argos (or Abydos) applauding in the empty theatre), and his nostalgia for it when cured, might be called a compassionate - or at least empathetic - attitude to the insane. And at a philosophical level, some natural philosophers seem even to have validated the 'reality' of the madman's vision. According to Diogenes Laertius, Pyrrho (HN 95), when listing the ways in which peoples impressions vary according to different physiological conditions (health, illness, sleep, waking, youth, old age etc.), suggested that madness should be considered similar in effect: “Not even madmen are in a state contrary to nature, for why should they be any more than we are?”554 Epicurus too (HN96) is reported to have said that “the objects presented to madmen and people in dreams are true, for they produce effects - i.e. movements in the mind - which that which is unreal never does.”555 On the other hand a perhaps compassionate but definitely not empathetic attitude can be seen in a comment by Philo Judaeus: διἀ τί δ᾽ ούχὶ καὶ μανίαν λεκτέον θάνατον, ᾧ τὸ κράτιστον ἀποθνῄσκει τῶν ἐν ἡμῖν, ὁ νοῦς; ἀλλά μοι δοκεῖ τις ἂν εἰκότως τὸν διακρίνοντα καὶ διαλύοντα ψυχήν τε καὶ σῶμα ὡς κουφότερον ἀντὶ βαρυτέρου τοῦ κατὰ τὴν ἔκστασιν, εἴ τις ἦν αἵρεσις, ἀνενδοιάστως ἑλέσθαι. And yet why should we not call madness death, seeing that by it mind dies, the noblest part of us? Nay it appears to me that, were a choice offered, a man would be likely to choose without

552 Gill 1985, 315 In addition to the scenes discussed by Gill, Eur. Hipp. 260 and 284-300 should be considered, where the expressions of sympathy and attempts by the nurse to get Phaedra to speak and relieve herself of her “madness” clearly demonstrate compassion and a desire (however ill-conceived) to help. 553 Quote: Gill 1985, 316; see the sections on Humouring and Deceiving the Patient, and Redirecting Thoughts and Awakening Interests in ch. 9 below. 554 DL. 9.82, οὐδὲ γὰρ οἱ μαινόμενοι παρὰ φύσιν ἔχουσι· τί γὰρ μᾶλλον ἐκεῖνοι ἢ ἡμεῖς; 555 DL 10. 32; (Trans. Loeb), τά τε τῶν μαινομένων φαντάσματα καὶ κατ᾽ ὄναρ ἀληθή, κινεῖ γάρ· τὸ δὲ μὴ ὂν οὐ κινεῖ; cf. Plut. Mor. 1123B-E.

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hesitation the death that separates and dissolves the union of soul and body, in preference to going out of one's sense, feeling that he was choosing the lighter in place of the heavier.556 IV Protection and Prevention There are some indications that thought was given to how to avoid becoming insane. Avoiding and warding off the contagion of the insane or epileptic, as we have seen, was one approach. Herodotus (2.173) suggests the need to avoid the stress of all work and no play, and Xenophon's Socrates (Mem. 3.12.6) upholds the belief that good physical condition will combat depression, discontent and insanity, (ἀθυμία, δυσκολία, μανία). Plutarch (Mor. 555E) prescribes a regimen of exercise and diet for children of melancholics, epileptics, and gout sufferers to help them avoid inheriting familial physical and mental illnesses ( and vices, he adds). In addition to attention to regimen there were recourses to protective devices; the magical amulet, for example, was much used throughout antiquity. Even Galen conceded that wearing peony root around the neck was of benefit to some epileptics.557 One amulet which has survived from late antiquity consists in a narrow band of inscribed silver which was rolled up and worn around the neck in a bronze cylinder (HN97). Its function was to protect the wearer from various evils, among them daemons (male and female) and curse tablets. The inscription is long but reads in part, “Protect Alexandra, to whom Zoe gave birth, from daimonia and spells and dizziness and from all suffering and from insanity.558 C. Responsibility and Limits - Public Concerns and the law It is clear that care and treatment of the mentally disturbed were primarily the responsibility the family, yet, as we have seen, at times a certain level of public concern was expressed. The Spartans, we are told, consulted the oracle at Delphi and called in the appropriate consultant physicians or purifiers when public health and safety were at risk, and among the factors singled out for such measures were cases of insanity. This kind of thinking - an awareness of a collective responsibility - is visible too in the story about the people of Abdera who wrote to Hippocrates, the leading medical figure of their day, to request his help in curing their leading citizen, Democritus. It is again in evidence in the response of the citizens of Locris and Rhegium to the mania which was seizing their women; they went as a body to seek assistance from Apollo's oracle. The citizen's of Miletus too, met to discuss ways of stopping the suicide mania which was destroying their daughters. And it was said to be at the initiative of a group of citizens that Timoleon was successfully coerced back into public life and restored to sanity. Finally, and unusually, the

556 Phil. Jud. De Plant. 36, cited in Rosen 1969, 90; Trans. Loeb. Cf. also the “hedonistic calculus” between Tecmessa and chorus in Soph. Aj. 254-281. 557 Galen, Kühn 6,859 ;see Temkin [1945] 1971, 25. Physicians were very much aware of the extent of popular belief in amulets (and some prescribed their use)others were, like Galen basically sceptical; see e.g. Cael. Aur. Morb. Chron. I.1, ignorant people often proudly avoid physicians and attribute ... cures to new incantations or amulets or luck.” See below ch. 9. 558 Gager 1992, 233-4, #125.

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women of Amphissa demonstrated a special kind of awareness beyond civic duty in their actions towards the women from Phocis, by protecting them and supervising their return to sanity.559 I. Restrictions and Political Participation The degree to which mad people were publicly restricted is a difficult question. Considerable tolerance for informal, random, public activity by disturbed people who were harmless seems indicated by many of the anecdotes above and, as we shall see, is confirmed by evidence from the medical writers. Certainly Solon's foray into the agora drew a crowd and the sight of mentally disturbed people walking about, lecturing to the world at large, was probably at least as familiar in antiquity as it is today. The phenomenon is suggested in Artemidorus' description of the typical madman as one who moves about and is ἀκώλυτος, not hindered in anything he wants to do, a feature which he links associatively with the demagogue who seeks to win popularity from the crowd thus underscoring the public dimension of the madman's behaviour.560 On the other hand, a passage in the Politeia of the Athenians by the 'Old Oligarch' states specific limits to political participation for madmen (HN98): If it is good government you seek, you will first observe the cleverest men establishing the laws in their own interest. Then the good men will punish the bad; they will make policy for the city and not allow madmen to participate or to speak their minds or to meet in assembly. ... καὶ βουλεύσουσιν οἱ χρηστοὶ περὶ τῆς πόλεως καὶ οὐκ ἐάσουσι μαινομένους ἀνθρώπους βουλεύειν οὐδὲ λέγειν οὐδὲ ἐκκλησιάζειν.561 The madmen to whom the Old Oligarch refers here may not strictly speaking be the insane - merely those who hold opinions contrary to him. This passage should not, therefore, be read as a direct report of Athenian practices. But the fact that such a figure of speech is used suggests that the problem of a madman attempting to speak in the assembly and methods for preventing this had been given some thought. In a similar vein, the almost mythological references to Athenian condemnation of certain poets because of their madness are quite certainly historically unfounded; what they do point to, however, is a level of societal concern about the sanity of public figures and some probable

559 Spartans, Ael VH 12.50, HN 86; Democritus, [Ps.] Hipp. Ep. 10, HN 35; Locris etc., Aristoxenus apud Apollon. Hist. Mir. 40, HN 26; Miletus, Plut. Mor. 249B-D, HN 27; Plut. Tim. 7, HN 18; Amphissa etc., Plut. Mor. 249E-F, HN 28. 560 Artem Oneir. 3.42, (see above discussion); other dream associations having to do with madness suggest similar thought connections: dancing because of its movement signifies mental derangement or delirium ; reciting mimes, playing the fool, acting upon a the stage and deceiving people signifies the same; singing in the marketplace signifies disgrace and ridicule for a sick man - insanity for a poor man. (1.76) 561 Ps. Xen. Ath. Pol.1.9.4, emphasis mine.

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measures to define and constrain inappropriate participation.562 Yet the extent and degree of formality of such putative measures remains unknown because of inadequate evidence. II Legal Restrictions: Insanity and the Courts If there were restrictions upon political participation, albeit informal ones, there were certainly definite restrictions on the legal status of mad persons, although the evidence for these is meagre and comes almost exclusively from what we know of Athenian legal practices.563 What is known is that that the law was concerned with questions of property and sanity and that limitations were placed upon the insane person's capacity both to make a will and to carry out adoption procedures, and could be placed too on their administration of the family property.

562 DL 2.43, “For they [the Athenians] fined Homer (so says Heraclides) fifty drachmae for a madman ὡς μαινόμενον ἐζημίωσαν) and said Tyrtaeus was beside himself (παρακόπτειν ἔλεγον).” See Hicks' note ad loc. “Most probably Heraclides of Pontus. This remarkable assertion may have occurred in one of his dialogues, and was perhaps not meant to be taken seriously.” For Tyrtaeus as Athenian and both lame and feeble-minded see schol. ad Pl Leg. 629 A; Paus. 4.15.6 (νοῦν τε ἥκιστα ἔχειν δοκῶν). On the discredited story of Tyrtaeus' Athenian origins see Campbell 1967, 169-170. The connection between poetic inspiration and madness is made explicit in e.g. Pl Phdr.245 and [Ps.] Arist. Prob. 30.1 and can almost certainly be regarded as part of popular opinion. 563 Although participation and legal process form a part of MacDowell’s (1986) discussion of Spartan law, there is no information on the insane. The Law Code of Gortyn makes no mention of provisions for insanity; see Willetts 1967.

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i. Γρ αφὴ Πα ρα νοίας The right of a son to remove control of the family property from the hands of an insane father by legal action, the γραφὴ παρανοίας, noted above in connection with Sophocles' old age, resulted in civic limitations much discussed in antiquity because of the difficulties, both social and legal, in the successful implementation.of the law and the ethical dilemma involved in a son challenging the authority of a father.564 According to the Athenian Constitution , among the criminal and civil law-suits to be brought before the Archon for a preliminary hearing before going to trial in a jury court were, “prosecutions for insanity, when one man accuses another of wasting his property when insane” (γραφαὶ δὲ καὶ δίκαι ... παρανοίας, ἐάν τις αἰτιᾶταί τινα παρανοοῦντα τὰ ὑπάρχοντα ἀπολλύναι) (56.6). A phrase in Aeschines suggests that the outcome of such a trial could result in an official declaration that the defendant was of unsound mind.565 The law was designed to protect families from dissipation of family property through the actions of a mentally unfit father or grandfather. The action could be brought by anyone, thus protecting the hereditary rights of minors.566 The decision as to what constituted mental unfitness rested with the court; there is no indication that expert witnesses, such as physicians, were called in to give evidence.567 It seems plausible to conjecture, however, considering the extent to which legal argument in antiquity relied upon appeals to probability and common sense, that arguments designed to demonstrate mental incapacity would have followed along similar lines.568 We should, however, also consider the plight of the father or grandfather convicted of senility or madness. At Athens, sons were legally charged with the care of their aged parents and this responsibility could be enforced by an interested third party. Anyone concerned for the old people's welfare could bring a legal action, called a γραφὴ γονέων κακώσεως, against a son in dereliction of his duties. This law not only required that the parents be fed and housed but also protected them from physical violence and from neglect of the rites due after death.569 No exceptions to this law have been recorded; legally it seems, the father who was declared of unsound mind still

564 On this law see Harrison 1968-1971, i 80-81; MacDowell 1978, 92; cf.Aristoph.Neph. 845; Xen. Mem. 1.2.49; Aeschin.3.251. 565 Aeschin. 3(Ctes. ), 251, “as though in very dotage or declared of unsound mind - ὥσπερ παραγεγηρακὼς ἢ παρανοίας ἑαλωκώς. 566 So Harrison 1968, 80. Wyse [1904] 1967, 251 ad Is. 2.15, refers to the law as a δίκη παρανοίας, and notes that some authorities “seem to show that this suit could be instituted only by sons or representatives of sons”. Wyse cites Meier and Schömann Att. Proc 2nd ed. p. 566 ff and [Arist.] Ath Pol. 56.6. 567 Harrison 1968, i 81; cf. Vaughan 1919, 65; Rosen 1969, 126; for Roman law see Semelaigne 1869, 215-216, who concedes no evidence for an expert witness but conjectures that physicians must have been consulted. This is possible but not necessarily probable and in any case incapable of proof. 568 Argument from probability: Arist.. Rhet. 1357a32-b20; 1376a18-24; argument in Athenian law courts frequently rested on assumptions very similar to the “reasonable man” or (now) “reasonable woman” assessments which form part of the contemporary legal system. 569 Harrison 1968, i 77-78.

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remained the responsibility of the son who assumed the management of the family property. A passage in Xenophon suggests that in such circumstances the son was then entitled to keep his father under some form of restraint.570 In connection with this Athenian law it should be noted that it was incorporated by Plato into the ideal legal system he devised for his utopian Cretan city, Magnesia. Plato's Laws are considered to be based on an amalgam of legal and constitutional practices from several Greek cities, with the early constitutions of Athens and Sparta as the predominant models.571 For the most part, however, the book cannot be used as a guide to existing legal and constitutional practices, since it is in essence reformist in intent.572 In any one instance it is impossible to tell, without comparative historical data, whether the law which Plato sets out is descriptive of an existing practice (somewhere in Greece), or prescriptive, and proposing rationalized ideal measures. Consequently such legal information as is offered by the Laws must be used with caution by historians. In the case of the γραφὴ παρανοίας, however, Plato's law and existing Athenian practice seem to confirm one another. Plato describes the situation which calls for such a measure (HN99): Now suppose illness or old age or a cantankerous temper (τρόπων χαλεπότης)or all three make a man more wayward (or “unusually demented” - ἔκφρονα ἀπεργάζεται διαφερόντως τῶν πολλῶν [Loeb]) than old men usually are, unbeknown to all except his immediate circle; and suppose he squanders the family resources on the grounds that he can do as he likes with his own property, so that his son is driven to distraction but hesitates to bring a charge of lunacy (ἀπορῇ καὶ ὀκνῇ τὴν παρανοίας γράφεσθαι δίκην). This is the law the son must observe. First of all he must go to the eldest Guardians of the Laws and explain his father's misfortune, and they, after due investigation, must advise him whether to bring the charge or not. If they advise that he should, they must come forward as witnesses for the prosecution and plead on his behalf. If the case is proved, the father must lose all authority to manage his own affairs, even in trivialities, and be treated like a child (καθάπερ παῖς δὲ οἰκείτω τὸν ἐπίλοιπν βίον) for the rest of his days.573 Some sense of the familial and societal tensions attendant upon implementation of a law of this kind may be glimpsed here in Plato's reference to the son's reluctance to charge his father with lunacy. It is not known how often the γραφὴ παρανοίας was resorted to; other than the legend of Sophocles and his sons, there are no surviving records of such a case. There are, however speeches surviving from other trials in which a

570 Xen. Mem. 1.2.49; see discussion below. 571 Stalley 1983, 7; citing Morrow 1960. 572 Stalley 1983, 7, “The Laws is, in fact, a systematic attempt to codify and reform Greek practice in the light of a clear understanding of the ultimate aims of law.” 573 Pl. Leg. 11.929D-E; all quotations from Plato's Laws are from the Penguin edition, translated by T.J. Saunders.

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defendants soundness of mind is called into question.574 These cases are all to do with the issues of inheritance of property and the related issue of adoption. ii. Contracts: Wills and Testaments; Adoptions A contract or testament made by a person who could be shown in a court of law to have been materially incapacitated or unduly influenced was liable to be found invalid.575 The laws concerning these issues are referred to in a number sources. The orator Demosthenes, for example, cites a law of Solon's which states that a valid will must be made by a person whose mind is sound (HN100): Any citizen, with the exception of those who had been adopted when Solon entered upon his office, and had thereby become unable either to renounce or to claim an inheritance, shall have the right to dispose of his own property by will as he shall see fit, if he have no male children lawfully born, unless his mind be impaired by one of these thing, lunacy or old age or drugs of disease, or unless he be under the influence of a woman or under constraint or deprived of his liberty. Ὅσοι μὴ ἐπεποίηντο, ὥστε μήτε ἀπειπεῖν μήτ᾽ ἐπιδικάσασθαι, ὅτε Σόλων εἰσήει τὴν ἀρχήν, τὰ ἑαυτοῦ διαθέσθαι εἶναι ὅπως ἂν ἐθέλῃ, ἂν μὴ παῖδες ὦσι γνήσιοι ἄρρενες, ἂν μὴ μανιῶν ἢ γήρως ἢ φαρμάκων ἢ νόσου ἕνεκα, ἢ γυναικὶ πειθόμενος, ὑπὸ τούτων τοῦ παρανοῶν, ἢ ὑπ᾽ ἀνάγκης ἢ ὑπὸ δεσμοῦ καταληφθείς.576 Adoptions too were contestable on the basis of undue influence or unbalanced mind as several extant court speeches attest. This was true both of adoptions made while both parties were living and adoptions made by testament.577 And evidence from a speech of Hyperides suggests that similar kinds of legal constraints applied in the context of betrothal contracts.578 iii. Marriage and Betrothal Implicit in Plato's discussion of ways to mitigate the sometimes inflexible harshness of his proposed legal system is an awareness that some laws, and his marriage laws in particular, could give rise to intolerable social and personal situations. He describes the difficulties people may encounter, for example, when they are under a legal obligation to marry a kinswoman. Plato admits that there may be many deterrents to complying with the law, “I mean difficulties 574 Harrison 1968, i 80. 575 Harrison 1968, i 152 & n.5. 576 Dem. 46.14 cf. also 46.16; 44.68; Hyp. Athenog. 16-17; Ath. Pol. 35.2; Is. 6.9.3; 4.14; 4.16.2; 6.9-10; on the link between insanity and the influence of women see Just 1989, 209-212 577 MacDowell 1978, 101-102; Harrison 1968, i 84-87; cf. Is. 2.1; 2.19; 6.9; Dem. 46.14; 48.56; Hyp. Athenog. 17; Lys. Fr. 74 Th. 578 Hyp. Athenog. 16.

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like physical or mental illnesses or defects in the man or woman one is told to marry.” (11.925D) There are situations in which some people, he says, would have no choice but to disobey the law, “because the instructions devised by the lawgiver would lead to untold trouble - as for instance if they tried to compel him to marry someone suffering from lunacy or some other terrible physical or mental defect that would make the life of the partner not worth living.” (11.926A) Plato's solution to this difficulty is to make provision in his system for a panel of arbitrators to judge such matters individually. Plato's scenario is grounded in the marriage legislation of his ideal state and seems primarily to envision a situation in which a man is forced to marry a mentally ill or defective wife. Historically, however, although there were certainly family pressures in Greek society upon both men and women to marry appropriate, and often selected, partners, there was no legal constraint upon a man to marry a specific woman. Matters were different for women, and especially for a woman who was an heiress, for there were legal provisions in Athenian law for male kin to claim in marriage an epikleros.579 No evidence is extant, however, which suggests that in the event, the mental fitness of either partner could provide exemption from a legally obligated union of this kind. It is reasonable to assume that in actuality some marriages were arranged in which one of the partners was mentally ill or incompetent, and that at times one or another partner would object to and resist such a contract. Such matters would seem, however, to have been historically a matter less for the courts than for intra- and inter-familial decision-making. iv. Sale of Slaves One further law which probably reflects contemporary legal practice concerning insane persons is found incorporated into Plato's Laws. This law regulates the sale of slaves who are suffering from any mental or physical disorders that are difficult to identify by the ordinary methods of inspection in the slave market. The law is designed to protect slave-dealers and other purchasers and it lists the kinds of disorders which present problems (HN101): If someone sells a slave suffering from consumption or stone or strangury or the so-called 'sacred' disease or some other mental or physical complaint that is chronic and difficult to cure (ἢ τῇ καλουμένῃ ἱερᾷ νόσῳ ἢ καὶ ἑτέρῳ τινὶ ἀδήλῳ τοῖς πολλοῖς νοσήματι μακρῷ καὶ δυσιάτῳ κατὰ τὸ σῶμα ἢ κατὰ τὴν διάνοιαν) and which the ordinary man could not diagnose, and if the purchase was made by a doctor or trainer, or if the facts were pointed out before the time of sale, the buyer shall have no right to return him to the vendor. But if a layman is sold such a slave by a professional, the purchaser may return him within six months, except in the case of the 'sacred' disease, when the period for restitution is to be extended to a year.580

579 Just, 1989; Harrison 1968, 9-12. 580 Pl. Leg. 11.916A (Trans. Saunders).

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Such laws are common in slave-owning and slave-dealing societies and Plato's law here, although it may not be identical, almost certainly reflects provisions in the laws of certain Greek cities. Indeed, a contemporary inscription from the town of Maronea in Thrace contains a stipulation concerning the sale of slaves similar to the one in Plato’s Laws.581 v. Cases According to a brief reference in the Athenian Constitution, litigation based on the assertion that the mind of a testator or adoptor had been unbalanced by madness, senility, drugs, and the like, must have been relatively frequent. For, speaking of the attempt by the Thirty to limit the power of the dikasteries by removing some of the causes of litigation arising from Solon's legislation, the writer gives as an example their elimination of this particular clause (HN102):582 ... for example, in regard to the bestowal of one's property on whomsoever one wishes, making the single act of donation valid absolutely, while they removed the tiresome qualifications 'save when in consequence of insanity or of old age, or under the influence of a woman,' in order that there might be no opening for blackmailers; ...(35.2) οἷον περὶ τοῦ δοῦναι τὰ ἑαυτοῦ ᾧ ἂν ἐθέλῃ κύριον ποιήσαντες καθάπαξ, τὰς δὲ προσούσας δυσκολίας "ἐὰν μὴ μανιῶν ἢ γήρως ἢ γυναικὶ πειθόμενος" ἀφεῖλον ὅπως μὴ ᾖ τοῖς συκοφάνταις ἔφοδος· (35.2) As noted above, in several cases which are extant the issue of a testator's sanity forms a significant part of the argument. Isaeus, who seems to have specialized in cases of disputed inheritance, provides a number of references, some formal citations, some implicating allusions, to the Solonic law cited above.583 In one of the more notable cases, the adoptive son of Menecles (HN103) tries to persuade the jury that his adoption was valid and that when he was adopted, Menecles “was not insane or under the influence of a woman”.584 Of this case Wyse has remarked, “The phrase in the law on which everything turned, γυναικὶ πειθόμενος, ὑπὸ τούτων τοῦ παρανοῶν, was vague, and the judges were controlled by no legal tradition in settling the kind of passion for a woman that might be

581 Garlan [1982] 1988, 54, Garlan unfortunately provides no citation for this. Vaughan 1927, 71 cites Egyptian slave purchase contracts with these kinds of provisions. With respect to the sale of epileptic slaves, Athenian law seems to have offered some protection for the buyer, see Temkin [1945] 1971, 48, who cites Hyp. 522 and Westerman, RE Suppl VI (1935) col. 911 “Sklaverei”. 582 Harrison 1968, i 152 n.5. 583 For example, Is. 1.19-21; 1.50; 2.1; 2.19-22; 2.38; 3.17; 4.14; 4.16; 6.9.3; 6.9-10; 6.18-26; 6.29, 6.35; 6.48; 9.36; 9.43. 584 Is. 2.38, οὐ παρανοῶν οὐδὲ γυναικὶ πειθόμενος; cf. 2.1; 2.19-22; on this case see Wyse [1904] 1967, 234-236; and notes ad 19-22.

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branded as paranoia, and invalidate an adoption or a will.”585 We have, unfortunately, no information on the judges' reactions to his arguments. We do, however, have another speech, this one by Demosthenes, in which the speaker accuses his opponent, Olympiodorus, of having been deranged by his passion for a beautiful and greedy mistress and he describes his behaviour as proof of this (HN104). He alleges that Olympiodorus has become a perjurer, a thief and conspicuously and degenerately wealthy. He tells the jury that the woman has deranged him and he is not in his right senses (διέφθαρται ... καὶ παραφρονεῖ). That it is she who drives him “to a higher pitch of madness” (περαιτέρω μαίνεσθαι). “Is it not indeed a proof of his madness (μαίνεται) that he refuses to do anything whatever that was stipulated in the agreement which was entered into with his full consent and with my own, and which was confirmed by an oath?” The speaker describes the opulent life-style of Olympiodorus and his mistress and concludes with the question, “And in adopting such a manner of life is not Olympiodorus not manifestly mad and beside himself (καταφανῶς μαίνεται καὶ παραφρονεῖ)?” The deposition at the end of the speech sums up the speakers position: The defendant Olympiodorus, then, is a person of this sort. He is not only dishonest, but in the opinion of all his relatives and friends is proved by the manner of life which he has adopted to be mentally deranged; to use the language of the lawgiver Solon, he is beside himself as no man ever was, for he is under the influence of a woman who is a harlot. And Solon established a law that all acts shall be null and void which are done by anyone under the influence of a woman, especially of a woman of her stamp. In this matter the lawgiver made wise provision; ... Ὀλυμπιόδωρος μὲν οὑτοσὶ τοιοῦτός ἐστιν ἄνθρωπος, οὐ μόνον ἄδικος, ἀλλὰ καὶ μελαγχολᾶν δοκῶν ἅπασι τοῖς οἰκείοις καὶ τοῖς γνωρίμοις τῇ προαιρέσει τοῦ βίου, καὶ ὅπερ Σόλων ὁ νομθέτης λέγει, παρφρονῶν ὡς οὐδεὶς πώποτε παρεφρόνησεν ἀνθρώπων, γυναικὶ πειθόμενος πόρνῃ. καὶ ἄκυρά γε ταῦτα πάντα ἐνομοθέτησεν εἶναι ὁ Σόλων, ὅσ᾽ ἄν τις γυναικὶ πειθόμενος πράττῃ, ἄλλως τε καὶ τοιαύτῃ. περὶ μὲν οὖν τούτων καλῶς ὁ νομθέτης ἐπεμελήθη ... . 586. Elsewhere the state of sanity of an adoptive father or a testator is used as part of a larger arguments from probability: for example, the speaker disputing the adoption of his cousin by the testator Astyphylus in Isaeus 9 (HN105), seeks to demonstrate a state of bitter enmity between Astyphilus and the cousin's family and sums up his arguments by saying that if the judges, in the face of these estranged relations, still pronounce the cousin to be the legitimate adoptive heir, they will in effect be convicting Astyphilus after his death of madness (παρανοίας αἱρήσετε). “For if he adopted this man as his son with whose father he was on terms of the bitterest enmity, will not those who hear of

585 Wyse [1904] 1967, 235. 586 Dem.48.52-55; it is only here that the law, cited elsewhere in connection with adoption, testamentary and (possibly) betrothal practices is described as including any action undertaken by a person mentally unbalanced.

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it imagine that he was mad (παρανοεῖν) or that his senses had been impaired by drugs?”587 Similarly the argument in Isaeus I, in which the speaker tries to suggest that the testator, Cleonymus (HN106), had not altered his will to include his next of kin for one of two reasons: either he was hindered in his last minute attempts to revoke the will by the prospective beneficiaries with whom he was at odds - or - he was patently not in his right mind to neglect the claims of his nearer kin with whom he was on very good terms indeed.588 The speaker's hazy reasoning has been noted by commentators, but his impassioned rhetoric concerning the state of mind of his uncle serves as a fairly typical example of the manner in which allegations of insanity were brought into the lawcourts: Cleonymus is represented by my opponents as desirous, when he was on terms of the closest affection with us, still further to confirm the will [disinheriting us] which he made in anger. So, even if we were to admit that he did so and you yourselves were to believe it, my opponents, you must observe, are accusing Cleonymus of utter madness. (παράνοιαν αὐτοῦ τὴν μεγίστην οὗτοι κατηγοροῦσι) For what great act of insanity (μανία) could be committed than that Cleonymus, when he was at variance with Deinias, should wrong us and make a will whereby he did not punish Deinias but wronged his nearest and dearest, whereas now, when he was on terms of the closest friendship with us and held us in higher esteem than any one else, he should have wished, as my opponents allege, to leave his nephews alone without any share in his property? Who, gentlemen, in his right mind (εὖ φρονῶν) would determine so to dispose of his estate? ... if he was so mad (παραφρονῶν) as always to have the least regard for us, his nearest kinsmen and most intimate friends, you would be justified, I presume, in declaring such a will invalid. (1.20-21) Another kind of argument from probability, this time one in which the testator is assumed to have been sane, is made by Demosthenes in his case Against Stephanus II (HN107). Here the speaker seeks to prove that the will his opponents allege to have been made by his father is a forgery. He cites the Solonic law on categories of incompetents, and then asks, “Now consider whether the will which these men say my father made, seems to you to be the will of a man of sound mind (εὖ φρονοῦντος ἀνδρὸς)?"589 And he proceeds to demonstrate the madness of the presumed testator by the contradictory nature of the contents of the will. Whether the judges consider his father to have been sane or insane, in either case he scores over his opponents; if sane, the will is forged, if insane, invalid.

587 Is. 9.36-37; See Wyse's discussion of paranoia and mania ad Is. 1.19.7; In contrast to Plato's tendency to treat mania and paranoia as interchangeable Wyse notes that in “ordinary speech” paranoia seems to have been the more common term. His assessment appears to be derived from the assumption that legal terminology equates to ordinary speech - a questionable assumption and one difficult to confirm. 588 Is. 1.50, see Wyse ad loc. 589 Dem. 46.14-17.

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vi. Diminished Responsibility Certain reported cases of feigned madness, especially the stories about Odysseus and the Trojan war and Meton, the astronomer, carry with them the implication that the insane person was permitted exemption from some civic responsibilities such as going to war and participating in political decision-making. The question of criminal responsibility and the insane person is another issue; Solon's flouting of a recent Athenian law under the pretext of madness suggests that insane persons were not always held accountable for their actions and that some level of immunity from prosecution was the norm.590 Other evidence however suggests that, particularly in certain serious cases - sacrilege for example - insanity was no protection. Aelian relates the story of Atarbes (HN108), who killed a bird sacred to Asclepius (whether involuntarily or in a fit of madness is unclear) and was not pardoned by the Athenians, who held that sacrilege cannot be excused either by ignorance or madness. Ὅτι τοσοῦτον ἦν Ἀθηναίοις δεισιδαιμονίας, εἴ τις πρινίδιον ἐξέκοψεν ἐξ ἡρῴου, ἀπέκτειναν αὐτόν. ἀλλὰ καὶ Ἀτάρβην, ὅτι τοῦ Ἀσκληπιοῦ τὸν ἱερὸν στρουθὸν ἀπέκτεινε πατάξας, οὐκ ἀργῶς τοῦτο Ἀθηναῖοι παρεῖδον, ἀλλ᾽ ἀπέκτειναν Ἀτάρβην καὶ οὐκ ἔδοσαν οὔτε ἀγνοίας συγγνώμην οὔτε μανίας, πρεσβύτερα τούτων ἀμφοτέρων τὰ τοῦ θεοῦ ποιησάμενοι. ἐλέγετο γὰρ ἀκουσίως, οἱ δὲ, μεμηνὼς τοῦτο δρᾶσαι. 591 The factor which underlies this passage, and which is apparent too in the passage which follows concerning homicide, is the pervasive fear in Greek society of pollution.592 Certain actions in themselves, regardless of the will or awareness of the perpetrator, brought with them the prospect of divine vengeance and havoc to society as a whole. Bloodshed and dishonouring the gods were chief among these and it is not difficult to conceive that the legal system would allow for no extenuating circumstances in connection with such actions. The passage from Aelian does, however, seem to imply that in other cases, cases in which pollution was not an issue, some consideration might be given in the courts to a plea of ignorance or insanity. For example in some cases simple restitution by a relative on the insane person's behalf may have sufficed - but as there is no record of a case of this kind, the possibility can only be conjectured. Plato's Laws in several passages make provision for the insane and others not accountable for their actions; but, as we have noted, discussion of these laws is problematical as evidence for actual Greek practice. The laws are included here then, not as evidence of Greek laws regarding the insane, but as evidence that there was a climate of

590 Solon - DL 1.46 &49 cf. 1.65 HN 34. It has been remarked by several scholars that had Solon's enterprise ended in disaster, his apparent immunity from legal consequences might have been quite otherwise; Vaughan 1927, 63; Rosen 1969, 124-125. 591 Ael. VH 5.17; for a discussion of Aristotle's distinction with regard to actions performed êkvn and those performed while drunk or mad see Rickert 1989. 592 Pollution and homicide: see Parker 1983, ch. 4; cf. Vaughan 1927, 60-61.

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awareness, at least among some elements of society, that insane and mentally incompetent persons provided special problems when it came to questions of personal responsibility and the law. The key passage which demonstrates this awareness is in the section of the Laws which deals with homicide (HN109).593 The section begins with a discussion of persons “unfit to plead” and it concerns not simply people who have committed murder, but those who “pillage from the gods”, those who are traitors, and those “who do violence to the laws in order to subvert the existing constitution”. Plato explains: τούτων δή τις ἂν ἴσως πράξειέ τι μανείς, ἢ νόσοις ἢ γήρᾳ ὑπερμέτρῳ ξυνεχέμενος ἢ παιδιᾴ χρώμενος, οὐδέν πω τῶν τοιούτων διαφέρων. A man who commits one of these crimes might be suffering from insanity, or be as good as insane either because of disease, or the effects of advanced senility, or because he is still in the years of childhood. (a) If clear proof of any of these states is ever shown to the judges selected in each case, on the submission of either the criminal or his counsel, and in the opinion of the court the man was in that condition when he committed his crime, he must pay, without fail, simple recompense for any damage he may have inflicted on anyone, but the other details of the penalty should be waived, except that (b) if he has killed someone and his hands are polluted by murder, he must depart to a place in another country and live there in exile for a year. If he comes back before the legally appointed time, or even puts a foot into any part of his native country, he must be imprisoned in the public gaol by the Guardians of the Laws for two years, after which he shall be released. (9.864) Scholars have assumed that here Plato intended the law to apply to any murder committed by an insane person and not just those connected with treason, subversion and temple robbery, and his failure to specify this has been noted by Saunders, who calls it “mere oversight”.594

593 Saunders notes Plato's concern with personal motivation and responsibility in his discussions of homicide law and of categories of persons unfit to plead. See Saunders translator's notes p. 376 and more generally Stalley 1983, 151-165. That this concern reflects a more general societal concern with such ethical distinctions is unlikely; whether or not it was reflected in contemporary Greek legal practices is difficult to know. Saunders 1991, 104-118 discusses the historical evidence for considerations in the courts of mitigating circumstances - however he does not mention insanity and mental incompetence. 594 Vaughan 1927, 60-63; Rosen 1969, 124; Saunders 1991, 218 n.4.

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In another passage Plato also specifically exempts insane persons from criminal responsibility. Here it is in connection with assault upon parents or grandparents (HN110): ὃς ἂν τολμὴσῃ πατέρα ἢ μητέρα ἢ τούτων πατέρας ἢ μητέρας τύπτειν μὴ μανίαις ἐχόμενος, πρῶτον μὲν ὁ προστυγχάνων καθάπερ ἐν τοῖς ἔμπροσθεν βοηθείτω ... If a man who is not in the grip of insanity dares to strike his father or mother, or their father or mother, the first point is that the passer-by must render assistance as provided in former cases. (9.881) The passage goes on to provide details of the punishments for such an action - but it does not discuss what measures the passer-by should take in the event that the attacker was in the grip of insanity - would he then not be expected to render aid? Or was it merely that his failure to render aid would go unpunished? Presumably, however, the intent of the passage is to excuse the insane person from the usual punishments for those who assault their elder family members, punishments which included whipping, public humiliation and ostracism, permanent banishment to the country and death if he attempted to return to the city. vii. Restriction of Freedom of Movement Dangerously deranged individuals were a matter for concern at another level. Although it seems to have been customary for those suffering from harmless forms of mental aberration to wander freely about, both the medical and historical evidence indicate that measures were employed for physically restraining severe and threatening cases of madness.595 The despot Maiandrios kept his crazy brother, Charileos, bound in a dungeon for some period of time.596 And, again according to Herodotus (6.75), King Cleomenes, when he persevered in his habit of hitting fellow citizens in the face with his sceptre, was restrained by relatives in what may have been some form of stocks: αὐτὸν ... ἔδησαν οἱ προσήκοντες ἐν ξύλῳ. The friends of the Leukippe, who, in the absence of any family, tried forcibly to restrain her wild frenzies, were finally compelled “with pity and regret” to tie her down with ropes so that she could be treated by a physician.597 In each of these stories, just as in Aristophanes' Wasps, it is the members of the household who are responsible for keeping the deranged person under control. Whether or not this specific responsibility was codified in law in the classical period is not known; it was in Roman law and certainly seems to 595 On restraint see Vaughan 1919, 41-44, who suggests that one of the earliest legends referring to the confinement of the insane is in some accounts concerning Cassandra's disturbance at the entry of the wooden horse into Troy. Vaughan cites Lyc. Alex. 348ff.; and n. p. 33 Scheer's ed; Schol. on. 16; Tzetzes, p.61 ll. 708 ff. and for further evidence on confining the insane, Eur. Ion 1402; Ba. 226f.; 443f.; Herac. 1009ff.; Soph. Ant. 937; Celsus 3.18.4, 10 &21; cf. Cael Aur. Morb. Acut I 65; Morb. Chron. I 157; 172; 179. 596 HN 4; Herod. 3.145, Μαιανδρίῳ δὲ τῷ τυράννῳ ἦν ἀδελφεὸς ὑπομαργότερος, τῷ οὔνομα ἦν Χαρίλεως· οὗτος ὅ τι δὴ ἐξαµαρτὼν ἐν γοργύρῃ ἐδέδετο ... . 597 Ach. Tat. 4.9.3, HN 17, ἔπαθέ τι ... ἠλέσε

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have been universally codified by custom. Xenophon's Socrates, for example (HN111), is reported to have approved of a law that allowed a son to imprison his father if he could convince a jury of his insanity. He thought it expedient, both for themselves and for their friends, that madmen should be kept confined: ... φάσκων δὲ κατὰ νόμον ἐξεῖναι παρανοίας ἑλόντι καὶ τὸν πατέρα δῆσαι, ... ...he said that the law allowed a son to put his father in prison if he convinced a jury that he was insane;... ... καὶ τοὺς μὲν μαινομένους ᾤετο συμφερόντως ἂν δεδέσθαι καὶ αὐτοῖς καὶ τοῖς φίλοις ... That madmen should be kept in prison was expedient, he thought, both for themselves and for their friends.598 And Plato's Laws also explicitly enjoin the relatives of an insane person (or in the case of slaves, their master) to keep their charges confined at home under penalty of a heavy fine (HN112): Μαινόμενος δὲ ἄν τις ᾖ, μὴ φανερὸς ἔστω κατὰ πόλιν· οἱ προσήκοντες δ᾽ ἑκάστων κατὰ τὰς οἰκίας φυλαττόντων αὐτούς, ὅτῳ ἂν ἐπίστωνται τρόπῳ, ἢ ζημίαν ἐκτινόντων, ὁ μὲν τοῦ μεγίστου τιμήματος ἑκατὸν δραχμάς, ἐάν τ᾽ οὖν δοῦλον ἐάν τ᾽ οὖν καὶ ἐλεύτηερον περοορᾷ, δευτέρου δὲ τιμήματος τέτταρα μέρη τῆς μνᾶς τ῀ςν πἐντε, τρία δ᾽ ὁ τρίτος, καὶ δύο ὁ τέταρτος. Lunatics must not be allowed to appear in public; their relations must keep them in custody in private houses by whatever means they can improvise. ...If they fail to do so, they must pay a fine: 100 drachmas for a member of the highest property-class (whether it is a slave or a free man that he fails to keep an eye on), eighty for a member of the second class, sixty for the third, and forty for the lowest.599 It is, as we have noted, problematical, when citing Plato's laws, to what extent specific passages reflect existing custom and to what extent they propose revisions.600 Certainly the story of the slave Monimus, who feigned madness so that his master would dismiss him, suggests that common practice may have been less protective of the mentally deranged than Plato's proposed legislation. Nevertheless it seems reasonable to conjecture that relatives were held responsible for acts committed by deranged members of their family and that social and economic pressures were therefore upon them to keep a certain measure of control. In actuality it was probably only in cases of violently disturbed and dangerous people that social sanctions of the kind Plato's law sought to codify would have 598 Xen. Mem. 1.2.49-50; (Trans. Loeb); this passage is one of those often cited as evidence for the δίκη παρανοίας; it does however go further than others in suggesting imprisonment. 599 Pl Leg. 934 (Trans. Saunders, original emphasis). 600 Cf. Gager 1992, 23 discussing Plato's legislation with respect to curse tablets. “Does his law mirror existing but unknown laws of his time or is he seeking to fill a void in current jurisprudence?”

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come into effect. There are a sufficient number of references to wandering and dispossessed madmen to speculate that harmlessly disturbed people were often left unconstrained. But it is likely that others too, despite social or even legal sanctions, were not always kept within the oikos: those who were too difficult for a family to manage or who were felt to bring contagion or pollution, may well have been expelled in the same way that Monimus the slave was dismissed, or the unfortunate sufferer from hydrophobia who, Caelius Aurelianus tells us, was driven from his home to a secluded place where he died.601 C. Summary Remarks Greek writers recognize a multiplicity of behavioural anomalies which were attributed to mental disturbances and labelled with the vocabulary of madness. Some kinds were thought amenable to treatment, but many were considered incurable. In general, popular thought distinguished to a limited extent between the disease of epilepsy, and madness; but other distinctions we might make, such as emotional upsets, physical illnesses, depression, and ‘real’ madness (or psychoses) were not made in any systematic way. Yet other distinctions which we do not make, such as the madness of prophetic or poetic inspiration, were noted, although the same rich vocabulary of madness served for all aberrant mental states alike. A great variety of causes for mentally aberrant behaviour was identified in the popular mind, many of them magical but many cases too were thought to be brought about by either physical or emotional influences. The responses to the behaviour of mentally aberrant people also varied widely. It is impossible to isolate any one typical popular ancient Greek attitude to the insane or mentally disturbed. Rather it seems more important to stress the complexity and diversity of responses. It is probable that popular attitudes toward and treatment of mentally disturbed individuals in antiquity was governed less by theories of causation (natural or supernatural) than by the kinds of behaviour that were exhibited and by considerations of social class, age, and gender. Legal reponses were minimal and seem to have been designed primarily with a view to protection of family property. The family itself was responsible for the care, treatment and possible confinement of severely disturbed members - although such responsibilities appear to have been at times difficult to carry out.

601 Monimus, DL 6.82, HN 32; Cael. Aur. Morb. Acut. III, 105, ex domo fugatum.

PART THREE: EVIDENCE FROM THE MEDICAL SOURCES CHAPTER SEVEN Syndromes, Symptoms, and Cases This section will examine various aberrant mental states as they are presented in the works of key medical writers of antiquity. Again the emphasis here will be on anecdotal reports - descriptions of cases and their symptoms and additional general observations on the part of the physicians which are relevant to such cases. The approach continues to be that of social history rather than medical or psychiatric history. Much important work has been done tracing the history of specific diseases and their treatment; melancholy and epilepsy in particular, of the mental disorders, have received careful attention, and such work will not be reduplicated here 602 The histories of the diseases and disorders themselves as entities from the perspectives of the various medical writers are not the primary focus of this study; it is rather the experience of mentally disordered individuals and their families as they come into contact with the medical practitioners which we are trying to reconstruct. The kinds of treatments mentally disordered people received at the hands of physicians and the expectations and attitudes displayed by the medical men toward these individuals are quite diverse. This diversity is what we intend to explore here, mindful always of the fact that the medical experience is only one aspect, albeit an important one, of the total experience of mental illness in antiquity. Accordingly, the questions addressed in this chapter and the two which follow will be of three kinds: questions about the cases themselves, questions about causes, and questions about cures. First, with respect to cases we should like to know what kinds of mentally aberrant individuals reached the physicians, what were the symptoms presented and noted? How were various states of mental disorder distinguished from one another (or not as the case may be) and how were they labelled? Who, with respect to age, class and gender, were more commonly patients, who were less so? Secondly, what kinds of causes did the doctors identify or ascribe to for the various aberrant mental states? Were there thought to be underlying causes and precipitating causes? Are there references to folk or lay beliefs as distinct among the medical beliefs? And finally, how were the patients treated? What were the doctors' methods and what were their attitudes toward the patients? Were there tests or criteria for sanity/insanity - or for real /feigned insanity? How were patients cared for and by whom? What cures were generally used and how distinct were they for the different syndromes? What expectations of recovery did the physicians have in the various cases? What differences in treatment (and perhaps prognosis) can be seen to depend upon age, class, or gender? A. The Hippocratic Corpus 602 Epilepsy: Temkin [1945] 1971; Schneble 1987; Melancholy :Müri 1953; Klibansky and Panofsky 1964; Flashar 1966; Pigeaud 1984; Jackson 1986; see also Pigeaud 1987 (“La manie”).

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We must begin with the diverse works included in the Hippocratic Corpus.603 which are enormously varied, sometimes contradictory, often elliptical - even cryptic. Because they include works by numerous authors written over several centuries, it is difficult to speak of the Hippocratic approach or attitude to mental disorders. Nevertheless for our purposes it is possible to view the Hippocratic material as a moderately coherent body of evidence for early Greek medical practices. Later medical writers made the same assumption and developed their own methods and theories against this more or less cohesive background. The Hippocratic Corpus is particular useful as a starting point for examining the medical approach to mental disorders because in many treatises there is a notable lack of focus upon the disease as entity and an emphasis rather upon treating the patient and observing symptoms with a view to prognosis.604 The experiences of the patient then, albeit through the eyes of the physician, are particularly visible in the many case histories which make up the bulk of the Corpus. In addition, whatever distinctions, classifications, and labels with respect to aberrant mental states emerge from the Hippocratic material are of particular interest because they are the earliest and least defined. Later medical writers, as we shall see, tried to make finer distinctions and to delimit more systematically the several boundaries of mental illnesses not always very clearly or with any great consistency. In the Hippocratic corpus there are a great many terms used to describe disturbed mental function and their various shades of meaning are not at all clear. Sometimes the context will help by indicating the presence of other symptoms such as fever, so that the best translation for μανία might at times be our word “delirium”. On other occasions the question is less simple; μελαγχολία, for example, can include in its meaning depression or prostration, indigestion or general biliousness, nervousness or deeply disturbed mental function - or a combination of these. It has been suggested that the rich collection of words generally translated as “delirium” in the Hippocratic corpus had at one time elaborate,subtle, and distinct shades of meaning which are no longer discernible to the modern reader.605 This may have been true, but it is surely more probable that the medical vocabulary, just as the popular one, contained a wealth and variety of words and phrases for mental dysfunction, many of which were not at that time precisely delimited and some of which were employed more or less interchangeably.606 Chief among the terms for disturbed mental states were παραφροσύνη, παράνοια, μανία, μελαγχολία, and φρενῖτις. We may include for consideration 603 On madness (and melancholy) and the Hippocratics see: Heiberg 1927, 5-9; Köhm 1928, 19-20; Liebbrand and Wettley 1961, 24-34 and passim; Flashar 1966, 21-49; Kudlein 1967, passim; Simon 1978, 215-227; Pigeaud 1987, 11-69; and 1981, 28-46 & 70-133, passim; Lloyd 1987, 21-30. 604 Smith 1979, 32-3. 605 Jones Introd. Loeb Hipp. Vol. 1, lix-lx: only discernible now are two main classes: “(1) Those in which the mental derangement of delirium is the dominant idea; e.g. παραφέρομαι, παραφρονῶ ... παρανοῶ, παρκρούω ... παρακοπή, ἐκμαίνομαι, μανία. (2) Those in which stress is laid upon delirious talk; e.g. λῆρος, παράληρος, παραληρῶ, παραλέγω, λόγοι πολλοί. It is more difficult to say exactly which words in each class signify the greater degree of delirium. Of class (1) ἐκμαίνομαι is obviously the most vigorous word, meaning ‘wild raving’, μανία comes next to it, and παρακοπή is apparently slightly stronger than the others. Of class (2) λῆρος or παράληρος seems to be the strongest, then παραλέγω, and finally λόγοι πολλοί. 606 On the interchangeability of such terms see Leibbrand and Wettley 1961, 31.

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too, ἐπίληψις, for much of the language describing epileptic symptoms, their causes and treatment is closely similar to that of other aberrant mental conditions, and mania, melancholy and epilepsy are grouped together in many part of the Corpus.607 These, and the later more emphasized condition of phrenitis, are the categories of mental illness which emerge to become canonical in the medical literature of succeeding centuries.608 Since the material is so varied, the most useful approach seems to be to present a diverse range of cases in which either the vocabulary of mental disturbance is employed or a description of mental symptoms predominates. These cases, together with some brief observations and a few more lengthy discussions of aberrant mental states found scattered throughout the Corpus, serve primarily to underline the difficulties inherent in attempting strictly to delimit categories of mental illness for this early period of medical history.609 (MT1) In the first case, a woman was seized with a fever on the third day after giving birth to a daughter. Among the many symptoms noted were the following mental symptoms: “Eighth and following days. Much delirium, quickly followed by recovery of reason (πολλὰ παρέκρουσε καὶ τὰς ἐχομένας καὶ ταχὺ πάλιν κατενόει).... Eleventh day. Was rational, but comatose (κατενόει, κωματώδης δ᾽ ἦν).... Twentieth day. ...slight wandering (σμικρὰ παρέλεγεν)... Sixtieth day. ...wandering, but reason quickly recovered (παρέλεγε καὶ ταχὺ πάλιν κατενόει).... Eightieth day. Death. ...Coma was present, aversion to food, despondency, sleeplessness, irritability, restlessness, the mind being affected by melancholy (ἀπέθανε. ... κῶμα παρείπετο, ἀπόσιτος, ἄθυμος, ἄγρυπνος, ὀργαὶ, δυσφορίαε, τὰ περὶ τὴν γνώμην μελαγχολικά).” (Epid. 3. case 2 Loeb 1, 260-262) (MT2) “A servant of Timochares, apparently suffering from melancholic affections (ἐκ μελαγχολικῶν) of such a kind and to such an extent, died in a similar way in about the same number of days.” (Epid. 5.87 L. 5, 252 & 7.91 L. 5, 448) (The preceding cases are significant here to give some idea of the symptoms and time being referred to. At Epid. 5.86, a young man who drank a lot wine, fell asleep on his back in his tent and a snake crawled into his mouth. Feeling it and unable to think what it was, he clenched his teeth and took a bite of the snake and was overcome with a great pain; he put his hands up as though he was strangling, threw himself about, went into convulsions and died. At Epid. 7.90, the account is of a servant of Conon who suffered

607 ἐπίληψις is used in other contexts too, as in descriptions of spasms and hysterical symptoms; cf. Mul. 9; Epid. 5.15. 608 Jackson 1986, 30. 609 In keeping with the pattern followed in the previous chapters, the medical testimonia will identified in sequence with the initials MT followed by a number. Citations and translations are from Loeb editions of Hippocrates (Vols I – VIII, various dates) when noted, otherwise references are to the Littré edition by volume number (e.g. L. 5, 28488).

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from a pain beginning in her head, went out of her mind (ἐκτὸς ἑωυτῆς), shouted, gave many plaintive cries, short periods of quiet. Died about the fortieth day; for the six days preceding death she became dumb and had spasms.).610 (MT3) A disease caused by thickening - it arises from bile whenever it flows to the liver and settles in the head. The liver swells, presses on the diaphragm and the patient has pains in head especially at the temples. His sight and hearing are impaired and he suffers from intermittent fevers and shivering of varying intensity. His bodily distress increases and his vision is so impaired that he does not see a finger held before his eyes. “He plucks at the threads of his garment (if he does see) imagining that they are lice. And whenever the liver expands toward the diaphragm, he is delirious(παραφρονέει). He thinks he sees before his eyes creeping things and other animals of various sorts, and armed men fighting, and he himself thinks he is fighting in their midst. And he speaks of such things as seeing battles and wars, and he gets up and threatens anyone who does not allow him to do so. And if he stands up, he cannot raise his legs, and falls down. ... And when he is asleep, he may start up out of his sleep, and he is terrified, seeing frightening dreams. This is the way we know that he is startled and terrified by his dreams. For when he is restored to his senses (ἔννοος γένηται), he recounts the dreams which conform to what he did with his body and what he said with his tongue.” The patient may lie speechless day and night and may also have completely lucid intervals - then plunge back into the same state. (Int. 48 L. 7, 284-288)611 (MT4) “A branded slave of Antiphilos, feverish, had a crisis on the seventh day, became filled with bile, in a stupor, on the third day after the crisis in this way there was an effusion of blood; he survived, and later suffered a relapse, a first crisis came, as it should about the setting of the Pleiades, after the setting of the Pleiades, he became filled with bile to the point of madness (χολώδης ἐς μανίην).” (Epid. 4.2 L. 5, 144) (MT5) “After the setting of the Pleiades, a servant of a man of Attica was taken with a quartan fever; he was in a stupor, then recovered. Another, at the same time, suffered from true typhomania (τυφωμανίη)“ (This was a disease characterized by alternating states of stupor and mania, later writers describe it as a combination of phrenitis and lethargy) (Epid. 4.13 L. 5, 150)

610 The introductory comment by Littré ad Epid. 7.91 suggests that either of the disorders suffered in the two preceding passages may be understood to be melancholic disorders. 611 The translation is by Simon 1978, 218, who comments that the description is one of “an acute brain syndrome with fluctuation in level of disorientation, accompanied by visual hallucinations. In our day” a common cause of such a state would be withdrawal from alcohol, delirium tremens.” (219)

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(MT6) The case of “a woman who had some form of mania (μανικόν τι ἐνῆν), but when she emitted a rather thick worm and a small amount of excrement, it stopped, she slept and was cured.” (Epid. 4.55 L. 5, 194) (MT7) “In Elis, Timokrates drank a great deal and went mad as a result of black bile (μαινόμενος δὲ ὑπὸ χολῆς μελαίνης). He drank the drug; thus the cathartic purged abundantly - phlegm and black bile - it went well during the day; toward evening he stopped purging and during the purge he was in great pain; and he drank barley water and slept all night until sunrise. During the night he seemed to those present not to breathe at all but to have died - he perceived nothing, neither word nor action; his body was taut and rigid. He lived and revived. “ (Epid. 5.2 L. 5, 204) (MT8) “The illness of Nicanor who, whenever he started to drink, became afraid (φόβος) of the flute-girl. Whenever he would hear the sound of the flute beginning to play in the symposium he would be troubled (ὑπὸ δειμάτων ὄχλοι) - he said he could hardly bear to stay if it was night-time; hearing it during the day he was not deterred. These kinds of symptoms accompanied him for a long time.” (Epid. 5.81 L. 5, 250 & 7.87 L. 5, 444) (MT9) “Damocles, who was with him [Nicanor], seemed to have dim sight and a relaxed body (loose/uncoordinated? λυσισωματεῖν ἐδόκει); and he said he could not go alongside a precipice or over a bridge, nor could he bring himself to cross even the slightest depth of ditch for fear that he might fall - but he could travel along the ditch itself. This happened to him for a period of time.” (Epid. 7.87 L. 5, 444 & 5.82 L. 5, 250) (MT10) “Parmeniscus was overcome ... with depression (ἀθυμίαι) and longing to die, then again he became cheerful. This happened at Olynthus in the autumn; he became speechless, staying still and silent, making short attempts at beginning to speak,when he was questioned he then again became silent. At times he slept, at times he was wakeful; and he tossed himself about in silence; and uneasiness, and he pressed his hands to his hypochondria as though in pain; at another time, turning away, he would lie quietly. He had no fever throughout, and breathed well. He said later that he recognized everyone who came in. Sometimes, although it was offered, he didn't want to drink all day and all night; at other times suddenly he would snatch the jug and drink all the water. His urine was thick like that of an ass. His disease ended about the fortieth day.” (Epid. 7.89 L. 5, 446 & 5.84 L. 5, 252 cf. Aph. 4.70).612

612 For discussion of treatments for melancholics with suicidal tendencies see Loc. Hom. 39 L6,328.

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(MT11) Mnesianax, about autumn suffered from ophthalmia and a quartan fever. ... [After the fever he suffered from a variety of physical complaints] and later, when he was walking in the agora, he saw flashes in front of his eyes and was not able to see the sun completely. “When it passed off he was somewhat out of his mind (σμικρὸν ἐξ ἑωτοῦ ἦν) and he had spasms of the throat. When he was brought to the house he had scarcely recover his sight and was hardly himself (αὐτὸς ἑωυτοῦ μόγις ἐγένετο). First he saw those standing nearby, and his body was chilled and warmed only with difficulty by exercise and heat under the bed. When he was himself again (ἐντὸς ἑωυτοῦ ἦν) and had recovered he did not want to go outside, but said he was afraid; and if someone would start to talk about dangerous illnesses, he would get up and go out; and at times he said heat would overcome him in the region of the hypochondria and his eyes would see flashes.” [ discussion of treatment follows - no outcome noted]. (Epid. 7.45 L. 5, 412-414) (MT12) “Frenzies (τὰ παρακρούοντα) which become bold/rash (θρασέως) for a short time, are melancholic. And if they are the result of women's complaints (ἀπὸ γυναικείων), they are savage (θηριώδεα). These things often occur together; ask especially if they are also accompanied by spasms or spasms and loss of voice with deep coma - as in the daughter of the shoemaker. It began when female complaints were present.” (Prorrh. 1.123 L. 5, 552-554 cf. 1.26).613 (MT13) Vomiting attended with nausea, a strident voice, eyes with a wool like covering (ὄμματα ἐπίχνουν ἔχοντα), are signs of mania (μανικἀ), as in the wife of Hermozygus who became acutely mad (ἐκμανεῖσα ὀξέως), speechless and died. (Prorrh. 1.17 L. 5, 514 cf. Coac. 550) (MT14) Ademantus, the melancholic (ὁ μελαγχολικός) after a strong dose of wild purslane vomited black bile, at another time after onions. (Epid. 6.8.20 L. 5, 352) There are, in addition to enigmatic case histories such as these, a number of short observations about melancholy, mania and phrenitis. Many of them give warning indications, others seem designed to help discriminate between various states. Some of the more explicit examples follow:614 (MT15) - For those who go out of their minds (ἐξισταμένοισι) from melancholy, if tremor supervenes the disease is malignant. (Prorrh. 1.14 L. 5, 514 cf. Coac. 87 & 92)

613 Littré translates γυνακείων παρεόντων to mean “when menstruation began again”, which in view of the standard medical belief that hysterical suffocation and related disorders arose from retention of the menses, seems odd. I prefer to translate the phrase more loosely. 614 These excerpts are chosen to show the variety of statements and vocabulary used. This list is by no means an exhaustive.

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(MT16) - Those who go out of their minds acutely (οἱ ἐκστάντες ὀξέως), are feverish with a sweat, become phrenetics. (Prorrh. 1.15 L. 5, 514 cf. Coac. 94) (MT17) - Silent delirium ἐκστάσιες) without calm, eyes rolling and harsh breathing is deadly. It produces long paralysis, but also such patients go mad (ἐκµαίνονται) .... (Coac. 476 L. 5, 690) (MT18) - In a burning fever, ringing in the ears along with dim vision, and a heaviness felt along the nose, the disease is a derangement from melancholy (ἐξίστανται μελαγχολικῶς). (Prorrh. 1. 18; Coac. 128, 3) (MT19) - A trembling tongue is a sign of a deranged mind (οὐχ ἱδρυμένης γνώμης). (Prorrh. 1.20 L. .5, 516) (MT20) - To grind the teeth in fevers, when this has not been a habit from childhood, signifies madness (μανικόν) and death. And if the grinding be also accompanied by delirium (παραφρονέων) it is a very deadly sign indeed. (Prog. 3. Loeb 2, 12) (MT21) - When blood collects at the breasts of a woman, it indicates madness (μανίην σημαίνει). (Aph. 5,40 Loeb 4, 168 cf. Epid. 2.6.32)) (MT22) - The varicose veins of the bald-headed individual, if they are not large, indicate madness (μανιώδεις) (Epid. 2.5.23 L. 5, 132) (MT23) - If there should be throbbing as well in the hypochondrium, it indicates a disturbance or delirium (παραφοσύνη). The eyes of such patients ought to be examined, for if the eyeballs move rapidly you may expect the patient to go mad (μανῆναι). (Prog. 7 Loeb 2, 16) (MT24) - The individual whose vein in the elbow pulses, is mad (μανικός) and sharp tempered. He in whom it is quiet is in a stupor (τυφώδης). (Epid. 2.5.16 L. 5, 130) (MT25) - In spring occur melancholia, madness, epilepsy (τὰ μελαγχολικά, καὶ τὰ μανικά, καὶ τὰ ἐπιληπτικά). (Aph. 3,20 Loeb 4, 128) (MT26) - In autumn occur many summer diseases, ... epilepsy, madness, melancholia ἐπιληψίαι, καὶ τὰ μανικά, καὶ τὰ μελαγχολικά. (Aph. 3.22 Loeb 4, 130) (MT27) - Mania leaves with a cold accompanied by a cough. (Coac. 474)

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(MT28) - Hemorrhoids supervening on melancholic or kidney affections are a good sign. (Aph. 6.11 Loeb 4, 182 cf. Iudic. 41 L9, 290) (MT29) - In manic afflictions (τοῖσι μανιώδεσι) a spasm supervening causes dullness of sight. (Coac. 475 L. 5, 690) (MT30) -For madness (μανία) to be followed by dysentery, dropsy or raving (ἔκστασις) is a good sign. (Aph. 7,5 Loeb 4, 194) (MT31) - Fear or depression that is prolonged means melancholy. (Ἢν φόβος ἢ δυσθυμίη πολὺν χρόνον διατελῇ, μελαγχολικὸν τὸ τοιοῦτον) (Aph. 6.23 Loeb 4,184) (MT32) - In melancholic affections the melancholy humour is likely to be determined in the following ways: apoplexy of the whole body, convulsions, madness (μανίη), or blindness. (Aph. 6, 56 Loeb 4, 192) (MT33) - Melancholics are accustomed for the most part to become epileptics and epileptics melancholics. Between these two states what determines the preference is which direction the disease takes; if it tends to affect the body they become epileptic; if the mind, melancholics. (Epid. 6.8.32 L. 5, 354-356) In a few passages some Hippocratic authors give a little more detailed insight into their understanding of mental disturbances. Some acknowledge that there were forms of madness which occurred for no apparent reason: (MT34) Then again one can see men who are mad and delirious (μαινομένους ἀνθρώπους καὶ παρφονέοντας) for no obvious cause and committing many strange acts. While in their sleep, to my knowledge, many groan and shriek, others choke, others dart up and rush out of doors, being delirious (παραφονέοντας) until they wake, when they become healthy and rational (ὑγιέας ἐόντας καὶ φρονέοντας) as they were before ....(Morb. Sacr. 1 Loeb 2, 140)615 Other authors give more detailed causal explanations and make more comprehensible distinctions: (MT35) Phrenitis is as follows: the blood in man contributes the greatest part to his intelligence, some people say everything; therefore, when the bile that has been set in motion enters the vessels and the blood,it stirs the blood up, heats it, and turns it to serum, altering its normal consistency 615 See also Iudic. 42 L9,290, “Those who rave (μαίνονται) either spontaneously (αὐτόματοι) or in accompaniment with a disease ....”

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and motion; now the blood heats all the rest of the body, too, and the person, because of the magnitude of his fever, and because his blood has become serous and abnormal in its motion, loses his wits (παρανοέει) and is no longer himself (οὐκ ἐν ἑωυτῷ ἐστιν). Patients with phrenitis most resemble melancholics in their derangement (κατὰ τὴν παράνοιαν), for melancholics too, when their blood is disordered by bile and phlegm, have this disease and are deranged (παράνοοι γίνονται) - some even rage (μαίνονται). In phrenitis it is the same, only here the raging and derangement (ἡ μανίη τε καὶ ἡ παρααφρόνησις) are less in the same proportion that this bile is weaker than the other one. (Morb.1. 30 Loeb 5, 176-178) Such clarity is, however, rare. More typical of the information given in the Hippocratic Corpus is a disease without a name described in Diseases II which might belong to either or neither of the above categories. In this disorder(MT36), the patient feels something like a thorn pricking his inward parts (σπλάγχοισιν) and he is overcome with loathing, he flees the light and people and loves darkness. He is seized by fear. His diaphragm swells and is painful to the touch. The patient is afraid and sees terrible things and frightful dreams and sometimes the dead. This disease attacks most people during the spring.616 To the extent that there were theoretical explanation for mental disorders, two passages in particular can be singled out as representing the two most significant contributions of Hippocratic medicine to subsequent medical attitude toward mental disorder. A passage from The Sacred Disease clarifies the first of these central themes: the brain as the locus of all mental disturbances: (MT37) Men ought to know that from the brain, and from the brain only , arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant .... It is the same thing which makes us mad (μαινόμεθα) or delirious (παραφρονέομεν), inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absent-mindedness, and acts that are contrary to habit. These things that we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist, or dry, or suffers any other unnatural affection to which it was not accustomed. Madness (μαινόμεθα) comes from its moistness. When the brain is abnormally moist, of necessity it moves, and when it moves neither sight nor hearing are still, but we see or hear now one thing and now another, and the tongue speaks in accordance with the things seen and heard on any occasion. But all the time the brain is still a man is intelligent (φρονεῖ). (Morb. Sacr. 17 Loeb. 2,174) 616 Hipp. Morb. II .72 Loeb 5, 326 L7,110-112, the disease is introduced by the words, φροντὶς νοῦσος χαλεπή. See also Morb. II .3 Loeb 5, 192, a disease with intense pain in the head and overheating causing derangement. again no name is given to the disorder.

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And a passage in the Regimen presents a rather elegant explanation for disordered mental states which emphasizes a second central theme in ancient medicine, that of health as a balance and a mixture of elements. The explanation is based on the hypothesis that the human body is composed of fire and water and that these when balanced and at their most intense result in the highest intelligence for the human being. (Reg. 1. 35 & 36) It follows then that various imbalances produce people with mental deficiencies and/or disorders. For example, “if ... fire receive a power inferior to that of water, such a soul is of necessity slower, and persons of this type are called silly (ἠλίθιοι). Such people are slow to “perceive sensations of sight or hearing unless they are already familiar with them.” If the fire is very greatly inferior to the power of water, then “we have cases of what are called by some 'senseless' people (ἄφρονας), and by others 'grossly stupid' (ἐμβροντήτους). Now the imbecility of such inclines to slowness (ἔστι δ᾽ ἡ μανίη τοιούτων ἐπὶ τὸ βραδύτερον); they weep for no reason, fear what is not dreadful, are pained at what does not affect them, and their sensations are really not at all those that sensible persons should feel.” There are dangers if such individuals do not live according to the proper regimen; especially they should reduce their flesh, “for abundance of flesh cannot fail to result in inflammation of the blood, and when this happens to a soul of this sort it turns to madness.” (Reg. 1. 35.50-80 & 110-120 Loeb 4, 284-290) If, however fire masters water, (MT38) such a soul is too quick, and men of this type inevitably suffer from dreams. They are called 'half-mad' (ὑπομαινομένους); their condition, in fact, is next door to madness, as even a slight untoward inflammation results in madness, whether arising from intoxication, or from overabundance of flesh, or from eating too much meat.” (Reg. I. 35.120-130 Loeb 4, 290) It seems clear that a great many medical situations described in the Hippocratic Corpus involved certain kinds of imbalances of mind. Some of these mental disorders involved fever and/or pain, some resulted from wounds, some were closely associated with other physical symptoms, others were not and seemed to arise spontaneously. 617 Moreover, similar kinds of language seems to have been employed in a multitude of situations. What is important to extract from these observation is, however, that all mental disorders, whether they were temporary or long term, explicable or inexplicable, were assumed without exception to have a somatic explanation.618 For our purposes it is also important to note that there were patients who were identified as manic, phrenetic, melancholic, epileptic among other more periphrastic descriptions - and that there were numerous occasions when aberrant mental states

617 Loss of reason from a wound, Hip. Epid. 5.1.39. Lloyd 1987, 23-24 notes the manner in which the Hippocratic rationalist approach assumed that mental illness,was “like any other illness investigable and treatable” and yet failed to specify what mental illness consisted in. 618 See Simon, 1978, 215-225 on the Hippocratic contribution to the medical model of madness.

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were noted and treated. For a more systematic attempt to fashion a nosology for insanity we must turn now to Celsus.619

619 On Hippocratic nosology see Leibbrand & Wettley 1961, 31-59; cf. Pigeaud 1987, 13-40 &67-69, who suggests a post-Hippocratic shift in the concept of mania.

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B. Celsus Aulus Cornelius Celsus lived and wrote his medical encyclopedia during the reign of Tiberius. It is not known whether he himself was a practicing physician; his work however,is most probably a translation from an original Greek treatise using as sources the writings of the Hippocratic Corpus and the now lost works of Asclepiades, Heraclides, Erasistratus and the surgeon Meges of Sidon who lived slightly earlier than Celsus.620 In the prooemium to the work the writer discusses the history of medicine and the Dogmatic, Methodist and Empirical schools. He himself is considered to have tried to “follow a via media between the Dogmatics and the Empirics.”621 Celsus distinguishes four kinds of insanity (insania ), only one of which has a distinctive name. The types seem to be differentiated on the basis of precipitating cause. The first kind he identifies with the Greek phrenesis (φρένησιν) and describes it as being both acute and found in connection with fever (3.18.1, MT39). The second kind begins without fever, but can later excite some feverishness; “it consists in depression (tristitia ) which seems caused by black bile” (3.18.17, MT40). The third type is the most prolonged and has two forms, in one the person is deceived by phantoms (imagines); in the other they are deceived by their minds (animo desipiunt or consilium fallit) (3.18.19, MT41). A final and fourth kind of insanity, described as delirium, is thought to be very rare and caused by fright (3.18.24, MT42). The first kind of insanity, phrenesis, has in turn two forms; one of short duration and the other, more serious, a state of continual dementia. Celsus recognizes the delirium and mental confusion which accompanied high fevers to be a temporary state from which the mind quickly restored itself. This kind of phrenesis is not treated as a separate disease, rather the treatment for the fever itself is thought usually to be sufficient remedy for the mental condition too (3.18.2). The long term version of phrenesis however, was considered more serious and demanded its own treatment. Celsus describes the condition: (MT43) Phrenesis vero tum demum est, cum continua dementia esse incipit, cum aeger, quamvis adhuc sapiat, tamen quasdam vanas imagines acccipit: perfecta est, ubi mens illis imaginibus addicta est. Eius autem plura genera sunt: siquidem ex phreneticis alii tristes sunt; alii hilares; alii facilius continentur et intra verba desipiunt; alii consurgunt et violenter quaedam manu faciunt; atque ex his ipsis alii nihil nisi impetu peccant, alii etiam artes adhibent summamque speciem

sanitatis

in

captandis

malorum

operum

occasionibus

praebent,

sed

exitu

deprenduntur.622

620 Biographical material is from the introduction by W.H.S. Jones to the Loeb edition of Celsus De Medicina, I. vii-ix; on the question of Celsus as a physician see also W.G. Spenser ibid.,.xi-xii. All passages and translations of Celsus are from the Loeb edition. 621 Jones op. cit. ix. 622 Celsus De Med. 3.18.3, (Trans Loeb).

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But insanity is really there when a continuous dementia begins, when the patient, although up till then in his senses, yet entertains certain vain imaginings; the insanity becomes established when the mind becomes at the mercy of such imaginings. But there are several sorts of insanity; for some among insane persons are sad, others hilarious; some are more readily controlled and rave in words only, others are rebellious and act with violence; and of these latter, some only do harm by impulse, others are artful too, and show the most complete appearance of sanity whilst seizing occasion for mischief, but they are detected by the result of their acts. During his discussion of treatment for this condition, Celsus make some further observation about the behaviour of the individuals afflicted with this illness. He remarks that some individuals, if they have been fettered, are able to talk rationally and pitifully (prudenter et miserabliliter) when they want the fetters removed and warns that this is a madman's trick (dolus insanientis) (3.18.4). Some are afraid of the dark, others disturbed by the light, and yet others are indifferent (3.18.5). Some are burdened with obsessive fears; as an example Celsus cites a wealthy man who was in dread of starvation. (Pretended legacies were announced to this person to relieve his fears as part of his therapeutic regime) (3.18.10). Some have melancholy (tristes) thoughts, others exhibit uncontrolled laughter, others refuse to eat. Sleep is difficult for all who are affected with phrenesis and their minds are “disposed to any foolhardiness.”623 The second category of insanity is also considered to be serious and is of even longer duration than the established phrenesis. Sadness or depression is its primary symptom, and the cause seems to be black bile (3.18.17).624 In addition such people may be easily frightened and are troubled with sleeplessness. In contrast to the phrenetics they are thought to be to some extent amenable to reason, for Celsus suggests reminding them from time to time that “in the very things which trouble him there may be cause of rejoicing rather than of solicitude”.625 Fever can arise in this disorder, and should be treated separately (3.18.18). The third kind of insanity is the most prolonged and usually afflicts those with a robust nature (robusti corporis), without shortening their lives (3.18.19). For this third type Celsus proposes two subcategories: in one the sufferers are deceived not by their minds, but by phantoms, such as the ones Ajax and Orestes, for example, are said to have seen. In such cases the persons affected may be either depressed (tristes) or hilarious (hilares). If the madness is accompanied by laughter (cum risu), it is thought to be less serious than if it is accompanied by gravity (cum serio) (3.18.20). Of the second subcategory, madness when the mind deceives, little that is more descriptive is added by Celsus. Such individuals too may laugh or be dejected without apparent cause (3.18.22). The distinctive difference 623 Celsus De Med. 3.18.10-12 and 3.20.1, prompta ad omnem audaciam mens est.... 624 See also 2.7.20, At si longa tristitia cum longo timore et vigilia est, atrae bilis morbus subest “And the black bile disease supervenes upon prolonged despondency with prolonged fear and sleeplessness.” (Trans. Loeb) Celsus does not here call this disease melancholy; he does however at 2.1.6 [μελανχολίαν (sic.)]. 625 Celsus De Med. 3.18.18 (Trans. Loeb).

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between this and the former class of insanity is visible only in the treatments Celsus prescribes. The final and rarest kind of insanity, delirium caused by fright, is not further described by Celsus; it too is distinct from the other forms only in its aetiology and in some aspects of the treatment prescribed (3.18.24).626 Elsewhere in Celsus there is some discussion of the signs and conditions which suggest imminent madness: (MT44) Ergo protinus insania timenda est, ubi expeditior alicuius, quam sani fuit, sermo subitaque loquacitas orta est, et haec ipsa solito audacior; aut ubi raro quis et vehementer spirat, venasque concitatas habet praecordiis duris et tumentibus. Oculorum quoque frequens motus, et in capitis dolore offusae oculis tenebrae, vel nullo dolore substante somnus ereptus, continuataque nocte et die vigilia, vel prostratum contra consuetudinem corpus in ventrem, sic ut ipsius alvi dolor id non coegerit, item robusto adhuc corpore insolitus dentium stridor insaniae signa sunt. (2.7.24-25) Thus madness is to be apprehended immediately: when a patient speaks more hurriedly than he did when well, and of a sudden becomes loquacious, and that with more audacity than was his wont; or when he breathes slowly and forcibly, and has dilated blood-vessels, while the part below the ribs are hard and swollen. Further signs of madness are: frequent movement of the eyes, and, in cases of headache, shadows passing before the eyes; or loss of sleep in the absence of pain, the wakefulness persisting night and day; or lying on the belly contrary to habit without being obliged to do so by abdominal pain; or, while the body is still vigorous, an unaccustomed grinding of the teeth. He goes on to enumerate various physical illnesses in which there is danger of insanity (periculum furoris or insania) supervening. These include congestion with fever, earache with fever, breasts suffused with blood, and lung diseases with pain in the side. After head wounds, he predicts delirium. The distinction which Celsus has expressly made in his discussion of mental aberration between the type of insania which is associated with disease with high fevers (what we would call delirium) and all others, is apparently not one which is systematically marked in the ordinary medical language of his time. Part of the difficulty here lies in the ancient concept of fever, which was often thought to be a disease in itself, rather than a symptom. Mental disorders too were either accompanied or not by fever, but the causal relationship was not always clearly identified or explicated.627 Celsus also describes the condition of epilepsy, which he call comitialis morbus, describing it as a well-known disease. (MT45) Homo subito concidit, ex ore spumae moventur, deinde interposito tempore ad se redit, et per se ipse consurgit. Id genus saepius viros quam feminas occupat. (3.23.1) 626 On treatments and cures see below ch. 9. 627 See Smith, “Implicit fever theory in Epidemics 5 and 7,” in Nutton 1981, 1-18. See also Pigeaud 1987, 67-69.

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The man suddenly falls down and foam issues out of his mouth; after an interval he returns to himself, and actually gets up by himself. This kind affects men oftener than women. This disorder was apparently sometimes thought to occur in conjunction with a form of mental damage, for Celsus in his prognoses for the various kinds of epilepsy, states that if “the patient falls down unexpectedly, he scarcely ever gets well, ... further, if either the mind is diseased (mens laesa est), or paralysis has been set up, there is no opportunity for the Art of Medicine.” (2.8.29 Trans. Loeb) Ages of susceptibility are, according to Celsus, adolescence for epileptic seizures, and maturity for lethargy and madness (insania) (2.21-22). C. Caelius Aurelianus (Soranus) Caelius Aurelianus was a medical writer of the fifth, or possibly sixth, century CE; the works which we are considering here are however, his Latin translations of the lost works of a much earlier Greek physician, Soranus of Ephesus, who practiced medicine at Rome in the time of the Emperors Trajan and Hadrian. 628 For the sake of simplicity and clarity, however, we will refer in the following discussion to the opinions of Caelius, rather than Soranus. Both Caelius and Soranus belonged to the Methodist school of physicians, a school which emphasized the formulation of general principles based on the observation of specific cases, and they are said to have “developed symptomatology and differential diagnosis to a high degree of perfection.”629. The two treatises, On the Acute Diseases and On the Chronic Diseases, have been described as “the only surviving ancient text to contain a full and orderly discussion of mental illness” in antiquity.630 The discussion of a disease in these works typically follows a set pattern which includes, “(1) the etymology of the name of the disease, (2) the definition of the disease, (3) the symptoms, (4) the method of distinguishing other similar diseases, (5) the part affected, (6) the treatment as practiced by the Methodists, and (7) the treatment as practiced by others, with a refutation thereof.”631 This last section provides extremely valuable access to the opinions of many medical writers now lost.632 Both because of the great variety of medical observations discussed in it and by virtue of its own thoroughness, an examination of the work of Caelius will form the larger part of this chapter. Extant relevant material from other medical writers both

628 For biographical information about Soranus and Caelius see Drabkin's introduction to his edition of Caelius Aurelianus On Acute Diseases and On Chronic Diseases, Chicago, 1950 and also Temkin's introduction to his edition of Soranus' Gynecology, Baltimore, [1956] 1991. For a cautionary note on regarding Caelius as simply a translator of Soranus see Lloyd 1987, 25 n.80 and 1983, 186 n. 258. 629 Drabkin 1950, xvii. 630 Dols 1984, 138 n.17. 631 Drabkin 1950, xii. 632 Drabkin, op.cit., xii, lists Diocles, Praxagoras, Asclepiades, Heraclides of Tarentum, Themison, and Thessalus.

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contemporaneous and subsequent to him will follow, but none we shall find, including even the great Galen, was so attentive to mental disorders.

One of the features of Methodism was that it distinguished quite sharply between acute and chronic diseases.633 We may thus expect in Caelius an attempt to demarcate more clearly than in previous medical works the terms used for various disturbed mental states . Under the rubric of acute mental disorders we find primarily phrenitis; other acute diseases which are characterized to a noticeable extent by disturbance of mind are lethargy, stupor (or catalepsy), apoplexy; hydrophobia and satyriasis. I. Acute Diseases i. Phrenitis In his preliminary discussion of phrenitis Caelius searches for a definition by examining the criteria used by previous medical writers. This provides us with a glimpse of some early attempts to make distinctions among mental syndromes. Without emersing ourselves in the minutiae of Caelius' objections to each one, it is possible to survey the versions he gives of these prior opinions and by doing so get some sense of the difficulties physicians had then, as now, in categorizing and understanding mental aberration. Caelius cites first Demetrius, a follower of Herophilus, who defined phrenitis as a violent attack of madness (deliratio) accompanied by loss of reason (alienatio) and frequently by fever, which ended swiftly either in death or recovery.634 Next Asclepiades is reported as saying that phrenitis “is a stoppage or obstruction of the corpuscles in the membranes of the brain frequently without any feeling [of pain] and accompanied by loss of reason and fever.”635 Asclepiades also notes that loss of reason (mentis alienatio) may occur in people without the accompaniment of fever, as for example those who have drunk certain drugs (poppy juice, mandragora or henbane), or those under the influence of a great emotion (profound anger, grief or fear), or those who are in the grips of an epileptic seizure. These people are not considered to be phrenetics. Nor are those who, in the grip of some other disease are afflicted with delirium, for Asclepiades added to the definition of phrenitis the proviso “without any feeling [of pain]” so as to exclude people with, for example, pleurisy and pneumonia, who suffer from mental aberration (mentis erroribus) at the height of their disease. Caelius cites a further passage from Asclepiades in which he defines mental impairment (alienatio): “Mental impairment is an affection in the senses, and in this affection sometimes the mental activity is too great for the capacity of the sensory passages; but in other cases the passages are too large for the motions [of the corpuscles]. When this disease

633 Drabkin, op. cit., xvii. 634 MT46 Cael. Aur. Morb. Acut., 1.4, citing Demetrius De passionibus 6, hanc diffiniens delirationem dixit vehementem cum alienatione atque febre, et in interfectionem celerem, aliquando et in sanitatem. 635 MT47 Cael Aur. Mor. Acut. , 1.6, citing Asclepiades De celeribus passionibus 1, phrenitis...est corpusculorum statio sive obtrusio in cerebri membranis frequenter sine sensu, cum alienatione et febribus.

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is chronic and without fever, it is called furor or, commonly, insania, but a recent [i.e. acute] case with fever and without any feeling [of pain] is called phrenitis.”636 Caelius's own perspective becomes clear as he makes several important points among his criticisms of the above definitions. First, in response to Demetrius, he says that loss of reason (alienatio) is the same thing as madness (deliratio) and that phrenitis can never occur without fever (1.5). In response to Asclepiades he states that phrenitis is sometimes accompanied by violent pain (1.7). The problem is that in phrenitis “the mind, being deprived of its reason is unable to complain of the pain.” (1.123) He cites as evidence the observation that phrenetics often bite, burn or prick themselves because of some compelling pain.637 He disagrees with the notion of “stoppage” as the cause of phrenitis (1.14), and asserts that phrenitis can occur as a result of “persistent and severe affection, as well as from other antecedent causes.”638 Caelius also wants to make clear distinctions between mental derangement (alienatio) and the state of stupor (pressura) which is characteristic of the disease of lethargy (1.16-17). He also wants to clarify the fact that mania (furor) too can occur in conjunction with a fever and that this state is separate from that of phrenitis: “the first onset of mania or insanity, as it is called, also frequently occurs with fever.”639 In fact, he says, Asclepiades' definition of phrenitis would make all these conditions the same, for all, according to his theories, involve a stoppage in the membranes of the brain. Finally Caelius' own definition of phrenitis is offered: “We say that phrenitis is an acute mental derangement accompanied by acute fever, a futile groping of the hands, seemingly in the effort to grasp something with the fingers (Greek crocydismos or carphologia), and a small, thick pulse” (1.21).640 Having defined the syndrome Caelius next address the question of signs indicating that phrenitis is likely to occur. He explicitly states that these signs, taken one by one, cannot be considered to presage the disease, just as the concomitant signs of the disease, taken singly are not infallible indications of the presence of phrenitis (1.27). Singly they may be found in other diseases; it is the concurrence of many signs which confirm a condition (1.33). What Caelius understands to be significant is a state in which certain specific combinations of signs are present; it is from

636 MT48 Cael Aur. Mor. Acut., 1.15 citing Asclepiades On Definitions, alienatio est passio in sensibus, ex qua aliquando maiores intellectus efficiuntur capacitate sensualium viarum, aliquando vero viae capaciores motibus. Sed hoc intardans, ... ac sine febribus furor vocatur, quem vulgo insaniam dicunt; recens autem atque cum febribus neque cum sensu phrenitis intelligitur. The Greek term for insania here is man€a, see Drabkin's note loc.cit. 637 MT49 Cael Aur. Morb. Acut. 1.123, ...phrenitici dolent, sed eorum mens, quia iudicio caret, nescit queri quod doleat. Videmus namque eos sese mordere aut urere aut pungere, et naturale non est nullo dolore cogente fieri existimare. 638 MT50 Cael Aur. Morb. Acut. , 1,16, addo etiam fieri phrenitim ex consensu perseveranti ac vehementi, sicuti ex aliis antecedentibus causis. On causes see below ch. 8. 639 MT51Cael Aur. Morb. Acut., 1.20, sed etiam novus furor, quem insaniam vocant, saepe movetur cum febribus. 640 MT52 Cael Aur. Morb. Acut. , 1.21, phrenitum esse alienationem mentis celerem cum febri acuta atque manuum vano errore, ut aliquid suis digitis attrectare videantur, quod Graeci crocydismon sive carphologian vocant, et parvo pulsu ac denso. A thick pulse is a rapid one, see Drabkin ad loc.

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this definable state that a patient can be seen to be slipping into phrenitis.641 Each disease is distinguished by its own confluence of signs (1.30). Although “unreasoning boldness or giddiness” (audacia ... sine ratione atque hilaritas) (1.28) are indicated by Caelius as sure signs of incipient phrenitis, it is the concurrence of a significant number of the following signs which, he says, should particularly be noted: (MT54) ... febris acuta atque difficile ad superficiem corporis ascendens, pulsus humilior densior, vultus subinflatus sive plenus, sanguinis per nares destillatio, vigiliae iuges aut turbatus somnus et insomnia turbulenta, mentis sollicitudo ac gravitas sine ratione, frequens tergorum conversio iacendi cum capitis assidua commutatione, aliquando etiam sine causa hilaritas, oculorum rubor cum levi lacrimatione, et circumiectio manuum sine ullo capitis dolore, articulorum frigus sine tremore, urinae abundantia flavae aquatae tenuis et paulatim exclusae, aliquibus etiam sonitus capitis atque aurium tinnitus, dolor quoque capitis repentino quiescens nulla ex manifesta ratione, praecordiorum etiam tensio, visus attentus vel frequenter palpebrans. (1.31-32) ... an acute fever hardly rising to the surface of the body, pulse low and thick, face somewhat puffed up or full, dripping of blood from the nostrils, continual sleeplessness or troubled sleep with confused dreams, unreasonable worry and concern, frequent turning of the back while lying, and continual changing of position of the head; at times there is also giddiness without reason, redness of the eyes with slight tearing, tossing about of the arms, absence of pain in the head, coldness of the limbs without trembling, abundance of urine, light-colored, watery, thin, and discharged a little at a time. In some cases there is also a sensation of noise in the head and ringing in the ears; also pains in the head suddenly abating for no obvious reason, precordial [i.e. hypochondrial] tension, and fixity of gaze or frequent blinking. When phrenitis is present the person demonstrates, first of all, those core signs which formed the definition of the disease: acute fever, mental derangement, small and rapid pulse and the plucking at straws and hairs (1.34). In addition there are many other symptoms to be noted, which were thought useful for gauging the severity of the disease. The detailed observations which are quoted at length in the following passage include a broad range of behavioural symptoms in conjunction with other, physical symptoms. The number, variety, extent of abnormality and duration of such symptoms exhibited by any one patient indicated for Caelius and the Methodists generally the degree of seriousness of the disease (1.35; 39; 41).

641 MT53 Cael. Aur. Morb. Acut. 1.30, secundum nos itaque declivitatis atque pronae aegritudinis in phrenitim recte nuncupantur, ut labiles in passionem aegros pronuntiemus, quos Graeci eunosus [§unÒsouw ] totius appellatione vocant.

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(MT55) febres continua vel hemitritaeae [esse] vel inaequales, atque superficiem corporis difficile ascendentes, alienatio intra diatriti vel post diatriti tempus, iugis aut intercapedinata, cum risu tacito aut cum cachinno et cantilena vel certe maestitudine, silentio vel murmure aut vagitu aut levi secum sua ipse mussitatione vel mentis indignatione, ut in furore exiliens difficile teneatur, atque omnibus iracundus sit et exclamet vel sese percutiat aut suam vestem atque propinquantium scindat aut metu se abscondendum existimet aut lacrimetur, atque secum loquentibus non respondeat, cum loquatur tamquam visis, et non solum visis, sed etiam mortuis, et neque potum postulet neque cibum, aut acceptum vehementer invadat et immasticatum transvoret , aut masticet neque transvoret sed in ore contineat, et post paululum proiciat; lucem quoque aut tenebras fugiat, adsint etiam vigiliae iuges aut parvus et turbulentus somnus, oculi sanguinolenti cum tensione venarum suarum, et fixo visu atque sine ulla palpebratione aut multum mobili et cum iugi palpebratione, aliquando etiam manuum ante oculos praemissione quasi aliquid apprehendere vel detrahere volentium, quod aut inhaesisse oculis aut antevolare aegrotanti videatur; vultus etiam quibusdam collectus atque conductus, genarum rubor perseverans aut per intervalla in pallorem mutatus, capitis siccitas quae statim ebibat fomenti liquorem, dentium stridor, guttae sanguinis levissimae per nares, capitis fequens alienatio, cum aurium intentione, ut aliquid audire videatur, indecens iancendi positio, pedum quoque iugis ex alto submissio, corporis vacua fortitudo, articulorum iugis torpor, raptus etiam vel attractio cooperimentorum a pedibus ad superiora, ventris fluor, uriae aquatae vel felleae cum nubeculis portentuosis; ultimo quibusdam etiam vultus mortuosus, aliis cum collo subinflatus, manuum tremor, pulsus creberrimus atque submersus et tremulus et imbecillis, aliquando etiam deficiens et in similitudinem oleo defecti luminis marcescens, praecordiorum vehemens tensio atque ad superiora adductio, singultus, linguae impedimentum atque locutionis inapprehensibilis articulatio; dehinc quibusdam diaphoresis, quibusdam spasmus, aut pressura quae lethargicam passionem attestantibus ceteris denuntiet. (1.35-1.38) ...unremitting or semitertian or irregular fevers, fevers hardly reaching the surface of the body; mental aberration before the end of the three-day period or after that period, either continuous or interrupted, quiet or loud laughter, singing or a state of sadness, silence, murmuring, crying, or a barely audible muttering to one's self; or such a state of anger that the patient jumps up in a rage and can scarcely be held back, is wrathful at everyone, shouts, beats himself or tears his own clothing and that of his neighbors, or seeks to hide in fear, or weeps, or fails to answer those who speak to him, while he speaks not only with those who are not present but with the dead, as if they were in his presence; and asks for neither food nor drink, or when he does take food falls violently upon it and gulps it down unchewed, or else chews it but does not swallow it, keeping it in his mouth and after a while spitting it out. And he shuns light or darkness, experiences continuous sleeplessness or short troubled sleep; his eyes are bloodshot, the blood vessels being distended; his

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gaze is fixed without any blinking; or else keeps wandering about with constant blinking; sometimes he puts his hands before his eyes as if seeking to catch or remove some object which he thinks has become stuck in his eye or is flying in front of him. In some cases the face is contracted and drawn; there is redness of the cheeks, either persisting or changing at intervals to pallor, a dryness of the head so that the moisture of a fomentation is quickly absorbed, gnashing of the teeth, slight bleeding from the nostrils, frequent change of position of the head, with a straining of the ears so that the patient seems to be listening to something; unseemly position in lying, constant raising of the feet from below, useless bodily strength, continual numbness of the extremities, pulling or drawing of the bedclothes from the feet upward, flux of the bowels, urine that is watery or bilious with unnatural cloudy patches; finally, in some cases a deathlike face, in others face and neck somewhat puffed up; trembling of the hands, very rapid pulse, submerged, quivering, feeble, sometimes even failing, and fading away like a lamp that has run out of oil; pronounced tension and drawing up of the precordia, hiccoughs, and an impediment of the tongue, rendering speech unintelligible. Then in some cases there occurs colliquative sweating, in others convulsion or so profound a stupor as to indicate, in conjunction with the other symptoms, the imminence of lethargy. Caelius notes further that patients who are fierce and violent (asperrimi atque audaces) are the more dangerously ill, as are those who smile to themselves, gnash their teeth or have hiccoughs - for this is an indication that convulsions may supervene. Other serious indications are: if the patient shows a change in complexion, trembles, snores, or shows distaste for everything (fastidiosi per omnia).642 In addition to his own views, Caelius reports the thinking of the leaders of some other sects with respect to phrenitis and its symptoms. Some believe that age is a factor which influences the seriousness of the disease, younger people being more severely afflicted than others (1.40). Gender too is thought by some to be significant, men being more seriously affected than women. The reasoning behind these conclusions appears to be that because the minds of young people and of men are more vigorous (sapere plus est in iuvenibus atque maribus) the disease flourishes there more strongly (1.41). Before moving on to other categories of mental disorder distinguished by Caelius, we might usefully attend to the distinctions he makes in his discussion of diseases which resemble phrenitis (1.42-51). Phrenitis is similar to several other diseases which involve loss of reason (alienatio): mania (furor, quam vulgo insaniam vocant), melancholy, pleurisy and pneumonia - its symptoms are also similar to the results of drinking mandragora or henbane (1.42). Of these our main interest here is in mania and melancholy. In neither of these diseases, we are initially told, is fever

642 MT56 Cael. Aur. Morb. Acut., 1.40, C. remarks in connection with those who are fierce and violent, “In fact, even people in health who are given to fits of anger are, in a sense, mad.” (insanitivi etenim etiam sani si iracundi esse perspiciuntur)

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universally present, nor do the sufferers pluck at bits of wool or straw.643 Both diseases are generally chronic and free from pain. Melancholy is marked by the vomiting of black bile, and the esophagus is the most markedly affected region of the body. Melancholics have a strong dislike for people and a leaden complexion (1.43). Most importantly however, in diseases such as pleurisy and pneumonia where pain is the cause of the alienatio, there is a correlation between the intensity of the pain and the degree of mental derangement. In phrenitis by contrast the loss of reason is more persistent and does not fluctuate (1.43). The central problem in Caelius' system, however, is how to distinguish between phrenitis and mania accompanied by fever (1.45-1.48). Generally he says the fever of phrenitis is acute and swift whereas that of mania is slow (chronic) - and yet he is forced to admit that there are acute attacks of mania with fever (1.46). Next he suggests that the order of the symptoms is critical; in phrenitis fever precedes loss of reason, but in mania the reverse is true. This distinction too turns outs to be insufficient, for “in mania the loss of reason may sometimes be accompanied by fever and the order of occurrence may be unknown and the facts unobtainable ... because of the patient's inability to give an account” (1.47). He next suggests the pulse as a guide to diagnosis; in phrenitis the pulse is always small and rapid, whereas in mania it is large. This too is not an infallible test, for certain phases of mania may be accompanied by a small and rapid pulse (1.47-8). The only sign which always occurs in phrenitis and never in mania is the plucking or crocydismos and carphologia - and if they do occur in a case of mania accompanied by fever “we say that the case has passed from mania to phrenitis, just as, on the other hand, cases may pass from phrenitis into mania with the disappearance of the symptoms of phrenitis”.644 Diagnosis of mania and/or phrenitis cannot always have been an easy task. Whether or not it was a critically important one from the point of view of the sufferer is, however, an open question, for the treatments for the several diseases involving mental aberration tended not to be too dissimilar. It is plausible to speculate that any significant differences in treatment very often depended more on the nature of the symptoms displayed than on the name that was given to the syndrome. Caelius next proceeds to examine whether there are different types of phrenitis and what part of the body is affected by the disease (1.52-57). Other (and anonymous) physicians are said to have distinguished different types of phrenitis according to the symptoms exhibited; one kind, for example, was accompanied by laughter and childish dancing (cum risu atque puerili saltatione), another by sadness, crying out, silence, or fear (cum maerore atque exclamatione vel silentio aut timore). Caelius rejects this method of making distinctions by symptom and states that general and invariable indications are required - he himself holds that there are two types of phrenitis, “one

643 Here Caelius contradicts himself, for in several passages he expressly mentions the possibility that fever can accompany the onset of mania, cf. 1.17; 20; and the discussion at 1.45. 644 MT57 Cael Aur. Morb. Acut. 1.48, Quae denique si furiosis advenerint in febribus constitutis, in phreniticam passionem ex insania venisse pronuntiamus: tamquam rursum ex phrenitica passione, cedentibus propriis signis, hoc est supradictis, in furorem transeant , [And, he adds, in the same way phrenitis may pass into lethargy and vice versa.] non aliter quam si etiam aliis adtestantibus signis in lethargiam veniant, vel certe relevati ex lethargia in phreniticam redeant.

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involving a state of stricture, the other a combination of stricture and looseness.”645 All major diseases are thought to be identifiable by such leading features and Caelius's system of treatment is based on such general indications (1.52). As to the part of the body which is affected in phrenitis, Caelius himself is indifferent, for his method of treatment is not local, but a general therapy in which the whole body is treated (1.54-5). Leaders of other sects do treat the disease locally and in each case “they hold that the part affected in phrenitis is that in which they suspect the ruling part of the soul (animae regimen) to be situated.” (1.54) This location has been variously identified by different medical writers as the brain, the fundus or base of the brain, both the brain and its membranes, the heart, the apex of the heart, the membranes which encloses the heart, the artery called the aorta, the “thick vein”, or the diaphragm.646 Caelius, although he treats the whole body, does concede that the head is the part of the body most affected in this disease on the basis of the number and variety of symptoms which occur there. This, he says, is the only reason for treating the head. Those physicians who argue that the head is the part affected on the basis of a theory of physiology which assumes a priori that the ruling part of the soul is located in the head and that it therefore must be the source of mental derangement are, according to Caelius, proceeding wrongly, since “the place of this ruling part is uncertain.”647 ii. Lethargy Among the other acute disease involving loss of reason, lethargy is the most serious. Caelius compares it to phrenitis on the basis of its intensity - it is a disease not different in kind but in severity, just as complete blindness is to visual impairment or complete loss of speech to a speech impediment (2.1). As we have seen above patients can move back and forth between lethargy and phrenitis - the movement into lethargy being more common. Caelius discusses the many definitions of lethargy, and again it will be useful here to survey briefly the definitions he presents as representative of the various medical writers and the most important of his objections to these. A common definition of lethargy, he says, is “loss of reason with acute fever leading to death” (2.4). Demetrius the follower of Herophilus “calls lethargy an acute disease involving stupor and an impairment of the senses frequently

645 MT58 Cael Aur. Morb. Acut. 1.52, nos vero aliam dicimus esse ex strictura, aliam ex complexione stricturae atque solutionis. 646 MT59 Cael Aur. Morb. Acut. 1.53-4, aliqui igitur cerebrum pati dixerunt, alii eius fundum sive basin, ... alii membranas, alii et cerebrum et eius membranas, alii cor, alii cordis summitatem, alii membranam quae cor circumtegit, alii alii arterium eam quam Graeci aorten [ἀορτὴν] appellant, alii venam crassam, quam iidem phleba [φλέβα παχεῖαν] vocaverunt, alii diaphragma. 647 MT60 Cael Aur. Morb. Acut. 1.56. I give Drabkin's translation here, the text is uncertain at this point. siquidem praenoscentes animae regalia in capite constituta, exinde mentis alienationem fieri acceperimus, ita expugnamus ut primo regale locum incertum* remanserit. *incertum Triller ap. Kühn 30: maternum G: internum R.

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with fever”.648 Asclepiades, according to his follower Alexander of Laodicea, thought that lethargy was “a sudden loss of reason, i.e., one of recent origin, with fever and stupor and unremitting impairment of the senses.”649 Athenaeus of Tarsus, according to Asclepiades, “defines lethargy as mania together with depression”, while others disagree with Athenaeus and say that the mind doesn't pass into a state of mania (furor) but only into a state of mental aberration (alienatio); they define lethargy as “loss of reason with depression and uninterrupted sleep”.650 Leonides the Episynthetic states that lethargy is a stoppage in the pores of the membranes [of the brain], accompanied by madness (cum furore mentis), fever, depression (maestitudine), stupor, and a large pulse (2.7-8). Menemachus “defines lethargy as a swift or acute attack of stupor with acute, though not in all cases continuous, fever” (2.8). Finally we might ask what were the views of Caelius? First of all he distinguishes stupor not only from sleep, but also from loss of reason (2.3-4). Lethargy, he says, always involves fever and an affliction of the senses (difficultate sensuum) - which is the same thing as stupor (2.4-5). In criticism of Leonides, Caelius asserts that the cause of lethargy is obscure and a matter of dispute both among the ancients and still among contemporaries (2.8). Caelius then goes on to say (confusingly) that in defining lethargy, “it is not necessary to speak of dejection, depression, and madness. For the term 'stupor' contains the notions of dejection and madness.”651 The definition which he presents is that of Soranus, who calls lethargy “a swift or acute attack of stupor with acute fever and a large, slow, and hollow pulse. He add that it is more common in old people, for impairment of the senses and depression are more characteristic of old age.”652 Indications that a person is slipping into lethargy are very much the same as those for phrenitis (2.9). Textual problems make it difficult to pinpoint securely the outstanding differences between the symptoms preceding phrenitis and lethargy, but specifically noted are: acute and violent fever, unremitting and not reaching the surface of the body, heaviness in the head, sleep, sharp pain suddenly disappearing without obvious reason, ringing in the ears, puffy face, pallor like that caused by excessive wine-drinking and depression or dejection (maestitudo vel tristitia) (2.9-10). In addition, the sufferer is silent and sluggish, never initiating discussion and although answering, is silent 648 MT61 Cael Aur. Morb. Acut. 2.4. ... passionem inquit acutam cum pressura et obstrusione sensuum cum febribus. 649 MT62 Cael. Aur. Morb. Acut. 2.5. ... ait lethargum esse subitam vel recentem cum febribus et pressura atque sensuum iugi difficultate. 650 MT63 Cael. Aur. Morb. Acut. 2.6, Athenaeus of Tarsus: furorem inquit mentis cum maestitudine .... He is said to base this definition on a statement of Asclepiades, Book 1, On Acute Diseases, that in phrenitis loss of reason (alienatio ) occurs with violent turmoil (cum turbore ), whereas in lethargy it occurs with sleep and depression (cum somno atque tristitia ). Others: ..alienationem cum maestitudine et iugi somno. 651 MT64 Cael Aur. Morb. Acut. 2.8, sed neque causam oportuit dicere ... neque etiam maestitudinem vel tristitiam atque mentis furorem, etenim pressura in semet maestitudinem atque furorem continet. 652 MT65 Cael Aur. Morb. Acut. 2.8, ...pressuram inquit celerem esse vel acutam, cum acutis febribus et pulsu magno ac tardo atque inani. frequentare inquit in senibus, siquidem aptior sit sensuum dificultati atque demersioni ipsa quoque senectus.

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about his illness or else says things devoid of reason (2.10). People who are susceptible to lethargy are thought by some to be those who have always had an excessive flow of saliva, and those of middle age (2.12). In the discussion which follows Caelius gives details of how to recognize a patient in a state of lethargy and outlines the process of deterioration of function. It can be summarized briefly as successive stages of unresponsiveness beginning with impairment of the senses and proceeding through degrees of stupor and confusion with loss of control of bodily functions. Some patients recover and go through a slow abatement of symptoms to return to normal function. Some pass through a phase of phrenitis first, others undergo an alternation of phrenitis and stupor. Finally there are other who, “though their stupor passes, are beset by loss of reason” (alienatione mentis ... tentantur) ( 2.19). Although several writers suggest the existence of different kinds of lethargy which they distinguish with respect to time, intensity and cause, Caelius considers it unnecessary to speak of different types (2.23-25). As in phrenitis he again asserts that treatment should be of the whole body, but that the head is obviously the area particularly affected (2.26). iii. Hydrophobia This disease will not be discussed here in any detail; it was clearly understood both by lay and medical people in antiquity to be a disease caused by contact with a mad or rabid animal, although Caelius allows for the possibility that the disease might arise within the body “without any visible cause, when a state of stricture, such as that which comes from poison is produced spontaneously.” (3.100) He does not, however, provide examples of such cases but he does discuss in some detail how to distinguish hydrophobia from diseases which resemble it, syndromes with which we are specifically concerned: mania, phrenitis, melancholy and other phobias (3.107-108). It is of some interest here again to note Caelius' technique of classification and his observations on the differences and similarities between these clusters of syndromes. First, he says, it is the head which is the part principally affected in cases of mania and phrenitis, and in the latter case there is also fever. In hydrophobia it is the esophagus which is the principally affected part and there is no fever. (Caelius here contradicts himself - cf. 3.103 “in some cases there is fever”.) Hydrophobia is classed, at least by Caelius, as a swift and acute disease, mania is generally chronic. 653 Caelius disagrees with Themison who says that hydrophobia is the same disease as melancholy, again because the former is an acute, the latter a chronic disease. Some writers, according to Caelius, suggest that there are other severe phobias similar to hydrophobia, ones such as aerophobia, which generally accompanies phrenitis, and a mysterious disease identified by Andreas and his followers called pantophobia (whose existence Caelius doubts). Hydrophobia, he says, is distinct from these because it is specifically identified by a fear of water (3.108).654

653 Cael. Aur. Morb. Acut. 3.107, but cf. the contrary opinions of Demetrius and Asclepiades (with examples) at 106. 654 For a history of hydrophobia and rabies see now Théodoridès 1986.

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According to Caelius, the question of whether hydrophobia was a disease of the body or the soul (animus) was of concern to some medical writers.655 Certain of them argued that desire or longing (appetere vel desiderare) is a function specifically of the soul rather than the body and, further, that fear, sadness and anger are affections of the soul; therefore the hydrophobic's desire to drink and fear of water stem from an affection of the soul (3.109). Again, mental images, whether they are normal or abnormal (sive naturalia sive contra naturam), belong to the soul rather than the body, and the abnormal phantasia which torment the hydrophobic mean that the affliction is one of the diseases of the soul (3.110). Caelius does not agree with these approaches, saying that longing for and delight in eating and drinking arise from an affection of the body and fear too arises as the result of “a sympathetic accord between body and soul.”656 For these reasons and because of the dog bite which precedes it and the physical symptoms which accompany it, hydrophobia is for Caelius clearly a disease of the body. Affections of the soul are, he remarks, in philosophical terms, affections of our judgement. But hydrophobia, in the same way as mania and melancholy, derives from the body, is a bodily disease and then “attacks the psychic nature.”657 Mental derangement (mens alienata) results when the head is affected, but the head is not the source of the disease. Rather the disease originates in that part which the rabid animal has bitten, and from there it affects the whole body including the head (3.115-117). II. Chronic Diseases The diseases we have examined up to now were considered by Caelius and others to be acute diseases; they were thought to be more amenable to treatment - some, given the right conditions, would even cure themselves spontaneously.658 But neither nature nor luck come into play in the cure of the chronic diseases; here it is the physicians art which is preeminently required (1.2). Of the chronic diseases which are either mental diseases per se or else include a significant component of mental dysfunction, we shall single out for discussion Incubus, Madness or Insanity, Melancholy, and Epilepsy. In addition, Caelius classified “effeminate men or pathics (Greek malthacoe)” as diseased in mind rather than in body (corruptae mentis vitia) (4.131). A brief summary of his discussion of this topic will also be included here. i. Incubus

655 For discussion see Pigeaud 1981, 112-120. 656 Cael Aur. Morb. Acut. 3.110, per consensum animae corpori compatientis. 657 MT66 Cael Aur. Morb. Acut. 3.111 (italics mine), nam animae passiones, ut philosophi volunt, nostri sunt iudicii; hydrophobica autem passio ex corporis necessitate descendit. Quo fiet ut sit corporis passio, sed etiam animae occupet qualitatem, tamquam in furiosis vel melancholicis. 658 MT67 Cael Aur. Morb. Chron. 1.1, cum quoties repentino nuntio laeti aut territi aegrotantes mutatione quadam corporis morbos excludunt, vel ea per intemperantiam gerunt quae ratione occulta sibi profutura nescientes duce desperatione committunt., “sometimes a patient who is suddenly made happy or frightened by an unexpected message will undergo a bodily change that will drive out the disease. Or in ignorance and desperation he will do something rash, which for some unknown reason will help him”.

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Incubus or nightmare is carefully defined by Caelius. It is the vision of a human or form which the patient perceives as climbing over him and settling on his chest - a choking sensation results. It is said to affect those who have been weakened by continual intoxication or indigestion (1.54). The single occurrence of such a vision does not constitute a disease, only if it occurs “continually and with bodily discomfort” ( iugiter atque cum corporis incommoditate). When it does so occur it is thought to herald epilepsy (1.55). People who suffer from incubus have a variety of physical and mental symptoms: they are sluggish and stiff. During the dream they feel heaviness, oppression and choking, and they imagine that someone has stunned them. They jump up and cry out “with confused and indistinct sounds”; they are prey to grotesque visions and often “imagine they see the attacker urging them to satisfy a shameful lust.”659 If they have suffered from this for a long time they become fearful and unable to sleep and, as a result, pale and thin (1.56). The disease can be fatal because of the severity of the choking. It seems to have been thought to be a disorder which could become epidemic, for Caelius reports that “Silimachus, a follower of Hippocrates, tells us that many persons at Rome were carried off by this disease, incurring it through contagion as in plague.”660 ii. Epilepsy “Epilepsy takes its name from the fact that it is a seizure both of the senses and of the mind.”661 It can begin after drunkenness, indigestion, an injury or, according to Asclepiades, a blow, especially if it penetrates the membranes around the brain. It can also result from extreme fear.662 Caelius differentiates two types of epilepsy; in one, the sufferer appears to go into a deep sleep - this is thought to be the more serious form of epilepsy since it resembles apoplexy (1.61). The second type is the one in which the body is wracked with convulsions - and from this a third or mixed type can emerge in which the epileptic goes from a convulsive state to one of profound sleep (1.61). These distinctions of type, says Caelius, are not significant since they have no bearing on the treatment which is given. The symptoms of people about to undergo an epileptic attack are the same as those for other diseases which have their origins in the membranes of the brain (for example phrenitis, lethargy and mania). They include: (MT72) ... gravedo atque vertigo capitis et interior sonitus, consesnus etiam occipitii, oculorum intentio, aurium tinnitus, aut difficilis auditus, et cum vertigine visus obtusio ...(1.62)

659 MT68 Cael. Aur. Morb. Chron. 1.55-56, ...saepe erumpentes non articulata sed confusa voce exclament. Quidam denique ita inanibus adficiuntur visis, ut et se videre credant irruentem sibi et usum turpissimae libidinis persuadentem. 660 MT69 Cael. Aur. Morb. Chron. 1.57, memorat denique Silimachus Hippocratis sectator contagione quadam plurimos ex ista passione veluti lue apud urbem Romam confectos. 661 MT70 Cael. Aur. Morb. Chron. 1.60, Epilepsia vocabulum sumpsit quod sensum atque mentem pariter apprehendat. 662 MT71 Cael. Aur. Morb. Chron. 1.61, fit plerumque vel nascitur ex vinolentia aut indigestione aut contusione vel, ut Asclepiades, percussu atque divisura membranorum quae cerebrum tegunt, aut nimio timore. Causes are discussed in more detail below ch.8.

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... heaviness of the head and dizziness, head noises, sympathetic pain in the back of the head, eyes staring, ringing in the ears or impairment of hearing, and blurring of vision accompanied by dizziness .... Caelius follows these symptoms with a detailed account of visual perceptions which are probably what later writers call the epileptic aura (1.62-3). He adds further physical and mental symptoms which indicate that an attack is coming; the latter including troubled dreams, frequent desire for sex, an unsettled and troubled mind (mens suspensa cum anxietate), a tendency to become angry for no reason - or sad, and forgetfulness of what has just recently occurred (1.64; 68). After the attack (the symptoms of which are given with Caelius's customary thoroughness [1.64-66]), the epileptic may be left with some residual mental aberration and an inability to recognize familiar persons (mentis alienatio, et nulla notorum agnitio) (1.66). Epilepsy is said to be most common in children, especially while they are teething. Young people and the middleaged are the next most susceptible group whereas the aged very rarely develop it. It is more violent in young babies and in aged and declining persons “for weak bodies cannot endure violent diseases.” (1.71) Epilepsy often leaves of its own accord, for boys at the time of puberty, and for girls at the onset of the menses or with the birth of their first child (1.71). It can be confused with one of the diseases of women: hysterical suffocation often resembles epilepsy, “for in either case the patient is bereft of her senses.” But epilepsy can be distinguished by the fact that at the end of an attack there is foaming at the mouth and nostrils (1.71-2). iii. Madness, Insanity, Mania The title of this section of Caelius' work is, De Furore sive Insania, Quam Graeci Manian Vocant. The abundance of terms points to the difficulties experienced by ancient writers (and ourselves) in translating and defining the vocabulary of madness. Caelius introduces this section with a summary of the several kinds of madness distinguished by philosophers (Plato, the Stoics, Empedocles) and from these isolates the category of madness with which he is concerned: madness which involves “an impairment of the reason resulting from a bodily disease or indisposition.”663 Mania is a disturbance of reason (alienatio) and it may be distinguished from phrenitis by the fact that it is chronic and occurs without fever (1.146). If, however, mania should be accompanied by fever, Caelius repeats in simplified form some of the distinctions made in his discussion of phrenitis, those of timing and pulse. In mania, madness (furor) precedes fever; in phrenitis the opposite occurs. Phrenetics have a small pulse; maniacs do not (1.146). A person may be attacked suddenly and with no warning by mania, but if there are premonitory signs they are, according to Caelius, the same symptoms experienced by those on the verge of epilepsy or apoplexy (1.148). He reports that other (anonymous) physicians claim, on the basis of early signs, to be able to distinguish between the

663 Cael. Aur. Morb. Chron. 1.144, ...alienatione mentis ex corporis causa sive iniquitate.

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onsets of epilepsy and mania. The say, for example, that deep sleep indicates the coming of epilepsy; light and short sleep, mania. Other signs that specifically predict mania, according to these physicians, are: (MT73)... sic etiam in iracundia constitutos capitis implemento affici atque aestimare se in furorem devenisse, et rursum silentio opprimi ex inani timore, item maestitudo, vel animi anxietas, et iactatio, vel plurima ciborum appetentia, et oculorum frequens palpebratio, cordis saltus, et somni cum timore terribili vel turbato effecti, item ventris extantia, et frequens descensus venti per podicem, pulsus parvus atque creber et vehemens. etenim in epilepsiam declives ac pronos maior atque rarus pulsus sequetur et imbecillus. (1.148) ... when a person in a state of anger suffers congestion of the head and believes that he has gone mad or, again, when such a person is overcome by speechlessness resulting from groundless fear. Other such signs ... are unhappiness, mental anxiety, tossing in sleep, immoderate appetite, frequent blinking of the eyes, palpitation of the heart, sleep marked by great fear and turmoil, abdominal distension, frequent passing of wind through the anus, and a small, rapid, hard pulse. On the other hand...persons on the verge of epilepsy have a large, rare, and soft pulse. Caelius's response to this list is sceptical. Some of the signs suggested can indicate either mania or epilepsy; some, but not all of them, may appear in any one case, and other signs can appear which these physicians have overlooked (1.149). When mania does erupt it can be described fundamentally as impairment of reason (alienatio mentis ), unaccompanied by fever; yet the individual cases of mania may differ greatly both in degree of severity and in the kinds of symptoms they exhibit (1.150). (MT74) nam furor nunc iracundia, nunc hilaritate, nunc maestitudine sive vanitate occupat mentem, nunc timore comminante inanium rerum, sicut quidam memoraverunt, ut nunc speluncas timeant, nunc lacunas, ne in easdem concidant, vel alia quae terrori esse possunt. (1.150) For, when mania lays hold of the mind, it manifests itself now in anger, now in merriment, now in sadness or futility, and now, as some relate, in an overpowering fear of things which are quite harmless. Thus the patient will be afraid of caves or will be obsessed by the fear of falling into a ditch or will dread other things which may for some reason inspire fear. Further, mania, although chronic, is a disorder subject to intervals of remission, during which the patient feels fatigued (1.151; 154). As a result persons suffering from mania forget what they are doing, and are sometimes unaware of their own forgetfulness; their senses are impaired and they are deluded by false impressions and other

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kinds of aberrations.664 Physical symptoms at the time of an attack of mania include bloodshot, bulging and intently staring eyes (attenti), distended veins , flushed cheeks, and a body hard (durities) and possessing abnormal strength. The person is also continually wakeful (1.152-153). Caelius provides us with brief descriptions of several cases of mania. The first is an account of mania caused by overwhelming fear. Caelius cites the physician Demetrius who held the view that mania could be understood as “a strain imposed on the mind for a brief period”; he suggests, for example, that some persons can be so terror stricken in a sudden moment of confusion that they lose all memory of past events.665 As a demonstration of this Caelius relates a story told by Apollonius about the philologist Artemidorus, who was terrified by a crocodile; his mind was so struck by its motion that he believed his left leg and hand had been devoured by the animal and, overcome by amnesia, he lost his memory of literature.666 Others suffering from mania present an odd assortment of delusions: (MT78) sic denique furens alius se passerem existimavit, alius fallum gallinaceum, alius fictile, alius laterem, alius deum, alius oratorem, alius tragoedum vel comoedum, alius stipulam ferens mundi se centrum tenere, alius se sustentandum manu poscebat vagiens ut infans. ... one victim of madness fancied himself a sparrow, another a cock, another an earthen vessel, another a brick, another a god, another an orator, another a tragic actor or a comic actor, another a stalk of grain and asserted that he occupied the center of the universe, and another cried like a baby and begged to be carried in the arms.

Caelius summarizes his description of mania, saying that it is a major chronic disease involving principally the head and senses, although the whole system of nerves and sinews too are affected (1.152). It results from a state of stricture - those physicians, Caelius asserts, who claim that the kind of mania which manifests itself in merriment (hilaritas) involves a state of looseness are confused (1.153-154). Moreover Caelius maintains that mania is first and foremost a disease of the body; it is not the case, as some (anonymous) writers hold, that it is chiefly the soul which is affected and only secondarily the body: “For no philosopher has ever set forth a successful treatment for this

664 MT75 Cael Aur. Morb. Chron. 151, ... efficiens ut aegri nunc non meminerint sui laboris, nunc oblivionem nesciant suam, et nunc omnium sensuum alienatione vexentur falsitate possessi, nunc aliarum specierum errore fallantur. 665 MT76 Demetrius apud Cael Aur. Morb. Chron. 1.150, Demetrius etiam parvi temporis mentis extensionem furorem appellat: item turbore repentino expavescentes atque percussos quosdam ut etiam oblivione praegestorum afficiantur. 666 MT77 Apollonius apud Cael. Aur. Morb. Chron. 1.151, sic denique Artemidorum grammaticum Apollonius memorat nitente gressu crocodilum in harena iacentem expavisse, atque eius motu percussa mente credidisse sibi sinistrum crus atque manum a serpente comestam, et literarum memoria caruisse oblivione possessum.

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disease; moreover, before the mind is affected, the body itself shows visible symptoms.”667 It is a disease which afflicts primarily young and middle-aged men; it occurs rarely in old men and even more infrequently in children and women (1.146). iv. Melancholy The disease of melancholy is so called, according to Caelius, from the fact that melancholics often vomit black bile not, as many believe, because black bile is the cause or origin of the disease. This is an untrue assertion, which Caelius has elsewhere refuted, and it is made only by those who guess at the truth rather than observe it (1.180).

Melancholics are characterized as being always downcast, irritable and almost never cheerful or relaxed.668 Both Themison and Apollonius, among many other, are said to have categorized melancholy as a form of mania (1.183; 151). The two should be distinguished, says Caelius, because in mania it is the head which is chiefly affected, whereas in melancholy it is the esophagus (1.183). People who are prone to melancholy or on the verge of it show the same signs as the ones indicated previously for those who are about to go insane (insanos).(1.181) When melancholy is actually present the sufferers displays the following mental and emotional symptoms: (MT80) ... animi anxietas atque difficultas tenet, attestante maestitudine cum silentio et odio conviventium. Sequitur etiam nunc vivendi nunc moriendi cupido, cum suspicionibus velut insidiarum sibi paratarum; item inanes fletus, atque murmura vacua, et rursum hilaritas .... (1.181-182) ... mental anguish and distress, dejection, silence, animosity toward members of the household, sometimes a desire to live and at other times a longing for death, suspicion on the part of the patient that a plot is being hatched against him, weeping without reason, meaningless muttering, and, again, occasional joviality ... The physical signs which accompany this condition are particularly marked: (MT81) ... magis post cibum cum inflatione praecordiorum, et articulorum frigore, et levi sudore, atque stomachi mordicatione vel oris ventris usque ad interscapulas, quas Graeci metaphrenum vocaverunt; item capitis gravedo, color viridis cum nigrore aut sublividus, corporis tenuitas, virium debilitas, et accepti cibi corruptio cum ructationibus odoris tetri, hoc est fumosi vel 667 MT78 Cael Aur. Mor. Chron. 1, 154, ...peccant denique etiam hi qui animae passionem principaliter, dehinc corporis esse concipiunt, cum neque quisquam philosophorum eius tradiderit curationem, et antequam mente falluntur, accidentia substantia corporis habere videatur. 668 MT79 Cael. Aur. Morb. Chron. 1.180, ... melancholici semper tristes ac nulla paene hilaritate laxati esse videantur. is the variant reading in R which Drabkin translates but leaves as a footnote.

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bromosi, vel piscosi; item intestinorum tormenta, vomitus nunc inanis, nunc fellossus vel ferrugineus aut niger, et eiusdem qualitatis per podicem egestio. (1.182) ... precordial distention, especially after eating, coldness of the limbs, mild sweat, a sharp pain in the esophagus or cardia extending even to the region between the shoulder blades (Greek metaphrenon), heaviness of the head, complexion greenish-black or somewhat blue, body attenuated, weakness, indigestion with belching that has a foul, i.e., a fumy, fetid, or fishy odor; intestinal cramps; vomiting, sometimes ineffectual and at other times bringing up yellowish, rusty, or black matter; similar discharges through the anus. Melancholy is said to occur most frequently in men, especially those of middle-age. It is uncommon in other age groups and rarely occurs in women (1.181). v. Effeminate Men or Pathics As the Latin title of this chapter, De Mollibus Sive Subactis, Quos Graeci Malthacos Vocant, indicates, it is primarily men who wish to play the passive partner in the homosexual act who are singled out here as diseased. Such individuals adopt the dress, walk, and other characteristics of women and are described as unable to be “content with their own lot, the lot which divine providence ... marked out for them in assigning definite functions to the parts of the body.”669 To these men are equated a category of women called tribades, women who participate in both homosexual and heterosexual partnerships, but who prefer women to men and pursue them “with almost masculine jealousy” (invidentia paene virili ) (4.132). Caelius states that both pathics and tribades are victims of an “affliction of the mind” and that their actions are caused by “a diseased mind” rather than a diseased body; he reiterates this verdict several times.670 He discusses several theories on how such individuals came about and asserts that because it is the mind which is affected, there is no effective bodily treatment for this disease - instead “the mind must be controlled.”671 This affliction, unlike epilepsy and mania which grow milder as the patient ages, does the opposite - “it causes a hideous and ever increasing lust” (infanda magis libidine) (4.137). Caelius does, however have a physical explanation for the increasing severity of this “disease of the soul”: with age the virile power which caused such men to assume a dual sexual role, sometimes active, sometimes passive, as it declines leaves the old man with only an abiding desire to

669 MT 82 Cael. Aur. Morb. Chron. 4.131, singulis Spartae non sufficiunt suae (nam sic nostri corporis loca divina providentia certis destinavit officiis). On homosexuality in Caelius see Pigeaud 1981, 120-122. 670 MT83 Cael. Aur. Morb. Chron. 4.131, ... quae sunt a passionibus corporis aliena, sed potius corruptae mentis vitia; 4.132, C.cites Soranus , “... this affliction comes from a corrupt and debased mind” (est enim, ... malignae ac foedissimae mentis passio.); 133, sic illi comparatione talium animi passione iactari noscuntur. 671 Cael. Aur. Morb. Chron. 1.133, on theories of causation and attempts at treatment see below ch. 8 and 9.

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play the “feminine role in love” (4.137). For the same reason, i.e. absence of virile powers, young boys too can become victims of this affliction. The discussion of mental disturbances found in the works of Caelius is unique in its detailed comprehensiveness and its systematic approach. Because of this, because of the fact that his writings are based primarily on much earlier work (of Soranus), and because Caelius himself compares his own approaches with those of a wide variety of other medical writers, Caelius's discussion can be taken as a base-line against which we may examine the more sporadic observations on mental illness found in other medical writers both contemporary with and subsequent to him. In the discussion which follows, we shall examine the works of important figures such as Aretaeus of Cappadocia, Rufus of Ephesus, Galen of Pergamum, Oribasius, Aetius of Amida, Alexander of Tralles and Paul of Aegina, emphasizing primarily what they have that to say that is new or significantly different about the identification and treatment of mentally disturbed individuals. Our interest will be focused largely upon any case studies which these writers may present. D. Aretaeus of Cappadocia Aretaeus of Cappadocia was a Greek physician who lived and worked c. 120 -180 CE.672 He was an Eclectic in approach, but followed the doctrines of the Pneumatic school, whose principle exponent was Archigenes of Apamea.673 The works of Aretaeus are the only texts preserved in entirety representing that school, and consequently his writings have been treated in much the same way as those of Caelius Aurelianus, as reflecting the views of an earlier medical approach, in the case of Caelius, Soranus, and in the case of Aretaeus, Archigenes.674 Aretaeus, like Caelius divided diseases involving the mind into the acute and chronic; under acute he includes epilepsy, phrenitis, and lethargy; under chronic, epilepsy (again) mania and melancholy. The chapters on the causes and symptoms of phrenitis and lethargy are no longer extant, but those concerning their treatment are. I. Epilepsy In acute epilepsy Aretaeus minutely describes the physical and psychological precursors to an attack, mentioning, among these, that such persons are quick to anger and unreasonably irritable (ὀργίλοι, πικρόχολοι παραλόγως) and that they may fall over in a seizure from any cause - including lowness of spirits ἐξ ἀθυμίης). (Acut.1.5) His descriptions of the premonitory signs, including the aura, and the acute attack itself are not unlike those of Caelius and other writers. Epilepsy in its chronic form, however, was thought ultimately to have a significant impact upon

672 Citations for Aretaeus will be in the form of book and chapter according to Adams’ text. Please note that this text, in contrast to contemporary editorial conventions, retains a grave accent before a comma. 673 Archigenes fl. in Rome c. 100-117, for biographical sketches see Scarborough 1969, 150, who remarks of Aretaeus, “His work often reflected good sense at the expense of theory.” 674 Phillips 1973, 169. Heiberg 1927, assumes the discussion of the two forms of mental illness in the writings of Aretaeus, melancholy and mania, is fundamentally the work of Archigenes.

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the physical and appearance and mental faculties of its sufferers, and Aretaeus emphasizes this aspect of the disease considerably. (MT84) ποτὶ καὶ ἐπίπονος ἡ νοῦσος σπασμοῖσι καὶ διαστροφῇσι μελέων τε καὶ ὄψιος, ἔτρεψε δὲ κοτε καὶ γνώμην ἐς μανίην. (Chron.1.4) And sometimes the disease is rendered painful by its convulsions and distortions of the limbs and of the face; and sometimes it turns the mind distracted. In the intervals between attacks, chronic epileptics show the following symptoms: (MT85) ... νωθροὶ, ἄθυμοι, κατηφέες, ἐξάνθρωποι, ἄμικτοι, οὐδὲ ἡλικίῃσι μειλίχιου, ἄγρυπνοι, δυσόνειροι πολλοῖσι ἀλλοκότοισι, ἀπόσιτοι, πέψαι κακοὶ, ἄχροοι, μολιβδώδεες, δυσμαθέες νωθείῃ γνώμης τε καὶ αἰσθήσιος, βαρυήκοοι, ἦχοι, βόμβοι, ἀνὰ τὴν κεφαλήν. γλῶσσα ἀσαφὴς καὶ παράφορος· ἢ ὑπὸ τῆς διαθέσιος τῆς νούσου, ἢ ὑπὸ τρωμάτων ἐν τῇσι καταλήψεσι, σπασμώδεες. γλῶσσα μὲν στρωφᾶται ἐν τῷ στόματι ποικίλως· ὑποτείνεται δέ κοτε καὶ τὴν διάνοιαν ἡ νοῦσος, ὡς τὰ πάντα μωραίνειν ... (Chron.1.4) [They are] languid, spiritless, stupid, inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable, at any period of life; sleepless, subject to many horrid dreams, without appetite, and with bad digestion; pale, of a leaden colour; slow to learn, from torpidity of the understanding and of the senses; dull of hearing; have noises and ringing in the head; utterance indistinct and bewildered, either from the nature of the disease, or from the wounds during the attacks; the tongue is rolled about in the mouth convulsively in various ways. The disease also sometimes disturbs the understanding, so that the patient becomes altogether fatuous. Aretaeus largely concurs with Caelius that epilepsy is a disease primarily of boys and young men and that sometimes it can abate with the coming of adulthood. II. Melancholy Aretaeus defines melancholy and compares it with madness (μανίη) in a number of ways. First of all melancholy is “a lowness of spirits from a single phantasy, without fever”; it is however not as distinct from mania as it was in Caelius's schemata, for, says Aretaeus, “it appears to me that melancholy is the commencement and a part of mania.”675 The specific distinguishing signs are affective and behavioural:

675 MT86 Aret. Chron. 1.5, Ἔστι δὲ ἀθυμίη ἐπὶ μιῇ φαντασίῃ, ἄνευ τε πυρετοῦ· δοκέει τε δὲ μοι μανίης τε ἔμμεναι ἀρχὴ καὶ μέρος ἡ μελαγχολίη.

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(MT87) τοῖσι μὲν γὰρ μαινομένοισι ἄλλοτε μὲν ἐς ὀργήν, ἄλλοτε δ᾽ ἐς θυμηδίην ἡ γνώμη ρεέπεται, τοῖσι δὲ μελαγχολῶσι ἐς λύπην καὶ ἀθυμίην μοῦνον. ἀτὰρ καὶ μαίνονται μὲν ἐς τὰ πλεῖστα τοῦ βίου, ἀφρονέοντες καὶ δεινὰ καὶ αἰσχρὰ πρήσσοντες· μελαγχολῶσι δὲ οὐκ ἐπὶ ἑνὶ εἴδεϊ ἕκαστοι· ἀλλ᾽ ἢ πρὸς φραμκείην ὕποπτοι, ἢ ἐς ἐρμίην φεύγουσι μισανθρωπίῃ, ἢ ἐς δεισιδαιμονίην τρέπονται, ἢ μῖσός ἐστι τοῦ ζῆν τουτέοισι. ἢν δὲ ἐξ άθυμίης ἄλλοτε και ἄλλοτε διάχυσις γένηται, ἡδονὴ προσγίγνεται ἐπὶ τοῖσι πλείστοισι· οἱ δὲ μαίνονται. (Chron. 1.5) ... in those who are mad, the understanding is turned sometimes to anger and sometimes to joy, but in the melancholics to sorrow and despondency only. But they who are mad are so for the greater part of life, becoming silly, and doing dreadful and disgraceful things; but those affected with melancholy are not every one of them affected according to one particular form; but they are either suspicious of poisoning, or flee to the desert from misanthropy, or turn superstitious, or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes, but these persons go mad. Aretaeus explains that these latter individuals do not become mad from a change in the kind of affliction (πάθος), but from an increase in the severity of the disease (αὔξῃ τῆς νούσου). As melancholy begins, those suffering from it appear “dull or stern, dejected or unreasonably torpid without any manifest cause”. In addition they become “peevish, dispirited, sleepless, and start up from a disturbed sleep.”676 They are prey to irrational fears, for when they dream, whatever they have an aversion to while awake rushes upon them in their sleep, terrifyingly true and clear. Because the disease has a changeable nature they tend frequently to change their minds, “to become base, mean-spirited, illiberal, and in a little time, perhaps, simple, extravagant, munificent” (Chron. 1.5). If the illness progresses more extreme mental states appear: (MT89)... μῖσος, φυγανθρωπίη, ὀλόφυρσοι ἐς κενεὰ, ζωῆς κακήγοροι· ἔραντια δὲ θανάτου. πολλοῖσι δὲ ἐς ἀναισθησίην καὶ μώρωσιν ἡ γνώμη ῥέπει, ὅκως ἀγνῶτες ἁπάντων, ἢ ἐπιλήσμονες ἑωυτέων, βίον ζώωσι ζωώδεα ... (Chron. 1.5) ... hatred, avoidance of the haunts of men, vain lamentations; they complain of life, and desire to die. In many, the understanding so leads to insensibility and fatuousness, that they become ignorant of all things, or forgetful of themselves, and live the life of the inferior animals.

676 MT88 Aret. Chron. 1.5, ἢ γὰρ ἥσυχοι, ἢ στυγνοὶ, κατηφέες, νωθροὶ ἔασι ἀλόγως, οὔ τινι ἐπ᾽ αἰτίῃ, ... ἔτι δὲ ὀργίλοι, προσγίγνονται, δύσθυμοι, ἄγρυπνοι, ἐκ τῶν ὕπνων ἐκθορυβούμενοι.

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Further details follow of their physical condition - their colour is dark and greenish, they are voracious, yet emaciated because of their constant watchfulness, their excretions are scant, they suffer from hypochondriacal flatulence and bilious digestion. Their pulse is “small, torpid, feeble, dense, like that from a cold.” (Chron. 1.5) At the end of his section of melancholy, Aretaeus relates an interesting case which was told to him of a young man who appeared to be incurably ill with melancholy and who, when all the physicians had failed, was cured by falling in love. Aretaeus does not agree with this presentation of the case: according to him the young man was in love first and became “dejected (κατηφέα) and spiritless (δύσθυμον) when he was unsuccessful with the girl”.(Chron 1.5). These symptoms, says Aretaeus, “appeared to the common people to be melancholy”. But, as a physician, he here makes a distinction between what we might call ‘clinical’ melancholy and love-sickness. Neverthless Aretaeus does appear to recognize the existence of a syndrome something like love-sickness, for he goes on to say of the young man: (MT90) οὗτος οὔτε μὴν ἦν ἔρωτα ἐγγιγνώσκων· ἐπεὶ δὲ τὴν ἔρωτα ξυνῆψε τῇ κούρῃ, παύεται τῆς κατηφείης, καὶ διασκίδνησι ὀργήν τε καὶ λύπην, χάρμῃ δὲ ἐξένηψε τῆς δυσθυμίης· καθίσταται γὰρ τὴν γνώμην ἔρωτι ἰητρῷ.677 He did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician. Melancholy is understood by Aretaeus, as also by Caelius, to afflict primarily adult men in the prime of life, but it can strike those on the threshold of adulthood too. Women he believes, are prone to mania more than melancholy. III. Mania “The modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever.”678 Aretaeus quickly distinguishes madness from other syndromes which might fit this definition: wine may inflame the drunkard to delirium (ἐς παραφορὴν), and certain plants such as henbane or mandrake induce madness (ἐκμαίνει); but these conditions differ from true mania by virtue of their temporary nature - true madness “has something confirmed in it”.679 Madness should also be distinguished, according to Aretaeus, from “the dotage which is the calamity of old age”.680 For the latter condition is caused by a coldness of the system which brings “a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties”; madness, 677 Aret. Chron. 1.5. On this passage and love-melancholy in antiquity see Jackson 1986, 352-355. 678 MT91 Aret. Chron. 1.6, Μανίης τρόποι εἴδεσι μὲν μυρίοι, γένει δὲ μοῦνος εἷς. 679 MT92 Aret. Chron. 1.6, ... τὸ δὲ ἔμπεδον ἡ μανίη ἴσχει. 680 MT93 Aret. Chron. 1.6, τῆδε τῇ μανίῃ οὐδέν τι ἴκελον ἡ λήρησις, γήραος ἡ ξυμφορή.

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on the other hand, is hot, dry, and tumultuous in effect.681 In addition madness, for several reasons, may have periods of intermission; but dotage accompanies the aged unremittingly until death. Aretaeus' careful distinctions here suggest that in popular thought (and perhaps in the thinking of other medical men), not too fine a distinction was made between these various kinds of aberrant mental states, with similar terms commonly being used interchangeably in a variety of different ‘mad’ circumstances. Here the link which Aretaeus made earlier between mania and melancholy reappears in a somewhat different form. He had stated that melancholy was the beginning or a part of mania; he now remarks that those people are more prone to melancholy who have formerly been in a mad condition.682 But both mania and melancholy, according to Aretaeus, differ from phrenitis in that the locus of the disease in the latter is in the head and the senses, whereas in mania and melancholy it is in the bowels. For that reason, he says, people with phrenitis have their senses perverted and “see things not present as if they were present, and objects which do not appear to others, manifest themselves to them”. People who are mad (μαινόμενοι) on the other hand, “see only as others see, but do not form a correct judgement on what they have seen.”683 Here, I believe, the context makes it probable that Aretaeus is including melancholics under the heading of οἱ μαινόμενοι. The distinctions between mania and melancholy which Aretaeus makes are not always consistent or clear and overlaps often occur; this is particularly apparent when he is outlining their respective symptoms, many of which they have in common.684 The symptoms of mania are multitudinous but the individuals exhibiting them can be classified according to whether the illness makes them disposed to gloom or to cheerfulness (Chron. 1.6) - or , in another passage, whether they are joyful, angry or docile (Chron. 1.6). When the disease is severe, mad individuals are: (MT97) εὐκίνητοι, ὀξέες τὴν αἴσθησιν, ὕποπτοι, ὀργίλοι, οὐκ ἐπ᾽ αἰτίῃ τινὶ, δύσθυμοι μὲν ἀλόγως, οἷσι ἐς σκυθρωπὸν ἡ μανίη τρέπεται· οἷσι δὲ ἐς θυμηδίην, εὔθυμοι· ἀλλ᾽ οἵδε παραλόγως ἄγρυπνοι, ἄμφω ἀλλοιώδεες τὰς ὄψιας κεφαλαλγέες, ἢ πάντως γε βάρος τῆς κεφαλῆς ξύνεστι· εὐήκοοι δὲ, ἀλλὰ βράδιστοι τὴν γνώμην. ἐπ` ἐνίοισι γὰρ ἔασι δὴ ἦχοι ὤτων, καὶ βόμβοι, μέχρι δή γε σαλπίγγων τε καὶ αὐλῶν ... (Chron. 1.6) 681 MT94 Aret. Chron. 1.6, ... αἰσθήσιος γάρ ἐστι νάρκη, καὶ γνώμης νάρκωσις ἡδὲ τοῦ νοῦ ... . 682 MT95 Aret. Chron. 1.6, ... οἵδε καὶ μελαγχολῆσαι ἐτοιμότεροι, οἱ δὲ καὶ πρόσθεν ἐκμαίνονται. Jackson 1986, 39, suggests that Aretaeus “was perhaps the first to suggest an intimate connection between melancholy and mania”. See Rothkopf 1974 for an examination of Aretaeus' ideas about the connectedness of mania and melancholy. R. searches for an ancient precursor to the concept of manic depressive psychosis developed by Kraepelin and used in subsequent eras. He concludes, however, that the distinctions made by Aretaeus do not conform to this later concept; rather they simply serve to identify psychotic states of calm and psychotic states of agitation. 683 MT96 Aret. Chron. 1.6, οἵδε μὲν γὰρ παραισθάνονται, καὶ τὰ μὴ παρεόντα ὁρέουσι δῆθεν ὡς παρεόντα, καὶ τὰ μὴ φαινόμενα ἄλλῳ κατ᾽ ὄψιν ἱνδάλλεται· οἱ δὲ μαινόμενοι ὁρέουσι μόνως ὡς χφὴ ὁρῆν· οὐ γιγνώσκουσι δὲ περὶ αὐτέων ὡς χρὴ γιγνώσκειν. 684 See esp. Jackson 1986, 249-254 for a discussion of the interweaving of the diseases of mania and melancholy and their symptoms in antiquity.

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...of a changeable temper, their senses are acute, they are suspicious, irritable without any cause, and unreasonable desponding when the disease tends to gloom; but when to cheerfulness, they are in excellent spirits; yet they are unusually given to insomnolency; both are changeable in countenance, have headache, or else heaviness of the head; they are sharp in hearing, but very slow in judgment; for in certain cases there are noises of the ears, and ringings like those of trumpets and pipes. Physically the illness, as it becomes entrenched, leaves its mark both on appearance and behaviour: (MT98) ... φυσώδεες, ἀσώδεες, βοροὶ καὶ λάβροι ἐν τῇ ἐδωδῇ. ἀγρυπνέουσι γάρ· ἀγρυπνίη δὲ βορόν· ἀτὰρ οὐδὲ ἰσχνοὶ ὡς νοσέοντες· μελαγχολώντων μᾶλλον εὐσαρκίη·685 καὶ ὕπωχροι. ἢν δέ τι τῶν σπλάγγχνων ἐν φλεγμασίη ᾖ γεγονός, τὴν ὄρεχιν ἢ τὴν θρέψιν ἀμβλύνει ... (Chron. 1.6) ... they are flatulent, affected with nausea, voracious and greedy in taking food, for they are watchful, and watchfulness induces gluttony. Yet they are not emaciated like persons in disease (embonpoint is rather the condition of melancholics) and they are somewhat pale. But if any of the viscera get into a state of inflammation, it blunts the appetite and digestion .... In keeping with the popular perception of the madman is the emphasis Aretaeus places on the eyes and the visions of those suffering from mania: (MT99) ... ὀφθαλμοὶ κοῖλοι, οὐ σκαρδαμύττοντες· πρὸ τῶν ὀφθαλμῶν ἰνδάλματα κυάνεα, ἢ μέλανα, οἷσιν ἐς μελαγχολίην ἡ τροπή· ἐρυθρότερα δὲ οἷσιν ἐς μανίην, καὶ φοινίκεα φαντάσματα, πολλοῖσι μὲν ὡς ἀπαστράπτοντος πυρός, καὶ τάρβος αὐτέους ὡς ἀπὸ σκηπτοῦ λαμβάνει· μετεξετέροισι δὲ καὶ ἐνέρυθροι καὶ ὕφαιμοι ὀφθαλμοί. (Chron. 1.6) ... the eyes are hollow and do not wink; before the eyes are images of an azure or dark colour in those who are turning to melancholy, but of a redder colour when they are turning to mania, along with purple-coloured phantasmata, in many cases as if of flashing fire; and terror seizes them as if from a thunderbolt. In other cases the eyes are red and blood-shot. Aretaeus provides us with some very detailed observations of the actions and delusions of manic individuals, some general and some of more specific cases. Generally he observes that when mania is at its height, sufferers have 685 Adams cites a variant reading by Ermerins of εὐσαρκίη as ἀσαρκίη. This seems to be more consistent with what has been said of melancholics and the translation should then read, "gauntness is rather the characteristic of melancholics".

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erotic dreams and an uncontrollable desire for sexual intercourse without any sense of shame or restraint. At this point if they are admonished or restrained, they become enraged and completely mad.686 “Completely mad” can mean various things: (MT101) οἱ μὲν θέουσι ἀσχέτως, οὔτε ὅπως εἰδότες ἐς ταὐτὰ παλινδρομέουσι· οἱ δὲ ἐς δηρὸν τοῖσι πέλας ἀφικνέονται· ἄλλοι δ᾽ αὖ βοῶσι ὀλοφυρόμενοι ἁρπαγὴν, ἢ βίην. οἱ δὲ φυγανθρωπεύουσι ἐς ἐρημίην, σφίσι αὐτέοισι ὁμιλέοντες. (Chron. 1.6, 10-11) ... some run along unrestrainedly, and, not knowing how, return again to the same spot; some, after a long time, come back to their relatives; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves. Aretaeus tells us in a little more detail about the characteristics of his different types of mad individuals. Some, he says have the kind of of madness which is associated with joy, “they ... laugh, play, dance night and day, and sometime go openly to the market crowned, as if victors in some contest of skill; this form is inoffensive to those around.”687 Another kind are just the opposite; their madness is accompanied by anger. These “sometimes rend their clothes and kill their keepers, and lay violent hands upon themselves”, and are a danger to all around them. 688 But there is apparently a third type consisting of individuals who are indeed suffering from some form of mania but who are both “ingenious and docile” (εὐφυέσι τε καὶ εὐμαθέσι). Cases of this kind seem to interest Aretaeus and he appears to be impressed by some of their myriad manifestations. Class distinctions are clearly visible in Aretaeus' discussion of these individuals and their characteristics. Among the educated, for example, he has witnessed “untaught astronomy, spontaneous philosophy, poetry truly from the muses; for docility has its good advantage even in disease.”689 This same category of mad individual, the ingenious and docile, is found among the uneducated lower classes too. Aretaeus says they are commonly employed “carrying the loads, and working at clay, - they are artificers or masons.” (Chron.1.6) These disturbed individuals are prone to extraordinary fantasies: “one is afraid of the fall of the oil-cruets.....and another will not drink, ......... fancying himself a brick, and fearing lest he should be

686 MT100 Aret. Chron. 1.6, Ἐπὶ κορυφῆς δὲ τοῦ κακοῦ ὀνειρώττουσι· ἀφροδισίων δὲ ἄσχετος ἐπιθυμίη, ἀτὰρ οὐδὲ ἐς τὸ ἄμφαδον αἰδὼς ἢ ὄκνος ὁμιλίης· νουθεσίῃ δὲ καὶ ἐπιπλήξει ἐς ὀργὴν ἐκριπισθέντες ἐς τὸ πάμπαν ἐκμαίνονται. 687 MT102 Aret. Chron. 1.6, Καὶ οἷσι μὲν ἡδονὴ ᾖ ἡ μανίη, γελῶσι, παίζουσι, ὀρχεῦνται νυκτὸς καὶ ἡμέρης, καὶ ἐς ἀγορὴν ἀμφαδὸν, καὶ ἐστεμμένοι κοτὲ ὅκως ἐξ ἀγωνίης νικηφόροι ἔασιν· ἄλυπος τοῖσι πέλας ἡ ἰδέη. 688 MT103 Aret. Chron. 1.6, 59, μετεξέτεροι δὲ ὑπὸ ὀργῆς ἐκμαίνονται. ἔσθ᾽ ὅτε ἐσθῆτάς τε ἐρρήξαντο, καὶ θεράποντας ἀπέκτειναν, καὶ ἑωυτέοισι χεῖρας ἐπήνεγκαν· ἥδε καὶ τοῖς πέλας οὐκ ἀκίνδυνος ἡ ξυμφορή. 689 MT104 Aret. Chron. 1.6, ἰδέαι δὲ μυράι, τοῖσι μέν γε εὐφυέσι τε καὶ εὐμαθέσι ἀστρονομίη ἀδίδακτος, φιλοσοφίη αὐτομάτη, ποίησις δῆθεν ἀπὸ μουσέων. ἴσχει γάρ τι καὶ ἐν νούσοισι εὔχρηστον ἡ εὐπαιδευσίη. Adams, ad loc. suggests that αὐτοδίδακτος might be a truer reading of ἀδίδακτος and notes that the two are sometimes used synonymously. although he does not think that is the case here.

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dissolved by the liquid.”690 One very interesting case which is related by Aretaeus, concerns a carpenter with a very discrete and circumscribed kind of mania. (MT106) τέκτων ἤδη ἐπὶ οἴκου μὲν σαόφρων ἐργάτης ἦν, μετρῆσαι ξύλον, κόψαι, ξύσαι, ξυγγομφῶσαι, ἁρμόσαι, ξυντελέσαι δόμον νηφαλέως, τοῖσι ἐργοδότῃσι ὁμιλῆσαι, ξυμβῆναι, ἀμεῖψαι τὰ ἔργα μισθοῦ δικαίου. ὁ δὲ ἐπὶ μὲν τοῦ χωρίου τοῦ ἔργου ὧδε εἶχε γνώμης· ἢν δὲ ἐξίῃ κοτὲ ἐς ἀγορὴν ἐπὶ λουτρόν, ἢ τιν᾽ ἑτέρην ἀνάγκην, τιθεὶς τὰ ὅπλα πρῶτον ἔστενε, εἶτα ἐπῆγε ὤμῳ ἐξιών· ἐπὴν δὲ ἀπῆλθε τῆς τῶν οἰκετὼν θέης καὶ τῆς τοῦ ἔργου πρήξιος καὶ τοῦ χωρίου, πάμπαν εξεμαίνετο· κἤν παλινδρομήσῃ ταχὺ αὖθις ἐσωφρόνεε. καὶ ἥδε τοῦ χωρίου καὶ τῆς γνώμης ἡ ξυμβολή. (Chron. 1.6) A certain joiner was a skilful artisan while in the house, would measure, chop, plane, mortice, and adjust wood, and finish the work of the house correctly; would associate with the workmen, make a bargain with them, and remunerate their work with suitable pay. While on the spot where the work was performed, he thus possessed his understanding. But if at any time he went away to the market, the bath, or on any other engagement, having laid down his tools, he would first groan, then shrug his shoulder as he went out. But when he had got out of sight of the domestics, or of the work and the place where it was performed, he became completely mad; yet if he returned speedily he recovered his reason again; such a bond of connection was there between the locality and his understanding. At the end of his chapter on mania, Aretaeus appends a paragraph outlining Μανίης εἶδος ἕτερον. This other species of mania is a religious mania in which people are stirred up by flutes and rejoicing or wine - or the urging of the people around them - and cut their limbs “in a holy phantasy, as if thereby propitiating peculiar divinities.” Such people, he notes, are in all other respects sane; they are suffering from madness with respect to this one assumption solely. Aretaeus explains this madness in a manner quite unlike the usual somatic explanations which he and all other medical writers provide for most forms of mental disorder; this one is divine (ἔνθεος). If these individuals recover from their madness “they are cheerful and free of care, as if initiated to the god”, and yet at the same time they are pale and thin and remain weak from their wounds for a long time. (MT107) Τέμνονταί τινες τὰ μέλεα, θεοῖς ἰδίοις, ὡς ἀπαιτοῦσι, χαριζόμενοι εὐσεβεῖ φαντασίῃ· καὶ ἔστι τὴς ὑποληψιος μανίη μοῦνον, τὰ δὲ ἄλλα σωφρονέουσι ἐγείρονται δὲ αὐλῷ καὶ θυμηδίῃ,

690 MT105 Aret. Chron. 1.6, τοῖσι δὲ ἀπαιδεύτοισι ἀχθοφορίη, πηλοεργίη, τέκτονες, ἢ λιθοξόοι· γίγνονται δὲ καὶ ἀλλόκοτοι φαντασίαι. ἐδεδίει γάρ τις ληκύθων ἔκπτωσιν ... καὶ ἄλλος οὐκ ἔπινε, δοκέων ἑωυτὸν πλίνθον ἔμμεναι, ὡς μὴ τῷ ὑγρῷ λυθείη.

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ἢ μέθῃ ἢ τῶν παρεόντων προτροπῇ. ἔνθεος ἥδε ἡ μανίη· κἢν ἀπομανῶσι, εὔθυμοι, ἀκηδέες, ὡς τελεσθέντες τῷ θεῷ, ἄχροοι δὲ καὶ ἰσχνοί, καὶ ἐς μακρὸν ἀσθενέες πόνοις τῶν τρωμάτων.691 According to Aretaeus, individuals who are prone to mania belong to three categories. The first consists in those people whose temperaments predispose them to madness, and here two different and quite opposite types of temperaments are seen to be operative. One type is the individual who is naturally passionate, irritable, of active habits, of an easy disposition, joyous and playful.692 The other is the person who is “sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it”.693 The second category of persons given to mania is based on age and condition and is made up of young males and those who “possess general vigour”, also those approaching puberty (unless their temperament inclines them more toward melancholy).694 The third category of potentially mad individuals is comprised of women whose bodies remains unpurged (by menses) at the time when the uterus is mature and ready for a man (ἀπηνδρώθησαν). Other women under normal conditions “do not readily fall into mania, yet, if they do, their cases are difficult to manage.”695 E. Rufus of Ephesus Another significant medical writer, who flourished at the time of Trajan, was the eclectic physician Rufus of Ephesus, whose work has survived only in small fragments and some larger extracts from later compilers. His work on melancholy was much admired by Galen and is thought substantially to have influenced medical thinking up through the Arabic writers and the medieval and Renaissance schools to the beginning of modern medicine.696 Rufus seems to have discussed a number of mental disturbances in addition to melancholy; the extant fragments include passages concerned with loss of memory, epilepsy, nocturnal hallucinations, incubus, love sickness and hydrophobia. Because of the nature of the sources, the observations of Rufus are particularly difficult to assemble. They are very often intertwined in compilations with excerpts from other physicians with similar views - Galen or Poseidonius for example. In addition some of Rufus has survived by means of a tortuous transmission from Greek

691 Aret. Chron. 1.6. Heiberg 1927, 23, I believe, has misunderstood part of this passage; the flutes wine etc. rouse the participants into madness, not as he would have it, rouse them out of it: “Solche Patienten können aus ihrem Wahnsinn durch Musik, Lustigkeit und einen Rausch erweckt werden oder durch eindringliche Mahnung der Anwesenden”. Note also that the regular meaning of ἀπομαίνομαι is to go completely mad (cf. LSJ ). If Adams’ translation is correct this would make the usage here highly unusual. The alternative, which I prefer, is to translate, “if these individuals go completely mad, they are cheerful and free of care, as if initiated to the god...etc.” 692 MT108 Aret. Chron. 1.6, Καὶ γὰρ δὴ νοσέουσι οἱ φύσι ὀργίλοι, ὀξύθυμοι, ῥέκται, εὐμαρέες, ἱλαροί, παιδιώδεες. 693 MT109 Aret. Chron. 1.6, ... νωθροί, ἐπίλυποι, βραδεῖς μὲν ἐκμαθεῖν, ἐπίμονοι δὲ προσκαμεῖν, ποτῖ καὶ μαθόντες, ἀμνήμονες. 694 MT110 Aret. Chron. 1.6, ... τοῖσι ἀμφὶ ἥβην καὶ νέοισι καὶ οἷσι πάντων ἡ ἀκμή. 695 MT111 Aret. Chron. 1.6, ἐμάνησάν κοτε καὶ γυναῖκες ὑπὸ ἀκαθαρσίης τοῦ σκήνεος, εὖτε αὐτέῃσι ἀπηνδρώθησαν αἱ μῆτραι· ἄλλαι δὲ, οὐ μᾶλλον δὲ ῥηιδίως ἐκμαίνονται·μάλα δὲ χαλεπῶς ἐκμαίνονται. 696 Klibansky 1964, 49; Jackson 1986, 36; on the works of Rufus see especially Flashar 1966.

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into Arabic and thence into Latin - sometimes even back to Greek. Mistranslation at various levels is a significant difficulty.697 In view of this and in view of the fact that the major elements of the discussions of, for example loss of memory and hydrophobia, recur in more coherent form in Galen and the much later Paulus, we shall here note only some specifically interesting observations of Rufus on the other forms of mental disturbances and concentrate primarily on his work on melancholy. The works of Rufus will be referred to more extensively in the sections below on causes and cures.

697 Flashar 1966 84-104, is particularly useful for the textual and translation intricacies of Rufus.

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I. Hydrophobia With regard to hydrophobia, Rufus says that it is a form of melancholy, the rabid venom of the dog imitating the humour which causes some melancholics to fear one thing, some another.698 Several sources indicate that physicians believed hydrophobia could be caught merely from proximity to a person who had the disease.699 Rufus also held this opinion for he tells of a case in which a man, bitten by a mad dog, developed the symptoms characteristic of the disease: convulsions, mental derangement and a fear of water (σπασθῆναι καὶ πραφρον καὶ δεῖσαι τὸ ὕδωρ). The man died, but not before having had sexual relations with his wife who was three months pregnant. As a result she began to exhibit a dread of water. Rufus gave orders for her child to be aborted, “otherwise I believe she would have suffered the same fate.”700 II. Love-Madness An Arab medical treatise of D'Abu Djafar on love sickness states that those who are in love are suffering from a disease which takes place in the brain and Rufus is cited by the author in this connection. The text is at this point fairly unintelligible, but it seems to imply that Rufus regards the state of passionate love as a form of ἀφροσύνη (madness), and recommends sexual intercourse as a cure.701 III. Loss of Memory Loss of memory often appears in a disease at the same time as reason is also damaged and it leads to a state termed μώρωσις, which has been variously described as idiocy, extreme dementia, fatuity or loss of intelligence.702 Loss of memory occurs in connection with lethargies and stupors and can be found as the result of plagues, as for example, the plague suffered by the Athenians during the Peloponnesian war.703 But if loss of memory occurs suddenly in an otherwise healthy individual, it presages epilepsy, paralysis, apoplexy, or some other severe

698 MT112 Rufus, Oeuvres, 447,(The passages from Rufus, with the exception of those from the Quaestiones Medicinales, are cited according to the page numbers in the edition of Daremberg-Ruelle [1879] 1963, and identified in the text with a D. Note that this text, like that of Aretaeus, adheres to the tradition of permitting a grave to stand before a comma.) ... Ὁ δέ γε Ῥοῦφος μελαγχολίας αὐτοῖς εἶδος τὸ τοιοῦτον ἀπεφηνάτο γίνεσθαι τοῦ ἰοῦ τὸν χυμὸν ἐκεῖνον μίμησαμένου καθάπερ ἑτέρους ἴσμεν μελαγχολικοὺς ἄλλους ἄλλα φοβουμένους. 699 Paulus, Adams comm. p. 163. See discussion ch. 8, “Contagion”. 700 MT113 Rufus, Quaest. Med. (ed. Gärtner), 46; see discussion below, ch. 8. 701 MT114 Rufus Oeuvres, 582, Ὁ μὲν ἔρως ὑπάρχει νοῦσος γεγεννημένη ἐν τῷ ἐγκεφάλῳ· ἔστι δὲ ὑπερβολή ἔρωτος, μετὰ συλλογισμοῦ καὶ ἀγρυπνίας ... ὁ δὲ σοφώτατος Ῥοῦφος ἔφη ὅτι ἡ συνουσία ὀνίνησιν εἰς τοὺς ὑπερνικῶντας αὐτοὺς ἡ μελαίνα χολὴ, ἢ ἡ ἀφροσύνη ..., .see Daremberg, n.6 “Ce texte me paraît inintelligible.” For Rufus's prescription of sexual activity for the cure of melancholy (and other diseases) and the pros and cons of sexual activity as therapy see below ch. 9. 702 MT115 Rufus, Oeuvres, 363, Ἡ τῆς μνήμης βλάβη φαίνεται πολλάκις ἐν νοσήμασί τισι γιγνομένη, συμβεβλαμμένου καὶ τοῦ λογισμοῦ; cf. 364 and 365 (Galen). 703 Rufus, Oeuvres, 364, this passage is a mixture of Galen and Rufus.

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illness. 704 Rufus also notes that the memories of adolescents are not as stable as those of adult men and therefore certain measures and precautions must be taken to keep them robust.705 IV. Epilepsy Rufus distinguishes between epileptics, phrenetics and those suffering from lethargy partly on the basis of the pulse. The pulse of phrenetics is small and strong due to the constant breathing and motion brought about by their insomnia. That of lethargics, large and hollow. Epileptics however are of two kinds: those who do not have spasms or contractions of the limbs (presumably in their seizures); these people have a large and hollow pulse which is normally continuous and racing. Those who do have spasms and contractions have only one kind of pulse - large and hollow like that of the lethargic.706 One fragment attributed to Rufus gives instructions, of the kind which are found elsewhere in popular literature, on how to test for epilepsy by exposing individuals to fumigations of the following substances which cause them to fall: asphalt, gagates stone (possibly jet), the horn of a goat, or the smell of a goat's liver being cooked - or indeed eating the liver will have the same effect.707 Cures for epilepsy are given more attention in Rufus's writings than descriptions of causes or symptoms. As for prognosis, Rufus is optimistic in places but states that when an epileptic is afflicted with “Baros” (a kind of skin blemish?), which are like white shapes, then the cure is difficult, and most of all when they are only on his head or neck.708 V. Melancholy No fragments of Rufus's work contain a discussion of mania, but his work on melancholy was substantial and comprehensive and comprised originally two books.709 Galen speaks highly of Rufus’s work: “Of the more recent physicians the best works on melancholy have been written by Rufus of Ephesus, and one can say with certainty that there is nothing lacking for those who listen properly and do not prefer from the beginning to take issue

704 MT116 Rufus Oeuvres, 459 cf. 366, Ὅσοις δὲ αἰφνίδιον ἐκλείποι ἡ μνήμη, τἀ δ᾽ ἄλλα ὑγιαίνειν δοκοῦσιν, ἐπὶ τούτων προσδοκᾶν δεῖ ἐπιληψίαν ἐπιγίγνεσθαι, ἢ πάρεσιν, ἢ καὶ ἀποπλεξίαν, καὶ ὅλως μέγα τι εὕροις ἐπ᾽ αὐτῶν κακόν. 705 MT117 Rufus Oeuvres, 459-60, ... et quoniam complexio adolescentium est humida, debent iuvari ad meliorandum eorum memoriam; ... et eorum memoria non est stabilis sicut memoria virorum. 706 MT118 Rufus, Oeuvres, 227-228, τῶν δὲ ἐπιληπτικῶν τῶν μὲν γιγνομένων ἄνευ σπασμῶν τε καὶ συνολκῆς τῶν μερῶν ὁ σφυγμός ἐστι μέγας τε καὶ διάκενος, συνεχής τε καὶ δεδιωγμένος ἐπὶ τὸ πλεῖστον· τῶν δὲ γιγνομένων μετὰ σπασμῶν ὁ σφυγμός ἐστι μέγας τε καὶ διάκενος μόνον παραπλησίως τῷ τῶν ληθαργικῶν σφυγμῷ. 707 MT119 Rufus, Oeuvres, 363, Ἐλέγχει ἐπιληπτικοὺς ὑποθυμιώμενος, καὶ καταπίπτειν αὐτοὺς παρασκευάζων, ἄσφαλτος, γαγάτης λίθος, κέρας αἴγειον, καὶ ἡ ὀσμὴ τοῦ αἰγείου ἥπατος ὀπτωμένου, καὶ αὐτὸ τὸ ἧπαρ ἐσθιόμενον. Cf. Apul. Apol. 44. 708 MT120 Rufus,Oeuvres, 460-461, Quando supervenit epileptico baros, quod est quasi morphea alba, tunc difficilis est eius cura, et maxime quando in capite et collo solum est. 709 Flashar 1966, 84.

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contentiously.”710 Of the original two books all that remains are two major sections from Book 6 of the Tetrabiblion of the sixth century compiler Aetius, in which the writings of Galen, Poseidonius, Rufus and Aetius himself are interwoven. However a second valuable source for Rufus comes from a Latin translation of the Continens, by the ninth century Arab physician, Rhazes.711 In the extracts from Aetius, Rufus identifies a number of symptoms of melancholy although he remarks on the difficulty in comprehending the reasons for their great variety: (MT122) Πάντων μὲν οὖν τῶν παρεπομένων ἑκάστῳ συμπτωμάτων τὰς αίτίας εἰπεῖν, ἀδύνατον· ἀπορίαν γὰρ πολλὴν ἔχει τὰ πλεῖστα, οἷον, διὰ τί μὲν φεύγουσιν ὡς δεινὰ, μὴ ὄντα δεινὰ, τὰ δὲ διώκουσιν ὡς χρηστὰ, μὴ ὄντα χρηστά· καὶ διὰ τί ὁ μὲν τοὺς οἰκείους φοβεῖται, ὁ δὲ ὅλους τοὺς ἀνθρώπους, καὶ τὰ τοιαῦτα. (D.354) It is impossible to enumerate the causes of all the symptoms accompanying each individual case. One is at a complete loss for the most part - such as, why some flee as terrifying things which are not, and others pursue as goods things which are not, and why one fears his relatives, and another fears all human beings and such like. Some symptoms, however, are more readily understood by the physician and these are described by Rufus. Three cases in particular exhibit symptoms which allow Rufus to demonstrate the aetiological factors he believes underlie melancholy. In the first, the melancholic thinks that he is a terra cotta pot or tile (κεράμον); the second think his own skin is like parchment (ταῖς ξηραῖς διφθέραις ὅμοιον). These symptoms, says Rufus, are caused by the dryness of the melancholy humor.712 A third patient thinks that he has no head - the result, we are told, of the lightness of the pneuma rising up to the head. We also learn from the question and answer format which follows, that some melancholics have a large appetite, drink a lot of wine, have continual indigestion, and often want to kill themselves. The answer to why the latter is that no doubt they suppose death will deliver them from greater evils - or else they believe “as some barbarians believe” that to die is a good thing.713 It is noteworthy that here Rufus assumes a rational motive (albeit perhaps a mistaken one) to underlie the suicidal tendencies of melancholics.

710 MT121 Galen, Atr. Bil. 1.2, τῶν δὲ νεωτέρων ἰατρῶν ἄριστα γέγραπται περὶ μελαγχολίας τῷ Ἐφεσῴ Ῥούφῳ. καὶ τις εὐλόγως ἂν φαίη μηδὲν ἐνδεῖν τοῖς κατὰ φύσιν ἀκούουσιν, οὐκ ἐριστικῶς ἀντιλέγειν προῃρημένοις. 711 The best discussion of sources for Rufus is Flashar 1966, 84-91. 712 Rufus, Oeuvres, 355. 713 MT123 Rufus Oeuvres, 355, Διὰ τί ἀποκτιννύουσι σφὰς αὐτούς; ἢ ὅτι μειζόνων κακῶν ὑπολαμβάνουσιν ἀπαλλάτεσθαι, εἰ μὴ ἄρα δόξα τοιαύτη ὑπογίγνεται αὐτοῖς, ὅτι τὸ ἀποθνήσκειν ἐστὶ καλὸν, ὥσπερ τῶν βαρβάρων ἐνίοις. For a discussion of causes see below, ch. 8.

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Further physical symptoms of melancholics are: a dehydrated abdominal cavity which leads to obstructed elimination, blinking and protruding eyes, thick lips (because of the dense pneuma) and a dark complexion due to the melancholy humor. Most melancholics become hairy and develop speech difficulties - they speak quickly, lisp and stammer because of their inability to control the tongue and this reflects a general and sudden lack of movement involving effort.714 Rufus here speaks of two kinds of melancholy, the first kind is natural and innate; some people from birth have the constitution (κράσις) of melancholics. The second kind is acquired and develops later in life as a result of a bad regimen. This second form is always characterized by sluggishness and dejection (νωθρὸν καὶ κατηφὲς).715 There is, however another aspect to this form of melancholy. (MT124) Ὅτι δὲ ἐξ ὑπεροπτήσεως τῆς ξανθῆς χολῆς τῇ παραφροσύνῃ παραπίπτουσι, θρασύτεροι καὶ ὀργιλώτεροι τῶν ἄλλων εἰσὶ, καὶ πλὴκται, καὶ τὰ πάνδεινα πράττοντες κατὰ τὸν καιρὸν ἐκεῖνον μάλιστα, ἐν ᾡ ὑπεροπτᾶται ἡ χολή. Τῷ χρόνῳ δὲ ὅταν καὶ αὐτὴ καὶ ἀποσβεσθῇ, κατηφεῖς, ἐπίλυποι καὶ ἐπίφοβοι γενόμενοι.716 But when, from an over-heating of the yellow bile, they [melancholics] fall into dementia, they are more audacious and irascible than the others, and they are inclined to strike out and do very terrible things, especially at that time when the bile is being heated. But at the time when it is being extinguished they are despondent, very sad and full of fears. Further discussion of the characteristic symptoms and types of melancholy can be found in the Latin translation of Rufus from the arabic texts of Rhazes (863-923 CE). Here the some of the chief indications of melancholy are fear, hesitation, and false ideas about one thing only - yet in all other respects, says Rufus, the person will be sane.717 Again Rufus stresses the infinite variety of manifestations of the illness: (MT126) Et species opinionum eorum sunt infinitae: quidam enim eorum dubitant de tono, et quidam solaciantur nominare mortem, et quidam delectantur abluere, et quidam fastidiunt

714 Rufus, Oeuvres, 356. 715 Rufus, Oeuvres, 355-356. 716 Rufus, Oeuvres, 357-358; Flashar 1966, 100, “Leider geht aus den Fragmenten nicht eindeutig hervor, ob Rufus als Auswirkungen der Erhitzung manische Erregungsformen und als Ergebnis der Abkühlung depressive Äusserungsformen der Melancholie angenommen hat.” Flashar also notes in this connection the indications of melancholy which a physician is to look for, θρασύτης καὶ ἄκαιρος λύπη (Rufus, Quaest. Med. Gärtner ed., p. 2 l.12). On the manic-depressive question see now Rothkopf 1974 and Jackson 1986, 249-254. 717 MT125 Rufus, Oeuvres, 455, Et signa eius principii sunt timor, dubitatio, cogitatio falsa in una re sola, et in omnibus aliis dispositionibus suis erit sanus.

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aliquem cibum aut potum , aut odiunt aliquod genus animalium; et quidam credunt transglutire viperas et ei similia. And the kinds of ideas they have are infinitely varied: some of them are hesitant about thunder, some of them are comforted by choosing death, and some delight in washing, some loathe any kind of food or drink, or detest some species of animal, and some believe that they have swallowed snakes or similar things. (D.455) Some general indications of melancholy are easily recognizable and if they are taken in conjunction with certain physical signs, the diagnosis is firm and secure.718. First of all, as to temperament, melancholics are quickly angered, made joyful or saddened, and they prefer to remain solitary and flee from people. In fact one of the first signs of melancholy is the desire to remain in solitary places and to avoid people for no discernible reason.719 Physical signs which accompany these characteristics are: (MT128) ... non possunt aperire oculos, sicut illi qui patiuntur corruptionem in eorum palpebris, et habent eorum angulos strictos; et alba oculorum eminent praeter solitum; et labia apparent grossa, coloris rubei et bruni corporis; toraces eorum sunt magni, et omnia quae sunt sub toraces versus ventrum apparent extenuata; et sunt fortis et velocis motus, et nulla in eis reperitur patientia; et non possunt formare 's', sed loco eius ponunt 't'; habent subtilem vocem et lingua eorum velox ad loquendum, et in eorum vomitu et secessu apparet chimus niger, sed secundum plures videtur flegmaticus. (p.456) ... they are unable to open their eyes, as though suffering from a disease of the eyelids, and the corners of their eyes are constricted and the whites of the eyes protrude. The lips appear swollen and red and the body brown; their chests are enlarged and everything between the chest and the stomach appears distended. They make strong, swift motions and they have no patience. They are unable to form the letter 's' and instead say 't'; they have a thin voice and their tongue is swift at speaking and in their vomitus and faeces appear black flecks (?) and phlegm appears following many evacuations. Other general observations on melancholics are scattered throughout the treatise; some, for example are notable because of their desire for coitus - a symptom indicative of melancholy ‘windiness’.(D.457) Others talk or sleep

718Rufus, Oeuvres, 456. 719 MT127 Rufus, Oeuvres, 456, Et signa quae apparent in principio melancoliae sunt quod morantur melancolici libenter in locis solitariis et fugiunt homines sine causa aliqua, sicut accidit sanis quando volunt inquirere de aliqua re, vel caute tenere ea quae debent esse cauta.

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more than usual and foretell the future - and the things which they predict come true.720 This observation is notable because here Rufus does not present the prophetic gift as one of the delusional attributes of the disease, but rather as a positive quality of the melancholic.721 In a similar vein he describes one category of those prone to fall into melancholy as individuals who have a subtle intelligence and a great deal of perspicacity ... because of which they are swift in their movements and have many precognitions and imaginings.722 In general melancholy strikes men more often than women, but when women are afflicted the disease is worse because they imagine worse things and their confinement is more difficult.723 Adolescents do not suffer from melancholy, but sometime infants and young boys do. The disease is endemic in the elderly and feeble- in fact melancholy is a necessary and inseparable accompaniment to that condition. (MT132) Et non accidit adolescentibus, sed aliquando accidit infantibus et pueris et senibus et decrepitis; multiplicatur in tantum quod non posset narrari, et maxime decrepitis, eo quod melancolia est eis accidens necessarium et inseparabile: et sunt etiam decrepitis paucorum gaudiorum, malae ordinationis et opinionis, et patiuntur multas ventris inflationes. Et haec sunt accidentia melancoliae. In general Rufus emphasizes the need to treat melancholy speedily when it is first detected, for delay fortifies the symptoms and makes the patient less amenable to treatment.(D 455) Melancholy is a potentially fatal disease. In particular if, on top of other signs of melancholy, a patient develops hot and painful abscesses on the chest or any other surface of the body, and a tendency to redness and itching, such symptoms announce imminent death. (D 455) Detection is not, Rufus admits, always an easy matter ( as we might expect in a disease with such an array of symptoms). (MT133) Et quando accidit melancolia, possibile est quod eius notitia occultatur medico in principio; sed peritus medicus et subtilis indagationis poterit eam congnoscere in initio per malitiam animae, per paucam eorum abstinentiam, membrorum ariditatem et propter tristitiam quae accidit eis occasione principii melancoliae aut ex casusa alia accidenti in hominibus. (456)

720 MT129 Rufus Oeuvres, 456, Et contingit quod quidam istorum narrant et somniant praeter solitum, et pronosticantur future, et eveniunt ea quae ipsi praedicunt.; cf. 457. 721 See Jackson 1986, 36 and Flashar 1966,97, who discusses the possible connection here with the [Ps.] Aristotelian treatise on melancholy and the division of melancholy (not apparent in other physicians in antiquity) into positive or healthy and negative or unhealthy, types. See discussion below ch. 8. 722 MT130 Rufus, Oeuvres, 457, Et illi qui sunt subtilis ingenii et multae perspicationis de facili incidunt in melancolias,eo quod sunt velocis motus et multae praemeditationis et imaginationis. 723 MT131 Rufus, Oeuvres, 455, ...sed mulieribus erit deterior; et imaginantur peiora et earum angustiae sunt difficiliores.

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And when melancholy occurs, it is possible that awareness of it is hidden from the physician at the beginning; but an experienced physician and a subtle investigative procedure will be able to recognize it at the outset by the malice of mind, by the few abstinences, the dryness of the limbs and because of the sadness which comes upon them when the melancholy first begins or from some other cause which befalls human beings. As we have seen in the fragment from Aetius, Rufus classified melancholy into two types, the innate and the acquired. He is also the first to have classified the disorder in another way - on the basis of the location of the disease. This method yielded a tripartite division of melancholy which was adopted and refined by Galen and which became fundamental to an understanding of the disease for centuries to come.724 The three kinds of melancholy according to this view are, 1) a kind in which the whole body, including the brain, is full of melancholy blood darkened skin is a sign of this type; 2) a kind in which predominantly the head is affected by melancholy blood mental symptoms predominate here; and 3) hypochondriacal melancholy, in which digestive disturbances are primary symptoms.725 It seems that in each of these three types the mind is affected either primarily or secondarily, however, in the extant works of Rufus only this third type of melancholy is treated in detail, although the other two kinds are referred to.726 There are differences in some treatment methods, although the causes for all three types of melancholy appear to have been viewed as the same. F. Galen In contrast to many of the physicians before him, Galen does not presents a coherent and systematic discussion of mental disorders per se. This fact perhaps reflects his method of approaching disease rather than his focus of interest, for scattered throughout his works are many comments describing aberrant mental states along with their aetiology and therapeutics. In fact Galen has been described as “a man of considerable depth of understanding as a medical psychologist” both by the standards of his own day and the present.727 But Galen approached disease not from an analysis of clinical symptoms but from a primarily anatomical or physiological viewpoint; that is he proceeded to examine sequentially the parts or systems of the body and to discuss the ways in which each may be

724 Jackson 1986, 37 and note; Klibansky et al. 1964, 53; Flashar 1966, 92-93. 725 Rufus, Oeuvres, 358-359; 455. 726 Flashar 1966, 92; Jackson 1986,37. There was puzzlement and confusion very early about Rufus's role in establishing the triadic classification in light of the fact that his works deal only with the hypochondriacal form of melancholy.. Rhazes (865-923CE) remarks, “Et Ruffus (sic) non nominavit nisi hanc speciem melancoliae, et miror qualiter. Galenus non dixit quod Ruffus non narravit nisi hanc speciem pelancoliae.” (457) 727 Jackson 1969, 365; on Galen's apparent lack of interest in mental disorders see Flashar 1966, 105 and Heiberg 1927, 31, “Im Gegensatz zu den Pneumatikern und Methodikern scheint Galenos sich nicht sonderlich für Geisteskrankheit interessiert zu haben; in seiner ganzen weitlaüfigen Produktion findet sich keine zusammenhängende und systematische Darstellung davon, und die zerstreuten Bemerkungen, die er hier und da hat, enthalten fast nichts Neues.”

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influenced and affected so as to result in a functional disturbance.728 Any part of the body, including the brain, might be the locus of a disorder primarily or secondarily, that is by sympathy.with a primary disease elsewhere - as in the epigastric kind of melancholy for example.729 Galen approached mental disorders in exactly the same way that he approached any other disease, that is by locating the organ or system responsible and analyzing what dyscrasia: or imbalance of the qualities or humors was involved. “I always searched in which [primarily] affected part or in which part involved by sympathy the activity was damaged. When I was convinced that I had found the [affected] part, I further looked for its constitution (diathesis).“730 Disturbances of the mind, for example, are primarily, although not exclusively, discussed in Book III of his work On the Affected Parts, under functions and diseases of the brain and spinal cord. His discussion here of symptoms and cases is fairly detailed and provides much of the substance of the following summary.731 But comments and observations about specific cases are embedded in other works; some very interesting cases are discussed for example in his treatise On differential diagnosis of symptoms and another in his work De motu musculorum. Some disorders, and mental disorders in particular, presented a special challenge to Galen's approach because there were no visible physical signs to indicate clearly the “affected part”. (MT134) ἔνθα δὲ ἀπόλωλεν ἡ μνήμν, σημεῖον οὐδέν ἐστι τόπου πεπονθότος, οὐκ ὄγκος παρὰ φύσιν, οὐκ ὀδύνη τις, οὐκ ἔκκρισις, ούκ ἄλλο οὐδέν· ὥσπέρ γε καὶ ἐπὶ μελαγχολίας καὶ φρενίτιδος καὶ μανίας, ἐπιληψίας τε καὶ ληθάργου καὶ κάρου καὶ τῆς ὀνομαζομένης ὑπὸ τῶν νεωτέρνω ἰατρῶν κατοχῆς τε καὶ καταλήψεως· ἀλλ᾽ οὐδὲ τῶν ὅλου τοῦ σώματος σπασμῶν, ἢ παλμῶν, ἢ τῆς ἐξ ἡμίσεος αὐτοῦ μέρους παραλύσεως, ἡ οἷον ῥῖζα προβάλλει τι σημεῖον, οὔτε δι᾽ ὄγκου παρὰ φύσιν, οὔτε δι᾽ ὀδύνης, οὔτε διὰ χρώματος ἐξηλλαγμένου παρὰ τὸ πρόσθεν, ἢ διά τινος τῶν ἐκκρινομένων· ...

728 Flashar 1966, 107-108, remarks that this anatomical line of approach (... an zu zeigen, durch welche Einflüsse und auf welche Weise bestimmte Körperstellen affiziert werden) leads Galen to neglect much that was present in earlier writers on mental diseases, particularly any kind of psychotherapy. Recent discussion of Galenic psychology and therapeutic technique, however, suggests that, depending upon how psychotherapy is defined, Galen’s approach may be differently evaluated. See especially Ballester 1974 and 1988 in Manuli and Vegetti 1988, 117-152; and cf. Gill 1985 on ancient psychotherapy; although Galen’s works are not discussed Gill’s observations on the medical, religious, and philosophical approaches to psychic illnesses are generally relevant. 729 See Jackson 1969, 372. 730 Gal. Loc. Aff. K 146, S 75. ἐζήτησα γὰρ ἀεὶ, τίνος τόπου πεπονθότος, ἢ τίνος αὐτῷ συμπάσχοντος ἡ τῆς ἐνεργείας ἐγένετο βλάβη, καὶ πείσας ἐμαυτὸν εὑρηκέναι τὸ μόριον, ἐφεξῆς ἐζήτησα τὴν διάθεσιν αὐτοῦ. All subsequent passages cited from this work will be identified by the bracketed pages numbers in the edition by Kühn (=K) and the translation by Siegel (=S). The doctrines of the humors, temperaments, and qualities are briefly discussed with causes below, ch.8. 731 For much of the following discussion I have found Jackson 1969 to be a particularly useful and comprehensive survey of Galen's writings on mental disorders. Heiberg 1927, 31-36 is still helpful in part. For Galen on melancholy specifically see Flashar 1966, 105-117; Jackson 1986, 41-45. Siegel 1973 (esp. 262-278)provides a good overview and analysis of Galen's works on psychology, psychopathology and nervous system function and diseases.

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But when memory is lost, no sign or unnatural swelling, pain, discharge or anything else will indicate the affected part. The same occurs in melancholy, phrenitis, mania, epilepsy, lethargus, stupor (karos) and in a condition which the younger physicians define as katoche and katalepsis; also in cases of convulsion of the entire body, in palpitations, or in paralysis of one half of the body. There is no symptom which points to the source (rhiza, root) [of the illness] by swelling, pain or change of color.... (K156-157, S 79) When the locus of the disorder cannot be identified by physical symptoms of this kind, the only recourse, according to Galen, is to “discover the affected part by its damaged activity”. (K.147, S 75) The affected part in mental disorders was for Galen the brain; this organ was considered to be both the centre for all rational thought and the processor of sensation and movement, consequently disturbances of mental function might take the form of faulty perceptions and sensations or erroneous thought processes - which could include disorders of imagination, intellect and memory.732 Galen held to the traditional categories of mental disorders, primarily those which Jackson has identified as the canonical three of ancient medicine: melancholy, mania, and phrenitis, but his discussion also includes many other conditions in which the mind is primarily affected. In fact on the basis of both locus of affection and humoral aetiology Galen specifically groups together for discussion a number of disorders involving mental dysfunction: apoplexy (or stroke), lethargy, phrenitis, mania, melancholy, μώρωσις (dementia), and loss of memory (K200, S97).733 In many respects Galen brought nothing new to the discussion of mental illness except a clarifying, shaping and sharpening of some of these categories of disease and their aetiologies. As Flashar has noted of Galen's handling of melancholy, “Das Neue besteht lediglich in der Ausgestaltung and Verknüpfung von Lehren, die zuvor unverbunden waren.”734 Yet Galen's schematization of mental disorders according to physiological principals was sophisticated and complex and had an enormous influence on medical classifications for centuries to come. Much attention has recently been directed to questions of Galenic psychology but it is not within the scope of the current study to pursue in any detail his physiological and psychological theories.735 What is particularly useful for our purposes is Galen's propensity to integrate illustrative cases into his wider discussions.

732 Jackson 1969, 371; see pages 366-371 for a concise account of aspects of Galen's physiology and pathology relevant for mental disorders; cf. Siegel 1973, 163; the brain as the seat of reason cf. Gal. Loc. Aff. K 159-169; de Plac. VI,K V, 505-585; see De Lacey comm. ad loc.; de Usu Part. Helmreich, I, 228; (May, p. 229) and for discussion see Siegel 1973, 114-172. 733 Elsewhere he also includes paraphrosyne, epilepsy and catalepsy, Jackson 1969, 371; 1986, 249. 734 Flashar 1966, 107. 735 See Veith 1961; Ballester 1974 and esp. 1988 in Manuli and Vegetti 1988; Pigeaud 1981 and 1988.

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A passage in the work On differential diagnosis of symptoms gives a good idea of Galen's approach to understanding and labelling mental dysfunction, which may be take the form either of loss of function, deficiency in function or distortion of function.736 In addition the passage provides us with descriptions of two very interesting cases.737 (MT135) I want to discuss now the damage to the primary activity of the soul (τής τῶν ἡγεμονικῶν ἐνεργειῶν βλάβας), and first its mechanism of forming sense data (τῆς φανταστικῆς). Its damage is called a form of paralysis (παράλυσις τις) or it is defined as stupor (κάρος), or as seizing (κατάληψις). There is another form, the faulty or disturbed movement (μοχθηρά τις ἢ πλημμελὴς κίνησις) (literally: 'being out of tune') [with our thoughts], which is called παραφροσύνη ('the wandering of the mind', derangement); and this is like a weakening or failing of the brain's function (οἷον ἐλλιπὴς καὶ ἄτονος) as in coma or lethargus (κώμασί τε καὶ ληθάργοις). καὶ μέν γε καὶ αὐτῆς τῆς διανοητικῆς ἐνεργείας ἡ μὲν οἷον παράλυσις, ἄνοια, ἡ δ᾽ οἷον ἐλλιπὴς κίνησις, μωρία τε καὶ μώρωσις, ἡ δ᾽ οἷον πλημμελὴς, παραφροσύνη καλεῖται. τὰ πολλὰ μὲν γὰρ ἐπ᾽ ἀμφοῖν ἅμα συνίσταται τὸ παραφρονεῖν, ἔν τε τῷ μὴ καλῶς φαντασιοῦσθαι κᾀν τῷ μὴ δεόντως λογίζεσθαι, ἔστι δ᾽ ὅτε καὶ κατὰ τὸ ἕτερον αὐτῶν μόνον ... When the thinking faculty (dianotike energeia) itself is paralysed, it is [called] anoia (want of understanding); if its movements are defective we deal with moria (folly) and morosis (dementia). It is also called paraphrosyne when it is out of tune. ... Mostly both [disturbances] exist in mental derangement (paraphronein), when simultaneously both happens: wrong sense data are formed and the reasoning becomes improper. - Sometimes only one of the [functions] is affected ... And he goes on to demonstrate with the two case studies; in the first one the individual is suffering from acoustic hallucinations with no concomitant disturbance of reasoning power: (MT136) ... ὥσπερ γε καὶ Θεοφίλῳ τῷ ἰατρῷ νοσοῦντι τὰ μὲν ἄλλα σωφρόνως ὑπῆρχε διαλέγεσθαί τε καὶ γνωρίζειν ἀκριβῶς τοὺς παρόντας, αὐλητὰς δέ τινας κατειληφέναι τὴν γωνίαν τοῦ οἰκήματος ἐν ᾧ κατέκειτο, καὶ διαπαντὸς αὐλεῖν τε ἅμα καὶ κτυπεῖν ἐνόμιζε καὶ τούτους βλέπειν ᾤετο, τοὺς μὲν ἑστῶτας αὐτόθι, τοὺς δὲ καθημένους, οὕτω διηνεκῶς αὐλοῦντας, ὡς μήτε νύκτωρ ἀνιέναι τι, μήτε δι᾽ ὅλης ἡμέρας ἡσυχάζειν μὴ τὸ σμικρότατον· ἐκεκράγει δὲ διὰ παντὸς, ἐκβληθῆναι κελεύων αὐτοὺς τῆς οἰκίας. καὶ τοῦτ᾽ ἦν αὐτῷ τὸ τῆς παραφροσύνης εἶδος. καὶ ὡς ἐῥῥώσθη γε τελέως καὶ ἀπέφυγε τὸ νόσημα, τά τε ἄλλα πάντα τὰ

736 Jackson 1969. 371. 737 Gal. De sympt. diff. K. 7, 60-62 cf. Loc. Aff. K 226; The translation is Siegel 1973, 163-164.

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ὑπὸ τῶν εἰσιόντων ἑκάστου ῥηθέντα καὶ πραχθέντα διηγεῖτο καὶ τοῦ περὶ τοὺς αὐλητὰς ἐμέμνητο φαντάσματος. ...as in the illness of the physician THEOPHILUS, since he was able to correctly discuss and judge about everything present, but assumed that some flute players had seized the corner of his house which he occupied, and that they continuously played the flute and made crashing sounds and gazed upon him, some standing there, others sitting, and continuously played the flute without interruption during the night, nor was there the slightest quietness during the day; he shouted all over, demanding they be thrown from the house. This was a form of paraphrosyne (derangement). And when he finally recovered and escaped this disease, he described in detail what everybody had said and had done who had entered the house, and he remembered all the appearances ... concerning the flute players. In the second case the person's thought processes are aberrant but the perceptual and sensory aspects of his mind are undisturbed: (MT137) ἐνίοις δὲ φάντασμα μὲν οὐδὲν φαίνεται. λογίζονται δ᾽ οὐκ ὀρθῶς, τοῦ διανοητικοῦ τῆς ψυχῆς αὐτοῖς πεπονθότος· ὥσπερ καὶ τῷ φρενιτικῳ τῷ κλείσαντι μὲν τὰς θύρας ἔνδοθεν, ἕκαστον δὲ τῶν σκευῶν προτείνοντι διὰ τῶν θυρίδων, εἶτα ἐρωτῶντι τοὺς παριόντας, εἰ κελεύοιεν ῥίπτειν. οὗτος γὰρ ἑκάστου μὲν τῶν σκευῶν ἀκριβῶς ἔλεγε τοὔνομα, κᾀν τῷδε δῆλος ἦν οὔτ᾽ ἐν τῇ φαντασίᾳ τῇ περὶ αὐτὰ βεβλαμμένος οὔτ᾽ έν τῇ τῶν ὀνομάτων μνήμῃ. τί δὴ βούλεται αὐτῷ τὸ πάντα ῥίπτειν ἀφ᾽ ὑψηλοῦ καὶ καταγνύναι; τοῦτ᾽ οὐκέθ᾽ οἷος τ᾽ ἦν συμβαλεῖν, ἀλλ᾽ ἐν αὐτῷ δὴ τῷ ἔργῳ τῷδε κατάδηλος ἐγίνετο παραπαίων. However, to some people [such] appearances do not occur, but they are unable to reason correctly, since the reasoning power of their soul is affected. Take for example, the patient who, when suffering from phrenitis, closed all doors from the inside and presented all his household utensils at the window, asking each one passing by to command him to throw it down. But he identified each of the things by its right name and thus was evidently not deranged in recognizing (phantasia) each of these things nor in recalling its name. Why did he therefore want to throw it all down and break it? He was unable himself to understand it, but manifestly he demonstrated his disturbance by his acts.' In another similarly embedded case, here in a discussion of consciousness, memory and muscle movements, Galen describes a person who was παραπαίοντες and suffering from παρανοία.738

738 Gal. De mot. musc. 4.446-447. I owe this reference to Dr. Philip De Lacey. The translation is mine.

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(MT138) Indeed moreover, deranged people (οὁ παραπαίοντες) both talk and walk and make all their movements by impulse (καθ᾽ ὁρμὴν): but when their madness (παρανοίας) has ceased they no longer remember what they did. I knew a certain madman (τινα παραπαίσαντα) who was this way for thirteen days. He thought that he was lying sick in Athens, not in Rome. And repeatedly, calling for his usual slave, he would order him to bring him his equipment for the gymnasium, and after a little while - “You there” he would say, “I mean to the Ptolemaion; for I want to bathe there after a while.” And indeed in the meantime he would jump up and, wrapping his cloak around him, would go straight out of the door of the courtyard. And when the people inside would get hold of him and prevent him from going out, “Why,” he would enquire of them “are you preventing me?” And they (for they weren't able to say anything but the truth itself) would say that he had suffered from a fever and was still feverish. He for his part would respond to this quite regularly. He would say that he himself knew that he still had a trace of fever left, but that this was an extremely small trace and there was no suspicion that he would be harmed by a bath: for the whole present fever had come upon him as a result of travelling. “Or don't you remember”, he would say, turning his attention to the slave, “how strenuously we journeyed yesterday from Megara to Athens?” While he was saying and doing such things a copious hemorrhage through the nose occurred to him, and along with it a sweat - he became sane at once (ὑγίαινε μὲν αὐτίκα μάλα) and remembered nothing of the former events. Galen's use of such terms as παραφροσύνη, παραπαίοντες, and παράνοια seems at time to be relatively unspecific; he did, however, recognize certain mental syndromes and make some consistent distinctions.

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I. Phrenitis Galen distinguished phrenitis from mania in much the same way as Caelius and other writers, by the presence of fever.739 He also, more clearly than most other physicians, distinguished the delirium of phrenitis from fever delirium - phrenitis is centred in the brain and meninges whereas the delirium of fever arises from a condition centred elsewhere, is sudden and short-lived: (MT140) ὅσαι δ᾽ ἐν ταῖς ἀκμαῖς τῶν πυρετῶν γίγνονται παραφροσύναι, κατὰ συμπάθειαν αὗται πάσχοντα τὸν ἐγκέφαλον, οὐ κατ᾽ ἰδιοπάθεισαν ἔχουσιν· καὶ διὰ τοῦτο παραπαῖσαι μὲν καὶ παραφρονῆσαι καὶ παρακόψαι τούτους οὐ μόνον οἱ ἰατροὶ λέγουσιν, ἀλλὰ καὶ ἰδιῶται, φρενιτικοὺς δ᾽ οὐκ ὀνομάζουσιν, οὐ γὰρ συναποκαθίστανται ταῖς ἀκμαῖς τῶν πυρετῶν αἱ φρενιτικαὶ παραφροσύναι. When delirium arises at the peak of a fever, the brain is affected by sympathy. But this does not constitute a specific disease [of the brain, idiopatheia ]; consequently [the patients] lose their wits [literally: strike a false note], are delirious and deranged [frenzied] as confirmed not only by physicians but even lay people. But we do not call these patients phrenetics (phrenetikous), because the delirium of phrenitis (phrenetikai paraphrosynai) does not subside completely at the height of the fever.740 And again: οὐ γὰρ ἐπὶ συμπαθείᾳ κατ᾽ ἐκείνην τὴν νόσον ὁ ἐγκέφαλος πάσχει, ἀλλὰ κατ᾽ ἰδιοπάθειάν τε καὶ πρωτοπάθειαν κάμνει ... ...the brain is not involved by sympathy during this disease [phrenitis ] but by idiopatheia [intrinsic disease] or protopatheia [primary seat of disease]. (K329, S 148) Phrenitis develops gradually - there is no sudden derangement as there is in burning fevers centred in other organs. Symptoms which precede phrenitis include sleeplessness or sleep disturbed by “vivid hallucinations (phantasmata) which cause the patient to shriek and jump up.” (K 330, S 148) At times there is irrational forgetfulness, “ when, for

739 MT139 Gal. De sympt. caus. 7.202; In Hipp. prorrh. i 16.493-494, μαίνεσθαι μὲν γὰρ ὀνομάζουσιν ἅπαντες ἄνθρωποι τοὺς ἄνευ πυρετοῦ παραφρονοῦντας, φρενιτίζειν δὲ τοὺς ἐν πυρετῷ. τὸ δ᾽ ἐν ἀκμῇ σφοδροῦ πυρετοῦ [παραφρονῆσαι] παρακόψαι τε καὶ παραχθῆναι καὶ παραληρῆσαι καὶ αὐτὸ δὴ τοῦτο παραφρονῆσαι καλοῦσιν. φρινῖτιν δ᾽ οὐκ ὀνομάζουσιν ἄνευ τοῦ πυρετοῦ. 740 Gal. Loc. Aff. K 178, Trans. Siegel, 88. Siegel notes (with some frustration) that paraphrosyne occurs occasionally in fever, like phrenitis, and fever is a necessary condition of phrenitis. Paraphrosyne, however, can occur independently of fever - it is a symptom (perhaps best translated as delirium) “attributable to numerous causes, even drugs, whereas phrenitis appears as a more sharply defined clinical entity”. (p. 210 n.37).

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instance, the patients ask for the urinal but do not pass their water, or forget to surrender the urinal after having voided; or they give noisy and upsetting answers, particularly though they had previously been well-behaved.” The patients drink little, their respiration is deep and fast, their pulse small and tense and have pains in their neck muscles (K 330, S 148-149). As the attack of phrenitis takes hold their eyes feel dry, red, and bleary; blood oozes from their nostrils and when they are no longer perfectly sensible they pick at little pieces of wool or straw. Some have acoustic illusions, they lie in bed with a sad expression on their faces and answer little; parts of their body may be painful or else have no feeling at all even if someone touches the affected area with full force (K330 S 149). Galen, having distinguished between fever delirium and phrenitis, then added a second kind of phrenitis for consideration, one “in which the diaphragm was primarily affected and the brain only secondarily. In this condition the delirium was almost continuous, but the eye and nose symptoms were lacking, and the respiration was more like that of fever delirium.”741 Elsewhere Galen speaks of three types of phrenitis based on symptomatology: two simple kinds and a third which combined the two: “Some people with phrenitis make no mistake at all in the distinction of visual impressions but base their judgment on an abnormal thought process. Others, on the contrary, do not commit any error of judgement but have a distorted sense perception. Still others happen to be affected in both ways.” (K225, S107-108) He gives examples, one of which resembles in part the case of the man with the utensils described above. (MT141) A man who was confined to his house in Rome in the company of a young wool-worker rose up from his bed and went to the window, where he could be seen and also could watch the people passing by. He then showed to them each of his glass vessels and demanded that they should ask him to throw them down. The people laughed, clapped their hands and demanded him to do so. Then the man grasped one vessel after another and threw it down. The people laughed and screamed. Later he also asked whether they wanted him to throw down the wool-worker. And when they told him to do so, he complied. When the people saw the man fall from high up, they stopped laughing, ran to the fallen man, who was crushed, and lifted him up. (MT142) The opposite condition occurred not only to other persons but to myself, when I was still a young man. Stricken by a burning fever during summer (πυφρέττων γὰρ ἐν θέριε πυρετῷ διακαεῖ›), I thought that little sticks of dark straw were protruding from my mattress, as well as pieces of wool from my gown. I attempted to pull these out. When I was unable to catch onto anything with my fingers I renewed these efforts more steadily and forcefully. When I heard two friends who were present telling each other, 'He is pulling wool and straw' (οὗτος ἢδη κροκυδίζει τε καὶ καρφολογεῖ), I understood that I had the affection of which they spoke, but I realized that I was not deranged in my reasoning faculties (ἀκριβῶς δὲ παρακολουθῶν ἐμαυτῷ μὴ παραπαίοντι

741 Jackson 1969, 373; Gal Loc. Aff. , K331-332, S 149.

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κατὰ τὴν λογιστικὴν δύναμιν) and said: 'What you say is right, but help me that I should not suffer from phrenitis (μὴ φρενιτίσω) [i.e. should not be delirious because of the fever].' Then they busied themselves applying wet dressings to my head. Throughout the entire day and night I remained agitated by frightening dreams, shrieking very loudly and even trying to get out of bed, but on the next day all symptoms subsided. (K226-227, S 108) II. Mania In contrast to phrenitis and melancholy, mania is given only brief and superficial mention in Galen's works. He considered it to be a chronic and primary disorder of the brain, differentiated from phrenitis by the absence of fever.742 One indication of mania, according to Galen, was that the vein in the elbow of one who was mad throbbed; in one who was delirious it was still.743 Disturbances of reasoning power and hallucinations were the principle manifestations of mania.744 It has been noted repeatedly that by Galen's time the term mania (and indeed melancholia) comprised a multitude of abnormal mental states - in fact it has been called “the terminological wastebasket” for a number of mental diseases.745 Galen himself seems to have used much more frequently the equally flexible general term παραφροσύνη to describe a wide variety of deranged states primarily without fever.746 III. Melancholy Much of Galen’s thinking on melancholy develops from the work of Rufus of Ephesus which, as we have seen, he praised highly.747 Galen’s own writings on melancholy have been called complex and - at times- even inconsistent.748 As the pseudo-Galenic treatise On Medical Definitions explains, melancholy was a chronic condition, without fever, in which the mental symptoms were the secondary result of some humoral disorder; an excess of black bile, as the term suggests, was at the root of all melancholic conditions.749 Galen himself rarely

742 Jackson 1969, 376; Gal. In Hipp. Prorrh. i, 16.493; Siegel 1973, 273 states that mania was seen by Galen to be either a primary or a sympathetic affection of the brain, or that it occurred secondary to another ailment. 743 Gal. Quod an. mor. corp. temp. sequ. 4.803-804 cf. Hipp. Epid. 2.5.16. 744 Siegel 1973, 273. 745 Siegel 1973, 273-274. 746 See Siegel 1973, 264-265 on delirium without fever (paraphrosyne). Contra Siegel, Galen expressly describes phrenetic and fever delirium as paraphrosyne.(Loc. Aff. K 178, S. 88). 747 Jackson 1969, 374; 1986, 35-36; Flashar 1966, 84. Siegel 1973, 190-191 748 Jackson 1969, 374; Galen discusses melancholy principally at Loc. Aff. 3.10 (K180-193); also in the small treatise, de Atra Bile; and de Temp.. 749 Ps. Gal. Def. Med. K19, 416, no.247, Μελαγχολία ἐστι πάθος βλάπτον τὴν γνώμην μετὰ δυσθυμίας ἰσχυρᾶς καὶ ἀποστροφῆς τῶν φιλτάτων γιγνόμενον ἄνευ τοῦ πυρετοῦ. τισὶ δὲ αὐτῶν καὶ χολὴ προσγινομένη πολλὴ μέλαινα βλάπτει στόμαχον, ὥστε καὶ ἀπεμεῖσθαι καὶ οὕτως τὴν γνώμην συγκακοῦσθαι. “Melancholy is an affection which damages the judgement, causes a grave disturbance of the mood and an estrangement from those

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used the term melancholy or melancholia as a noun, preferring rather to describe people as suffering from black bile (melancholesantes; melancholousin) or a symptom as due to black bile (melancholicon).750 A distinction was made between a group of so-called ‘melancholic diseases’, which included purely physical conditions such as dropsy or elephantiasis, and melancholy proper (K 181, S 89). Melancholy proper, or melancholia, was divided into three kinds along the lines suggested by Rufus: “cases in which the entire mass of blood was affected, cases in which only the brain was affected, and cases of melancholia hypochondriaca.”751 In the second type the brain was affected primarily; in the other two only secondarily by virtue of the humor primarily affecting other areas, the blood or the region of the hypochondria. These three categories can, however, be interpreted as three intensifying phases of the one disorder.752 Galen agreed with Hippocrates that melancholy was in some ways akin to epilepsy and in fact could become epilepsy if the black bile carried by the blood accumulated in the ventricles of the brain and caused a blockage.753 People who are prone to melancholy are those who are “lean ... with a darker complexion, much hair, and large veins”, also those with a very red complexion or even those with a fair complexion under certain conditions of stress.754 The epigastric type of melancholy is said to most frequently befall young people and quite suddenly (K186, S 91). The indications of melancholia are primarily fear and despondency. Galen cites with approval the Hippocratic aphorism (6.23), “Fear or a depressive mood (dysthumia) which last for a long time render [patients] melancholic.” (K188, S 92) In addition there are a wide variety of other symptoms. (MT143) ἀεὶ μὲν οὖν οἱ φόβοι συνεδρεύουσι τοῖς μελαγχολικοῖς, οὐκ ἀεὶ δὲ ταὐτὸν εἶδος τῶν παρὰ φύσιν αὐτοῖς γίγνεται φαντασιῶν, εἴ γε ὁ μέν τις ὀστρακοῦς ᾤετο γεγονέναι, καὶ διὰ τοῦτ᾽ ἐξίστατο τοῖς ἀπαντῶσιν, ὅπως μὴ συντριβείη· θεώμενος δέ τις ἄλλος ἀλεκτρυόνας ᾄδοντας, ὥσπερ ἐκεῖνοι τὰς πτέρυγας προσέκρουον πρὸ ᾠδῆς, οὕτω καὶ αὐτὸς τοῦς βραχίονας προσκρούων ταῖς πλευραῖς ἐμιμεῖτο τὴν φωνὴν τῶν ζώων. φόβος δ᾽ ἦν ἄλλῳ, μή πως ὁ βαστάζων τὸν κόσμον Ἄτλας ἀποσείσηται κεκμηκὼς αὐτὸν, οὕτως τε καὶ αὐτὸς συντριβείη καὶ ἡμᾶς αὐτῷ συναπολέσειεν· ἄλλα τε μυρία τοιαῦτα φαντασιοῦνται.

most closely associated. There is no fever. Those patients who have an abundant production of black bile suffer from stomach disease which causes emesis, and their mind becomes clouded.” 750 Siegel 1968, 300-301. 751 Jackson 1969, 374. 752 Gal. Loc. Aff. K192-193, S 93-94; for discussion see Flashar 1966, 105-107. 753 Gal. Loc. Aff. K177, S 88; K180-181, S 89; cf. Siegel 1968,304-3306 on Galen’s linkage of melancholy, epilepsy and apoplexy; also Jackson 1973, 374. 754 Gal. Loc. Aff. K182-183, S 90; discussion of somatic types, predispositions and precipitating causes is postponed to ch. 8.

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Fear generally befalls the melancholic patients, but the same type of abnormal sensory images (phantasion) do not always present themselves. As for instance, one patient believes that he has been turned into a kind of snail and therefore runs away from everyone he meets lest [its shell] should get crushed; or when another patient sees some crowing cocks flapping their wings to their song, he beats his own arms against his ribs and imitates the voice of the animals. Again, another patient is afraid that Atlas who supports the world will become tired and throw it away and he and all of us will be crushed and pushed together. And there are a thousand other imaginary ideas.755 However, while individual cases may present a wide array of symptoms such as the above, Galen reiterates that there are two qualities central to the melancholic condition: (MT144) διαφέρονται δὲ ἀλλήλων οἱ μελαγχολικοὶ, τὸ μὲν φοβεῖσθαι καὶ δυσθυμεῖν καὶ μέμφεσθαι τῇ ζωῇ καὶ μισεῖν τοὺς ἀνθρώπους οὐ πάντες, ἀλλ᾽ ἔστιν ἐνίοις αὐτῶν αὐτὸ δὴ τοῦτο κεφάλαιον τῆς μελαγχολίας, τὸ περὶ τοῦ θανάτου δέος· ἔνιοι δὲ ἀλλόκοτοί σοι δόξουσιν, ἅμα τε καὶ δεδιέναι τὸν θάνατον καὶ θανατᾷν. Although each melancholic patient acts quite differently than the others, all of them exhibit fear or despondency. They find fault with life and hate people; but not all want to die. For some the fear of death is of principal concern during melancholy. Others again will appear to you quite bizarre because they dread death and desire to die at the same time. ὥστε ὀρθῶς ἔοικεν ὁ Ἱπποκράτης εἰς δύο ταῦτα ἀναγαγεῖν τὰ συμπτώματα αὐτῶν πάντα, φόβον, καὶ δυσθυμίαν· ἐπί γέ τοι τῇ τοιαύτῃ δυσθυμίᾳ μισοῦσιν πάντας, οὓς ἂν βλέπωσιν, καὶ σκυθρωποὶ διὰ παντός είσι, δειμαίνοντες, ὥσπερ ἐν σκότῳ βαθεῖ τά τε παιδία ἔξωθεν σκότος εἰς φόβον ἄγει σχεδὸν ἅπαντας ἀνθρώπους, πλὴν τῶν ἤτοι πάνυ φύσει τολμηρῶ, ἢ πεπαιδευμένων, οὕτως καὶ τῆς μελαίνης χολῆς τὸ χρῶμα παραπλησίως σκότῳ τὸν φρονοῦντα τόπον ἐπισκιάζον ἐργάζεται τοῦς φόβους. Therefore, it seems correct that Hippocrates classified all their symptoms into two groups: fear and despondency. Because of this despondency patients hate everyone whom they see, are constantly sullen and appear terrified, like children or uneducated adults in deepest darkness. As external darkness renders almost all persons fearful, with the exception of a few naturally

755 Gal. Loc Aff. K190, S93 cf. a similar description at Sympt. Caus. K 7, 202-204, αἱ δὲ μελαγχολικαὶ παράνοισι πολυειδεῖς μέν εἰσι ταῖς κατὰ μέρος ὑπούλοις φαντασίαις ... . See Siegel 1973, 196, “In this context he characterized the melancholic people as taciturn and sluggish, although in many instances these people seemed to be endowed with an unusual mental ability.[K 17A, 213] Many exhibited increased sexual desire. [K 17b, 29-30]”.

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audacious ones or those who were specially trained, thus the color of the black humor induces fear when its darkness throws a shadow over the area of thought. (K190-191, S 93) Galen also speaks of a kind of melancholy which he characterizes as “the bestial (θηριώδης) and melancholic delirium (μελαγχολιὴ παραφροσύνη) due to overheated dark-yellow bile.” (K178, S 88) Evidently for Galen as for others, a very wide range of states indeed could fall under the category of melancholy, and it has been rightly stressed by many commentators that “the ancient diagnosis of melancholy has no correct analogue in modern psychiatric classifications”.756 Such an observation holds true for the majority of the mental disorders in antiquity, but particularly for phrenitis, mania and melancholy. IV. Loss of Memory, Dementia, Morosis Memory loss occurs, according to Galen, often in conjunction with loss of reason, just as damage to the power of reason often results too in damage to the power of memory.757 If both powers are lost together the resulting condition is called μώρωσις or dementia.758 Because of this it was considered particularly important to watch closely the sleep of those who had lost their memory or their intelligence for indications of abnormal somnolence which could lead to dementia (K 165, S 82). In addition to dementia, the conditions of lethargy and of carus ( a coma-like sleep).also involve loss of memory and reason together. In fact Galen sometimes spoke of loss of memory and lethargy as equivalent conditions.759 In general loss of memory was thought to occur as the result of “emotion, deep thought, inebriation and phrenitis, in fear and in severe affections of the mind (psyche).”760 It is listed by Galen among those diseases which show no visible physical symptoms and which are discernible only by examination of loss of function. Galen speaks of being called upon to restore the memories of several individuals and initially having to invent his own method of treatment (K147-155, S 75-78). He also seems to have averted memory loss by timely intervention on two occasions. 756 Siegel 1973, 274; S., citing Diethelm, suggests that, for example, schizophrenic illness fell under mania or melancholy in antiquity while its catatonic form fell under a separate entity called catalepsy. Jackson 1969, 374, suggests the attempt to explain both the depressed and the “bestial raving” symptoms of the one disease, melancholy, by different actions of the atrabilious humor may indicate “an inclination among the ancients to seek connected, and yet separate, explanations for their equivalents of modern depression and mania”. 757 Gal. de Sympt. diff. 7.62, “The same occurs in regard to the symptoms of the soul's memorizing faculty (περὶ τὸ μνημονευτικὸν τῆς ψυχῆς γίνεται συμπτώματα) in those people who are sick or already recovered, as we can learn from THUCYDIDES, [who wrote] that some of those who were saved from the great plague ... had forgotten everything until that time, so that they were not only unable to recognize their next of kin but even themselves.” (Trans. Siegel) 758 Gal. Loc Aff., K 161; Trans. Siegel 1976, 81. 759 Jackson 1969, 376, citing Gal. On Medical Experience, Trans. Walzer, 90, 137, 148-149. 760 Gal. De motu musc. K 4, 445.

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(MT145) ἐγὼ γοῦν οἶδά τινα καὶ τὴν μνήμην μὲν ὀλίγου δεῖν ἀπολέσαντα, καὶ τὸν λογισμὸν δὲ βλαβέντα, διὰ φιλοπονίαν τε καὶ ἀγρυπνίαν ἐπὶ μαθήμασιν· ἕτερον δ᾽ ἀμπελουργὸν, ἐπὶ τοῖς κατὰ τὴν ἀμπελουργίαν πόνοις, καὶ διαίτῃ λεπτῇ, ταὐτὰ τούτῳ παθόντα. I knew a person whose memory was nearly lost and whose reasoning power was damaged by overwork and lack of sleep during his studies. ... Another person, a vinedresser, was also affected in the same manner as the former patient because of a meager diet during his labors in the vineyards. (K 165-166, S 83) Dementia (Morosis ) or foolishness (moria) were conditions in which understanding (and with it memory).was severely impaired through some kind of failure of reasoning power. A state of complete mental deficiency was anoia - which Galen thought of as a paralysis of the thinking faculties.761 This condition could occur in senility as a result of “abnormal cooling of the brain”, or it could result from the harmful humoral influences on the brain in severe cases of phrenitis, lethargy or melancholy.762 As did other medical writers, Galen seems to have considered mental retardation (morosis) to have been at times either the result of or an accompaniment to epilepsy.763 V. Epilepsy Epilepsy was categorized by Galen, much as the melancholic diseases were, into three types base on the area primarily affected. Indeed Galen seems to have believed, in keeping with Hippocrates, that under certain conditions epileptics could become melancholics or melancholics epileptics (K180, S 89). All forms of epilepsy “have in common an affection of the brain” but in some - the most common forms - the disease originates in the head. In others the head is only secondarily affected in sympathy by the disease as it rises from the opening of the stomach (K193, S94). A third and rarer type “develops when the affection happens to start in some part [of the body] and then ascends to the head in a manner perceptible to the patient.”764 The latter kind, which in modern medicine is termed ‘Jacksonian epilepsy’, is elucidated by Galen in the form of a case history.

761 Gal. De sympt. diff. K7, 60; see Siegel 1973, 274-275 on dementia. 762 Siegel 1973, 275, citing K. 16, 696. 763 Gal. Loc. Aff. K194, S, 95 (by implication); see below MT147. Siegel 1973, 275, also notes that Galen mentions a category of garrulous and idiotic patients with large protuberant ears (K4, 797) and suggests these patients exhibit the same signs as those noted by Hippocrates, (Reg. L6, 466ff). S. suggests these are cases of “hypothyroidism with mental dullness”. 764 K194, S 94; for a succinct medical analysis of Galen’s diagnoses and theory of epilepsy see Siegel 1968, 308315.

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(MT146) In my younger years I first observed this [illness] in a lad who was 13 years old. I met with the best physicians of our country during a consultation about the treatment of this case. I heard the boy telling how his condition started at the shin bone, then went quickly up through the thigh and flank of the same side to the ribs and finally to the neck and head. After it had arrived there he could not observe it further. When one of the physicians asked him about the nature of this transfer to the head, the child could not give a reply. (MT147) However, another youth who was not mentally retarded had formed a satisfactory impression of the events and was more able to put it into words (ἀλλ᾽ ἕτερός γέ τις ἐκείνου νεανίσκος, οὐκ ἄφρων, ἀλλ᾽ ἱκανῶς αἰσθάνεσθαι τοῦ γιγνομένου δυνάμενος, ἑρμηνεῦσαί θ᾽ ἑτέρου δυνατώτερος). He stated that it felt as if a cool breeze (aÎran tinå cuxrãn) of air rose [to his head]. My teacher Pelops believed that we are dealing here with one of two possibilities: either some quality is transmitted through adjoining organs which had suffered a metabolic change, or it is a vaporous substance (πνευματική τις ούσία). He said that it was not astonishing that a counternatural humor (παρὰ φύσιν χυμόν) which was produced in the affected part exerted a strong effect similar to the venoms of poisonous animals. (K194-195, S 94-95) The second kind of epilepsy, the type which has its origin at the opening of the stomach, has also its characteristic symptoms which Galen identifies and explains: (MT148) ...when I occasionally saw that a patient fell to the floor (κατάπτωσιν) without seizure (χωρὶς σπασμῶν σφοδρῶν) ... because of a similar sympathetic [affection] and that he had clonic movements with short intermissions (ἐν βραχείαις κατὰ διaλείμματα παλμώδεσι κινήσεσι), [the evidence] seemed to me sufficient that this was similar to the hiccups which one sees originating in the stomach at very frequent intervals. Sometimes, I instantly get hiccups when I indulge in eating too much pepper. This also happens to quite a few other persons who have a sufficiently sensitive opening of the stomach. ... I also observed that those epileptics who suffer from falling sickness by sympathy (συμπάθειαν), but not by primary involvement of the brain (οὐκ ἰδιοπάθειαν ἐγκεφάλου), develop a kind of clonic shaking spell (οἷον παλμώδη τινὰ κλόνον) which occurs at intervals but not in the form of continuous contractions (οὐ συνεχῆ σπασμὸν). Therefore I can guess that a movement originates in the brain which is comparable to the annoying [affection] which occasionally befalls the stomach (ὥστέ με τεκμαίρεσθαι παραπλησίαν τινὰ κίνησιν γίγνεσθαι κατὰ τὸν ἐγκέφαλον τῇ κατὰ τὸν στόμαχον ἐπὶ τοῖς ἀνιῶσιν αὐτὸν ἐνίοτε συμπιπτούσῃ). (K199, S 96-97)

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The upper opening of the gastric cavity was thought to be a frequent source of disorders which, having arisen there as a result of some digestive irregularity, would move to upper regions of the body and involve them sympathetically. The regions affected were usually the heart, esophagus the eyes and especially the brain. Galen gives a detailed history of his treatment of one such case: (MT149) A young student of literature was attacked by epileptic spells each time he studied very intensely, meditated, failed to eat for too long, or became emotionally upset ( ἡνίκα μάλιστα σφοδρότερον ἐδίδασκεν, ἢ ἐφρόντισεν, ἢ ἐπιπλέον ἠσίτησεν, ἢ ἐθυμωθη). I assumed that he had an ailment of the opening of the stomach, since the kardia [here the opening of the upper gastric cavity] appeared to be hyper sensitive, and I thought that his brain caused his entire body to shake sympathetically. ... (Details of treatment follow) This patient survived on this regimen more than twenty years in good health. But on rare occasions when he was forced to remain without food because of urgent business, he was again attacked by very brief spells. (K 340-341, S 152-153) Elsewhere Galen tells of a similar case in which again a regime directed toward ‘strengthening the stomach’ was recommended, this time to “a certain grammarian ... who was continually seized with epileptic convulsions, and he benefited greatly; and especially I hoped to help him, when I learned from him that the symptom of the convulsions occurred when he had remained a long time without food, and more when worry or anger supervened.765 Others became prone to the epigastric form of epilepsy when they were under different kinds of stress: (MT150) ἐθεασάμην δὲ καὶ ἄλλους ἀπὸ τοῦ στόματος κοιλίας ἐπιληπτικῶς σπωμένους, ὁπότε σφοδρῶς ἡπέπτησαν, ἢ οἴνου πλέονος ἀκρατεστέρου πίνοειν, ἢ ἀφροδισίοις ἀκαιρότερον χρήσοιντο. I observed that other patients suffered from epileptic seizures which arose from the cavity of the stomach when they were bothered by a severe indigestion, had taken too much undiluted wine, or had overexerted themselves by untimely sexual activity. (K 341, S 153) VI. Senility Galen recognized that often with old age came loss of mental faculties. He describes old age as a condition rather like convalescence, in which the body is midway between health and disease.766 Old age was seen to be a cold and dry condition particularly prone to abnormal cooling of the brain; if this occurred, both understanding and memory

765 Galen Hyg. Trans. Green, p. 275.(κατάπτωσιν). 766 Gal. Hyg. Trans. Green, p. 201; cf. De Part. Ar. Med. Trans. M. Lyons, p. 25.

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became severely impaired resulting in a state of senility, variously described as morosis, dementia or anoia.767 The proper management of men in old age, according to Galen (women are not discussed), requires the physician’s art (gerontology) and a description of the regimen conducive to healthy long life is given in Galen’s De Sanitate Tuenda. He also provides case histories of two old men and, in the course of one, notes specifically that the physician Antiochus cared for himself so well that he “continued until the last, unimpaired in all his senses and with all his members intact.”768 VII. Diseases of the Soul (Passions and Errors) Galen also write about a group of disorders which he clearly regarded as distinct from mental dysfunctions arising in the brain from somatic disorders. These were called “the passions and errors of the soul” and consisted in certain kinds of emotional states and wrong-headed attitudes viewed by Galen, and other Stoic writers, as distinct mental disorders.769 The passions which he singled out as requiring therapeutic intervention were: rage and greed, lust, fear, obstinacy, love of glory, lust for power, envy and grief; the main error of the soul consisted in a pretence of wisdom. It has been noted that in the case of these emotional states alone, Galen “approached the idea of a strictly psychological frame of reference for psychological disorders.”770 For although he prescribes therapy for these conditions using medical rhetoric, the treatment he advocates is primarily educational. It consists largely of moral instruction under the guidance of an older, wiser, and more restrained mentor, with the goals of self-knowledge, selfcontrol and self-improvement. No detailed discussion of these works will be undertaken here since, despite its quasimedical tone, in these works Galen was writing as a moral philosopher rather than a physician. These “diseases”, in fact, are not 'aberrant' in the sense being used here, for Galen finds them to be ubiquitous and firmly entrenched in most people's lives. Moreover, he is not optimistic about a cure; “the passions have increased in the souls of the majority of men to such a point that they are incurable diseases.”771 G. Other Aberrant States in Later Compilators I. Lycanthropy A mental disorder frequently mentioned in the medical writings of late antiquity and the middle ages, which has no correspondence with any modern clinical entity, is the condition of Lycanthropy. Description of its symptoms are extant from a number of writers and compilers: Oribasius of Pergamon (325 - 403 CE); a pseudo-Galenic treatise On

767 See Siegel 1973, 274-275; cf. K. 16, 696 and Loc. Aff. K 165, S 83. 768 Gal. Hyg. 6.324, Trans. Green, p.202. 769 Galen on the passions and errors of the soul, Trans. Harkins 1963. 770 Jackson 1969, 380. 771 Gal. The Diagnosis and Cure of the Soul's Passions, Trans. Harkins 1963, 66.

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Melancholy, now believed to be the work of Aetius of Amida (sixth C. ?) and the seventh century compilator Paulus Aegineta.772 The latter gives a vivid account of this disease: (MT151) Οἱ τῇ λυκανθρωπίᾳ κατεχόμενοι νυκτὸς ἐξίασι τὰ πάντα λύκους μιμούμενοι καὶ μέχρις ἡμέρας περὶ τὰ μνήματα διατρίβουσι. γνωριεῖς δὲ τὸν οὕτω πάσχοντα διὰ τῶνδε· ὠχροὶ τυγχάνουσι καὶ ὁρῶσιν ἀδρανὲς καὶ ξηροὺς τοὺς ὀφθαλμοὺς ἔχουσι καὶ τὴν γλῶσσαν ξηροτάτην, καὶ σίελον οὐδ᾽ ὅλως προχωροῦν αὐτοῖς. εἰσὶ δὲ καὶ διψώδεις, καὶ τὰς κνήμας διὰ τὸ πολλάκις προσπταίειν ἀνιάτως ἡλκωμένας ἴσχουσιν. τοιαῦτα μὲν τὰ γνωρίσματα· γινώσκειν δὲ χρὴ εἶδος μελαγχολίας εἶναι. Those labouring under lycanthropia go out during the night imitating wolves in all things, and lingering about sepulchres until morning. You may recognize such persons by these marks: they are pale, their vision feeble, their eyes dry, tongue very dry, and the flow of the saliva stopped; but they are thirsty, and their legs have incurable ulcerations from frequent falls. Such are the marks of the disease. You must know that lycanthropia is a species of melancholy.773 To an essentially identical account Oribasius adds one additional symptom; such persons also have “a languid expression”.774 The discussion in Aetius implies that lycanthropy and kynanthropy were a single disease - both a form of melancholy - and suggests that lycanthropy tended to have its onset in the month of February.775 II. Love-sickness Allusions to abnormal mental states in connection with love are found in several writers - we have seen how Aetius made a distinction between the mental distress of an unrequited lover and true melancholy.776 Galen too provides a famous case history of a woman suffering from a mysterious disorder which he identifies, using the tactics of a medical sleuth. (MT152) I was called in to see a woman who was said to lie awake at night, constantly tossing from one position to another. When I found that she was not suffering from fever, I asked about 772 Aetius 6.11; Orib. Synop. 8,10. See the discussion in Jackson 1986, 345-346 and Siegel 1973, 266, who discusses lycanthropy and the related kynanthropy in Greek folklore (ancient and modern) and possible pharmacological and psychological explanation for the phenomenon (265-269). 773 Vol. 1, 389: book 3, ch. 16 Trans. Adams. Adams’ commentary compares the similar accounts of lycanthropy in other writers, noting the use of an alternate term, melancholia canina , by Avicenna and Alsaharavius. 774 Cited in Jackson 1986, 345; Orib. vol. 5, 414-415. 775 Jackson, 1986, 345-346. Jackson (346)makes the persuasive suggestion that “the lore about werewolves provided the delusional content for some who were inclined to be delusional, much as the delusions of many psychotic persons have been noted to have a correlation with current topics in more recent times.” See also Siegel 1973 266-269 on wolves and men and Greek and Roman mythology. 776 Morb. Chron. I ch.5.

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each of the details that had happened to her from which we know the presence of insomnia. She replied hesitantly or not at all, as if to show the folly of such questions, and finally turned over, buried herself completely deep in the blankets, covered her head with a small wrap and lay there as if wanting to sleep. On my departure I decided she was suffering from one of two things: from a depression caused by black bile (μελαγχολικῶς) or from some worry (τι λυπουμένην) she was unwilling to confess. I thus postponed a further investigation until the next day and, on my arrival, I was first told by the maid in attendance that it was impossible to see her just then. I was told the same thing on my second visit, but I came yet a third time. Then the maid ordered me to go away, for her mistress did not wish to be disturbed. Knowing full well that she had bathed and eaten a normal meal after I had left, I returned the next day, and in a private conversation with the maid on one subject and another I discovered beyond doubt that she was racked with grief (τινι λύπῃ τειρομένην). Exactly what this was I found out only by chance, as I believe Erasistratus did. After I had diagnosed that there was no bodily illness and that the woman was troubled by some psychological disturbance (ἀπὸ ψυχικῆς τινος ἀηδίας ἐνοχλεῖσθαι), I happened to receive some information at the time of my visit which confirmed my suspicions. A man coming from the theatre remarked that he had seen Pylades dancing. Her expression and facial colour changed, and observing this and putting my hand on her wrist, I found that her pulse had suddenly become irregular in several ways, which indicates that the mind is disturbed (τὴν ψυχὴν τεθορυβῆσθαι): the same happens to those who are entering any sort of contest. The next day I told one of my followers to arrive just after I had come and seen the woman and to announce that Morphus is dancing today. When he did so, I found that her pulse was unaffected. Similarly also on the following day, when I had an announcement made about the third member of the dancing troupe, her pulse stayed steady. On the fourth evening I kept a very careful watch when it was announced that Pylades was dancing and I saw that her pulse became immediately wildly disturbed. Thus I discovered that the woman was in love with Pylades, and by careful watch on subsequent days my discovery was confirmed.777 Both Oribasius and Paulus include love-sickness among their discussions of mental disorders.778 (MT153) It will not be out of place here to join love to the affections of the brain, since it consists of certain cares. For care is a passion of the soul occasioned by the reason’s being in a state of laborious emotion. The following symptoms attend lovers: Their eyes are hollow, and do not shed tears, but appear as if overflowing with gladness, their eyelids move rapidly; and even when none 777 Gal. De Prog. 6, 4-10, (Nutton); the case history is modelled on the story of the great physician Erasistratus’ discovery of the love of Antiochus for Stratonice, (above ch. 5); for commentary see Nutton 1979 ad loc. and for a discussion of the the motif of the love-sick prince and the physician see Pinault 1992, ch. 6 and ch.3. 778 Orib. Synop. 8,9-8,10; Paulus vol. 1, 390-391, book 3, 17 Trans. Adams.

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of the other part of the body are affected, these parts are always so affected in lovers. There is no pulse peculiar to lovers, as some have supposed, but it is the same as that of persons labouring under care. When they call to recollection the beloved object, either from seeing or hearing, and more especially if this occur suddenly, then the pulse undergoes a change from the disorder of the soul, and therefore, it does not preserve its natural equability or order. Such persons, therefore, being desponding and sleepless, ....[details of treatment follow]. H. Summary remarks Several observations may be made about the kinds of mental disorders described in the preceding passages and their various classifications First of all it seems very clear that the syndromes described are extremely difficult to fit into modern nosological categories or even to identify. Indeed it is now widely recognized that, with the exception perhaps of epilepsy, there are no exact contemporary equivalents to states such as mania, melancholy and phrenitis.779 That is not to say that there are no specific individual symptomatic and behavioural parallels to be found; merely that the constellations of such symptoms, which make up the disease or syndrome, are differently configured for antiquity and for the present day. Secondly, it seems apparent that not even in antiquity was there a high level of agreement and consistency about which symptoms constituted which disease. Some observations were constant: phrenitis, for example, seems always to have been associated with fever. Most physicians made a distinction between the short term delirium associated with the feverish diseases such as pleurisy or pneumonia and the long-term or even permanent derangement of phrenitis. But the actual symptoms could well bring muddle - hence Caelius points out that mania can also be accompanied by fever and be confused with phrenitis. Again, melancholy was often associated with fears and depression - but not always- it could also involve raving and rage, just as mania might also show itself in sadness and fears and this cross-over of symptoms should be noted.780 Another complicating factor was that some physicians evidently considered many disorders to be inter-related, hence the comments implying that epilepsy and melancholy could become one another, or mania and melancholy, or that lycanthropy was a kind of melancholy or that lethargy and mania could become one disease (typhomania ). The truth is that then, as now, mental disorders resist classification. It is simply far more noticeable when we examine the writings of physicians in antiquity to see how very likely it must have been that an individual's mental disorder was identified fairly arbitrarily, partly on the basis of its most outstanding symptoms, partly on the basis of information solicited by the physician in the course of his diagnosis, and partly on the basis of a the physicians own

779 See, for example, Jackson 1986, 249; Leibbrand and Wettley 1961, 34.; on the difficulty of classifying epilepsy see Temkin [1945] 1971, 15-21 - the various diseases called sacred. 780 Jackson 1986, 252; see also 249-254 generally on the complex history of the relationship between melancholy and mania and the ancient medical writers.

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set of assumptions and theories about physiology and disease. In the following sections we will explore what some of these assumptions were with respect to the causes of mental disorders and their successful management.

CHAPTER EIGHT The Medical Causes of Mental Dysfunction A. Humors and Temperaments Although ancient discussions of the reasons for individuals succumbing to various aberrant mental states included a multiplicity of precipitating causal factors, one central conceptual system, the doctrine of the humors (and the later related doctrine of the temperaments), provided the underpinnings of the majority of accounts of disease in antiquity - and indeed up to modern times.781 With roots in pre-Socratic philosophy and medical empiricism, humoral theory became a part of early medical thinking and was originally articulated in the Hippocratic treatise On the Nature of Man. In this work the writer proposes for the first time the existence of four humors operating within the human body which in proper combination caused health; illness resulted when one or another of them either predominated or was deficient.782 The impressively simple system comprised blood, yellow and black bile and phlegm, humors thought to be always present in the body and determining its nature but which varied in their relative quantities according to the four seasons. Black bile, for example, was in the ascendency in autumn but “winter was unfavourable to it and the spring inimical, so that autumn-engendered pains would be relieved by the spring.”783 To this schema of the four humors and their conjunction with the four seasons was added another tetrad - that of the four qualities, heat, cold, moist and dry. These categories provided medical explanatory power from the original Pythagorian and Empedoclean four elements of earth, air, fire, and water.The following schema was evolved by the author of the treatise On the Nature of Man:

781 One of the best and most concise accounts of the evolution of humoral theory, particularly as it related to mental disorders, is that of Klibansky, Panofsky and Saxl 1964, esp.3-15. 782 Klibansky et al. 1964, 8-9 citing Hipp. apud Galen, Comment. 1,20, Corp. Med. Gr. V,ix, 1,p.33, ὑγιαίνει μὲν οὖν μάλιστα, ὅταν μετρίως ἔχῃ ταῦτα τῆς πρὸς ἄλληλα δυνάμεως καὶ τοῦ πλήθεος καὶ μάλιστα, ἢν μεμιγμένα ᾖ. 783 Klibansky et al. 1964, 9.

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Humor

Season

Quality

Element

Blood

Spring

Yellow Bile

Summer

Warm and Dry

Fire

Black Bile

Autumn

Cold and Dry

Earth

Phlegm

Winter

Warm and Moist Air

Cold and Moist

Water

784

The crucial humoral elements in bodily health and disease became also a way of characterizing a person who was thought to have, either as the result of some temporary imbalance, or as a result of constitutional factors, an excessive amount of any one of them in their makeup. Gradually a doctrine of the four temperaments emerged in which people could be spoken of as, for example, choleric, melancholic, or phlegmatic.785 This might mean either a) such individuals were in a specific pathological state due to an excess of one of the humors, or b) their constitutions were determined by a permanent predominance of phlegm, bile etc., and, normally healthy, they were particularly prone to develop certain kinds of illnesses. A full discussion of the development of humoral theory is not within the purview of this study; it is sufficient for our purposes to recognize that of the various medical writers we have considered most operated within this kind of framework, a framework in which a proper balance (eukrasia) of the humors and/or qualities constituted health, imbalance (dyskrasia) disease, and treatment consisted in the first instance in eliminating the excess and restoring a right balance or mixture. For our purposes consideration of ideas about one humor in particular, black bile, is especially relevant since it is the one which for over two millennia signalled illnesses “mainly characterized by symptoms of mental change, ranging from fear, misanthropy and depression, to madness in its most frightful forms.”786. The concept of black bile and its link with mental disturbances is very old, almost certainly pre-Hippocratic, and many scholars find its roots in the realm of magical thinking and popular belief.787 The term μελαγχολᾶν was used extensively from the early fifth century synonymously with μαἰνεσθαι and the nexus of associations which such a term had with darkness and black moods of anger and fear has often been noted. 784 Hipp. Nat. Hom. 7; the basic schema is from Klibansky et al. 1964, 10 with the addition of the corresponding column of elements from Jackson 1986, 9; cf. Sigerist 1961, 2:323. 785 “Greek physiology, in which humoralism meant primarily humoral pathology, apparently lacked an adjective to describe a constitution determined by the blood, as the choleric is determined by the yellow bile, or the phlegmatic by the phlegm.” Klibansky et al. 1964, 13. 786 Klibansky et al. 1964, 14; it should be noted however that black bile was held to be responsible for a very large group of diseases, many of which were not mental diseases, “diseases ranging from headache, vertigo, paralysis, spasms, epilepsy, ... quartan fever and diseases of the kidney, liver, and spleen.” Sigerist 1961, 2:320 cited in Jackson 1986, 8; see also Siegel 1968, 258-321 for a discussion of the numerous diseases caused by black bile in the works of Galen. 787 Klibansky et al 1964, 14&16, see esp. Kudlien 1967, 77-99 and Simon 1978, 232 &234-5. On the association of black with evil and disease see Lloyd 1979, 37; Padel,

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The word μέλας, as its equivalent in most other languages, means far more than a colour; μέλανες ἄνθρωποι for instance, are ruthless men, µέλαιναι ὀδύναι are horrible pains. Hence we have no difficulty in understanding Galen's words: “Just as outward darkness fills nearly all men with fear, unless they are very brave or very enlightened, so the dark colour of black bile generates fear, in that it darkens the seat of reason.”788 Before becoming one of the canonical four natural humors, black bile in its earliest appearance seems to have had the status of a toxic pathogenic agent.789 In the Hippocratic works prior to The Nature of Man black bile was considered to be rather a noxious degenerative product of yellow bile or blood - an idea which was to resurface later in the works of Rufus and Galen particularly in the idea that a form of atrabilious humor which caused the most extreme symptoms of madness was produced by the combustion of yellow bile.790 The earliest treatise concerning the effects of black bile on the human mind, and a work which was influential both in antiquity and later during the Renaissance, is the Pseudo-Aristotelian treatise, usually attributed to Theophrastus, in section 30 of the Problemata.791 Since the views on melancholy expressed here were absorbed gradually and selectively into the medical traditions of antiquity, a brief overview of some of the work's more important considerations will be given. This will have the additional benefit of providing an example of humoral theory at work, since in the section which follows humoral aetiologies receive only summary treatment in company with the many other explanatory factors adduced by ancient medical writers. Problem 30,1 begins with the question: “Why is it that all those who have become eminent in philosophy or politics or poetry or the arts are clearly melancholics, and some of them to such an extent as to be affected by diseases caused by black bile? An example from heroic mythology is Heracles.”792 The black bile diseases in the case of Heracles include his epilepsy, the mad frenzy in which he killed his family, and an eruption of sores before he disappeared on Mount Oeta. Other heroes are similarly afflicted: Lysander of Sparta with sores; Ajax who went completely mad (ἐκστατικὸς ἐγένετο παντελῶς); and Bellerophon who sought out empty places in which to live. Included among these heroes are more recent figures: Empedocles, Plato and Socrates, each of whom had either a 788 Klibansky et al. 1964, 16 n.44 citing Galen Loc. Aff. iii,10 in Kühn VIII,191; Simon 1978.Padel 1992, passim sensitively explores the complex of associations in Greek tragic discourse of blackness, innards, blood, anger, madness, and passion. 789 Jackson 1978, 8. 790 Galen Loc. Aff. K 178 S88; Rufus Oeuvres D 356-357. 791 Arist. Pr. 30,1. An edition of the treatise and translation are easily accessible in Klibansky et al. 1964, 18-29; for discussion see also Flashar 1966, 60-72; Simon 1978, 228-237; Jackson 1986, 31-33. 792 MT154 Διὰ τί πάντες ὅσοι περιττοὶ γεγόνασιν ἄνδρες ἢ κατὰ φιλοσοφίαν ἢ πολιτικὴν ἢ ποίησιν ἢ τέχνας φαίνονται μελαγχολικοὶ ὄντες, καὶ οἱ μὲν οὕτως ὥστε καὶ λαμβάνεσθαι τοῖς ἀπὸ μελαίνης χολῆς ἀρρωστήμασιν, οἷον λέγεται τῶν τε ἡρωικῶν τὰ περὶ τὸν Ἡρακλέα;

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bodily disease resulting from this temperament or a propensity towards them - all of them are said to be “melancholics by constitution” (τοιοῦτοι τὴν φύσιν). Here is the concept of the melancholic temperament - a person in whom the balance of humors is dominated by black bile and who may or may not develop one or another of the associated diseases. In an attempt to demonstrate plausibly the ways in which black bile works upon the minds and temperaments of individuals, the author develops an analogy between it and the effects of wine. The drinking of large quantities of wine creates a variety of characters in men - some are irritable, others benevolent and compassionate, still others reckless. These changes in character come about gradually in tandem with wine consumption. An individual may progress from “cold” sober taciturnity to loquaciousness, to grandiloquent and boisterous recklessness, to insolence, frenzy (μανικοὐς) and finally to a feeble moronic stupidity similar to “those who have been epileptic from childhood or ... those who are a prey to excessive melancholy.” Now as wine produces these various states in an individual temporarily, just so do varying quantities of black bile produce among humans individuals in permanent states which coincide with these. For black bile, as distinct from other humors as wine is from milk and honey, possesses a special quality which is able to affect an individual's disposition. “Wine makes a man abnormal not for long, but for a short time only, but a man's natural constitution does it permanently, for his whole lifetime; for some are bold, other taciturn, others compassionate and others cowardly by nature.” But black bile is not only present and determinative in individuals in varying amounts, it can also vary in quality, for it is by nature a mixture of heat and cold and can therefore undergo changes in temperature any of which will produce effects in the temperament and condition of the person concerned. “Now, if black bile, being cold by nature and not superficially so, is in the stated condition, it can induce paralysis or torpor or depression or anxiety when it prevails in the body; but if it is overheated it produces cheerfulness, bursting into song, and ecstasies and the eruption of sores and the like.” Most people's character (for everyone contains some black bile as a result of the daily ingestion of food), is not notably affected by shifts in the quality or quantity of black bile. The schema, as Simon has noted, admirably attempts to cope with the problem of the relationship between normal and pathological mood states and does so by positing one simple substance which acts to produce varying emotional states.793 “So too with the despondency which occurs in everyday life, for we are often in a state of grieving, but could not say why, while at other times we feel cheerful without apparent reason. To such affections ... we are all subject in some small degree, for a little of the stuff which causes them is mixed in with everybody. But with people in whom this quality goes deep, it determines the character.” This is not always detrimental - those who have a great deal of melancholy temperament, if it is

793 Simon 1978, 234; cf. also 230, “The author seeks to build a theory that will invoke only one simple substance as the cause of a variety of phenomena in melancholics. Thus he argues that the qualities of black bile may vary, particularly its temperature, and that the variations in qualities can explain why a variety of effects may be produced”.

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“undiluted” (σφόδρα κατακορής) are too melancholy - but if it is tempered they are outstanding (περιττοί).794 It has been suggested that here there may be a blending and a secularization of the medical notions of madness and Plato's concept of divinely inspired madness.795 “The mythical notion of frenzy was replaced by the scientific notion of melancholy, a task made the easier as 'melancholic' and 'mad' - in the purely pathological sense - had long been synonymous, and as the peculiar gift of true dreams and prophecies belonging to the diseased melancholic corresponded to the Platonic equation of 'mantic' and 'manic'.”796 Those who are melancholic by temperament run the risk of a variety of illnesses (or other 'abnormal' states), and we shall conclude our overview of the treatise with a number of those singled out. Different individuals are of course affected in different ways and in different parts of the body: “some people suffer from epileptic symptoms, others from paralytic ones, others from violent despondency or terrors, other from over-confidence, as happened to Archelaus, King of Macedonia.” Unduly cold melancholic temperaments make people dull and stupid and produce “irrational despondency (δυσθυμίας ... ἀλόγους); hence suicide by hanging occurs most frequently among the young and sometimes also among elderly men.[old age is considered to be a cold state].” Such suicides are often sudden and unexpected, astonishing to everyone because no previous sign of such intention has been given. On the other hand unduly heated black bile makes people “elated and brilliant or erotic or easily moved to anger and desire, while some become more loquacious. Many too are subject to fits of exaltation and ecstasy, because this heat is located near the seat of the intellect; and this is how Sibyls and soothsayer arise and all that are divinely inspired, when they become such not by illness but by natural temperament. - Marcus the Syracusan, was actually a better poet when he was out of his mind.” (ὅτ᾽ ἐκσταίη).797 B. Causes of Abnormal Mental States in Medical Sources ποικιλί α πολ υειδ ὴς γίγ νε ται τῶ ν βλ απ τόν τω ν τ ὰς ψυχι κὰ ς ἐ νερ γείας αἰ τίω ν.798 The causes of mental disorders have always been - and still remain today - shadowy and conjectural. It is perfectly comprehensible that physicians writing so widely apart in time as the Hippocratics and Caelius Aurelianus could

794This is the beginning of what came later to be the great romantic tradition of melancholics as men of genius, for after Aristotle (with the exception of many of the medical writers), “ideas about melancholia often included something of the theme of specialness”, Jackson 1986, 33 and passim; see also Klibansky et al. 1964; Flashar 1966; Jackson 1986. 795 Jackson 1986, 32 cf. Klibansky 1964, 17, 40-41. 796 Klibansky et al. 1964, 40. 797 The association between inspired and prophetic states and melancholy is only occasionally found as part of the medical tradition. Rufus (MT129) considered the melancholic's gift of prophecy to be a reality (although apparently pathological in origin); more often, however, emphasis was on interpreting such phenomena as the illusions of a sick mind. See discussion in Klibansky et al. 1964, 54 cf. 50; 41-42. 798 Rufus Oeuvres D 364-365, “There is a manifold diversity of causes harming the mind's activities.”

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both say of mania, for example, that it has no obvious cause, that it comes spontaneously, that sometimes the causes are hidden.799 Yet what kinds of explanations were likely to be offered to an individual or his/her family seeking medical assistance for a mental problem? Certainly the level of explanation would vary according to the the social and educational level of the patient, but there is no doubt that many physicians saw it as part of their role to educate patients about the causes of their illnesses and the ways in which the conditions could be both cured and prevented from recurring.800 A wide variety of causes, both underlying and precipitating, are noted in the medical discussions of aberrant mental states and the following is a summary of these. The approach in this and the subsequent section on treatment and care consists in categorizing by type of cause and type of treatment rather than by disease, an approach which is designed deliberately to emphasize the experience of the patient. We should like to discover to what extent the explanations and cures for the several categories of mental illnesses recognized in antiquity were distinct and dissimilar - and ultimately, as far as the treatment of the individual suffering from a mental disturbance was concerned, we can ask to what extent the diagnosis of the physician made any difference? I. Humoral Explanations i. Bile: Black and Yellow; Blood and Phlegm The frequent and repeated attribution to some form or other of black bile in a number of diseases involving disturbed mental function has been noted in the preceding discussion. In the Hippocratic Corpus bile is sometimes divided into black and yellow (as in The Nature of Man) but elsewhere simply referred to as χολή.801 Χολή is responsible for fevers, phrenitis, melancholy, derangement and madness - sometimes by its own action alone, more often in conjunction with phlegm or blood. All fevers are caused by bile but quartan fevers especially are said to be chronic and difficult to resolve because the black bile which predominates in them is the most viscous and longest lasting humor.802 Phrenitis too is caused by bile entering the blood and heating it up (Morb. 1,30; Loeb 5, 178). “The person, because of his fever, and because his blood has become serous and abnormal in its motion, loses his wits (παρανοέει) and is no longer himself (οὐκ ἐν ἑωυτῷ ἐστιν).” Patients with phrenitis “most resemble melancholics in their derangement” - for melancholics and phrenetics both suffer from blood which is corrupted by bile and phlegm. The difference between the two diseases is simply in the strength of the bile involved.803 In another disease (not

799 Hipp. Morb. Sacr. 1; Iudic.. 42, L9, 290; Morb. Chron. 147. 800 Simon 1978, 225-227; who cites Pl. Leg. 721 cf. 857 on class distinctions and the doctor patient relationship. On managing and educating the patient cf. Steph. Comm ad Hipp. Aph. I.2, (Westerink p. 45); Galen de Sanitate Tuenda; see also Nutton 1990, on a recently translated treatise by Galen, De optimo medico cognoscendo libelli versionem arabicam primum edidit, in linguam anglicam vertit, commentatus est Albert. Z. Iskandar, CMG Suppl Orient. 4 (Berlin: 1988). 801 Black and yellow bile appear in The Nature of Man 4 and Epid. 1, case 5 (Loeb 1, 196); on the development of two independent humors from the earlier single fluid see Klibansky et al. 1964, 9. 802 Nat. Hom. 15 (Loeb 4, 40); on fever symptoms and black bile see also Hipp. Acut. 16, (Loeb 6, 278). 803 Hipp. Morb. I,30 (Loeb 5, 176-178; see note ad loc. (Loeb 5, 179). Also on phrenitis and biliousness see Hipp. Aff. 10 (Loeb 5, 217).

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named) the patient suffers intense pain in the head, “vomits bile, suffers dysuria and becomes deranged” because the blood in his head is “overheated by bile or phlegm” (Morb. II, 3 [10]; Loeb )..Sometimes black bile itself is spoken of as if precipitated by an external cause, as in the case of Timokrates of Elis (MT7) who drank a great deal and became manic as a result of black bile (μαινόμενος δὲ ὑπὸ χολῆς μελαίνης) and was with difficulty cured (Epid. 5.1.2 L.5,204). Again in a discussion of the central importance of the brain in The Sacred Disease, the question of its damaged function is explained by referring to the two humoral agents, phlegm and bile. In one passage, epilepsy itself is said to be a disease of the phlegmatic, not the bilious, but in another: “Most melancholics usually become epileptic, and epileptics melancholics. One or the other [condition] prevails according to whether the disease leans: if towards the body, they become epileptics, if towards reason, melancholics”.804 Besides epilepsy other mental dysfunctions can result either from phlegm or bile: (MT155) The corruption of the brain is caused not only by phlegm but by bile. You may distinguish them thus. Those who are mad through phlegm (ὑπὸ φλέγματος μαινόμενοι) are quiet, and neither shout nor make a disturbance; those maddened through bile (ὑπὸ χολῆς) are noisy, evil-doers and restless, always doing something inopportune. These are the cases of continued madness (ἢν ... συνεχῶς μαίνωνται). But if terrors and fears attack, they are due to a change in the brain. Now it changes when it is heated, and it is heated by bile which rushes to the brain from the rest of the body by way of the blood-veins. The fear besets the patient until the bile re-enters the veins and the body. Then it is allayed. The patient suffers from causeless distress and anguish (ἀνιᾶται δὲ καὶ ἀσᾶται παρὰ καιρόν) when the brain is chilled and contracted contrary to custom. These effects are caused by phlegm, and it is these very effects that cause loss of memory. Shouts and cries at night are the result of the sudden heating of the brain, an affection from which the bilious suffer but not the phlegmatic. (Morb. Sacr. 18 Trans. Loeb 2, 174-176) In later authors, Celsus notes a specific type of insania , of long duration which consists in depression seemingly caused by black bile (tristitia, quam videtur bilis atra contrahere).805 Aretaeus accounts for at least one of his categories of melancholy, the one characterized by digestive and mental disturbances, by specifically citing black bile as the cause: “Black bile ... if it be determined upwards to the stomach and diaphragm, it forms melancholy” (Morb. Chron. 1,5). It has been suggested that for his second category of melancholy, a disorder marked by strong affective disturbances without digestive symptoms, Aretaeus was proposing a psychological aetiology rather than the more usual somatic one, for in these cases he said, “there is neither flatulence or black bile but mere anger and 804 Phlegmatics - Hipp. Morb. Sacr. 8 (Loeb.2, 154); quote - Hipp. Epid. 6, 31, L5, 354-356, Οἰ μελαγχολικοὶ καὶ ἐπιλημπτικοὶ εἴωθασι γίνεσθαι ὡς ἐπὶ τὸ πουλὺ, καὶ οἱ ἐπίλημπτοι, μελαγχολικοἰ· τουτέων δὲ ἑκάτερον μᾶλλον γίνεται, ἐφ᾽ ὁπότερα ἂν ῥέψῃ τὸ ἀῥῥώστημα, ἢν μὲν ἐς τὸ σῶμα, ἐπίλμπτοι, ἢν δὲ ἐπὶ τὴν διάνοιαν, μελαγχολικοί. 805 Celsus III, 18,17; Celsus does not use the term melancholy.

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grief and sad dejection of mind; and these were called melancholics, because the terms bile and anger are synonymous in import, and likewise black with much and furious"806 Generally, however, Aretaeus stresses the role of the humors in mental disorders: for example, “those in whom the heat is enkindled by black bile, and whose form of constitution is inclined to dryness, most readily pass into a state of melancholy” . Moreover, black bile was also seen to be, by implication, the cause of mania, for melancholy in Aretaeus' system, was “the commencement and a part of mania”.807 Caelius Aurelianus on the other hand, whose works are a translation of the great methodist physician Soranus, rejected humoral theory and specifically denied that black bile was the cause of melancholy: (MT156) Melancholia dicta quod nigra fella aegrotantibus saepe per vomitum veniant: Graeci enim nigrum melan vocaverunt, fel autem cholen appellant. et non, ut plerique existimant, quod passionis causa vel generatio nigra sit fella, hoc enim est aestimantium magis quam videntium veritatem, vel potius falsum, sicut in aliis ostendimus Melancholy derives its name from the fact that the patient often vomits black bile, the Greek work for 'black' being melas and for 'bile' chole. The name is not derived, as many believe, from the notion that black bile is the cause or origin of the disease. For such a notion would be put forward only by those who guess at, rather than observe, truth; and it is, in fact, a false notion, as we have shown elsewhere.808 With Rufus of Ephesus and Galen, both eclectics, humoral theory and especially the role of black bile, becomes increasingly elaborated. Rufus speaks of “the melancholic humor” (ὁ μελαγχολικὸς χυμός), describing it as cold and dry (D. 355). It chills and disturbs the stomach causing indigestion and blockages in the passage of air throughout the body with its “thickened superfluities” (D.355-356). Melancholy humor becomes black either from the overheating or over-cooling (D 356-357); indeed the more dangerous forms of insanity (παραφροσύνη) especially occur during the time when the yellow bile is being heated (D 358).809

806 Morb. Chron. 1,5; cf. Jackson 1986, 40. Rufus of Ephesus too suggested psychological aetiological factors for melancholy, see discussion below on emotional causes and mental disorders in general. 807 Aret. Morb. Chron. 1,5 & 6. 808 Morb. Chron. 1, 6, 180. Methodists preferred an aetiology of disease which depended upon a doctrine of 'general states' (κοινότητες). See Drabkin (1950) xvii. 809 Evidence of black bile in the system is listed in an extract of Rufus in Rhazes (MT 157): et indicatur humor niger esse in eis egestione, vomitu, urina, apostematibus exeuntibus in superficie corporis, morphea et lentiginibus coloris nigri, scabie, distillatione emorroydarum, varicibus, et secundum plures accidunt eis varices. .(D 456).

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Galen was a firm proponent of humoral theory, concerned with the effects of accumulations of excess bilious, melancholic or phlegmatic humors in the blood.810 He attributed a vast array of diseases, known as the melancholic diseases, to the actions of the atrabilious humor.811 It was the function of the spleen to remove excess amounts of black bile from the blood; if it was not evacuated several syndromes could result, among them: despondency (ἀθυμία), melancholy, depression (δυσθυμία) - sometimes even strange food craving and aversions (Loc. Aff. K378 S 168 cf. K342 S153-154). Of those involving mental disturbances, melancholy and epilepsy receive the most detailed discussion, although Galen does speak of “madness caused by black bile or excessively heated yellow bile”.812 Epilepsy, he thought, could be produced either by phlegm or black bile, but only black bile could produce melancholy (Loc. Aff. K180 S89). The atrabilious humor could also produce delirium (παραφροσύνη) and phrenitis - and if it was present in a woman's menstrual discharge she became despondent (Loc. Aff. K433 S 190). Galen describes the two types of melancholic humor and explains their effects on the mind: (MT158) ... the melancholic humors exhibit obvious differences in composition (σαφεῖς διαφοράς). One type is like a sediment of the blood and appears rather heavy (ἱκανῶς παχύς). The other is of much finer composition (λεπτότερος) and seems acid (ὀξύς) to those who vomit or smell it. ... I usually speak of the atrabilious humor or of atrabilious blood (μελαγχολικὸν χυμὸν ἢ μελαγχολικὸν αἷμα), since I consider it incorrect to call it black bile (μέλαιναν χολήν). This humor develops in some persons in large quantities either because of their original constitution (ἐξ ἀρχῆς κρᾶσιν) or when the customary diet is transformed into this humor by digestion in the blood vessels (κατὰ τὰς φλέβας). When the heavy atrabilious humor obstructs the outflow from the cerebral ventricles, like the thick humor of the phlegm, it sometimes causes epileptic spells (ἐπιληψίας), since it is retained either in the middle or the posterior ventricle. But when black bile overflows into the substance of the brain itself (ἐν αὐτῷ τῷ τοῦ ἐγκεφάλου σώματι), it causes melancholy (μελαγχολίαν) in a manner similar to the other atrabilious humor which is [generated] by combustion of yellow bile and provokes violent delirium (θηριώδιες παραφροσύνας) in the presence or absence of fever, because it occupies the substance of the brain itself. (Loc. Aff. K176177 S 88) Galen also describes the effects of various kinds of yellow bile, which seems to have a more violent action upon the mind as it darkens through some kind of combustion:

810 See Gal. On Treatment by Venesection, K271-272, Trans. Brain, 77. 811 For a detailed discussion of these see Siegel 1968, 259-319. 812 Gal. De opt. med. cognos. , Trans. Iskandar 1988, p. 119; one type of melancholy is defined by Galen as “a primary affection of the brain (protopatheian ) due to an accumulation of black bile in this organ.” Loc. Aff. K192 S 93.

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(MT159) καὶ διὰ τοῦτο τῆς φρενίτιδος ἡ μέν τίς ἐστι μετριωτέρα, τὴν γένεσιν ἐκ τῆς ὠχρᾶς ἔχουσα χολῆς· ἡ δέ τις σφοδροτέρα, τῆς ξανθῆς ἔγγονος ὑπάρχουσα· καὶ τις ἄλλη θηριώδης τε καὶ μελγχολικὴ παραφροσύνη γίνεται, κατοπτηθείσης τῆς ξανθῆς χολῆς. Therefore, the type of phrenitis [delirium with fever] is milder, when it originates from paleyellow bile, but the type caused by dark-yellow bile is more violent. And there is another [third] type: the bestial and melancholic delirium due only to overheated dark-yellow bile. (Loc. Aff. K178 S88) Phlegm has been mentioned several times in connection with bile as one of the humors particularly involved in mental disorders, notably epilepsy and melancholy. According to the Hippocratic treatise On the Sacred Disease, epilepsy is a disease which attacks phlegmatic children whose brains have not been “purged” of impurities while still in the womb (Morb. Sacr. 8). The phlegm which is in the brain makes its descent into the two large veins connecting the liver and the spleen respectively to the brain. These veins are the great “vents of our bodies” drawing air in and spreading it through smaller veins throughout our bodies (Morb. Sacr. 7 & 10). In an epileptic fit, each of the symptoms is explicable in terms of phlegmatic congestion of the veins stopping the passage of air to the various parts - the brain, the hands, the eyes, the mouth and lungs etc. (Morb. Sacr. 10). (MT160) The patient suffers all these things when the phlegm flows cold into the blood which is warm; for the blood is chilled and arrested. If the flow be copious and thick, death is immediate, for it masters the blood by its coldness and congeals it. If the flow be less, at the first it is master, having cut off respiration; but in course of time, when it is dispersed throughout the veins and mixed with the copious, warm blood, if in this way it be mastered, the veins admit the air and intelligence (ἐφρόνησαν) returns. (Morb. Sacr. 10 Trans. Loeb 2, 160-162) Phlegm is also implicated in cases of melancholy according to Rufus, who instructs the physician that in some difficult cases patients are more alleviated by draining off phlegm than by draining off the black humor - for, he adds obscurely, nihilominus est ex humore nigro (D 456). Galen, on the other hand expressly states that melancholy cannot be caused by phlegm (Loc. Aff. K180 S89). He does, however, agree with Hippocrates in ascribing one of the causes of epilepsy to an accumulation of phlegmatic humors in the blood. In fact he gives instructions on the proper rearing of children for them to have exercise in the right amounts in order that they not become too phlegmatic and cold and prone to diseases such as epilepsies and apoplexies.813 Thick, viscous, and heavy humors which obstruct the passage of the pneuma psychikon in the cerebral cavities are the cause of epileptic convulsions - and these heavy humors may consist of mucus (phlegmatodes ) if they are mainly moist and cold, or alternatively, if they are mainly dry and cold, black bile (Loc. Aff. K173-175 S 86-87).

813 Gal. Hyg. , Trans. Green, 26-27.

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According to the Byzantine compilator Paulus Aegineta, phlegm is also responsible for another disease involving a lesion of the rational part of the brain - lethargy. “Lethargy ... has the same seat as frenzy, I mean the brain, but the matter which causes it is of an opposite nature; for it is occasioned by a humid and cold phlegm irrigating the brain.” (3,9) The last of the four humors is one which is slightly different in kind. Blood in itself is an essential component of a healthy body; it is primarily when it becomes mixed with other elements - the bilious or phlegmatic humors or air for example, that it becomes dangerous. In this way a state of plethora may be produced in the body and a variety of disorders result.814 We have seen how bile and phlegm entering the blood has been viewed by many as the cause of diseases such as epilepsy, melancholy, mania and phrenitis.815 Blood is considered by the author of the Hippocratic treatise Breaths to be central to the proper functioning of the mind. “Now I hold that no constituent of the body in anyone contributes more to intelligence than does blood. So long as the blood remains in its normal condition, intelligence too remains normal; but when the blood alters, the intelligence also changes” (14, Loeb 2, 248). Blood mixed with air and hence impeded in its passage throughout the body is said by the author to be the cause of epilepsy and other alterations and irregularities in the function of the mind. Heating of the blood, according to Aretaeus, is the source of severe mental disorders. Mania can result when the blood becomes heated at certain highly vigorous periods of life such as puberty and youth, but when the heat is engendered by black bile in the system the result is melancholy (Morb. Chron. 1,6). The passages in Aretaeus which discuss the symptoms and causes of phrenitis are unfortunately not extant; several other writers however associate phrenitis with the blood. Heraclides, according to Caelius, thought blood to be the cause of phrenitis and accordingly advised withdrawing blood from a vein on the forehead.816 Paulus too gives one of the causes of phrenitis as “fullness of blood” - the others being either an abundance of yellow bile or the excessive heating and conversion of yellow bile into black (3,6). And Galen, in company with Erasistratus and his followers, believed that plethora was responsible for many disorders, several of them affecting mental function, although they evidently did not agree about the use of phlebotomy for relieving or preventing these.817 In confirmation of this approach Galen argues that women are greatly benefited as a sex by their monthly evacuations of blood which cleanse them and free them from many categories of disease:

814 On the dangers of plethora see Galen on Bloodletting, Trans. Brain, passim. 815 Rufus D 456; cf the comment which follows by Rhazes (D 457) (MT161): Dico etiam: quando sanguis est permixtus melancoliae, oportet quod cerebrum nutriatur ex illo sanguine nigro; et quando non est permixtus, nutrietur cerebrum nutrimento bono et claro. “ But I say when the blood is mixed with melancholy it is probable that the brain is nourished from that black blood; and when it is not mixed together the brain is nourished by good clear nutriment.” 816 Heraclides apud Cael. Aur. Morb. Acut. 1, 182. 817 See in general the arguments in Galen on Bloodletting , Trans. Brain 1986, esp. 62-63; 65; 77.

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(MT162) ... οὔτε ποδάγραις οὔτε ἀρθρίτισιν οὔτε πλευρίτισιν ὄυτε περιπνευμονίαις ἁλίσκεται γυνὴ καλῶς καθαιρομένη. ἀλλ᾽ οὐδὲ ἐπίληπτος οὐδὲ ἀπόπληκτος οὐδὲ ἄπνους οὐδὲ ἄφωνος οὐδενὶ ἐν καιρῷ ποτε γίνεται καθαιρομένη καλῶς. ἑάλω δέ ποτε φρενίτισιν ἢ ληθάργοις ἢ σπασμοῖς ἢ τρόμοις ἢ τετάνοις ἐπιμηνίων ἰόντων. εἶδες δέ ποτε μελαγχολῶσαν ἢ μαινομένην ἢ πτύουσαν ἐκ θώρακος ἢ ἐμοῦσαν ἐκ γαστρὸς αἷμα, ἢ κεφαλαίᾳ κάμνουσαν, ἢ συνάγχῃ πνιγομένην, ἢ τι τῶν μεγάλων καὶ ἰσχυρῶν παθημάτων ὑπομένουσαν, εἰ καλῶς ἐκκρίνεται τὰ καταμηνία· ἰσχομένων δ᾽ αὖ πάλιν ἕτοιμον ἐν παντὶ κακῷ γενἐσθαι. ... a woman who is well cleansed is not seized with gouty or arthritic or pleuritic or peripneumonic diseases, and ... neither epilepsy nor apoplexy nor suspension of breathing nor loss of speech occur at any time if she is properly cleansed. Has a woman ever been known to be stricken with phrenitis, or lethargy, or spasm, or tremor, or tetany, while her menstrual periods were coming? Or did you ever hear of a woman who suffered from melancholy or madness or haemoptysis or haematemesis, or headache, or suffocation from synanche, or from any of the major and severe diseases, if her menstrual secretions were well established? And, on the other hand, if they are suppressed, she is certain to fall into every sort of illness.818

818 Gal. On Venesection against Erasistratus K165-166, Trans. Brain, 26-27; for the Hippocratic theory of the role of blood in hysterical suffocation and its associated insanity see discussion below.

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ii. Vapours and the Brain In addition to substances circulating about the body in the form of humoral secretions, a less substantial notion of transference of noxious effects is apparent in the many medical references to vapours and aromas being carried upward and affecting the workings of the mind. According to an ancient commentator on the Hippocratic Aphorisms, “vapours arising to the brain cause delirium, hardness of hearing, or dim sight” (παρακοπᾶς ἢ βαρυηκοίας ἢ ἀμβλυωπίας).819 Later writers refer to a variety of sources for these disturbing exhalations: Caelius warns against fomenting or anointing patients with phrenitis with oils that are aromatic or fragrant - they must be “odorless and untainted by any breath of vapor, to avoid filling the patient's head and aggravating his derangement”.820 He also advises treatments in cases of phrenitis to eliminate the pungent vapour which is exhaled from retained fecal matter (acrimonia quae ex ipsis nascens exalatione ) because it aggravates the symptoms in the head (Morb. Acut. 1,74). Galen too refers to effluvia from excrement full of biliary fluid which has collected in the body as a result of bad nutritional habits. The result, among other symptoms, can be headaches and in some people epileptic convulsions (Hyg. ch. 10, Green, 262). Elsewhere Galen describes “hot vapours” being transmitted to the brain in cases of paraphrosyne and phrenitis (Loc. Aff. K178 S88). Their source is unspecified, but the context seems to suggest that they are the result of the combustion of yellow bile. Galen refers rather unspecifically at times to the transfer of the damaging effects of accumulations of humors in one part of the body to another - the brain for example - by a process which he calls sympathy. Sometimes vapours, sometimes humors, seem to be involved in this process: “Indeed, when noxious vapors or even the humors themselves rise up from the cavity of the stomach to the brain and the mind becomes damaged, nobody will declare that the brain is affected in the beginning nor will he say that the brain remains wholly undamaged.” (Loc. Aff. K4849 S 35) In one his explanations for melancholy Galen posits a process in which a noxious serum (ichor ) produced by the spleen flows into the stomach; evaporations of the toxic humors from this serum rise up to the brain causing disorders of the mind - among them: dreams, restless sleep, hallucinations, (paranoiai), epilepsy and, notably, melancholy.821 Galen gives a particularly vivid description of the kind of process which could produce epilepsy, melancholy and the other atrabilious diseases: (MT164) ἔοικε μὲν γὰρ εἶναί τις ἐν αὐτῇ φλεγμονὴ, τὸ δ᾽ ἐν τῷ φλεγμαίνοντι μορίῳ περιεχόμενον αἷμα παχύτερόν τε καὶ μελαγχολικώτερον ὑπάρχειν. ὥσπερ οὖν ἐπὶ τοὺς 819 Steph. Comm. ad Hipp. Aph II, 12, (Westerink, 161); the reference is to the residues (τὰ ἐγκαταλιμπανόμενα) left behind in the body after a disease has passed its crisis. 820 MT163 Cael Aur. Morb. Acut. 1, 67, sed haec singula sine ullo esse odore debent atque nullo fumi afflatu vexata, ne caput impleant et alienationem exasperent. 821 Loc. Aff. K338-342 S152-153; cf. K194-195 S 95 - a description of the experience of the epileptic aura and the possibility that a vaporous substance (ousia pneumatike) carries the effects of a counternatural humor from the primarily affected part of the body to the head.

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ὀφθαλμοὺς ἀναφερομένης ἐκ τῆς γαστρὸς αἰθαλώδους τινὸς ἢ καπνώδους ἀναθυμιάσεως, ἢ ὅλως ἀτμῶν τινων παχέων, ὅμοια τοῖς ὑποχεομένων γίγνεται συμπτώματα, κατὰ τὸν αὐτὸν λόγον καὶ νῦν ἐπὶ τὸν ἐγκέφαλον ἀναφερομένης τῆς μελαγχολικῆς ἀναθυμιάσεως, οἷον αἰθαλώδους τινὸς, ἢ καπνώδους ἀναθυμιάσεως, τὰ μελαγχολικὰ γενήσεται· περὶ τὴν διάνοιαν συμπτώματα. For it seems that there is an inflammation in (the stomach) and that the blood contained in the inflamed part is thicker and more atrabilious. As some kind of sooty and smoke-like evaporation or some sort of heavy vapors are carried up from the stomach to the eyes, equally and for the same reason the symptoms of suffusion occur, when an atrabilious evaporation produces melancholic symptoms of the mind by ascending to the brain like a sooty substance or a smoky vapor. (Loc. Aff. K189 S92-93) II. Heredity and Temperament In the view of the writer of the Hippocratic treatise On the Sacred Disease, the origin of epilepsy, “like that of other diseases”, lay in heredity. For if a phlegmatic parent has a phlegmatic child, a bilious parent a bilious child, a consumptive parent a consumptive child, and a splenetic parent a splenetic child, there is nothing to prevent some of the children suffering from this disease [epilepsy] when one or the other of the parents suffered from it; for the seed comes from every part of the body, healthy seed from the healthy parts, diseased seed from the diseased parts. (Morb. Sacr. 5 Trans. Loeb 2, 150) Later in the same work he asserts that the disease begins in the womb, before the birth of the child, ἄρχεται δὲ φύεσθαι ἐπὶ τοῦ ἐμβρύου ἔτι ἐν τῇ μήτρῃ ἐόντος.822 In addition to epilepsy there are other conditions which the Hippocratics apparently considered to have been established by heredity. In a vexed passage, stuttering and stammering, baldness, some physical deformities, mental deficiency and some kind of insanity are listed as constitutional or innate:

822 Hipp. Morb. Sacr. 8, cf. Steph.Comm. Hipp. Aph. II 44, (Westerink, 235-241), in which the case of a suckling child with epilepsy is discussed. The physician is instructed first to establish if the disease was inherited from a parent or grandparent ( if so there is no cure - the disease was inherent in the seed itself at conception), if heredity is not the source the nurse's milk should be checked, and if neither of the above explanations suffice the cause is said to be phlegmatic humor present in the brain. On deformity in children and heredity generally see Hipp. On Generation 1.9-11, Trans. Lonie 1981, 4-5.

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(MT165) Ὥν κατακορέα τὰ στήθεα, ψελλοὶ, μανιώδεες, καὶ φαλακροί· τουτέων ὅσοι ἐκ γενεῆς καὶ στρεβλοὶ, ἀσύνετοι, ἢ λιθιῶντες, ἢ μαινόμενοι· οἷσι δὲ μὴ ἑτέρου κακοῦ λύσις. 823 Later writers speak of constitutional and inherited factors in connection with other mental disturbances. Aretaeus describes two quite opposite temperaments which are prone to mania: those with a propensity to mania are “naturally passionate irritable, of active habits, of an easy disposition, joyous, puerile; likewise those whose disposition inclines to the opposite condition, namely, such as are sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it”.824 Rufus states that some individuals by nature and from the very beginning have the constitution of melancholics - whereas others acquire it from a bad regimen.825 Galen too takes this view, and describes a type of person who develop an excess of atrabilious humors because of their original constitution - people who are then in turn prone to develop melancholy, epilepsy and other such diseases (Loc. Aff. K177 S88). Galen recognized both hereditary and environmental factors in the genesis of disease and part of his influential Hygiene is concerned with the upbringing of children; he advises a judicious regime of diet, exercise and education so that they emerge into a sane and sound adulthood. Neverthless this approach did not blind him to the fact that many children were born “more passionate than they should be, or more dispassionate, or over-sensitive, or insensitive, or unduly greedy” - and in addition there were those born with with slow perceptions and impaired minds.826 Galen attempted to link humoral doctrine with physiological types and thus tried explain mental and somatic features by a single aetiological factor.827 He describes, for instance, the somatic types who develop atrabilious conditions: those who are lean with a rather dark complex, who are hairy and have large veins; pale or fat persons do not possess this type of constitution. On the other hand individuals with very red complexions, also fair

823 Hipp. Epid. 2.6.14 L136, “Those who have excessively deep coloured chests (see LSJ ad loc for the uncertain meaning of κατακορέα)are subject to stuttering/stammering, mania and baldness; for those who are deformed by birth, void of understanding, suffer from stone [or alternatively - are fools], or are insane, for these less than for those who become deformed, it has not been the outcome from another affliction.” I have given the Littré text, although the versions of Mss FHJ and K given in note 4, p. 136, ἠλιθιῶντες - “fools”, seem to me to be more appropriate in this context. 824 MT166 Aret. Morb. Chron. 1 ch. 6 Trans. Adams, Καὶ γὰρ δὴ νοσἐουσι οἱ φύσι ὀργίλοι, ὀξύθυμοι, ῥέκται, εὐμαρέες, ἱλαροὶ, παιδιώδεες· ἀτὰρ καὶ οἷσι ἐς ἐναντίην ἰδέην ἡ φύσις ῥέπει, νωθροὶ, ἐπίλυποι, βραδεῖς μὲν ἐκμαθεῖν, ἐπίμονοι δὲ προσκαμεῖν, ποτὶ καὶ μαθόντες, ἀμνήμονες ... . 825 MT167 Rufus Oeuvres D 357, τινὲς μὲν γὰρ αὐτῶν ἐκ φύσεως καὶ τῆς ἐξ ἀρχῆς κράσεως ἔχουσι τὸ μελαγχολικόν ... . 826 MT168 Gal. Hyg. ch. 8 Trans. Green, p. 26. 827 Siegel 1973, 202; for a discussion of Galen's theories of humors, temperaments, constitutions and somatic types see pp. 173-202.

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complexioned people if the are stressed by lack of sleep, pain, worry or hunger, can suddenly change and become subject to atrabilious excess and to the atrabilious diseases (Loc. Aff. K183-184 S90). The idea of temperament however, appears often in a less specific and rationalized form in many explanations of disease - in that of Aretaeus above, for example and again in a report in Caelius that Asclepiades and his followers, in considering the antecedent causes of phrenitis, among many factors such as excessive wine drinking, exposure to heat, or lack of sleep, spoke also of “the nature of the patient, e.g., if he is of inconstant temperament and easily angered, or much devoted to reading, or if his head is weak and prone to feel congestion, or if he is easily subject to mental aberration whenever he suffers from illness.”828 Elsewhere in Caelius, in his discussion of effeminate men or pathics, several explanations which assume an inherited temperament are offered for this disorder: Parmenides, according to Caelius, claimed the condition to be the result of circumstances at conception; other writers (anonymous) are said to have described effeminate men as the result of disease passed on in the seed and inherited from generation to generation.829 Caelius himself, along with his mentor Soranus, describes the disorder not as the outcome of a physical condition but rather as an affliction of a diseased mind (corruptae mentis vitia). Indeed, Soranus goes so far as to call the disorders suffered both by men who wish to play the female role in sexual intercourse and by women who are bisexual (tribades) afflictions of a “corrupt and debased mind” (malignae ac foedissimae mentis passio).830 It is unclear whether Caelius or Soranus themselves viewed diseases of the mind such as they termed these to be the result of heredity. Certainly they appear to have despaired of a cure - often the sign of a disease considered to be innate and established.831 III. Qualities and States Allied to the concepts of humors and temperaments were the conceptual categories of qualities or states - dryness, moisture, cold and heat. All bodies partook of these and diseases could be explained in terms again of an excess of one or more of these, either alone or in combination. Hippocrates is misquoted by Caelius as saying in connection with epilepsy: “Whoever understands the causes of dryness, moisture, cold, and heat in the human body will also be able to understand the principles of this disease.”832 In the Hippocratic corpus some writers saw the body's

828 MT169 Cael. Aur. Morb. Acut.. I 2, 33, naturam inquiunt aegrotantis, ut si fuerit mente mobilis atque iracundus, vel in disciplinis literarum exercitatus, aut capite debilitato et facile inflationem sentienti, vel si quoties aegritudine afficitur facile alienatione vexetur .. See also considerations of the patient's nature in states of lethargy, Morb. Acut II 2, 12. 829 Cael. Aur. Morb. Chron. 4.9; Parmenides, 134; leaders of other sects, 135-136. “These physicians place the blame rather on the human race, because, having once incurred the defects, it retains them and cannot rid itself of them by any kind of renovation, and leaves not opportunity for a fresh start”. Trans Drabkin, p. 905. 830 Cael. Aur. Morb. Chron. 4.9, 131-133. 831 See below on cures.ch. 9. 832 MT170 Cael Aur. Morb. Chron. I 4, 131; quisquis in humano corpore agnoverit siccandi vel humectandi aut frigidandi vel calefaciendi causas, idem etiam istius passionis poterit videre rationem. cf. Hipp. Morb. Sacr. 18,

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composition in terms both of the primary elements and the four qualities. In Regimen I for example, the human body and the soul are described as a blend of the fiery and watery elements (3, Loeb 4,230). Fire contains the hot and dry, water the cold and moist (4, Loeb 4, 232). From time to time one element dominates the other; the person in whom fire dominates is more prone to madness.whereas the person in whom water gains mastery is described as slow, silly, senseless, or “grossly stupid” and “imbecilic”.833 The author of The Sacred Disease , in his discussion of the role of the brain in psychic health and disease, clearly indicates the importance of a balance of the four qualities: (MT172) τῷ δὲ αὐτῷ τούτῳ καὶ μαινόμεθα καὶ παραφρονέομεν, καὶ δείματα καὶ φόβοι παρίστανται ἡμῖν, τὰ μὲν νύκτωρ, τὰ δὲ καὶ μεθ᾽ ἡμέρην, καὶ ἀγρυπνίαι καὶ πλάνοι ἄκαιροι, καὶ φροντίδες οὐχ ἱκνεύμεναι, καὶ ἀγνωσίαι τῶν καθεστώτων καὶ ἀηθίαι. καὶ ταῦτα πάσχομεν ἀπὸ τοῦ ἐγκεφάλου πάντα, ὅταν οὗτος μὴ ὑγιαίνῃ, ἀλλὰ θερμότερος τῆς φύσιος γένηται ἢ ψυχρότερος ἢ ὑγρότερος ἢ ξηρότερος, ἤ τι ἄλλο πεπόνθῃ πάθος παρὰ τὴν φύσιν ὃ μὴ ἐώθει. καὶ μαινόμεθα μὲν ὑπὸ ὑγρότητος. (Morb. Sacr. 17, Loeb 2, 174) It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts that are contrary to habit. These things that we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist, or dry, or suffers any other unnatural affection to which it was not accustomed. Madness comes from its moistness. Much later in the tradition, Aretaeus explains most mental disturbances in terms of these same qualities: epilepsy is caused by coldness with humidity, melancholy and mania are caused by dryness and heat- mania especially is hot and dry, and is contrasted with the state of senility which is a result of coldness in the system.834 Rufus describes the melancholy humor as cold and dry and emphasizes the state of dryness which explains many of the symptoms and delusions of melancholics - such as imagining they are made of parchment or terra cotta (D 355). Elsewhere, however, he explains that the melancholic humor becomes black [bile] either from overheating or overcooling, using vivid metaphors of blackened extinguished coals and sunburned desiccated bodies and fruits (D 356357). The melancholic humor is described too as producing particularly violent and dangerous symptoms in people

Ὅστις δὲ ἐπίσταται ἐν ἀνθρώποισι τὴν τοιαύτην μεταβολὴν καὶ δύναται ὑγρὸν καὶ ξηρὸν ποιέειν καὶ θερμόν καὶ ψυχρὸν ὑπὸ διαίτης τὸν ἄνθρωπον, οὗτος καὶ ταύτην τὴν νοῦσον ἰῷτο ἄν, εἰ τοὺς καιροὺς διαγινώσκοι τῶν ξυμφερόντων, ἄνευ καθαρμῶν καὶ μαγευμάτων καὶ πάσης ἄλλης βαναυσίης τοιαύτης. “Whoever knows how to cause in men by regimen moist or dry, hot or cold, he can cure this disease also, if he distinguish the seasons for useful treatment, without having recourse to purifications and magic.” (Test TLG; Trans. Loeb, 2,183). 833 MT171 Hipp. Reg. i 35, Loeb 4, 290: fire - ... ὑποµαινοµένους· ἔστι δὲ ἔγγιστα μανίης τὸ τοιοῦτον· καὶ γὰρ ἀπὸ βραχείης φλεγμονῆς ἀσυμφόρου μαίνονται ... Loeb 4, 286: water - ... βραδυτέρην [ψυχήν]; ἠλίθιοι; ... οἱ μὲν ἄφρονας ὀνομάζουσιν, οἰ δὲ ἐμβροντήτους. ἔστι δ᾽ ἡ μανίη τοιούτων ἐπὶ τὸ βραδύτερον· ... 834 Aret. epilepsy, Morb. Chron. 1 ch. 4; melancholy and mania, Morb. Chron. 1 ch. 5; mania and senility, Morb. Chron I ch. 6; For the combinations mania and heat and blood and melancholy and heat, black bile and dryness see Morb. Chron I ch.6.

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when it is in the process of being heated (D 358). According to Rufus, other disturbances which affect the mind may be caused by humidity or dryness alone or in combination - the accompanying symptoms differ: humidity alone brings prolonged and deep sleep; dryness alone, insomnia; coldness with humidity makes a constitution lethargic and somnolent, but if, however, humidity dominates the coldness in such cases, loss of memory results and fatuity (μώρωσις).835 Galen developed an elaborate system of diatheses based on relative proportions of heat and cold, moisture and dryness and on relative balance or imbalance of the humors. He describes many conditions in which damage to the mental powers occurs as involving a cold diathesis: loss of memory, loss of reason, lethargy, all types of carus (coma), torpor and sinking spells (Loc. Af. K160-162 S80-81). He also speaks of warm and biliary conditions in which insomnia, delirium and phrenitis could arise (Loc. Aff. K161 S81). Dryness and moisture are causally involved in these conditions too - moisture causing somnolent symptoms and dryness sleeplessness. Galen associated loss of memory with a cold constitution (Loc. Aff. K165 S83). Some kinds of convulsions may be caused by dryness and a depletion of moistening substance - as in cases incurred by overwork, lack of sleep, want or worry or a dry burning fever such as in phrenitis (Loc. Aff. K172-173 S86). On the other hand, other kinds of convulsions, among them epileptic convulsions, were thought to be caused by an opposite condition - a condition of plerosis or an excess of moisture which , in the case of epilepsy causes thick humor to obstruct the passage of pneuma in the cerebral cavities (Loc. Aff. K172-173 S86). Caelius Aurelianus and the Methodists notably avoid speaking of humors but incorporate some aspects of the concept of qualities into their doctrine of 'communities' or general states (κοινότητες). The basic types of disease, according to Methodism, are “(1) an excessively dry, tense, and stringent state; (2) an excessively fluid, relaxed, atonic state; and (3) a condition which involves both types of abnormality.”836 Accordingly where Caelius does give an aetiology of a disease, in his descriptions of phrenitis for example, he describes the general state - a state of stricture in one type of phrenitis, and in another, a state of stricture mixed with looseness (Morb. Acut. I ch. 7, 52). Paulus continues many of the earlier associations of qualities and disorders of the mind: phrenitis is caused by, among other things, heated bile; frenzy is caused by dryness and heat, and lethargy the opposite, humid, cold phlegm.837 Loss of memory is caused by cold, which may be accompanied by either humidity or dryness (3,11 Adams 372). Epilepsy is a moist condition often accompanied by a “cold aura” (3,13 Adams 376). Melancholy and 835 Rufus Oeuvres, D 364; the term μώρωσις, always problematical to translate - fatuity, dementia, idiocy, and imbecility have all been employed by translators. Other passages in Rufus in which the qualities are discussed in connection with mental function are: D 367, excessive heat or cold causing congestion in the head, and D 459, in which advice is given to avoid excessive or rapid heating and drying of the body in order to achieve good mental function. 836 Drabkin 1950, xvii. 837 Paulus 3,6, Trans. Adams p. 360; frenzy and lethargy 3,9 Adams p. 366 cf. 3,11 p. 372, dryness and heat incur delirium and frenzy.

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mania (which are viewed as separate stages of the same disease) are disorders in which excessive heat is involved (3,14 Adams 383). In addition to considerations of internal states, the effects of external heat and cold, particularly when excessive or ill-timed, are also included in the aetiologies of mental disorders. In the Hippocratic corpus a chill from a bath is said to have brought one woman into a state of mania and death (Epid. 7.1,11 L5, 382-386). Elsewhere fright followed by a chill is given as a cause of derangement (ἐξίσταναι) (Coac. 473 L5, 690). Mania may also result from overheating - as in the case of feverish patients who, we are advised, should not have their heads purged for the medicines used engender heat and result in mania.838 According to Aretaeus, children could become epileptic from excessive cold (Morb. Acut. I ch. 5). And Caelius agreed, stating in addition that either intense heat or severe cold (a chill or a too hot bath) were causative factors in both epilepsy and mania (Morb. Chron. I , 66-67 & 147). Both Caelius and Asclepiades suggest exposure to intense heat as one of the causes of phrenitis.839 Galen recommends a thorough knowledge of the heating and cooling properties of drugs and other substances such as wine, in order to apply them properly, as opposites, to each condition (Loc. Aff. K130-133 S68-69). He notes that cold engenders conditions characterized by somnolence, coma and unconsciousness whereas heat produces sleeplessness and delirium without fever (Loc. Aff. K131 S 68). Using the analogy of the viper he describes how, during the cold of winter it lies as if dead and even when held in the hand will not bite. In summer however, “especially during the heat of the dog-days, [it] becomes raving mad from the great heat because it cannot sleep even for a brief time. Nikandros observed this and wrote about this serpent: ‘even if you are courageous do not try to meet the raving serpent’.”840 IV. Seasonal and Climatic Influences The four qualities are associatively linked to the four seasons and it was customary among many medical writers to indicate specific times of the year, or failing that at least certain climatic conditions, which seemed likely to foster particular kinds of illnesses because of the prevailing heat, cold, moisture or dryness. The Hippocratic author of Airs, Water, Places, elaborately developed such considerations, and observations on season and climate are found not only throughout the Corpus but in much of the long later tradition of medical writing.841 The Hippocratic Aphorisms inform us that “All diseases occur at all seasons, but some diseases are more apt to occur and to be

838 MT173 Hipp. Loc. Hom. 33 L6, 324, Πυρεταίνοντι κεφαλὴν μὴ κάθαιρε, ὡς μὴ μαίνηται· θερμάινουσι γὰρ τὰ τὴν κεφαλὴν καθαίροντα φάρμακα· πρὸς δὴ τὸ ἀπὸ τοῦ πυρετοῦ θερμὸν τὸ ἀπὸ τοῦ φαρμάκου προσελθὸν μανίην ποιέι. 839 Cael. Aur. Morb. Acut. I , 32-33 & 103. 840 Gal. Loc. Aff. K133 S 69; G. goes on to make a connection which has not been made explicit before; he explains the delirium of patients with fever as the result of the burning heat of the fever (K133 S 69). Although a concept of fever as a disease process within the body was present in Greek medicine from Hippocratic times, “it was left to succeeding generations of Greek physicians, and chiefly to Galen ... to set ... clinical experiences within an explicitly articulated general theory”, Nutton 1981, vii-viii. 841 For a discussion of the Hippocratic heritage and ideas about weather and human health see Sargent 1982.

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aggravated at certain seasons” (Aph. 3,19 Loeb 4, 128). “In spring occur melancholia, madness, and epilepsy” (Aph. 3,20, Loeb 4,128). But in addition these same diseases are liable to appear in autumn (Aph. 3,22, Loeb 4, 130). Phrenitis is said to attack most people in the spring (Morb. 2, 72 L7,110), although it is reported in the empirical Epidemics I that phrenitis was most frequent and fatal during the fall and winter.842 Climate as well as season was thought to have significant influence on the development and course of diseases; melancholics and the bilious generally were thought to suffer “if the weather be northerly and dry, with no rain either during the Dog Star or at Arcturus”.843 In the passage cited previously from The Nature of Man in connection with black bile, we should also note that “autumn is the season of all seasons which is most under its mastery” and all bilious diseases including melancholy were traditionally thought to be autumnal (Nat. Hom. 15, Loeb 4, 40). In this context we might note a case in Epidemics VII which concerns a certain Parmeniscus (MT10), who fell into a state of depression (ἀθυμίαι) and longing to end his life which alternated with periods of well-being. The case is of interest here because the writer notes that the affliction occurred during the autumn - although nowhere is the term melancholy used (Epid. 7,89 L5,446). Epilepsy, according to the author of Airs, Water, Places, is more likely to occur in children who inhabit a city that lies exposed to hot winds - whereas in the opposite case, in a city exposed to cold north winds, the incidence of epilepsy is lower but the rare cases which do occur are violent (ἰσχυρά) (Aer. 3 Loeb 1, 74 & 4 Loeb 1, 78). Epilepsy is one of the diseases said to arise in rainy weather (Aph. 3, 16). The author of The Sacred Disease gives climatic and seasonal factors a large role in the aetiology of the disease MT175): “This disease styled sacred comes from the same causes as others, from the things that come to and go from the body, from cold, sun, and from the changing restlessness of winds.” (Morb. Sacr. 21 Loeb 2, 183) He describes the effect on the brain and its humors of the sudden chilling and heating associated, among other things, with climatic factors. Children who are attacked by epilepsy usually die if the flow of blood and phlegm through their veins is copious and accompanied by a south wind. If however the humoral flux is slight and the wind is in the north, they can recover without any mark of the disease on their body (Morb. Sacr. 11, Loeb 2, 162). Again, the south wind suddenly coming after north winds can cause a state of loosening and relaxation in the brain and a dangerous flux of phlegmatic humor causing a seizure. In older epileptic patients winter is “the great enemy” with its extremes - the head and brain are heated (or overheated) by the fire and then chilled out of doors. A similar risk is run in the spring if the head is struck by the sun (Morb. Sacr. 13 Loeb 2,166). In patients who have been epileptic from birth, a pattern is thought to have been developed whereby an attack occurs whenever there is a change in the wind - particularly if the wind is from the south (Morb. Sacr. 14 Loeb 168). The author explains the effects of the changes in the winds on the mind:

842 MT174 Hip.. Epid. I 18 Loeb 1, 172, “About the equinox up to the setting of the Pleiades, and during winter ... cases of phrenitis were most frequent at this time, and most of them were fatal”; cf. 22 Loeb 1, 178, “During winter, near the time of the winter solstice, and continuing until the equinox, ... the phrenitis still caused many deaths ....” 843 Hipp. Aer. 10 Loeb 1, 102; the rising of the Dog Star or Sirius is July 17; Arcturus September 10.

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(MT176) ...the north and south are stronger than any other winds, and the most opposite, not only in direction but in power. For the north wind contracts the air and separates from it what is turbid and damp, making it clear and transparent. It acts in the same way upon everything as well that rises from the sea or waters generally. For it separates the moist and the dull from everything, including men themselves, for which reason it is the most healthy of the winds. But the action of the south wind is the opposite. ... All ... things feel the effects of this wind, and become dull instead of bright, hot instead of cold, wet instead of dry. ... Since then it ... makes the body feel its effects and change with the changes of these winds, of necessity a south wind relaxes and moistens the brain and enlarges the veins, while north winds press together the healthiest part of the brain (ὑγιηρότατον τοῦ ἐγκεφάλου), separating the most diseased and moist (νοσηλότατον καὶ ὑγρότατον), and washing it out; for which reason the fluxes occur at the changes of these winds. (Morb. Sacr. 16 Trans. Loeb 2, 170-172) Celsus concurs with the Hippocratics in anticipating both in spring and in autumn “those maladies which arise from black bile” (2.1.16). In spring the movement of humor is stirred up bringing, in addition to melancholy, madness (insania) and epilepsy (morbus comitialis) (2.1.6). On the other hand, Celsus adds that summer is not exempt from the list of spring diseases and in autumn “there is scarcely one of the foregoing which does not happen” (2.1,7 &8). Wet weather is considered conducive to epileptic fits and when the south wind prevails throughout the winter and spring “the insanity of those in fever which is called phrenesis, [is] very rapidly fatal.” (2.1,12 & 2,1,15) Rufus stated that melancholy occurred less in winter, when digestion was good; and second to winter was summer, for in summer the stomach is relaxed and all superfluities dissolved (D 455). Spring was considered by Rufus to be a time when the blood was increased, appeared thick and turbid and moved with its superfluities through the body like waters of fountains, et movetur in corpore cum aliis eius superfluitatibus, sicut aquae fontium in hoc tempore (D 523-524). In spring, therefore, the melancholic humor was thought to invade the veins rather than the brain itself and through these move upward to the brain (D 457). Spring was a particularly dangerous time, when the blood heated and dispersed throughout the body the excesses generated in it over the winter (D 524). Aretaeus, who classified melancholy and mania as two phases of a single illness, said that they were engendered in summer and autumn, but that spring brought each of them to a crisis.844 Spring was also a season which might bring on a relapse in persons who seemed to have been freed from mania (Morb. Chron. I ch. 6). Asclepiades is reputed by Caelius to have assigned phrenitis to very hot weather, particularly to the end of the summer and the autumn (Morb. Acut. I, 31). Caelius on the other hand, in his customary manner, denied that there

844 Aret. Morb. Chron I ch 5; cf. Morb. Chron. Ther. I ch.5 - a cure for melancholy to be undertaken in the spring.

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were specific seasons for phrenitis and that exposure to.heat could be its cause.845 He also stated that epilepsy could occur during all seasons - but that it was especially prevalent in the spring (Morb. Chron. I, 71) Other anonymous medical writers cited by Caelius suggest that lethargy most commonly occurs in mid-autumn and strongly advise the physician to consider the seasons of the year and the climate as factors when making their diagnoses - to enquire for example whether lethargy is common in the region (Morb. Acut II, 12). Galen too advises a careful scrutiny of seasonal and climatic factors when making diagnoses, particularly of atrabiliar diseases: “Quite helpful for a better founded diagnosis is a knowledge of the time of the year and of the past and present conditions [katastasis, climate and environment], of the particular location (chorion) and the age of the patient.” (Loc. Aff. K185 S91). Galen adhered to the Hippocratic tradition that spring was the season for melancholy and epilepsy; he advised forestalling the rise of such atrabilious and phlegmatic conditions in persons subject to them either by purging or by phlebotomy at the beginning of spring so as to to evacuate any accumulations of humors.846 V. Age and Gender It was widely recognized in antiquity that some disorders (epilepsy is a particularly good example), had different aetiologies, different symptoms, different prognoses and sometimes different modes of treatment depending upon the age of the patient. In addition, many medical writers observe that people at certain stages of life were prone to develop different kinds of mental disorders. Galen recommends that the person's age be taken into careful consideration, not only when prescribing treatment, but particularly when making one's diagnosis (Loc. Aff. K185 S91). Observations about age groups vulnerable to specific diseases are frequently coupled with distinctions in propensities conceived along gender lines. For example, according to Caelius mania was most common in young and middle-aged men, rare in old men, and least frequent in children and women.847 In this section generalized comments in the medical writers will be reviewed, in which age and/or gender are identified as factors influencing mental disorders.

845 Cael. Aur. Morb. Acut. I 23, although see 103 in which C. prescribes venesection as a treatment for cases of phrenitis “arising from ... causes, such as exposure to intense heat (adustio).” 846 Gal. On Treatment by Venesection, K270-272 Trans. Brain 1986, 77-78. 847 Cael. Aur. Morb. Chron I, 146. Caelius as usual dissents from the common tradition that age is of significance in treating diseases; according to him it is an irrelevant criterion, instead of which the strength of the disease and its symptoms should receive primary consideration (Morb. Acut. I , 103). This view, as is readily apparent, does not prevent Caelius from making observations about critical age groups and diseases.

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i. Epilepsy Epilepsy in the Hippocratic Corpus is notably, but not exclusively, a disease of children and the young. The Sacred Disease devotes considerable space to descriptions of the kinds of symptoms and the serious prognosis for the disease in children.848 In Airs, Waters, Places epilepsy is called “the disease of childhood” in addition to “the sacred disease”.849 Epilepsy is also listed among the diseases of young men (Aph. 3, 29 Loeb 4, 132). In Prorrhetic , the discussion of epilepsy in children is in line with that of The Sacred Disease ; but, it adds that the kind of epilepsy which arises in the prime of life (between 25 and 45) is less serious, depending upon where it strikes (Prorrh. 2, 9 L9, 28-30).850 Old people too may succumb to this disease, usually with fatal results - or else have a sudden and spontaneous recovery. In Celsus epilepsy is considered to be a disease of adolescents (2.1, 21). It can, however occur in other stages of life. As in the Hippocratics, fits which commence before puberty are thought to be more curable than those which arise later, particularly after the twenty-fifth year (2.8, 11 & 29). But epilepsy which has its onset after the fortieth year is considered to be untreatable, although the possibility of a spontaneous cure is not ruled out (2.829). Again in Aretaeus epilepsy “dwells with boys and young men; and, by good fortune, it is sometimes driven out in another more advanced period of life, when it takes its departure along with the beauty of youth” (Morb. Chron.I ch. 4). Aretaeus also describes epilepsy as a disease of children, who can contract it from dyspepsia or excessive cold (Morb. Acut. Ther. I ch.5). Caelius too emphasizes the incidence of epilepsy in children, calling it puerilis passio (Morb. Chron. I 60). He recognizes that it occurs also in young and middle-aged people, but notes that it is rare in the elderly. Epilepsy is said to be especially common in children when they are cutting teeth and is more violent in young babies and in persons who are growing old “for weak bodies cannot endure violent diseases” (Morb. Chron. I 70-71). Paulus follows the same general trend of thought, reporting that the disease of epilepsy “attacks mostly the young, more especially infants, and after them boys and adults; but least of all elderly persons and the old.” (3,13) ii. Melancholy and Black Bile Disorders The time of puberty in men and menarche in women marked the onset or cessation of some types of disorders. At this time a type of severe headache accompanied by melancholy was liable to occur both to young men and to young women: (MT178) Αἱ δὲ ἄλλαι νοῦσαι αἱ ἀμφὶ κεφαλὰς ἀνδράσι τε καὶ γυναιξὶν ἀσφαλῶς ἰσχυρόταται καὶ πουλυχρονιώτεραι· γίνονται δὲ καὶ νεανίσκοισί τε καὶ παρθένοισι τῇσιν ἐν ἡλικίῃ, καὶ μάλιστα τῶν καταμηνίων ἐς τὴν πρόοδον. Τῇσι δὲ γυναιξὶν ἐν τῇσι κεφαλαλγίῃσι τὰ μὲν ἄλλα πάντα

848 MT177 Hipp. Morb. Sacr. 8; 11; 13; 14; 15; cf. Aph. II 45 “Epilepsy among the young is cured chiefly by change - change of age, of climate, of place, of mode of life.” (Trans. Loeb 4,119). 849 Hipp. Aer. 3 Loeb 1, 74; In his Commentary on the passage quoted in the above note, Stephanus provides an etymological explanation for the name παιδικόν “children's evil”, used of epilepsy: it is common in children because their bodies accumulate crude humors by greedy eating and indigestion (Westerink, 237). 850 Cf. Steph. Comm. in Hipp. Aph. II, 38 (p.221), “Epilepsy is a disease which is not conformable to old age, but is conformable to the prime of life”.

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γίνεται ἃ καὶ τοῖσιν ἀνδράσιν· αἱ κνιδώσιες δὲ καὶ τὰ μελαγχολικὰ ταύτῃσιν ἧσσον ἢ τοῖσιν ἀνδράσιν, ἢν μὴ τὰ καταμήνια τελέως ἠφανισμένα ᾖ. (Prorrh. 2, 30 L9, 64) The other maladies of the region of the head are undoubtedly more intense and of longer duration: they occur also among youths and girls at the age of puberty, and especially at the onset of menstruation. In these headaches the same symptoms occur for the women as for the men. But the itching and the melancholic disorder is less than for the men - except for those whose menstrual periods have stopped. The prime of life, between the ages of 25 and 45 (as noted in the observations on epilepsy), was when people were considered to be under the influence of black bile and most prone to atrabiliar diseases - including various types of fevers and in particular melancholy.851 According to Rufus melancholy occurs more in men than women, although when it does occur in women it is more serious (deterior) - “for they imagine worse things and their restraint is more difficult.”852 Rufus also claims that adolescents do not suffer from melancholy, but that it does from time to time occur in infants and young children (infantibus et pueris), in the elderly and especially “those who are enfeebled by old age” (decrepitis) , that is those who appear to be suffering from some degree of senility.853 Aretaeus suggests in several passages that melancholy is a disease of the young - although he specifically points to adult men as a vulnerable group.854 According to Caelius, melancholy is most commonly found in middle -aged men; it rarely occurs in women and is uncommon in the other age groups (Morb. Chron. I 181). iii. Mania and Insania Celsus lists madness (insania) as one of the diseases of mid-life (2.1,21). Both mania and melancholy are considered by Aretaeus to be diseases of adult men - however he qualifies this statement several times to include a younger age group: “or of persons of less age than adults” or again “towards manhood and those actually in the prime of life” (Morb. Chron. I ch. 5). Of mania specifically he says, “But in those periods of life with which much heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour.” (Morb. Chron. I ch. 6). Women, he says, are worse affected with mania than men, although it is

851 MT179 Hipp. Nat. Hom. 15 Loeb 4, 40, “This age is that which of all ages is most under the mastery of black bile, just as autumn is the season of all seasons which is most under its mastery.” 852 MT180 Rufus Oeuvres D 455, et imaginantur pejora et earum angustiae sunt difficiliores. 853 MT181 Rufus Oeuvres D 455, ... et maxime decrepitis, eo quod melancolia est eis accidens necessarium et inseparabile: et sunt etiam decrepiti paucorum gaudiorum, malae ordinationis et opinionis, et patiuntur multas ventris inflationes. “and ... most of all the senile, by that necessary and inevitable experience which melancholy is to them: and there are people enfeebled by old age who have few pleasures, are disorganized in their actions and thoughts, and suffer much intestinal gas”. 854 See the discussion below under mania; and cf. Morb. Chron. Ther. I ch. 5.

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implied by his general remarks that men suffer from it more frequently.855 “Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood [sic]; but the others do not readily fall into mania, yet, if they do, their cases are difficult to manage.” 856 According to Caelius in the passage cited at the opening of this section, “Mania occurs more frequently in young and middle-aged men, rarely in old men, and most infrequently in children and women” (Morb. Chron I 146).857 iv. Phrenitis Asclepiades and the leaders of other sects reviewed by Caelius seem to have thought that phrenitis was more serious when it attacked the young (Morb. Acut.1 33 & 40). In addition, men were thought to be more seriously affected with it than women, “since the mind is more vigorous in young people and in men” - and “a disease is more severe when there is general strength to support it” (Morb. Acut. I 40). v. Mental Disorder of Old Age Old age indeed brings innumerable disorders; melancholy has been noted above, but in addition there are other afflictions, often unlabelled, which involve a concomitant loss of mental function in the aged. In the Hippocratic Diseases II, an unnamed syndrome is described which occurs frequently in older persons and which involves pains in the head, loss of the ability to speak and to control bodily functions - in addition, the patient comprehends nothing (ξυνιει δ᾽ οὐδέν). If they regain their senses (ἢ δ᾽ ἔμφρων γένηται) a restorative regimen is prescribed (Morb. II, 21 Loeb 5, 228). Aretaeus describes the dotage (λήρησις) “which is the calamity of old age” as “a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties” which accompanies a person unremittingly until death.858. Caelius cites Soranus in his description of lethargy as an affliction of old people in whom sense impairment and depression are common: frequentare inquit in senibus, siquidem aptior sit sensuum difficultati atque demersioni ipsa

855 MT182 Aret. Morb. Chron. I ch. 5, κἀκιον δὲ ἀνδρῶν αἰ γυναῖκες ἐκμαίνονται; cf. Rufus on women and melancholy above. 856 MT183 Aret. Morb. Chron. I ch. 6, ἐμάνησάν κοτε καὶ γυναῖκες ὑπὸ ἀκαθαρσίης τοῦ σκήνεος, εὖτε αὐτέῃσι ἀπηνδρώθησαν αἱ μῆτραι· ἄλλαι δὲ, ού μᾶλλον δὲ ῥηιδίως ἐκμαίνονται· μάλα δὲ χαλεπῶς ἐκμαίνονται. See below for discussion of uterine causes of mania. 857 In what must properly be called a pseudo-medical passage, the young physician in Lucian’s Bis Accus. describes the causes of mania as being “of one sort with men, another with women, and even among men they are of one sort with the young and different with the aged”. This ‘physician’ also states that women are “affected by many things which easily incline them to this ailment” - notably excessive emotions (30). His assumptions seem to reflect popular beliefs rather than those of the medical writers examined here. It is noteworthy, however, that it is the woman’s madness and not that of the father which is portrayed as incurable - this does seem to be in keeping with the ancient medical assumptions. 858 MT184 Aret. Morb. Chron. I ch.6, αἰσθήσιος γάρ ἐστι νάρκη, καὶ γνώμης νάρκωσις ἠδὲ τοῦ νοῦ ... .

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quoque senectus (Morb. Acut.II 8).859 Yet other anonymous writers seem to have considered middle-age to be a critical time for lethargy (Morb. Acut. II 12). Loss of memory is a mental disorder commonly assumed of the elderly, although it was by no means thought to be theirs exclusively. Rufus, however, makes special note of the elderly in his description of treatment for loss of memory.860 And Galen, who discusses the syndrome at some length, refers to a book on the recovery of memory by the physician Archigenes, in which he advises a certain Marsos on the methods to be used to help his elderly father regain his lost memory (Loc. Aff. K150 S76). Caelius' discussion of effeminacy or pathic homosexuality in men concludes with the remark that this is the only disorder that becomes worse with age. It is particularly prevalent in old men - but it is also found in young boys, for both groups are thought to have less virile powers, the one having been deserted by them, the other not yet having gained them (Morb. Chron IV 137). VI. Emotions The earliest statement in ancient medical literature about the role of emotions in causing mental illness is the much quoted saying from the Hippocratic Corpus: “Fear or depression that is prolonged means melancholia.”861 A variation in Celsus states that, “the black bile disease supervenes upon prolonged despondency with prolonged fear and sleeplessness".862 According to Rufus, much thinking and sadness (cogitatio et tristitia) brings about melancholy, and he describes the subtle onset of the disease which may include a sadness occurring “from some other cause which happens to human beings”.863 In other writers the list of emotional triggers expands. Aretaeus considered anger, grief and sad dejection which overpower the mind, without the operation of black bile, to be the causes of one type of melancholy. Melancholy itself, which consisted in this emotional state was (as noted previously), considered by Aretaeus to be in turn “a commencement and a part of mania” (Morb. Chron I ch. 5). Mania, on the other hand, could be engendered or, if intermittent, could recur, as the result of several factors - among them “the heat of passion” (Morb. Chron. I ch. 5).

859 MT185 Various definitions are given in this chapter which associate lethargy with loss of reason and madness. Caelius himself defines lethargy as a condition of stupor which he say “contains the idea of dejection and madness” (Morb. Acut. II 8). 860 Rufus Oeuvres , D 366; but see also D 459 in which the memories of adolescents are compared unfavourably with those of adult men and methods prescribed to strengthen the faculty. 861 MT31 Hipp. Aph. 6, 23 Loeb 4, 184, Ἢν φόβος ἢ δυσθυμίη πουλὺν χρόνον διατελεῃ, μελαγχολικὸν τὸ τοιοῦτον. The passage is quoted by Galen (among others) as centrally important for a diagnosis of melancholy (Loc. Aff. K188 S92). 862 MT186 Cels. 2.7,20, At si longa tristitia cum longo timore et vigilia est, atrae bilis morbus subest. 863 MT187 Rufus Oeuvres 455-456, ex causa alia accidenti in hominibus.

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Aretaeus thought too that the several precipitating causes of epileptic convulsions included an emotional one, “lowness of spirits” (ἐξ ἀθυμίης). Asclepiades, according to Caelius, asserted that loss of reason (mentis alienatio ) may be incurred by a variety of external and internal causes, and notably in people who “were under the influence of profound anger or great fear or grief” (Morb. Acut. I , 6). Caelius himself considers emotional factors to be important both at the onset and during the course of any disease, stating (MT188), “For if healthy people in many instances incur bodily illnesses because of a troubled state of mind, it is not surprising that those who are not yet cured of a disease should suffer a relapse when their mental state has, so to speak, dealt a wound to their sickbed.” (Morb. Acut. I, 99) Several different emotions are noted among the precipitating factors in a variety of mental disorders: melancholy may result from “grief, fear” and (somewhat vaguely), “other circumstances” (et cetera ) (Morb. Chron. I, 181); mania may arise from “anger, grief, anxiety, or superstitious fear” (Morb. Chron. I, 147). In phrenitis, as in other diseases, “tedium or sadness often has the effect ... of exciting the malady anew”.( Morb. Acut. I , 99). Caelius also remarks on the working of anxiety in his discussion of the causes of incubus or nightmare, saying that “many patients by trying to imagine or conceive what is to be, cause their diseases to become active almost at will” (Morb. Chron. I, 59). Galen's observations on the role of emotional factors in disorders are very similar to those of Caelius, in fact Galen's works are rich with references to “how the body tends to be affected by mental conditions”, and more specifically his colourful demonstrations that “the pulse is altered by striving and fears that suddenly upset the mind”.864 His instructions on the correct raising of children underscore his belief that emotional and somatic factors are essentially interrelated and he warns that it is important always to provide what an infant needs before “their distress increases and throws the mind into excessive and disordered activity along with the body.” (Hyg. ch 8, Green 27) The actions of mind and body are clearly seen by Galen to be reciprocal, for although he stated clearly that the activities of the humors and the whole constitution of the body influence and change the activity of the soul or mind (Loc. Aff. K191 S93), he also believed that “... anger, weeping, rage, sadness, excessive worry and great wakefulness ... kindle fevers and constitute the beginnings of severe diseases; just as on the other hand slowness of perception and imperfection and an altogether impaired mind produce much disease and atrophy” (Hyg. ch. 8, Green 26). Epileptic convulsions for example, could demonstrate both somatic and emotional causes at work for, according to Galen, they could be precipitated by worry and anger on top of a state of severe hunger.865 Fear as a causal agent in mental disorders has been noted in the discussion above in conjunction with several other emotions. But severe fear, a fright or a shock seem to have been singled out more than other emotions in the context of mental disturbances. In the Hippocratic Corpus, in addition to the association between fear and the development of melancholy, we are informed that an epileptic attack may be caused “by fear of the mysterious, if the patient be 864 Gal. On Prognosis, Nutton 1979,105. 865 Gal. Hyg. ch. 14, Green 275; cf. above MT145 and a similar anecdote.at Loc. Aff. K340 S152-153, where “emotional upset” is cited as one of the causes.

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afraid at a shout, or if while weeping he be unable quickly to recover his breath, things which often happen to children.” (Morb. Sacr. 13). And elsewhere in the Corpus, treatment is suggested for “those who have become deranged (ἐξίστανται) because of a fright with a chill on top of it” (Coac. 473 L5, 690). Among Celsus' classifications of types of insanity is a delirium caused by fright, which occurs rarely but is similar in configuration and treatment to other kinds of insanity - with the exception that for this type of madness alone wine is given as a cure.866 As noted above, both Asclepiades and Caelius indicated fear to be a causal factor in loss of reason and in mania and melancholy respectively. The story from Apollonius which Caelius reports about the the grammarian Artemidorus and the crocodile was used to demonstrate the capacity of sudden and extreme fear to induce loss of memory and what Apollonius (and others) called a form of mania (Morb. Chron I , 151). Both Asclepiades and Caelius agree with the Hippocratics in understanding the onset of epilepsy too to be at times linked with extreme fear - or even precipitated by a fright from a loud noise or a shout (Morb. Chron I, 61 & 66). Finally Paulus gives as one of the precursors of epileptic attacks “terrifying visions and dreams” but here the experience is described more as a prodromal symptom than a cause (3, 13 Adams 376). VII. Strain, Stress, Overwork, Fatigue, Hunger In addition to impacts from specific emotions, some medical writers describe more general mental and physiological states as having a place in the aetiologies of mental disorders. Rufus warns that the strain of too much purging could be a stress on the body leading to loss of memory and instructs the patient to guard against fatigue - especially in the mind itself (D 366 & D371). He also attributes melancholy to the strain of “much thinking and sadness” (multa cogitatio et tristitia ) (D 455). Asclepiades in Caelius gives as one of the antecedent causes of phrenitis lack of sleep (Morb. Acut. I , 33). And Caelius, in turn, suggests continual sleeplessness as one of the causes of mania, along with “a shock or blow, [or] intense straining of the senses and mind in study, business or other ambitious pursuits” (Morb. Chron. I , 147). Galen several times warns of the danger to the mind of going for long periods of time without food. Epilepsy in particular was thought to be precipitated by an empty stomach, indigestion or fasting. Galen cites several case histories in which individuals (usually scholars) suffered epileptic convulsions from their propensities to go for long periods without eating, or with a very meagre diet, when involved in intense study or meditation, or when emotionally upset.867 Loss of memory too could be caused by overwork, loss of sleep and/or a meager diet, as in the cases of the scholar and the vine dresser cited above.868 An atrabilious constitution and a concomitant predisposition to atrabiliar diseases such as melancholy and epilepsy could be induced in certain somatic types by such stresses as sleeplessness, intense pain, worries or anxieties or a meager diet (Loc. Aff. K183 S90 & K184-185 S91). Paulus continues with this causal tradition; epileptics whose disorder comes from the stomach may suddenly fall into paroxysms “when fasting, or during a delayed meal” (3, 13 Adams 376).

866 MT189 Cels. 3.18, 24, Raro sed aliquando tamen ex metu delirium nascitur. Quod genus insanientium specie . ... * similique victus genere curandum est praeterquam quod in hoc insaniae genere solo recte vinum datur. *indicates a lacuna for which Marx suggest species similes habet; see text and note, Loeb 1,302. 867 Gal. Hyg. ch. 14 Trans. Green, 275; On Venesection against the Erasistrateans at Rome K241-242 Trans. Brain, 63; Loc. Aff. K340 S152-153. 868 Loc. Aff. K165 S83, MT145.

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VIII. Ingestion of Substances i. Milk As early as infancy the mind of the child was seen to be affected by the quality of the milk it received when nursing. Soranus believed that the embryo while still in the womb could handle whatever the mother ate and drank, but that after birth, when on its own, the infant was weak and susceptible and required a slow progression of foods and drink. In particular, as was repeatedly emphasized in a long succession of gynecological writings, it was essential to attend to the diet and activities of the wet nurse (or, more rarely, the mother) in order to ensure that her milk supply remain safe for the child.869 It was thought by Soranus, for example, that if the wet nurse drank wine too soon and in too great a quantity, the child would be seized by epileptic convulsions. In addition a nurse was warned not to feed an infant too frequently at night, for new milk ingested on top of old milk causes it to spoil and “if the milk becomes spoiled and sour, the nervous system suffers and epilepsy and apoplectic attacks take place.” (2, 27 &38 Trans. Temkin) ii. Wine Later in life the drinking of wine, perhaps of the wrong type, in the wrong quantities or strengths, or at the wrong time, is held to be responsible for a variety of mental disorders. The case cited in earlier discussion of Timokrates of Elis who drank a great deal and became manic as a result of black bile, demonstrates some assumptions which appear to have been regularly made about the role of excessive drinking in precipitating patients into delirious or manic states.870 The same may be said of the prognoses projected in another category of cases where the physician is told that “If the patient is in the prime of life, and his body is in good condition from exercises, or if he is subject to dark bile, or if his hands tremble from drink, it is good to predict derangement (παραφροσύνην) or convulsions.”871 And in Diseases II the treatment and prognosis is described for a person who has lost his speech as a result of drunkenness; among the possible symptoms of the course of this disorder is “talking nonsense” (φλυηρῇ) and raging madness (μαίνεται) (Morb. II 22 Loeb 5, 230). According to Rufus drunkenness is one of the key factors causing loss of memory (D 459). Aretaeus too is concerned with the effects of wine on the mind. He makes a distinction between the delirium which is inflamed by

869 Soranus Gyn. 2, 17-29; Galen Hyg. ch. 9 Trans. Green, pp.29-30; Aetius 16, 36 (Ricci); Paulus 1, 3-4; Steph. Comm. in Hipp. Aph. II, ,(Westerink, 237) suggests that the milk of the nurse of a child with epilepsy may be at fault. 870 Hipp. Epid. 5.1,2 L5,205, MT7. 871 Acut. [Sp,] 29 Loeb 6, 292; cf. a case which has been acknowledged by several scholars as a description of delirium tremens at Epid. III, 5 Loeb 1, 226-228; see Adams' comm. ad Paulus 3,21 p. 409 and Paulus 3,21, “The Tremblings”. On alcoholism in antiquity see Rolleston 1927; Leibowitz 1967.

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drunkenness or the ingestion of certain drugs and mania proper, which is a more long-term disorder.872 He does, however, specifically warn that the diet and mode of life which predispose a person to mania (and in some cases, melancholy) include among other things, drunkenness. Even those who are aroused to Aretaeus' special species of religious mania become so through the agencies of music, communal revelry, and drink (Morb. Chron 1, ch.6). Asclepiades and his followers list excessive drinking of wine among the antecedent causes of phrenitis, and in addition they say that if wine is given to a phrenetic patient, the result will be an aggravation of mental disturbance (alienatio mentis).873 Caelius points to wine as a precipitating cause in a number of mental disorders; it is one of the causes of phrenitis and one of the causes of permanent damage to the mental faculties of those who have succumbed to the disease. Caelius comments on the custom of both laymen (quos idiotas appellant) and physicians of giving wine to phrenetics, saying that is such cases there is danger of death and that “insuperable mental derangement” has been caused in cases of phrenitis by giving wine at the wrong time.874 Caelius speaks of drunkenness as a form of mental derangement (mentis alienatio) which constant drinking aggravates, and he ascribes to continual intoxication (or indigestion) the phenomenon known as incubus or nightmare, which he considered to be a possible forerunner of epilepsy (Morb. Acut. I, 151 & Morb. Chron. I, 54). Epilepsy itself “generally occurs or commences after drunkenness ....” (or after several other antecedent factors such as indigestion, extreme fear, or an injury).875 The physician Galen concurs with Caelius here, observing that some patients suffered from epileptic seizures when they had taken too much undiluted wine.876 Finally, according the Caelius, frequent and uncontrolled drunkenness (quod Graeci craepalen vocant) is one of the known causes of mania (Morb. Chron. I , 147). iii. Drugs Several drugs were almost universally recognized in the ancient sources as causing some form of temporary madness. The mind-altering substances most commonly noted by medical writers were henbane, mandragora, poppy

872 MT190 Aret. Morb. Chron I ch. 6, ἐκφλέγει γὰρ καὶ οἶνος ἐς παραφορὴν ἐν μέθῃ· ἐκμαίνει δὲ καὶ τῶν ἐδεστῶν μετεξέτερα, ἢ μανδραγόρη, ἢ ὑοσκύαμος, ἀλλ᾽ οὔ τί κω μανίη τάδε κικλήσκεται. ἐπὶ γὰρ σχεδίου γιγνόμενα καθίσταται θᾶττον. τὸ δὲ ἔμπεδον ἡ μανίη ἴσχει. 873 Phrenitis - Asclepiades apud Caelius Morb. Acut. I, 33 & 147-148; Caelius (23) seems to concur, with the proviso that antecedent causes such as excessive wine drinking may also apply in a number of other disorders, such as lethargy, apoplexy epilepsy and mania. 874 Cael. Aur. Morb. Acut. I, 87-88 and cf. discussion of Asclepiades' methods 147-154. 875 Cael Aur. Morb. Chron. I 61; the physician Diocles as cited by Caelius (131)as advocating venesection in cases of epilepsy resulting from excessive wine drinking or meat eating. See also Adams' comm. ad Paulus 1,95, p. 176 (on wines); Avicenna remarks that “immoderate use of wine induces disease of the liver and brain, and debilitates the nerves.” 876 Gal. Loc. Aff. K341 S153 and cf. the case at K132 S69, in which a young male slave left at home drank a large quantity of old wine. His symptoms were prolonged sleeplessness followed by a “fever from the lack of sleep” and delirium (παραφροσύνη), from which he died.

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and ivy.877 Galen lists several drugs which drive men mad, among them a form of winter cherry, the nightshade plant and henbane (De Simp. Med. 12.145-147). Of another group he states that if they are drunk in quantity “some drive men mad (ἐκμαίνει), others bring death; these include the black oak fern, stinging caterpillar, the thapsia (deadly carrot), the manic strychnon (thorn apple) and arsenic” (De Simp. Med. 11.767).878 Although the effects of drugs are largely temporary (or else fatal), at times certain writers seem to speak of drugs as being the cause of more long-term and labelled pathological mental states. Caelius especially tells us that phrenitis can be caused by drinking a drug “for the antecedent causes of phrenitis are not immutably fixed and perfectly regular” (Morb. Acut.I, 44). Drugs, especially those specifically intended to incite love (a Graecis philtropota apellata) can also be the cause of mania (Morb. Chron. I, 147). And not only mania but melancholy too, says Caelius, may result from the drinking of drugs (Morb. Chron I, 181).

877 See, for example, Aret. Morb. Chron I , Ch. 6, mandragora and hyoscyamus (henbane) cause temporary madness; Asclepiades apud Cael. Aur. Morb. Acut. I, 6, poppy juice, mandragora and henbane cause alienatio mentis; Paulus 5,38, hyoscyamus “brings on disorder of mind (παρακοπήν) like that of persons in intoxication; but is easily cured”; 5,39 coriander, madness similar to intoxication , “those who have taken it talk obscenely”; 5,41, hemlock, disorder of the mind; 5,52, a substance called pharicum which brings paralysis, disorder of the mind and convulsions; 5,53 toxicum, a poison causing “irrestrainable madness leading to various fantasies, so that in the treatment of them they are difficult to cure, and it is rare that any of those who have drunk of it can be saved.” On the nature of these last two see the discussion in Adams’ comm. ad loc. pp.226-228. Cael Aur. Morb. Acut. I, 103, ivy and mentis error. 878 Cf. also 12.145-147.

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iv. Bad Food, Bad Eating Habits, Indigestion As will become overwhelmingly apparent in the succeeding section on the treatment of mental disorders, the kinds of food one eats, the frequency and quantities involved and one's general state of digestion were factors of critical importance in ancient medical thinking for the diagnosis, prognosis and therapy of every type of disease. We have seen in the foregoing discussion that fasting and a meagre diet were thought to be aetiological factors in epilepsy, loss of memory and black bile disorders. The opposite conditions too, excessive consumption of food (and wine) and the resultant states of plethora, indigestion and flatulence, were frequently cited as contributing to most of the aberrant mental states we have considered. Rufus considered melancholy, the action of black bile, and indigestion to be causally linked, for the disease was thought to supervene when the stomach was not relaxed and digestion (and with it the clearing away of superfluities from the body) was in some way hindered and blocked (D 355 - 356 & 455). A bad regimen is said to be responsible for the sluggish and dejected (νωθρὸς καὶ κατηφές) type of melancholy (D 357). Aretaeus also describes the digestive interference of black bile and the flatulent or hypochondriacal form of melancholy, but in his descriptions of the process, indigestion seems to be more a symptom than a cause. On the other hand Aretaeus claims that “voracity, immoderate repletion and drunkenness” (πουλυφαγίη, πλησμονὴ ἄμετρος, μέθη) dispose a person towards mania and he reinforces the role of digestion in the disorder when he informs us that any slight error in the diet may plunge a person who seemed to have been cured back into a state of madness (Morb. Chron. I ch. 6). In addition to mania, Aretaeus thought that in children epilepsy could be precipitated by a bout of indigestion (Morb. Acut. Ther. I ch. 5). According to Caelius, Heraclides attributed some cases of phrenitis to indigestion (Morb. Acut. I, 179), and lethargy also to “a large amount of undigested matter and the thickening of the body fluid” (Morb. Acut. II, 53). Again in Caelius, Diocles is said to have given, in addition to excessive wine drinking, the excessive eating of meat as an antecedent cause of epilepsy (Morb.. Chron. I, 131). Caelius himself agrees, suggesting indigestion not only as one of the causes of epilepsy, but also of incubus (along with intoxication), mania and melancholy (Morb. Chron. I, 61; 54; 147; & 181). For melancholy, in addition to indigestion, he specifically mentions as casual factors acrid food and the practice of habitually vomiting after eating. Galen and Paulus concur with Diocles and Caelius in explaining an epileptic seizure by the disturbances of an upset stomach.879 Poor digestion, usually from some dysfunction of the spleen, produces toxic humors which can cause any number of afflictions of the brain (and eyes), notably epilepsy, hallucinations (paranoiai) or melancholy. In connection with the earlier discussion of humoral theory, Galen's theory of sympathetic affections was previously

879 Gal. On Venesection against the Erasistrateans at Rome , Trans. Brain, p. 63; cf. Loc. Aff. K341 S153, epilepsy from severe indigestion (or from too long without food). In Paulus 3,13, epilepsy caused by the stomach being primarily affected is given a separate mode of treatment.

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outlined, in which a disorder in one part of the body, here the stomach, causes a sympathetic disorder in another, for example the brain.880 What Galen calls hypochondriac or flatulent afflictions arise in the stomach or the upper opening of the gastric cavity (the cardia), but their effects are felt also in the head. Certain kinds of melancholy and epilepsy are thought to be explicable in terms of this process of sympathetic involvement.881 Galen quotes at length a description from Diocles of a melancholic or 'gassy' disease which consists entirely of what sound to be symptoms of severe indigestion (Loc. Aff. K186-188 S91-92). Both Galen and Diocles assume a condition in which the stomach is disordered and inflamed and which in turn causes a change in the blood - it may thicken from the heat or thicken and darken from heating of the bile contained in it. In consequence the intellect is damaged (Loc. Aff. K181 S 89). Galen provides an extensive list of foods which produce an atrabilious condition of the blood and which will predispose an individual to gastrically triggered mental disorders and which, therefore, should be avoided.882

880 Above “Vapours and the Brain”. See also Loc. Aff. K178 S88, “The gastric cavity transmits its affections to the head and the head to the stomach. The [transmission] is made possible by the large size of the nerves which descend from the brain to the upper opening of the stomach.” 881 See Loc. Aff. K179 S88; K189 S93; and in general K185-200 S91-97. 882 Loc. Aff. K183-184 S90-91); the list is notable for containing food of a heavy or dark character; these include: the meat of goats, oxen (esp. he-goats and bulls), asses, camels, foxes and dogs; in addition hare, wild boar, snails, pickled meats and fish, tuna, whale, seal, dolphin, dog shark and species related to the whale. Of vegetables: cabbage, sprouts in brine or vinegar, shoots of mastich, terebinth, and bramble, and the white rose. Pulses: lentil, wheatbreads from bran and others from one-grained wheat or spoiled seed. Heavy and dark wine - especially in large quantities in hot surroundings, and aged cheese.

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IX. Other Physical Causes Overindulgence in sexual activity is noted by several writers as a cause of mental aberrations. Aretaeus gives 'lechery' (λαγνείη) and 'venereal desires' (ἔρωτες ἀφροδισίων) as precipitating causes of mania (Morb. Chron I ch. 6). Caelius, as noted above, warns of aphrodisiacs in connection with mania - and of 'excesses of venery' (amor nimia) (Morb. Chron. I, 147). In fact in lengthy passage contradicting those physicians who prescribe love as a cure for mania, Caelius expressly states that “in many cases love is the very cause of madness” - in fact, he adds, it may well be “a form of insanity” (Morb. Chron. I, 176-177). Galen too attributes some epileptic attacks to overexertion in “untimely sexual activity”.883 When discussing the kind of regime conducive to melancholy, both Rufus and Galen single out lack of exercise as a causal factor. Rufus is specific: ... et multa repletio cibi et vini, et dimissio exercitii faciunt accidere melancolias (D 455). And Galen notes that when a physician suspects that a patient's veins contain atrabilious blood, for a wellfounded diagnosis the causes should be sought. One should enquire first about the patient's dietary habits and, if they appear to be wholesome one should ask “whether he performed exercises, had worries [or suffered from] sleeplessness and anxiety” (Loc. Aff. K184-185 S 91). Epilepsy in particular was thought to be able to be triggered by a great variety of experiences and substances. Many of these have been noted in the above sections; but many others are described in the medical texts either as situations to be avoided or quite openly as tests or proofs of epilepsy. The description in Caelius is typical of many; according to him the dizziness and dimness of vision which signal that an attack is imminent can occur, (MT191) ... aut navem aut rotam figuli celeri motu ferri conspexerint, aut aquam fluentem vel altitudinem aut rupem viderint, aut strepitum vel clamorem audierint, aut vehementer refrixerint, vel ingneis lavacris usi fuerint, aut odoribus nimium bonis vel malis adfecti, ut storacis incensi aut thuris aut bdelli aut gagatis lapidis vel bituminis aut cervini cornu.884 when the patient does something while bending forward, or watches a ship or a swiftly rotating potter's wheel, gazes at flowing water, looks up a great height or a cliff, hears a loud noise or shout, suffers a severe chill, takes too hot a bath, or smells strong odors whether pleasant or unpleasant, such as that of burning storax, frankincense, bdellium, lignite, bitumen, or stag's horn. X. Diseases, Defects, Wounds, and Medical Procedures

883 Loc. Aff. K341 S153, ἀφροδισίοις ἀκαιρότερον χφήσοιντο. Averrhoe says venery induces a variety of bodily evils, among them effeminacy and imbecility, see Adams comm. Paulus ad 1,35 p. 45. 884 Cael. Aur. Morb. Chron. I , 66-67; cf. also Aret. Morb. Chron. I ch. 4, epileptics to avoid river travel or anything revolving, such as a top; Rufus Oeuvres D 363, the smell of asphalt, gagates stone [jet or fossil bitumen cf. Diosc. 5.146] , goat's horn, the smell of roasted goat's liver or eating goat's liver; Paulus 3,13 has a similar list but specifies the liver of a buck-goat cf. Diosc. 2.47.

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The transitory state of delirium in a patient suffering from a severe illness has been noted by several medical writers as a phenomenon distinct not so much in kind but in duration, and treatable by treating the main disease.885 But some of the canonical and more enduring forms of mental derangement were also considered to be the product (or by-product) of other diseased or damaged states. A wound, especially a head wound, often resulted in loss of reason - whether from pain, fever, or a combination of the two is often difficult to tell. According to one Hippocratic aphorism, Ἐπὶ πληγῇ ἐς τὴν κεφαλὴν ἔκπληξις ἢ παραφροσύνη, κακόν.886 Other wounds too could have the similar effects on the mind; in the case of a παῖς recorded in the Epidemics, the patient was wounded in the stomach and liver by a boar and the symptoms are given without temporal or causal connections: he died on the fourth day, his breathing was rapid, he lost his reason, and he had a fever.887 Rufus records the case of a man who was struck on the head with a stone without, however any visible wound. He was initially giddy and unable to speak but later appeared to recover - until 20 days later when “his mind began to wander” (παραφρονεῖν ἄρχεται). At this point a physician was summoned (Rufus) who observed that the man “kept touching his head and was tremulous and wandering” (συνεχῶς μὲν ἁπτόμενον αὐτὸν τῆς κεφαλῆς τρομώδη τε ὄντα καὶ παρακρουστικόν). By questioning others Rufus was able to confirm his preliminary diagnosis that the man's skull had been fractured.888 Caelius too records that both mania and epilepsy could arise from an injury - a blow or a wound. He cites Asclepiades in support of a theory that epilepsy might be caused by a blow, especially one which penetrates the membranes covering the brain (Morb. Chron. I, 61). Mania may have a similar aetiology; it can arise from a shock or a blow - or from the surgical “removal of long-standing hemorrhoids or varices” (Morb. Chron. I, 147). Finally Galen was quite explicit that illusions, hallucinations and mental diseases were all the result of some morbid condition of the sense organs or the brain - whether that condition was the result of birth, disease or damage.889 Galen demonstrated the effects of damaged brain function experimentally on animals and, with respect to mental aberrations, concluded that delirium could be caused by pressure on the brain from the eye muscles being affected.890 He warned that many affections to the head would in turn afflict the mind, saying the “even lay people are of the opinion that one should think first of the head when someone is delirious or his entire mind is affected in some manner” (Loc. Aff. K128 S67). Among the conditions affecting the mind, often

885 Celsus 3.18.2; Cael. Aur. Morb. Acut. I, 3. 886 MT192 Hipp. Aph/ 7, 9 Loeb 4, 196, “Stupor or delirium from a blow on the head is bad.” But see Jones' note ad loc., if the final word, "κακόν is omitted (according to Galen) by certain MSS”, the reading would be “Stupor or delirium follows a blow on the head.” See also Celsus 2.7,28, ubi caput vulneratum est, delirium, after a head wound, delirium and cf. 8.4,1-2 on the mental symptoms resulting from head wounds. 887 MT193 Hipp. Epid. 5,39 L5,230, ἀπέθανε τῇ τετάρτῃ, τὸ δὲ πνεῦμα πυκονὸν εἶχε, καὶ οὐ κατενόεει, καὶ πυρετὸς εἶχεν. See also Epid. 2.3.18 on severe wounds and mania. 888 MT194 Rufus Quaest. Med. 57-58, Gärtner 1970; Trans. Brock, p.121-122. 889Siegel 1973, 157 citing Kühn 7,56. 890 Gal. De Usu Part., 2.3 (Helmreich II,.118, Trans, May 1968).

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permanently, were excessive pressure during the medical procedure of trepannation, severe cauterization of the head, and any serious injury or inflammation of the head (Loc. Aff. K128 S67). Apart from wounds, surgically or otherwise inflicted, diseases and other somatic disorders were known to bring about mania or some form of mental derangement. A description in the Hippocratic Corpus of the symptoms of a fatal liver disease places significant stress on the mental state of the patient: “when this bile breaks out, the patient very soon rages, casts himself about, talks nonsense, and howls like a dog; ... he cannot look up with his eyes, the hairs of his head stand on end”.891 A slightly more bizarre case is reported in the Epidemics (MT6) in which an intestinal worm was believed to have been the cause of a manic condition in a woman (μανικόν τι ἐνῆν) (4,55 L5, 194). Many medical texts are concerned with symptoms which could arise during the course of a disease and cause or signal derangement of mind. For example pulsations in the stomach during a fever were thought to cause the patient to go out of his mind (ἐκστάσιας ποιέουσιν) (Coac. 292 L 5, 648). Celsus reports a variety of physical signs which, when they supervene upon other affections and especially when they are accompanied by fever, indicate the onset of madness.892 The signs are varied; acute ear ache with fever for example, will disturb the mind (mentem turbat), or a woman's breasts, if they become suffused with blood, indicate incipient madness (furor).893 Again,”when swellings which have supervened upon ulcerations subside suddenly, if situated in the back, either spasm or rigor may be apprehended; but if this happens in front, either acute pleural pain or madness (insania) is to be expected” (2.7,17).894 Loss of memory, and its more extreme state, μώρωσις, could also result from a serious disease; Rufus, among others, cites the after-effects of the Athenian plague as an example (D 363). In Caelius, “severe and persistent affections” could bring about phrenitis. Galen makes a general observation with respect to disease engendered mental disorders, when he states that, in cases where delirium has arisen from a primary ailment elsewhere (pleurisy for example), a permanent form of delirium (παραφροσύνη) may remain, persisting in the head when the original disease has subsided elsewhere (Loc. Aff. K133-134 S69). Paulus' explanation is clearly extracted from Galen; he describes a form of epilepsy which arises in sympathy with a colicky stomach or is propagated by means of a cold aura reaching the brain from an affliction in other parts of the body - the leg, the fingers, or even the uterus of pregnant women (for it ceased after delivery) (3,13). A number of diseases associated with sexual and reproductive organs were thought to result in disturbances of mind. For some Hippocratics and later, for Caelius, erotic dreams and especially nocturnal emissions (Oneirogmos),

891: MT195 Hipp. Int. 29, Loeb 6,174, καὶ ὅταν διαρραγῇ, τάχιστα μαίνεται, καὶ ἀναΐσσει, καὶ διαλέγεται ἀσύνετα. καὶ ὑλακτέει ὡς κύων, ... καὶ τοῖς ὀφθαλμοῖς οὐ δύναται ἀνορᾶν, καὶ αἱ τρίχες αἱ ἐν τῇ κεφαλῇ ὀρθαὶ ἵστανται... . 892 Celsus 2.7,17; 20; 21;24-28. C. uses the terms insania, furor, mens labat, mentem turbat, insaniunt and delirium almost interchangeably in these passages; he also speaks of a condition resulting in hallucinations (2.7,20): ut quaedam ante oculos tamquam imagines obversentur. 893 MT196 Celsus 2.7 &26-27 cf. Hipp. Epid. 2.6.32. 894 MT197 Celsus 2.7,17 cf. Hipp. Epid. .2.3.18.

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although normal and explicable, could, under certain conditions, become a disease. It was then thought to be the forerunner or antecedent cause of other diseases such as gonorrhea, epilepsy, and insanity (μανἰα).895 Satyriasis was another such disease. It was thought by Soranus that this disorder was not limited to men but that there was a form which also afflicted women. It was characterized by intense genital itching and pain and, “because of this they develop an irresistible desire for sexual intercourse and a certain alienation of mind (because of the sympathetic relation of the meninges with the uterus) which throws aside all sense of shame ***.”896 In his translation of Soranus' work on satyriasis, Caelius repeats that this disease afflicts both men and women and gives its antecedent cause as “the drinking of drugs for the purpose of arousing sexual desire (Greek satyrica or entatica)” - and also “excessive and untimely venery” (Morb. Acut. III , 175-176). Among the mental symptoms listed for satyriasis are: mental aberration (mentis alienatio), despondency (desponsio), sleeplessness (vigiliae), and wandering of the mind (hallucinatio) (176). The descriptions here of the women so afflicted are even more vivid; they experience all of the symptoms of the men (but the itching is more intense), and “they accost all who come to see them, and on their knees beg these visitors to relieve their lust” (177). Aretaeus, who can't resist moral judgements, calls satyriasis “a most acute, disgusting, and unseemly ailment” (ὀξύτατον ἠδὲ ἀτερπὲς, ἠδὲ ἄκοσμον κακόν) (Morb. Acut. II ch. 12). He describes the effects of this disease on the personality of the patient: (MT199) περιστελλόμενοι, ἡσυχῇ ἐπίλυποι, κατηφέες, ὥσπερ ἀχθόμενοι τῇ ξυμφορῇ· ἢν δὲ ὑπερίσχῃ καὶ τὴν αἰδῶ τοῦ ἀνθρώπου τὸ πάθος, ἀκρατέες μὲν γλώσσης ἐς τὸ ἄκοσμον· ἀκρατέες δὲ ἐς τὸ ἄμφαδον καὶ τῆς τοῦ ἔργου πρήξιος, παράφοροι τὴν γνώμην ἐς τὸ ἄσχημον. κατέχειν γὰρ οὐ δύνανται· (Morb. Acut II ch. 12, Trans. Adams) Wrapped up in silent sorrow, they are stupid, as if grievously afflicted with their calamity. But if the affection overcome the patient's sense of shame, he will lose all restraint of tongue as regards obscenity, and likewise all restraint in regard to the open performance of the act, being deranged in understanding as to indecency; for they cannot restrain themselves .... Contrary to Soranus, Aretaeus specifically denies that women can suffer from this affliction. He agrees that “lust is engendered in women of a humid temperament, so as to induce a copious discharge of the superfluous humors”, but he believes that women's cold nature is not adapted to the disease of satyriasis, nor is it physically possible, for

895 Hipp. Genit. 1,3; see discussion, Lonie 1981, 109f.; and cf. Reg. 1.35. 120-130 Loeb 4, 290, (MT38); Cael. Aur. Morb. Chron. V, 81. 896 MT198 Sor. Gyn. 3.25, Trans. Temkin: καὶ διὰ τοῦτο ἀκἀθεκτος αὐταῖς πρὸς συνουσίαν ὁρμὴ γίνεται καὶ παρατροπὴ τῆς διανοίας ἐπὶ ποσὸν διὰ τὴν πρὸς τὴν ὑστέραν τῶν μηνίγγων συμπάθειαν παραγκωνισσαμένη πᾶσαν αἰδῶ ***. A very similar description is given by Aetius, 16.77 (Zervos).

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“neither ... has woman the parts necessary for erection, like those of a Satyr, whence the affection derives its name; and neither also are men subject to suffocation from the womb, because men have not an uterus”.897 Paulus evidently follows Soranus and Aetius rather than Aretaeus in this matter, saying of satyriasis that “this complaint sometimes, though rarely affects women” (3.56). He makes no additional comments, however, upon its effects on the minds and behaviour of sufferers. Aetius writes of a disease engendered in women which he calls “uterine fury”, and which seems to have some of the same characteristics as the female form of satyriasis discussed above. (MT201) “Uterine fury is an unreasonable behavior of the uterus, involving the brain in sympathy with this disease, and leading to hallucinations and madness.” (16.74, Ricci) This disease is not to be confused with hysterical suffocation (discussed below), for in uterine fury the uterus is not believed to move upward and exert pressure on other organs, but it “sends via the spinal column or some other means inherent to it, whatever defective quality it may have”. It differs somewhat in symptoms too; uterine fury in particular, makes a woman “garrulous, irascible and restless”.898 Moreover: (MT202) Those (subject to uterine furor) become completely mad in sex matters; they imagine (day-dream) and talk about nothing other than coitus, and they have pruritus of the external genitals and they find wonderful pleasure in an attack (of furor?). This disease attacks (those) with a warm body temperature, girls of twenty, virgins and chaste women and those who eat the best (the richest?) foods. And those who are given to pleasure and delights of the spirit, especially if they should be deprived of other acts of venery and libido. This disease is nothing other than an ardor and a raging heat of the uterus, distributed throughout the entire body and brain. (16.74, Trans. Ricci) Hysteria or hysterical suffocation is assigned a place in the pantheon of ancient mental illnesses by historians who, although they recognize that hysteria was viewed solely as a disorder of the uterus in antiquity, nevertheless cannot resist the temptation to see hysteria as a psycho-sexual expression of some of the tensions inherent in the relationships between men and women in ancient society.899 For fuller treatment of hysteria as a medical and social phenomenon the reader is referred to several detailed studies; our interest here is primarily in the ancient

897 MT200 Aret. Morb. Acut. II ch. 12, Trans. Adams; cf. Morb. Acut. Ther. II ch. 11. On hysterical suffocation and men see discussion below. 898 Aetius 16.74, Trans. Ricci; this passage is headed “Concerning Uterine Fury, According to Soranus” and resembles the passage cited above from Gyn. 3.25. The additional material may well have come from Soranus, since there is a lacuna in the Soranus text; alternatively the Soranus text may have been supplemented with other material by Aetius. 899 Simon 1978, ch. 13, “Hysteria and Social Issues”, is an analysis of hysteria in Greek antiquity along orthodox Freudian lines; S. makes a number of rash assumptions about the status of women in Greek society and about hysteria itself, along with some useful insights. Jackson 1969, 378-380 is more cautious in discussing Galen's views on hysteria.

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belief that this uterine disorder was thought to have an effect upon the minds of women and young girls. 900 Women were thought to suffer from hysteria, or hysterical suffocation either a) when the uterus itself became displaced within the body and exerted pressure on other organs and functions, or b) when the uterus became congested with blood and/or humors which then in turn congested and affected functions in the upper regions of the body. When there was loss of consciousness and convulsions, the symptoms of hysterical suffocation were sometimes compared to those of epilepsy - at other times hysteria was said to drive women mad. Some of the relevant passages will be reviewed here, but any observations about the role hysteria may have played in the delineation of mental aberration in antiquity will be deferred to the concluding discussion. The author of the Hippocratic treatise On Virgins speaks at the outset of a general category of conditions difficult to understand: epilepsy, loss of consciousness or apoplexy and intense fears which plague people to the point of madness (ὥστε παραφρονέειν). Some people seem to see hostile daemons at night, during the day, or both night and day, and, as a result of these visions, many of them choke to death (ἀπηγχονίσθησαν). He goes on to say that this occurs more frequently in women than men (“for the nature of women is less courageous and is weaker”) and particularly in young virgins who have not married at the appropriate time. These young women are prone to such visions particularly at the time of their first monthly period and there is a physiological explanation for this: the uterus becomes congested with blood which is given no egress and as the supply of blood increases it rushes up to the heart, (here assumed to be the location of the mind) and as the heart becomes sluggish and numb, “insanity takes hold of the woman.” The blood flows back from the heart and the phrenes only with difficulty for here “the veins are slanted, and it is a critical place for insanity, and suited for madness”.901 When the regions around the heart and phrenes is filled with blood the girl experiences shivering with “erratic fevers” and her behaviour too becomes erratic: (MT204) ... the girl goes crazy (μαίνεται) because of the violent inflammation, and she becomes murderous (φονᾷ) because of the decay and is afraid and fearful because of the darkness. The girls try to choke themselves because of the pressure on their hearts; their will, distraught and anguished because of the bad condition of the blood, forces evil on itself. In some cases the girl says dreadful things: [the visions] order her to jump up and throw herself into wells and drown, as if this were good for her and served some useful purpose. When a girl does not have visions, a desire sets in which compels her to love death as if it were a form of good. When this person returns to her right mind (φρονησάσης), women give to Artemis various offerings .... (Virg. 1 L8,468, Trans. Lefkowitz)

900 For an excellent bibliographic review of the literature on hysteria see Micale 1989. 901 MT203 Hipp. Virg. 1 L8, 466-468, Trans. Lefkowitz, παράνοια ἔλαβεν; ... ἐπίκαιρος ἔς τε παραφροσύνην καὶ μανίην ἔτοιμος. See also a brief but similar passage at Hipp. Superf. 34 L8,504-506.

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But the phenomenon, although common in young girls, was not limited to them alone- all women were subject to displacement of the womb and its subsequent complications. In Diseases of Women a classic case of hysterical suffocation is described in which the woman becomes voiceless, her legs, knees and hands become cold, and her uterus, when palpated, is found to be displaced. Her heart pounds and she gnashes her teeth, sweats profusely - and in short undergoes all the symptoms of someone undergoing an attack of epilepsy. Women in this condition, it is said, “do all sorts of unheard of things” (καὶ ἅσσα ἀπ᾽ οὔατος δρῶσι).902 Similar responses were seen in other women when their reproductive organs malfunctioned in other ways. (MT206) For example, if after childbirth the lochial discharge is displaced toward another part of the body - the head, chest or lungs are suggested - a variety of conditions may result, including death, depending on the the part of the body involved and the duration of the condition. If it goes to the head but drains through the mouth or nose, and if the process is slow, the woman will suffer all the symptoms described above in the case of virgins at their first menstrual period (πἀσχοι ἂν ἡ γυνὴ ὁκοῖα εἴρηται ἀμφὶ τῆς παρθένου, ᾑ (sic) τὰ ἐπιφαινόμενα πρῶτα ὥρουσεν ἄνω). If, however, the lochial discharge moves upward, doesn't drain in the direction of the mouth or lungs, but instead congests the face and eyes, a number of marked physical symptoms occur along with severe mental disturbance; the patient is delirious and suffers from manic hallucinations (καὶ ἀλλοφάσσει, καὶ πράνοιαι γίνονται μανιώδεες) (Mul. 1.41 L 8, 98-100). Hysterical suffocation is a major interest of all subsequent medical writers, naturally more detailed in those who produce specialized gynecological works. Celsus does not, but he does describe the disorder, like Hippocrates drawing a parallel with epilepsy, but distinguishing between the two (4.27 [20]). Soranus' gynecology, on the other hand, is both more descriptive of symptoms and speculative about the causes of hysterical suffocation. than previous writers. Its antecedent causes, for Soranus, may be recurrent miscarriages, premature birth, long widowhood, retention of the menses and the end of ordinary childbearing or inflation of the uterus - in short it can occur at any point in a woman's life. Soranus links hysterical suffocation to epilepsy, apoplexy, catalepsy, lethargy and the “aphonia caused by worms”, but suggests a number of methods for distinguishing among them, notably that in the former, the uterus is either inflamed or retracted. He describes the symptoms, which include aphonia, laboured breathing, teeth clenching, stridor and seizure of the senses, adding that “sometimes [the women] are even deranged” (ἐνιάκις δὲ καὶ παρακόπτειν) (Gyn. 3.26). Soranus also informs us in his discussion of 'atony of the uterus' (a disorder resulting from frequent pregnancies, tensions of the uterus and, especially, too large fetuses), that these women undergo all the same symptoms as those suffering from hysterical suffocation - and moreover some are 902 Hipp. Mul. 2.151 L8, 326; see also MT205 Prorrh. 1.123 L5,552-554, “States of delirium which become audacious for a short time are melancholic; if they are also from female [menstrual] causes they are savage (θηριώδεα) and mostly these things occur together. Ascertain if there are also spasms or loss of voice with deep coma, as in the daughter of the shoemaker; this will begin when there are menstrual considerations.” (γυναικείων παρεόντων). See above n.10.

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seized with melancholic madness and mania (ἐνίοτε δὲ καὶ μελαγχολικαῖς παρανοίαις περιπίπτουσι καὶ μανίαις) (Gyn. 3.47 cf. Aet. 16,69 = 73 Ricci). Aretaeus, for whom famously “the womb is like an animal” in its movements about the female interior, does not specifically give mental derangement as one of the symptoms of hysterical suffocation. But he does posit a link between characteristics of the female mind and the womb: “the affection occurs in young women, but not in old. For in those in whom the age, mode of life and understanding is more mobile (γνώμη πλανωδεστέρη), the uterus also is of a wandering nature (ῥεμβώδης); but in those more advanced in life, the age, mode of living, understanding, and the uterus are of a steady character” (Morb. Acut. II ch.11). Elsewhere, however, in his discussion of mania, Aretaeus is more specific and refers to the same kind of uterine disorder and madness, noted by other physicians: “Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood”.903 In a brief similar passage, Caelius too explains one of the origins of mania as “suppression of the menses in women” (Morb. Chron. I , 147). Aetius too provides a vivid description of the ills that befall women who fail to menstruate. A number of factors, he says, may bring about the cessation of menstruation: among them, strong anxiety, fear or grief (διὰ φροντίδα ὑπερβάλλουσαν καὶ διὰ φόβον ἰσχυρὸν καὶ διὰ λύπην μεγίστην). In addition to various physical symptoms, some women will also show signs of mental disorder: “some lapse into a melancholic state, or even insanity” (ἔνιαι δὲ αὐτῶν καὶ εἰς μελαγχολίαν ἢ μανίαν ἐνέπεσον).904 Galen, the great and experimentally grounded anatomist, denied that the uterus could wander about within a woman's body - but he did believe that it could become retracted or pulled sideways and he certainly believed in the reality of hysterical suffocation, describing it as having many degrees and variations (Loc. Aff. K414 S182-183). According to Galen the disease affected primarily widows, “particularly those who previously menstruated regularly, had been pregnant and were eager to have intercourse, but were now deprived of all this” (Loc. Aff. K417 S184). The cause he attributed to retention either of menstrual flow or of semen (the feminine form of this). Both sexes were thought by Galen to suffer when semen was not released by regular intercourse - in fact, he states, “the retention of semen does greater harm to the body than the suppression of the menstrual flow” (Loc. Aff. K418 S184). He describes the resultant condition; individuals become despondent, dull, inactive, and have sad and hopeless expressions “like melancholics”. Galen gives several histories of such cases, among them one of a widow who was afflicted with a number of symptoms, among them “nervous tension” because of a retracted womb.905 Her serendipitous cure is noteworthy:

903 MT207 Aret. Morb. Chron. I ch. 6, ἐμάνησάν κοτε καὶ γυναῖκες ὑπὸ ἀκαθαρσίης τοῦ σκήνεος, εὖτε αὐτέῃσι ἀπηνδρώθησαν αἱ μῆτραι. 904 Aetius 16.50. 64-74 (= Ricci, ch. 51 and 52). 905 MT208 Gal. Loc. Aff. K420 S185, ... κατεχόντων γὰρ αὐτήν καὶ ἄλλων μέν τινων ὀχληρῶν καὶ νευρικῶν διατάσεων; cf. this story and Aetius 16.68 (Ricci).

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(MT208) εἰπούσης δὲ τῆς μαίας ἀνεσπάσθαι τὴν μήτραν, ἔδοξε χρήσασθαι βοηθήμασιν οἷς εἰώθασιν εἰς τὰ τοιαῦτα χρῆσθαι· χρωμένης δ᾽ αὐτῆς, ὑπό τε τῆς αὐτῶν θερμασίας καὶ τῆς κατὰ τὴν θεραπείαν ψαύσεως τῶν γυναικείων τόπων, ἐγένοντο συνολκαὶ μετὰ πόνου τε ἅμα καὶ ἡδονῆς ὅμοιαι ταῖς κατὰ τὰς συνουσίας, ἐφ᾽ αἷς ἐκκριθέντος παχέος τε καὶ πολλοῦ σπέρματος, ἀπηλλάγη τῶν κατεχόντων αὐτὴν ὀχληρῶν ἡ γυνή. When the midwife told her that her womb was pulled up, she thought that she should employ remedies customarily used for this ailment. On application the heat of this medicine and the contact with her sexual organs provoked [uterine] contractions associated with the pain and pleasure similar to that experienced during intercourse. As result the woman secreted a large quantity of heavy semen and thus lost the bothersome complaints. (Loc. Aff. K420 S185) Suppression of semen was an important factor in causing disturbances of mind, but suppression of the menses was also considered by Galen to be significant. In a lengthy passage cited above, Galen lists the vast array of diseases which women were fortunate as a sex to be able to avoid so long as their monthly purging through menstruation took place. Notable among the conditions were, epilepsy, phrenitis, lethargy, melancholy and madness.906 Aetius, although he retells Galen's story about the widow, dwells less on the mental and emotional effects of hysteria, noting primarily mental languor, sluggishness and a sad appearance. He believes that not only the ascent of the uterus itself or the humors collected in it can cause hysterical suffocation , but also that some transmission from the stomach to the uterus can take place and affect the whole body. The symptoms of the attack of hysteria follow the qualities of the humors involved - if black bile is present, then melancholia or sadness of the soul occurs. He warns that hysterical suffocation is more likely to occur in winter and autumn and “more often in young women, particularly the sexually inclined and the sterile ones, especially if they become sterile because of the excessive use of drugs hindering conception” (16.68, Ricci 71). If the disorder occurs repeatedly, it may, according to Aetius, lead to chronic epilepsy. Aetius also discusses atony of the uterus, following Soranus, and repeats his opinion that in this disorder similar symptoms are found to hysterical suffocation - indeed, “when these women are excited as if by black bile, they become silly and are driven into madness” (ἐνίοτε καὶ μελαγχολικαῖς παρανοίαις συμπίπτουσιν αἱ πάσχουσαι καὶ μανίαις (16.73, Ricci 77; 16.69 TLG). Finally Paulus has little new to add, but reiterates the traditional parallels with epilepsy and the complex of mental symptoms associated with hysterical suffocation: languor of mind, fear, sadness (of the eyes), and mental aberration. Paulus, like Caelius, attributes to uterine conditions not only the disease of uterine suffocation, but also those of epilepsy and melancholy (3.71; 3.13; 3.14).

906 Gal. On Venesection against Erasistratus , K165-166 , Trans. Brain 1986, 26-27. MT162.

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XI. Contagion There was a concept of contagion in ancient medicine which seems to have applied when certain mental disorders were discussed. Caelius, for example, refers to a period at Rome where incubus, a form of lethal nightmare, was reputed to have become epidemic: “In fact, Silimachus, a follower of Hippocrates, tells us that many persons at Rome were carried off by this disease, incurring it through contagion as in plague.”907 Another notable form of contagious madness which seems to have been recognized as such throughout antiquity was hydrophobia, the madness caused by rabies. Nearly all medical writers focus upon the fact that the cause of this disease is some form of contact with a mad dog - although their ideas about the kind of contact required are somewhat exaggerated. Certainly the bite of a mad dog was known to be the most dangerous form of contact, but in addition there are reports of people who had gone mad from more peripheral forms of contact. Rufus tell of a pregnant woman who had sexual relations with her husband, a man who had been previously bitten by a mad dog, neglected to attend to the wound, and subsequently had become mentally deranged and died. When his widow began to show symptoms of hydrophobia, Rufus ordered her foetus to be aborted and claims to have forestalled the full onset of the disease.908 The contagion was thought to be so strong that, according to Aetius, if the saliva of a rabid dog touched the human body it could produce madness (16.68 Ricci 72). Caelius, who gives the most detailed discussion of hydrophobia, states clearly that the antecedent cause is the bite of mad dog - or other animal subject to madness such as wolf, bear, leopard, horse, or ass - but that even the bite of a human being afflicted with hydrophobia was contagious. Although he clearly points to the part of the body which has been bitten as the original and antecedent cause of hydrophobia, Caelius too seems to allow for other, less direct contact in his aetiology (Morb. Acut. III, 116). Some people, he says, go mad “merely from the wafting of an odor from a mad dog”, or as a result of being injured by the claws of a rabid animal. One woman became ill of hydrophobia when her face was slightly scratched by a small puppy, and another case was said to have been caused by a slight scratch of a struggling poultry-cock. “And once when a seamstress was preparing to patch a cloak rent by the bites of a rabid animal, she adjusted the threads along the end, using her tongue, and then as she sewed she licked the edges that were being joined, in order to make the passage of the needle easier. It is reported that two days later she was stricken by rabies.” The disease is one which, says Caelius, perplexes and troubles even the most skilled physicians (Morb. Acut. III, 119 & 122). That may be one reason why he indicates that it is possible for hydrophobia to arise for no apparent reason, “to originate in the body without any visible cause, when a state of stricture, such as that which comes from poison, is produced spontaneously” (Morb. Acut. III , 99-100). If the causes of hydrophobia were understood (albeit rather hazily), the original cause of the madness in the dogs themselves was a mystery to the medical writers. Paulus reports that “dogs for the most part become mad during violent heat, but also , as Lycus, says, sometimes in extreme cold” (5,111). Rufus, on the other hand, explains their madness in terms of poison: the dogs carry a form of poison which acts like the melancholic humor and accordingly 907 Cael. Aur. Morb. Chron. I , 57, memorat denique Silimachus Hippocratis sectator contagione quadam plurimos ex ista passione veluti lue apud urbem Romam confectos. (MT69). 908 Rufus Quaest. Med. 46-49, Gärtner, Trans. Brock, 120-121. (MT113).

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affects those they bite with hydrophobia which he considered to be a species of melancholy (D 447). The elder Pliny (HN 29.100) refers to a worm-like tendon found under the tongues of dogs which was removed in the popular belief that it caused rabies - significantly its name was λύττα (est vermiculus in lingua canum, qui vocatur a Graecis lytta). XII. Divine Causes, Superstitions and Folk Tales Although the medical writers universally distanced themselves from divine or supernatural explanations for diseases, they did from time to time make reference to such beliefs in popular thought. Sometimes this was specifically to refute them in detail, as in the Hippocratic treatise On the Sacred Disease. 909 Caelius is less polemical, and although he himself accounts for epilepsy in strictly somatic terms, he nevertheless gives a full etymological accounts of the terms sacra and its connection in popular thought with the disease: (MT209) ...et sacra, sive quod divinitus putetur immissa, sive quod sacram contaminet animam, sive quod in capite fiat quod multorum philosophorum iudicio sacrum atque templum est partis animae in corpore natae, sive ob magnitudinem passionis. maiora enim vulgus sacra vocavit sacrum dictum mare, sacra domus, velut tragicus poeta sacram noctem, hoc est magnum. (Morb. Chron. I , 60) And it is called 'the sacred disease' either because it is thought to be sent by a divine power or because it defiles the soul, which is sacred, or because it is centered in the head, which, in the judgement of many philosophers, is the sacred abode of that part of the soul which originates in the body, or because of the great power of the disease,for people generally call what is powerful 'sacred'. Thus the sea and a powerful family are called 'sacred'; and the tragic poet speaks of the night as 'sacred,' that is to say, mighty. The link between prophecy and madness which is visible in popular thought is acknowledged by the medical writers, who, although they categorize such people as mentally ill, nevertheless recognize that mysterious powers may be at work. At times in the medical works there are brief and enigmatic passing references to supernatural aetiological factors; Caelius, for example, reports without comment that “the ancients ... associated madness with a kind of prophetic power” (item esse furorem cum quadam vaticinatione veteres posuerunt.) (Morb. Chron. I, 150). However Rufus seems to have reserved some small role for divine causation among the several physical explanations he gives for melancholy, for although unspecified, some kind of supernatural agency is suggested by his statement that at times some melancholics foretell the future and that occasionally the things which they predict come true.910 Paulus reports that indeed some melancholics believed themselves to be divinely gifted with the

909 See discussion above ch. 7. 910 MT211 Rufus Oeuvres D 456, Et contingit quod quidam istorum narrant et somniant praeter solitum et pronosticantur futura, et eveniunt ea quae ipsi praedicunt.

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power of prophecy.911 And Aretaeus' describes a special category of divine mania upon which his thoughts seem to have been rather ambivalent. On the one hand he ascribes the cause of this frenzy to intoxication, flute music, mirth, and the shouted encouragement of those present - on the other hand he states that this madness is of divine (ἔνθεος) origin a mania “of the apprehension (ὑπολήψιος) only”; and that in all other respects such people are sane.912 It may be that Aretaeus was assuming here a dual causation, one underlying cause and several precipitating, but the text is too elliptical for us to be sure. Elsewhere Aretaeus,reports folk beliefs without comment; his remarks on epilepsy resemble in their neutral tone those found in Caelius: (MT210) Ἀλλὰ καὶ ἄδοξος ἡ ξυμμορφή· δοκέει γὰρ τοῖσι ἐς τὴν σελήνην ἀλιτροῖσι ἀφικνεῖσθαι ἡ νοῦσος· τοὔνεκεν ἱερὴν κικλήσκουσι τὴν πάθην· ἀτὰρ καὶ δι᾽ ἄλλας προφάσιας, ἢ μέγεθος τοῦ κακοῦ· ἱερὸν γὰρ τὸ μέγα· ἢ ἰήσιος οὐκ ἀνθρωπίνης, ἀλλὰ θείης, ἢ δαίμονος δόξης ἐς τὸν ἄνθρωπον εἰσόδου, ἢ ξυμπάντων ὁμοῦ, τήνδε ἐκίκλησκον ἱερήν. But also it is reckoned a disgraceful form of disease; for it is supposed, that it is an infliction of persons who have sinned against the Moon: and hence some have called it the Sacred Disease, and that for more reasons than one, as from the greatness of the evil, for the Greek word ἱερὸς [sic] also signifies great; or because the cure of it is not human, but divine; or from the opinion that it proceeded from the entrance of a demon into the man: from some one, or all these causes together, it has been called Sacred. Finally Caelius, in a condensed remark about the role of music and madness, makes a very compressed and puzzling allusion to some sort of nexus of the religious, prophetic and manic. (MT212) ... cum cantilenae sonus caput impleat, ut etiam recte valentibus apertissime videtur, vel certe, ut plerique memorant, accendat aliquos in furorem, qho saepe vaticinantes deum accepisse videantur. (Morb. Chron I , 176) But actually the sound of music congests the head, as is perfectly clear even in the case of healthy persons. In fact, it is abundantly attested that in some cases music arouses men to madness. Thus, as they chant their prophecies, priests often seem to be possessed by the god. C. Summary Remarks

911Paul. 3.14, τινὲς δὲ καὶ δοκοῦσιν ὑπό τινων μειζόνων ἐφορᾶσθαι δυνάμεων καὶ προλέγειν τὰ ἐσόμενα καθάπερ ἐνθεάζοντες, οὓς καὶ ἐνθεαστικοὺς ἰδίως ὀνομάζουσιν. "Some imagine that they are watched over by some greater power and foretell the future just as if they were divinely influenced, and they call these especially the inspired." 912 Aret. Morb. Chron. I ch. 6.

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There are several interesting observations to be drawn from the rather particularist observations we have made about causation and mental aberration. First, frequently the same cause was said to produce a host of different diseases; secondly, and in complete contrast, a great many different causes were suggested for any one single disease, and thirdly, in a causal sense many of these mental disorders were very closely interrelated. The latter is particularly noteworthy, in that many of the mental disorders discussed above were said to be able to bring one another about: according to Caelius, mania could become phrenitis or phrenitis mania; phrenitis turn into lethargy and lethargy become phrenitis; and phrenitis or lethargy could become catalepsy or catoche and vice versa.913 Asclepiades had similar ideas about epilepsy turning into madness, and, according to Aretaeus, the formerly mad could more readily become melancholic. In addition, he thought, melancholy itself could engender incurable spasms, paralysis and mania.914 Galen, in concert with Hippocrates, thought epilepsy could become melancholy and vice versa and that melancholy often succeeded epilepsy.915 This interrelationship of causality seems to reflect the difficulty we have noted previously in constructing categories for mental dysfunctions. Plural causation for complex phenomena is to be expected; and particularly when, as in medical thinking, several levels of causal explanation are operative. The underlying explanatory theories of humors, qualities, temperaments and states, it seems, required in practice to be supplemented by a battery of precipitating or antecedent causes, such as indigestion, chills, lack of exercise or too hot a bath. Sometimes the two levels of explanation were integrated, as in Galen's explanation of the causes of lethargy and karos: a cold diathesis caused by an over abundance of a thick cold humor, phlegm, a condition which can be duplicated by the actions of certain drugs or the eating of large quantities of lettuce (Loc. Aff. K161 S81). At other times the connection was left unarticulated - and a certain level of tension or paradox seems to have been tolerated. The plurality of causes is especially noticeable in diseases that have some mental component, for example the epilepsy, apoplexy, catalepsy, catoche, karos, coma group, in which dramatic physical symptoms dominate but the mind is also known to be affected. Aretaeus' discussion of paralysis, a disorder in which physical symptoms predominate, is a good example of the way in which a variety of causal explanations, some quite contrary, are offered - and here at two levels: (MT213) There are six causes of paralytic disorders; for they arise from a wound, a blow, exposure to cold,indigestion, venery intoxication. But so likewise the vehement affections of the soul, such as astonishment, fear, dejection of spirits, and in children, frights. Great and unexpected joy has also occasioned paralysis, as likewise, unrestrained laughter, even unto death. These, indeed, are the primary causes; but the ultimate and vital cause is refrigeration of the innate heat. (Morb. Chron I ch.7)

913 Cael. Aur. Morb. Acut. I, 48; Morb. Acut. II, 2 & 73. 914 Asclep. apud Cael Aur. Morb. Acut. I 6; Aret. Morb. Chron. I ch. 6; Morb. Chron. Ther. I ch. 5. 915Gal. Loc. Aff. K180, S89; Hipp. Epid. 6.8.32 L5, 354-356, (MT33). cf. also K177 S88; K180 S89.

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But a similar shopping-list can be generated for most of the states we have discussed in which mental symptoms predominate - mania, melancholy and phrenitis. Caelius' suggestions about the causes of mania, for example, are similarly diverse: (MT214) generatur autem frequentius in iuvenibus ac mediis aetatibus, difficile in senibus, atque difficilius in pueris vel mulieribus, et nunc repente invadens, nunc paulatim increscens, et nunc ex occultis, nunc ex manifestis causis, ut et ustio, perfrictio, indigestio, vinolentia frequens atque immodica, quam Graeci craepalen vocant, item vigiliae iuges et amor vel iracundia aut maestitudo vel timor vel superstitio nimia, item concussio sive percussio, et intentio nimia sensuum et intellectus ob cupiditatem disciplinarum vel quaestum pecunialem aut gloriam, item pota medicamina, vel magis ea quae amorem facere videantur, a Graecis philtropota appellata, item detractio haemorrhoidarum veterum sive varicum, aut abstinentia in feminis solitae purgationis. (Morb. Chron. I, 146-147) Mania occurs more frequently in young and middle-aged men, rarely in old men, and most infrequently in children and women. Sometimes it strikes suddenly, at other times it takes hold gradually. Sometimes it arises from hidden causes, at other times from observable causes, such as exposure to intense heat, the taking of severe cold, indigestion, frequent and uncontrolled drunkenness (Greek craepale), continual sleeplessness, excesses of venery, anger, grief, anxiety, or superstitious fear, a shock or blow, intense straining of the senses and the mind in study, business, or other ambitious pursuits, the drinking of drugs, especially those intended to excite love (Greek philtropota), the removal of long-standing hemorrhoids or varices, and finally, the suppression of the menses in women. The readily observable fact that the same causes were thought to produce an array of quite different diseases was noted by Caelius. As an example he observes that phrenitis, lethargy, apoplexy and epilepsy can all be produced by “exposure to heat, indigestion, excessive drinking of wine, exercise after eating, living or sleeping in caves or in rooms in which the walls have been freshly plastered” (Morb. Acut. I, 23) (MT215). Caelius explains that no single aetiological factor, and likewise no single symptom, should be taken in isolation by the physician in his diagnosis rather “all the circumstances must be taken into account”. By this he means all the physical symptoms, the weather, the season, the patient's age and nature and all the antecedent causes must be considered. The diagnosis of a specific disease “is confirmed not by one or two signs but by the concurrence of many, since each one by itself is found in other diseases, too, but the concurrence of many signs make possible a clear differentiation between this and the other diseases.” (Morb. Acut. I , 32-33) This may be the medical ideal; we can only speculate to what extent practitioners in actual cases considered “all the circumstances” and to what extent a salient few sufficed.

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It should also be noted that the medical writers constantly describe men as more susceptible to mental disorders than women, although this is a times tempered with the observation that when women do succumb - to mania for example - the disease is far more difficult to cure. In addition the great majority of the cases described, whether they are of epilepsy, mania, melancholy, phobias or delirium tremens, are of males. There are several possibilities for why this is the case. First, women may not have been treated by physicians to the same extent as men for reasons both economic and social. Secondly, women's minds, as Caelius remarks (Morb. Acut. 1.41), may not have been considered strong enough or highly developed enough to be disordered. Finally, and this is perhaps the chief reason, women's disorders tended always to be seen in terms of their reproductive organs.916 Unless the illness was manifestly located elsewhere, some form of uterine disturbance would normally be held accountable, and in cases where mental and emotional symptoms predominated, it is very probable that this form of socio-medical default system would come into play. Women are present in the medical literature primarily, although not exclusively, in a gynecological context; perhaps the abundance of cases of hysterical suffocation, uterine fury and hysterical convulsions, have absorbed most of the manifestations of mental disorder among women in antiquity.

916Issues involving women, women’s bodies and the medical writers of antiquity (particularly the Hippocratic Corpus) are receiving increasing scholarly attention: see Lloyd 1983, esp. 58-111; Hanson, 1990; and on the cultural construct of the female body, Dean-Jones in Pomeroy 1991, 111-137. She points to physiological bases in Greek medical science for believing (with Padel 1983) that women were closer to the irrational than men - and implies that they were thus more susceptible to madness (p.115). Our observations here suggest that the frequency with which women’s aberrant mental states were linked to gynaecological problems and not to other canonical ‘mad’ states (phrenitis, mania and melancholy) is highly significant.

CHAPTER NINE

The Treatment of Mental Dysfunctions When called upon to treat any individual, but especially one with a mental disorder, in antiquity as now, there are two initial concerns for the physician. First, is this person mentally disturbed? And secondly is this condition curable? More specific decisions about diagnosis and treatment are necessarily subsequent to these primary considerations. A. Is There an Illness? We have seen in the various discussions of epilepsy above that there were thought to be several reliable tests for epilepsy, many of which involved the patient smelling some acrid substance or gazing at a swiftly moving object. Such tests were of particular importance in the slave markets, where the actual practice of selling undeclared epileptic slaves was not necessarily curbed by the legal instruments which were in place, and where caveat emptor had real application. But, if it was important to uncover a concealed disorder, it was also important to expose attempts at malingering - which were not, as some of the examples tell us, found among slaves alone.917 As we have seen from the historical evidence, feigned insanity was a well recognized phenomenon in antiquity and physicians were certainly aware that a case of mania or melancholy could be simulated for a number of reasons. There are several references in the medical writers to a form of testing procedure which the good physician was expected to undertake if his suspicions were aroused about the authenticity of a disease. An early example of this questioning of the reality of a mental disorder may be seen in the Pseudepigraphic Letters, when Hippocrates is called in by the people of Abdera to cure Democritus of his madness.918 His early response to the townsfolk is cautious, and he remarks parenthetically at the close of his letter, "if it is a disease and you are not darkly deceived" (εἰ μὴ καὶ νοῦσός ἐστιν, ἀλλὰ μὴ ἀπάτῃ συσκιάζεσθε) (Ep, II). Later, before he leaves for Abdera, he comments to a friend, "It is my wish, rather my prayer, that he is not truly mad but seems so to them."919 Upon his arrival and at his first meeting with the philosopher, Hippocrates probes to find out "the truth of his affection" (τοῦ πλαθος τῆν ἀλήθειαν) (Ep. 17.2). Right at the outset, with the remark, "And making test of the man in all ways, though it was already obvious to me that he was not really mad ...", Hippocrates asks Democritus a simple question: "Do you know Philopoimen, your fellow townsman?" - a question designed expressly to test the man's grasp of reality, yet tactfully woven into the context of politely exchanged mutual introductions. Here we may have

917 See for example the man summoned to the assembly who feigned (rather badly according to Galen) an attack of colic (Gal. How to Detect Malingerers, Trans. Brock, 226. 918 Above HN35; all citations are from the Smith 1990 edition. Of course the question in this series of letters about the 'reality' of Democritus' madness is really a philosophical issue set in a framework of quasi-medical discourse. 919 Hipp. Pseudepig. Ep . 14, μὴ ἐόντος αὐτὸν παρακόπτειν, ἀλλ᾽ ἐκείνοισιν δόξαν εἶναι. See also Ep. 15 & 16, τῆς λεγομένης μανίης.

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one of the few rare glimpses into the nature of patient-doctor interchanges in antiquity and the tact which was demanded of physicians when dealing with their elite patients. In this connection, an extremely valuable treatise survives from the second century CE by Rufus of Ephesus, On the Interrogation of the Patient.920 Rufus regarded the information which careful questioning of the patient could elicit a vital contribution to the physicians understanding of a disease. He valued the taking of a case history and he recognized that time and process were involved, not only in understanding how a disease had developed, but also in achieving its cure.921 His treatise, which is not specifically concerned with the issue of feigned illness, begins by emphasizing that both the mental and physical soundness of a patient is best revealed by a process of questioning. (MT216) πρῶτον δὲ ἐκεῖνο ὑποτίθημι τὰς πεύσεις αὐτοῦ τοῦ νοσοῦντος ποιεῖσθαι. μάθοις γὰρ ἂν ἐνθένδε ὅσα τε κατὰ γνώμην νοσεῖ ἢ ὑγιαίνει ὁ ἄνθρωπος καὶ ῥώμην αὐτοῦ καὶ ἀσθένειαν, καὶ τίνα ἰδέαν νόσου καὶ τίνα τόπον πεπονηκ[οτ]ὼς . εἰ μὲν γὰρ ἐφεξῆς τε ἀποκρίνοιτο καὶ μνημονικῶς καὶ τὰ εἰκότα καὶ μηδαμῆ σφαλλόμενος μήτε τῇ γλώττῃ μήτε τῃ γνώμῃ καὶ εἰ καθ᾽ ὁρμὴν τὴν οἰκείαν καὶ, εἰ μέν ἐστιν ἄλλως κόσμιος, πράως καὶ κοσμίως, ὁ δ᾽ αὖ φύσει θρασὺς ἢ δειλὸς θρασέως ἢ δεδοικως, τοῦτον μὲν χρὴ νομίζειν τὰ γοῦν κατὰ γνώμην καλῶς ἔχειν. εἰ δὲ καὶ ἄλλα σὺ μὲν ἐρωτᾷς, ὁ δὲ ἄλλα ἀποκρίνοιτο, καὶ εἰ μεταξὺ λέγων ἐπιλανθάνοιτο, αἱ δὲ τρομώδεις καὶ ἀσαφεῖς γλῶσσαι καὶ αἱ μεταστάσεις ἀπὸ τοῦ ἀρχαιόυ τρόπου τὸ ἐναντίον, πάντα ταῦτα πρακρουστικά.922 And I place the interrogation of the patient himself first, since in this way you can learn how far his mind is healthy or otherwise; and also his physical strength and weakness; and you can get some idea of the disease and the part affected. For, if his answers are given in a consecutive way, and from memory, and are relevant, and if he shows no hesitancy either in judgement or utterance; if he answers according to his natural bent; that is to say, if, being in other ways well-bred, he answers gently and politely; or if, on the other hand, being naturally bold or timid, he answers in a bold or timid way, one may then look on him as being at least sound mentally. But if you ask him one thing and he answers another; and if in the middle of speaking his memory fails him; if, again, his enunciation is tremulous and hesitating and he exhibits complete changes of manner; all these are signs of mental inadequacy. Rufus continues with a discussion of signs of physical weakness and disease but then returns once more to disorders of the mind and their clues. 920 Rufus Ἰατρικὰ Ἐροτήματα. The text is in Daremberg's 1879 edition, pp. 195-218; more recently see Gärtner 1970, Quaestiones Medicinales. 921 See discussion below and cf. Rufus Oeuvres, D359-360. 922 Rufus Quaest. Med. 1 Trans. Brock [1929] 1972.

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(MT217) τὰ μὲν γὰρ μελαγχολικὰ διασημαίνει θρασύτης τε καὶ ἄκαιρος λύπη· μάλιστα δὲ ἄνθρωπος καταφανής ἐστι καὶ θαρρῶν καὶ ἀνιώμενος οἷς λέγει, καταφανὴς δὲ καιὶ ἑτέρως ἐστιν· ἀλλὰ [καὶ] ἥδ᾽ ἡ πεῖρα αὐτῷ προσφγένοιτο, σαφῶς ἂν ἤδη διαγινώσκοιτο ἡ νόσος. καὶ ληθάργῳ δέ τις καθέξεσθαι μέλλων δῆλός ἐστιν ἀποκρινόμενος λήθῃ τε ὧν λἐγει καὶ ἀσαφείᾳ γλώττης. οὕτω μὲν οὖν ἐν πυρετοῖς· ἄνευ δὲ τούτων σπασμοὺς καὶ ἐπιληψίας προσδοκᾶν. ὅλως δὴ σύμπαντα, [τ]ἃ τοῦ παρακρουστικοῦ τρόπου ἐστίν, ἐνθένδ᾽ ἄν τις ῥᾷον ἢ ἄλλως κατμανθάνοι. (Quaest. Med. 1) Thus misplaced boldness or depression are signs of melancholia, and it is chiefly by his speech that an individual shows boldness or grief. He shows these also in other ways, but if the physician has the experience we are speaking of as well, he will now easily diagnose the condition. Further, an individual sickening for lethargic fever (lethargus) is observed, when answering, to forget what he says and to be uncertain in his utterance. This happens when there is fever; in default of which, convulsions and epilepsies may be looked for. Generally speaking, if the whole thing is a matter of mental disturbance [ἃ τοῦ παρακρουστικοῦ τρόπου ἐστίν], this is more easily recognized by the method of questioning than by any other. Not only does Rufus point to the necessity and procedures for identifying disturbed mental states during the physicians initial examination, but he also allows for special measures to be taken with respect to people in such disturbed states. He notes that in certain cases questioning the patient him or herself is impossible; the individual may be too weak, too young, too old, or unable to speak the language. In addition, states such as apoplexy, lethargy, catalepsy, and aphasia present obstacles to communication and it is in this context that Rufus also singles out people with "severe mental disturbances" (σφοδρῶς παρακρούων τις) or those with "other forms of mental weakness" (ἄλλως ἠλίθιος). For such people, he says, it will be necessary to question others close to them (τοὺς παρόντας). Galen provides two famous examples of medical detection which show the physician at his most tactful in discovering the hidden psychological causes of apparently physical disorders. In both these cases he questioned the patient as a preliminary, establishing that no somatic conditions underlie the patient's distress. The first case (MT218) is the one reported above concerning a woman troubled with restlessness and insomnia. Having ascertained that none of the usual causes applied Galen concluded that she was suffering "from one of two things: from a depression caused by black bile or from some worry she was unwilling to confess." 923 Galen was refused entry on several subsequent visits, but nonetheless made enquiries from the maid and learned that the woman was "racked with grief". By chance he discovered the cause of this: A man coming from the theatre remarked that he had seen Pylades dancing. "Her expression and facial colour changed, and observing this and putting my hand on her wrist, I found that her pulse had suddenly become irregular in several ways, which indicates that the mind is 923 Galen On Prognosis 6. Trans. & ed. Nutton 1979; the two accounts which follow are both taken from Nutton's edition.

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disturbed: the same happens to those who are entering any sort of contest." He then carried out several tests: he had various people announce at intervals the names of other dancers and then re-introduced the name of Pylades and observed the same reaction. In this way he discovered that the woman was in love with Pylades.924 His second case (MT219) was that of an elderly slave who exhibited the same symptoms as the woman. Galen again could find no physical disorder and speculated that the old man was terrified by the imminent prospect of rendering an account to his master from which he knew a considerable sum was missing. Galen elicited the help of the master in testing his hypothesis and had him announce to the slave that he only required an statement of the moneys in hand, not a full audit of the account, and the slave recovered within three days. Galen's works are frequently enlivened by dramatic anecdotes such as these and he seems in particular to have had a penchant for playing the great detective. Among his works is a fascinating essay, How to detect Malingerers. It begins, (MT220) People pretend to be ill for many reasons, and it would seem a physician's business to discover the truth in all such cases. The laity also reckon him the one to distinguish those who are lying from those who are speaking the truth.925 Διὰ πολλὰς αἰτίας ἄνθρωποι πλάττονται νοσεῖν. δοκεῖ δ᾽ ἰατρῷ προσήκειν ἡ τῆς ἀληθείας εὕρεσις ἐν τοῖς τοιούτοις ἅπασι, καὶ τοῦτον οἱ ἰδιῶται ἀξιοῦσι διακρίνειν τοὺς ψευδομένους τῶν ἀληθευόντων. (19.1.1) He goes on to explain how certain effects are achieved, for example, the spitting of blood after a bout of coughing to simulate consumption, and then remarks, "Others pretend to be delirious or even insane." 926 Unfortunately no details either of their pretences or of his techniques for unmasking them are offered. Caelius, according to one interpretation, does give somewhat more detailed advice about a method for detecting malingering in a patient who is being cured of mania. When the disease is in retreat and the patient's mental aberrations are much reduced, the convalescent is to be soothed with baths and massage and given gentle exercise including vocal exercise as bodily strength recovers. The vocal exercises are to be carefully chosen:

924 Resemblances to the story of Erasistratus and Antiochus are not accidental; Galen refers to Erasistratus in the account he gives. 925 Gal. Quomodo morb. sim.ut sint deprehend.,Trans. Brock, p. 225, Deichgräber and Kudlien 1960, 113-116.; see discussion by Adams Appendix to vol V of Paulus Aegineta, pp.244-246; he cites Galen on feigned diseases and Rhazes on the intricate deceptions performed by imposters in the medical profession. 926 Trans. Brock, p. 226, καὶ παραληρεῖν προσεποιήσαντο καὶ + μωραίνεσθαι + καὶ μωραίνειν ἕτερα τοιαῦτα. (19.2.9-10)

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(MT221) nam literalis etiam lectio adhibenda est, et quae sit aliqua falsitate culpata, quo interius mentem exerceant aegrotantes. quapropter interrogationibus quoque erunt fatigandi, ut nunc mendacii causa, nunc promendi quod quaerimus exerceri videantur.927 Thus have the patient read aloud even from texts that are marred by false statements. In this way he will exercise his mind more thoroughly. And for the same reason he should also be kept busy answering questions. This will enable us both to detect malingering and to obtain the information we require.

927 Cael. Aur. Morb. Chron. I, 162; Trans. Drabkin who notes ad loc.: a) the meaning of interius is here obscure, and b) the interpretation of mendacii causa is conjectural. More context is required properly to understand the statement - it may well simply mean "so as to detect false statements".

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B. Is There a Cure? Having ascertained whether or not the patient is truly mentally disturbed, it is the physician's responsibility to identify whether or not the conditions is curable. A prognosis, and an early one, was essential in all cases of serious illness, for the physician's reputation and livelihood was at stake. As a consequence he might prefer to refuse treatment in order to avoid giving the impression of incompetence - or else he could make clear the fatal prognosis but still prescribe treatments to alleviate symptoms. Even in a situation where the physician himself was unsure of a successful outcome for his treatments, he was well advised to emphasize the danger and possibly incurable state of the patient. Caelius says of epilepsy: (MT222) ac si accessio in secundum diem duraverit, praedicto periculo eius propinquis vel ministris, atque adiutoriorum ex ratione venientium exitum incertum, ne novis quicquam male gestum imputetur, si forsitan vi passionis superatus aegrotans vitam finierit, et intemporaliter nos quisquam adiutorium adhibuisse arguat .... (Morb. Chron.I, 87). Now if the attack lasts to the second day, first inform the patient's relatives or attendants that there is danger and that the result of the remedies to be applied is uncertain, although they are based on reason. The purpose of this announcement is to forestall a charge that the case was mishandled and that a treatment was administered at the wrong time, if it should turn out that the patient is overcome by the violent disease, and dies. And in the Hippocratic Corpus, the phrase which often follows a list of fatal symptoms, "it is good to predict death", communicates something of this same necessity for a physician of being to guard against the professional consequences of failure to heal.928 Some mental conditions were at times pronounced incurable - in particular.epilepsy. The author of The Sacred Disease states that epilepsy is "curable no less than other illnesses, unless by long lapse of time it be so ingrained as to be more powerful than the remedies that are applied." He latter adds that small children who are attacked by epilepsy under certain climatic conditions generally die.929 Other references in the Corpus, reflect the somewhat contradictory conjectures of physicians confronted with the difficulty of curing epilepsy: "Epilepsy among the young is cured chiefly by change - change of age, of climate, of place, of mode of life." (Aph. 2.45 Loeb 4,118) Or

928 On the Hippocratics' concern about whether a condition is treatable or not see Lloyd 1979, 48 n.209. The physician in Lucian Bis Accusat. explains at length the general reluctance of his profession to treat incurable disorders (2; 4; 7). Of the two types of madness (μανία) he is confronted with, one is and one is not curable - the latter apparently because it takes the form of adamant hostility to the physician. 929 Hipp. Morb. Sacr. 5 (Loeb 2,150); 11 (Loeb 2,162); cf. also 14 (Loeb 2,168), recovery is difficult when the disease dates from infancy.

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again, "Epileptic fits that occur before puberty admit of cure (μετάστασιν ἴσχει), but if they occur after the age of twenty-five they usually last until death."930 Celsus too admits that there are epileptics who cannot be cured and says that in such cases, after exhausting all methods of treatment, the physician should simply do his best to mitigate the symptoms with exercise, massage and a dietary regimen.931 There are suggestions that the physician should assess the capacity of an epileptic to be healed before undertaking his or her treatment; the place of origin of the epilepsy should be considered (some parts of the body are more amenable to treatment), and the patient who is young and hardy is to be preferred. Contra indication are: if there is something wrong with the person's wits, or if someone is apoplectic or if there is a propensity to melancholic derangement.932 Apollonius of Kition is reported to have discovered a test to see whether an epileptic was able to be healed: (MT223) Ἐκ τῶν Ἀπολλωνίου εὐπόριστον, εἴπερ ἰάσιμός ἐστι ὁ ἐπιληπτικός. Ἐπειδὰν καταπέσῃ, πρόσθες αὐτῷ θύμον, καὶ εἰ μὲν ἀναλήψεται, ἰάσιμός ἐστιν, εἰ δὲ μὴ, οὔ. εἰς δὲ πρόγνωσιν ἐπιληπτικῶν καὶ τοῦτό φασιν, ὡς χλωραὶ αἱ ὑπὸ τὴν γλῶτταν αὐτῶν εὑρίσκονται φλέβες.933 According to Apollonius it is easy to find out if an epileptic is curable. When he falls, apply thyme to him, and if he recovers he is curable. if not, he isn't. He also says this with respect to the prognosis for epileptics, that the veins under their tongue are found to be pale (green?). Besides epilepsy, other aberrant mental states were sometimes considered incurable. According to the Hippocratics, there were certain signs that indicated death would be the only outcome; clenching or grinding the teeth for example, ("in one who has not the habit from childhood") was thought to indicate the onset of mania and death. In one who was already mad (παραφρονέων) it was an absolutely clear sign of death - as was the drying out (ξηραίνεσθαι) of the teeth (Coac. 230 L5,634). Or, in more detail, a state of silent derangement (αἱ σιγῶσαι ἐκστάσιες) with restlessness, continual rolling of the eyes and heavy expiration of breath was considered invariably fatal (Coac. 476 L5, 690). In contrast to the Hippocratic pronouncement that melancholy was among the diseases that were not mortal, Rufus warns that melancholy which develops in conjunction with abscesses on the chest or other parts of the

930 Hipp. Aph. 5,7 Loeb 4,158, see Jones' note ad loc.: possibly 'change' or 'modification' rather than cure is the preferred translation here. 931 Cels.3.23.8; Celsus reiterates the Hippocratic pronouncement that epileptic fits with an onset before puberty are easier to cure (2.8.11); fits arising after twenty-five are harder to relieve - after forty, "whilst there may be some hope from nature, there is scarcely any from the Art of Medicine" (2.8.29). On age and the intransigence of epilepsy see also: Hipp. Prorrh. 2.9 L9,28; Cael. Aur. Morb. Chron. I, 71; Aret. Morb. Acut. Ther. I, ch.5; Paulus 3.13. 932 Hipp. Prorrh. 2.9 L9, 28, πλὴν ὅσον αἱ φρένες τι κακὸν ἔχουσιν, ἢ εἴ τις ἀπόπληκτος γέγονεν· αἱ μὲν γὰρ μελαγχολικαὶ αὗται ἐκστάσιες οὐ λυσιτελέες. 933 Apoll. apud Alex. Trall. I, 15 S. 559 Puschm., #279 in Deichgräber 1965, 209.

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body will quickly be fatal (proximam mortem denuntiant).934 Caelius reports several cases of incubus which were fatal (Morb. Chron. I, 56-57), and in his discussion of phrenitis points to a very serious form of the disease that has little likelihood of being cured - whatever remedy the physician may try (Morb. Acut. I, 39). Several physicians, like Celsus, emphasize the duty of the physician to mitigate incurable states. Aretaeus pronounced melancholy to be a most intransigent state; he gives a series of directions for its treatment and stresses urgency in applying them, "for melancholy does not yield to small remedies, and, if long continued, it remains fixed in a spot." (Morb. Chron Ther. I, ch.5) When melancholy has become incurable it seems then able to generate in turn other, equally incurable diseases: (MT224) καὶ ἢν πάντη τοῦ σώματος ἐνοικήσῃ, αἰσθήσεσι, γνώμῃ, αἵματι, χολῇ, λάβήται δὲ καὶ νεύρων, αὐτη τε ἐς ἀνήκεστον τρέπεται, ἐντίκτει τε τῷ σκήνει ἑτέρων νοσημάτων τόκους, σπασμοῦ, μανίης, παρλύσιος· κἢν ἐκ μελαγχολίης τάδε γίγνηται, τὰ ἐπιγιγνόμενα ἀνήκεστα. (Morb. Chron Ther. I, ch.5) And if the disease lodge in all parts of the body, - in the senses, the understanding, the blood, and the bile, - and if it seize on the nerves, and turn to an incurable condition, it engenders in the system a progeny of other diseases, - spasms, mania, paralysis. And if they arise from melancholy, the newly-formed diseases are incurable. Aretaeus is clear about the physician's role in intractable cases such as these: (MT225) ὑγιέας μὲν ὦν ἅπαντας ποιέειν ἀδύνατον τοὺς νοσέοντας· ᾖ γὰρ ἂν ἰητρὸς κρέσσων θεοῦ. ἀπονίην δὲ καὶ διαλείψιας καὶ νούσων ἐπικρύψιας, δρῆν θέμις ἰητρόν. ἢ ὦν ἀπαυδῆν ἐπὶ τοῖσδε καὶ ἀπαρνεῖσθαι, προισχομένους τὸ ἄναλθες, ἢ καὶ ἐς τέλος τοῖσι ἔργοισι ὁμιλέειν· (Morb. Chron. Ther. I, ch.5) It is impossible, indeed, to make all the sick well, for a physician would thus be superior to a god; but the physician can produce respite from pain, intervals in diseases, and render them latent. In such cases, the physician can either decline and deny his assistance, alleging as an excuse the incurable nature of the disease, or continue to the last to render his services. Caelius and Soranus, followers of a the notably humane Methodist tradition, advocated that even in the event that no absolute cure for their condition be found, epileptics should continue to be treated. (MT226) dabit haec diligentia vel ex parte beneficium, quo neque frequentius admoneatur aegrotans, neque longioribus accessionibus opprimatur, neque turpiter in foro vel publicis in 934 Rufus D 455; cf. Hipp. Morb. 1.3. Melancholy need not, of course, be fatal to be incurable.

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locis apprehensus etiam post passionis impetum animi luctatione vexetur. quibus enim prima vel optata non proveniunt, erunt secunda mitigationis causa capienda. (Morb. Chron. I, 115). For this treatment may confer some partial benefit, so that the patient will not suffer frequent attacks or attacks of long duration and will not suffer an unsightly fit outdoors and in public places, with the mental distress that follows such a seizure. Those who do not succeed in obtaining the highest and most desirable benefits from the treatment will at least obtain secondary benefits, because the treatment lessens the intensity of the disease. C. Spontaneous Cures It was recognized that sometimes mental disturbances resolved themselves naturally - some conditions could even be said to be cured spontaneously.935 # There were signs, for example, in some disorders that nature was bringing about a recovery by removing impurities. Hemorrhoids, it seems, were one of these and one of the Hippocratic Aphorisms tells us that, "hemorrhoids supervening on melancholic or kidney affections are a good sign". The same is also said to be true those who are mad (μαινομένοισι) and for melancholics with fever (i.e. phrenitis).936 A similar process underlies another aphorism, "For madness (μανίη) to be followed by dysentery, dropsy or raving (ἔκστασις) is a good sign." Both physical evidence of an excess of impurities and an increase in the maniacal symptoms are here evidently assumed to be natural progressions towards a crisis and a cure.937 Celsus follows this tradition, informing his readers that "madness (insania) is relieved ... by the formation of varicose veins or by a sudden effusion of blood from haemorrhoids or by dysentery." (2.8.15) Elsewhere we are told that mania can leave "with a cold and a cough" (Coac. 474 L5, 690), and that for those who rave (μαίνονται) either spontaneously or in accompaniment with a disease, relief comes from the pain or distress moving into the chest or feet or when they get a strong cough (Iudic. 42 L9, 290). The strange case in Epidemics of the woman with some sort of mania who emitted a large intestinal worm, then slept and awoke cured, might also be considered a spontaneous cure (MT6).

935 See for example, Cael. Aur. Morb. Chron. I, 1, celeres enim vel acutae passiones etiam sponte solvuntur, et nunc fortuna nunc natura favente. "For swift or acute diseases may be cured spontaneously, with the aid sometimes of chance and sometimes of nature." In such cases, says C., people attribute their cures to "new incantations or amulets or luck". He explains: cum quoties repentino nuntio laeti aut territi aegrotantes mutatione quadam corporis morbos excludunt, vel ea per intemperantiam gerunt quae ratione occulta sibi profutura nescientes duce desperatione committunt. "Sometime a patient who is suddenly made happy or frightened by an unexpected message will undergo a bodily change that will drive out the disease. Or in ignorance and desperation he will do something rash, which for some unknown reason will help him." 936 Hipp. Aph. 6.11 Loeb 4, 182; Aph. 6.21 Loeb 4, 184 - varicose veins or hemorrhoids remove madness; Iudic. 41 L9, 290. 937 Hipp. Aph. 7.5 Loeb 4, 194; see Jones' note ad loc.

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Epilepsy, as previously noted, was thought occasionally to leave spontaneously at the time of puberty for boys or with either menarche, marriage or the birth of their first child for girls.938 Paulus notes that the physician ought not to be particularly concerned about epilepsy in an infant, "for when its age changes to a more bilious and drier constitution, and the diet is more prudently regulated, the affection most commonly goes off spontaneously" (3.13). And finally, although it does not strictly constitute a cure, it is significant that both epilepsy and mania were thought by some to grow milder in the patient's declining years.939 It is Rufus, however, who gives most eloquent expression to the delicate balance some physicians visualized between the healing forces of nature and their own skills. In his discussion of the treatments for melancholy he says, (MT227) Εὔ γε μὴν εἰδέναι χρὴ ὅτι πολλοὶ τῶν οὕτω νοσούντων, ἐν μὲν τῷ καιρῷ τῆς θεραπείας, οὐδέν τι ὠφελήθησαν· ἀσθέντες δὲ, κατέστησαν τὸ προθεραπεύεσθαι, καλῶς ἰσχυσάσης τῆς φύσεως κατὰ τῶν νοσημάτων ἀσθενῶν τῇ βοηθείᾳ γεγενημένων. Διόπερ χρὴ ἄνεσιν διδόναι τῇ φύσει· ἔοικε γὰρ συνταλαιπωρεῖσθαι ταῖς θεραπείαις· ἰσχύειν δὲ ἐν τῇ ἀναπαύσει, καὶ κρατεῖν τῶν νοσημάτων ἤδη προλελεπτυνθέντων.940 It is indeed essential to understand that many who suffer in this manner at the critical time of treatment have not been helped at all. But left to themselves, they have felt the benefits of the therapy given earlier, nature having prevailed well over diseases weakened by the help [which has been given]. For this reason it is necessary to give a period of remission to nature; for it seems to be distressed by treatments; but it seems to strengthen during the intervals and to overcomes the diseases which have been already reduced. D. Physical Treatments I. The Physical Surroundings Many physicians in antiquity believed that the atmosphere in which the patient was kept had an important effect on his or her well-being. They considered especially such factors as the amount of light or darkness, the size and temperature of the room, its security, and in some cases its decorations. There was considerable disagreement on the question of whether mentally disturbed people should be kept in the dark or in well lit rooms. Celsus presents the opposing views and provides a rational and empirical solution: (MT228) Fere vero antiqui tales aegros in tenebris habebant, eo quod iis contrarium esset exterreri, et ad quietem animi tenebras ipsas conferre aliquid iudicabant. At Asclepiades, tamquam tenebris ipsis terrentibus, in lumine habendos eos dixit. Neutrum autem perpetuum 938 Celsus 3.23.1; Cael. Aur. Morb. Chron. I, 71. 939 Cael. Aur. Morb. Chron. IV, 136. 940 Rufus Oeuvres, D 360 cf. also D 519.

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est: alium enim lux, alium tenebrae magis turbant; reperiunturque, in quibus nullum discrimen deprehendi vel hoc vel illo modo possit. Optimum itaque est utrumque experiri, et habere eum, qui tenebras horret, in luce, eum qui lucem, in tenebris. At ubi nullum tale discrimen est, aeger, si vires habet, loco lucido; si non habet, obscuro continendus est. (3.18.5) The ancients generally kept such patients in darkness, for they held that it was against their good to be frightened, and that the very darkness confers something towards the quieting of the spirit. But Asclepiades said that they should be kept in the light, since the very darkness was terrifying. Yet neither rule is invariable: for light disturbs one more, darkness another; and some are met with in whom no difference can be observed, either one way or the other. It is best, therefore, to make trial of both, and to keep that patient in the light who is frightened by darkness, and him in darkness who is frightened by light. And when there is no such difference, the patient if strong should be kept in a light room, if not strong he should be kept in a dim one. Aretaeus also takes the patients' own reactions into account. In cases of phrenitis for example, darkness or light are to be chosen with a view to avoiding that which is fearful to the patient - although, Aretaeus adds, it is considered to be a good sign when exposure to light causes phrenetics to regain soundness of mind and their delirium to abate (Morb. Acut. Ther. I, ch.1). Caelius cites a number of physicians who prescribed darkness for patients with several kinds of mental disturbances: Heraclides recommended darkness for phrenitis; Themison for lethargy; and certain other sects (and even the early Methodists) felt that patients with mania should be kept in dark rooms.941 Asclepiades, as we have already learned from Celsus, objected to keeping phrenetics in the dark, and Caelius explains why (Morb. Acut. I, 111;118-119; & 132). The visions or hallucinations experienced by such patients were thought to lose their force under conditions of light, when actually perceived images tended to overwhelm them; in the dark, on the other hand, these visions would become larger and more powerful. (MT229) denique tamquam praesentia vel vera fiunt sicuti somniantum; etiam tunc enim silentibus sensibus solius mentis visa operantur, ac deinde cum nullis adhuc sensualibus visis avocantur, tamquam praesentium non praessentium visa sequuntur. (Morb. Acut. I, 118-119) These visions of the mind become, in a sense, actual and real, like the visions in dreams; for in dreams, too, the senses are at rest and it is the visions of the mind alone that have effect. And these mental images are not diverted by any actual sense-perceptions and therefore strike the patient as visions of real objects, though they are not real.

941 Cael. Aur.: Heraclides - Morb. Acut. I,166; Themison - Morb. Acut. II, 44; others - Morb. Chron I, 171.

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Caelius, in criticizing this approach, argues that the use of light or darkness should properly be gauged from the phrenetic patient's underlying condition; states of stricture should be treated with light, states of looseness, with darkness. Furthermore, he argues, persons whose minds are disturbed are capable of seeing visions even in the light - and in fact of converting actual perceived objects into fantastic hallucinations, as for example Hercules, who saw his wife and children as enemy faces, and Orestes, who mistook Electra for a Fury (Morb. Acut. I, 121-122). Although he felt that it was not appropriate for all patients to lie in brightly lit rooms, Caelius himself believed in the healing qualities of light. He said that patients with mania not only disliked the darkness but were impeded in their cures under dark conditions (Morb. Chron. I, 171). But in the event that a manic patient should have his mind upset by the light, Caelius advises shading his eyes, "but let the rest of his body be touched by the light". (Morb. Chron. I, 158) He suggests a bright room for patients with lethargy - but not sunlight, which is believed in such cases to have a harmful, relaxing effect (Morb. Acut. II, 26 & 45). In cases of phrenitis, Caelius generally advises a room not excessively bright (Morb. Acut. I, 58). Problems arise, however, in that some patients shun light, others darkness. In the case of the former Caelius advises, as in cases of mania, covering the patient's eyes; in the case of the latter the physician is instructed to admit a small amount of soft light (lamplight or daylight), skillfully arranging it so that it covers the patient's face without touching other parts of the body. "In this way the mental derangement will be allayed .... For, as we have indicated above, light is a relaxing agent by reason of the color by which it is seen; .... Similarly, shade or darkness, if distasteful to patients but necessary to their treatment, will have to be arranged with skill and adroitness." (Morb. Acut. I, 61-62) In cases where patients are so completely deranged (ita fuerint alienatione commoti) that they demand total darkness or brilliant light Caelius' instructions are to make the dark air warm and the bright air cool, "In this way we may adhere to the type of treatment required by the disease and at the same time soothe the madness of the patients and avoid exciting them." (Morb. Acut. I, 62) Some physicians give further requirements for the sick-room itself. For patients with phrenitis, Aretaeus (MT230) prescribed a moderately sized room with a mild temperature, regulated according to the season. The room should be "smooth, level, without projections, not adorned with a frieze or painting; for painting on a wall is an excitant. And, moreover, they [the patients] catch at certain false appearances before their eyes, and grope about things which are not projecting, as if they were so; and any unreal occasion may be a cause sufficient to make them raise their hands." A state of calm and quiet should prevail, and the patient should lie in a bed of moderate size, soft, and with plain covers – "so that there be no inducement to pick at their nap" (Morb. Acut. Ther. I, ch.1). Several other medical writers concur with this stricture against wall decoration in cases of phrenitis.942 Caelius is one (MT231); he adds that bright colours on walls, spreads or bedcovers should be avoided so as not to further injure the patient's mind with their violence. Caelius prescribes a moderately lighted, warm and spacious room for states of stricture, moderately cool and dark for states of looseness, noting that the room should have high windows, 942 Paul. 3.6; Cael. Aur. Morb. Acut. I, 59, "There should be no paintings in the room, lest they cause the patient to experience apparitions (Greek phantasmata ) and to become more excited or burst into laughter."

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"for it often happens in this disease that unguarded patients in their madness (alienationis causa) jump out" (Morb. Acut. I, 58). The patient with phrenitis should have soft bedding and covers: for those in a state of stricture these should be heavy and warm, thin for those in a state of looseness. The bed should be fixed firmly to the floor to withstand the patients restlessness. An atmosphere of calm and quiet should be preserved for phrenetics - the patient should face away from the door and windows in order to avoid being excited by viewing passers-by, and too many visitors should be discouraged (Morb. Acut. I, 59 & 60). According to Caelius, sometimes a change of room to one which was smaller was recommended for evening and nighttime, in order to avoid an excess of fresh air.943 For other disturbed states Caelius has very similar recommendations. For those with lethargy the room should be bright and moderately warm and the patient moved from one bed to another from time to time (Morb. Acut. II, 2627). In cases of incubus, the room should be moderately lighted and warm and the patient kept calm and distracted from his fears (Morb. Chron. I, 57 & 59). The same kind of room is prescribed for sufferers of epilepsy and, in addition, the head of their bed is to be elevated. Patients with mania (and those with melancholy,for Caelius expressly states that their treatments are the same), are given surroundings similar to patients with phrenitis or epilepsy (Morb. Chron. I, 183 & 155). They require a moderately warm and well lit room, "perfectly quiet, unadorned by paintings, not lighted by low windows, and on the ground floor rather than on the upper stories, for victims of mania have often jumped out of windows." The bedclothes should be soft, the bed fastened down firmly, and again, it should face away from the entrance to the room so the patient will not see people coming and going. "In this way the danger of exciting and aggravating his madness by letting him see many different faces will be avoided." (Morb. Chron. I, 155) One further note: a state of calm and quietude was evidently also prescribed by some physician for persons suffering from love-sickness. Paulus, who reports this, disagrees strongly with this approach, and recommends quite the opposite.944 The physical therapeutic regimes of ancient medicine have been described as having three main thematic components: treatments designed to build up an individual's strength and support his own natural healing tendencies; treatments designed to cleanse the body of noxious substances and eliminate excesses; and treatments designed to act as opposites to the qualities thought to be inherent in the disease.945 The common aim of each of these was to restore a balanced state of healthy equilibrium within the individual. It is technically possible to group the specific therapeutic methods employed by the physicians under each of these three headings, and, for the sake of clarity, this has been done in the following sections. But it must be remembered that these are merely useful conceptual

943 Asclepiades apud Cael. Aur. Morb. Acut. I, 132. 944 Paul. 3.17; for Paulus' prescriptions see discussion below. 945 Jackson 1969, 381-382; Jackson is here describing features of Galen's therapeutic approach, but he adds, correctly, that "in these themes he was not very different from the other medical writers of antiquity". See also Jackson 1986, 390-391, "A Few Themes and Many Therapies".

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schemata; any one remedy - in fact any good remedy - probably worked in several ways at once.946 Massage, for example, built up strength, dispersed noxious humors, and provided an opposite, soothing condition to counteract the tension and restlessness of some disturbed mental states - or, alternatively brought warmth to a 'cold' condition such as lethargy or epilepsy. By categorizing ancient medical treatments in this way we are running the risk of overlooking the complex relationship between a variety of therapeutic effects and we are also perhaps overlooking something else. Some treatment of mentally disturbed individuals, whatever the medical or quasi-medical rationale given, can more readily be seen to be primarily a direct response to socially problematical symptoms. Such treatments, for example, as soothing or sedating patients, putting them in the dark, chaining them or flogging them are more readily understood in this way than by appealing to ancient medical theories of opposites. Neverthless, since the primary object here is to understand the approaches and attitudes of the physicians as they affected their patients, the chief therapeutic techniques which were used in cases of mental dysfunction are presented in terms of the three conceptual themes outlined above. In addition we shall consider two other categories of treatment discussed in the texts: surgical intervention, and healing remedies from folk medicine. II. Supplying Deficiencies, Building Up Strength Under this rubric will be considered the induction of sleep, and its contrary, the rousing of those in stupor; massage and the use of ointments and fragrant smells; exercise, the baths, swimming; sexual activity; and dietary regimens and the uses of wines. i. Sleep as Remedy The knowledge of the curative value of sleep and the concomitant use of sleeping draughts and sedative ointments, especially in connection with mental disturbances, was an early feature of Greek medicine.947 In the Hippocratic Corpus, several cases of mental disorder are recorded toward the end of which the patient is described as having slept heavily and been cured.948 For both those suffering from madness and those ill and mentally distressed (ἀνιωμένους καὶ νοσέοντας) with a tendency to hang themselves, a sedative drink made from mangrove root was prescribed - the dosage was to be less for the depressed than for the mad (Loc. Hom. 39 L6, 328-9). Celsus recognizes that for individuals suffering from some types of insanity sleep is very difficult - but also "especially necessary; for under it many get well". He prescribes saffron ointment with oris applied to the head which, he says, will not only promote sleep but help to compose the mind (ad mentem ipsam conponendam) (3.18.12). (MT232) Si nihilo minus vigilant, quidam somnum moliuntur potui dando aquam, in qua papaver aut hyoscyamos decocta sint, alii mandragorae mala pulvino subiciunt, alii vel

946 And, indeed, for all the conditions considered here a whole range of treatments are usually proposed, to be performed both simultaneously and sequentially. 947 For an overview of the early use of opium in psychological disorders see Weber 1987, 31-33. 948 For example, Epid. 4.55 L5, 194; Epid. 5.1.2 L5, 205; Coac. 473 L5, 690.

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amomum vel sycamini lacrimam fronti inducunt. ... Plurimi, decoctis papaveris corticibus, ex ea aqua spongia os et caput subinde fovent. (3.8.12) If, in spite of this patients are wakeful, some endeavour to induce sleep by draughts of decoction of poppy or hyoscyamus; others put mandrake apples under the pillow; others smear the forehead with cardamomum balsam or sycamine tears. ... Many foment the face and head at intervals with a sponge dipped in a decoction of poppy heads. Sleep was also induced by massage, especially as part of a regime suggested by Asclepiades, in which the patient was kept awake and without food and drink during the day and then in the evening was gently rubbed and given liquids.949 "Sleep is also assisted by the sound of falling water near by, also rocking after food and at night, and especially the motion of a slung hammock." (3.18.15) Celsus also suggests, if all else fails, incising the occiput and applying a cup over it - this was thought to extract materies morbi which had collected in the region and caused the wakefulness and instability of mind.950 Aretaeus' recommendations for the treatment of phrenitis include a number of methods for inducing sleep: herbal fomentations applied to the head with a sponge, anointing the head, nose and ears with herbal oils, placing fresh poppy heads under the pillow, or anointing the forehead and nostrils with poppy juice and pouring it into the ears.951 He also suggest rubbing the feet with oils, patting the head, and in particular stroking the temples and ears of disturbed patients, "for by the stroking of their ears and temples wild beasts are overcome, so as to cease from their anger and fury." (Morb. Acut. Ther. I, ch. 1) Aretaeus ends his instruction with some perceptive observations: (MT233) ὕπνου δὲ ἀγωγὰ ἑκάστου καὶ τὰ ξυνήθεα· ναυτίλῳ μὲν, ἡ ἐν ἀκάτῳ κατάκλισις, καὶ ἐν θαλάσσῃ περιφορὴ, καὶ αἰγιαλῶν ἦχος, καὶ κυμάτων κτύπος, ἀνέμων τε βὸμβος, καὶ θαλάσσης καὶ νηὸς ὀδμή· μουσικῷ δὲ ἔτι, ἐθισμὸς αὐλῶν ἐφ᾽ ἡσυχίῃ, ἢ ψαλμὸς λύρης, ἢ πηκτίδος, ἢ μελέτη παίδων σὺν ᾠδῇ· διδασκάλῳ δὲ, νηπιάχων μύθων προσομιλίη. ἄλλοισι δ᾽ ἄλλα ὕπνου θελκτήρια. (Morb. Acut. Ther. I, ch. 1) But whatever is familiar to any one is to him a provocative of sleep. Thus, to the sailor, repose in a boat, and being carried about on the sea, the sound of the beach, the murmur of the waves, the boom of the winds, and the scent of the sea and of the ship. But to the musician the accustomed notes of his flute in stillness; or playing on the harp or lyre, or the exercise of

949 Asclep. apud Celsus 3.18.14-15. 950 Cels. 3.18.16; see Spencer's note ad loc. Loeb 1, 298. 951 Because of the enormous variety and detail involved in many of the recipes for fomentations, plasters, oils, ointments and internal remedies, a full listing of ingredient will be omitted here. The reader is referred to the original texts for more precise information.

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musical children with song. To a teacher, intercourse with the tattle of children. Different persons are soothed to sleep by different means. Caelius advocates encouraging sleep in cases of phrenitis and mania (Morb. Acut. I, 73; Morb. Chron. I, 161). He too suggests the sound of water - here rapidly dripping water - as a soporific. For mania, passive exercise in a hammock or sedan chair is recommended for lulling the patient into a relaxed state, after which, Caelius says, heat should be applied to the eyes with warms sponges to relax the lids, "the beneficial effects of this treatment will pass through the eyes to the membranes of the brain." (Morb. Chron I, 161) Caelius objects to the use of decoctions of poppy or its juices (or indeed fomentation of the head with any fragrant substance), measures advocated by Heraclides and others for cases of mental derangement. According to Caelius such drugs produce stupor, not sleep and it is only the sleep which comes when bodies are relaxed by the gentle healing action of natural sleep.952 Among other recorded treatments, Galen refers disparagingly to physicians who "pour water on the heads of all the sleepless and weakened [patients] and of those who are delirious, phrenetic and lethargic", perhaps in an attempt to induce sleep, or perhaps in an effort to restore rationality - the text is cryptic (Loc. Aff. K167 S83-84). And Paulus advocates the use of medicine from the heads of poppies in cases of phrenitis, unless the patient is very weak (3.6). In cases of lycanthropy, soporific embrocations are to be used on the patient and his nostrils rubbed with opium ( 3.16). ii. Attempts to Rouse and Restore There was a general fear that a patient left in a state of stupor or unresponsiveness, whether it was called lethargy, catalepsy, catoche, or coma vigil (a type of coma in which the patients eyes are open), would die from lack of nourishment if left too long. Some of this fear seems to have also obtained in the case of epileptic attacks of the kind without spasm but with prolonged unconsciousness. Celsus describes this situation: (MT234) Quidam hos quoque isdem quibus lethargicos excitare conantur; quod admodum supervacuum est, et quia ne lethargicus quidem his sanatur, et quia, cum possit ille numquam expergisci atque ita fame interire, hic ad se utique revertitur. (3.23.2) Now sometimes there is a spasm of the sinews when the man falls down, sometimes there is none. Some try to rouse the patients as is done in the case of those affected by lethargy; which is quite useless, both because not even the lethargic patient is cured by this method, and because, though it may be impossible to awaken him and he may thus die of starvation, the epileptic, on the other hand, returns to himself.

952 Cael. Aur. Morb. Acut. I, 169; 171-172; 174; Morb. Chron. I, 173.

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Nevertheless many medical writers give suggestions for methods of arousing patients with, among other conditions, epilepsy, hysterical suffocation, lethargy, and phrenitis. Aretaeus gives instructions for resuscitating a patient with phrenitis who has collapsed in the course of venesection. If deferral of the treatment was contra-indicated, the physician should rouse the patient with strong odours, stroking the face and pricking the feet, and then continue the further withdrawal of blood (Morb. Acut. Ther. I, ch. 1). Similar measures are suggested for rousing women suffering from hysterical suffocation – "friction of the countenance, plucking of the hair, with bawling aloud, in order to arouse." (Morb. Acut. Ther. II, ch. 10) Caelius criticizes both Asclepiades and Themison for their use of extreme measure in attempting to rouse patients. According to Caelius, Asclepiades used similar kinds of techniques for phrenetics, epileptics, lethargics, and those suffering from hysterical suffocation, namely: sternutatories, aromatic preparations of castor, rue, vinegar, cowparsnip, fleabane, agnus castus, bayberries, and "in general, anything which may be able to attenuate the membranes of the brain and set them into violent motion". He also uses unpleasant odours from burning wool, hair, deer's horn, or the juice of allheal and recommends above all a mixture of powdered mustard and vinegar, using it as a plaster for the head (Morb. Acut. II, 37-38). To rouse epileptics, in addition to using the above odours and fumes, he puts vinegar in their nostrils (Morb. Chron. I, 136). Caelius also chastises Themison for using pungent and offensive odours of pitch, cow parsnip, castor, allheal, and mustard and vinegar in cases of epilepsy (Morb. Chron. I, 143). On the other hand Caelius gives a number of examples of disturbed states in which he felt it was desirable to keep the patient awake or if necessary to rouse them. His methods are, however, strikingly different. He recommended keeping phrenetics awake if possible until the attack was on the decline - but permits sleep if the attack is long (Morb. Acut. I, 64). Lethargic patients should be prodded so that they swallow sufficient food, and they should be roused gently at intervals by calling their name - there should be no tickling, shaking or pricking of the patient, which "simply aggravates the state of stricture, affording him no rest." (Morb. Acut. II, 26 & 28) Epileptic patients should receive the same gentle treatment; from time to time they should be roused by calling to them, their faces sponged with warm water, and their heads continually fomented (Morb. Chron. I, 76). More aggressive than Caelius, Paulus recommends rubbing the limbs and whole body of a woman attacked by hysterical suffocation. In addition fetid substances should be brought close to her nose to arouse her; he suggests extinguished lamp, castor, liquid pitch, gum vernix, burnt wool and rags - "some have even brought ... a chamberpot containing stale urine or faeces" (3.71). Aetius' suggestions for hysteria are similar; he suggests strong aromatics both to be inhaled and for massaging the nose, hot vapours and fumes from acrid decoctions to be blown into the nose, sternutatories, induced vomiting (16.68). Epileptics, according to Paulus, also require to be roused by strong smells such as "hog's fennel, Cyrenaic juice, bitumen, and the pitch of cedar" (3.13). iii. Aromatherapy

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In addition to the use of odours to rouse patients, Caelius also mentions the restorative properties of some aromatic substances. In helping a patient overcome an epileptic attack he suggests "aromatic substances which, without being pungent, have a healing and nourishing effect, e.g., hot bread, melon, cucumber, and the like." (Morb. Chron. I, 108) In this context we might also mention the use of fragrant substances in cases of hysterical suffocation to try to draw the uterus back into its natural position. Hipp. Mul. L8,176ff & L7,346 ff. passim). Aretaeus recommends fragrant pessaries - mild, "not pungent to touch" such as nard, Egyptian bacchar, medicine from the leaves of the malabathrum, the Indian tree (wild cinnamon or cassia), or cinnamon pounded with fragrant oils. These should also be injected into the uterus (Morb. Acut. Ther. II, ch.10). Paulus too suggests injections of fragrant ointments such as those from marjoram or Indian leaf (3.71). Both Aretaeus and Paulus also suggest the application of fetid odours to the nose which would repulse the uterus which was thought to be "like an animal within an animal".953 But by far the most elaborate lists of the varieties of aromatics, acrid decoctions, sternutatories, fetid fumes and perfumed fumigations used in cases of hysterical suffocation both for luring the uterus back into position from below and driving it downward from above, are to be found in Aetius' lengthy discussion of this disorder.954

953 Quote - Aret. Morb. Acut. II, ch.11; cf. Morb. Acut. Ther. II, ch. 10; Paul. 3.71. Fumigation for uterine "displacement" has a long tradition in ancient medicine, and is first recorded in the Hippocratic Corpus, cf. Loc. Hom.47 L5,344-346; Mul. 2.126, 123 L8.271-271, 266; Nat. Mul. 8,3 L7 322-324, 314-316. For detailed criticism of this approach to hysterical suffocation by the Methodists see Sor. Gyn. 3.29. 954 Aet. 16.68; the passage repeats many of the substances already cited and is in any case too long and detailed to be given here in full.

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iv. Massage, Rub-downs, Anointing Both gentle massage and more vigorous rubbing, especially when combined with the use of oils, ointments, plasters and cerates, were thought to bring a variety of benefits to a mentally disordered individual. It could warm the body, thus countering the cold effects of some diseases, restore strength to the parts exercised, arouse a lethargic patient or calm a frenzied one, and contribute to the elimination of toxins and plethora. According to Caelius, anointing the limbs and sponging the face refreshed the body and aided digestion - an essential factor in rebuilding the patient's strength (Morb. Acut. I, 178). One form of massage or another was advised in almost every extant medical text and, at one time or another, for every type of mental disturbance. Rubbing was also one of the prescriptions for women suffering from hysterical suffocation (Sor., Gyn. 3.28; Paul. 3.71). Celsus provides a manual on the uses of rubbing and anointing and cites Hippocrates, who said that "rubbing, if strenuous, hardens the body, if gentle, relaxes; if much, it diminishes, if moderate, fills out." 955 Celsus, citing Asclepiades, prescribes prolonged rubbing (unless the patient is very weak) for those suffering from each of his categories of insanity and for epileptics (3.18.7; 14; 17; 23 & 23.6). Aretaeus says the the feet of phrenetic patients should be rubbed with oil and their temples and ears stroked to calm them (Morb. Acut. Ther. I, ch.1). Gentle rubbing is to be used to straighten the limbs of epileptics during an attack and a more vigorous form on their arms and head forms a part of the recuperative regime (Morb. Acut. Ther. I, ch. 5; Morb. Chron. Ther. I, ch. 4). Melancholics are strengthened by massage with various oily liniments containing herbal extracts.(Morb. Chron. Ther. I, ch 5). According to Caelius, Asclepiades, and several other sect leaders, prescribed rubbing of the body and head in one of the treatments for phrenitis (the 'cautious' treatment) and also instructed the physician to arouse lethargics through manual massage. Epileptics were also to be massaged and restored with the use of various scented oils and other embrocations.956 Caelius himself suggests gently anointing the body of the phrenetic patient and, again gently, rubbing the limbs of patients in lethargy. The epileptic should have his forehead, throat, and neck massaged gently with warm hands and his body anointed under covers (for warmth) with oils and soft cerates. As he recovers his regime should include being anointed with restorative ointments under the direction of a trainer. Patients with mania or melancholy should be held gently, if frantic, and have their limbs rubbed. In the intervals between attacks they should be bathed in oil, have soft cerates applied to the head and any scarified parts and have the entire body anointed with these as they melt. When they are more fully recuperated and after any vocal or physical exercise they should have a firm rubdown (Greek cataspasmos) and their heads should be massaged. 957 Galen too prescribed frequent rubbing, primarily as a form of evacuation for any condition, such as epilepsy or

955 Hipp. Off. 17 Loeb 3.76 and Celsus 2.14.2; on rubbing - Celsus 2.14; this passage is largely derived from a handbook written by Asclepiades entitled Common Aids, most of which concerned rubbing. 956 Asclepiades apud Cael. Aur. Morb. Acut. I,133 & II, 38; cf. Themison apud Caelius, Morb. Acut. I, 158-159; 163 II, 50; Morb. Chron. I, 141; Diocles apud Caelius, Morb. Acut. II, 33; Heraclides apud Caelius, Morb. Acut. II, 53; Serapion apud Caelius, Morb. Chron. I, 137. 957 Cael. Aur. phrenitis, Morb. Acut. I, 72; lethargy, Morb. Acut. II, 27; epilepsy, Morb. Chron. I, 74; 88; 90-91; 97; mania and melancholy, Morb. Chron I, 156; 162; 165-166.

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melancholy, which involved plethora - and in fact Galen suggests that rubbing can be used in some circumstances as a substitute for phlebotomy.958 Baths are frequently cited as things to be avoided in certain cases of mental disorder. Caelius, for example, forbids baths to phrenetic patients while the disease is still at its height. In response to those who recommend them he says that "a soothing treatment should be given rather than a bath, with the disturbance and excitement that it involves. I need not point out that, in addition, the bath aggravates the patient's mental derangement so that he fails to cooperate with us in following our instructions and accepts or refuses everything in the manner of a brute." (Morb. Acut. I, 161-162) Despite this aspect of the use of baths in therapy, they seem to have been a part of many treatment programs. Water (and oils) were a part of therapy in a variety of ways: swimming, especially in natural waters with curative powers, oil baths, the plunging of the body into water or oil, pouring water over parts of the body or the head, and the washing, sponging and moistening of the face and other areas of the body. Frequent baths, especially medicinal ones restored strength to melancholics and helped treat loss of memory;959 epileptics and those recovering from mania were helped by baths but also by swimming in natural water, such as alkaline springs; 960 patients with mania were given olive oil baths if they were in pain;961 baths of sweet water and milk-whey were used in the cure of lycanthropy;962 cold water was dashed on the face to rouse lethargics - other physicians merely washed their faces and mouths and moistened their throats;963# more harshly, oil or water were poured over the heads of depressed patients;964 and, in addition, the baths were suggested as kind of cheering recreational therapy in cases of love-sickness.965 v. Exercise Hippocrates forbade exercise for patients suffering from a disease called merely φροντὶς νοῦσος χαλεπή - to judge by the symptoms, a condition similar to what was later called hypochondriacal melancholy (Morb. 2.72 L7, 110). However for most other mental disturbances, exercise, usually graduated from 'passive exercise' to the more vigorous, was part of the therapeutic regimen. Celsus delineates the gradations of therapeutic exercise: passive exercise began with rocking the patient whose disease was abating, but who was not yet strong. Some physicians 958 Gal. On Venesection against the Erasistrateans at Rome, Trans. Brain, 63. 959 Melancholy - Aret. Morb. Chron. Ther. I, ch. 5; Rufus Oeuvres, D 457; Paul. 3.14; loss of memory - Rufus D 371. 960 Epilepsy and mania - Cael. Aur. Morb. Chron. I, 111-112 & 169; Caelius notes that the waters should not have too strong an odor. He also recommends sun baths (Greek heliosis) for patients with mania, so long as the head is protected. Other physicians forbid baths to epileptics, e.g. Erasistratus apud Galen On Venesection against the Erasistrateans at Rome, Trans. Brain, 62. 961 Cael. Aur. Morb. Chron. I, 161. 962 Paul. 3.16. 963 Themison apud Cael. Aur. Morb. Acut. II, 50; cf. Cael. ipse, 30; similar nursing treatment for mania, Morb. Chron. I, 156. 964 Cels. 3.18.22 cf. Gal. Loc. Aff. K167 S83-84. 965 Paul. 3.17.

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apparently even recommended it for patients with fever, but Celsus, among other, was more cautious, allowing it only when the fever was in remission and adding a warning against rocking any patient in pain (2.15.1-2). The forms of rocking were flexible and the choice depended on the strength of the patient and his financial resources: (MT235) Genera autem gestationis plura sunt adhibendaque sunt et pro viribus cuiusque et pro opibus, ne aut inbecellum hominem nimis digerant, aut humili desint. Lenissima est navi vel in portu vel in flumine, vehementior vel in alto mari navi vel lectica, etiamnum acrior vehiculo: atque haec ipsa et intendi et leniri possunt. Si nihil eorum est, suspendi lectus debet et moveri: si ne id quidemst, at certe uni pedi subiciendum fulmentum est, atque ita lectus huc et illuc manu inpellendus. (2.15.3-4) But there are many sorts of rocking, and they are to regulated both by the patient's strength and by his resources, lest either a weak patient undergo overmuch depletion, or a poor man come short. The gentlest rocking is that on board ship either in harbour or in a river, more severe is that aboard ship on the high seas, or in a litter, even severer still in a carriage: but each of these can either be intensified or mitigated. Failing any of the above, the bed should be so slung as to be swayed; if not even that, at any rate a rocker should be put under its foot so that the bed may be moved from side to side by hand. Other physicians recommended rolling an epileptic patient in a sheet as a form of passive exercise.966 Passive exercise was usually prescribed for patients with phrenitis or lethargy - although there seem to have been differences of opinion as to the degree of passivity required. Caelius suggests using a hammock or sedan chair in the fresh air and with a moderate amount of movement for certain cases of phrenitis, and for lethargics a very mild motion in a hammock (Morb. Acut. I, 83 & II, 31). He deems excessive the therapeutic approach of Themison, who prescribed that the lethargic patient, as the disease declined, should be taken out of the house and carried a distance of 20 to 30 stades in a litter (Morb. Acut. II, 48). Caelius also takes issue with Asclepiades who recommended passive exercise for all phrenetics - according to Caelius only those whose condition is the result of a state of stricture will benefit; for those who suffer from a mixed condition of looseness and stricture the disease will be aggravated by such exercise (Morb. Acut. I, 142). For those who suffer from epilepsy or madness in a persistent form without fever, Celsus recommends a moderately strenuous form of exercise - the kind for "healthy, yet not strong men", which include reading aloud, drill (arma ), handball, running, walking, especially out of doors and up and down hills (1.2.6). Elsewhere, however, he gives as a general rule that "the insane are to be put to fatiguing exercises" (insanientes vehementer exerceri debere) (3.18.23).

966 Cael. Aur. Morb. Chron. I, 117, "the leaders of other sects" and their treatment of epilepsy; Asclepiades apud Cael. 136.

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Exercise was consistently recommended for epileptics - sometimes with objurgations to avoid carriage rides (which cause dizziness), to walk in a straight line (to avoid twists and turns), and not to hold the breath, lean forward, bend or turn frequently.967 Aretaeus even suggests that epileptics walk "under trees of myrtle and laurel, or among acrid and fragrant herbs, such as calamint, penny-royal, thyme and mint; so much the better if wild and indigenous, but if not, among cultivated" (Morb. Chron. Ther. I, ch. 4). And the restorative regime of Caelius for epileptics includes swimming, sunbathing, sailing and body building exercises (Morb. Chron. I, 111-112). Interestingly, Aetius advocates a similar regime for women recovering from hysterical suffocation - a disorder frequently compared with epilepsy in the medical texts. For such women he suggests "matitutinal walks, driving a carriage, sailing a boat and riding a horse. After these activities, have the patient speak loudly, read or sing with a modulated and clear voice" (16.68). Melancholics were also thought to benefit from exercise; Celsus prescribes frequent exercise and massage for those depressed with the black bile disease.968 Caelius' treatments for those recovering from mania and melancholy include passive exercise in a hammock, then a sedan chair and later as recovery progresses, in a cart drawn by hand. Walking and both vocal and physical exercises under the guidance of a trainer are also prescribed (Morb. Chron. I, 161-163; 167; 169). vi. Sexual Activity and Pregnancy Although it was occasionally restricted, moderate, regular, sexual activity was thought by most physicians to be an important means of restoring mental and physical health. From the Hippocratics on, marriage (or re-marriage) and pregnancy were traditional medical recommendation for women suffering from hysterical symptoms - or indeed many of the other disorders of the womb.969. In a similar fashion, epilepsy was considered likely to be cured spontaneously when a young boy or girl entered adolescence - a stage of life characterized as "hot" and one which marked the beginning of sexual activity.970 Because of these assumptions, some physicians, according to Aretaeus, prescribed coitus as a cure for epilepsy for children who were far too young. Aretaeus disapproves deeply of this practice: (MT236) ἀπάτη δέ τις ἔς τε μετεξετέρους ἰατροὺς ξυνουσίης. ἐπεὶ γὰρ ἡ τῆς φύσιος εἰς ἄνδρα μεταβολὴ ἀγαθόν τι πρήσσει, μετεβιάσαντο τὴν παίδων φύσιν ἀώρῳ ξυνουσίῃ, ὡς θᾶσσον ἀναρρώσοντες· ἀγνοέουσι δὲ τῆς φύσιος τὴν αὐτομάτην προθεσμίην, ἐφ᾽ ᾗ πάντα γίγνεται τὰ 967 Cael. Aur. Morb. Chron. I, 92; cf. also 96-97; 102; 117; Diocles apud Cael. 132; Praxagoras apud Cael. 133; Serapion apud Cael. 137; Asclepiades apud Cael. 136; Themison apud Cael. 141; other passages concerning epilepsy and exercise: Cels. 3.23.6; Aret. Morb. Chron. Ther. I, ch. 4; Gal. Hyg. Trans. Green ch. 14, p. 275; Erasistratus apud Gal. On Venesection against the Erasistrateans at Rome, Trans. Brain, 62, K240; Paul. 3.13. 968 Celsus 3.18.17 &. 23; cf. also Rufus Oeuvres, D457; Aret. Morb. Chron Ther. I, ch. 5. 969 For example: Hipp. Nat. Mul. 2; 8; 17; 18; L 7, 314; 324; 338; Virg. L 8, 468-470; Galen, Loc. Aff. K417 & 420 S 184-185. See summary discussion of the early Greek and Arab medical writers' treatments for hysterical suffocation in Adams' ed. of Paulus ad 3, 52. 970 Hipp. Aph. 5.7 Loeb 4, 158; see Steph. comm. ad loc.

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ἄκεα· ἥδε γὰρ ἑκάστῃ ἡλικίῃ ξυντίκτει τὰ οἰκεῖα ἐν χρόνοις ὡραίοισι. ἐν χρόνῳ γὰρ οἱ πεπασμοὶ σπέρματος, γενείου, πολιῆς. τίς ὦν ἰητρὸς παραλλάξαι τῆς φύσιος τοῦτο μὲν τὴν ἀρχῆθεν τῶν σπερμάτων μεταβολὴν, τοῦτο δὲ τὴν ἐς ἑκάστου προθεσμίην; ἀλλὰ καὶ προσέκοψαν ἐς τὴν φύσιν τοῦ νοσήματος. οὐκέτι γὰρ ἔγκαιροί τινες ἔασι τῇ ἀρχῇ τῆς ξυνουσίης, προσινόμενοι ἀωρίῃ τοῦ πρήγματος. (Morb. Chron. Ther. I, ch.4) Certain physicians have fallen into a mistake respecting coition; for seeing that the physical change to manhood produces a beneficial effect, they have done violence to the nature of children by unseasonable coition, as if thus to bring them sooner to manhood. Such persons are ignorant of the spontaneous law of nature by which all cures are accomplished; for along with every age she produces that which is proper for it in due seasons. At a given time there is the maturity of semen, of the beard, of hoary hairs; for on the one hand what physician could alter Nature's original change in regard to the semen, and, on the other, the appointed time for each? But they also offend against the nature of the disease; for being previously injured by the unseasonableness of the act, they are not possessed of seasonable powers at the proper commencement of the age for coition. Celsus too is suspicious of the effect which any sexual activity (not just premature) might have upon the epileptic and includes 'venery' in his list of prohibitions (3.23.3). On the other hand, the restorative powers of sex are emphasized in several fragments from Rufus of Ephesus which survive in the works of Aetius and Oribasius. Coition was thought to be useful since it evacuates plethora, develops and aids maturation and virility, dissipates obsessions (συνεστηκότα λογισμόν), calms anger, heals melancholy, diminishes attacks of delirium (frenzy?), and is very effective in conditions caused by phlegm (D 306). Elsewhere Rufus states that for the melancholic, with his misanthropic tendencies, there is no better remedy than sex - for it brings sanity to all kinds of madnesses (and in addition, he says, it puts an end to epilepsy) (D 320). In this context Rufus also cites a statement by Hippocrates, that sexual activity was beneficial for all maladies of a phlegmatic nature.971 Somewhat contradictory then is his advice on curing loss of memory, for here he recommends a sparing use of sexual activity since, he says, it is of benefit neither to one's health as a whole, nor to the mental faculties, rather it causes depression.972 In addition, says Rufus, the usual violent motions accompanying coition resemble spasms, and the accompanying cooling which follows the act, makes the mind stiff and numb.973

971 Hipp. Epid. 6.5.15 L5,320 apud Rufus Oeuvres, 320, Ιπποκράτης δὲ, ἐνὶ λόγῳ τοίς ἀπὸ φλέγματος νοσήμασιν εἶναι κράτιστα τὰ ἀφροδίσια ἔφη. 972 MT237 Rufus Oeuvres, D 370, Ἀφροδισίων δὲ σπανιαιτάτη ἡ χρῆσις ἔστω· οὔτε γὰρ τῇ ὑγείᾳ λυσιτελεῖ, οὔτε τοῖς τῆς ψυχῆς λογισμοῖς, ἀλλὰ καὶ ἀθυμίαν ἐμποιεῖ. I am puzzled by the apparent inconsistency here, for loss of memory was considered to be caused by a cold, phlegmatic congestion of the head. The extracts cited are from Rufus and Galen apud Aetius. Since Galen, like Rufus, generally recommended sexual activity as a remedy for

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Caelius reports that a number of medical sects prescribed sex as a cure for both epilepsy and mania.974. But Caelius himself, who enjoins moderation in sexual desire for epileptics, strongly disapproves of sex as a kind of homeopathic remedy for those suffering from mania. He protests eloquently: (MT239) alii vero amorem furentibus aiunt procurandum, quo mentis intentio conversa furoris asperitate purgetur, non intuentes nudissimam veritatem, quod plerisque furoris amor fuerit causa. sic denique alius amore Proserpinae petit inferna, et sibi licitas alienae ac divae coniugis credidit nuptias. alius nymphae ob desiderium Amphitritis sese deditum mari proiecit. ferunt Graecorum commenta loquacia aetheriae prolis feminam humanis exercitatam fatis et saevo poenitudinis dolore commotam sua manu suos extinxisse successus. neque apsernandos ceteros accipiamus, qui ipsum quoque amorem generaliter furorem vocaverunt, ob similitudinem accidentium quibus aegrotantes afficiuntur. et est impium atque absurdum passioni adiutoriorum [in] id ipsum probare quod curas. omitto quod sit impossibile amorem furentibus persuadere, siquidem iudicio carentes pulchritudinem probare non possint. nam saepe homines feras existimant vel ea quae viderint fingendo praesentia putant. dehinc etiamsi amor fuerit acquisitus, quid magis probemus erit incertum, utrumne prohibendus sit usus venereus an admittendus. sed prohibitus indignari magis cogit aegrotantes cum desiderata producuntur; item permissus vexat cum corpore evirato animae quoque substantia turbatur. (Morb. Chron. I, 176-178) Some physicians hold that love is a proper remedy for insanity, on the ground that it frees the patient's mind from the agitation caused by madness and thus purifies it. They are not aware of the obvious truth that in many cases love is the very cause of madness. Thus one man through love for Proserpina sought to enter the lower world, thinking he could rightly take to wife a goddess wedded to another. Another threw himself into the sea because of his longing for the sea nymph Amphitrite. In the rich mythology of the Greeks there is a story that a woman of divine descent, harried by human fates and beset by the grim pangs of vengeance, killed her offspring with her own hand. Nor should we disdain the view of those who have actually called love a form of insanity because of the similarity of the symptoms which the victims show. And surely it is absurd and wrong to recommend, of all remedies for the disease, the very thing that melancholic disorders (Loc. Aff. K 417-421 S184-185), perhaps Aetius has here interpolated views of another tradition. 973 MT238 Rufus Oeuvres, D 371, Σπασμῷ τε γάρ πώς ἐστι συγγενὴς ὁ κατὰ τὰς συνουσίας σπαραγμὸς, καὶ ἡ ἐπιγιγνομένη καταψύξις πήγνυσί πως καὶ ναρκοῖ τὴν διάνοιαν. 974 Cael. Aur. Morb. Chron. I, 118, epilepsy; Asclepiades apud Cael. sex for epilepsy, Morb. Chron. I, 136; mania – "others" apud Caelius Morb. Chron. I, 176-177; Titus, pupil of Asclepiades, 179 (the patient is to "be made.to abstain beyond all reason from food and drink, and then enticed by wine and incited to love"); Themison and Asclepiades, 179.

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you are trying to treat; not to mention the fact that it is impossible to get an insane person to fall in love, for, since he is bereft of reason, he cannot properly appreciate beauty. Indeed, those suffering from mania often mistake human being for wild animals and believe that what they see in their imagination is real. Moreover, even if the patient falls in love, there is considerable doubt as to which course is preferable, to forbid coitus or to permit it. When the patient sees the object of his desire, he will become even madder if venery is forbidden him. On the other hand, if permitted, it will harm him; for it not only deprives the body of strength but also agitates the soul. In his work De Mollibus sive Subactis, quos Graeci Malthacos Vocant, Caelius also refers obliquely and disapprovingly to the kinds of cures prescribed by other physicians, specifically a certain Clodius, for pathic homosexuality. Homosexual activity, and possibly masturbation, may have played a part in these cures, for Caelius, who denies that any bodily treatment will remedy such a diseased condition of the mind, remarks of these cures, "no man has ever overcome bodily lust by playing the woman's sexual role, or gained relief by contact with a penis". And he goes on to say that the account of a cure for this condition which was given by Clodius must not have been for pathic homosexuality at all, but only for a case of ascarides (worms).975 The real remedy, says Caelius, who seems to doubt that there is an effective one, lies in self control. The modest and moderate approach of Caelius (Soranus), whether or not it was the norm, seems to have survived in modified form in other medical writers. Some, like Paulus, may have thought more along the lines of the Asclepiadic sect and Rufus. Others, like Galen, evolved a more complex approach to sex as therapy. Galen allows that men differ in their responses to sex. Some, "already in their early youth, become instantly enfeebled by intercourse, others, if they do not have regular sexual relations, feel heavy in the head, become nauseated and feverish, have a poor appetite and bad digestion. Plato compared these people to trees overloaded with fruit".976 The latter category of men, if they repress their sexual needs - perhaps out of modesty - or, as in a case cited by Galen, out of grief over the loss of one's wife - these men suffer mentally and physically. They become dull and inactive, their faces wear sad and hopeless expressions, "like those of melancholics" and they "lose their appetites and have poor digestion" (Loc. Aff. K418 S 184). Some, again like melancholics, become despondent for no obvious cause. Galen concludes that retention of semen is harmful for such people and suggest a return to a normal pattern of life, one which includes regular sexual activity. Women too, particularly widows as we have seen,could become burdened with 'excess seed', be troubled with uterine conditions like those resulting from retained menstrual flow -

975 Cael. Aur. Morb. Chron. IV, 133, nemo enim pruriens corpus feminando correxit vel virilis veretri tactu mitigavit,... . Drabkin's note ad loc; in general the meaning of this passage is obscure, not least because of Caelius' elliptical delicacy when discussing Clodius' cure. 976 Gal. Loc. Aff. K417-418 S 184; cf. Hyg. Trans. Green ch. 14, p. 275.

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they would then become "apnoic, suffocated or spastic" or "afflicted with nervous tension".977 They too benefited from a regularization of their sexual lives. Paulus concurs with Celsus and Caelius that chronic epileptics should abstain from "frequent venery" or "vehement venereal impulses" - that is sex was to be permitted to them in moderation but not necessarily prescribed as a cure. And, in a passage previously noted, in contrast to the many accounts which suggest that epilepsy and other diseases of women were thought to be cured by puberty, marriage and pregnancy, Paulus provides an exception. Sometimes, he says, epilepsy has been known "to proceed from the uterus in females, at the time they were pregnant, for after delivery it ceased" (3.13). He does not indicate, however, if the women were epileptic before they became pregnant in which case childbirth would still, in effect, be the cure. Paulus repeats Rufus' observations on the beneficial effects of sex in his chapter On Venery. He recommends it as "the best possible remedy" for those suffering from either melancholy or mania, saying it will restore the latter to reason (1.35). He prescribes sexual activity rather in the manner of a programme of gymnastic exercises, warning, however, that, "strong desires I do not approve of, but think that they ought to be contended against, especially by those who have any distemper" (1.35). This view of sexual activity as a purely physical requirement of a healthy body, from which excessive desire, or indeed passion, was to be excluded was much praised by Galen. He admired the approach of Diogenes the Cynic, renowned for his self-control, who nevertheless "indulged in sexual relation, since he wanted to get rid of the inconvenience caused the the retention of the sperm, but he did it not for the pleasure associated with this elimination". From a traditional anecdote associated with Diogenes Galen concludes that chaste persons indulge in intercourse, not for pleasure, but only with the intent to relieve the sexual urge, and that they regard the elimination of semen (both by males and females) as a natural act, much like the elimination of stool and urine (Loc. Aff. K419-420 S184-185). In general (and, it must be said, as usual), the medical texts give a variety of views on the uses of sex in the cure of mental disorders, but a significant tradition seems to concur with the Elder Pliny who said of coition, medetur et lumborum dolori, oculorum hebetationi, mente captis, ac melancholicis (it cures pain in the loins, dullness of vision, madness and melancholy) (HN 28.16) vii. Food and Wine - the Dietary Regimen A large portion of the therapeutic instructions for patients suffering from mental disorders is taken up with dietary prescriptions and prohibitions. Nor only are many of these instructions minutely detailed, but they also fall into a number of successive stages, with the kind and quantity of diet changing over the course of the disease and its rehabilitation. The minutiae of such programmes, although meriting detailed study, will be reserved for discussion elsewhere. It will be sufficient here to indicate generally the kinds of regimens recommended for people suffering from the various mental disturbances we have discussed. 977 Gal. Loc. Aff. K417 &420 s 184-185; cf. MT208, Galen on hysterical symptoms.

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Total abstention from food and drink was sometime prescribed in the initial phases of diseases in which the mind was disturbed. This fasting was usually for a period of one to three days but it could turn into an even longer affair. Galen quotes, for example, the "unremitting fasts and restricted diet" with which the Erasistrateans treated epilepsy, and Celsus gives instructions for some insane people to be coerced by (among other means), starvation.978 Caelius too mentions that some physicians starved their manic patients to make them tractable - much in the way that wild animals were tamed (Morb. Chron. I, 171-172). Because of the amount of detailed instructions he provides, Caelius is a good example of the ways in which physicians used abstinence in their treatment of mental disorders. He employs abstinence on alternate days in the early stages of phrenitis and for longer (3 days) in cases of mania, melancholy and incubus, the initial fast is to be followed by alternate days of fasting.979 Epilepsy he treats with a combination of venesection and fasting in the initial periods between attacks - but he also claims that an attack might be averted if the patient, upon first receiving the premonitory signs, fasts for the entire day (Morb. Chron. I, 84 & 106). Foods were thought of in antiquity in terms of "classes".980 Moderation in food and drink was an almost universal recommendation, and the importance of good digestion could not be overestimated in treating complaints in which the mind was involved.981 Long lists of restricted food appear early in the medical tradition, particularly for those suffering from epilepsy and melancholy because in such disorders it was considered important to reduce by diet the production of phlegmatic or atrabilious humors. Foods, for example, which were thought to produce atrabilious humors leading to various concomitant mental disorders seem, for the most part, to have been foods that were dark, thick, aged or strong - notably dark, thick wines and red meat.982 Galen's list is fairly typical: (MT240) I can tell you that atrabilious blood is generated (μελαγχολικὸν αἷμα γεννᾷν) by eating the meat of goats and oxen, and still more of he-goats and bulls; even worse is the meat of asses and camels, since quite a few people eat these as well as the meat of foxes and dogs. Above all, consumption of hares creates the same kind of blood, and more so the flesh of wild 978 Gal. On Venesection against the Erasistrateans at Rome; K240, Trans. Brain, 62; Cels. 3.18.21. On abstinence see: Cels. 3.18.17, melancholy; 3.23.3, epilepsy; Scrib. Larg. Comp. 6, epilepsy; Themison apud Caelius, Morb. Acut. I, 160, phrenitis; Heraclides and the Empirics apud Caelius, Morb. Acut. I, 177, phrenitis; Paul. 3.71, hysterical suffocation; 3.6, phrenitis. 979 Cael. Aur. Morb. Acut. I, 82 & 176, phrenitis; Morb. Chron. I, 158-159, mania (n.b. the treatment for melancholy in Caelius is the same as for mania); Morb. Chron. I, 57-58, incubus. 980 Cels. 2.18 gives a detailed breakdown of the foods and drinks of the three classes: the weak (or light), medium, and strong classes. Each class may be subdivided again into three strengths and the calculations can become quite complex, taking into consideration not only the type of food, but, for example, the age and part of the animal, the soil, the climate and the method of preparation. Foods may also be prescribed as being "of a mixed class". 981 Moderation and good digestion: Cels. 3.18.16, epilepsy; Hipp. Morb. 2.72 L7,110, phrenitis or melancholy; Hipp. Steph. Comm. ad Hipp. Aph. 2.44 p.239, epilepsy, Rufus D370-371 loss of memory; D359, melancholy; D373 hydrophobia; Aretaeus Morb. Acut. I, ch. 1, phrenitis; Caelius Morb. Chron. I, 58, incubus; 166 mania and melancholy; Paul. 3.17, love-sickness. 982 "Others" apud Cael. Aur. Morb. Chron. I, 117, epileptics should avoid wine and beef, pork or goat's meat; Paul. 3.14, melancholics should avoid: beef, roe's flesh, dried lentil, cabbages, snails, thick and dark coloured wines.

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boars. Snails produce atrabilious blood in a person who indulges in them, and so do all kinds of pickled meat of terrestrial animals, and of the beasts living in water, it is the tuna fish, the whale, the seal (φώκης), dolphins, the dog shark and all the cetaceous species. (Loc. Aff. K183184) He goes on to list vegetable of the brassica family, pickles, shoots and sprouts, certain pulses and grains and also, "heavy and dark wine" and "aged cheeses". A similar list from the Hippocratic Corpus of foods epileptics should avoid mentions red mullet, black-tail, hammer and eel, the flesh of goats, deer, pigs, and dogs, the cock, pigeon and bustard, and "all birds that are considered substantial foods"; and the plants mint, leek and onion - because of their pungent nature (Morb. Sacr. 2). Wine was a controversial question in cases of mental illness.983 Several physicians were adamant in their rejection of wine in the therapeutic regimes of such patients - others were more moderate, and some it seems even prescribed it. The Hippocratic prohibition was clear; in a case of phrenitis the physician is instructed not to give wine, for wine "does not benefit a deranged mind in either this disease or any other." (τοῦ νοῦ παρακόποντος).984 According to Aristotle, dark wine was one of the prime causes of melancholy (Pr. 30.1) - and Celsus forbids it to the insane who suffer from the black bile disease, and indeed to all people who are mad except those who suffer from the rare kind of madness that is produced by fright (3.18.17 & 24). Epileptics were generally forbidden wine when the disease was active, although most physicians incorporated wine into the therapeutic regime of chronic epileptics who were not currently afflicted.985 Caelius makes a clear distinction in the use of wine as therapy, stating that wine should be forbidden to any patient before the declining phase of an illness (Morb. Acut. II, 36). For patients with mania or melancholy, Caelius allows wine only slowly to be reintroduced into their diet after their recovery is well established (Morb. Chron. I, 166). And for phrenetic and lethargic patients similarly - wine in moderate amounts may be given after the third day, if the patient's strength is very depleted and recovery seems established.986 During the early phases of a disorder some physicians advised caution even in the medicines given. Paulus, for example, warns against giving patients with phrenitis a medicinal drink prepared with wine, "... the vinous hydromel which is brought from Cebyra in small vessels must be rejected, as it produces more mischief than wine itself...". Some

983 For the ancient belief in wine as health giving see McKinlay 1950 (with bibliographic note); on alcoholism in antiquity see Rolleston 1927; Leibowitz 1967. 984 Hipp. Aff. 10 Loeb 5, 18-20 L6, 218; cf. also Morb. 2.72 L7, 110, phrenitis or melancholy. 985 Rufus Oeuvres, D 460; Cael. Aur. (and others apud Cael.) Morb. Chron. I, 85; 117. For wine in the epileptic's regimen see: Aret. Morb. Chron. Ther. I, ch. 4; Cael. Aur. Morb. Chron. I, 93-95; Praxagoras apud Caelius Morb. Chron. I, 133; Galen, Hyg. Trans. Green ch. 14, p. 275; Paul. 3.13. 986 Cael. Aur. Morb. Acut. I, 86; II, 32; but on phrenitis see also Morb. Acut I,53, "But we forbid wine absolutely, as harmful and no different from poison. For, as soon as it is taken, it excites the patient's madness (furorem exasperat) and greatly aggravates it."

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physicians suggests testing the body, as the patient recuperated, by introducing wine-like foods such as fruits or fruits in wine and mulse; if these were tolerated, wine could slowly be re-introduced.987 Most physicians, it seems, prescribed wine in their treatments of each variety of mental disorder as part of a healthy regime, once the critical phase of the disease was past and it was felt that the patient needed restoring. Other physicians, however, enthusiastically endorsed the use of wine from the outset, and again for all varieties of mental disorder. Rufus recommended a light young wine to restore loss of memory (D 370 & 460) and as one of the best cures for melancholy - in fact, wine alone could be a sufficient cure in some cases, for wine promotes happiness and removes 'brooding' (D 457). He also advised a light, young, white wine in his cure for hydrophobia (D 373). Aretaeus also recommends wine as a cure for melancholy and asserts that wine is the only cure if phrenitis turns into a state of syncope.988 Asclepiades and members of his sect prescribed strong salted wine in their treatment of phrenetics and undiluted wine in copious amounts for both phrenetics and lethargics.989 Themison too was said to use large amounts of wine for patient's in the declining phase of phrenitis and both Heraclides and Erasistratus advocated the use of honeyed wine for phrenitis from the beginning of the disease (Cael. Aur. Morb. Acut. I, 104; 164 & 182 ). Both Themison and Titus, according to Caelius, advocated curing mania in part by giving their patients an abundance of wine and food and making them drunk (Morb. Chron. I, 175 & 179). And Paulus points to the useful qualities of wine in healing the love-sick person and turning his mind to other things (3.17). III. Removing Harmful Elements and Eliminating Excess This category of treatment consists in the various methods for achieving purgation and catharsis. These ranged in degree of severity and included the use of phlebotomy, cupping, emetics, cathartics, clysters, suppositories, laxatives, diuretics and sternutatives. There are numerous recipes for purging the body both 'upward' and 'downward', and, in addition, massage, shaving the head, fomentations, plasters and cleansing agents were also involved in the process of clearing the body of excessive and/or toxic substances. i. Bleeding, Cupping, Scarification Only in a very few cases of mental disturbance did some physician forbid phlebotomy. Asclepiades is reported to have called it the equivalent of murder in cases of phrenitis and Celsus advises not to bleed an epileptic who has fallen in a fit.990 In most other cases and at all other times, phlebotomy seems to have been an essential part of the cure, and sometimes a part of the prevention, of all mental disorders.991 Sometimes a test was made to see if toxic

987 Aret. Morb. Acut. Ther. I, ch. 1; Cael. Aur. Morb. Chron. I, 93. 988 Aret. Morb. Acut. Ther. I, ch. 1 & Morb. Chron. Ther. I, ch.4. 989 Cael. Aur. Morb. Acut. I, 144-147, phrenitis; II, 38, lethargy. 990 Asclep. apud Cels. 3.18.6 (phrenesis) cf. apud Cael. Aur. Morb. Acut. I, 119; Cels. 3.23.2. 991 Bleeding, cupping and scarification are listed among the cures most diseases, among them, insanity, epilepsy, hysterical suffocation, phrenitis, loss of memory, fatuity, melancholy, mania, lycanthropy, and lethargy. Prevention e.g. Gal. On Treatment by Venesection, K272; Trans. Brain, 77-78, those with a tendency to phlegmatic or atrabiliar

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humors were present in the blood; at other times bleeding was performed as a matter of course.992 People were bled and scarified at various points of their anatomy: the occiput was a favourite place to perform bleeding and cupping, then the whole head, the back of the head and neck, the throat, the temples, the vein at the forehead, or the one under the tongue, the chest and back, between the shoulder blades,the praecordial region, around the bladder and the loins, the legs and the arms - by some even arteries were opened.993 Bleeding could be performed at the onset of the disease, after a period of time or regularly during the course of a disease. The more common methods were phlebotomy and scarification (sometimes in conjunction with cupping), which involved incisions, but some physicians also employed leeches to draw blood.994 Both bleeding and cupping could vary in severity depending upon the nature of the disease and the attitude of the physician. Some, like Caelius, gave instructions to avoid fainting; and to use mild or intense cupping with or without scarification, as the situation required. Some, like Galen merely instructed the physician to bleed according to the patient's constitution (Loc. Aff. K185 S91). Others, like Themison, bled copiously and repeatedly and were reportedly not concerned about fainting. 995 Still others were said to apply venesection to both arms or to open an artery until the patient fainted - these procedures frequently resulted in death. ii. Purging the Head: Sternutatives, Shaving, Fomentations and Plasters Sneezing was often induced to rouse patients out of epileptic or hysterical fits and from lethargic or comatose states. It was also thought to purge the head of the humoral congestion which caused aberrant mental states.996 Thus Celsus recommends holding rue, vinegar and other drugs to the nostrils of the insane unless they are in a very weak

diseases (including epilepsy, apoplexy, and melancholy) are aided by bleeding at the beginning of spring then following a healthy regime which includes exercise. cf. also Paul. 3. 14 on incipient cases of melancholy. 992 Gal. Loc. Aff. K185 S91, melancholy and other atrabilious conditions; Paul. 3.11. 993 The following list is not comprehensive, it merely serves to provide examples: occiput - Cels. 3.18.16, insanity (phrenesis); head - Cael. Aur. Morb. Acut. I, 57 & 76-78, phrenitis; back of head - Cels. 3.23.7, epilepsy (plus cauterization); throat - Cael. Aur. Morb. Chron. I, 57-58, incubus; temples - Cael. Aur. Morb. Chron. I, 89, epilepsy; forehead - Paul. 3.6, phrenitis; Heraclides apud Caelius Morb. Acut. I, 182, phrenitis; tongue - Diocles apud Caelius, Morb. Acut. I, 101, phrenitis; chest, back and shoulders - Cael. Aur. Morb. Chron. I, 160, mania; praecordial area - Cael. Aur. Morb. Acut. I, 57, phrenitis; hypogastrium and groin - Paul. 3.71, hysterical suffocation; bladder region and loins - Cael. Aur. Morb. Acut. I, 78, phrenitis; legs - Cels. 3.23.7, epilepsy; Aret. Morb. Acut. Ther. II, ch. 10, hysterical conversion; arms - Aret. Morb. Acut. Ther. I, ch. 1, phrenitis; Morb. Chron. Ther. I, ch. 5, melancholy; Paul. 3.6, phrenitis; 3.13, epilepsy; 'others' apud Caelius Morb. Chron., 174, mania; arteries - Aret. Morb. Chron. Ther. I, ch. 4, epilepsy; 'others' apud Caelius Morb. Chron. I, 178, mania. 994 Cael. Aur. Morb. Acut. I, 76, phrenitis; Morb. Chron. I, 160, mania; Paul 3.14, mania. 995 Themison apud Caelius Morb. Chron. I, 141-142, epilepsy; cf. Paul. 3.16, who advises bleeding persons with lycanthropy until they faint and Aret. Morb. Acut. Ther. I, ch. 1 who advises bleeding some phrenetic patients until they faint, reviving them and repeating the procedure. 996 Sternutatives were a part of the treatment for, among other conditions, hysterical suffocation - Aret. Morb. Acut. Ther. II, ch. 19; Aet. 16.68; Paul. 3.71; see also discussion at Sor. Gyn. 29; epilepsy - Rufus Oeuvres, D 362; Cael. Aur. Morb. Chron. I, 98; Praxagoras apud Caelius Morb. Chron. I, 133; Diocles apud Caelius Morb. Chron. I, 132; Paul. 3.13; lethargy - Asclepiades apud Caelius Morb. Acut. II, 37-38; Diocles apud Caelius Morb. Acut. II, 33; Themison apud Caelius Morb. Acut. II, 47; Heraclides apud Caelius Morb. Acut. II, 47; loss of memory Archigenes apud Galen Loc. Aff. K 153 S78; mania or melancholy - Cael. Aur. Morb. Chron. I, 168; and phrenitis/phrenesis - Cels. 3.18.8; Asclepiades apud Caelius Morb. Acut. I, 131.

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condition (3.18.8). Caelius, who advises sternutatives between attacks in cases of epilepsy and also in cases of chronic mania or melancholy, presents a glimpse of some of the measures taken by different physician to induce sneezing in epileptic patients: (MT241) ... sternutamento commoto ex aceto naribus interius flato cum sinapi, vel castoreo oleo irino infuso cum chalcantho, vel sulphure vivo aut strutio incenso, vel his quaie ad matricis praefocationes incendenda posuerunt, item hyssopum, et origanum, et thymum, vel ignis flammam oculis offerentes cum titillatu quodam et oppressione praecordiorum ad inferioires partes. (Morb. Chron. I, 116) They provoke sneezing by blowing into the nostrils fumes of vinegar, mustard, or of a mixture of castor, iris oil, and chalcanthum, or fumes obtained by burning virgin sulphur, soapwort, or any of the substances which these same physicians burn for cases of hysterical suffocation. They also use hyssop, marjoram, and thyme. Or they place a flame close to the patient's eyes, at the same time tickling him and pressing the precordia toward the lower parts. Other methods both medicinal and manual were employed to clear the head and mind of phlegm and viscous humors. Drainage through the mouth or nose was considered important particularly in cases of lethargy, epilepsy, loss of memory and melancholy.997 For example, Themison purged the heads of his lethargic patients with a drink made of aloes, and Heraclides had his patients chew radishes with mustard and pepper. Archigenes was said to purge phlegm from the head of patients who had lost their memories by using a mixture of mustard, cardamom, Cnidian grain and dried grapes.998

997 Epilepsy and drainage of phlegm: Scrib. Larg. Comp. 6; Paul. 3.13; melancholy: Hipp. Morb. 2.72 L7, 110; Rufus Oeuvres, D 456. 998 Themison apud Caelius Morb. Acut. II, 45-47; Heraclides apud Caelius Morb. Acut. II, 54; Archigenes apud Galen Loc. Aff. K153 S78.

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iii. Emetics For most mental disorders it was customary to induce vomiting or to 'purge upwards' in order to rid the body of undigested foods which, it was thought, sent toxic humors or vapors up into the head and brain. White hellebore was often used as an emetic, as were radishes. Celsus suggests white hellebore, with repeated doses if necessary, for his manic form of insanity and for epilepsy (3.18.20 & 2.13). Rufus recommended care and moderation in using emetics, but said that melancholy improved when belching and vomiting were provoked after eating (D 359-360 & 457). Aretaeus, however, preferred melancholic patients to employ emetics before eating (Morb. Chron Ther. I, ch. 5); he also advised inducing epileptic children in paroxysms to vomit by smearing their tonsils with a feather dipped in oil of iris (Morb. Acut. Ther. I, ch. 5). Caelius used emetics for chronic incubus, mania and melancholy and concurred with many of the leaders of other sects in advising induced vomiting for epileptics.999 One of these, Diocles, Caelius reports, had even invented a kind of pill which induced gagging (Morb. Chron. I, 132). Galen too prescribed emesis, particularly for the type of epileptic convulsion which was due to gastric sources (Loc. Aff. K341 S153). iv. Purgatives and Cathartics: Clysters, Suppositories and Diuretics Many of the recipes which we encounter in the context of mental disorders are for purgatives; they are administered by mouth, as in the case of draughts of aloes or black hellebore, or in the form of clysters or suppositories. Diuretics were also used, sometimes in conjunction with cathartics to increase the effectiveness of the cleansing process. 1000 Some purgative medicines were even injected into the ears.1001 Physicians seem to have relied heavily on this 'purging downward' to relieve the body of plethora and accumulated matter which would engender toxic humors, and they administered purges and clysters repeatedly during the course of the illness and even when recovery was established, as a kind of precautionary act.1002 There was some difference of opinion about the timing of such treatments and particularly about the strength of the components used. Caelius repeatedly criticizes rival schools for the use of "sharp clysters" and daily purges in their treatment of mental disorders.1003 All forms of mental disorder were treated at some time by these various purgative methods; the only distinction in treatment seems to have been in its frequency and severity - which depended largely upon the seriousness of the disorder and the approach of the individual physician.

999 Cael. Aur. Morb. Chron. I, 59; 169; 97; Praxagoras apud Caelius, 133; Serapion apud Caelius, 138; Themison apud Caelius, 142. 1000 Diuretics were certainly used in cases of phrenitis, epilepsy, and mania - and probably for other conditions although explicit evidence is lacking; Cael Aur. Morb. Chron. I, 117; 132; 174; Paul. 3.6. 1001 Cael. Aur. Morb. Chron. I, 169, chronic mania (also melancholy). 1002 Gal. Loc. Aff. K340 S153 recommends purging two or three times a year as a preventative for epilepsy. 1003 Cael. Aur. Morb. Acut. I, 102; 167; Morb. Chron. I, 117; 174.

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Black hellebore was the earliest known purgative and figures prominently throughout antiquity, especially in cures for melancholy, mania, and epilepsy.1004 Many physicians had their own recipes for purgatives or traditional ones which had been handed down, and these were referred often to simply as hiera. Scribonius Largus is a treasure trove of such recipes, many of which are long and complex.1005 The hiera which Rufus is said to have developed for melancholy is a good example of the kind of remedy which was commonly used: The pulp of a pumpkin - 2 1/2 dr.; herb ivy - 10 dr.; mountain germander - 10 dr.; cassia - 5 dr.; agaric (a tree fungus) and horehound - 10 dr. each; gum of Hercules woundwort (assa foetida) 1 ... ; sagapenny, wild parsley, aristolochia (birthwort), white pepper - 5 dr. each; cinnamon, spikenard, saffron, myrrh troglitis, hulwort - 4 dr.. Mix all with honey and give a dose of 4 dr. in a solution of hydromel and salt water. (D 323-326) This remedy was said to be efficacious for purging the head and collecting the mind; also for curing vertigo, heaviness of the head, glaucoma that has been long established, epilepsy, localized paralysis, and melancholy - and it is also recommended in small daily doses to aid digestion and as a preventative or antidote to melancholy.

1004 See for example, Hipp. Morb. 2.72 L7,110; Vict. 1.35-36 Loeb 4, 280-292; Cels. 2.12; Cael Aur. Morb. Chron. I, 99 & 107-108; 183. 1005 For example Scrib. Larg. Comp. 104; 97-99; 107 & 12.

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IV. Treating by Opposites, Restoring Equilibrium As noted above, rousing the stuporous or sedating the frenzied can be seen as a type of treatment by opposites; but the concept is more usually applied to the employment of the four qualities, hot, cold, wet, and dry, in opposition to one another or to combinations of one another. Hot plasters, heating or cooling fomentations, the use of water, oils and herbal remedies of certain qualities were the usual methods of treating by opposites. Galen describes the principles involved in this approach in his preliminary discussion of cures for loss of memory: (MT242) εἰ μὲν γὰρ ὑγρὸν εἴη, ξηραίνειν αὐτὸ προσῆκεν· εἰ δὲ ξηρὸν, ὑγραίνειν· οὕτω δὲ καὶ τὸ μὲν ψυχρὸν θερμαίνειν, τὸ δὲ θερμὸν ψύχειν. ἔτι δὲ καὶ εἰ κατά τινα συζυγίαν πεπόνθοι, διὰ τῆς ἐναντίας συζυγίας αὐτὸ θεραπεύειν προσήκει, τὸ μὲν ξηρὸν καὶ θερμὸν ὑγραίνοντα καὶ ψύχονται, τὸ δ᾽ ὑγρὸν καὶ ψυχρὸν ξηραίνοντα καὶ θερμαίνοντα, κᾀπὶ τῶν λοιπῶν δυοῖν συζυγιῶν ἀνάλογον. When the body is moist it seems proper to dry it up; when dry one has to make it moist. Likewise, a cold condition should be heated, a warm one cooled. If someone suffers from a combination of two such conditions, one must treat him by application of a combination contrary to these [qualities]: to a dry and warm condition only moist and cool remedies should be applied, whereas a moist and cold condition must be treated by dry and warm remedies; the same rule applies to the two analogous combinations. (Loc. Aff. K130 S68)1006 These principles, Galen says, hold true for diseases which befall the brain and meninges; those conditions which are caused by cold involve somnolence, coma and unconsciousness; the effect of heat is to cause sleeplessness and "delirium without fever".1007 Accordingly cold substances and drugs will bring numbness and loss of consciousness; warm drugs, in turn, will causes sleeplessness and increased bodily movement and activity. For example a light diet and unmixed wine, especially an old wine, will, according to Galen, have a heating effect and cause loss of sleep (Loc. Aff. K132 S69). i. Heating: kataplasms, fomentations and plasters Because many of the disorders of the brain, such as loss of memory and epilepsy, were thought to be brought about by cold and dry, or cold and moist conditions, methods of applying external heating and drying or moistening to the 1006 See also the discussion of the several aberrant mental states caused by an imbalance of fire and water in the system in Hipp. Vict. 1.35-36 Loeb 4, 280-292. A change in regimen, adding to the fire or water respectively, can correct the balance to some extent and may avert madness (120-130). Other mental states such as irascibility, indolence, craftiness, simplicity, quarrelsomeness and benevolence are, however, not influenced by this balance, but "by the nature of the passages through which the soul passes" (151). 1007 Gal. Loc. Aff. K131 S 68; cf. Paul 3.11 on loss of memory and loss of reason, "These complaints have for a cause the exciting in temperament; but if it is humid only, it will occasion impairment of the memory and reason, torpidity, drowsiness, long and deep sleep; but if complicated with coldness, it will produce carus and lethargy. In like manner, dryness alone brings on watchfulness, but when joined with heat, delirium and frenzy."

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region of the brain were highly developed.1008 Galen describes a violent treatment by Archigenes for loss of memory called "mustard blisters", in which a mustard plaster is applied to the entire head, after which the head is sprinkled with sodium bicarbonate (nitron) and bathed in warm water (Loc. Aff. K153 S77).1009 Heating methods employed by other physicians varied in their potency. Regions of the body, usually the head or the hypochondrium for mental disorders but sometimes also the chest, back and lower parts, were fomented with oiled cloths and unscoured wool, poultices and cerates were applied, rubefacients, mustard and pitchplasters were employed in addition to emollient and astringent ones. It was thought that shaving the head was in itself beneficial to the afflicted brain, and this treatment was usually carried out in conjunction with the application of cerates and fomentations to the head, forehead, temples and/or occipital region.1010 Cupping and bleeding could also form a part of this type of treatment. Heating was also achieved by vigorous rubbing, massaging and anointing - both the head and other parts of the body.1011 In addition there are instructions to apply heat with moist sponges to the face and body and, in some cases to bake the body, with head covered, in the sun.1012 ii. Cooling remedies Most mental disorders seem to have been considered to have originated from some type of cold condition, epilepsy, lethargy, loss of memory - even melancholy, which, even though over-heated yellow bile played a causal role, was generally thought to be a cold and dry condition (Rufus D 355). Mania, however, was considered by most to be a hot disease and was accordingly treated with cooling remedies by many physicians.1013 Cooling remedies

1008 Loss of memory and fatuity - Gal. Loc. Aff. K152 S77; K152 S77, Archigenes apud Galen; K165 S83;cf. also Rufus Oeuvres, D 365-366; Paul 3.11; epilepsy - Steph. comm. ad Hipp. Aph. 2.44. 1009 Archigenes is the foil for Galen's discussion of the importance of establishing the original locus of affection when diagnosing a disease. A. believes that the centre of reason is in the heart, but he paradoxically does not try to cure loss of memory by treating that region - Galen comments, "Even Archigenes applies remedies to the heads of persons suffering from memory defects, and he will administer everything to the head in the attempt to cure some moron." (Loc. Aff. K167 S84) 1010 Combing and cutting hair, shaving head (note, this list is not exhaustive): loss of memory, Archigenes apud Galen Loc. Aff. K153 S76-77; epilepsy, Cels. 3.23.3 & 6; Aret. Morb. Chron. Ther. I, ch. 4; Cael. Aur. Morb. Chron. I, 89; Paul. 3.13; phrenitis/phrenesis, Cels. 3.18.8; Aret. Morb. Acut. Ther. I, ch. 1; lethargy, Cael. Aur. Morb. Acut. II, 29; incubus, Cael. Aur. Morb. Chron. I, 59; mania, Cael. Aur. Morb. Chron. I, 160; Paul. 3.14 (implied); melancholy, Aret. Morb. Chron. Ther. I, ch. 5. 1011 For example in lethargy, Cael. Aur. Morb Acut. II, 30; Themison apud Caelius, 50; epilepsy - Aret. Morb. Acut. Ther. I, ch. 5, massage and fomentations. 1012 Sponging - Cael Aur. Morb. Chron. I, 161; sunbathing is prescribed for mania, usually considered a 'hot' disease, by Caelius, who did not base his therapy strictly on the theory of opposites; Cael Aur. Morb. Chron. I, 168, C. also lists here the application of 'intense heat' among his other prescription for mania. 1013 Apud Cael. Aur. Morb. Chron. I, 173; Caelius himself says the heat of mania comes from internal inflammation and is not the cause of the disease, therefore cooling treatments are an error and only exacerbate the disease.

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consisted in sponging and bathing a patient, applying cold oil, and the use of fans.1014 Some foods and herbal remedies were also thought to have cooling properties. Galen, for example, suggests as sleep inducing and therefore moistening and cooling treatments "wild lettuce, bathing in sweet and warm water, and the drinking of wine moderately mixed with water" (Loc. Aff. K131 S 68). The use of narcotic drugs, such as poppy, and of aromatic oils to attempt to sedate the manic patient may also be seen as a form of cooling the system.1015 V. Surgical Methods Radically invasive methods for curing mental disturbances seem only to have been employed in cases of epilepsy, although visible damage and distortions to the brain such as head wounds and hydrocephalus were certainly treated surgically.1016 Ê# Aretaeus describes a procedure designed to apply heat to the head of the chronic epileptic: (MT243) τετρῆναι δὲ χρὴ πρῶτα τὸ ὀστέον μέχρι διπλόης, ἔπειτα κηρωτῇσι καὶ ἐπιπλάσμασι χρέεσθαι. ἔς τ᾽ ἂν ἡ μῆνιγξ τῶν ὀστέων ἀποστῇ, τερέτῳ χρη περικόπτειν τὰ γυμνὰ ἢν ἔτι σμικρὰ ἀντέχῃ μέχρι αὐτομάτου ἀποστπάσιος, ὅτε μέλαινά κοτε τουτέων καὶ παχείη εὑρεθῇ ἡ μῆνιγξ· καὶ ἐπὴν ἐς μύδησιν, ἢ καὶ κάθαρσιν, τοῦ ἰητροῦ εὐτόλμως ἀκεομένου, ἐς ὠτειλὴν ξυμβῇ τὸ τρῶμα, ὥνθρωπος ἐξῆλθε τῆς νούσου. In the first place,we must perforate the bone as far as the diploe, and then use cerates and cataplasms until the meninx separate from the bone. The exposed bones are to be perforated with the trepan if still any small portion prevent its spontaneous removal, when the meninx there is found black and thickened; and when, having gone through the process of putrefaction and cleansing under the bold treatment of the physician, the wound comes to complete cicatrization, the patients escape from the disease. (Morb. Chron. Ther. I, ch.4) In his discussion of the various treatments for epileptics, Aretaeus advocates the use of particularly powerful medicines, "for the habit of such persons renders them tolerant of pains, and their goodness of spirits and good hopes render them strong in endurance" (Morb. Chron Ther I, ch.4). The remark is unusual and striking; it seems evident that in view of the treatment methods of Aretaeus (and others) those epileptics who survived must have been very resilient and determined indeed.

1014 Aret. Morb. Acut. Ther. I, ch.1, phrenitis, cool and dampen head with oil of unripe olive; Cael. Aur. Morb. Acut. I, 68 & 69, cold oil and fans for phrenitis (unless their use further deranges the patient); 'others' apud Caelius Morb. Chron. I, 173-174, use of cooling substances advocated by followers of Aristotle and Diocles who believe mania to be caused by heat. 1015 Cael. Aur. Morb. Chron I, 173. 1016 Hydrocephalus - Hipp. Morb. 2.15 Loeb 5, 216-220; Cels. 4.2; Aetius 6.1; Paul 6,1; Head wounds - Hipp. VC Loeb 3, 6-50.

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Caelius provides information about other kinds of procedures which seems frequently to have been performed and of which he strongly disapproved. Some leaders of other sects, he says, in their efforts to cure epileptics, recommend an elaborate cruciform incision at the back of the head, called chiasmos - on top of which they try to produce a scab by burning the incision with caustic substances or with fire. They practice arteriotomy, a violent form of bleeding in which the arteries before and behind the ear are opened and practiced by, among others, Aretaeus. They recommend trephining the middle of the skull (bregma), and some even advocate castration.1017 Caelius also refers to another (rather puzzling) process carried out by Themison: "the burning of the skin of the head in a circle with an iron cautery, the scales thus being removed from the skull" (et ferro circumscripta in capite cutis ustura qua testa squamulis despumatur) (Morb. Chron. I, 143). VI. Folk Remedies in Medical Contexts Most physicians who mention remedies from that vague realm of folk, popular, lay and/or magical cures, do so in a manner either dismissive or reluctant. It seems to have been the case, however, that a number of these methods were incorporated to some degree into the therapeutics of many ancient medical practitioners.1018 Again, as with the use of surgery, epilepsy is the disorder which seems to have demanded these more extreme and speculative measures. The earliest treatise on epilepsy, the Hippocratic On the Sacred Disease, as we have noted before, strongly repudiates the use of supernatural and magical methods for curing epilepsy.1019 It mentions specific practices, some of which resonate throughout the later medical texts: the use of blood purifications and incantations, the avoidance of black clothing, of goat skin, and the foot and hand 'binding' prohibitions (Morb. Sacr. 2-4 Loeb 2,140-150). This denigration and refutation of magical practices is found again later in the works of Caelius/Soranus. Other medical writers, however, seem to have had a more equivocal attitude toward popular and magical cures - and still others, according to Caelius, approved of using the help of amulets and magical incantations (Morb. Chron. I, 119.& 130). Many of these popular cures involve blood and organs of animals - and sometimes of humans. Celsus suggests a remedy for epilepsy to which he seems to give some credence: "Some have freed themselves from such a disease by drinking the hot blood from the cut throat of a gladiator: a miserable aid made tolerable by a malady still more miserable." 1020 Scribonius Largus, a physician with a strong penchant for folk medicine, lists a large number of popular, quasi-medical cures. Aside from his many herbal remedies (some of which were to be prepared in

1017 Cael. Aur. Morb. Chron. I, 118 & 134 (Praxagoras' treatment); cf. Aret. Morb. Chron. Ther. 1, ch. 4. 1018 Temkin 1971 [1945], 21-27 is a comprehensive discussion of the rather complex attitudes of ancient physicians toward magic, especially with regard to the treatment of epilepsy. Temkin detects a change in attitude from the scepticism of the fifth century to a more tolerant inclusion of magical practices from the fourth century B.C. on (Soranus/Caelius being an exception in this regard), (23-24). I am inclined to think the shift more apparent than real; the rhetorical power of On the Sacred Disease masking a contemporary substratum of diverse and eclectic medical practices which continued on throughout antiquity. On the rationalism and the criticism of magic see now Lloyd 1979, esp. ch. 1; 1983, part 3, on pharmacology, popular beliefs and practice and physicians; 1987, 26-29, esp. n.89 on the new mystification which replaced the old as Greek medical science emerged. 1019 See above ch. 5. 1020 Cels. 3.23.7; cf. Plin. NH 28.4.10.

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conjunction with the phases of the moon), he suggests a preparation from the dried blood of a fawn less than nine days old, killed preferably with a tinctorio by which a gladiator had been butchered (hoc remedium qui monstravit, dixit ad rem pertinere occidi hinnuleum tinctorio, quo gladiator iugulatus sit) (Comp. 13). A mixture made from crocodile's testicles is suggested and two separate recipes are given, one for epileptic boys and one for girls. These involve, among other substances, for the boy, the blood which flows from the living body of a recently captured male turtle and a male dove. For the girl, the same process should be used but the animals should be female (Comp. 14 & 16). He reports that some epileptics in their search for a cure drink the blood from their own veins or take three spoonfuls [of blood, water?] from the skull of a dead man for thirty days.1021 Others consume nine portions of a slain gladiator's liver (Comp. 17). Scribonius, having given detailed instructions about the measurements and quantities for these and similar cures, then proclaims ingenuously: "This, and whatever is of the same kind, falls outside professional medicine - although it has apparently helped in some cases."1022 Aretaeus reports a variety of cures for epilepsy which, although he himself has not used them, he seems reluctant to dismiss as entirely fanciful. (MT244) λόγος ὅτι καὶ γυπὸς ἐγκέφαλος καὶ αἰθυίης ὠμῆς κραδίη, καὶ αἱ κατοiκίδιοι γαλέοι βρωθέντες λύουσι τὴν νοῦσον· ἐγὼ δὲ τῶνδε μὲν οὐκ ἐπειρήθην· ἐθεησάμην δὲ ἀνθρώπου [γε] νεοσφαγέος ὑποθέντας φιάλην τῷ τρώματι καὶ ἀρυσαμένους τοῦ αἵματος πίνοντας. ὤ τῆς παρεούσης μεγάλης ἀνάγκης, τλῆναι κακὸν ἀκέσασθαι μιάσματι κακῷ· εἰ δὲ καὶ ὑγιέες ἐκ τούτου ἐγένοντο, ἀτρεκὲς οὐδεὶς ἔχει μοι λέγειν· ἄλλη δέ τις γραφὴ ἔφραζεν, ἧπαρ ἀνθρώπου φαγεῖν. ἀλλὰ τάδε μὲν γεγράφθω τοῖσι μέχρι τῶνδε τλήμοσι. (Morb. Chron. Ther. I, ch. 4) It is told, that the brain of a vulture, and the heart of a raw cormorant, and the domestic weasel, when eaten remove the disease; but I have never tried these things. However, I have seen persons holding a cup below the wound of a man recently slaughtered, and drinking a draught of the blood! O the present, the mighty necessity, which compels one to remedy the evil by such a wicked abomination! And whether even they recovered by this means no one could tell me for certain. There is another story of the liver of a man having been eaten. However, I leave these things to be described by those who would bear to try such means. Both Rufus and Galen show an interest in, to misuse a contemporary term, 'alternative medicine'. Galen admits to having witnessed known physicians cure epilepsy and arthritis with a decoction made of burnt human bones, "the

1021 Scrib. Larg. Comp. 17, de calvaria defuncti terna coclearia sumant per dies triginta; cf. Pliny NH 28.7 reports a certain Artemon, who prescribed water to be drawn at night and drunk from the skull of a murdered and unburned man. See Temkin 1971 [1945], 23 n.131, who suggests Artemon may have been either a physician or a magician. 1022 Scrib. Larg. Comp. 17, quaeque eiusdem generis sunt, extra medicinae professionem cadunt, quamvis profuisse quibusdam visa sint.; Trans. Temkin [1945] 1971, 23. Temkin interprets this sentence to imply that Scribonius Largus (and possibly Celsus too) "admits the possibly salutary effects of such cannibalistic remedies but thinks that the professional physician is not allowed to use them."

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patients not knowing what they drank lest they should be nauseated." 1023 And they both included in their therapeutics the use of certain substances linked to folk healing; Rufus recommended for epilepsy the gall of a bear and both Rufus and Galen used peony root in their treatments.1024 Rufus anointed the body with ground peony root, but Galen found to his surprize that the root worn as an amulet around the neck was efficacious. Peony root, according to Galen, possessed drying qualities and it was a substance commonly used in many ancient cures for epilepsy. It was also used as an amulet, particularly for epileptic children. Galen had come across a child who had not been attacked by epilepsy for eight months while he was wearing a peony root amulet, but when it accidentally slid off he suffered a seizure - when it was replaced, he recovered. These observations led Galen to attempt to find an experimentally based, rational explanation. (MT245) ἔδοξε δέ μοι κάλλιον εἶναι καὶ αὖθις άφελεῖν αὐτὸ πείρας ἕνεκα, καὶ οὕτω πράξαντες, ἐπειδὴ πάλιν ἐσπάσθη, μέγα τε καὶ πρόσφατον μέρος τῆς ῥίζης ἐξηρτήσαμεν αὐτοῦ τοῦ τραχήλου, κᾳντεῦθεν ἤδη τοῦ λοιποῦ τελέως ὑγιὴς ἐγένετο ὁ παῖς καὶ οὐκετ᾽ ἐπελήφθη. εὔλογον οὖν ἦν ἢ ἀποῥῥέοντά τινα τῆς ῥίζης μόρια, κᾄπειτα διὰ τῆς εἰσπνοῆς ἑλκόμενα, θεραπεύειν οὕτω τοὺς πεπονθότας τόπους ἢ καὶ τοῦ ἀέρος αὐτοῦ τρεπομένου καὶ ἀλλοιουμένου πρὸς τῆς ῥίζης. But for experiment's sake it seemed better to me to take it [the amulet] off again; and when I had done so, and he was seized by convulsions again, I hung a big, fresh part of the root around his neck. And from that time on the boy was absolutely healthy and was no longer seized by convulsion. It was now logical [to assume] either that certain particles of the root fell out, were sucked in by inspiration, and did thus heat the affected part - or that the air itself was tempered and changed by the root. 1025 Amulets were a common method of protecting against epileptic attack. Alexander of Tralles devotes considerable attention to directions for their preparation, recommending in particular the stone jasper. Another noteworthy amulet was to be made with a nail from the arm of a criminal who had been crucified.1026 The attitude of Caelius and the Methodists generally was relatively hostile to the infiltration of popular practice into treatment methods. At times Caelius specifically refutes the habitual practices of ordinary people (inertes, quos idiotas appellant), stating, for example, that their dangerous custom of prescribing wine for phrenetic patients is potentially deadly (Morb. Acut. I, 88). Elsewhere, and particularly in his discussion of epilepsy, Caelius gives a

1023 Gal. de simp. 11.18 K12, 342 cited in Temkin 1971 [1945], 23. 1024 Rufus Oeuvres D 460-461; cf. Diosc. 2.96, bear and tortoise gall; Gal. de simp. 6.c.3 K11, 859 cited in Temkin 1971 [1945], 25. Peony root was a medicinal substance also much used in magic and magical lore, see Temkin, 25. 1025 Gal. de simp. 6.c.3 K11, 859 cited in Temkin 1971 [1945], 25. 1026 Alex. Trall. 1.15, cited in Adams' notes ad Paulus 3.13, p. 381.

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detailed critique of the magical and popular elements in the cures of other physicians and their schools. From this we receive some valuable insights into the extent to which magic and medical treatment were interwoven. Several themes recur: restrictions about lying on goat skins (Morb. Chron. I, 117), the avoidance of certain foods, especially meats, and the eating of special animal substances: (MT246) dant etiam bibendum lac asininum cum sale, vel sanguinem testudinis marinae, vel humanum, aut vituli marini, et non solum sanguinem verum etiam coagula quae lacti miscentur. item mandendam mustelam, sed longo desiccatam tempore, et tunc carnem hominum, atque equorum [quorum] impetigines quas in cruribus habent, sive asinorum vel mulorum, item testes vel veretrum marini sive fluminalis canis, et porcelliones, hoc est animalia quae humectis et aquosis locis saepe nascuntur, a Graicis appellata onisci, dehinc squamulas ferri cum aqua in qua fuerit candens ferrum praetinctum dant etiam cameli cerebrum fumo siccatum atque concisum, sed infantibus vbel pueris odorandum, perfectis autem aetatibus bibendum ad modum cyathi cum mulso ex aceto tribus cyathis; similiter etiam leporis cor, et cerebrum gaviae. alii vero etiam ligamenta probaverunt, et magos adhibendos, atque eorum incantationes. (Morb. Chron. I, 118-119) They give the patient ass's milk with salt to drink, or the blood of a sea turtle, or human blood, or that of a seal - and not merely the blood but also the rennet. They have the patient eat weasel flesh that has been dried a long time, human flesh, the calluses which horses, asses, and mules have on their legs, the testes or generative organs of the beaver, wood lice (Greek oniscoe animals often generated in moist and swampy places), and iron filings together with the water in which the glowing hot iron has previously been dipped. The also prescribe camel's brain, cut up and dried in smoke; this is merely to be smelled by infants or children but is to be drunk by adults, a cyathus of it with three cyathi of oxymel. Hare's heart and sea gull's brains are similarly prescribed. And some also rely on amulets and on the magi and their incantations. Caelius calls many of the treatments recommended by "the ancients","abominable, cruel, inhuman and often dangerous" (execrandis et crudelibus atque inhumanis plerumque etiam periculosis) (Morb. Chron. I, 130). He gives a detailed refutation of the treatments suggested by the Hippocrates, Diocles, Praxagoras, Asclepiades, Serapion, Heraclides of Tarentum, and Themison (Morb. Chron. I, 131-143). Of a host of others, including the notorious Menekrates Zeus, he gives only the names, saying that it is not necessary to review their methods, "for the influence of these physicians has obviously vanished, time having revealed their shortcomings" (Morb. Chron. I, 139-140). The implications are, then, that the influence of those whom Caelius criticizes is still flourishing, certainly at the time of Soranus, and probably also during Caelius' own time. Many methods, many approaches flourished simultaneously. It indeed seems probable that throughout antiquity, the experience of the epileptic patient - and very

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likely the mentally ill patient - was heavily dependent upon the kinds of physicians he or she had the good or bad fortune to consult. Temkin has observed that "the majority of physicians accepted various remedies from popular or magicians' practices. In doing so they probably were not always conscious of the magical background but justified their procedure by apparent experience and rational explanations."1027 This seems demonstrably true in the example of Galen and the peony root amulet, and it seems understandable that some professionally encoded version of the same 'try anything' approach which.was noted in the chapter on historical narrative sources, prevailed in medical practice. Temkin concludes that, insofar as most ancient physicians recognized the efficacy of such forces as amulets, miraculous remedies and the influence of the moon, nevertheless, "as far as can be judged from the fragmentary remains of their works, all these factors played only a subsidiary role and were separated from the rational explanation and treatment of the disease.1028 We can only speculate about the degree of discrepancy between the recorded rational explanations of the few and the actual practice of the many. Yet if Caelius' criticisms are even a slight indication, the use of magic in the quasi-medical treatment of epilepsy can be understood as pervasive. Our evidence for the use of these kinds of remedies comes, as we have noted, almost exclusively from cases of epilepsy. Yet although it is only possible to conjecture, it is certainly not improbable that some of the "epileptics" so treated were what we would term people with mental illnesses, and that some of the more esoteric remedies were very probably tried by medical or quasi-medical practitioners on people suffering from mania, melancholy, paranoia or any one of the many severe states of mental disturbance. But in addition to these indications, a late treatise by Rhazes on the activities of professional imposters may give further insight into the kinds of experiences ordinary people may have encountered - even sought out- in their search for cures for intractable mental disorders. (MT247) The frauds of imposters [says Rhazes], are more numerous than could be contained in his whole work. Some of them, he adds, pretend to be able to cure epilepsy, and having made a crucial incision in the back part of the head, they extract from the wound something which they hold in their hands, and thus impose upon people. Others, in like manner, cause it to be believed that they extract a small lizard by the nostrils. ... There are some who undertake to collect all the infirmities of the body into one spot, and then extract them; for this pretended object they raise an itching and violent heat in some place by means of alkekengi (winter cherry); and having accomplished this they exact a fee for removing the uneasiness from the spot, which they do by anointing it with oil. There are others who will make a man believe that he has swallowed hairs, glass, or the like; and then tickling his throat with a feather, and making him vomit, they exhibit the substance in question as if it had been brought up. Thus, he adds, they often do much 1027 Temkin 1971 [1945], 24. 1028 Temkin 1971 [1945], 27; cf. Edelstein 1967, 205.

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mischief, and sometimes are guilty of culpable homicide. He concludes by warning sensible people to be upon their guard against such wretches.1029 In view of the fact that successful deceptions and sleights of hand have been cited by some of our most respected medical authors, it is not difficult to believe that people suffering not only from epilepsy but many other mentally disturbed conditions would have been prime targets for these kinds of medical charlatans. E. Attitudes and Handling of the Mentally Disturbed There is considerable evidence in the medical literature both for what we might term humane and for inhumane treatment of mentally disturbed persons. It is noteworthy, however, that all recommendations for treatment, whatever their nature, have as a goal the well-being (or at least the most expedient management) of the patient and his or her disease. There is no suggestion of punishment in applying the harshest measures - rather primarily the desire seems to be to control and contain - and if possible to cure. I. Physical Restraint, Threats and Coercion Celsus gives perhaps the grimmest picture of the treatment of the insane. For some cases, notably "those who conduct themselves more violently", he recommends the use of fetters, "lest they do harm to themselves or to others". He also warns against the cunning of such patients: "Anyone so fettered, although he talks rationally and pitifully when he wants his fetters removed is not to be trusted, for that is a madman's trick (dolus insanientis)" (3.18.4). Celsus notes that all cases of insanity are not alike and that it is best "to proceed according to the nature of each case." Some "need to have their violence restrained as is done in the case of those who are controlled even by flogging." Others, those who, for example, exhibit unseemly laughter, may be able to be controlled simply by "reproof and threats" (obiurgatione et minis) (3.18.10). In his discussion of his third category of insanity, the type which is prolonged and in which the sufferers "become foolish in spirit" (animo desipiunt), Celsus gives a more explicit regimen of coercive treatment: (MT248) Si vero consilium insanientem fallit, tormentis quibusdam optime curatur. Ubi perperam aliquid dixit aut fecit, fame, vinculis, plagis coercendus est. Cogendus est et attendere et ediscere aliquid et meminisse: sic enim fiet, ut paulatim metu cogatur considerare quid faciat. Subito etiam terreri et expavescere in hoc morbo prodest, et fere quicquid animum vehementer turbat. Potest enim quaedam fieri mutatio, cum ab eo statu mens, in quo fuerat, abducta est. Interest etiam, ipse sine causa subinde rideat, an maestus demissusque sit: nam demens hilaritas terroribus iis, de quibus supra dixi, melius curatur. (3.18.21-22) If, however, it is the mind that deceives the madman, he is best treated by certain tortures. When he says or does anything wrong, he is to be coerced by starvation, fetters and flogging. He is to 1029 Adams' ed. of Paulus. Bk 5, appendix citing Rhazes Ad Mansor vii 27.

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be forced both to fix his attention and to learn something and to memorize it; for thus it will be brought about that little by little he will be forced by fear to consider what he is doing. To be terrified suddenly and to be thoroughly frightened is beneficial in this illness and so, in general, is anything which strongly agitates the spirit. For it is possible that some change may be effected when the mind has been withdrawn from its previous state. It also makes a difference, whether from time to time without cause the patient laughs, or is sad and dejected: for the hilarity of madness is better treated by those terrors I have mentioned above. The picture painted by Celsus is not unique; it may be glimpsed too in the remarks of other medical writers. According to Caelius many physicians of other sects and even the early Methodists indiscriminately advocated restraining bonds for patients with mania - and in addition starved them. Their reasons were practical: (MT249) aiunt enim ferarum similitudinem intuendam, quae deductione cibi posita ferocitate mansuescunt. Non aliter etiam furentes posse iugi abstinentia mitigari, quippe cum inter sanos homines facile sapere ieiuni videantur, post cibum vero affici hilaritate facilius aut furore. (Morb. Chron. I, 171-172) Thus they say that we must consider as analogous the case of wild beasts, who when food is denied are supposed to lose their ferocity and grow tame. In the same way, they say, madmen may be calmed by continual fasting; for even sane persons seem more readily inclined to be sensible when they have not eaten for some time, but after eating have a greater tendency to mirth and folly [madness]. Caelius cites specifically Titus, a pupil of Asclepiades, who advocated flogging manic patients, putting them in bonds and keeping food and drink from them - then enticing them with wine and inciting them to love.1030 Caelius himself disagrees completely with these methods, saying that those who recommend them "seem to be the madmen themselves rather than the physician of madmen" (Morb. Chron. I, 172). Although he recognizes the need under certain circumstances for restraining a patient, Caelius on more than one occasion stresses the importance of an approach less violent and less harmful to the patient. He warns against damage to the limbs from improperly applied bonds and says it is easier to have servants use their hands to restrain a patient with mania (Morb. Chron. I, 172). When a manic patient keeps getting out of bed - or "is distressed especially because of loneliness", Caelius directs the servants to covertly restrain him by massaging his limbs "and in this way they will avoid upsetting him" (Morb. Chron. I, 157). For phrenetic patients again he advocates that, should it become necessary, a large number of servants should gently hold the patient back so that relaxing treatments may be applied. But he adds:

1030 MT250 Titus De Anima 2, apud Cael. Aur. Morb. Chron. I, 179, ... Titus ... memorat flagellandos. sed idem etiam officiis solitis amoveri iubet aegrotantes, et vinculis constringi, et abstinentia ciborum nimia coerceri, et siti affici, tunc vino corrumpi, vel in amorem induci.

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(MT251) vel si defuerint quie ut supra diximus teneant, aut ipsorum visu commoti fuerint aegrotantes, ligationibus utimur, sed praetectis lana aut veste locis quos vinculis nectimus, ne maior utilitate quiescendi imprimatur vexatio. ligationibus etenim immodice constricta necessario tumescunt: propterea omnis in peius extenditur passio. 1031 If, however, there are not the servants to hold the patient back in this way or if the patient is aroused by the sight of the servants, use bonds. But use wool or clothing to protect the places where the ropes are tied, lest the harm done the patients be greater than the advantage gained in keeping them quiet. For those parts which are very tightly constricted by bonds always become swollen and such swelling aggravates every disease. Much later Paulus states that patients with mania must above all be secured in bed so as not to injure themselves or others - or, as an alternative, he suggests they be swung in a wicker basket or small couch "suspended from on high" (3.14). People with phrenitis, Paulus instructs, are to be kept recumbent and quiet. He makes the same class distinction in treatment as Caelius; if the patients are rich, they are to be restrained by their servants, if not, they should be bound by ligatures (3.6). For patients undergoing an attack of epilepsy or hysterical suffocation with spasms or convulsions, it was widely thought necessary to bind and restrict the movement of their limbs. This was done in the hope of preventing permanent damage or distortion of the affected part. Aretaeus describes the process to be followed in treating epileptic children: the child is to be laid on his stomach and the limbs gently rubbed with oil; any distortions of the face and lower jaw are to be rectified and the straightened parts gently bound so that they retain their shape (Morb. Acut. Ther. I, ch.5). Caelius reports that the practice of binding and constricting limbs during an attack was common among other sects.1032 He himself agrees with the process in principle and advises that during an attack the epileptic's eyelids should be held open and his movements restricted during the convulsions. Servants should hold his hands and feet, but force should be avoided when straightening out the patient's body: (MT252) ... corrigi etiam ea quae forti raptu torquentur. ac si minime consenserint, erunt in eodem schemate [sic]servanda, ne ulterius torqueantur; tunc quodam laxamento captato corrigenda, ne nimio occurrentia certamine superare cupientes nervorum quassationes faciamus. linguam quoque relocare curabimus aut mentum corrigere vel coaequare ... (Morb. Chron. I, 74)

1031 Cael. Aur. Morb. Acut. I, 65; cf. 60; see also Morb. Chron. I, 157, binding manic patients without injury by placing wool coverings under the bandages. 1032 Cael. Aur. Morb. Chron. I, 116 & 143; see also Paul. 3.13, who advises ignoring epilepsy in children, but suggest that those who, after boyhood, suffer from epileptic attacks should have the convulsed limbs anointed and ligatures applied.

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If a part of the body is contorted by a powerful spasm, put it back in place. But if it resists replacement, keep it in the new position to prevent further twisting; and then, when there is a relaxation, take advantage of it to replace the part. By thus avoiding the use of force to overcome resistance when it is strong, we shall avoid injury to the sinews. Also see to it that the tongue is replaced and the chin straightened and made even. In cases of hysterical suffocation similar measures to those for epileptic convulsions seem to have been the rule. Soranus makes no mention of any restraining or binding methods of treatment, but Aretaeus prescribes as part of the immediate measures to be taken in cases of hysteria, "ligatures of the hands and feet so tight as to induce torpor". Later he also recommends that the abdomen of the woman be compressed "by the hands of a strong woman, or of an expert man, binding it round also with a roller, when you have replaced the part [the uterus], so that it may not ascend upwards again" (Morb. Acut. II, ch.10). According to Paulus, "During the paroxysms, ... ligatures are to be applied around the extremities, and the limbs and whole body rubbed as for the recovery of persons in deliquium animi" (3.71). Aetius has similar advice, "in the very midst of an attack the lower parts of the body should be held and the feet and legs should be rubbed" - in addition "the precordial region should be bandaged" (16.68). Celsus, at the beginning of this section, introduced the idea of using threats and fear to coerce a patient. There are a few other medical texts which suggest procedures along these lines. Caelius, customarily more gentle in his methods, suggests that in cases of phrenitis, when a patient is refusing to take food which is suitable for him, various methods of deceit be used. He suggests that this will be easy if the patient's mind is severely affected, but, "if he has some measure of sanity, he can be controlled by exhortation or fear" (Morb. Acut. I, 81). Again, in cases of mania and of phrenitis, where the patient is excitable and difficult to manage, Caelius suggests judicious visits from an imposing figure who inspires fear and respect. (MT253) ac si quemquam timere vel revereri consueverint, non erit itidem frequenter inducendus: continuatio enim contemptibilitatem parit. vel cum causae coegerint, vel adiutorio adhibendo non succubuerint aegrotantes, tunc erit necessario inducendus, quo aegri terrore vel reverentia opprimantur.1033 Now if there is a person whom the patient has customarily feared or respected, he should not be brought into the sickroom repeatedly. For this frequent repetition gives rise to a lack of regard. But when circumstances require it, as when the patient does not submit to the application of a remedy, this person should then be brought in to overcome the patient's stubbornness, by inspiring fear or respect. Paulus too makes reference to threats or some form of coercion when he says the some persons suffering from lovesickness must be "attacked with fear; for while they think of nothing but love, the affection if difficult to remove." 1033 Cael. Aur. Morb. Chron. I, 157-158; cf. Morb. Acut. I, 65 & 72 - the same advice for phrenetic patients.

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His proposals for achieving this state of fear are not spelled out, but the context suggests perhaps a stern rebuke from some revered senior personage. II. Allaying Fears, Soothing, and Calming Quite the opposite sort of therapy from the preceding coercive approach seems also to have been a part of the ancient treatment of the mentally disturbed. Many patients exhibited symptoms of fearfulness rather than violence and a number of references attest to a concern on the part of physicians to provide a soothing setting from which causes of fear were excluded. We have already seen in the discussion above that some physicians considered their patients' reactions to being placed in the dark or in the light and arranged their rooms accordingly. Celsus gives further, more detailed instructions on allaying the fears of the mentally ill. They are not to be left alone, or among people they do not know, or among people they despise or disregard (3.18.23). Caelius agrees with this emphasis on the right kinds of attendants - and visitors - for he says of the phrenetic patient, "do not permit people who were disliked by the patient before he became ill to enter the sickroom, for his condition would be aggravated by seeing them." (Morb. Acut. I, 64) He also recommends having the patient anointed and washed by his own servants to avoid the aggravation new faces might cause, and, because "persons familiar with the patient become prudent through experience and accept the aberrations without resisting them." (Morb. Acut. I, 72) According to Celsus, particularly in the type of insanity which consists in depression caused by black bile, "causes of fright are to be excluded, good hope rather put forward". In the more manic forms of insanity, empty fears, says Celsus, will require solutions specific to each case; and he cites the example of the exceptionally wealthy man, who was terrified of dying of starvation, to whom from time to time pretended legacies were announced so as to alleviate his fear.1034 Caelius warns about the harmful effects of fright on several different conditions. Patients suffering from incubus should have their minds strengthened with stories that don't cause excitement or fear, and they should be discouraged from thinking about impending nightmares, "For many patients, by trying to imagine or conceive what is to be cause their diseases to become active almost at will." (Morb. Chron. I, 59) All causes of fright, "for example, pretenses of terror", should also be avoided in the cases of babies with epilepsy (Morb. Chron. I,80). And patients with mania should be protected from too many people, particularly strangers, entering their room ( Morb. Chron. I, 156). In conjunction with the injunctions to exclude frightening experiences were more positive suggestions for soothing difficult patients. Caelius, in his discussion of the use of light in treating phrenitis, is careful to insist that the primary consideration in cases where the patient perversely demands conditions opposite to those required by his illness, is the mental well-being of the patient. He suggest skilfully managing the light so that medical requirements are met, but at the same time the patient is not excited and his madness is calmed. But such a compromise is not always 1034 Cels. 3.18.10; more examples will be found below in the section "Humouring and deceiving the patient".

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possible, and in the event, "since excitement, motion, and tossing of the body heighten the acuteness of a disease, we must on occasion yield to the desires of the patients for the sake of soothing their madness" (Morb. Acut. I, 63) Even when a patient is on the road to recovery Caelius is cautious; he warns against letting the epileptic patient upset his mind with violent disputes - or indeed even raise his voice too loudly (Morb. Chron I, 102). In fact Caelius suggests a form of verbal therapy aimed at restoring a sane balance of mind. Some patients require settling and calming, others soothing and encouraging: (MT254) plerique enim usque ad sanitatis tempus maestitudinem vel iracundiam aut alienationem mentis servaverint. quare oportet eos qui hilaritate afficiebantur severa verborum atque tristi oratione corrigere; sic enim mentis laxata habitudo atque puerilis effrenata bacchatio coercetur: eos vero qui maestitudine atque ira afficiebantur, leni consolatione atque nunc dictis hilarioribus et iucunditate relevare; etenim taedium vel maestitudo non solum in his sed etiam in aliis passionibus valuit saepe passionem refricare. (Morb. Acut. I, 98-99) For in most cases patients remain in a state of sadness, anger, or aberration right up to the return of physical health. It is necessary, therefore, to use grave and serious language to those whose state had been one of hilarity. For thus the weakened condition of their mind and their childish and unrestrained raving are brought under control. But those who are in a state of sadness or anger must be soothed with gentle encouragement and pleasant and cheerful language. For tedium or sadness often has the effect, not only in this but in other diseases, of exciting the malady anew. III. Humouring, and Deceiving the Patient Humouring and agreeing with a patient was seen to be a part of the calming and soothing process. Celsus advises agreeing with the patient more often than opposing him, for the patient's mind in this way is to be slowly turned from the irrational to "something better" (3.18.11). Aretaeus says that patients with phrenitis "ought to be gratified in everything, especially in cases where the delirium (ἡ παραφορή) tends to anger" (Morb. Acut. Ther. I, ch.1). Caelius advocates an easy-going approach in most matters. As we have seen the patients vehement desires in the matter of lighting are to be taken into account, and in other areas too the same consideration is to be shown. If, after several attempts, a patient will simply not accept the food appropriate for his condition he should be humoured, for, "the serving of what the patient desires will in itself mitigate in some measure and relieve his mental derangement" - and prevents him from dying of thirst or starvation (Morb. Acut. I, 81-82). Caelius recognizes that the care of patients with phrenitis, melancholy and mania makes special demands on the tact of the household slaves. (MT255) mandandum quoque ministris ut eorum errores quodam consensu accipientes corrigant, ne aut omnibus consentiendo augeant furorem eorum visa confirmantes, aut rursum

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repugnando asperent passionis augmentum, sed inductive nunc indulgeant consentientes, nunc insinuando corrigant vana, recta demonstrantes.1035 And instruct the servants to correct the patient's aberrations while giving them a sympathetic hearing. That is, have the servants, on the one hand, avoid the mistake of agreeing with everything the patient says, corroborating all his fantasies, and thus increasing his mania; and, on the other hand, have them avoid the mistake of objecting to everything he says and thus aggravating the severity of the attack. Let them rather at times lead the patient on by yielding to him and agreeing with him, and at other times indirectly correct his illusions by pointing out the truth. Sometimes soothing and calming a patient required diplomacy amounting to deception. We have already noted Celsus' ploy of announcing imaginary legacies to the wealthy man in fear of starvation and Caelius' covert restraining of a patient by having many servants massage him. Other kinds of deception were often recommended in order to get patients to accept medicines or to eat the proper foods. Celsus suggests that if the patient refuses to drink a draught of hellebore it should be put in his bread "to deceive him more easily" (3.18.20). Paulus too advises concealing purgative medicines in the food, "in mouthfuls of meat, or dried figs, or dates, or else with their drinks" (3.14). According to Caelius, deceiving a mentally disturbed patient is easy; if the patient demands something unsuitable, "give him the suitable food, pretending it is what he himself asked for. But if he does not yield, you will have to win him over by counterfeiting the food. For example, if he wants wine, give him mead; if he asks for barley water, give him spelt water prepared, say, with millet to seem like barley water." But, as noted above, he does allow for the possibility that the patient will not accept even these close approximations and will, in the end, have to be given what he desires (Morb. Acut. I, 81-82). Sometimes the deception was in the diagnosis. Rufus advises the physician that, in cases of melancholy, it is often prudent to pretend to be curing a case of indigestion and to reassure the patient from time to time that you are of that same opinion – "and make for him solace and happiness" (solatia et gaudia) (D 459). Other deceptions have become legendary as spectacular cures. A man suffering from hypochondriacal melancholy, who was convinced he had lost his head, was cured by making him wear a heavy hat made of lead; and a woman whose fantasy was that she had swallowed a serpent was relieved when a small snake was discreetly placed in her chamber pot.1036 IV. Redirecting Thoughts, Awakening Interests, Changes of Scene 1035 Cael Aur. Morb. Chron. I, 156-167; cf. Morb. Acut. I, 64: MT256 The attendants will have to endure the crazy whims of the patient and deal skilfully and ingeniously with them, agreeing to some and rejecting others, sympathetically, however, to avoid exciting him by frequent opposition. delirationes vero aegrotantium usu dextero atque artificio servientes accipere et tolerare debebunt, ut aliis assentiant, alias vero consentientes redarguant, ne frequenti correctione asperos faciant aegrotantes. 1036 Lead hat - Gal. K19, 701; snake and lead hat - Alex. Trall. Ther. 607.1-20; see also Heiberg 1927, 43-44.

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For certain types of cases, positive measures to alter the direction of a patient's thoughts were often advocated: exhortations to busy the patient with work or study, to exercise his mind, or to find new areas of interest. Thus Rufus recommended that the melancholic be "taken out of his thoughts" (remove eum a cogitationibus) (D 459). And Paulus said that those suffering from love-sickness "ought to be roused to emulation with regard to the objects of their peculiar interest in life; and, upon the whole, their understanding should be diverted to other concerns". (3.17). Celsus gives some suggestions for achieving such a goal in cases of insanity: (MT257) Interdum etiam elicienda ipsius intentio; ut fit in hominibus studiosis litterarum, quibus liber legitur aut recte, si delectantur, aut perperam, si id ipsum eos offendit: emendando enim convertere animum incipiunt. Quin etiam recitare, si qua meminerunt, cogendi sunt. (3.18.11) At times also his interest should be awakened; as may be done in the case of men fond of literature, to whom a book may be read, correctly when they are pleased by it, or incorrectly if that very thing annoys them; for by making corrections they begin to divert their mind. Moreover, they should be pressed to recite anything they can remember. A similar programme, but one perhaps more supportive, is suggested for those suffering from the insanity caused by black bile: (MT258) ... laudanda, si qua sunt, ipsius opera et ante oculos eius ponenda; leviter obiurganda vana tristitia; subinde admonendus, in iis ipsis rebus, quae sollicitant, cur potius laetitiae quam sollicitudinis causa sit. (3.18.18) ... work of his, if there is any, should be praised, and set out before his eyes; his depression should be gently reproved as being without cause; he should have it pointed out to him now and again how in the very things which trouble him there may be cause of rejoicing rather than of solicitude. Reading and speaking play an important role in the psychotherapeutic techniques of the ancient world.1037 According to Rufus, to restore loss of memory and benefit the mind it was good to read a great deal (D 460). Caelius

1037 Laín Entralgo 1970 has made an important study of Homeric, Platonic, Hippocratic and Aristotelian concepts of λόγος and its healing and charming powers. See also Simon 1978, ch. 9, "The Philosopher as Therapist" (Plato); Pigeaud 1981 addresses the interface between ancient medical science and philosophy with respect to "diseases of the soul"; see esp. ch. 5, "L'Euthymie: Connaissance et Guerrison de la Maladie de l' Ame". Gill 1965 explores ancient psychotherapy "to ask whether we can find anything in the Ancient World which resembles what we, currently, call 'psychotherapy' .... .But it is verbal psychotherapy I have especially in mind." (p. 307) G. generally does not find modern analogues, but does see in ancient philosophy a dialogue "(like modern psychotherapeutic

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in numerous passages suggests different kinds of literary mental exercise for the various disturbed mental states. Those prone to epileptic attacks were helped by a regimen which included reading aloud (Morb. Chron I, 97). For patients with mania (or melancholy), Caelius acknowledges the importance of "various mental diversions" in his therapeutics (Morb. Chron. I, 170). He repeats and elaborates upon some of Celsus' recommendations: for mental exercise the patient should read aloud from texts marred by false statement and should be kept busy answering questions. Then he should be permitted to relax and given reading that is easy to understand so that he not overexert himself - for mental exercises when carried to excess, he said, were just as harmful as physical (Morb. Chron. I, 162-163). As the patient improves he should be encouraged to deliver discourses and speeches, but there were important guidelines set out for the structure and delivery of these.1038 In addition, it was thought desirable that when the convalescent spoke "an audience should be present, consisting of persons familiar to the patient; by according the speech favorable attention and praise, they will help relax the speaker's mind" (Morb. Chron. I, 163164). Finally, when his recovery from the mania or melancholy was complete, it was felt beneficial, if the patient was willing, for him to hear discussions of philosophers. "For by their words philosophers help to banish fear, sorrow, and wrath, and in so doing make no small contribution to the health of the body". (Morb. Chron I, 167). In an important passage, Caelius acknowledges that different styles of treatment may be required when treating different classes of patient - although the underlying principle of the therapy remains the same. (MT259) ei autem qui literas nesciat immittendae quaestiones erunt quae sint eius artis propriae, ut rustico rusticationis, gubernatori navigationis. ac si ex omni parte iners fuerit curandus, erunt vulgaria quaedam quaestionibus tradenda, vel calculorum ludus. habet enim quiddam quod animum exerceat, et magis si peritior aegrotanti colludat. (Morb. Chron. I, 165) Now if he is unacquainted with literature, give him problems appropriate to his particular craft, e.g., agricultural problems if he is a farmer, problems in navigation if he is a pilot. And if he is without any skill whatever, give him questions on commonplace matters, or let him play checkers. Such a game can exercise his mind, particularly if he plays with a more experienced opponent. Travel and a change of scene were prescribed for many illnesses. An aphorism in the Hippocratic Corpus, much quoted in antiquity, states that "epilepsy among the young is cured chiefly by change - change of age, of climate, of place, of mode of life." 1039 Passages in the work of later physicians suggest that travel was often prescribed for those suffering from epilepsy. For the chronic epileptic, says Aretaeus, "it is good to take a journey, but not by a

dialogue) aimed at inducing the 'patient' to examine himself and improve his capacity for autonomous living." (p.232). 1038 On vocal exercises see the section above, "Exercise". 1039 Hipp. Aph. 2.45; cf. Stephanus comm. ad 2.44.

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river side, so that he may not gaze upon the stream (for the current of a river occasions vertigo)" (Morb. Chron. Ther. I, ch.4). He also recommends, if necessary a permanent change of locale for he states that epileptic patients should reside in hot and dry places to counteract the cold and humid nature of the disease (Morb. Chron. Ther. I, ch. 4). Caelius too suggests a trip for the epileptic patient, either on land or by sea "if sailing is not too much for him" (Morb. Chron. I, 112). Patients with mania were also thought to be helped in their recovery by the mental and physical stimulation of travel. Celsus says that for those individuals suffering from the long-term hallucinatory form of insanity, "if the mind returns (si mens redit), they should undergo the tossing incident to travel once a year" (3.18.23). Caelius too prescribed a change of climate for patients recovering from mania or melancholy, stating that, "a trip abroad by land or sea and various mental diversions are helpful in affording relaxation of the mind" (Morb. Chron. I, 166 & 170). Cheering Up: Friends, Music, Entertainment, Stories and Games "Those who are subject to melancholy ... are to be treated with frequent baths, and a wholesome and humid diet, together with suitable exhilaration of mind, without any other remedy".1040 Diversion, entertainment, companionship - each of these held a significant place in the physician's repertoire of therapeutic techniques. Friends (as well as relatives and slaves) were used in various ways to help a patient regain his grip on normal life. Celsus says that some disturbed patients were able to be induced to eat by placing them on couches between the other diners (3.18.11). Aretaeus advises that for phrenetic patients, "access of their dearest friends is to be permitted" and that they should hear "stories and conversation not of an exciting character" (Morb. Acut. Ther. I, ch. 1). And Paulus follows suit: "Let some of his most beloved friends come in and converse with him in a suitable manner, sometimes gently soothing him, and at other times chiding him more harshly" (3.6). Many of the suggestions which Caelius makes about the use of friends have been considered in the material above: the infrequent visits from a person the patient fears and respects, the need to discourage visitors the patient dislikes, the use of care-takers who correct sympathetically the patient's aberrations, and the value of an appreciative audience for restoring the patient's selfesteem as he recovers. Celsus recommended that the insane patient should be entertained by storytelling and by games, "especially by those with which [he] was wont to be attracted when sane" (3.18.18). Both the epileptic and the melancholic patient, according to Aretaeus, will benefit from "promenades" and "swings" (περίπατοι, αἰωραι), and the epileptic also should enjoy "recreation to dispel grief" (θυμηδίη ἄλυπος) (Morb. Chron. Ther. I, ch. 4). Caelius suggests that some

1040 Paul. 3.14, Τοὺς μὲν οὖν κατὰ πρωτοπάθειαν τοῦ ἐγκεφάλου μελαγχολικοὺς διά τε λουτρῶν συνεχῶν καὶ διαίτης εὐχύμου τε καὶ ὑγρᾶς ἐκθεραπεύειν ἅμα τῇ κατὰ τὴν ψυχὴν προσηκούσῃ θυμηδίᾳ χωρὶς ἑτέρου βοηθήματος.

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patients with mania should have cheerful things related to them which will relax the mind.1041 When these patients are recovering he further suggests using theatre as a therapeutic device: (MT260) item post lectionem aliqua composita vel mimica sunt offerenda, si maestitude furentes laborent; aut rursum tristitiam vel tragicum timorem habentia, si puerili lusu furentes afficiantur. oportet enim contrarietate quadam alienationis corrigere qualitatem, quo animi quoque habitus sanitatis mediocritatem agnoscat. And so after the reading let him see a stage-performance. A mime is suitable if the patient's madness has manifested itself in dejection; on the other hand, a composition depicting sadness or tragic terror is suitable in cases of madness which involve playful childishness. For the particular characteristic of a case of mental disturbance must be corrected by emphasizing the opposite quality, so that the mental condition, too may attain the balanced state of health. Some disturbed individuals were thought to respond well to certain kinds of music and noise. We have already seen that the sound of flowing or rapidly dripping water was used to calm frenzied patients. Other forms of acoustic therapy were also suggested. Celsus says that in some cases, "melancholy thoughts are to be dissipated, for which purpose music, cymbals and noises (strepitus) are of use" (3.18.10). In recommending this Celsus is following the tradition of Asclepiades, whom we are told first prescribed music for mental patients at Rome.1042 Caelius refers to the use of music by Asclepiades and his followers, but, although he recommends voice exercises under a trained musician for patients recovering from mania, he does not entirely concur with the use of music for patients suffering from mania.1043 (MT261) utuntur etiam decantionibus tibiarum varia modulatione, quarum alteram phrygiam vocant, quae sit iucunda atque excitabilis eorum qui ex maestitudine in furore noscuntur; aliam diram vel quae occupata mente pudorem suadeat, iniecto rigore, ut in bello, quam dorion appellant, in his qui risu vel puerilibus cachinnis afficiuntur, cum cantilenae sonus caput impleat, ut etiam recte valentibus apertissime videtur, vel certe, ut plerique memorant, accendat aliquos in furorem, quo saepe vaticinantes deum accepisse videantur. (Morb. Chron. I, 175176)

1041 Cael. Aur. Morb. Chron I, 160. The passage has a number of variant readings, but a general sense can be gained. attendendae etiam species alienationis cuius accidentia contrariorum coniectura erunt mitiganda, ut eum [an cum vel aegrum] hilaritate [hilaritatem] relaxent [relaxemus] nuntiantes quicquam quod animum resolvat. 1042 Censorinus, De Die Natali 12. See Dodds 1951, 79-90 on musical cures in Greek medical thought. 1043 Cael. Aur. Morb. Chron. I, 167, vocis exercitium musico monitore compositum cf. Morb. Chron. I, 175-176 & 178. In fact Caelius and the followers of Soranus generally regard those who use of music to cure sever diseases as "victims of a silly delusion" (hi mentis vanitate iactari); Morb. Chron V, 23.

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Some recommend that melodies be played on pipes for the patient, the melodies differing in mode. They say that one mode, which they call 'Phrygian,' is of pleasant character and serves to arouse those whose insanity is characterized by depression; another mode, called the 'Dorian,' is grave, has a sobering effect when the mind is impaired, and, as in war, inspires firmness and strength. The Dorian mode, they say, is for those whose insanity is marked by laughter and childish hilarity. But actually the sound of music congests the head, as is perfectly clear even in the case of healthy persons. In fact, it is abundantly attested that in some cases music arouses men to madness. Thus, as they chant their prophecies, priests often seem to be possessed by the god. Finally, wine, which holds a sober place among the various dietary recommendations and prohibitions for madness, was also given a recreational and cheering role, for it is recommended for melancholy by Rufus (D 457), who says that wine takes people out of their brooding thoughts and promotes happiness (et removentur ab eorum cogitatione et efficiuntur hilares). F. Summary Remarks Insofar as physical treatment for mental disorders is concerned, it is immediately apparent that a limited variety of methods of therapy were available to the ancient physician, but that almost all of these could be employed at different times, in different combinations, and at different stages to any of the various conditions.1044 The degree of severity and intransigence involved seems to have dictated the number of different treatments employed and to some extent their degree of harshness - although the latter seems also to have depended in part on the school or sect to which the physician belonged. Some, like Caelius and Soranus, were outspoken in their criticisms of the harshness and contradictory nature of some of the treatments propounded by other physician. Others, like Aretaeus, advocated strong and bold measures when dealing with mental illness. There is some evidence that the harshness and severity of the cures employed depended to an extent on the desires (and probably the status) of the patient. Galen speaks of treating some patients with brisk massage instead of his usual treatments, because they were "too faint-heated to take a purgative or allow a vein to be opened".1045 And a passage in Celsus on treatment for 'hydrops', suggests that physicians often found it difficult to prescribe unpalatable treatments for their free patients:

1044 In the texts examined here a number of passages specifically state that the cures are the same for several mental disorders: e.g. Scrib. Larg. Comp. 98, melancholy, epilepsy, insanity; Rufus Oeuvres D 366-367, loss of memory, epilepsy, paralysis, apoplexy; D 359, types of melancholy; D 324, epilepsy, melancholy, madness(?); Aret. Morb. Acut. Ther. I, ch.5, epilepsy, apoplexy; Morb. Chron. Ther. I, ch.4, headaches, epilepsy; Morb. Chron. I, ch. 4, chronic epilepsy and vertigo; Asclep. apud Cael. Aur. Morb. Acut. I, 144, two types of phrenitis; Morb. Acut. II, 37, phrenitis and lethargy, epilepsy, hysterical suffocation; Cael. Aur. Morb. Acut. I, 45, all acute disease and chronic diseases at stage of attack require same treatment, e.g. mania with or without fever and phrenitis; Morb. Acut. II, 29, lethargy and phrenitis; Morb. Chron. I, 61, all types of epilepsy; Morb. Chron. I, 155 & 166, epilepsy and mania; Morb. Chron. I, 183, melancholy and mania; Morb. Chron. II, 90, catalepsy and epilepsy; Gal. Loc. Aff. K168 S84, apoplexy, epilepsy, tetanus, paralysis; Paul. 3.14, mania and melancholy, 3.16, lykanthropy and melancholy. 1045 Gal. On Venesection against the Erasistrateans at Rome, Trans. Brain, 63, K241.

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(MT262) It [hydrops] is relieved more easily in slaves than in freemen, for since it demands hunger, thirst, and a thousand other troublesome treatments and prolonged endurance, it is easier to help those who are easily constrained than those who have an unserviceable freedom. But even those who are in subjection, if the cannot exercise complete self-control, are not brought back to health. (3.21.2-3) It seems highly unlikely, however, that patients suffering from severe derangement, whatever their status, were in any position to express their preferences or to protest effectively against the hunger, thirst, or "thousand other troublesome treatments". With respect to the attitudes toward and handling of the disturbed individual, the relationship between the patient and the physician seems also to have admitted of a wide variety of forms. Some have suggested that the frequent visits over relatively long periods of time, the questioning of the patient, even the mere presence of a caring physician, would have provided a form of "non-specific psychotherapy" in antiquity. 1046 This may certainly have been true in some cases, however the variety of approaches noted above include many which would not have been perceived by the patient as being either kindly or caring. In addition, the few glimpses which we have gleaned of physicians' attitudes toward their mentally troubled patients include as well as compassion, distrust, stern moralizing and some expressions of outright disgust.1047 The perception that the medical approach to mental illness in antiquity encompassed aspects of modern psychotherapeutic techniques has been refined and modified of late, but it should be further tempered with an awareness that the treatment of mentally disturbed persons in antiquity was a more complex and diverse matter than has often been assumed.1048

1046 The phrase is Simon's; see Simon 1978, 225-227 on the nature of the doctor patient relationship. 1047 E.g. Cael Aur. Morb. Chron. IV, 131-134; Aret. Morb. Chron. I, ch.4; Morb. Chron I, ch. 6; Paul. 3.71; 3.17; Aet. 16.74; Cels. 3.18.4. 1048 Psychotherapy and ancient medical treatment: cf. above, n. 120; cf. also Pivnicki 1969; Ballester 1974 and 1988 in Manuli and Vegetti 1988.

CHAPTER TEN Summary and Conclusion A. Aims and Evidence The stated aim of this dissertation has been to generate a comprehensive picture of mental illness or aberration as it was popularly perceived and experienced in the Greek and Greco-Roman societies of antiquity. To this end several fairly general questions were put forward at the outset: what kinds of behaviours and emotional states signalled to society at large and to the physician the presence of various types of mental aberration and how were these labelled? Were certain categories of people thought to be more or less prone to mental illnesses and what kinds of causes were thought, both medically and popularly, to be operative? What was the spectrum of responses, public, private and professional, toward individuals exhibiting aberrant behaviour? To answer these questions it has been necessary to survey an extensive array of primary sources encompassing a wide time frame. These have been preponderantly historical narrative accounts and legal and medical texts. From them we have assembled a large number of descriptions of individuals and syndromes exhibiting significant disturbances in the balance of the mind. Next, in an attempt to recover as much as possible of the experience of the mentally ill or mentally deficient person in ancient Greek society, we have surveyed the kinds of causes to which mental disorders were attributed, both popularly and medically, and also the types of remedies sought. We have also surveyed the various ways in which the mentally ill were treated, both in terms of their physical care and in terms of the attitudes displayed toward them by their families and friends, by their physicians, and by society at large. Because the topic was little discussed in antiquity it has been important to consult as broad a range as possible of primary sources which make any reference to the mentally ill and their treatment. Even so these have been able to yield only a partial picture. Much remains unanswered, much is provided only from a biased perspective, and much can only be conjectured. The inferences made here from the somewhat fragmentary evidence are considered to be cautiously plausible, and to go some way toward improving our understanding of the manner in which people thought about and treated mentally disturbed individuals in antiquity. B. Perceptions of the Mentally Ill From the examination of a representative collection of popular anecdotes concerning disturbed individuals, it is apparent that a great variety of mental states were popularly recognized to be abnormal in antiquity and that a large number of terms and phrases were used in a fairly general manner to indicate such states and persons. In addition, from the kinds of cases reported in the medical sources, it is clear that a wide array of mentally disorders were identified by physicians, and that a number of rather general labels were developed which were applied to various disturbed states. Many of the symptoms characterizing these states appear to have overlapped, and many mental illnesses categorized by the ancient medical writers were probably difficult, in practice, to distinguish.

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For the purposes of this study, disturbed mental states were initially distinguished on the basis of whether they involved single individuals or groups, and, within these two categories, whether the disorders were thought to be permanent or temporary. Both historical narrative and medical sources provided examples of each category, but case histories of single individuals predominated, particularly among the medical writings. Some of these disturbed mental states were found to be associated with stages of life, as, for example, the suicidal young women of Miletus (HN27) or the melancholy of Lysander in old age (HN44). Some disturbances were precipitated by critical events and strong emotional reactions: Timoleon’s response to his brother’s assassination (HN18); Herodes’ grief (HN1), or the mass frenzy of the besieged Lycians (HN61). Still others were associated with physical disorders: Cambyses’ epilepsy (HN2), or Marius’ derangement in his final illness (HN45). Ingestion of substances brought about aberrant states - drugs in the cases of Lucullus (HN10) and Leucippe (HN17); wine in the cases of Marius (HN44), Cleomenes (HN3) and Arcesilaus (50). So too could natural substances with poisonous effects as, for example, the honey eaten by Xenophon’s army (HN25) or the roots by Antony’s (HN19). Sometimes an individual is described as ‘out of his mind’ in the context of religious and/or poetic activity: briefly, as in the case of Olbius the prophetic paedagogue (HN78) or the women celebrating the rites of Dionysus (HN28), permanently and fatally as in Plutarch’s reluctant priestess (HN79), or deceptively as in the case of Alexander, the false prophet (HN33). Other disturbed mental states seem to have occurred unaccountably, as discrete, independent events - Thrasyllos with his “strange new kind of madness” (HN14), or the women of Southern Italy unaccountably dashing out of doors (HN26). Some mental disorders were thought to be episodic or recurrent: the wine merchant who went mad every night but was sane during the day (HN16), the “otherwise normal” man who applauded in an empty theatre (HN15); or the carpenter in Aretaeus, who was only afflicted when he left his place of work (MT106). Some disordered mental states were thought permanent: the elder son of Aratus (HN7) and Arrhidaios, son of Philip II (HN8); some were considered curable - the geometer Hipponicus (HN49) or Timoleon after twenty years (HN18). Others were thought incurable and many of these conditions were seen to be fatal - Plutarch’s priestess (HN79), Antony’s Parthian army (HN19) - and often because of suicide: Cleomenes (HN3); Timanthes of Cleonae (HN12); the Lycians (HN61); King Midas (HN63). The aberrant behaviour of individuals is described in some sources in considerable detail, in others there is simply a brief, often enigmatic report. From the former a general picture of the ways in which various mentally aberrant individuals were identified emerges. I. What is Madness? Manifestations, Clues and Signals. People judge others to be mentally disturbed on the basis of a number of perceived behavioural and affective manifestations. In antiquity such judgements seem to have been a fairly simple and uncontroversial matter. In contrast, our own society has a dichotomous approach to mental illness; on the one hand most of us think that we can readily detect a person who is seriously mentally disturbed - certainly someone severely mentally deficient. We feel that a combination of common sense, intuition, experience and practical wisdom can serve to identify when a person is “off track”. On the other hand we are also aware that some mental disturbances may be hidden, much may be borderline, and, increasingly in our changing and multicultural societies, behaviour which would once have seemed aberrant is coming to be explained in terms of differing social and cultural expectations. Consequently, for

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secure identification - in the legal realm for example - we rely upon medical criteria and definitions for insanity (and other less extreme aberrant mental states), and we recognize that these may differ from ‘popular’ perceptions. Furthermore, we do not merely solicit advice from professionals in times of need; as a society very much aware of change, we also accept the dicta of psychological experts when it comes to labelling as ‘aberrant’ or ‘dysfunctional’ behaviour which may have long been a part of the normal, everyday spectrum. In contrast in antiquity, there seems to have been less of a split between expert and lay opinion. Both ordinary people and physicians seem to have shared common, rather static assumptions about the criteria for rational behaviour and comprehensible emotional states. Physicians’ diagnoses as distinct from lay diagnoses seem primarily to have been important in cases where the mental disturbance was suspected of being a pretence. Galen’s treatise on detecting malingerers (MT220) and Rufus’s on interrogating the patient (MT216) suggest that physicians were expected to be able identify real and feigned mental illnesses, and something of this expectation is apparent too in the Ps. Hippocratic letters concerning the madness of Democritus (HN35). But in general there appear to have consensual normative standards of behaviour which, in instances of mental illness, were understood by physician and lay person alike to be visibly violated. Even in the legal realm evidence from forensic oratory shows that allegations of insanity were based on references to commonly assumed standards of reasonable behaviour - and the surviving (largely Roman) legal decisions indicate that there apparently were no direct formal appeals in antiquity to physicians as expert witnesses in cases where a man’s sanity was impugned. Apuleius’ description of his epileptic slave, Thallus, (HN57) which includes references to the fact that physicians were consulted but failed to achieve a cure, was probably typical of the way in which medical testimony could be included indirectly as part of an argument from probability. In the sources examined here, an analysis of the anecdotal descriptions of aberrant individuals yields an array of behavioural cues thought to signal mental illness in antiquity; it also points to emotional states considered dangerous, and, particularly in the medical sources but not exclusively, to a wide variety of physical symptoms considered part of mental illness. The behavioural symptoms vary from the violent to the trivial: murders performed at whim, as in the cases of Cambyses (HN2), King Cotys of Thrace (HN5) and Dionysios I of Syracuse (HN6). Delusions of persecution and/or omnipotence: Cambyses (HN2); King Cotys (HN5); Dionysios I (HN6); Menekrates “Zeus” (HN20) and his followers (HN21, 22, 23); and Eunus the Sicilian slave leader (HN24). Unprovoked attacks on family, friends, fellow citizens, the gods: Heracles pre-eminently (HN36); (Cambyses (HN2); Cleomenes (HN3); King Cotys (HN5); Dionysios I (HN6); Cleomedes of Astypalaea (HN13); Apuleius’ Thallus (HN57); the drunken mercenary Lucius (HN58); the frenzied Lycians (HN61); Lucian's insane father (HN64a); Artemidorus’ woman who killed her child (HN76); Aristotle’s cannibalistic men (HN39 & 40); the myths of the Thracian King Lycurgus (HN75) and the Athenian trireme crew (HN71). Harming oneself, mutilation and suicide often indicated an unbalanced mind: Cleomenes (HN 3); Timanthes of Cleonae (HN12); Timoleon’s initial impulses (HN18); the young women of Miletus (HN27); King Midas (HN63); Aristodemus (HN64); the myths of Boutes and of Glaucus (HN69 & 70). Again simple, random violence may be a clue: Cleomedes of Astypalaea who pulled down the roof of a school (HN13); Diogenes’ “bruiser” (HN53). There was also a vague category of

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inappropriate acts - activities variously described as "strange”, “absurd”, or “shameful”, as in the cases of the elder son of Aratus (HN7); the despot Nikokrates (HN9); Leukippe’s madness (HN17); the impulses of the women of Southern Italy (HN26); Aelian’s “stupid” people (HN56) and his men with “extravagant passions” (HN65). Actions simply childish or inappropriate too could earn the epithet “madman”. Some specific behavioural signs associated with mental disturbances in both popular and medical thought included: wakefulness - Democritus (HN35); Marius (HN45); Phaedra (HN 80); irrationality and helplessness - Lucullus (HN10); Leukippe (HN17); Hipponicus (HN49); the Bacchantes from Thebes (HN28). Persistent delusions or obsessions: Thrasyllos at the Piraeus (HN14); the man of Abydos (or Argos) at the empty theatre (HN15); Antony’s Parthian army turning over stones (HN19); the women of Southern Italy called from their dinner tables (HN26); the young women of Miletus (HN27); Nicias of Engyium’s feigned delusions (HN31); Democritus’ many suns and voices of birds (HN35). Avoidance of human contact and wandering were a much noted signs if mental instability: again Timoleon (HN18); Strabo’s account of wandering madmen (HN77); Democritus (HN35); Nicias (HN31); and the stories of the misanthropes Diogenes, Heraclitus and Pyrrho (HN41-43). An inability to communicate, or disturbed or unintelligible speech was also a sign - pre-eminently in Cassandra (HN27a) - but also in the cases of Leukippe (HN17), Nicias (HN31), and Alexander the False Prophet (HN33); bizarre speech also featured in the traditions surrounding the eccentric Alexarchos “Helios” (HN23). Strange speech might include talking to oneself like Democritus (HN35) - versifying but senseless ravings, or what was seen to be prophetic or poetically inspired speech, like that of Solon (34), Olbius (HN 2478), Eunus (HN24), Alexander (HN33) or Plutarch’s priestess (HN79). Emotional states which in their extreme forms were thought to signal mental derangement - or its approach included the following: excessive distress and sadness: Timoleon (HN 18), or the stepmother of Lucian’s physician (HN64a); uncontrolled rage: Cambyses (HN 2); Dionysios I of Syracuse (HN6); Cleomedes (HN13); Dion’s son (HN59); excessive grief Herodes (HN1); Timanthes (HN12); shock and extreme fear: the Lycians (HN61), Dion and the apparitions (HN62); King Midas (HN630 and Aristodemus (HN64). Love-sickness could lead to some forms of mental aberration: mental distress in the case of Antiochus (HN66), “mad” passion in the case of Dionysios (HN67 cf. HN65) - even suicide in the case of Anthia (HN69). Inappropriate emotional reactions too were considered signs of mental dysfunction - whether they were laughter, sadness, or fears: Cambyses (HN2); Democritus (HN35); cf. Nicanor (MT8), Damocles (MT9) or Mnesianax (MT11). Among the popularly perceived physical signs of mental disturbance were included first of all unusual eye movements or contact - rolling or staring eyes, a misdirected gaze, bulging, or bloodshot eyes, as in Philostratos’ description of Heracles (HN36). In addition, loosed, tossed hair, a sign of Maenadic transport, was used by Eunus and Alexander to signify their mad and prophetic status (HN24 & 33) - and longed for by Phaedra in her distress (HN80). A foaming mouth; convulsive, uncontrolled or simply ‘odd’ gestures and movements - and inordinate frenzied strength- these were all recognized indications of serious mental distress. A bad complexion too, associated

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with the melancholic form of madness in the medical writers (see below), seems also to have been a commonly recognized sign of mental illness (HN35).1049. Many of the same behavioural, affective and physical signs of mental disorder noted in the lay descriptions are echoed and amplified in the medical sources; but in addition the medical writers display a more technical interest in certain other physical manifestations, clinical symptoms such as pulse, breathing, colour and digestive function. In common with the popular sources the medical sources note the following behavioural cues for mental disorders: wandering and incoherent speech, rapid or disordered speech;1050 wakefulness and watchfulness, disturbed sleep and bad dreams;1051 hallucinations - visual and acoustic - and delusions (some of grandeur or persecution);1052 silence or silent delirium;1053 wild raving;1054 fierceness, violence, attacks on others; frenzy or angry shouting;1055 religious frenzy (MT107); attacks on self and suicidal impulses;1056 ‘strange’ acts, ‘silly’, ‘dreadful’, ‘disgraceful’ meaningless and out of character activities;1057 avoidance of human contact or animosity toward people;1058 special ingenuity; prophetic or poetic ability;1059 singing, childish dancing and play (MT55; 102); murmuring or muttering to oneself (MT55; 80); excessive stupidity, fatuity, dementia.1060 To these the medical sources add some other behavioural cues: changeability of temperament;1061 avoidance of light, preference for dark or vice versa;1062 artful, devious trouble-making (MT43); erratic or immoderate gulping and devouring of food or drink;1063 refusal to eat or drink, lack of appetite;1064 rash, over-bold behaviour or

1049 On the connection in Greek myth between madness and skin diseases see Padel 1992, 177; see also Parker 1983, 218, 208, 212-214. The Erinyes bring both - and both are notably visible forms of suffering involving the whole person. 1050 MT1; 44; 55; 85; 128. 1051 MT1; 34; 36; 38; 41; 43; 44; 54; 55; 68; 73; 85; 89; 97; 98; 152; 153. 1052 MT3; 36; 41; 54; 55; 78; 80; 85; 87; 96; 97; 99; 102; 123; 136; 137; 138; 141; 142; 143; 151. 1053 MT10; 17; 55; 80; 85. 1054 MT12; 30; 35; 43; 101. 1055 MT35; 43; 55; 103; 124; 141. 1056 MT55; 80 87; 89; 103; 107; 123; 126; 144. 1057 MT 34; 87; 101; 126; 141. 1058 MT36; 80; 85; 87; 89; 101; 122; 144. 1059 MT104; 129; 154 & sq.. 1060 MT85; 89; 115; 145 sq.. 1061 MT87; 89; 97; 140 sq.. 1062 MT36; 43 sq.; 55. 1063 MS 10; 55; 73; 89; 98. 1064 MT43 sq.; 55 85; 126.

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talk;1065 excessive or inappropriate sexual appetites;1066 forgetfulness or memory loss;1067 inability to recognize familiar persons or places, disorientation.1068 Both the medical and narrative sources concur in the array of emotional signals which they recognize to be symptomatic of mental dysfunction: depression and sadness;1069 excessive, inexplicable, or obsessive fears or anxieties;1070 loathing;1071 rage, inexplicable anger, irritability;1072 inappropriate or uncontrolled laughter or joviality, even smiling to one’s self.1073 As is to be expected, the list of physical signs of mental aberration is much expanded in the medical sources. Certainly the importance of the eyes in signalling mental disorder is strongly echoed here: a ‘wool like covering’ of the eyes; rolling eyes or rapid eye movements or blinking; distended eyes or fixity of gaze;1074 bloodshot, or swollen watery eyes.1075 Other signs noted in the popular descriptions were also considered diagnostically important to physicians: the foaming distinguished the epileptic from those suffering from hysteria;1076 the convulsive movements and unusual actions, motions and gestures; convulsions or clonic shaking spells;1077 unusual (and unseemly) positions or changes of position while lying in bed;1078 perhaps allied to the legendary excessive strength of the madman were the suggestions of abnormal bodily strength and strong swift motions.1079 Complexion and colouring were particularly noted by some physicians in connection with mental disorders: changes in colour, complexion, skin disorders; hairiness and baldness factors.1080 But in addition to these a host of other physical symptoms were considered of importance in detecting and identifying the various conditions. vomiting (especially of black bile);1081 a strident voice (MT13); trembling,

1065 MT43; 44; 124. 1066 MT72 sq.; 83; 99 sq.; 128 sq.. 1067 MT72 sq.; 74sq.; 77; 89; 115; 140 sq.; 145. 1068 MT72 sq.; 138. 1069 MT1; 10; 31; 38; 40; 43 & sq.; 55; 64; 72 sq.; 73; 74; 80; 84 supra; 87; 97; 124; 140 sq.; 144; 153. 1070 MT3; 8; 9; 11; 31; 36; 38; 42; 43 sq.; 55; 68; 73; 74; 80; 99; 106; 112; 122; 124; 126; 143; 144. 1071 MT36; 126. 1072 MT55; 72 sq.; 73; 74; 84 supra; 87; 124; 128; 133. 1073 MT43 & sq.; 55; 74; 80; 87. 1074 ‘wool like covering’, MT13; rolling etc., MT17; 23; 44; 55; 73; 74; 99; 122 sq.; 153. 1075 MS 54; 55; 74; 128; 140 sq.. 1076 MT45; 72 sq.. 1077 MT55; 72 supra; 84; 118; 148; 149. 1078 MT44; 54; 55. 1079 MT74; 128. 1080 MT22; 55; 74; 81; 89; 98; 120; 123 sq. 128. 1081 MT13; 14; 81; 128.

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rolling, or uncontrolled tongue; 1082 teeth grinding;1083 pulse indications;1084 throbbing, swelling, tension or pain in the hypochondrium or other intestinal areas;1085 varicose veins, distended or dilated blood vessels;1086 plucking at threads or garments;1087 disturbed breathing;1088 unnatural or excessive sleep, stupor and sensory deprivation;1089 heart palpitations (MT73); digestive upsets;1090 head pains, noises in the head, ringing in the ears;1091 urine and bowel indications;1092 fever, chill, temperature changes;1093 nosebleeds;1094 sweating or dryness.1095 In general then the medical sources consider in much more detail disturbed bodily functions associated with disturbed mental states. Yet the general perceptions of both physicians and lay people of what constituted mental illness or dysfunction seem to have been consistent with one another and to have been largely based on similar kinds of observations about an individual’s behaviour, mood and physical appearance. This contrasts markedly with our own society, in which the sane or insane status of an individual accused for example of murder, is often hotly debated by legal and psychiatric experts and the general public alike. As noted above, in antiquity there was no appeal to professional criteria for mental illness, even in the legal realm, rather there were commonly acknowledged standards for judging a person to be mentally disturbed, standards shared by lay and professionals alike. And in general, although they may have applied the terms with a fineness of distinction that varied enormously, physicians and ordinary people used the same vocabulary of madness to describe much the same aberrant conditions. The evidence from both the historical narrative sources and from the medical writings suggests too that it was usually a complex of actions and emotional states, rather than any single one, which was thought to signal an aberrant mental state. Herodotus’ accounts of Cambyses’ madness shows clearly this summing up of a number of symptoms which together indicated madness. (HN 2) Timoleon is another example; overwhelmed with grief and determined to starve himself to death, he was forestalled, whereupon he withdrew from all social contact and wandered off into isolated places. (HN 18) And among physicians Caelius stresses the need to consider a

1082 MT19; 85; 123 sq.. 1083 MT20; 44; 55. 1084 MT24; 73; 89; 118; 140 sq.; 142 sq.; 153. 1085 MT23; 36; 44; 55; 73; 81; 123 sq.; 128. 1086 MT22; 44; 55; 74. 1087 MT3; 140 sq.. 1088 MT44; 140 sq.. 1089 MT5; 7; 62-65; 72 supra; 74; 129; 140 sq.. 1090 MT81; 89; 98; and see above, hypochondrial disturbances. 1091 MT54; 55; 72; 85; 97. 1092 MT54; 55; 128. 1093 MT54; 55; 65; 81. 1094 MT54; 55; 140 sq.. 1095 MT80; 123 supra; 133.

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constellation of symptoms in order to distinguish the kind of mental illness at hand. (MS 44a) There are some cases in which an individual is described as having one particular symptom (usually a hallucination or delusion), but as being in all other respects sane - for example Horace’s man who applauded in an empty theatre or Theophilus, who was convinced that flute players inhabited a corner of his room. (HN15; MT136 cf. also MT106; 107) For the most part, however, some sort of critical mass - or critical intensity - of symptoms seems to have been required for a condition to be considered a mental disorder. II. Cultural Specifics The clues and signals noted above are the cultural markers which form a part of the definition of madness in antiquity. But it should be noted that they are extremely varied and no single indication is found to be universally present in all cases. Mental illnesses have enough similarities, it seems, that they are readily identifiable by all and may be popularly referred to by a common vocabulary, but they resist classification and they are individual and idiosyncratic enough that it is difficult to isolate a common thread in their descriptions. For antiquity, as a preliminary, we can conclude that from the varied descriptions in the narrative sources of mentally disturbed individuals and groups, one common thread seems to be that the diverse actions or moods of such people are seen to be somehow incomprehensible and out of phase with the generally perceived realities. In addition, it seems that people labelled mentally dysfunctional all display, to a greater or lesser degree, behaviour which is not adaptive which runs counter to what may be very loosely defined as their own and their societies’ best interests.1096 The tendency to seek solitude and to avoid one’s fellows, as in the examples of Timoleon and Democritus, is one of the most frequently noted signs of mental instability in Greek antiquity. It appears to have been a particularly strong cultural marker - perhaps because Greek society could not conceive of the individual’s best interests outside of those of the collective. Solitariness was thus clearly perceived to be non-adaptive behaviour. This requirement that normal behaviour have a component of self or social interest may also explain why the prophetic, telestic and poetic were singled out as ‘special’ kinds of madness, distinct from the diseased form (although here again no specialized terminology was applied - the regular description of madness – μαινόμενος, ἔκφρων, ἐκστατικός -sufficed). The inspired states of the seer or poet, although in many ways considered to be abnormal mental states closely resembling ‘ordinary’ madness, were also viewed as socially valued forms of ekstasis - out of phase with everyday reality but in phase with a more significantly useful one, and therefore in essence an adaptive form of aberration. III. Terms and Labels Some mental disorders were thought to be recognizable and clearly marked. Epilepsy is a notable example, and it is referred to both in lay and medical texts by a group of terms largely distinct from the other vocabulary of madness. But other distinctions which we in our society might make, such as those between extreme emotional upset, 1096 This criterion for mental health is visible too in other societies. A good is example is the case of a gentleman farmer in 19th century England who was brought by his neighbours to an asylum and (with difficulty) certified insane on the grounds that he overpaid his farm workers to the point of endangering his own prosperity. See Parkinson in Porter 1991, 187-188. Padel 1981, 109 indicates that “madness in tragedy is ... seen as a neglect of selfinterest”. From the material examined here this seems to hold true too of popular perceptions of madness.

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depression, physical illness and fever, senility and psychoses, seem not to have been systematically made among the general populace in antiquity. The same vocabulary of madness served for all, and if different causes were recognized (and they were) the resultant states themselves were simply described by these multifarious but unspecific terms. It should be noted, however, that in this the contrast with our own society is not absolute. Although now the educated public employs psychological terms with some degree of sophistication (if questionable accuracy), describing an individual as, for example, depressed, compulsive, anorexic, schizophrenic, senile - or simply neurotic or psychotic - there still remains a large proportion of the populace who do not attempt to differentiate between states but merely refer to people as ‘crazy’ or, more genteelly, as ‘having a nervous breakdown’. Many are content simply to indicate that there is something wrong with another person’s head - this is conveyed by a variety of suggestive but non-specific terms - or even non-verbally. The Greek vocabulary of madness was rich in such nonspecific terms (see Appendix 1) and, we can reasonably speculate too that, as in contemporary Greek or North American society, the language of gesture was used to indicate those individuals who seem to be in some way mentally impaired. In addition, as previously noted, there seems to have been a sharing, both medically and popularly, of the vocabulary of mental illness - although no systematically agreed upon unity of usage is apparent. (And even among the medical writers there were difficulties over definitions; see for example, Caelius' preliminary discussion on phrenitis, Morb. Acut. I, 4-21.) There are, however, some indications that physicians made efforts to differentiate their more specialized use of the vocabulary of madness, and demonstrate their expertise by distinguishing their usage from that of lay people: Aretaeus, for example, pointedly diagnoses a case of love-sickness “which appeared to the common people to be melancholy” (Chron. 1.5). And the young physician portrayed in Lucian’s Disowned, displays his superior knowledge with a flurry of “technical” terms (many of which must be translated quite arbitrarily): Ἐπεὶ καὶ τῆς μανίας αὐτῆς μυρία εἴδη ἐστὶν καὶ παμπόλλας ἔχει τὰς αἰτίας καὶ οὐδὲ τὰς προσηγορίας αὐτὰς ὁμοίας. οὐ γὰρ ταὐτὸν παρανοεῖν καὶ παραπαίειν καὶ λυττᾶν καὶ μεμηνέναι, ἀλλὰ ταῦτα πάντα τοῦ μᾶλλον ἢ ἧττον ἔχεσθαι τῇ νόσῳ ὀνόματά ἐστιν. To be sure, of madness itself there are countless varieties, with many causes and even dissimilar names; for perversity, eccentricity, delirium, and lunacy are not the same thing, but are all names that signify whether one is more or less in the grip of the disease. (Trans. Loeb.).1097 Over time, however, somewhat clearer attempts to define mental illnesses and distinctions in terminology for aberrant mental states evolved among the medical writers. The earliest evidence from the medical sources on the identification of the mental disturbance seems to indicate that the physicians felt themselves to know, a priori, what mental illness was. G.E.R. Lloyd’s description of the Hippocratic physicians’ approach to madness can probably be understood to hold true for a great number of other physicians practicing throughout antiquity: 1097 Luc. Bis Accus. 30.

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Madness is mental illness, and mental illness, like any other is investigable and treatable. Yet the assumptions that are made are considerable. There is no sign of any realization of the particular difficulty of specifying what mental illness is, what it takes for a patient to be mad. Foul language and random talk ... even ... “much talking, laughter, and singing” are signs of abnormality; so too is loss of memory (not specified further): so too, on some occasions, is silence. The doctor is confident that the patient was merely babbling, or was unnaturally silent. He is confident, too, that he can tell the difference between depression arising from a distinct external stimulus, µετὰ προφάσιος, and straight depression.1098 In the Hippocratic Corpus the vocabulary of madness, although varied, is applied neither specifically nor consistently enough for us to comprehend the extent to which categories of mental illness were articulated. Clearly madness and epilepsy were distinguished, and other disturbed mental conditions, among them the phrenetic, manic and melancholic, were referred to. These conditions were to become the canonical mental disorders of the later medical tradition. A more developed attempt to distinguish and categorize mental disturbances is visible first in Celsus and then in more detail in Soranus/Caelius Aurelianus. One early distinction was that made between madness pure and simple and the madness or delirium accompanying diseases such as pleurisy and pneumonia with their high fevers and pain. In addition, the mental disturbances associated with old age were noted as somehow separate. These distinctions were not, however, considered to be differences of kind - no new terms were involved - but primarily of duration, as various remarks attest: “Madness has something confirmed in it”, or, “the madness of old age lasts to the end of one’s life”.1099 When physicians did attempt to establish nosological categories for the mentally disordered, they seem to have based their categories primarily on the predominating behavioural symptoms. As in epilepsy, whose chief symptom was a sudden seizure, so in the canonical three, phrenitis, mania, and melancholy, patients came to be categorized primarily by their actions and moods: manic (in all its varied manifestations) with fever was phrenitis, without, mania. A tendency to depression, gloom and fearfulness indicated melancholy. In addition to these there were a number of conditions variously identified in which the patient’s mind was thought to be affected largely on the basis that he or she was unresponsive: lethargy, carus, coma, coma-vigil, catoche, hysterical suffocation, apoplexy and catalepsy. In some of these, other physical symptoms, such as paralysis, were present; in others not, and some disorders of this latter kind may in fact have been mental disorders similar to later psychiatric categories such as schizophrenic catatonia. Yet even among these basic syndromes the lines drawn by the medical writers were not hard and fast; mania and melancholy in particular seem to have caused difficulty, perhaps because these two seem to have functioned 1098 Lloyd 1987, 24. 1099 Aretaeus Chron 1.6 ; cf. Celsus 3.18.3.

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generally as “terminological wastebaskets” for a variety of mental disorders. And medical usage here seems to reflect something of the wider application of popular usage. 1100 ‘Melancholy’, for example, and its associated forms, in popular speech had a broad range of meanings, and is often translatable simply as ‘mad’. In the medical writings too, melancholy appears to have comprised a wide variety of symptoms, and although it came increasingly to be particularly associated with depression and sadness, it could also involve delusions, hallucinations, raving and rage. Again, mania and its forms seems to have be a catch-all term both in popular and medical usage, and although it often seems to have had connotations of wild, raving activity, it could also be marked by sadness and fears. Some physicians even called melancholy a branch of mania. It is apparent that the medical writers’ categories of mental illness frequently included symptoms which overlapped; there was disagreement and at times confusion evident among physicians about certain of these categories, and some, like Caelius, were aware of the conflicts and inconsistencies in physicians’ use of terms and the resultant difficulties of diagnosis.1101 Again, not all aberrant mental states were covered by these core terms, and physicians employed, in addition to these, the same kinds of terms again found in lay descriptions of mental disorder – παράνοια, παραφροσύνη, ἔκστασις etc. Despite their professional recognition of distinct categories of mental illness identifiable by terms such as mania and melancholy, throughout antiquity physicians also appear to have employed a considerable variety of non-specific terms in a less than systematic manner. Underlying this was perhaps the assumption that all mental dysfunctions were essentially similar kinds of phenomena: Caelius, for example states that “loss of reason in all cases manifests itself by a similar type of mental disturbance.”1102 Moreover, many physicians regarded mental disorders as interrelated; each was thought to be able, under certain conditions, to become another.1103 In actual practice, therefore, many conditions must have been difficult to diagnose and it is probable that mental disorders were identified by physicians in a fairly arbitrary manner. Illnesses would have been identified partly based on the physician’s diagnostic enquiries, partly on his own physiological

1100 See, for example, Themison and Apollonius apud Cael. Aur. Morb. Chron. i, 183; 151; Aretaeus, MT86; cf. hydrophobia and melancholy, Rufus, MT112; lykanthropy and melancholy, Paulus, MT151. For the phrase, Siegel 1973, 273-274. 1101 For example his instructions on how to differentiate between mania with fever and phrenitis, or lethargy and phrenitis, or indeed, different types of phrenitis, Morb. Acut. I, 45-52. 1102 Morb. Acut. I 148; cf. also 5, “no one can hold that loss of reason (alienatio) is essentially different from madness (deliratio)”. 1103 For example, according to Caelius, mania could become phrenitis or phrenitis mania; phrenitis turn into lethargy and lethargy become phrenitis; and phrenitis or lethargy could become catalepsy or catoche and vice versa (Morb. Acut I, 48; Morb. Acut. II, 2; 73). Asclepiades had similar ideas about epilepsy turning into madness (apud Cael. Aur. Morb. Acut. I, 6), and, according to Aretaeus, the formerly mad could more readily become melancholic. In addition, he thought, melancholy itself could engender incurable spasms, paralysis and mania (Chron. i ch. 6; Morb. Chron Ther. I ch. 5). Galen, in concert with Hippocrates, thought epilepsy could become melancholy and vice versa and that melancholy often succeeded epilepsy (Gal. Loc. Aff. K180, S89; Hipp. Epid. 6.8.32 L5, 354-356, (MT33). cf. also K177 S88; K180 S89). This interrelationship of causality seems to reflect the difficulty we have noted previously in constructing categories for mental dysfunctions.

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assumptions and psychological theories, and probably largely on the basis of the dominant presenting symptom of the patient. In general we can say too that, although a great many of the individual symptoms and conditions are recognizable to us and to contemporary psychological specialists, with the exception of epilepsy, none of the categories or syndromes of mental illness described in the ancient medical sources conform to contemporary syndromes. This is true of the major categories such as mania, melancholy and phrenitis, but it is manifestly evident in such disorders as incubus and lykanthropy. Such syndromes seem quite alien to us and they highlight the fact that the constellations of symptoms comprising the variously labelled forms of mental illness were differently configured in antiquity than for our present society. IV. Who Goes Mad? One of the questions asked at the outset of this study was whether it would be possible to identify groups, categorized by age, gender or class, that were considered particularly vulnerable to mental disturbances. With respect to age, clearly old age was recognized as a stage of life prone to mental deterioration - old men, their problems and health care are significantly represented in the sources - as opposed to old women, who are consistently under-represented. Children were generally expected to be less likely to exhibit most mental disturbances, the exceptions being, possibly, mental retardation and certainly epilepsy, often called “the children’s disease”. Puberty was recognized as an important stage in which youths and young women were prone to mental and physical dysfunction (see, for example, MT178)- it was seen to be a turning point to be negotiated in safety. Girls were considered particularly vulnerable to mental disorders associated with the menarche. But generally it was men in mid-life (approximately twenty-five to forty-five),who were thought to be principally afflicted with most mental disorders, especially mania and melancholy, and they too form the majority of the cases recounted.1104 We should, however, be cautious in concluding from this that adulthood for men constituted some kind of “cultural stress point” in Kiev’s terms. This may, in fact, have been the case, and many adult men may have responded to the pressures and harsh realities of life in the ancient world with visibly identifiable mental illnesses. But this perception may also simply be accounted for by the fact that the surviving literary and medical record overwhelmingly represents the adult male experience. Again with respect to gender, contrary to what might be expected, women seem not only to be underrepresented in both the anecdotal and medical sources, but they are also specifically described by the medical writers as being less prone to a great many mental and physical disorders - melancholy and mania in particular. It is noted, however, by more than one medical writer that when women did become mentally ill, their conditions were more difficult to

1104 Cf. Cael. Aur. Morb. Chron. I, 146 (mania); MT 179 &180 (melancholy); Aret. Morb. Chron Ther. I ch.5; MT183; Cael. Aur. Morb. Acut. I, 40 (phrenitis).

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manage.1105 Some mentally disordered women do appear in the sources, primarily in groups, usually in a religious context as Bacchantes, or individually as priestesses. They are also portrayed as women deranged by love or love potions. Their limited appearance may partially be accounted for by the fact that women’s experiences generally are underrepresented in the extant sources. More attention might be anticipated from the medical texts, but here again it is possible that women were less seen by physicians for reasons both social and economic. However the most likely interpretation of this lack of representation is that in antiquity women’s disorders tended to be seen in terms of disorders of their reproductive systems. Unless the illness was manifestly located elsewhere, some form of uterine disturbance would normally be held accountable, and in cases where mental and emotional symptoms predominated, it is very probable that this form of socio-medical default system would come into play. A good example of this is the explanation for the phenomenon of adolescent girls afflicted with mental derangement and a propensity to hang themselves - such conditions were generally considered curable either by the onset of menstruation, or by marriage, sexual intercourse and/or childbirth.1106 Women are present in the medical literature primarily, although not exclusively, in a gynecological context. It is therefore plausible to conjecture that the abundance of cases of hysterical suffocation, uterine fury and hysterical convulsions, have absorbed most of the manifestations of mental disorder among women and young girls in antiquity. V. Perceived Causes The diversity in the array of popular and medical explanations for mental illness is astonishing. What is most striking, in contrast to the accounts of madness in myth and drama, is the fact that divine causation is not a dominant factor in historical accounts of mental illness. Moreover it is almost completely absent from the medical texts, although in some there are a few brief references to religious frenzy and prophetic madness. The narrative sources do include evidence for the phenomenon of religious ritual possession and for the conjunction of prophetic and poetic powers and divine inspiration in popular thought.1107 But the idea of madness sent from the gods as punishment seems to have been confined largely to stories about kings and heroes - the great figures of history and myth. Ordinary people looked to an array of other explanations for their own mental troubles, and, although many of these were supernatural, they were at a less Olympian level. Curses, spells, daemons and magically empowered

1105 E.g. Rufus Oeuvres D455. Lucian’s account of the insane stepmother in Bis Accus. describes an illness impossible to cure because it is the insanity of a woman (29). This is in keeping with the medical testimonia. Generally this passage confirms our stereotypical expectations about attitudes to women and madness in antiquity: the woman is described as mad from “some form of trouble of long ago, lurking in the soul” (6), and women generally are described as “affected by many things which easily incline them to [madness]” - among them excessive hatred, jealousy or grief - passions which “slowly smouldering and acquiring strength in a long lapse of time produce madness.” (30). Certainly, as Padel (1983) indicates, the link between the female and the irrational was a part of Greek thought. The findings here suggest, however, that women’s irrationality tended not to be categorized in quite the same manner as men’s. 1106 Caelius, for example says that even epilepsy will often depart at puberty, or at the onset of menstruation or the birth of the first child (Morb. Chron. I, 71). It is noteworthy that one can still hear women of today hoping that an ‘impossible’ pre-adolescent daughter will become easier to live with “when she starts having her period”. 1107 Rufus, MT211; Cael. Aur. Morb. Chron. 1, 150; Aretaeus, MT107; Paulus 3.14.

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objects were widely recognized to bring about madness - and to protect one from it and the medical writers are explicit about people’s propensity to believe in charms and incantations.1108 Supernatural and magical explanations for insanity seem to have operated at all levels of society throughout antiquity, as is suggested by mythology and as the evidence from curse tablets supports, but such explanations did not always operate in isolation. It is more probable that multiple explanations for the complex and difficult phenomenon of mental illness were the norm. Multiple causal explanations certainly dominate the medical sources and, in view of Herodotus’ account of the diverse reasons for Cleomenes' madness, they were undoubtedly present too in popular attempts to account for individual cases of madness. Medically - and again we may conjecture, popularly too - not only could any one disease have many causes, but many of same causes were said to result in array of different disorders. And in addition, as noted above, many mental diseases were believed to be closely interrelated and, in a sense, to cause one another. The medical sources present various schemata of underlying physiological causes for mental illness. Humoral explanations predominate, and other, often related, somatic explanations are offered: for example, the Methodists hypothesized communities or general somatic states (of stricture or looseness); others posited blockage of sensory passages, vapours to the brain, ‘superfluities’ and ‘seething’ of the blood, plethora, or the harmful mixture of opposing qualities and states. These explanations are buttressed, however, by an array of secondary, precipitating causes which include many of the factors noted below plus additional quasi-scientific elements such as the patient’s mix of inborn temperament, or climatic and seasonal considerations. In addition to these, some medical texts include references to popular superstitions and beliefs in divine causation for mental disorders- primarily in a manner dismissive or disparaging. Somatic aetiologies for mental illnesses are the rule, although, as noted above, a few physicians made special note in their discussions of instances of divinely inspired frenzy and of the truly prophetic capabilities of some of their patients. The impression given by medical aetiologies for mental disorders, as G.E.R. Lloyd has remarked of the Hippocratic texts, is largely one of medical “bluffing” or “whistling in the dark”.1109 The bluffing aspect is most noticeable in the explanations for the primary or underlying causes of mental disorders - the various theories of black bile, blocked passages, superfluities and seething blood. When it comes to second order causes, those factors immediately precipitating mental illness, it is apparent that physicians tended to identify those elements which they considered able to be affected by their own intervention: poor diet, lack of exercise, over-heating or chilling; an emotional shock or fright. In fact a ‘shopping list’ of such causes is offered in the medical texts for each syndrome. This is the case with the ‘experts’, but the evidence suggests that lay explanations of mental disorder could well be similarly multi-layered, numerous and diverse.

1108 HN 82; 83; 84; 85; 97; Hipp., MT1a; Cael. Aur. Morb. Chron I, 1. 1109 Lloyd 1987, 26; 28.

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To a very high degree the kinds of causes cited in both the popular accounts and the medical sources concur with one another. Age, for example, among physicians and lay people alike was seen to be a factor in mental disorders either old age with its diminution of faculties or youth with the disturbing effects from rapid physical change. Heredity and innate temperament were universally considered important in predisposing individuals toward mental dysfunction and such factors were especially discussed in connection with melancholy and epilepsy . In particular some forms of mental deficiency were recognized to be inborn conditions. They could also result, like mental illnesses, from various external causes - the administering of drugs and poisons or the ravages of epilepsy.1110 Mental disorders were also generally recognized to result from wounds, particularly head wounds, from contagion, as in cases of hydrophobia, or from other diseases. Among diseases, epilepsy was popularly considered a common cause of madness and the medical texts concur. They also add, as noted above, a considerable number of other mental disturbances thought to cause one another. For example, not only could epilepsy cause mania or melancholy , but the reverse was also true; in addition mania could cause melancholy or phrenitis,and vice versa; and lethargy and phrenitis could cause one another - or they could each turn into a variety of other syndromes. The lay view seems to have been consistent with the medical in this respect. In keeping with the propensity we have observed generally to assign multiple causation to mental disorders, some anecdotal descriptions suggest, for example, that illness plus old age (HN45) or illness or old age plus excessive drinking were causal factors in a plunge into insanity (HN50; 46). Ingested substances were considered the key to many instances of madness or mental distress. Some were administered deliberately - as in drugs or poisons - others accidentally, and these included, in popular belief, some magical substances. In addition it was recognized by all, but expressly emphasized by physician, that tainted breast milk could cause epilepsy in children, and that excess in food or drink or the wrong kinds of foods or wines could bring about harmful mental symptoms. Medically such effects tended to be explained in terms of harmful interactions between an individual’s regimen -’life-style’ - and his or her innate constitution or temperament. There is a marked emphasis, both in lay and medical literature, upon the role of extreme emotions in engendering mental disorders. Particularly noted are such states as depression, shock, stress - whether from anxiety, fatigue, overwork or hunger - and excessive states of fear, anger, grief, or love.1111 The notable prevalence of emotional explanations for severe mental disturbances may in part result from a confounding of symptom and cause. Many forms of mental illness, as noted above, were characterized by profound disturbances of mood, and it would be an easy step to ascribe causality to such emotional conditions - to look, for example, to an original fright to explain a condition of unreasoning obsessive fear. Causal explanations in terms of emotions may also reflect a tendency in Greek society to view some forms of mental illness as a quantitative matter - to define as mentally aberrant 1110 HN7; 8; 57; Gal. Loc. Aff. K194. 1111 The story (HN 18) of Timoleon’s mental distress connected with his complicity in the murder of his brother might be seen to imply an awareness in antiquity that guilt or remorse could engender madness; this seems an obvious interpretation of his mental state to a contemporary reader. The question must, however, remain open, for nowhere is such an emotion specified - simply grief and distress.

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excessive, obsessive, or uncontrollable expressions of anger, fear, grief or passion.1112 Galen’s professional description of a man beside himself with anger as one “rolling his wild eyes in the manner of madmen” is entirely in keeping with Plutarch’s remark that “a man who has lost his temper differs from one who has lost his mind only in duration of time.”1113 And here again it is apparent that the concerns and judgements, both lay and medical, are in accord and reflect common cultural assumptions about emotion and mental illness. C. Experiences of the Mentally Ill I. Responsibility for Care The role of family and kin was primary in determining the kinds of treatment a severely mentally disturbed individual would receive. It is probable that those individuals whose ability to function in daily life was disturbed by minor mental or emotional symptoms sought out cures for themselves. Perhaps sufferers from phobias, for example, such as Nicanor (MT8) or Damocles (MT9) consulted a physician or other healing expert on their own initiative. Several stories from Latin authors suggest that some patients could play an active role in their own treatment: M. Livius Drusus, for example, who suffered from comitiales morbus, was said to have sailed to Anticyra in order to drink its famous hellebore and returned to Rome cured.1114 Seriously deranged people, however, were compelled to depend upon their families or, among Romans, as in the case of the aged Lucullus (HN10), upon surrogate families in the form of liberti/ae , to care for them, restrain them when necessary, and, if possible, search for a cure. Concerned friends too seem on occasion to have played supportive and therapeutic roles. Slaves who were mentally disturbed or deficient were reliant upon their masters for any treatment they might receive; and depending on various factors (primarily it is assumed their economic value) they could either be sent to work in a remote area, treated by physicians or dismissed. Plato’s suggested legal reforms and later codified Roman law attest to strong social pressures throughout antiquity upon families and slave owners to take responsibility for the insane member of their households. Despite this, mentally aberrant individuals are often characterized as prone to wander at large, and, depending on their symptoms, either to mingle with the general populace or to flee to remote areas. These were probably individuals without kin or whose kin were either unwilling or unable to care for them. This does not necessarily imply, however, that wandering madmen were exclusively from the poorer segment of society - they may have been difficult to constrain, or they may have been expelled from the oikos for fear of contagion or pollution. II. The Physician's Role Physicians, as we have noted, played a role in treating mental illnesses, but recourse to physicians was not as common in antiquity as it is in our society, and other kinds of healing experts were consulted as a matter of course. Dream oracles, shrines of healer-heroes, temple priests, priests at Asklepeia, and dealers in magic spells and 1112 Dover 1974, 126-7. 1113 Gal. On the Passions and Errors of the Soul 5.16.7 (Trans. Harkins, p. 38); Plut. Mor. 199A. 5. 1114 Pliny 25.52 cf. Aulus Gellius 17.15.5. Note also the ex-praetor in Suet. Cal. 29, who retired to Anticyra and its hellebore valitudinis causa.

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purificatory rituals were for the most part accessible to all levels of society and widely used throughout antiquity. Physicians served primarily the affluent, but not exclusively. They were summoned to wealthy households to treat valued slaves, and a number of medical descriptions of mental disorders and their treatment include, in addition to slaves, references to poor men, uneducated men, and laborers. 1115 To judge from these case histories, it seems probable that not simply the mad and wealthy reached the physician but that some physicians sought out the more severe and clinically interesting cases. Physicians’ expert evidence, however as noted above, appears not to have been formally required in any legal contexts. But medical consultants do seem to have played some sort of role in connection with insanity and public life in Sparta (HN86). The evidence for this is, however, slight and cryptic, hence it is difficult to know just what kind of professional responsibility was involved. Physicians recognized by specific signs mental disorders which were incurable (some forms of epilepsy for example) or even fatal, and, although it was generally thought politic in antiquity for a physician to distance himself from a hopeless case, there is evidence that there were physicians who considered it an ethical duty to continue to treat such cases in the hope of alleviating some of the distressing symptoms. One of the expectations of a good physician was that he be able to identify malingering and this included testing for instances of feigned madness. We may plausibly conjecture that their expertise in this respect was required in connection with the military or slaves - at any rate in contexts where escape from responsibilities or consequences was of paramount importance. A topos in Greek literature, feigned madness as a strategy for self-preservation, seems, from the medical evidence, to have been a real social phenomenon, although we have no way of knowing its extent. In addition to incidents of feigned illness there were, in antiquity as today, feigned cures by professional imposters who performed sleight of hand and other deceptions on desperate and gullible patients. Epileptics particularly appear to have sought out their services and it seems probable that individuals with other mental disorders resistant to treatment would also have formed a significant target group for such quacks. These imposters are of interest for another reason, for their existence points to the phenomenon of a wider medical and quasi-medical community functioning throughout antiquity. In attempting to understand the experience of the mentally ill in antiquity we should be mindful of the fact that the evidence examined here depends on a mere handful of manuscripts, and that the ideas contained in them have survived partly through chance and partly because they were the work of exceptional and original medical thinkers who took pains to record them. We cannot assume, however, that all physicians in antiquity were of this rank. Mentally disturbed people who were treated by physicians undoubtedly put themselves into the hands of men whose competence and training varied widely. In addition, even among the ‘great’ physicians, those whose names - and sometimes works - have survived, the evidence is clear that a great diversity of medical opinion was prevalent with respect to the care and treatment of the mentally ill. III. Cures and Treatments 1115Aret., MT106; Aret. Chron. 1.6; Cael. Aur., MT259; Celsus, 235.

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Despite the foregoing remarks it seems probable that the great majority of people suffering from mental disturbances in antiquity were not treated by physicians. Instead, there is evidence from a variety of sources that other modes of healing were prevalent and that people resorted to these - sometimes in combination with one another, sometimes seriatim. It seems probable too that an essentially pragmatic “try anything” approach dominated popular searches for cures and that these could take many forms. In the medical texts, a professional version of this same approach is evident in the multiplicity of treatments, alternative treatments and successive phases of treatment suggested for each mental disorder. There were a limited number of methods of treatment available in antiquity for mental disorders (or for any disorder) and, in practice, any or all of these were applied, sequentially or in combination, to the gamut of mentally disturbed conditions. Psychological disorders are by their very nature recalcitrant and idiosyncratic, hence it is perfectly comprehensible that not only family and friends but medical professionals too resorted frequently to a ‘shotgun’ type of treatment programme. One of the outcomes of this approach was that some sudden and inexplicable cures were popularly ascribed to random, post hoc, (and to us) bizarre factors, for example Cambyses’ fall of his horse or Orestes’ bitten finger.1116 The medical writers were more cautious in assigning causal significance. They preferred either to attempt to explain odd phenomena in terms of their own theories (e.g. Galen and the peony root amulet, MT245) or to acknowledge simply, like Caelius, that some conditions cured themselves spontaneously by luck or happy accident (Morb. Chron. I, 1). There was then, a general tendency among lay people and physicians to employ multiple forms of treatment for any one disease. In addition, the same or similar kinds of treatment were often prescribed for different kinds of diseases. This suggests that the way in which a syndrome was labelled was, in practice, not of critical importance. Both mania and melancholy, for example, were treated in much the same ways - not only does an analysis of the prescribed treatments indicate this, but Caelius and Aretaeus quite specifically classify the two together for treatment purposes. Aetiologies too were significant only to a point. The kinds of causes thought to have been operative may have influenced the initial type of treatment undertaken, but the evidence suggests that the therapeutic responses of both lay and medical people was dictated in many instances primarily by the kinds of symptoms the patient presented. Although generally the severity of the disorder and the degree to which it resisted cure appears to have governed the severity and duration of the treatment methods, in addition the expressed preferences of the patient seems to have been a factor in determining treatment methods in some cases. But personal preferences can only have been a decisive influence in cases involving persons of high status, and even then only in cases where the patient was not so severely disturbed as to interfere with his or her ability to communicate reasonably with the physician - as in the milder forms of melancholy for example. For the most part treatment methods for the mentally ill depended upon the choices of others. i. Popular Cures 1116 Herod. 3.64; Paus. 8.34.2-3.

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We have noted that in matters of terminology and, to some extent, aetiology, popular and medical discourse significantly overlapped in antiquity. So too with respect to treatment, the medical texts include some discussion of folk cures and religious and magical remedies, and lay discourse is permeated with quasi-scientific references to medical procedures - notably the drinking of hellebore. But some therapeutic methods are characteristic of each of these two distinct worlds. Popular discourse emphasizes not only the use of wine, drugs and fragrant substances in order to dispel madness, but also touching or ingesting objects believed to have magical properties - waters, honey, plants, stones, and a great array of esoteric animal products. The wearing of amulets, both to protect and to cure, was an important part of folk medicine, as was the use of magical spells, charms, and curse tablets. In addition religious cures such as oracular consultation, temple prayers and dedications, purification and healing rituals (including music and dance) and the consulting of dreams through the process of incubation were recourses available to anyone who suffered in body or mind and their use was pervasive throughout antiquity at all levels of society. Incubation at healing centres, and particularly in the great Asklepeia of the Hellenistic and Greco-Roman world was a very popular therapeutic procedure, primarily available to the affluent leisured class. Unfortunately there is no evidence extant that it was a method used by people with mental illnesses. For the severely disturbed it may not have been deemed useful, since the therapeutic effect depended largely on what the patient brought to the process and his/her capacity to learn from the dreams. From the career of Aelius Aristides, however, it seems probable that such healing centres usefully provided a therapeutic community for individuals who, although not labelled mentally ill by their contemporaries, nevertheless seemed unable to function adequately amid the stresses of daily life. ii. Medical Cures To a very great extent the therapeutic experience of a mentally disturbed person depended upon luck; the kinds of cures sought, the choice of a physician, the sect or school to which the physician belonged - all these factors were governed by chance and could profoundly influence the kind of treatment the patient received. This might vary enormously - from being bound, flogged and starved to being rocked, soothed, massaged and indulged. The kinds of physical treatments propounded by the various medical writers are manifold, varied, even contradictory. In general however ancient physicians concerned themselves with the following kinds of issues: first, the physical surroundings of the patient - light or darkness, temperature (prescriptions varied), and the calm and comfort and/or security of the patient. Secondly some emphasized restoring the strength of the patient by trying to induce relaxation and sleep using narcotics, soothing sounds and restorative aromas, and by prescribing appropriate diet (a complex matter) and exercise. The latter could vary from passive exercise such as swinging and rolling in a sheet to massage, brisk rubdowns, and gymnastics. Some physicians recommended sexual activity and, for women, pregnancy as part of their therapeutic regimen for certain kinds of mental distress - and some were criticized for prescribing untimely sexual

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activity for the very young.1117 Patients who remained too long in lethargic or other unresponsive states were forcibly roused so that they might be restored to strength- the methods varied from gentle shaking and calling to using sternutatives and foul odors and pricking or pulling the patient’s hair. A third category of treatments was designed primarily to purge the body of toxic elements and eliminate any harmful humoral excesses. Bleeding, arteriotomy, cupping and scarification of the head and various other parts of the body was part of the treatment for most mental diseases. In addition the head was purged by the use of sternutatives and by shaving it and, in addition to cupping, applying fomentations and plasters of varying strengths. Vomiting was induced by emetics - white hellebore was commonly used and it was considered of the utmost importance that the system be purged ‘downwards’ by means of purgative drugs such as black hellebore and special recipes with a long tradition, called ‘hiera’. In addition patients were treated with cathartics, diuretics, suppositories and clysters - these too of varying intensities depending upon the physician. Treatment by opposites to restore a balanced equilibrium was a common medical principle, accordingly conditions thought to be, for example, moist and cold - such as epilepsy - were treated by applying heating and drying remedies. Heating and cooling remedies could be in the form of internally ingested drugs or externally applied fomentations and plasters. Patients were also anointed with oils and cerates possessing the appropriate herbal or aromatic qualities. Patients were cooled too by plunging them into water or oil, by sponging with water and by fans. Surgical methods were employed in some extreme cases: severe epilepsy, serious damage from a head wound, or in cases of hydrocephalus. Trepannation and an operation called chiasmos were the most common methods designed to alleviate either external or internal pressure on the brain. In addition procedures which involved burning the scalp were performed by some physicians. The medical sources also include accounts of folk remedies, sometimes to attack and discredit them, but at other times such methods are incorporated into the physician’s arsenal of therapeutic techniques. Some physicians approved of the use of amulets and magical incantation; some prescribed concoctions derived from parts of rare animal or humans and whose preparation and consumption involved magical rituals. Evidence for the use of folk remedies is found only in accounts of physicians’ treatments for epilepsy; yet we may fairly conjecture that some of these ‘epileptics’ were individuals suffering from what we would now categorize as other forms of mental illness, and further, that some physicians or quasi-medical practitioners resorted at times to cures of this kind for people suffering from mania, melancholy, paranoia or some other severe and persistent form of mental disorder. IV. Attitudes and Handling

1117 Other physicians forbade sexual intercourse for patients suffering from mental disorders such as mania and epilepsy - but in general the professional view seems to have been that regular sexual activity (as distinct from excessive passionate desire) was healthy and beneficial.

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Not only was there great diversity among treatment methods but in both the medical and the historical narrative sources, a broad spectrum of attitudes is visible in the way in which the mentally ill were handled and managed. There is considerable evidence both for what we would term humane and inhumane approaches. Physical restraint, threats and coercion, including starvation and flogging, were recommended by some physicians for certain kinds of madness. But such measures seem not to have been punitive in intent; rather their stated aim was to bring the patient to his/her senses or to contain their violence. Harsh measures were also part of the popular response to insanity. Some disturbed people were confined either in their own homes or publicly, some were ejected from the household. Public responses to those wandering at large included avoidance, spitting (to avert contagion), stoning and ridiculing. This type of treatment suggests that there was some kind of stigma attached to the mentally ill. This is not, however, perceptible in the narrative accounts. At a public level, there were legal measures designed to control and constrain the mentally ill - at least with respect to property. Laws prevented those who were convicted of mental illness from being a party to contracts - notably wills and adoptions. And, as several extant speeches attest, allegations of insanity were part of the fabric of law court rhetoric. Legally too a son could prosecute - and possibly confine - a father who was mentally unfit and take over the management of the family property. But in addition to attempts to constrain or drive away the mentally ill, a good measure of tolerance and even compassion is visible in both the popular and medical accounts. Public responses also included alms giving to wandering madmen. Privately, family and friends were expected to sooth, cheer, and humour the mentally distressed and, as Greek drama pre-eminently depicts, help those making the transition back to normality. Some physicians did the same. Many stressed allaying fears and calming disturbed patients, humouring their aberrations while gently correcting them, even at times deceiving them to provide peace of mind. Physicians enlisted family, friends, and especially household servants to cheer and entertain depressed or recovering patients, to redirect their thoughts and awaken their interests. Particularly compassionate physicians, like Caelius, stressed too the desirability of gentle treatment even in the event that a manic patient require restraints. D. Ancient Society and the Mentally Ill In summary what can be said of the perceptions and experiences of the mentally disordered in antiquity? Ancient society can truly be described as a “face to face” society, and this means, in the context of mental illness, a society in which people identified and responded to aberrant individuals on a continuing personal and immediate level. In a manner quite different from our own society - although there was some minimal involvement with religious or medical “experts” - mentally disturbed people in antiquity were not systematically labelled, classified, or segregated for treatment within an institutional framework. They remained throughout the duration of their illness - or indeed for life - a part of their family and their society. In fact the management of the mentally ill in antiquity may usefully be compared with that in China prior to the establishment of the bureaucratic Quing regime in the early nineteenth century. Vivien Ng, who has recently documented a shift in Chinese society from viewing madness as illness to

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classifying it as social deviance, points to the typically “eclectic, idiosyncratic, yet pragmatic responses” of Chinese families toward their mentally aberrant members.1118 In classical antiquity, just as in traditional Chinese society, madness was conceived to be an illness. And in the absence of any external authority in the form of concerned state or ecclesiastical officials, legal instruments or a medical establishment, the way was open for people to develop a varied and flexible set of responses toward mentally aberrant individuals. A very general comparison with our own society suggests that there were some similarities and many differences. Mental disturbances seem to have been a feature of all segments of society and did not predominate among the marginal elements such as the poor, slaves or women. In fact, in contrast to some of our stereotypical perceptions, women seem to have been considered less likely candidates for mental illness. As with us, a large vocabulary referred to aberrant mental state, with similar kinds of ‘wastebasket’ terms which covered a variety of manifestations was widely used. Again, like us, mental illnesses were considered by most people, both lay and professional to be diseases. However the split between the mind and the body was not marked in antiquity to the extent that it has been up to now in our society (where thinking on this is now rapidly changing, even among the general public). Mental disorders and bodily disorders were viewed in very similar ways. Expectations for recovery varied - some cases did and sometimes spontaneously, but the wide variety of both popular and medical cures suggests that the process, even more than today, could be a lengthy and difficult one. Causal explanations for mental disorders in antiquity were diverse and many differed widely from our own. But the medical writers in their search for physical causes at least show a similarity of intent to that part of our psychiatric tradition which emphasizes the biochemical aspect in explaining and treating mental illness. And in addition, some of the ancient popular modes of treatment approached some forms of therapy in use today.1119: In antiquity, as today multiple options for treatment were available, but the medical options was far less exercised than in our society. As is true today, the way in which an individual was treated depended upon a constellation of factors: status and education, age, gender, and luck. It also depended on the nature of his or her symptoms. As for attitudes, there was again great diversity. Mentally ill people were not seen to be simply the waste products of society as Vaughan would have it, nor, as Dodds suggests, were they invariably thought to have something of the sacred and divine attached to them. That some disturbed individuals did carry with them a sacred or prophetic aura is evident. We have seen, however, in the examples of Menekrates Zeus and Eunus, that different audiences responded to such people in different ways - ways which varied from adulation to mockery. Some attitudes and treatment in contrast to present-day practice appears to have been inhumane, notably the threatening, flogging and binding of severely disturbed individuals. But although the contrast is valid, there are still some therapies today 1118 Ng. 1990, 27-28. 1119 For example the music and dance therapies being used with success in England in the treatment of epilepsy, or the renewed emphasis in some current psychotherapeutic repertoires on the role of the will, introspection and selfrestraint, which seems not too different from the use of moral suasion in antiquity. See Laura Mansnerus, “Antidotes for Anger,” The Globe and Mail, 1 May 1993, Sec. D, p.8.

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which are coercive and frightening - electro-convulsive therapy is an immediate example. On the other hand in antiquity a high degree of compassionate involvement by family, friends, members of the household and physicians is also visible.1120 And this contrasts positively with our society’s tendency to treat with drugs and indiscriminately de-institutionalize mental patients, many of whom find themselves without a network of care and unable to function. The evidence clearly demonstrates that we can speak of no single Greek attitude to mental illness - rather what must be emphasized is the complexity of responses visible in Greek society among both ordinary people and physicians. These responses were extremely diverse and seem to have been governed more by the behaviours exhibited on the part of the sufferers than by any a priori attitudes to the mentally ill as a group. For antiquity the observations which Murphy has made about some simpler contemporary societies seem to hold true: ...there seems to be little that is distinctively cultural in the attitudes and actions directed toward the mentally ill....There is apparently a common range of possible responses to the mentally ill person, and the portion of the range brought to bear regarding a particular person is determined more by the nature of his behavior than by a pre-existing cultural set to respond in a uniform way to whatever is labeled mental illness. If the behavior indicates helplessness, help tends to be given, especially in food and clothes. If the behavior appears foolish or incongruous..., laughter is the response. If the behavior is noisy and agitated, the response may be to try to quiet, sometimes by herbs and sometimes by other means. If the behavior is violent or threatening, the response is to restrain or subdue. 1121 Variation and diversity have been a continuing theme throughout this examination of the perceptions and experiences of the mental ill in antiquity. Just as there is no single Greek response, there is no single entity called mental illness - simply myriad different kinds of behaviour eliciting myriad labels and reactions. These could take the form of attempts to explain, to dispel, to help, to curb or to cure. It was hypothesized at the outset that in antiquity “a variety of people thought a variety of things” about mentally aberrant states The evidence surveyed here has demonstrated more strongly than anticipated that this was indeed the case. In the end the truest picture we can construct of mental illness in antiquity must be a mosaic.

1120 It is possible to speculate that this tolerance and compassion for the mentally disturbed is in part a reflection of the fact that disturbances in the balance of the mind were not unusual experiences for anyone in antiquity. Fevers and malaria were ubiquitous, and since in general people did not consider the delirium of fever to be different in kind from other delirious states, this commonality of experience may have made some forms of mental illness less socially disturbing. The idea of a link between ancient melancholy, the popular concept of a “nervous breakdown” and “malarial prostration” was first proposed by W.H.S. Jones, Malaria and Greek History, (Manchester 1909): 98101; cf. Grmek [1983] 1989, 279-283. 1121 Murphy 1976, 1025.

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APPENDIX A The Vocabulary of Abnormal Mental States: Greek Vocabulary connected with aberrent mental states In the ancient world as now, a rich variety of terms were used in popular speech to refer to abnormal states of mind, terms which can seem imprecise, vague, capable of multiple meanings, and which carry more or less force depending upon their context. 1122 The following is an alphabetical listing of such words and word groupings followed in most cases by the appropriate definition from LSJ. Also included are words and phrases which were used to describe either (a) recovery from or (b) a state opposite to madness. The Greek vocabulary is followed by a similar section of Latin vocabulary. 1. ἀθ υμέ ω; ἀθ υμία - despond, despair: ἀθυμιάς τε καὶ δυσθυμίας μελαγχολικάς: Gal. Loc.Aff. K 378, despondency and bile (cf. below δυσθυμία); A. Pr. 474; Soph. Aj. 587. 2. ἀλ λοφά σσ ω - be delirious: Hipp. Dis. of Women 41.25; Prog. 20, al.; Gal.18 (2) 249 prob. l. in Aret. SA 2.4. Ionic word, cf. Xenocrit. apud Erot. Fr. 1; Eust. 1324.10. 3. ἀ λλοφ ρο νῆ σαι - be seized with frenzy: Hipp. Morb. 2.16; Mul. 1.41; Hdt. 5.85. ἀλλ οφρο σύ ν η, ἡ - absence or derangement of mind: Poll. 8.163. 4. ἀ λογισ τέω - (Rare usage) Plu. 2.656d; Longin. 10.3; Vettius Valens Astrologus 130.30. 5. ἄν οια; ἀ νοί η, ἡ -usually folly, but see Pl. Ti. 86b: δύο ανοίας γένη, τὸ μὲν μανίαν, τὸ δ᾽ ἀμαθίαν; Rep. 382c,e, etc, opp. μανία. ἀνό ημα, - α τπ ς, τὸ; ἀ νο ήμω ν, ο ν ἀνο ησί α, ἡ ἀνό ητ ος, ο ν; ἀν οηταίν ω; ἀ νο ητε ύω -τ ως ἄνοο ς; ἄ νου ς ὦ ἀν όη τε / οι = ὦν όη τε

1122Mattes 1970, 100-113 provides an excellent discussion of the use in Greek tragedy many of these words and phrases, grouping them according to their core meanings, or, in the case of phrases, according to their metaphorical associations, e.g Dunkel, Bremse, Wagen, Jagd, Meer und Sturm. Two other works, Rènier 1950 and Nardi 1983, discuss the (Roman) legal terminology for the insane. The vocabulary of madness in Roman comedy has been analyzed by Paschall [1939] 1966.

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6. ἀπο νοια, ἡ - loss of right perception, madness: D. 18. 249; 25.32; Phld. Lib. p. 11O.; PGiss. 8.7.8 (ii CE); Alciphr. 1.3; Plb. 1.70.5. ἀπο νεν οημέ νο ς, (ὁ ); - ως ἀπο νοέομαι; ἀ πον οηθέν τ-; ἀ πο νενο ημέ νο ς - have lost all sense; be desperate. 7. ἀρ χαῖος, ἀρ χαικό ς - simple, silly, (rare for senility); Ar. Nu. 915, al.; Pherecr. 205; Pl. Euthd. 295c etc. 8. ἄτ η, ἡ (ἄ τα; α ὐάτ α ) - (poetic) Il. 16.805. ἀτέω; ἀ τέ ων, ἀ τεό ντ- Il. 20.332 (Aristarchus); Hdt. 7.223. 9. ἀφρ αδέ ω, - ης, -ες, -ία (-ί η) - be silly, foolish, heedless. ἀφρά δμω ν; ἀφρ άσμ ων ἀφράζ ω ἀφραί νω 10. ἀφρ νε ύομαι, -ε υσις - be silly, play the fool. ἀφρο νέω, -η, ἡ; - ησις, ἡ; -ίζω; -ικό ς; ἀφρ όν ως ἀφροσ ύ νη, ἡ ἄφρω ν; ἄφ ρενο ς - crazy; frantic: Il. 5.875 cf. 761; A. Eu. 377; - also heedless, thoughtless, silly, senseless. ἄφρο ντις; ἀφ ρο ντισ τέω 11. ἀ χρεῖος, -ον; ἀ χρήιο ς - useless; unfit; helpless, foolish; - (possible rare metaphorical use) mentally unfit: Diog.L. 2.81. (Opp. εὐγενής: Soph. Fr. 667) 12. βα κχά ω - rave: Aesch. Th. 498. βακχεία, ἡ - Pl. Symp. 218b: τῆς φιλοσόφου μανίας τε καὶ βακχεῖας. βακχε ύω - Soph. Ant. 136; Eur. Ion 1204; - causal: Eur. Or. 411; HF 966 (βεβακχ-). 13. βλα ψίφ ρω ν, ον - maddening: φάρμακα, Euph. 14.2; êth, Tryph. 411; Orph. H. 77.3, etc.; - = φρενοβλαβής, A. Th. 725. 14. γερο ντ ομα νία, ἡ - craze or dotage of old men, name of a play by Anaxandrides; Arist. Rh. 1413b26. γερο ντιά ω - grow old and childish: DL 3.18. γερο ντο κομι κά, τά - Schol. Pl. Phdr. 240c. γέρω ν, -ο ντ ος (as adj.) - OT. 402 cf. Dawe Comm. p. 134; Ar. Nub. 821, Dover ad loc.; Eur. Andr. 678.

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15. δαιμο νά ω - be possessed, be mad: Eur. Ph. 888; Xen. Mem. 1,1.9; Plut. Marc. 20; Men. 140. δαιμονιζ όμενο ς - Plut. 2.362f; 996c; 458c; 363a δαιμονιό πλ η κτο ς = δ αιμονιό λ ηπτ ος - P. Mag. Leid. V.9.1; Ptol. Tetr. 169, 170; Petas apud Olymp. Alch. p. 95B. 16. διασ τρέφ ω – δια στρ αφῆ ναι (τῆν διάνοιαν) - (metaph.) distorted, twisted, perverted: Luc. Vitarum Auctio 24 (pass.). διαστ ροφ ή, ἡ - madness: DL 2.89; διαστροφός - Hdt. 1.167; Aesch. Pr. 673; Soph. Aj. 447; Metrod. Herc. 831.7. 17. διαφοιβ άζ ω - drive mad: Soph. Aj. 332. 18. διέφθα ρμαι; διέφθο ρα - to have lost one's wits: Dem. 48.52; Eur. Hipp. 1014. συ νδιαφ θείρω; συ νδιεφθ ορ ώς - (τὴν γνώμην / τὰς φρένας) - the mind destroyed (along with the body): Ps. Hipp. Ep. 10.1; DH 336. 19. δυ σθ υμαίν ω; -εω; δ υσθ υμία - melancholic depression: Gal. Loc. Aff. K179; 378; Democr.286.E; Aristot. Phgn. 813a 33; Hipp. VM 10. 20. ἑα υτό ς group: παρ᾽ ἑα υ ταῖς ἦσα ν - not in their right minds: Plut. Mor. 564 A. ἐξ ἑ ω υτο ῦ ἦ ν - out of his mind: Hipp. Epid. 7.45; (Opp. = ἐ ντ ὸς ἑω υ τοῦ ἦν regained his sanity: Hipp. Epid. 7.45). 21. ἔκστα σις, ἡ (τ ῶν λογισμ ῶν; μα νι κή ) - distraction of mind from terror, astonishment, anger, etc.: Hip.. Aph. 7.5; Prorrh. 2.9; Coac. 65; Aristot. Cat. 10a1; Plut. Sol. 8; Plot. 5.3.7; Men. 149 cf. Epit. 472; Epicur. Fr. 113; ἔκσ τασι ς καὶ μα νἰα - Hermias Alexandr. in Pl.Phdr. p.103A. ἐκσ τατι κό ς – (το ῦ λο γισμο ῦ): Aristot. EN 1145b11; - out of one's senses, of Ajax, Aristot. Problemata 953a 22, cf. Plut. 2.2a; Dio 55; - causing mental derangement: Thphr.HP 9.13.4. ἐκσ τατι κῶς ἔχει ν ἐξιστ άν αι; ἐ ξίστ ημ αι; ἐ ξεσ τη σ- (ἐ. τῶ ν λο γισμῶ ν; ἐ. το ῦ νο ῦ; τ ῶν φρεν ῶν ) Eur. Or. 1021 etc.; Isoc. 5.18; Aeschin. 2.4; Men. Sam. 276; 64 etc.; Plb. 32.15.8; Hipp. Prorrh. 1.18; Philippid. 27; Com. Adesp. 860; Vett. Val. 70.25; Aristot. HA 577a12; - of anger: Phld. Ir. p.78W.

443

22. ἐκφ ρο νέω; ἐ ξεφρο ν - to be demented: Dio Cass. 55.13, Fr. 9.2. ἔκφρ ω ν, -ο ν - out of one's mind: Hipp. Mul. 2.117; Luc. Nigr. 38; Plot. 2.9.8; - senseless, stupid, D. 19.267; frenzied (of poets), Pl. Ion 534b; (of Bacchantes), Luc. Bacch.1; Anth. Pal. 6.220.2(Diosc.); cf. Pl. Leg. 790e. ἐκφρό ν ως - Heliodorus (scriptor eroticus) 6.9. ἐκφρο σ ύν η / α, ἡ - madness, nonsense: Timaeus Locrus 102e. 23. ἑλ λεβορι άω - need hellebore, be mad, Callias Comicus 28. ἑλλεβο ρίζω - dose with hellebore, Hipp. Ep. 20,21, Mochl. 30, Plut. Alex. 41; Archig. apud Orib 8.1.1; - (and so bring to one's senses) D. 18.121. ἑλλεβο ρόμε νοι - title of a play by Diph.; AB 100. ἑλλέβο ρο ς, ὁ - plant given to the insane, Hipp. Vict. 1.35; hence πῖθ᾽ ἑ λλέ βορ ον = you are mad, Aristoph. V. 1489; Men. 69 (prob.1); Hipp. Fract. 11; Str. 9.3.3. 24. ἐμβρο ντ αῖος - (metaph.) - usually stupid, can mean madnesss, Plut.

2.1119b; Philostr. VS 2.27.5 ; - later

of ideas, crack-brained, mad, Porph. Advers. Chr. 35; Orphica Fr. 47. ἐμβρον τά ω; ἐνεβ ρο ντ ησ -; ἐμ βεβρο ν τῆ σθαι ἐμβρόν τ ητο ς; ἐμ βρο ντ ησί α, ἡ 25. ἐπιλ η ψία, ἡ ; ἡ ἐπί λη ψι ς - epileptic fit: Hipp. Aph. 3.22; Coac. 587; Morb. Sacr. 10; Aristot. Fr. 370; Pr. 960a18 etc.; - but invasion, attack of disease: Hipp. Morb. 3.16. The following alternative labels for epilepsy are extracted from Schneble 1987, 16-33. τὸ με γὰ νό σ ημα - Hipp. de iudicationibus 44; Epid. 2.5. τὸ θεῖον ἡ με γά λη νόσο ς ἡ ἱε ρὰ νο σό ς / ἡ ἱρ ή - Hdt. 3.33. νόσ ος αἰσ χρ ά πάθο ς παιδι κή Ἡρα κλεία νό σος σελ ηνια κό ς 26. ἐπίμαστο ς (ἐπιμαίομαι ) - Od. 20.377, “touched, i.e., ‘crazy’” as cited in Dodds 1951, 67 and 84 n.17, “Apoll. Soph. Hom . 73.30 Bekker explains ἐπίμαστος as ἐπίπληκτος, Hesychius as ἐπίληπτος. Cf. W. Havers, Indogerm. Forschungen, 25 (1909) 377 f.”. 27. θεοβ λάβεια - infatuation sent by gods, madness: Aeschin. 3.133; DH 1.24; DC 44.8.

444

θεοβλ αβ ής - Hdt. 1.127; 8.137; Ant. Lib. 22.4. θεοβλ αβ ῶς - Poll. 1.22. 28. θο λερό ς - (metaph.) troubled by passion or madness: A. Pr. 885; Soph. Aj. 206; Aet. 6.9.8. 29. θυιά ς, άδο ς, ἡ - inspired, possessed women, esp. Bacchantes: Plut. 2.293f.; fem adj. frantic, mad for love: Lyc.143 (Nauck TGF, 817). 30. κατ ήφεα, ἡ - depression: Plut. 2.528e; Them. 9; Cor. 20; D.H. 3.19. 31. κα το χεύ ς; κάτο χο ς; κα τεχόμενο ς - possession by a spirit, inspiration; catalepsy: Plut. Alex. 2. Rom. 9; Hipp. Prorrh. 1.92; Gal 9. 189; 10.932; Poll. I.19. 32. κο ρυβ αν τιά ω - be filled with Corybantic frenzy; be mad about, infatuated with a thing: Aristoph. Vesp. 8; Pl. Ion 543a. 33. κωφά ω; κε κωφ- - usually deaf/dumb; used metaphorically of the mind, dull, obtuse. ἡ κωφεία - stupor or depression: Phld. D. 1.24. κωφ ός - (see also below under stupid, silly etc.); Soph. Aj. 911; Pindar P. 9.87; Pl. Timaeus 88b. 34. - λ ηπ τος group: (see epilepsy above) νυμφ όλ ηπ τος - caught by the nymphs: hence raptured, frenzied: IG I2 788; pl. Phdr. 238d; Arist. EE 1214a23; Plut. Arist. 11. Θεολ η ψία; Θεόλ η πτο ς - inspiration; frenzy, madness: Arist. EE 1214a23; App. Hann. 42; in bad sense = Θεο βλα βή ς: Man. 4.80; Vet. Val. 114.12. μητρ όλ ηπ τος - possessed by the Mother of the gods: Herm. in Phdr. p. 105A. μουσό λ ηπ τος; μο υσο λ ηπτέ ομαι - be possessed by the Muse; Muse-inspired: Aristid. 2.13 J apud Phot. Bibl. p. 411B (om. codd. Aristid.); Phld. Mus. p. 86K; Plut. Marc. 17; 2.452b. οἰνολ η πτο ς - possessed by wine, drunken: Plut. 2.4b. Pan όλ ηπ τος - possessed by Pan: Mim Oxy. 413.173; Herm in Phdr. p. 105A. Φοιβό ληπτο ς - possessed by Phoebus: Hdt. 4.13; Lyc. 1416; Plut. Pomp. 48. 35. λ ηρεῖ ν group: ληρέω / - αίν ω - of a sick person, to be delirious: Hipp. Epid. 1.26. γ'. παρ αλ ηρέ ω - talk nonsense, rave; Hipp. Epid. 1.26.i'; Aristoph. Eques 531, Ra.

445

594; Isoc. 12.23; Pl. Tht.169a; Demosth. Prooem 4; - Crazy persons: Aristotle Rh. 1356b35. παρ αλ ήρ ησι ς, ἡ; πα ρά ληρο ς (= λῆρος : Hipp. Epid. 1.26 g') - raving, delirium: Hipp. Epid. 7.5., 1.2; Phil. 1.387 etc.; Hipp. Epid. 3.17.ζ'. ὑπο λ ηρέ ω - to be slightly imbecile: Ael. VH 3.37; Soph. Aj. 911; Pindar P. 9.87; Pl. Timaeus 88b. λήρησις, ἡ (το ῦ γ ήρα ος ) - dotage of the old: Aret. SD 1.6. 36. λύσ σα / η, ἡ (= λ ύτ τα ) - in Homer always martial rage; after Homer raging madness, frenzy as caused by the Gods; of love: Pl. Leg. 839a; Theoc. 3.47; - personified: Eur. HF 823; (of dogs = rabies: Xen. An. 5.7.26; Gal.1.296); Aristoph. Thes. 680 (λύσσῃ παράκοπος); Soph. Fr. 941.4 (λύσση μανίας). λυ σσά ω; λ υτ τά ω; λυ σσ αίν ω; λ υσσ όω; λε λ υσσ -; λ ύσ σημα; λυ σσ ήρ ης; λυ σσ ητι κός - rave, be mad: Soph. OT 1258; Pl. Rep. 329c & 586c; Epicur. Sent. Vat. 11; Man. 4.539; 6.560; - drive mad; make mad: Damocr. apud Galen 13.821; Ael. NA 12.10. λυ σσομ ανέ ω; λ υσσ ομα νία, ἡ - Man.: 4.216; Jul. Ep. 114 λυ σσ ώδ ης; (ν όσο ς) - of madness: Soph. Aj. 452; Eur. Ba. 981; Plut. Fr. 18.12. 37. μανί α / μαί νομαι group: μανία /η, ἡ - I. madness: Hdt. 6.112 &6.75; Hp. Aph.7.5; Isoc. 4.133;Pl. Philebus 45e; Lex Solonis apud Demosthenes 46.14. - II. enthusiasm, inspired frenzy. - III. passion, mad desire for. μανιά ω - to be mad, rave, Joseph. B.J. 1.7.5. ἀκρομα νής - on the verge of madness: Hdt. 5.42. μανικός - Aristoph. Vesp. 1496 & Plu. 424; Hipp. Aph. 3.20, Prog. 3; Pl. Rep. 403a, Phdr. 243c; Anaxandr. 28, cf. Epic. Epst. 2p.53U; Timocl. 612; Xen. Cyn. 3.5; Plut. Alex. 75 - generally mad, extravagent: Isoc.1.15; - disposed to madness, unbalanced: Pl. Symp 173d (dub); Sph. 242a. - Act. causing madness: Thphr. HP 9.11.5; Dsc. 4.73; Gal 11.767; Plin. HN

21.179; cf. Dsc. Alex. 6;

Plu. Arat. 54. μανιο υργέ ω - drive mad: Polyaenus Julius (Anthol. Gr.). 8.43. μανιώ δ ης ὑ πόσ χε σις - Thuc. 4.39. μανιω δ ῆς - Hipp. Aer. 7, Coac. 475; Thuc. 4.39; -δῶς -Gal. 5.415; Paul. Aeg. 3.6; Sch. Theocr. 1.83; - causing madness - Dsc. 1.68; 4.68. Nonn. D. 10.4. μαινά ς, -ά δος, ἡ (μαί νομαι ) - raving, frantic: -λύσσα Soph. Fr. 941.4; Eur. Bach. 915; - as subst. madwoman esp. Bacchante or Maenad, Il. 22.460 cf. Homeric Hymns -h.Cer. 386; Aesch. Fr. 382; Soph. OT 212; Aesch. Eu. 500; Eu. Tr. 173; - causing madness (love) - Pindar P. 4.216. μαινόλ η ς, μ αινό λιος - Sapph.1.18; active - maddening (of wine) Plu. 2.462.b.

446

μαίνομαι; μ αν οῦμ αι; μα ν ησ- ; μέμ ηνα; μεμ αν - ; ἔμαν ην; μα νείς; μ αν ῆναι; ἐμ ηνάμ νην; μην -; ἐμμα ν- ; ἐ κμαί νομαι, ἐ ξεμα ν- - Homeric use frequ. of martial rage, with anger; madman: Soph. Aj. 726; Pl, Sym. 173e ; - mad with wine: Od. 18.406; 21/298; - with Bacchic frenzy; - mad with joy: Aristoph. Ra, 103; 751; - madness in animals: Plut. 2.641c, al.; - active, causal sense: Eur. Ion 520, Aristoph. Thes. 561, Xen. HG 3.4.8; - medical, of malignant ulcers: Asclep. apud Aetius 15.14. ὑπερμ αίνομ αι; ὑπε ρεμά νη ν - Aristoph. Ra. 776. περιμαίν ομαι - rage round about, rash furiously about: Hes. Sc. 99; - with love: Ael. Ep. 7. ἐπιμαίν ω; ἐπεμά νη ν; ἐπεμ ην άμη ν - make madly in love with but also to be mad, rage, Aesch. Ag. 1427; Th. 155 (lyr.). ἐπιμαν ής - raving mad: Plb. 26.1a.1; Plut. Dio 47; Jewish epithet for King

Antiochus III of Syria.

ἀπομαί νομαι - go mad: Luc. D Deor. 12.1 (but cf. Adams' tran. of Aret. Morb. Chron. 1.6 [p. 62], κἢν ἀπομανῶσι, translated as “if they recover from madness”). ὑπομ ανι ώδ ης - somewhat mad: Sch. Arist. Av. 989. Types of μανία: ἀνδ ρομα νία - Plut. Lyc. & Num Syn. 3.3. δοξομα νεῖς - Athen. Deip. 11.12. γυ ναικομα νία - Amphis Com. (title) 1.1; Athen. Deipn. 9.37.3; 11.11; 14.49.13; Plut. Mor. 769B. μουσομ ανί α; μο υσομ ανέ ω; μο υσ ομα νής (= μο υσο λ ηπ τέομαι; μο υσ όλ ηπ τος - be possessed by the Muses; muse inspired, muse mad: Luc. Ner. 6; Ath. 4.183e; Soph. Fr. 245 (prob.); AP 10.16 (Theaet.); Plut. 2.706c. μητρ ομα νία, ἡ - hysteria: Cass. Fel. 79. οἰνομα ν ής – mad after wine: Athen. Deipn. 11.12. ὀρνιθ ομαν εῖς – mad about birds: Athen. Deipn. 11.12. ὀρτ υγομα νία - madness after quails: Chrysipp. Stoic. 3.167; Athen. Deipn. 11.11. ὀψομ αν ή ς – madness for dainties: Athen. Deipn. 11.12. παιδομ ανία, π αιδομ αν ής - mad after boys: AP 5.18 (Ruffin.); Plut. Mor. .88f; Plut. Mor. 769B. 38. Μαρ γίτ ης, ὁ, μαρ γαίν ω - Democr. 147. μαργά ω -Eur. HF 1005, Hec. 1128, Hipp. 1230. μαργόομ αι, μ άργο ς / μ αργ ῆ ς - Pind. N. 9.19; Aesch. Supp. 758; Eum. 67; Pl. Leg. 792e. μαργιτεία / μαρ γιτομα νία - Phld. Rh. 1.139S cf. also Vit. p.35J, Rh. 1448b30 etc. μαργο σύ ν η, μ αργ ότ ης, ὑ πομα ργό τερο ς - in comp. only: Hdt. 3.29,145; 6.75; DH 3.2; App.. BC 5.49.

1.207S;

Aristot.

Po.

447

39. μελα γχολία, ἡ - Hipp. Aer. 10; Aret. SD 1.5. μελαγ χο λά ω - Aristoph. Aves. 14, Pl. 12, 366, 903; Pl. Phdr. 268e; Demosth. 48.56; in Olympiod. 56; Alex. 211; Men. Sam. 218; Epitrep. 494 ff.; Gal. 1.500 etc. μελαγ χο λικό ς - Hipp. Aph. 3.20; Pl. Rep. 573c; Aristot. E.N. 1152a19. χολ ά ω - be mad: Aristoph. Nub. 832. 40. μω ρία, ἡ; μω ρός - stupid; of imbecility: Hipp. Prorrh. 1.92 μώρ ωσι;; μεμω ρωμέ να - dullness: Hipp. Virg. 1; extreme dementia: Hipp. Prorrh. 1.32; Gal. 16.696. 41. νο σέω - be sick, ail, whether in body or mind; also of passion; to be mad: Soph. Aj. 635Tr. 1235; ν. τὰ ς φρένα ς, Cratin. 329. νόσ ος, ἡ - LSJ II, 2, disease of mind, esp. caused by madness, passion, vice etc., : A. Pers. 750; θεία νόσος, of madness, Soph. Aj. 185; Ibid. 59; 452. 42. νο ῦς group: νοόπ λα γκτο ς - = ν οόπ λ ηκτος : Nonnus, Dionysiaca 9.255. νοόπ λ ηκτο ς - palsying the mind, (drink): AP 6.71 (Paul. Sil.), Trypho 275. νοοπ λα ν ής - wandering in mind, deranged, Nonn. D. 4.197. νοο σφαλ ή ς - = νο οπλ αν ή ς (distracting the mind) Nonn. D. 17.277. οὔτε ἔ ννο υ ς - out of one's mind: Philostr. 560. 43. οἰστ ρά ω / έ ω - sting to madness: Eur. Bacch. 32, 119; Soph. Tr. 653; Eur. IA 77. οἰστρ ηλ ατεῖτ αι - see- μαίνεται: Hsch.; AP 6.51. οἰστρ ηλ ασία - mad passion: Lxx (old testament) 4 Ma. 2,4; Suidas s.v.

Σαρδανάπαλος.

οἰστρομ αν ή ς / ία - Tim. Pers. 90; Nonn. D. 1.282; Hipp. Ep. 17.239. οἰστρο πλ άνεια - causing the wanderings of madness,epithet of Hecate: P Mag. Par. 1.2868. οἰστροφ όρο ς - AP 5.233 (Paul Sil.). οἶστρο ς, ὁ - metaph. anything that drives mad: Eur. HF 862, IT 1456; - insane passion: Hdt. 2.93; Eur. Hipp. 1300, Plato Rep. 577e etc.; - madness, frenzy: Soph. Ant. 1002; Eur. Or. 791, Ba. 665, IA 548. 44. οὐ χ ἱδρ υμέ νη ς γν ώμ υς - not in one's right mind: Hipp. Prorrh. 1.20, L5,516. 45. παρ αγ ηρ άω (παρ αγεγ ηρ α κώ ς) - be the worse for old age (be senile), Aeschin. 3.251; DS 9.4, J. BJ 1.30.3; Poll. 2.16.

448

46. παρ α κινέ ω; παρ ακε κι νημέ νο ς - excite violently, madden: Thphr. HP 9.19; - be out of one's senses: Com. Adespot. 885; Plato, Phdr. 249d; D.S. 24.3, cf. 10.14. (τῇ διανοία παρακεκινηκώς); - deranged: Plut. Fr. 3; παρακινητικῶς ἔχειν, Plut. Sol. 8. παρ ακι νημ ατι κώ ς (καὶ μα νιῶ δες ) - Phil. 2.477. 47. πα ρα κοπ ή, ἡ - infatuation, frenzy: Aeschylus Ag. 223, Eu. 329, Aristotle Pr. 965a 14; D.S. 15.7; Dscd 4.68; J. BJ 1.25.4; - delirium: Hipp. Aph. 6.26; Plut. 2.1223b. παρ ακοπό ς - Eur. Bach. 33 (φρενῶν) and1000; Metrod. Herc. 831.2; Sor. 1.39 (διὰ μέθην); Timotheus. Pers. 99 (φρενῶν). παρ ακοπτι κό ς - frantic, raving: Antyll. apud Oribasius 9.13.7 (gloss on

παρακρουστικός,

Erotianus, Galen 19.415). παρ ακόπτ ω - strike the mind awry, drive mad, derange, (φρενάς): Eur. Hipp. 238; (παρακεκομμένος τὸν νοῦν) Sch. rec. Aesh. Pers. 581, cf Phot. s.v.; - be deranged, go mad: Hippoc. Aff. 10; Aristot. Mir. 832b17; D..L. 4.44; D.S. 5.50; Plut. 2.963e, 1123f. 48. πα ρα κρο υσ τικός – ( = π αρ ακοπτι κό ς) Hippoc. Prorrh.1.11; Ruf. apud Orib. 45.30.59; Ruf. Quaest. Med. 1; Gal. 7.467. παρ ακρο υστ ός - = μωρός: Hsch. παρ ακρο ύω - be driven from one's senses: Comica Adespot. 705; Hipp. Epid. 1.26,.Case 1 (Loeb 1,187); confusion about everything: see Grmek 1989 [1983], 286 #4 ad Hipp. Epid. 1.1. 49. πα ρα λέγ ω - wander in one's talk, rave: Hipp. Epid. 1.18, 26.d'. 50. πα ρα λλα γή, ἡ - frenzy, madness: Lxx 4 Ki. 9.20, Iamb. Vita Pythag. 25.111. παρ άλ λα ξις, ἡ - mental aberration: (φρενῶν) Hipp. Acut. (Sp.) 1. παρ αλ λάσ σω /τ τ ω - metaph.; (φρενῶν) Lys. frag. 90; Plut. Luc. 43. 51. παρ ανοέ ω - be deranged, senseless, lose one's wits: Eur. IA 838; Aristoph. Nub. 1480; Lys. Fr. 74; Arisot. Ath. Pol. 56.6. παρ άνοι α, ἡ - derangement, madness: Aristoph. Fr. 226, Nu. 1476; Eur. Or. 824; Hipp. Prog. 23; Andoc. 2.10; - legal usage (e.g. παρανοίας ἑαλωκώς, dotage or declared of unsound mind): Aristoph. Nu. 845; Pl. Leg. 928e etc.; Aristot. Ath. Pol. 56.6, PA 653b5. παρ άν ησι ς, ἡ - = π αρά νοια : Herodotus Medicus in Rh. Mus. 58.70. τὰ π αρὰ τὸ νοῦ ς · οἱον· ἄνοια· δύσνοια· κακόνοια· παράνοια· διάνοια· περίνοια, Herodianus (and Ps. Herod.) 36.233.14f. 52. πα ράπ αισμα, τ ό - madness: Oenomaus apud Eusebium Caes. PE 5.25.

449

παρ άπαισ το ς- demented: Hsch. παρ απαί ω - metaph.; be infatuated, lose one's wits: Aesch. Pr. 1056; Aristoph. Pl. 508, Pax 90; Pl. Symp. 173e; Polyb. 12.8.1; Plut. 2. 963f. (παραπαίζων - epithet of Dionysus, [Eleusis] ÉArx. Delt. 8.171) medical, be delirious: Gal. 10.850, al. 53. παρ αφέρ ω / πα ραφέ ρομαι - of feigned madness: Lxx 1 Ki. 21.13; 4, Pass. παρενεχθέντι ( sc. τῆς γωώμης); - mad: Hipp. Prorrh. 1.21. παρ αφορ ά / -ρ ἠ, ἡ - mostly of the mind, derangement, distraction: Aesch. Eu. 330; Aret. CD 1.5, SD 1.6; Iamb. Myst. 3.7; Plut. 2.249b. παρ άφορο ς - wandering away from, e.g. παράφορος ξυνέσεως, - deranged: Pl. Soph. 228d; - abst. mad, frenzied: Plut. Art. 1; neut as adv. of a madman, Luc. Fug. 19, Am. 13. ἐν παρ αφο ρᾷ τ ῆς δια νοία ς. 54. παρ αφρο νέ ω - be beside one's self, deranged: Herodot. 1.109, 3.34,35; Aesch. Th. 806; Soph. Ph. 815; Aristoph. Nu. 844; Antiphon 2.2.9, etc.; - be delirious: Hipp. Progn. 10. παρ αφρό ν ησις / πα ραφρ οσ ύν η, ἡ - Lxx Za. 12.4; Hipp. Ep. 18; Herod. Med. Rh. Mus. 58.70; wandering of mind, derangement: Pl. Soph. 228d; Apsines (rhetor) p.333H; - delirium: Hipp. Aph. 2.2, 6.53, Prog. 10. παρ άφρ ων / παρ αφρό νιμο ς - wandering from reason, senseless: Soph. El . 473; - out of ones wits, deranged: Pl. Leg. 649d; Bacchyl. 10.103; Eur. Hipp. 232; Plut. Pomp. 72; Soph. OT 691; - adv., Zenobius. 1.43. 55. π ῆρο ς / π ᾶρο ς - disabled, of mind: Semon. 7.22; Ph. 1.624; - τῷ νῷ Sch. Aristoph. Pl. 48; Luc. Am. 46. τὸ πῆ ρο ς / π ᾶρο ς - dotage: Alcm. 98. ἐμπᾶρο ς = ἔμπληκτος - Hsch., (see πλάσσω). πηρόω / π αρό ω – πρὸς τὴν γνῶσιν, Anaxarch. apud Sextus Empiricus M. 7.55 cf. 298. 56. πλ άν ος, ὁ - (φρενῶν) - wandering of mind, madness: Eur. Hipp. 283. πλα ν ώδ ης - metaph., rambling (γνώμη): Aret. SA 2.11. 57. πλ άζ ω, παρ απ λάζ ω - (metaph.) go astray in one's wits: Eur. HF 1189; Od. 20.346; Nic. Ther. 757. 58. πλ άσ σω / π λάτ τω group: ἀποπ λ ηκτεύ ομαι - to be senseless: Phld. Po. 2.40. ἀποπ λ ηξί α, ἡ - madness: Phld. Rh. 1.145; Soph. Vita p.7J; μάντεων, Phlegon of Tralles Mir. 2 (cf. Dem. 34.16); (cf. of body - Hipp. Aph. 2.42; Aret. SD 1.7. ἀποπ λ ήσσ ω - disable in body or mind (stroke): Soph. Antt. 1189.

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ἐκπ λη ξία ἡ - mental disturbance, passion: Polyb. 3.81.6 ; - from ἐκπλ ήσ σ ω - generally meaning struck out of one's senses by panic, fear, desire, admiration. ἔμπλ ηκτο ς - stunned to the point of stupid, senseless: ἔ. καὶ μανικός Plu. Rom. 28; Agathias.(Anth. Gr. ) 3.24, etc. ἔμπλ ηκτα λ ηρεῖ ν - Galen 8.693. ἐμπεπλ ηγμέ νο ς - Galen Lex. Hipp. παρ απλ ηκτε ύομ αι - to be mad: Aquila (OT interpreter) 1 Ki. 21.14 (15), 15 (16). παρ άπλ ηκτ ος - frenzy stricken: Soph. Aj. 230; Melanipp. 4.4; - mad: Lxx De. 28.34; - metaph. mad: Herodot. 5.92 z'; Aristoph. Pl. 242; Xen. Oec. 1.13; Demetr. Eloc. 275. παρ απλ ηξία, ἡ - derangement, madness: Lxx De. 28.28, al.; Ph. 2.556; Oenom. apud Euseb. PE 5.22. παρ απλ ήσσ ω - to be deranged, mad: Aristoph. Lys. 831, Ec. 139, etc.; Eur. HF 935; Plut. Aem. 34. 59. τ υφογέ ρω ν - silly old man, dotard: Aristoph. Nub. 908, Lys. 335. τυφομ ανία - delirium (defined, Galen 7.655); Hipp. Epid. 4.13; Galen 16.497; - metaph., mad delusion: Plut. 2.830b. τῦφο ς, ὁ, - medical - LSJ, name of 4 kinds of fever, one accompanied by stupor; but see Littre VII 260 ff. - 5 different kind of τῦφος in Cnidian treatise περὶ τῶν ἐντὸς παθῶν; - delusion (οἴησις τῶν οὐκ ὄντων ὡς ὄντων) S.E. M. 8.5, philosophical usage; carziness, delusion: Ael. VH 12.51; delusive pride: Ael VH 9.17; 9.34. τυφό ω- (in pass.) to be crazy, demented: Plato Hipp. Maj. 290a; Demosth. 9.20,18.11 cf. 24.158; Polyb. 3.81.1; Cic. Att. 12.25.2, 1 Ep. Ti. 6.4, al.; Aristot. Pr. 873a23; Phld. Mus. p.54 K.; Luc. Nigr.1, Icar. 7; Arrian Epict. 4.1.150; filled with insane arrogance, Lucianus Sophista. Necyomantia. 12. Harp. explains τετύφομαι with ἐμβεβρόντημαι. νῦ ν ἐκτυφ ώθ η ς - has beclouded your wits: Babrius, 101. 60. ὑο σ κυ αμά ω - to be mad from taking henbane, to be raving mad: Pherecr. 72; in Hsch. 61. φρήν / φρεν- group: φρενεμπ άρο το ς - = βλαψίφρων, ον - Hsch. φρενῖτι ς, ἡ - inflammation of the brain, phrenitis: Hipp. Aph. 3.30, Com. Adesp. 344, D. Chr. 48.12; Luc. Symp. 20. φρενιτισμ ός - frenzy: Plut. Fr. 25.3 (pl. φρενετ- codd. Stob.). φρενιτιᾶ σις, ἡ - φρενῖτις, Suid. s.v. παρακοπὴ φρενῶν. φρενιτιά ω - = φρενιτίζω, Plut. Alex. 75; Alex. Aphr. Pr. 1.76. φρενιτιαῖο ς - = φρενιτικός. φρενιτίζ ω - be delirious: D.Chr. 66.8; Plut. 2.693a, 1128d; S.E. M. 7.247; Gal. 16.493; Alex. Trall. 1.13.

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φρενιτι κό ς - suffering from φρενῖτις: Hipp. Aph. 4.72, Epid. 1.6; Arr. Epict. 2.15.3; Antyll. apud Orib. 9.22.3; Sor. 2.1; Gal. 17 (1).890. φρενο βλά βεια / ία, ἡ - damage of the understanding, madness, folly: D.H. 5.9; Philo 2.49, Luc. Syr. D. 18; Cat. Cod. Astr. 2.174; Manetho Astrol. 6.599. φρενο βλα βέω - to be distraught, frantic: Sch. ABT Il. 20.332. φρενο βλα βής - deranged, crazy: Hdt. 2.120; Eupolis Comic. 181.7; Luc. Syr. D. 43, Hierocl. in CA 24 p. 472 M. φρενο δα λή ς - ruining the mind: παραφορά. Aesch. Eu. 330 μὴ φ ρεν ωθεί η ν - a brainstorm: Babrius 101. φρενό λ ηπτ ος - possessed, mad: Cat. Cod. Astr. 8(1).264. φρενομ αν ής - distracted, maddened: Aesch. Ag. 1140, Aristodem. 8.1. φρενομ όρ ως- Adv., suffering from a calamity to the mind: νοσοῦντα φ., Soph. Aj. 626 (-βόρως Dindorf). φρενο πλ ηγ ής - striking the mind, i.e.. driving mad, maddening: Aesch. Pr. 878. φρενό πλ ηκτο ς - stricken in the mind, frenzied: Aesch. Pr. 1054; (= φρενοπλήξ, ἡ / ὁ - AP 9.141). φρεν ώλ ης - distraugh in mind, frenzied: Aesch. Th. 757 φρεσσί λυ τος - mad: Stud. Ital. 2 (1922).394 (Phalasarna, iv BC, amulet). φρεν ῶν ἀφ εστ άν αι, ἐ κσ τῆναι, μεθε στά ναι - Soph. Ph. 865; Eur. Or. 1021, Ba. 944. τὰς φρέ να ς ἐκβάλ λειν - Soph. Ant. 648. φρλε νας ἐ κπε πατ αγμέ νος (ἐκπα τάσ σω ) - stricken in mind: Od. 18. 327; ἐξεπατάχθη· ἐξεπλάγη Hsch. ἐξέπ λω σα ς τῶ ν φρε νῶ ν - Hdt.. 3.155. ἐκπ λεῖν τ ῶν φ ρεν ῶ ν - Hdt. 3.155 (cf. ἐ.. τοῦ νοῦ - Hdt. 6.12). ἔξω φ ρεν ῶν - Pind. Ol. 7.47. φρεν ῶν ἀ ποσ φαλεί ς - Plut. Sol. 14.6 (Sol. 33.4); Aesch Pr. 472. φρεν ῶν ο ὐ κ ἔ νδ ον ὤν - Eur. HF 709. φρεν ῶν κε κομμέν ος - Aesch. Ag. 479. φρεν ῶν κεν ός - Soph. Ant. 754. οὐ φρε νή ρη ς φρεν ῶν τ ητώμε νοι -Soph. El. 1326. φρεν ῶν ἔ ξεδ ροι - Eur. Hipp. 935. φρεν ῶν π αρ άκοποι - Eur. Ba. 33. ποῦ π οτ᾽ φρε ν ῶν; - Soph. El. 390. πλά νο ς φ ρεν ῶ ν - Eur. Hipp. 283. φρένε ς διάσ τροφ οι - Aesch. Pr. 673; Soph. Aj. 447. μαργό τη ς φρε νῶ ν - Soph. Fr. 846. ἀνα κί νησις φρε νῶ ν - Soph. OT 727 etc.

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συμφο ρὰ τ ῶν φ ρεν ῶν - i.e. madness: And. 2.7.

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Terms describing sanity and persons in their senses 1. ἀρ τίφρ ων - sound of mind, sensible: Od. 24.261; Eur. Med. 294; Pl. Rep. 536b; Eur. IA 877 cf. τοῖς ἀρτίοις τὴν φρένα; - soundness of mind: Theog. 154; Eur. Troa. 417. 2. ἔμφρ ων - in one's mind or senses, sensible: to one mad, Aesch. Pr. 848, Ch. 1026; Soph. Aj. 306; Pl. Leg. 719c, 791b. 3 ἔν νου ς γίγ νομαι - come to my senses: Eur. Ba. 1270; Demosth. 31.2. 4. ἐπ ήβο λο ς φ ρεν ῶ ν - (= L. compos mentis ), Aesch. Pr. 444; Soph. Ant. 492. 5. εὖ φρο νῶ ν - commonly as “well disposed towards”, εἰς τινας or “right thinking”, but see LSJ I.3, in one's right mind: Aesch. Pr. 387. 6. κατ ανοέ ω, κατε νο - - be in one's right mind, senses: Hipp. Epid. 1.26.γ', 5.39. 7. κατ αφρο νέ ω, κατεφ ρο ν- - to come to one's senses, recover reason: Hipp. Morb. Sacr. 15; Nat. Mul. 3 (prob.1.), Plut. 2.165f. 8. ν οήμ ω ν εἶ ναι - Hdt. 3.34. 9. ν οῦ ν ἔ χο ντε ς καὶ φ ρέν ας - Ar. Ra. 535; Phld. Po 5.19, Rh. 1.240S, & 202S. 10. σ υν νοέ ω - Plut. Brut. 7.4.2. 11. σ ωφρο νέ ω - to be of sound mind: Hdt. 3.35; Gal. 15.449; Babr. 90.4. σωφ ροσ ύν η, ἡ - sanity, opp. μανία, Xen. Mem. 1.1.16, Act. Ap. 26.25. σώφ ρω ν - Pl. Cra.. 411e; Arist. EN 1140b 11. 12. ὑγιαί νω - to be of sound mind: Aristoph. Nub. 1275, Av. 1214; Plato Tht. 190c; Men. Pk. 220, etc.; in full τὰς φρένας ὑ., Hdt. 3.33; ὑγιαίνοντα νοῦν εἶχεν Plut. Mor. 15E. 13. φρεν ήρ ης - = φρεναρτίους, Hsch.; - = φρενοάρας, Bacchyl. 16.118 - sound of mind (opp. of ἐμμανής): Hdt. 3.25; cf. 30, 35; Eur. HF 150; Phld. Mort. 39; Plut. 2.323c; Luc. Cal. 3 etc.; -εστατος Harp. Astr. in Cat. Cod. Astr. 8 (3).137. 14. φρε νῶ ν ἔσ ω - Aesch. Ag. 1052; Soph. Ph. 1325.

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15. τὸ φρο νεῖν / φρο νεῖν - LSJ I.2. to be sane: Eur. Ba. 851; Aristoph. Nu. 817; Lys. 19.41, etc.; Aesch. Pr. 387; Soph. Aj. 1252, El. 394; Eur. Or. 99, al. LSJ IV to be in one's senses, right wits: Soph. Aj. 82 cf. 344; Eur. Ba. 853; Isoc. 5.18; X. Mem. 1.3.12. κα λῶ ς φρο νεῖν / κακῶ ς φ. - Od. 18.168; Soph. OT 600, Ant. 557. ὀρθ ῶς φρο νεῖν / ὀρ θὰ φρο νεῖν - And. 2.23; Aesch. Pr. 1000; Eur. Med. 1129, 1329. τοῦ φρ ονεῖ ν παρ όν τος α ὐ ταῖς - they recover their senses: Plut. Mor. 249 E-F. ζῶν καὶ φ ρον ῶ ν - alive and in his right mind, frequ. in inscriptions: I G Rom. 1.804 (Perinthus); ζῶν καὶ φρενῶν (sic) Jahresheft des österreichischen archäologishcen Institutes, 23 Beiblatt 206 (ibid.); Rev. Arch. 21 (1925). 240 (Callatis). νο ῶν καὶ φ ρο νῶ ν Testimonium Epict. 1.2, PPetr. 3 p.4 (iii BC).

Terms used primarily of foolish, senseless, thoughtless, or silly behaviour and of people who are foolish or stupid 1. ἀβε λτε ρία, ἡ - silliness, fatuity: Pl. Tht. 174c, Symp. 198d; Demos. 19.98; Aritot. Pol. 1315a 3, etc.; Rhet. 1390b30; Phld. Lib. p.410. ἀβελ τερε ύομαι - play the fool: Epicur. Nat. 89G. ἀβελ τερο κό κκυ ξ, ὁ - silly fellow: Pl. Com. 64. ἀβέλ τερο ς - silly stupid: Ar. Nub. 1201, Ra. 989 ; Antiph. 324; Pl. Rep. 409c etc.; Phlb. 48c; Plut. Mor. 127C. 2. ἀ λόγισ τος (παντάπασιν) - Xen. Oec. 20.15. 3. ὁ ἀ ναίσθ ητος - stupid fellow: Anth. Pal. 9.141; DL Men. 2.128. ἀναι σθ ησία, ἡ - stupidity: Thphr. Char. 14. 4. ἄ νοια, ἡ; ἀ νό ητ ος; ἀ νο ήμω ν - without understanding. ἀνό ημα - foolish act. ὦν όη τε / ὦ ἀν όη τοι - fool(s)!: Ar. Lys. 572; Vesp. 252. 5. ἀσυ νεσί α, ἡ; ἀσ ύ νετο ς - want of understanding, stupidity, witless: E. Ph. 1727; Thuc.1.122; Hipp. Fract. 25; 31. 6. ἀφρ αδέ ω; - ης (Ep.) be senseless; behave thoughtlessly: Il. 9.32; Od. 7.294. ἀφρα δία = ἀφ ροσ ύ νη - (Ep.) folly; thoughtlessness: Il. 5.649. 7. ἀφρ ονέ ω; ἀφ ραίν ω; ἄφρ ω ν - be foolish: Xen. Mem. 5.11.

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ἀφροσ ύ νη - Democr. 254; Hdt. 3.146, 9.82; Pl. Prt. 332e. 8. ἀτε λ ῆς τὸ φρ ονεῖ ν ὤ ν - mentally deficient: Plut. Alex. 77. 9. βρ αδ υτ ὴς ψυχῆ ς - slowness of mind: Thphr. Char. 14. 10. δ υσ νό ητο ς - slow of understanding: Vett. Val. 345.26. 11. εὐ ήθ ης - simple, silly; absolute simpleton: Hdt. 1.60, 2.45; D.18.11; Xen. HG 2.3.16. 12. ἠ λιθιάζ ω; ἠ λίθιος - speak or act idly, foolishly; foolish, silly: Xen. An. 2.5.21; Hdt. 1.60. 13. κε νεόφ ρω ν; κε νεοφ ροσ ύ νη - Plut. Ages. 37; DL. V.11 Aristotle; Aesch. Pr. 762. 14. κωφό ς - LSJ 5 - of the mind, dull obtuse: Soph. Aj. 911Pl Ti. 88b; title of satyr-play by Soph., “The Dullards”. 15. ὦ μά τιε / ὦ νό ητε - DL 2.79, 2.117; μάταιε, Hdt. 3.155. 16. μω ραίν ω; μω ρίζω - be foolish; μεμ ωρ ωμέ να - imbecility: Hipp. Prorrh.1.92. μῶρα φρ ονεῖ ν - foolish: Soph. Aj. 594. μῶρο ς - foolish, silly; dull sluggish; stupid: Simon. 57.6; Soph. Ant. 220, 470; Isoc. 5.94. 17. ν ήπιο ς - metaph. of the understanding, childish, silly: Od. 13.237; Aristoph. Nu. 105. 18. ν ώθεια, ἡ; ν ωθ ής; ν ωθ ρός, - ῶ ς - Hdt. 3.53; Hipp. Ep. 17, Aesch. Pr. 62; Pl. Tht. 144b; Plt. 310e; Aristot. Pr. 954a31; Plb. 3.90.6; 31.23.11; Babr. 16.7. 19. σ καιό ς - stupid: Ar. Vesp. 1183, Nu. 790; Lys. 10.15; Pl. Euthd. 295d.

Latin Vocabulary connected with aberrent mental states 1. alucinatio; alucinor,-ari - (also hal-) - delusion; wander in mind: Cic. Att. 15.29.2; Apul. Fl. 18. 2. amens, amentia - out of one's mind, demented, insane: Sal. Rep. 2.12.6; Liv. 2.40.5; Cic. Phil. 2.9; Tusc. 3.10; Catil .2.25. 3. bardus, -a, -um - stupid, dull: Pl. Bac. 1088; Cic. Fat. 10.

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4. baro, baronis - (Etr.) blockhead, lout: Cic. Att. 5.11.6; Fam. 9.26.3. 5. cerritus - possessed by Ceres, frenzied, demented: Pl. Amph. Fr. 8; Poen. 528; Rud. 1006; Hor. S. 2.3.278; Cic. Att. 8.5.1; see also below under insanus, cerebrosus and cf. Onians 1951, 148. 6. deliritas; deliratio - insanity: Cic, Sen. 36; Sen. Ep. 49.8 delirium - a derangement of the mental faculties, frenzy: Cels. 3.18.24. deliro - to be out of one's mind, mad, rave: Pl. Am. 727; Petr. 88.10. delirus - having a deranged mind, insane, crazy: Cic de Orat. 2.75; Suet. Nero 33.1. 7. demens, dementia - Out of one's mind, mad, frenzied, insane: Pl. Poen. 204; Cic. Pis. 47; Har. 39; Tusc. 3.10; Cels. 2.8.4.z; 3.18.3. dementio - become deranged, lose one's reason: Apul Apol. 45; 78. dementer - madly, crazily - Sen. Ben. 4.27.5. 8. desipio - be out of one's mind, lose one's reason: Cic Fam. 2.9.2Cels. 3.18.19. desipiens - lacking intelligence, witless: Cic. Fam. 3.8.4; Gel. 18.4.10. 9. furiosus, furens - mad, lunatic, frenzied, raving mad, out of one's wits (subst. = madman/woman): Plin. Nat. 30.95; Ulp. Dig. 24.3.22.7; Cic. Phil 2.1; Larg. 99; Var. Men. 148; Ulp. Dig. 3.5.3.5. furor - violent madness, delirium brainstorm; possession; personified Madness: Cic. Tusc. 4.52; Mur. 49; Cels. 2.7.26; ira furor brevis est, Hor. Ep. 1,2,62. furo - be out of one's mind, mad, crazed: Cic. Tusc. 3.11; Liv. 7.33.17. 10. insania / insanitas - unsoundness of mind, dementia, madness, delusion: P. Capt. 620; Cic. Pis. 46; Cic. Tusc. 3.8; 3.10; 5.11. insanio - be out of one' mind, be mad: Pl. Cist. 286; Men. 1046; Cels. 3.18.4 insanus; insane/insaniter - of unsound mind, demented, frenzied; insanely, madly wildly: Pl. Men. 373; Cic. Tusc. 4.54; Ulp. Dig. 21.1.4.1; insanum hominem et cerebrosum - affected with passion, enraged: Lucil 514; also used for madness P. Men. 890; Amph. 776. 11. insipiens - unwise, foolish: Vitr. 8.3.22Cic. Sen. 14; Quint. Inst. 6.3.8. 12. lunaticus - moon struck; epileptic: Paul. Dig. 21.1.43.6. 13. lymphatio; (?lymphatus) - a fit of panic or frenzy; madness: Plin. Nat. 34.151; 37.61; ?37.146 (lacunose).

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lymphatus; lymphaticus - Paul Fest. p.120M; Sen. Med. 386. 14. melancholicus (Gr.) - Cic. Tusc. 1.80; Plin. Nat. 20.227; 23.59; 22.133; 27.130. 15. mente captus - mad, insane: Cic. Off. 1.94. 16. mentis alienatio - derangement of mind; insanity, loss of reason: Cael Aurel. Morb. Chron. I. 66. 17. morbus comitialis - epilepsy: Larg. 12. The following list of Latin terms for epilepsy has been extracted from Schneble 1987, 34-47: deprehensio lues deifica morbus sacer - (also erysipelas or similar, OLD ) morbus magnus morbus maior morbus regius - (also jaundice, OLD ) morbus herculeus morbus divinus/divus/deificus moarbus coelestis morbus daemonicus/ daemoniacus/ daemoniaticus affectus/morbus puerilis affuctus/morbus infantilis mater puerorum morbus detestabilis morbus scelestus morbus foedus morbus sonticus - (or generally any disabling disease, OLD ) morbus insputatus morbus lunaticus morbus seleniacus morbus caducus morbus convulsivus 18. morio, -onis - an idiot kept as a laughing stock or fool: Mart. 6.39.17; Plin. Ep. 17.1; Ulp. Dig. 21.1.4.3. 19. phrenesis; phreneticus (Gr.) - madness, frenzy, delirium; suffering from madness, lunatic (subst. madman): Cels. 2.1.15; Sen. Dial. 3.13.3; Petr. 63.10; Sen. Dial. 2.13.1.

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20. rabio - be frenzied with rabies, rave: Var. Men. 217 rabidus; rabiosus - raging, frenzied, wild: Catul. 63.38; Stat. Silv. 2.7.100; Pl. Capt. 547. rabies - savageness, frenzy; uncontolled emotion, madness: Tac. Ann. 1.31; Plin. Nat. 30.8; Sen. Ep. 89.23. 21. stultitia; stultus - folly, stupidity; slow-witted, stupid, dense: Cic. Tusc. 3.11; Pl. Mer. 211; Post. hist. 2. 22. vecordia - disordered state of mind, derangement, frenzy: Sal. Cat. 15.5; Tac. Ann. 4.22; Flor Epit. 2.20 (4.10.10) vecors - Cic. Dom. 141; Har. 19; Pis. 47. 23. vesania - madness, frenzy: Hor. S. 2.3.174; V. Max. 9.2.4 vesanio - to act in frenzy, rage - Catul. 25.13. vesanus - acting without reason, or uncontrollably, frenzied, mad: Cic. Dom. 55; Pl. Trin. 826. Latin words meaning sane/sanity 1. animi / mentis compos - Ter. Ad. 310; Cic. Pis. 48; Liv. 27.50.2. 2. mens sana - Pl. Am 1083; Juv. 10.356; Cic. Catil. 2.35. 3. sanus - Pl. Aul. 769; Sen. Cl. 1.14.1; Hor. S. 1.9.45.