Ancient Theories

Abstract

In ancient medicine, mental and physical disorders were rarely systematically distinguished, as both were believed to be due to similar physical causes (e.g. disturbances in the humoural balance of the body). However, the medical authors described a number of illnesses characterised by the presence of mental symptoms, such as hallucinations, delusions, or irrational and inappropriate emotional states and responses. These comprised, most notably, mania and melancholy, often clustered together under such terms as ‘madness’ or ‘derangement’. Mania and melancholy were described as involving a loss or disturbance of reason, and as human reason was understood in a rather normative fashion, diagnosing madness in a patient was believed to be a fairly uncomplicated procedure. As a rule, medical authors interpreted mental symptoms as indications of disturbances in the physical apparatus of cognition and emotional regulation. Thus, for example, the famous Hippocratic tractate Sacred Disease explains mental symptoms such as hallucinations and bizarre fears and worries as resulting from a disordered state of the brain (1). According to the treatise, the brain regulates all thought, sense perception and emotional activity, and distortions of these functions are invariably due to humoural or elemental imbalances of the brain. Not all ancient medical authors subscribed to this view: both the brain-centred model and the humoural pathology had their critics. Still, many authors ascribed the various symptoms of mania (comprising delusions and excessive emotions of both ‘manic’ and ‘depressive’ type) to a disordered state of the head, while the symptoms of melancholy (comprising depression, fears/phobias, and aggressive or suicidal behaviour) were believed to originate either with the head or with the upper digestive tract. Mental disorders were usually treated by measures believed to address the physical cause of the illness. These comprised drugs (e.g. the purgative hellebore), bloodletting, and dietary prescriptions concerning the food, drink, physical exercise etc. of the patient. However, sometimes the mental symptoms were addressed directly by means of ‘psychotherapy’: the patient’s delusional ideas were corrected (sometimes even punished), and his mind was exercised with questions, games, and various distractions. Despite the diversity of ancient medical theories and schools, the discussion of mental illness was in many respects rather homogenous, and this is reflected in the philosophers’ comments on the issue.