Mental Illness in Ancient Medicine: From Celsus to Paul of Aegina
Edited by Chiara Thumiger and P. N. Singer, this volume is a collaborative collection of scholarly essays on how Greek and Roman medical writers conceptualized, diagnosed, and treated disorders of the mind. Its chronological frame is stated in its title and confirmed by its contents: it runs from Celsus, at the beginning of the imperial period, to Paul of Aegina in the seventh century CE. The book is not a history of “psychiatry” in the modern sense, nor a survey of philosophy of mind; it is a study of medical authors—their nosology, aetiology, therapeutics, and the theoretical assumptions behind them—together with the philosophical and theological debates with which those authors interacted. The contributors are specialists in classics, ancient medicine, and ancient philosophy, and the collection deliberately pairs the dominant figure of Galen with authors who are less often studied: Rufus of Ephesus, Archigenes of Apamea, Athenaeus of Attalia, Aretaeus, Caelius Aurelianus, Oribasius, Aetius of Amida, and the later Byzantine compilers.
A central concern across the volume is the vocabulary and classification of mental disturbance. Ancient medical texts do not possess a single, stable category corresponding to “mental illness.” Instead, they distribute symptoms across a range of conditions—phrenitis, mania, melancholia, delirium, lethargy, satyriasis, and others—and they disagree about whether such conditions belong to the head, the soul, the humours, the stomach, or the moral character of the patient. Several chapters trace how particular authors drew, or refused to draw, boundaries between bodily disease and psychological or ethical failing, and how those boundaries shifted between the Hellenistic, imperial, and late antique periods. Another recurring theme is the relationship between medical and philosophical therapy: whether the doctor’s regimen, drugs, and surgery were understood to address the same problems as the philosopher’s consolation and moral training, and whether the two traditions actually influenced one another in practice.
Chapters on early imperial and methodological authors
George Kazantzidis opens the collection with a study of the pseudo-Hippocratic letters, examining how melancholy is represented in that epistolary corpus and how the text negotiates the traditional association of madness with inspired wisdom—the idea that the insane or melancholic may possess insight unavailable to the sane. The chapter shows how a medicalizing account of melancholy can sit alongside, and qualify, a literary and philosophical one.
Nadine Metzger’s chapter, taking its cue from the phrase “not a daimon, but a severe illness,” considers Oribasius, Posidonius, and later ancient views on superhuman agents as causes of disease. The subject is the competition between explanations that attribute illness to divine or demonic agency and explanations that treat it as a natural somatic condition—and the ways late antique medical writers positioned themselves within that debate.
Sean Coughlin examines Athenaeus of Attalia on the psychological causes of bodily health. Athenaeus, a Pneumatist, is important for the volume’s larger argument because he represents a strand of medical thought in which the state of the soul or mind is treated as causally relevant to the health of the body—an anticipation of concerns usually associated with Galen.
Orly Lewis reconstructs Archigenes of Apamea’s treatment of mental diseases. Archigenes survives largely in fragments and quotations, and the chapter assembles the evidence for his therapeutic recommendations, situating them within the Methodist and Pneumatist currents of the period.
Melinda Letts treats mental perceptions and pathology in the work of Rufus of Ephesus. Rufus is a significant but fragmentary author whose views on melancholy, delirium, and the relationship between perception and mental disturbance are preserved chiefly through later quotations; the chapter assesses what can be attributed to him and what his positions were.
Galen
Three chapters are devoted to Galen, reflecting his centrality to the volume. Julien Devinant analyzes mental disorders and psychological suffering in Galen’s Cases—the clinical narratives in which Galen describes individual patients—and asks how Galen identifies and interprets mental symptoms at the bedside. Ricardo Julião examines Galen on memory, forgetting, and memory loss, considering how memory function and its failures were located within Galen’s physiology of the brain and the rational soul. P. N. Singer’s chapter, “Galen’s pathological soul,” considers diagnosis and therapy in Galen’s ethical and medical texts together, arguing that Galen’s account of the soul’s diseases cannot be understood by reading the ethical works in isolation from the medical ones, or vice versa.
Eating, sexuality, and the boundaries of disease
Two chapters by Chiara Thumiger extend the volume’s scope beyond the classic psychoses. The first discusses stomachikon, hydrophobia, and other eating disturbances, focusing on questions of volition and taste in late antique medical discussions—that is, on how ancient physicians distinguished involuntary bodily malfunction from failures of appetite and will. The second examines satyriasis and sexual disorders in ancient medicine, using the ancient description of satyriasis as “a most acute, disgusting and indecent disease” to explore how sexual pathology was classified, moralized, and treated.
Methodism, late antiquity, and the compilers
Anna Maria Urso analyzes mental derangement in Methodist nosography through the testimony of Caelius Aurelianus, the Latin adapter of Soranus. Methodism organized disease around constriction and relaxation rather than around specific affected organs, and the chapter considers what this framework implied for the classification and treatment of mental conditions.
Ricarda Gäbel turns to mental illnesses in the medical compilations of late antiquity, taking Aetius of Amida as her case study. The encyclopaedic compilers preserved and reorganized earlier material, and the chapter asks how their excerpting and arranging shaped the transmission and transformation of earlier psychiatric ideas. This is the strand of the volume that carries its narrative forward toward Paul of Aegina, the endpoint named in the title.
Philosophy and medicine in dialogue
The final group of chapters addresses the philosophical context. Marke Ahonen examines the Stoic view of mental illness, in particular the problem of “making the distinction”—how Stoic psychology, which treats the soul’s health as a matter of reason and virtue, separates vice from disease and the responsible from the pathological. Christopher Gill asks directly whether philosophical psychological therapy had any impact on medical practice, testing the assumption that philosophical consolation and medical treatment of the mind were parallel or interacting enterprises. Singer’s Galen chapter, placed last, returns to the question of how a physician who was also a moralist integrated ethical diagnosis and therapy into a medical account of the soul.
Overall character of the volume
Taken together, the essays offer a diachronic account of how medical writers from the early empire through late antiquity described and treated disturbances of mind and behavior. They attend closely to the fragmentary and indirect nature of much of the evidence, to the technical vocabulary of individual authors and schools, and to the interaction between medical theory and the philosophical and religious debates of their times. The volume does not impose a single narrative of progress toward modern categories; instead it documents a series of overlapping and sometimes incompatible frameworks—humoral, pneumatic, Methodist, Galenic, and encyclopaedic—within which ancient physicians understood the mind’s pathologies.
Significance and methodological contribution
The volume’s significance lies in its sustained treatment of a corpus that has often been marginalized in histories of psychiatry, which have tended to concentrate on classical Greek philosophy and tragedy or on the Hippocratic writings. By taking seriously the medical writers of the Roman and late antique periods, the essays reveal a continuous and evolving engagement with mental disturbance that is neither a mere prelude to modern psychiatry nor a static inheritance from classical Greece. Ancient physicians, the volume shows, actively reworked their categories in response to new theoretical commitments and to the practical demands of diagnosis and therapy.
Methodologically, the volume is concerned with the limits and possibilities of writing a history of “mental illness” avant la lettre. The contributors scrutinize the semantic range of ancient terms, the rhetorical strategies of medical authors, and the genre conventions of the texts they study—encyclopedias, handbooks, and commentaries. Rather than treating ancient descriptions as precursors of modern diagnoses, the essays ask what it meant for ancient writers to classify, explain, and treat disturbances of mind and behavior within their own intellectual frameworks. This reflexive attention to historiography and translation makes the volume a contribution not only to ancient medicine but also to the broader question of how to conceptualize mental disorder across cultures and epochs.
