Ancient Greek Depression and the Brain: Galen and Hippocrates

Galen, De Locis Affectis 8.190-191

“Fear always plagues people with melancholy but they don’t always have the same kind of abnormal (para phusin) thoughts. For example, one person believes that he has grown a shell and because of this he avoids everyone who nears him so that he might not break it. When another hears the roosters singing, just as if the birds strike their wings before their song, he also slaps his arms against his sides and imitates the animals’ voice. Fear comes to another that Atlas who is supporting the universe might drop it because he is worn out and for this reason he will be crushed and he will destroy us with him.

But there are ten thousand other fantasies. The melancholic differ from one another, but even though they all exhibit fear, despair, blaming of life and hatred for people, they do not all want to die. For some, fear of death is the principle source of their depression. Some will seem paradoxical to you because they fear death and desire death at the same time.

For this reason it seems right that Hippocrates divided all of these symptoms into two groups: fear (phobos) and despair (dusthumia). Because of this sort of despair, they hate everyone they see and are always gloomy and they are afraid like children are frightened in deep darkness and uneducated adults too. As external darkness makes nearly all people afraid, except for those who are bold by nature or have been well-educated for it, so too the color of the black bile overshadows places of thought with darkness and makes people afraid.

The fact that the humors and altogether the equilibrium (krâsis) of the body may alter the reality of the mind is agreed upon by the best doctors and philosophers and I have shown already in one publication in which, by pursuing the body’s balances, I demonstrated the abilities of the mind. For this reason, those who are ignorant about the power of humors do not dare to write anything about melancholy. Of these, there are also those of the school of Erasistratos. It is right to be amazed at him for people’s common thoughts, as with many other beliefs about which not a few philosophers and doctors are ignorant. Therefore, nearly everyone calls melancholy a sickness, indicating through this name that its cause is bile.”

ἀεὶ μὲν οὖν  οἱ φόβοι συνεδρεύουσι τοῖς μελαγχολικοῖς, οὐκ ἀεὶ δὲ ταὐτὸν εἶδος τῶν παρὰ φύσιν αὐτοῖς γίγνεται φαντασιῶν, εἴγε 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 τοὺς βραχίονας προσκρούων ταῖς πλευραῖς ἐμιμεῖτο τὴν φωνὴν τῶν ζώων. φόβος δ’ ἦν ἄλλῳ, μή πως ὁ βαστάζων τὸν κόσμον ῎Ατλας ἀποσείσηται κεκμηκὼς αὐτὸν, οὕτως τε καὶ αὐτὸς συντριβείη καὶ ἡμᾶς αὐτῷ συναπολέσειεν·

ἄλλα τε μυρία τοιαῦτα φαντασιοῦνται. διαφέρονται δὲ ἀλλήλων οἱ μελαγχολικοὶ, τὸ μὲν φοβεῖσθαι καὶ δυσθυμεῖν καὶ μέμφεσθαι τῇ ζωῇ καὶ μισεῖν τοὺς ἀνθρώπους ἅπαντες ἔχοντες, ἀποθανεῖν δ’ ἐπιθυμοῦντες 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. ὥστε ὀρθῶς ἔοικεν ὁ ῾Ιπποκράτης 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 εἰσι, δειμαίνοντες, ὥσπερ ἐν σκότῳ βαθεῖ τά τε παιδία φοβεῖται καὶ τῶν τελείων οἱ ἀπαίδευτοι. καθάπερ γὰρ καὶ τὸ ἔξωθεν σκότος εἰς φόβον ἄγει σχεδὸν ἅπαντας ἀνθρώπους, πλὴν τῶν ἤτοι πάνυ φύσει τολμηρῶν, ἢ πεπαιδευμένων, οὕτως καὶ τῆς μελαίνης χολῆς τὸ χρῶμα παραπλησίως σκότῳ τὸν φρονοῦντα τόπον ἐπισκιάζον ἐργάζεται τοὺς φόβους.

ὅτι γὰρ οἵ τε χυμοὶ καὶ ὅλως ἡ τοῦ σώματος κρᾶσις ἀλλοιοῖ τὰς ἐνεργείας τῆς ψυχῆς, ὡμολόγηται τοῖς ἀρίστοις ἰατροῖς τε καὶ φιλοσόφοις, ἐμοί τε δι’ ἑνὸς ὑπομνήματος ἀποδέδεικται, καθ’ ὃ ταῖς τοῦ σώματος κράσεσιν ἀκολουθούσας ἀπέδειξα τὰς τῆς ψυχῆς δυνάμεις· ὅθεν οὐδὲ γράψαι τι περὶ μελαγχολίας ἐτόλμησαν οἱ τὴν τῶν χυμῶν δύναμιν ἀγνοήσαντες, ἐξ ὧν εἰσι καὶ οἱ περὶ τὸν ᾿Ερασίστρατον.  ἄξιον δέ ἐστι κᾀν τούτῳ θαυμάσαι τὰς κοινὰς ἐννοίας τῶν ἀνθρώπων, ὥσπερ καὶ τἄλλα πολλὰ δόγματα, περὶ ὧν ἠγνόησαν οὐκ ὀλίγοι φιλοσόφων τε καὶ ἰατρῶν· ἅπαντες γοῦν ὀνομάζουσιν τὸ πάθος τοῦτο μελαγχολίαν, ἐνδεικνύμενοι διὰ  τῆς προσηγορίας τὸν αἴτιον αὐτοῦ χυμόν.

 

*Erasistratos was a doctor and author during the Hellenistic period.

I found this passage from reading: Patricia A. Clark and M. Lynn Rose. 2016. “Psychiatric Disability in the Galenic Medical Matrix.” In Christian Laes, Chris Goodey, and M. Lynn Rose (eds.). Disabilities in Roman Antiquity: Disparate Bodies a Capite Ad Calcem. Leiden: 45-72.

The modern debate about “mind” verses “brain” has its origins in antiquity and notions of the “soul” and the “body”. Hippocrates presents one of the earliest arguments that everything is physical and biological.

Hippocrates of Cos, On the Sacred Disease 14

 “People should know that our pleasures, happiness, laughter, and jokes from nowhere else [but the brain] and that our griefs, pains, sorrows, depressions and mourning come from the same place. And through it we think especially, and ponder, and see and hear and come to perceive both shameful things and noble things and wicked things and good things as well as sweet and bitter, at times judging them so by custom, at others by understanding what is advantageous based on distinguishing what is pleasurable and not in the right time and [that] these things are not the same to us.

By this very organ we become both sane and delirious and fears and horrors attend us sometimes at night and sometimes at day. This brings us bouts of sleeplessness and makes us mistake-prone at terrible times,  bringing thoughts we cannot follow, and deeds which are unknown, unaccustomed or untried.

Yes, we suffer all these things from or brain when it is not health but is hotter than natural, too cold or too wet or too dry or suffers any other kind of thing contrary to its custom. We go insane because of its moistness. For whenever it is wetter than natural, it is forced to move. And when it moves, neither sight can be still nor hearing. Instead, we hear and see different things at different times and the tongue talks about the kinds of things it sees and hears each time. But a person can think as long as the brain remains still.”

 Εἰδέναι δὲ χρὴ τοὺς ἀνθρώπους, ὅτι ἐξ οὐδενὸς ἡμῖν αἱ ἡδοναὶ γίνονται καὶ αἱ εὐφροσύναι καὶ γέλωτες καὶ παιδιαὶ ἢ ἐντεῦθεν καὶ λῦπαι καὶ ἀνίαι καὶ δυσφροσύναι καὶ κλαυθμοί. Καὶ τούτῳ φρονεῦμεν μάλιστα καὶ νοεῦμεν καὶ βλέπομεν καὶ ἀκούομεν καὶ γινώσκομεν τά τε αἰσχρὰ καὶ τὰ καλὰ καὶ τὰ κακὰ καὶ ἀγαθὰ καὶ ἡδέα καὶ ἀηδέα, τὰ μὲν νόμῳ διακρίνοντες, τὰ δὲ τῷ ξυμφέροντι αἰσθανόμενοι, τῷ δὲ καὶ τὰς ἡδονὰς καὶ τὰς ἀηδίας τοῖσι καιροῖσι διαγινώσκοντες, καὶ οὐ ταὐτὰ ἀρέσκει ἡμῖν. Τῷ δὲ αὐτῷ τούτῳ καὶ μαινόμεθα καὶ παραφρονέομεν, καὶ δείματα καὶ φόβοι παρίστανται ἡμῖν τὰ μὲν νύκτωρ, τὰ δὲ μεθ’ ἡμέρην, καὶ ἐνύπνια καὶ πλάνοι ἄκαιροι, καὶ φροντίδες οὐχ ἱκνεύμεναι, καὶ ἀγνωσίη τῶν καθεστεώτων καὶ ἀηθίη καὶ ἀπειρίη. Καὶ ταῦτα πάσχομεν ἀπὸ τοῦ ἐγκεφάλου πάντα, ὅταν οὗτος μὴ ὑγιαίνῃ, ἀλλ’ ἢ 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· ὅταν γὰρ ὑγρότερος τῆς φύσιος ᾖ, ἀνάγκη κινεῖσθαι, κινευμένου δὲ μήτε τὴν ὄψιν ἀτρεμίζειν μήτε τὴν ἀκοήν, ἀλλ᾿ ἄλλοτε ἄλλα ὁρᾶν καὶ ἀκούειν, τήν τε γλῶσσαν τοιαῦτα διαλέγεσθαι οἷα ἂν βλέπῃ τε καὶ ἀκούῃ ἑκάστοτε· ὅσον δ᾿ ἂν ἀτρεμήσῃ ὁ ἐγκέφαλος χρόνον, τοσοῦτον καὶ φρονεῖ ὁ ἄνθρωπος.

On the Sacred Disease, 9

“For these reasons I think that the brain has the most power in the human being. For when it happens to be healthy, it is our interpreter of all the things that happen from the air. And air furnishes intelligence. The eyes, and ears, and tongue and hands and feet do the kinds of things the brain decides. Indeed, the portion of intelligence distributed throughout the body comes from the air. The brain is the emissary to understanding. For whenever a person draws breath inside it rushes first to the brain and then it spreads through the rest of the body once it leaves its distilled form in the brain, that very thing which is thought and has judgment. If it were to enter the body first and the rain later, it would leave understanding in the flesh and the arteries and then go hot and impure into the brain, all mixed up with the bile from flesh and blood, with the result that it would uncertain.”

Κατὰ ταῦτα νομίζω τὸν ἐγκέφαλον δυναμιν ἔχειν πλείστην ἐν τῷ ἀνθρώπῳ· οὗτος γὰρ ἡμῖν ἐστι τῶν ἀπὸ τοῦ ἠέρος γινομένων ἑρμηνεύς, ἢν ὑγιαίνων τυγχάνῃ· τὴν δὲ φρόνησιν ὁ ἀὴρ παρέχεται. οἱ δὲ ὀφθαλμοὶ καὶ τὰ ὦτα καὶ ἡ γλῶσσα καὶ αἱ χεῖρες καὶ οἱ πόδες οἷα ἂν ὁ ἐγκέφαλος γινώσκῃ, τοιαῦτα πρήσσουσι·† γίνεται γὰρ ἐν ἅπαντι τῷ σώματι τῆς φρονήσιος, ὡςἂν μετέχῃ τοῦ ἠέρος.† ἐς δὲ τὴν σύνεσιν ὁ ἐγκέφαλός ἐστιν ὁ διαγγέλλων· ὅταν γὰρ σπάσῃ τὸ πνεῦμα ὥνθρωπος ἐς ἑωυτόν, ἐς τὸν ἐγκέφαλον πρῶτον ἀφικνεῖται, καὶ οὕτως ἐς τὸ λοιπὸν σῶμα σκίδναται ὁ ἀήρ, καταλελοιπὼς ἐν τῷ ἐγκεφάλῳ ἑωυτοῦ τὴν ἀκμὴν καὶ ὅ τι ἂν ᾖ φρόνιμόν τε καὶ γνώμην ἔχον· εἰ γὰρ ἐς τὸ σῶμα πρῶτον ἀφικνεῖτο καὶ ὕστερον ἐς τὸν ἐγκέφαλον, ἐν τῇσι σαρξὶ καὶ ἐν τῇσι φλεψὶ καταλελοιπὼς τὴν διάγνωσιν ἐς τὸν ἐγκέφαλον ἂν ἴοιθερμὸς ἐὼν καὶ οὐκ ἀκραιφνής, ἀλλ᾿ ἐπιμεμιγμένος τῇ ἰκμάδι τῇ ἀπό τε τῶν σαρκῶν καὶ τοῦ αἵματος, ὥστε μηκέτι εἶναι ἀκριβής.

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Edmund Wilson. “On Free Will and How the Brain is Like a Colony of Ants.” Harper’sSeptember 2014, 49-52.

“The self does not exist as a paranormal being living on its own within the brain. It is, instead, the central dramatic character of the confabulated scenarios. In these stories, it is always on center stage—if not as participant, then as observer and commentator—because that is where all of the sensory information arrives and is integrated.”

For a good overview of issues of brain, mind and consciousness from multiple disciplinary perspectives, see Dennett, Dale C. 2017. From Bacteria to Bach and Back: The Evolution of Minds. New York.

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