Night Terrors and Anxiety Attacks in Hippocrates

Hippocrates of Cos, Critical Days  302

“And whenever the liver swells more against his lungs, someone goes mad. He thinks he sees before his eyes creeping things and all kinds of beasts, fighting soldiers even as he believes that he is fighting with them. He speaks as if he is seeing these things and lashes out and threatens if someone forbids him from going out. If he stands, he may not be able to raise his legs and falls. His feet are always cold and whenever he sleeps, he jumps up from slumber and has witnessed frightening dreams.

We know that this fitfulness and fearing comes from dreams: whenever he calms down, he describes the kinds of dreams that he shaped out with his body and was describing with his tongue. He suffers these things in this way. And there are times when he is speechless for a whole day and night, gasping deeply for breath. When he stops this mad episode, he is immediately sensible again and if someone asks him a question, he responds right away and understands everything which was said. But, then later again, he falls under the same symptoms. This malady strikes most often when someone is abroad, especially if someone is walking on a deserted road. But it does happen other times too.’

καὶ ὁκόταν τὸ ἧπαρ μᾶλλον ἀναπτυχθῇ πρὸς τὰς φρένας, παραφρονέει· καὶ προφαίνεσθαί οἱ δοκέει πρὸ τῶν ὀφθαλμῶν ἑρπετὰ καὶ ἄλλα παντοδαπὰ θηρία, καὶ ὁπλίτας μαχομένους, καὶ αὐτὸς αὐτοῖς δοκέει μάχεσθαι· καὶ τοιαῦτα λέγει ὡς ὁρέων, καὶ ἐξέρχεται, καὶ ἀπειλεῖ, ἢν μή τις αὐτὸν ἐῴη διεξιέναι· καὶ ἢν ἀναστῇ, οὐ δύναται αἴρειν τὰ σκέλεα, ἀλλὰ πίπτει. οἱ δὲ πόδες αἰεὶ ψυχροί γίνονται· καὶ ὁκόταν καθεύδῃ, ἀναΐσσει ἐκ τοῦ ὕπνου, καὶ ἐνύπνια ὁρῇ φοβερά. τῷδε δὲ γινώσκομεν ὅτι ἀπὸ ἐνυπνίων ἀναΐσσει καὶ φοβέεται· ὅταν ἔννοος γένηται, ἀφηγεῖται τὰ ἐνύπνια τοιαῦτα ὁκοῖα καὶ τῷ σώματι ἐποίεέ τε καὶ τῇ γλώσσῃ ἔλεγε. ταῦτα μὲν οὖν ὧδε πάσχει. ἔστι δ᾿ ὅτε καὶ ἄφωνος γίνεται ὅλην τὴν ἡμέρην καὶ τὴν νύκτα, ἀναπνέων πολὺ ἀθρόον πνεῦμα. ὅταν δὲ παύσηται παραφρονέων, εὐθὺς ἔννοος γίνεται, καὶ ἢν ἐρωτᾷ τις αὐτόν, ὀρθῶς ἀποκρίνεται, καὶ γινώσκει πάντα τὰ λεγόμενα· εἶτ᾿ αὖθις ὀλίγῳ ὕστερον ἐν τοῖσιν αὐτοῖσιν ἄλγεσι κεῖται. αὕτη ἡ νοῦσος προσπίπτει μάλιστα ἐν ἀποδημίῃ, καὶ ἤν πῃ ἐρήμην ὁδὸν βαδίσῃ· λαμβάνει δὲ καὶ ἄλλως.

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Image from the British Library

Have You Tried Stabbing the Coronavirus?

Pliny the Elder, Natural History 34.151

“There are other medicinal applications of iron beyond surgery. For when a circle is drawn around both adults and infants—or of they carry a sharp iron weapon with them—it is useful against poisonous drugs. Iron nails which have been taken out of tombs are useful protections against nightmares if they are hammered down before a threshold.

A small penetration with an iron weapon which has wounded a man is effective against sudden side and chest pains. Some afflictions are treated by cauterization, especially true for the bite of a rabid dog, since even when the disease has advanced and those afflicted are starting to exhibit fear of water, they experience relief at cauterization. The drinking of water which has been heated with burning iron is good for many symptoms, but especially for dysentery.”

XLIV. Medicina e ferro est et alia quam secandi. namque et circumscribi circulo terve circumlato mucrone et adultis et infantibus prodest contra noxia medicamenta, et praefixisse in limine evulsos sepulchris clavos adversus nocturnas lymphationes, pungique leviter mucrone, quo percussus homo sit, contra dolores laterum pectorumque subitos, qui punctionem adferant. quaedam ustione sanantur, privatim vero canis rabidi morsus, quippe etiam praevalente morbo expaventesque potum usta plaga ilico liberantur. calfit etiam ferro candente potus in multis vitiis, privatim vero dysentericis.

Bodleian Library, MS. Ashmole 1462, Folio 16r

Ancient Shock Treatments for Mental Health

Celsus, On Medicine, 3.21-23

“If [the patient] is sick with an insane mind, he should be treated well with certain torments. When he does or says anything troubling, he must be corrected with starvation, chains, and beating. He must be forced to pay attention, to learn something, and to keep it in his memory. He will change in this way so that he will be compelled bit by bit by fear to think about what he is doing.

Sudden fear and complete horror is a good for this sickness and so is anything else which troubles the spirit intensely. For a certain change may happen when the mind is in a different state from where it usually is. For insane hilarity is better treated by the frightening I just described. Excessive sadness, however, needs light and long-lasting massage twice a day along with cold water poured over the head and immersing the body in water and oil.

Here are some common treatments: insane people should exercise vigorously, be given lengthy massages, and then fed neither fat nor wine. Once they are purged of what they ate before, they should have food of medium weight. You should not leave them alone or with people they don’t know or those they hate or ignore. It is best if they get a change of scenery and if their minds improve, they need to be shaken up with an annual trip.”

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 (§ 21) dixi, melius curatur. Si nimia tristitia, prodest lenis sed multa bis die frictio, item per caput aqua frigida infusa, demissumque corpus in aquam et oleum. Illa communia sunt, insanientes vehementer exerceri debere, multa frictione uti, neque pinguem carnem neque vinum adsumere; cibis uti post purgationem ex media materia quam levissimis; non oportere esse vel solos vel inter ignotos, vel inter eos, quos aut contemnant aut neglegant; mutare debere regiones et, si mens redit, annua peregrinatione esse iactandos.

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Medieval Breaking Wheel

How To Talk to a (Potentially Deranged) Patient

Rufus of Ephesus, Quest. Medic. 2

“It is right to ask someone who is sick questions from which something of the matters concerning the sickness might be diagnosed and might be treated better. First, I advise to make inquiries from the one who is sick himself. For you might from this learn how much the person is sick or healthy in respect to judgment along with his strength and weakness and what type of sickness and what place he has suffered.

If the patient answers right away and properly and plausibly and without stumbling in speech or sense and if it is according to is typical matter—if he is otherwise orderly, in a gentle and orderly way, but, if otherwise bold or fearful, in a brash or timid manner—it is right to consider him to be in his right mind. But if you ask him some things and he should answer others or forget in the middle of speaking, if his speech is unsteady and unclear and there are shifts from his first manner to the opposite, these are all signs of being deranged.”

     ᾿Ερωτήματα χρὴ τὸν νοσοῦντα ἐρωτᾶν, ἐξ ὧν ἂν καὶ διαγνωσθείη τι τῶν περὶ τὴν νόσον ἀκριβέστερον καὶ θεραπευθείη κάλλιον. 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 πεπονηκὼς <εἴη>. εἰ μὲν γὰρ ἐφεξῆς τε ἀποκρίνοιτο καὶ μνημονικῶς καὶ τὰ εἰκότα καὶ μηδαμῆ σφαλλόμενος μήτε τῇ γλώττῃ μήτε τῇ γνώμῃ καὶ εἰ καθ’ ὁρμὴν τὴν οἰκείαν, —εἰ μέν ἐστιν ἄλλως κόσμιος, πράως καὶ

κοσμίως, ὁ δ’ αὖ φύσει θρασὺς ἢ δειλὸς θρασέως ἢ δεδοικ<ότ>ως—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 ἀρχαίου τρόπου πρὸς τὸ ἐναντίον, πάντα ταῦτα παρακρουστικά.

 

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Sloane MS 1975, f. 91v

Pliny’s Slightly Less Stupid Treatments for Sickness

Uncertain about injecting bleach or buying a tanning booth? Maybe try some Ancient Roman nonsense first!

Pliny the Elder Natural History, 28.33

“The treatment is for their hands to be washed in water first and then for that water to be sprinkled on patients. However, those who are struck at some point by a scorpion are never attacked again by wasps and bees. Someone who knows that clothes worn at a funeral are never touched by moths or that snakes are only with great labor pulled out out of their holes except by the left hand will not be shocked by this.

Of the discoveries of Pythagoras, this will not prove false: an unequal number of vowels foretells lameness, blindness, or some similar disability on the right side; an even number predicts this on the left. People claim that a difficult birth labor will result in an immediate delivery if a stone or a missile which has killed three animals with a single strike (a human, a boar and a bear) is thrown over the home containing the pregnant woman. This is done with more success with a spear that has been pulled from a human body and has not touched the ground. This works the same if the spear is carried inside.”

remedio est ablui prius manus eorum aquaque illa eos quibus medearis inspergi. rursus a scorpione aliquando percussi numquam postea a crabronibus, vespis apibusve feriuntur. minus miretur hoc qui sciat vestem a tineis non attingi quae fuerit in funere, serpentes aegre praeterquam laeva manu extrahi. e Pythagorae inventis non temere fallere, inpositivorum nominum inparem vocalium numerum clauditates oculive orbitatem ac similes casus dextris adsignare partibus, parem laevis. ferunt difficiles partus statim solvi, cum quis tectum in quo sit gravida transmiserit lapide vel missili ex his qui tria animalia singulis ictibus interfecerint, hominem, aprum,  ursum. probabilius id facit hasta velitaris evulsa corpori hominis, si terram non attigerit. eosdem enim inlata effectus habet.

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From Arundel_ms_98_f085v

Know-nothings, Faith-healers, and Quacks: Mystifying and Abusing Mental Illness

Hippocrates of Cos, The Sacred Disease 1 and 2

“This work is about that disease which people call “sacred”. It does not seem to me to be more divine or more sacred than any of the rest of the diseases, but it also has a natural cause and people have assumed it is sacred because of their own inexperience and their considerable wonder over how different it seems to them.”

[…]

Περὶ τῆς ίερῆς νούσου καλεομένης ὧδ᾿ ἔχει. οὐδέν τί μοι δοκεῖ τῶν ἄλλων θειοτέρη εἶναι νούσων οὐδὲ ἱερωτέρη, ἀλλὰ φύσιν μὲν ἔχει καὶ πρόφασιν, οἱ δ᾿ ἄνθρωποι ἐνόμισαν θεῖόν τι πρῆγμα εἶναι ὑπὸ ἀπειρίης καὶ θαυμασιότητος, ὅτι οὐδὲν ἔοικεν ἑτέροισι·

“Those who first claimed that the disease is divinely caused seem to me to be something like the wizards, snake-oil salesmen, faith-healers, and quacks of today, those kinds of men who pretend to great piety and superior knowledge. These kinds of healers shelter themselves and use superstition as a shield against their own helplessness when they have nothing they can do to help. They claim that this affliction is sacred so it won’t be clear that they don’t know anything. They add a ready-made story and throw in a treatment in order to keep their own position strong.”

Ἐμοὶ δὲ δοκέουσιν οἱ πρῶτοι τοῦτο τὸ νόσημα ἱερώσαντες τοιοῦτοι εἶναι ἄνθρωποι οἷοι καὶ νῦν εἰσι μάγοι τε καὶ καθάρται καὶ ἀγύρται καὶ ἀλαζόνες, οὗτοι δὲ καὶ προσποιέονται σφόδρα θεοσεβέες εἶναι καὶ πλέον τι εἰδέναι. οὗτοι τοίνυν παραμπεχόμενοι καὶ προβαλλόμενοι τὸ θεῖον τῆς ἀμηχανίης τοῦ μὴ ἔχειν ὅ τι προσενέγκαντες ὠφελήσουσι, καὶ ὡς μὴ κατάδηλοι ἔωσιν οὐδὲν ἐπιστάμενοι, ἱερὸν ἐνόμισαν τοῦτο τὸ πάθος εἶναι· καὶ λόγους ἐπιλέξαντες ἐπιτηδείους τὴν ἴησιν κατεστήσαντο ἐς τὸ ἀσφαλὲς σφίσιν αὐτοῖσι,

As Vivian Nutton makes clear in the overview of Mental Illness in the Ancient World (available in Brill’s New Pauly), Hippocrates Breaks from Ancient Near Eastern and Early Greek tradition here in offering physical explanations for mental illness of all kinds instead of divine explanations. Platonic and Aristotelian traditions follow with variations on somatism (the body as the cause), adding in addition to the humors, bile, and disharmony among the organs, habits (excessive consumption, actions) and environments. These approaches were refined by Hellenistic doctors and the work of Rufus and Galen where treatments also came to include psychotherapeutic as well as the physical treatments. The swing towards demonic possession as an explanation during Late Antiquity and the Christian middle ages took mental health approaches back towards the ‘sacred’ explanations of pre-rational antiquity.

Some other posts about mental health from antiquity. Oftentimes translators keep the ancient Greek term melancholy (“black bile”)

Galen says loss of speech is not melancholy

Women, misogyny, and suicide

Lykanthropy as a type of melancholy

Hippocrates on melancholic desire for isolation

Hippocrates and Galen on hallucination and depression

The positive side of delusion

Aristotle on Mind-body connection

Music for healing mental affliction

Galen on the use of narcotics

Celsus on abusive treatments for mental illness

Seneca and Epictetus on Sick Days for Mental Health

Seneca and Plutarch on Whether Peace of Mind Helps

Epictetus, Treatises Collected by Arrian, 2.15: To those who cling tenaciously to any judgments they have made 

“Whenever some people hear these words—that it is right to be consistent, that the moral person is free by nature and never compelled, while everything else may be hindered, forced, enslaved, subjected to others—they imagine that it is right that they maintain every judgment they have made without compromising at all.

But the first issue is that the judgment should be a good one. For, if I wish to maintain the state of my body, it should be when it is healthy, well-exercised. If you show me that you have the tones of a fevered mind and brag about it, I will say ‘Dude, look for a therapist. This is not health, but sickness.’ “

ιε′. Πρὸς τοὺς σκληρῶς τισιν ὧν ἔκριναν ἐμμένοντας.

῞Οταν ἀκούσωσί τινες τούτων τῶν λόγων, ὅτι βέβαιον εἶναι δεῖ καὶ ἡ μὲν προαίρεσις ἐλεύθερον φύσει καὶ ἀνανάγκαστον, τὰ δ’ ἄλλα κωλυτά, ἀναγκαστά, δοῦλα, ἀλλότρια, φαντάζονται ὅτι δεῖ παντὶ τῷ κριθέντι ὑπ’ αὐτῶν ἀπαραβάτως ἐμμένειν. ἀλλὰ πρῶτον ὑγιὲς εἶναι δεῖ τὸ κεκριμένον. θέλω γὰρ εἶναι τόνους ἐν σώματι, ἀλλ’ ὡς ὑγιαίνοντι, ὡς ἀθλοῦντι· ἂν δέ μοι φρενιτικοῦ τόνους ἔχων ἐνδεικνύῃ[ς] καὶ ἀλαζονεύῃ ἐπ’ αὐτοῖς, ἐρῶ σοι ὅτι ‘ἄνθρωπε, ζήτει τὸν θεραπεύσοντα. τοῦτο οὐκ εἰσὶ τόνοι, ἀλλ’ ἀτονία’.

 

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Hygeia [“Health”] and her father Asklepios Taken from Pinterest

Hippocrates: Unmarried Women are Sad Because of Periods

Hippocrates of Cos, On Girls [Peri Parthenôn] 1

“Let’s talk first concerning the disease which is called sacred and paralyzed people and the many anxieties which frighten people seriously enough that they lose their minds and believe that they see evil spirits by night or even at times by die or sometimes on all hours. Many have hanged themselves before because of this kind of vision, more often women than men.

For a woman’s nature is more depressed and sorrowful. And young women, when they are at the age of marriage and without a husband, suffer terribly at the time of their menstruation, which they did not suffer earlier in life. For blood collects later in their uterus so that it may flow out. When, then, the mouth of the exit does not create an opening, the blood pools up more because of food and the body’s growth. When the blood has nowhere to flow, it rises up toward the heart and the diaphragm. When these organs are filled, the heart is desensitized and from this transformation it becomes numb. Madness overtakes women because of this numbness.”

Πρῶτον περὶ τῆς ἱερῆς νούσου καλεομένης, καὶ περὶ τῶν ἀποπληκτικῶν, καὶ περὶ τῶν δειμάτων, ὁκόσα φοβεῦνται ἰσχυρῶς ἄνθρωποι, ὥστε παραφρονέειν καὶ ὁρῆν δοκέειν δαίμονάς τινας ἐφ᾿ ἑωυτῶν δυσμενέας, ὁκότε μὲν νυκτός, ὁκότε δὲ ἡμέρης, ὁκότε δὲ ἀμφοτέρῃσι τῇσιν ὥρῃσιν. ἔπειτα ἀπὸ τῆς τοιαύτης ὄψιος πολλοὶ ἤδη ἀπηγχονίσθησαν, πλέονες δὲ γυναῖκες ἢ ἄνδρες· ἀθυμοτέρη γὰρ καὶ λυπηροτέρη ἡ φύσις ἡ γυναικείη. αἱ δὲ παρθένοι, ὁκόσῃσιν ὥρη γάμου, παρανδρούμεναι, τοῦτο μᾶλλον πάσχουσιν ἅμα τῇ καθόδῳ τῶν ἐπιμηνίων, πρότερον οὐ μάλα ταῦτα κακοπαθέουσαι. ὕστερον γὰρ τὸ αἷμα ξυλλείβεται ἐς τὰς μήτρας, ὡς ἀπορρευσόμενον· ὁκόταν οὖν τὸ στόμα τῆς ἐξόδου μὴ ᾖ ἀνεστομωμένον, τὸ δὲ αἷμα πλέον ἐπιρρέῃ διά τε σιτία καὶ τὴν αὔξησιν τοῦ σώματος, τηνικαῦτα οὐκ ἔχον τὸ αἷμα ἔκρουν ἀναΐσσει ὑπὸ πλήθους ἐς τὴν καρδίην καὶ ἐς τὴν διάφραξιν. ὁκόταν οὖν ταῦτα πληρωθέωσιν, ἐμωρώθη ἡ καρδίη, εἶτ᾿ ἐκ τῆς μωρώσιος νάρκη, εἶτ᾿ ἐκ τῆς νάρκης παράνοια ἔλαβεν.

Hippocrates should have consulted a woman physician like Trotula