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

Medically Mad or Just Thinking Bad? Early Greek on Being Crazy

An ancient distinction between mental maladies with absolutely no relevance to the modern day.

Assemblywomen, 248-253

[First Woman]: But what if Kephalos attacks you with abuse—
How will you response to him in the assembly?

[Praksagora]: I will say he’s out of his mind [paraphronein]

[First Woman]: but everyone knows this!

[Praksagora]: then I will also call him psychopathic [lit. ‘black-biled’=melancholic].

[First Woman]: They know this too.

[Praksagora]: But I will add that he produces terrible ceramics and will then do a fine job of doing the same to the city.

ἀτὰρ ἢν Κέφαλός σοι λοιδορῆται προσφθαρείς,
πῶς ἀντερεῖς πρὸς αὐτὸν ἐν τἠκκλησίᾳ;
ΠΡΑΞΑΓΟΡΑ φήσω παραφρονεῖν αὐτόν.
ΓΥΝΗ Α …ἀλλὰ τοῦτό γε
ἴσασι πάντες.
ΠΡΑΞΑΓΟΡΑ ἀλλὰ καὶ μελαγχολᾶν.
ΓΥΝΗ Α καὶ τοῦτ᾿ ἴσασιν.
ΠΡΑΞΑΓΟΡΑἀλλὰ καὶ τὰ τρύβλια
κακῶς κεραμεύειν, τὴν δὲ πόλιν εὖ καὶ καλῶς.

Melancholy here contrasts with “thinking -wrongly” (paraphronein). A scholion to another play by Aristophanes glosses the realms of these types of mental maladies (Schol. ad Plut. 11a ex 20-28)

“He seems to say this because he harmed or helped his master through his own virtue more—and while he disturbed him through prophecy, he made him crazy [melankholan] through medicine and took away his ability to think [phronein] through wisdom, which is the art of thinking. The servant lies. For he does not speak the truth….”

…τοῦτο οὖν
ἔοικε λέγειν, ὅτι διὰ τῶν ἑαυτοῦ
μᾶλλον ἀρετῶν ἔβλαψε τὸν δεσπότην
ἤπερ ὠφέλησε, καὶ διὰ μὲν τῆς
μαντείας ἐτάραξε, διὰ δὲ τῆς ἰατρι-
κῆς μελαγχολᾶν ἐποίησε, διὰ δὲ
τῆς σοφίας, ὅ ἐστι τῆς φρονήσεως,
τοῦ φρονεῖν αὐτὸν ἀφείλατο. ψεύδεται
ὁ δοῦλος· οὐ γὰρ ἀλήθειαν λέγει

Where melancholy denotes a physical ailment [i.e. biologically caused and treated], paraphrosunê indicates parafunctionality which may be treated without medicine.

μελαγχολάω: to be atrabilious, melancholy-mad.

μελαγχολία: atrabiliousness, melancholy, a disease [atual LSJ definition]

παραφροσύνη, ἡ:  wandering of mind, derangment, delirium

παραφρονέω: to be beside oneself, be deranged, or mad.

Lyrica Adespota, fr. 3.9-10

“Lust–that magician–takes me. It descends upon my mind
And makes me crazy!”

῎Ερως μ’ ἔλα]β’ ὁ γόης· εἰς τὴν ψυχήν μου εἰσπε-
σὼν [ποιεῖ μ]ε παραφρονεῖν.

Aristotle, Metaphysics 4.1009b

“In the same way, ‘truth’ concerning the way things appear has come to some people from their senses. They believe that it is right that truth should be judged neither by the multitude or the scarcity [of those who believe it]; and they believe that the same thing seems sweet to some who taste it and bitter to others with the result that if all men were sick or if they were all insane and two or three were healthy or in their right mind, wouldn’t it seem that these few were sick and crazy and not the rest?”

[1] —ὅμοιως δὲ καὶ ἡ περὶ τὰ φαινόμενα ἀλήθεια ἐνίοις ἐκ τῶν αἰσθητῶν ἐλήλυθεν. τὸ μὲν γὰρ ἀληθὲς οὐ πλήθει κρίνεσθαι οἴονται προσήκειν οὐδὲ ὀλιγότητι, τὸ δ᾽ αὐτὸ τοῖς μὲν γλυκὺ γευομένοις δοκεῖν εἶναι τοῖς δὲ πικρόν, ὥστ᾽ εἰ πάντες ἔκαμνον [5] ἢ πάντες παρεφρόνουν, δύο δ᾽ ἢ τρεῖς ὑγίαινον ἢ νοῦν εἶχον, δοκεῖν ἂν τούτους κάμνειν καὶ παραφρονεῖν τοὺς δ᾽ ἄλλους οὔ:

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The Jealousy and Play of Alexander the Great

Athenaeus, Deipnosophistae, 7.4.277a

“Chares the Mytilenaian claims that when Alexander found the most beautiful apples in the land of Babylon, he had his ships filled with them and put on an “apple war” from the ships that was a great delight to see.”

Χάρης δ᾽ ὁ Μυτιληναῖος ἱστορεῖ ὡς κάλλιστα μῆλα εὑρὼν ὁ ᾽Αλέξανδρος περὶ τὴν Βαβυλωνίαν χώραν τούτων τε πληρώσας τὰ σκάφη μηλομαχίαν ἀπὸ τῶν νεῶν ἐποιήσατο, ὡς τὴν θέαν ἡδίστην γενέσθαι.

Gnomologium Vaticanum, 78; 10, p. 3

“Alexander, after he arrived at Troy and looked upon the tomb of Achilles, said as he stood there: “Achilles, you obtained the magnificent herald, Homer, because you were so great.” Anaximenes, who was nearby, responded, “King, I too will make you famous”. And Alexander responded, “By the gods, I would prefer to be Homer’s Thersites instead of an Achilles for you.”

ὁ αὐτὸς (sc. ᾽Αλέξανδρος) ἐλθὼν εἰς ῎Ιλιον καὶ θεασάμενος τὸν ᾽Αχιλλέως τάφον στὰς εἶπεν· «ὦ ᾽Αχιλλεῦ, ὡς σὺ μέγας ὢν μεγάλου κήρυκος ἔτυχες ῾Ομήρου». παρόντος δὲ ᾽Αναξιμένους καὶ εἰπόντος· «καὶ ἡμεῖς σε, ὦ βασιλεῦ, ἔνδοξον ποιήσομεν», «ἀλλὰ νὴ τοὺς θεούς», ἔφη, «παρ᾽ ῾Ομήρωι ἐβουλόμην ἂν εἴναι Θερσίτης ἢ παρὰ σοὶ ᾽Αχιλλεύς».

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Writing about the Cause of Madness

Pseudo-Hippocrates. Epist. 17 9.352, 354, 356 

“When I [Hippocrates] was near [Democritus], he happened to be writing something eagerly and forcefully when I arrived. So I said. “First, tell me what you are writing about.” And, after he paused for a bit, said “madness.”

So I said, “But what are you writing about madness?” He responded, “What would I write except what it may be, how it afflicts human beings, and in what way it may be treated. This is why,” he continued, “I cut up all these animals you are looking at. It is not because I hate god’s works, but because I am researching the nature and the function of the bile.

For you know that the bile is the cause of madness in humans most of the time, since it appears naturally in most people, even though some have less of it and others have more. Illnesses emerge from an unbalanced amount, implying that the material is sometimes helpful and sometimes harmful.”

I added, “By Zeus, Democritus, you are speaking truthfully and prudently and this is why I think you are blessed for having achieving such a sense of peace. This has certainly not been allotted to me.”

Then he asked, “Why, Hippocrates, has it not?” I responded, “Because fields, my home, children, debts, illnesses, deaths, servants, marriages and all these kinds of things cut off any chance for it.”

At this, that man fell into his customary behavior—he laughed deeply and mocked me and then was silent for the rest of the time.”

ἐπεὶ δὲ ἐπλησίαζον, ἔτυχεν ὅτε ἐπῆλθον αὐτέῳ, τι1 δή ποτε γράφων ἐνθουσιωδῶς καὶ μεθ’ ὁρμῆς. [. . .]

[ΙΠ.] “καὶ πρῶτόν γε τί τοῦτο τυγχάνεις γράφων φράζε.” [. . .]

ὁ δ᾽ ἐπισχὼν ὀλίγον, “περὶ μανίης,” ἔφη. [. . .]

[ΙΠ.] “ἀλλὰ τί περὶ μανίης γράφεις;”

“τί γάρ,” εἶπεν, “ἄλλο, πλὴν ἥτις τε εἴη, καὶ ὅκως ἀνθρώποισιν ἐγγίνεται, καὶ τίνα τρόπον ἀπολωφέοιτο· τά τε γὰρ ζῷα ταῦτα ὁκόσα, ἔφη, ὁρῇς, τουτέου μέντοι γε ἀνατέμνω εἵνεκα, οὐ μισέων θεοῦ ἔργα, χολῆς δὲ διζήμενος φύσιν καὶ θέσιν· οἶσθα γὰρ ἀνθρώπων παρακοπῆς ὡς αἰτίη ἐπιτοπολὺ αὕτη πλεονάσασα, ἐπεὶ πᾶσι μὲν φύσει ἐνυπάρχει, ἀλλὰ παρ’ οἷς μὲν ἔλαττον, παρ’ οἷς δέ τι πλέον· ἡ δ’ ἀμετρίη αὐτέης νοῦσοι τυγχάνουσιν, ὡς ὕλης ὅτε μὲν ἀγαθῆς, ὁτὲ δὲ φαύλης ὑποκειμένης.”

κἀγὼ, “νὴ Δία,” ἔφην, “ὦ Δημόκριτε, ἀληθέως γε καὶ φρονίμως λέγεις, ὅθεν εὐδαίμονά σε κρίνω τοσαύτης ἀπολαύοντα ἡσυχίης· ἡμῖν δὲ μετέχειν ταύτης οὐκ ἐπιτέτραπται.”

ἐρεομένου δὲ “διὰ τί, ὦ Ἱππόκρατες, οὐκ ἐπιτέτραπται;” “ὅτι,” ἔφην, “ἢ ἀγροὶ ἢ οἰκίη ἢ τέκνα ἢ δάνεια ἢ νοῦσοι ἢ θάνατοι ἢ δμῶες ἢ γάμοι ἢ τοιαῦτά τινα τὴν εὐκαιρίην ὑποτάμνεται.” ἐνταῦθα δὴ ὁ ἀνὴρ εἰς τὸ εἰωθὸς πάθος κατηνέχθη, καὶ μάλα ἀθρόον τι ἀνεκάγχασε, καὶ ἐπετώθασε, καὶ τὸ λοιπὸν ἡσυχίην ἦγεν.

Dosso Dossi, 1540

Fire and Ice, Madness and Habit

Parmenides, R44 = Generation and Corruption Arist. GC 1.8 325a2–23

“So, then, for these reasons, too, people make claims about the truth. And even if it seems to be the case that these assertions are correct about arguments, it is nearly close to madness to think the same way when it comes to facts.

For no crazy person is so twisted as to believe that fire and ice are the same thing! No, beautiful things and those which seem beautiful only appear not to be different at all to some people because of habit, because of madness.”

οἱ μὲν οὖν οὕτως καὶ διὰ ταύτας τὰς αἰτίας ἀπεφήναντο περὶ τῆς ἀληθείας· ἐπεὶ δὲ ἐπὶ τῶν λόγων μὲν δοκεῖ ταῦτα συμβαίνειν, ἐπὶ δὲ τῶν πραγμάτων μανίᾳ παραπλήσιον εἶναι τὸ δοξάζειν οὕτως· οὐδένα γὰρ τῶν μαινομένων ἐξεστάναι τοσοῦτον ὥστε τὸ πῦρ ἓν εἶναι δοκεῖν καὶ τὸν κρύσταλλον, ἀλλὰ μόνον τὰ καλὰ καὶ τὰ φαινόμενα διὰ συνήθειαν, ταῦτ’ ἐνίοις διὰ τὴν μανίαν οὐθὲν δοκεῖ διαφέρειν.

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From  Tacuinum Sanitatis (c. 1390-1400)

A School of Madness and the Cynic’s Life

Empedocles, R88 : (Ps.-?) Hipp. Haer. 7.29.1–3 et 31.2–4

“Markiôn of Pontos was much crazier than these people: after dismissing many of the notions of the majority of people and moving into even more shame, he proposed that there were two principles of everything, claiming there was one good deity and one bad one. Because he thought that he had invented something new, he created his own school filled with madness and a cynic life, since he was something of a bellicose person.

This guy, somehow believing that he would evade most people in failing to be a follower of Christ but really of Empedocles who happened to come from a much earlier period and laid out the belief that there were two causes of the universe, Strife and Attraction…”

[29.1–3] Μαρκίων δὲ ὁ Ποντικὸς πολὺ τούτων μανικώτερος, τὰ πολλὰ τῶν πλειόνων παραπεμψάμενος ἐπὶ τὸ ἀναιδέστερον ὁρμήσας δύο ἀρχὰς τοῦ παντὸς ὑπέθετο, ἀγαθόν <θεόν>1 τινα λέγων καὶ τὸν ἕτερον πονηρόν· καὶ αὐτὸς δὲ νομίζων καινόν τι παρεισαγαγεῖν σχολὴν ἐσκεύασεν ἀπονοίας γέμουσαν καὶ κυνικοῦ βίου, ὤν τις μάχιμος· οὗτος νομίζων λήσεσθαι τοὺς πολλούς ὅτι μὴ Χριστοῦ τυγχάνοι μαθητὴς ἀλλ’ Ἐμπεδοκλέους πολὺ αὐτοῦ προγενεστέρου τυγχάνοντος, ταὐτὰ ὁρίσας ἐδογμάτισε δύο εἶναι τὰ τοῦ παντὸς αἴτια, Νεῖκος καὶ Φιλίαν. [. . .]

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Diogenes the Cynic in his Barrel

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