History of Medicine
Changing Explanations in Mind-Body Medicine
Class 1: Hippocratic Foundations
Introduction: The first class includes secondary as well as primary source readings to explain and illustrate the fundamentally biological (body-based) approach that Hippocrates and his school took to account for the phenomena of health and illness at the beginning of the Western medical tradition. The goal is to explain Hippocrates in context by projective intellectual empathy, that is, to accept his level of knowledge and his specific ideas in their own context and not judge them by what we know today. It starts with the intellectual and social context in which Hippocrates (ca. 450–370 BCE) worked, and illustrates how he and his school looked at the fluid and solid parts of the human body for keys to the mechanism of disease. His primary theory was based on the four “humors”: black bile, yellow bile, phlegm, and blood. When these humors were in balance health prevailed, but when they were out of balance or corrupted, disease took over. Sometimes anatomical abnormalities contributed to the imbalance of the humors or were the consequence of such imbalances. In general, disease symptoms were understood to be the result of departures from normal human biological functioning. The goal of medical therapy was to restore humoral equilibrium by adjusting diet, exercise, and the body’s evacuations. Hippocrates also used the humors to explain moods and emotional states in physical terms. For example, when a patient was melancholic, the feelings of sadness or depression were caused by an excess of black bile. Likewise, an excess of yellow bile caused a person to become angry or impulsive.
To understand Hippocrates’s general approach to medicine, one of his treatises, The Sacred Disease (about epilepsy), is studied carefully. Close reading reveals Hippocrates’s keen awareness of the same basic clinical picture of epilepsy we would recognize today, based, presumably, on his close bedside observation of patients. It also reveals Hippocrates’s repeated use of biological explanations of both the anatomical and humoral variety to explain the occurrence of particular symptoms, their relationship with one another, and their response to biological interventions aimed at relieving or eliminating them. Close examination of The Sacred Disease also reveals passages where Hippocrates explains mental states—both cognitive and emotional—in terms of the biological health of the brain and its humors. But there are also other passages here and in other treatises where he describes emotional states that seem to be separate from the brain and humors or any other biological state. For example, Hippocrates describes a woman who began to exhibit fears, depression, and incoherent rambling speech after suffering from “grief,” that is, from an emotional state that was brought on by personal loss and not by a biological abnormality of any kind. These moments in Hippocrates when he is attuned to psychological states are, however, rare, and his medical writings are dominated by biology.
- Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton & Company, 1997, 50–62.
- Hippocrates. “The Sacred Disease.” In Hippocrates Volume II. Loeb Classical Library Edition. Cambridge, MA: Harvard University Press, 1959, pp. 139–183. Available online at http://www.archive.org/stream/hippocrates02hippuoft#page/138/mode/2up (accessed on 1/27/2012).
- What are some similarities and differences in knowledge base and reasoning process between Hippocrates’ time and our own? For example, how modern does the logic if not the biological details of the following passage in The Sacred Disease seem?: “[W]hen the veins are cut off from the air by the phlegm and admit none of it, the patient is rendered speechless and senseless. … The eyes roll when the minor veins are cut off from the air and pulsate. The foaming at the mouth comes from the lungs; for when the breath fails to enter them they foam and boil as though death were near.” (p.161) Given the state of knowledge about the human body during his time, could Hippocrates have come up with better explanations for the symptoms of epilepsy than he did?
- In The Sacred Disease, Hippocrates presents a very biologically-based explanation for human emotions, thought, and mental stability. He writes: “Men ought to know that from the brain and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs and tears. … It is the same thing which makes us mad or delirious, inspires us with dread and fear … These things that we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist, or dry … [I]f terrors and fears attack, they are due to a change in the brain. Now it changes when it is heated, and it is heated by bile which rushes to the brain from the rest of the body…” (pp. 175–177) If we were to summarize this, we would say that Hippocrates’s view is that biological states produce emotional and other psychological states. But why then does he say elsewhere in The Sacred Disease that epilepsy can be “caused by fear of the mysterious, if the patient be afraid at a shout, or if while weeping he be unable quickly to recover his breath … [T]he body is immediately chilled, the patient loses the power of speech and … the brain hardens, the blood stays, and so the phlegm separates off and flows down”? (p. 167) Here Hippocrates seems to be saying that the emotional or psychological state comes first, which then leads to certain biological consequences, and in this case emotions are the cause and not the consequence of biology.
- If Hippocrates’s basic humoral theoretical orientation explains his first view, that biology causes emotion, what explains his second view, that emotion can on occasion cause biological consequences? How is Hippocrates’s deserved reputation as a close observer at the patient’s bedside possibly relevant to his second view?
What does Porter mean when he calls Hippocratic medicine “expectant” (p. 59) and “non-heroic” (p. 60)? Are these features of Hippocratic medicine still respected today? Why or why not?