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Changing Explanations in Mind-Body Medicine

Class 2: Late Ancient and Medieval Medical Views of Mind and Body

Introduction: In later antiquity, two major trends were evident in medical thinking. Authors after Hippocrates continued to rely primarily on humoral theory to explain both bodily symptoms and emotional states. They added anatomical knowledge and also systematized a therapy based on “opposition,” whereby excess humors were depleted and “cold” medicines were used to counter “hot” diseases and vice versa. But the psychological dimension in medicine also became more prominent in late antiquity. Galen (131–ca. 201), the most famous of Hippocrates’ successors, was particularly influential here. Deeply respected for his diagnostic skill, Galen was celebrated for his ability to distinguish between illnesses traceable to biological causes and those traceable to psychological causes instead. In one famous case, he treated a young woman who seemed to exhibit the signs of physical illness but who, upon closer examination, revealed no underlying biological abnormality. After eliminating every possible humoral explanation, Galen identified the real, emotional cause of her symptoms: a hidden love interest. Galen likewise contributed an important new general interest in the balance not only of the humors but of what he called the “passions or perturbations of the soul,” that is, of strong emotions.

In the long medieval period between later antiquity and the Renaissance, medical writers preserved while further systematizing the ideas of Hippocrates and Galen. The biological orientation of humoral theory dominated, as was apparent in Avicenna’s (980–1037) influential textbook, the Canon. But Galen’s psychological theory of the “passions” also persisted and was incorporated in medieval medical literature along with the humors. It thus became important for physicians to help patients keep both their humors and their emotions in balance, and psychological balance was essential for the health of both the mind and the body. Moses Maimonides (1135–1204) was one of many medieval medical writers who expressed these ideas clearly, as he did, for example, in his work on “The Regimen of the Body.”

Readings

  • Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton & Company, 1997, 69–77, 80–82, 98–101.
  • Jackson, Stanley. “Galen—On Mental Disorders.” Journal of the History of the Behavioral Sciences 5 (1969): 365–384.
  • Shah, Mazhar H. The General Principles of Avicenna’s Canon of Medicine. Karachi: Naveed Clinic, 1966, 5–14, 154–156, 180–182, 228, 254, 364–366.
  • Maimonides, Moses. “Two Treatises on the Regimen of Health.” Transactions of the American Philosophical Society 54 (1964): 16, 23–26

Discussion Questions

  1. After quoting Galen’s famous case report of the young woman whose actual cause of seemingly physical illness was lovesickness, psychiatrist and historian Stanley Jackson quotes him saying: “Now what was it that escaped the notice of previous physicians when examining the aforesaid young woman? … I suppose it is because they have no clear conception … of how the body tends to be affected by mental conditions.” (“Galen—On Mental Disorders,” p. 366)

    What possible reasons account for Galen’s greater sensitivity to “how the body tends to be affected by mental conditions” than other ancient physicians? What roles might the accumulation of bedside experience over the many years that separated Galen from Hippocrates and the influence of new religions like Christianity and new philosophies like Platonism (which both emphasized the immaterial soul) have played in pushing Galen to a more psychological orientation?
  2. After sorting through the complicated tangle of Galen’s ideas on the various kinds of mental illness and their differing explanations, Stanley Jackson writes “As a physiological [biological] psychologist, Galen frequently referred to physiological factors causing psychological symptoms. But he also made not infrequent references to psychological states causing physical symptoms, a ‘psychosomatic’ viewpoint shared by others among medical writers of antiquity. These two orientations seem to have dwelt together in his views as readily as they do for so many modern psychiatrists and other physicians.” (p. 381)

    Taking Jackson at his word, how and why might the competition in modern psychiatry between biological and psychological explanations of mental illness parallel to the one in Galen’s time?
  3. By carefully studying the excerpts from Avicenna’s Canon listed above, would you consider him biologically-oriented, psychologically-oriented, or both?
  4. Why did Moses Maimonides begin his “regimen of health” by focusing on biological states and biological remedies yet later say: “[C]oncern and care should always be given to the movements of the psyche; these should be kept in balance in the state of health as well as in disease, and no other regimen should be given precedence in any wise.” (p. 25) Would a modern physician endorse Maimonides’ combined approach, put things in a different order, or say something completely different?
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