Notes on Phrenitis in Galen and Sextus Empiricus

  Kazantzidis, George. 2023. “Notes on Phrenitis in Galen and Sextus Empiricus.” In “Γέρα: Studies in honor of Professor Menelaos Christopoulos,” ed. Athina Papachrysostomou, Andreas P. Antonopoulos, Alexandros-Fotios Mitsis, Fay Papadimitriou, and Panagiota Taktikou, special issue, Classics@ 25.

Perceptions are, to some extent, shareable—you and I can agree that there is a tree; but if I say, “I see a tree there,” and you see nothing of the sort, you will regard my tree a hallucination, something concocted by my brain or mind, and imperceptible to anyone else. To the hallucinatory, though, hallucinations seem very real; they can mimic perception in every respect, starting with the way they are projected into the external world.
Oliver Sacks, Hallucinations
There is no society without madness. Not that madness is inevitable or a necessity of nature, but rather because division is found in all cultures. By this I mean that a culture is distinguished not simply with respect to others (opposite, against the others), but that within its space, its own domain, every culture establishes limits […] The madman is a kind of mirror that, passing before things and people, [reveals] their truth … Madness is something that involves the double, the same, a shared duality, the analogon, the indeterminable distance of the mirror. While madness in societies is an absolute difference, the other language, inside language it is represented as the same thing, a reflected truth, a duplicate film. [1]
Michel Foucault, Madness, Language, Literature

Mental faculties and cognitive capacities can be damaged, compromised, twisted, and affected in all sorts of different and interesting ways. [2] The ones who undertake to discuss the wide range of attending dysfunctions are usually doctors; among them, Galen stands out as the most systematic and insightful physician in antiquity—not only when it comes to this particular subject, but generally.

The medical condition that I will be concerned with in this paper is identified in ancient medical texts as phrenitis. It takes its name from phrenes, the “diaphragm”—a metonymy for mental life—and it is diagnosed as a sudden and acute illness which makes its presence felt through symptoms of high fever, delirium and a rapidly increasing loss of touch with reality. [3] In what follows I will look at some examples discussed by Galen and I will attempt a close reading of them, pointing to parallels drawn from Sextus Empiricus. These are issues of fundamental importance for both physicians and philosophers, and although the discursive practices and contexts for discussing an illness may vary from one author to another, the same questions obtain, relating ultimately to what we understand reality to be and how we interact with it, in health and in illness.

My first text comes from De locis affectis (Περὶ τῶν πεπονθότων τόπων), Book 4. Galen states in this instance that:

τινὲς μὲν γὰρ τῶν φρενιτικῶν, οὐδὲν ὅλως σφαλλόμενοι περὶ τὰς αἰσθητικὰς διαγνώσεις τῶν ὁρατῶν, οὐ κατὰ φύσιν ἔχουσι ταῖς διανοητικαῖς κρίσεσιν· ἔνιοι δ’ ἔμπαλιν ἐν μὲν ταῖς διανοήσεσιν οὐδὲν σφάλλονται, παρατυπωτικῶς δὲ κινοῦνται κατὰ τὰς αἰσθήσεις, ἄλλοις δέ τισιν κατ’ ἄμφω βεβλάφθαι συμβέβηκεν.
De locis affectis 4.2 (8.225.14–19 K.)
Some people affected with phrenitis make no mistake at all in the distinction of visual impressions, but they develop an abnormal thought process. Others, by contrast, do not commit any error of judgment but they receive impressions in a distorted way. Still others happen to be affected in both ways. [4]

Theory in Galen always comes hand in hand with examples drawn from clinical experience at the level of everyday life and medical practice, and so the author, in the text that follows, goes on to report on cases of phrenetic patients corresponding to each of the categories he has just outlined. The first concerns a patient who exhibits symptoms of type A of phrenitis—which is to say that the affected individual can see and hear perfectly fine, but he develops a strange, to say the least, way of thinking:

καταλειφθείς τις ἐπὶ τῆς οἰκίας ἐν ώμῃ μεθ’ ἑνὸς ἐριουργοῦ παιδός, ἀναστὰς ἀπὸ τῆς κλίνης ἧκεν ἐπὶ τῆς θυρίδος, δι’ ἧς οἷόν τ’ ἦν ὁρᾶσθαί τε αὐτὸν καὶ ὁρᾷν τοὺς παριόντας. εἶτα τῶν ὑαλίνων σκευῶν ἕκαστον ἐπιδεικνὺς αὐτοῖς, εἰ κελεύοιεν αὐτὸ βάλλειν, ἐπυνθάνετο. τῶν δὲ μετὰ γέλωτος ἀξιούντων τε βαλεῖν καὶ κροτούντων ταῖς χερσὶν, ὁ μὲν ἔβαλεν ἐφεξῆς ἅπαντα προχειριζόμενος, οἱ δὲ γελῶντες ἐκεκράγεισαν. ὕστερον δέ ποτε πυθόμενος αὐτῶν, εἰ καὶ τὸν ἐριουργὸν κελεύοιεν βληθῆναι, κελευσάντων αὐτῶν, ὁ μὲν ἔβαλεν, οἱ δὲ ἐπεὶ καταφερόμενον ἐξ ὕψους ἐθεάσαντο, γελῶντες μὲν ἐπαύσαντο, πεσόντα δὲ προσδραμόντες ἀνείλοντο συντριβέντα.
De locis affectis 4.2 (8.226.2–13 K.)
A man who was left to his house in Rome in the company of a young wool-worker stood up from his bed and went to the window, where he could be seen and also could watch the people passing by. He then started showing to the crowd each one of his glass vessels and asked them if they would like him to throw them down. The people laughed, clapped their hands, and told him to do so. The man grasped one vessel after another and began to throw his stuff on the street. The people laughed and made loud cries. Some time passed by, and the patient asked them if they would also like him to throw down the wool-worker. And when they told him to do so, he complied. When the people saw the man fall from high up, they stopped laughing, ran to the fallen man, who was crushed, and lifted him up.
This is an incredibly rich and layered story. We have no way of knowing whether Galen actually saw this happening or whether it was reported to him by others. In fact, there is a fairly good chance that some of these stories were invented by the author himself, [5] so as to back up experientially the validity of his theories and delicate distinctions about how the human mind works or what happens when it stops functioning properly. This is an important methodological point, because it makes us ponder on the extent to which Galen is operating with established preconceptions which he then projects, as it were, onto everyday reality, or if it is the other way around: that is, whether it is everyday reality which constantly feeds Galen with incidents and patient-profiles of all sorts and kinds, which he then tidies up into neat abstractions. But since this is a question that primarily concerns how we study the history of mental illness and, specifically, what kind of hard evidence we take into account as historically reliable, I will leave it aside for the moment.

Back to Galen’s text. The whole incident is orchestrated as a spectacle of sorts (δι’ ἧς οἷόν τ’ ἦν ὁρᾶσθαί τε αὐτὸν καὶ ὁρᾷν τοὺς παριόντας … ἐθεάσαντο)—one that starts on a light-hearted tone that reminds us of comedy (τῶν δὲ μετὰ γέλωτος ἀξιούντων … οἱ δὲ γελῶντες ἐκεκράγεισαν [6] ), and then suddenly takes a tragic turn (γελῶντες μὲν ἐπαύσαντο, πεσόντα δὲ προσδραμόντες ἀνείλοντο συντριβέντα). The element of laughter in the story should not strike us as unusual: mentally incapacitated people were not always treated with kindness in antiquity, and there are several sources testifying to incidents of ridicule and inhumane abuse. [7] Such lack of empathy applied generally to deformity and disability—categories of the abnormal and the deviant, under which illness seems to be finding its place, time and again. Suffice it to be reminded here of the evidence provided by Plutarch at the point where he is telling us of the people in Rome who, instead of taking pleasure in paintings and works of art, haunt, instead, “the monster-market” (τὴν τῶν τεράτων ἀγοράν), driven by a morbid and twisted fascination with the sight of disabled people:

oἱ τοίνυν πολυπράγμονες, οὐ στίχων οὐδὲ ποιημάτων, ἀλλὰ βίων ἀστοχήματα καὶ πλημμελήματα καὶ σολοικισμοὺς ἀναλεγόμενοι καὶ συνάγοντες, ἀμουσότατον καὶ ἀτερπέστατον κακῶν γραμματοφυλακεῖον τὴν ἑαυτῶν μνήμην περιφέρουσιν. ὥσπερ οὖν ἐν ώμῃ τινὲς τὰς γραφὰς καὶ τοὺς ἀνδριάντας καὶ νὴ Δία τὰ κάλλη τῶν ὠνίων παίδων καὶ γυναικῶν ἐν μηδενὶ λόγῳ τιθέμενοι περὶ τὴν τῶν τεράτων ἀγορὰν ἀναστρέφονται, τοὺς ἀκνήμους καὶ τοὺς γαλεάγκωνας καὶ τοὺς τριοφθάλμους καὶ τοὺς στρουθοκεφάλους καταμανθάνοντες καὶ ζητοῦντες εἴ τι γεγένηται “σύμμικτον εἶδος καὶ ἀποφώλιον τέρας”, [8] ἀλλ᾿ ἐὰν συνεχῶς τις ἐπαγάγῃ τοῖς τοιούτοις αὐτοὺς θεάμασι, ταχὺ πλησμονὴν καὶ ναυτίαν τὸ πρᾶγμα παρέξει, οὕτως οἱ τὰ περὶ τὸν βίον ἀστοχήματα καὶ γενῶν αἴσχη καὶ διαστροφάς τινας ἐν οἴκοις ἀλλοτρίοις καὶ πλημμελείας πολυπραγμονοῦντες τῶν πρώτων ἀναμιμνησκέτωσαν ἑαυτοὺς ὅτι χάριν καὶ ὄνησιν οὐδεμίαν ἤνεγκε.
De curiositate 520b–d
Busybodies, however, by gleaning and gathering the blunders and errors and solecisms, not of lines or poems, but of lives, carry about with them a most inelegant and unlovely record-box of evils, their own memory. Therefore just as at Rome there are some who take no account of paintings or statues or even, by Heaven, of the beauty of the boys and women for sale, but haunt the monster-market, examining those who have no calves, or are weasel-armed, or have three eyes, or ostrich-heads, and searching to learn whether there has been born some Commingled shape and misformed prodigy, yet if one continually conduct them to such sights, they will soon experience satiety and nausea; so let those who are curious about life’s failures, the blots on the scutcheon, the delinquencies and errors in other people’s homes, remind themselves that their former discoveries have brought them no favour or profit. [9]

The inherent cruelty of an emotionally distanced crowd who are watching the ill and the deformed with a mix of curiosity and enthrallment is a common denominator between the texts of Galen and Plutarch. But there is also a crucial difference, and this has to do with the fact that, unlike Plutarch’s poor freaks who are exhibited as silent and passive objects, Galen’s madman is not at all disempowered. In fact, he is the one to engage the crowd in dialogue in the first place, insidiously luring them into his twisted game.

Medically speaking, this helps Galen illustrate the point he has made about phrenitis at the beginning of the text. The condition does not necessarily come with a total blindness of one’s mental faculties; sometimes, the patient is developing weird notions and ideas (οὐ κατὰ φύσιν ἔχουσι ταῖς διανοητικαῖς κρίσεσιν) but, other than that, he remains perfectly functional (οὐδὲν ὅλως σφαλλόμενοι περὶ τὰς αἰσθητικὰς διαγνώσεις τῶν ὁρατῶν). Affected by his illness as he may be, the mad patient who makes his appearance at the window of his house, retains, in this sense, a considerable degree of touch with reality; he can tell one glass vessel from the other, he can interact with the sane people who are watching him (just in the same way as he is watching them), and he has an absolutely clear idea of what it means to entertain a crowd and satisfy their demands. As it happens, the crime committed in the end [10] is equally his and the people’s responsibility; after all, it is them who, when asked if he should throw the woolworker, prompt him to do so.
What I am suggesting is that the whole scene implicates a delicate sense of mirroring, [11] one that ultimately makes us question the thin line between sanity and insanity. Just as a phrenetic patient is not entirely lost in madness, so the ‘sane’ audience prompting him to throw the slave from the window manifests a dark and irrational taste for a bloody spectacle. This is not that shocking, of course, when one considers that such tastes and spectacles were deeply embedded in Rome’s pop culture and mass psychology. One has only to think of the spectacles in the arena where, typically, an emperor would ask the crowd if a gladiator’s life should be spared or not; and the crowd would then act as a jury, condemning the gladiator to death or saving his life. [12] This script is implicitly present also in Galen’s text: [13] the phrenetic patient is fully aware that he is addressing an audience which is used to the idea that, when asked en masse, they have control over other people’s lives. It is worth noting, in this respect, that the word used by Galen for the window (ἐπὶ τῆς θυρίδος) through which the madman presents himself to the people below, has connotations of an imperial [14] appearance; cf. e.g. Plutarch Quaestiones Romanae 273c: ἐπεὶ δὲ Ταρκυνίου Πρίσκου τοῦ βασιλέως ἀποθανόντος ἡ γυνὴ Τανακυλλὶς ἔμφρων οὖσα καὶ βασιλικὴ διὰ θυρίδος προκύψασα τοῖς πολίταις ἐνέτυχε καὶ συνέπεισεν ἀποδεῖξαι βασιλέα τὸν Σέρβιον. [15] Read in this way, the main character in the story entertains a typical illusion of grandeur; only, as it turns out in the end, this is not simply an illusion but an actual reality: the patient, excused because of—or, rather, empowered by—his illness, can ultimately manipulate the crowd into complying with his own sick phantasies.
Added to this is another intriguing aspect of the text that seems to have gone so far unnoticed. On the face of it, the patient’s problem lies in the fact that he cannot distinguish between a (worthless) glass [16] vessel and a (precious) human life; to him it is all the same. But again, we need to ponder a bit more on the detail that the victim is not a random human being; he is a slave. [17] And a slave’s life—it is worth remembering—does not matter as much (if at all) as a freeman’s life. Notoriously, Greek and Roman antiquity saw slaves as objects. [18] Aristotle, for instance, maintained that a slave is a “thing” you possess, just as you possess cattle, coins and furniture (Politics 1267b11–13: ἔστι δὲ καὶ δούλων καὶ βοσκημάτων πλοῦτος καὶ νομίσματος, καὶ κατασκευὴ πολλὴ τῶν καλουμένων ἐπίπλων). [19] Varro is no different when claiming that a slave is an instrumentum—a “tool that has its own voice” and one that occupies the same ontological space with cattle and the rest of instruments we use in farming (Res rusticae– nunc dicam, agri quibus rebus colantur. Quas res alii dividunt in duas partes, in homines et adminicula hominum, sine quibus rebus colere non possunt; alii in tres partes,instrumenti genus vocale et semivocale et mutum,vocale, in quo sunt servi, semivocale, in quo sunt boves, mutum, in quo sunt plaustra). [20] Placed in this social and cultural context, the madman’s error of judgment in Galen is not, factually speaking, an error. True, the medical author mentions the whole incident as a means of illustrating what can happen when the mind stops functioning properly; But in doing so, Galen is wise enough, I think, to hint at the fact that often madness can also reside in the deep structure of an “ordered” society. Stories of punishing slaves with death—as though their lives did not matter—abound in antiquity; and in most of those cases nobody is said to be suspected of madness, for the simple reason that killing or inflicting great physical injuries on a slave, as long as the wrong which he had committed was deemed serious enough, was just the “natural” and “sane” thing to do: because a slave was essentially conceived and treated as an object, even under normal circumstances. It is tempting to speculate that Galen’s report of the incident with the man at the window articulates, albeit implicitly, a kind of social critique, one that invites his readers to ponder on the extent to which sometimes culturally validated and established notions concerning the value of human life, and more precisely the idea some lives matter more than others, may be flawed at their very core. His way of fleshing this out is by presenting us with a mentally confused, deranged patient whose problem is that he cannot tell the difference between a glass vessel, an inanimate object, and a human being [21] —a belief, on second thought, that many “sane” people at the time would be willing to share and take for granted. [22]

So much for type A of phrenitis. But what about type B, the one in which the patient, as we are told, thinks rationally, but he sees and hears strange things? Galen illustrates this type with the following story:

Τὸ δ’ ἐναντίον οὐ μόνον ἐπ’ ἄλλων, ἀλλὰ καὶ ἐμαυτῷ συμβὰν οἶδα μειρακίῳ τὴν ἡλικίαν ὄντι. πυρέττων γὰρ ἐν θέρει πυρετῷ διακαεῖ, τῆς τε κλίνης ἐξέχειν τινα κάρφη, κατὰ τὴν χρόαν ὀρφνώδη, καὶ τῶν ἱματίων ὁμοίας κροκύδας ἐνόμιζον· εἶτ’ ἀφαιρεῖν μὲν αὐτὰς ἐπεχείρουν, οὐδενὸς δὲ ὑπὸ τῶν δακτύλων ἀναφερομένου, συνεχέστερόν τε καὶ σφοδρότερον ἐπεχείρουν οὕτω πράττων. ἑταίρων δὲ δυοῖν παρόντων ἀκούσας ἀλλήλοιν λεγόντων, ὡς οὗτος ἤδη κροκυδίζει τε καὶ καρφολογεῖ, συνῆκα μὲν ὡς αὐτὸ τοῦτο πεπόνθοιμι τὸ λεγόμενον ὑπ’ αὐτῶν, ἀκριβῶς δὲ παρακολουθῶν ἐμαυτῷ μὴ παραπαίοντι κατὰ τὴν λογιστικὴν δύναμιν, ὀρθῶς, ἔφην, λέγετε, καὶ βοηθεῖτέ μοι, μὴ φρενιτίσω.
De locis affectis 4.2 (8.226–227 K.)
I know for sure that the opposite thing can happen; I have seen it happening to others, and I also experienced it myself when I was young. It was summer and I was seized by high fever. I thought I was seeing hay coming out from the bed sheet, black in colour, and tiny flocks of wool projecting from my clothes. I tried to remove them, and as there was nothing for my fingers to grasp, I kept doing it all the more insistently and tenaciously. There were two friends standing by my bedside, and I heard them saying “Look at Galen! He’s lost it and started plucking at his bedclothes!” This made me realize that this was exactly what was happening to me and looking at myself (my power of reason was still sound and present), I said to them: “you’re right! Please help me so that phrenitis doesn’t take hold of me.”

Two observations are pertinent at this point. Τhe first concerns the clinical details of the story. What Galen is describing here is a typical case of “carphology,” otherwise known as floccillation, defined in medical idiom as the action of grasping at imaginary objects or plucking at one’s bed clothes, and recognized as a characteristic of people affected by high fever and delirium. [23] The second observation relates to what modern psychiatry defines as “gradualism.” According to the gradualist approach, mental illness is not a matter of fixed and tidily delineated nosological categories which are easy to identify and to distinguish from a positive state of “health”; gradualism posits that illness should instead be approached in terms of degrees by which certain pathological states manifest themselves, without necessarily establishing a clear-cut break from the realm of reason. [24] This is to say that Galen’s medical case, in which he presents himself as conversing, rationally, with his friends is no less phrenetic than that of the patient who has lost it and throws stuff from the window. Crucially, Galen warns his friends that they should help him so that phrenitis does not take full hold of him (καὶ βοηθεῖτέ μοι, μὴ φρενιτίσω)—meaning that the illness is already there, although not to an advanced degree.

The important term in this case is paratuposis, translated by Liddell-Scott-Jones as a “counterfeit representation.” At the beginning of the text, Galen points out that Type B of phrenitis occurs when a patient is still able to form rational judgments but receives distorted impressions, that is, images which do not exactly correspond to existing objects: … ἔνιοι δ’ ἔμπαλιν ἐν μὲν ταῖς διανοήσεσιν οὐδὲν σφάλλονται, παρατυπωτικῶς δὲ κινοῦνται κατὰ τὰς αἰσθήσεις. The medical episode of carphology falls into this category. Plucking at one’s bed clothes because one thinks that she sees tiny flocks of wool standing out might not sound that big a deal; but it bears emphasizing that even this minimal optical illusion, when considered in association with other symptoms, raises, in Galen’s mind, a red flag.

I am talking here of minimal optical illusion in the sense that the cognitive and perceptual mistake involved in floccillation is not a major one; it is a sensory mistake that sometimes can take place even under normal circumstances, when, for instance, one is tired or feels dizzy. But in other instances, paratuposis can lead to grave illusions. In the context of discussing Stoic epistemology, Sextus Empiricus mentions that the Stoics allow for a distinction between representations which they call “vacuous” and those which they label “distorted”: for the first case Sextus invokes the example of tragic Orestes who sees the Furies chasing him; for the second case, that of the ‘distorted’ representations, he is citing the case of Heracles who kills his own children under the impression that they are the children of Eurystheus:

διακένους γὰρ εἶναί τινας φαντασίας ὡμολογήκασιν, ὁποῖαι προσέπιπτον τῷ Ὀρέστῃ ἀπὸ τὼν Ἐρινύων, καὶ ἄλλας παρατυπωτικὰς τὰς ἀπὸ ὑποκειμένων μέν, οὐ κατ᾿ αὐτὰ δὲ τὰ ὑποκείμενα, ὁποία ἦν ἡ κατὰ μανίαν τῷ Ἡρακλεῖ ἀπὸ τῶν ἰδίων παίδων ὡς Εὐρυσθέως ὑποπεσοῦσα. ἀπὸ ὑποκειμένων γὰρ ἐγίνετο τῶν παίδων, οὐ κατ᾿ αὐτὰ δὲ τὰ ὑποκείμενα· οὐ γὰρ ὡς ἰδίους ἔβλεπε παῖδας, ἀλλὰ φησὶν “εἷς μὲν νεοσσὸς ὅδε θανὼν Εὐρυσθέως / ἔχθραν πατρῴαν ἐκτίνων πέπτωκέ μοι”. [25]
Adversus Mathematicos 8.67–68
For they have allowed that some presentations are vacuous—such as those which Orestes received from the Furies,—and that others are distorted, being derived from real objects but not in conformity with those objects themselves,—as was that which came to Heracles in his madness from his own children as though from those of Eurystheus; for it came from the children who really existed, but not in conformity with the actual real objects; for he did not see the children as his own, but declares—“This nestling of Eurystheus slain by me / pays for his father’s enmity by death.” [26]

The distinction outlined in this passage is, in modern terms, that between a hallucination and an illusion. [27] When (Aeschylus’) Orestes sees the Furies chasing him, there is no existing person or object near him that he is misperceiving as such; what he comes face to face with is a fully formed hallucination which is entirely a product of his own imagination. Heracles, on the other hand, sees his children (who are actually present), but driven by a fatal spell of madness, mistakes them for something else—someone else’s children. This is what Sextus describes as a paratuposis.

The Orestes whom Sextus has in mind in this passage is the one from Aeschylus’ Choephori. Consider the following lines (1048–1062):

[Orestes] ἆ ἆ·
σμοιαὶ γυναῖκες αἵδε Γοργόνων δίκην,
φαϊοχίτωνες καὶ πεπλεκτανημέναι
1050 πυκνοῖς δράκουσιν· οὐκέτ᾿ ἂν μείναιμ᾿ ἐγώ.
[Chorus] τίνες σε δόξαι, φίλτατ᾿ ἀνθρώπων πατρί,
στροβοῦσιν; ἴσχε, μὴ φοβοῦ, νικῶν πολύ.
[Or.] οὐκ εἰσὶ δόξαι τῶνδε πημάτων ἐμοί·
σαφῶς γὰρ αἵδε μητρὸς ἔγκοτοι κύνες.
[Ch.] ποταίνιον γὰρ αἷμά σοι χεροῖν ἔτι·
ἐκ τῶνδέ τοι ταραγμὸς εἰς φρένας πίτνει.
[Or.] ἄναξ Ἄπολλον, αἵδε πληθύουσι δή,
κἀξ ὀμμάτων στάζουσι νᾶμα δυσφιλές.
[Ch.] εἷς σοι καθαρμός· Λοξίας δὲ προσθιγὼν
1060 ἐλεύθερόν σε τῶνδε πημάτων κτίσει.
[Or.] ὑμεῖς μὲν οὐχ ὁρᾶτε τάσδ᾿, ἐγὼ δ᾿ ὁρῶ·
ἐλαύνομαι δὴ κοὐκέτ᾿ ἂν μείναιμ᾿ ἐγώ.

[Or.] Ah, ah!
I see these hideous women looking like Gorgons—
clad in dark-grey tunics and thickly wreathed with serpents! I can’t stay here!
[Ch.] Dearest of men to your father, what are these fancies that are whirling
you about? Hold firm, don’t be afraid—you have won a great victory!
[Or.] These afflictions are no fancies I am having;
these are plainly my mother’s wrathful hounds!
[Ch.] Ah, the blood is still fresh on your hands;
that, you see, is the cause of this confusion falling on your mind.
[Or.] Lord Apollo, there are more and more of them!
And they’re dripping a loathsome fluid from their eyes!
[Ch.] There is only one way you can be purified: Loxias,
by laying his hand on you, will set you free from these sufferings.
[Or.] You don’t see these creatures, I do!
I’m being driven, driven away! I can’t stay here! [28]

Orestes’ unmistakable symptom of madness in these lines takes the form of a visual hallucination. Where the Chorus sees only Orestes and the corpses of Aegisthus and Clytemnestra, Orestes sees the Chorus and the corpses, but also Erinyes. Glenn Most observes:

We might perhaps be tempted to think that what Orestes ‘really’ sees is the Chorus, a group of black-garbed women, whom he mistakes as being Erinyes; but this is impossible, for throughout these lines Orestes consistently uses the second person for the Chorus and the third person for the Erinyes, so he evidently has no difficulty in distinguishing the two groups and in recognizing that he is engaged with them in different ways, with the Chorus as his interlocutors and with the Erinyes as their victim. Repeatedly he designates the Erinyes with the deictic pronoun αἵδε (1048, 1054, 1057, 1061), normally reserved for indicating something near at hand and visible to all. But, despite his insistence, the Chorus cannot see them. [29]

Glenn Most’s reading is supported by Sextus Empiricus’ distinction between Orestes’ hallucinations and Heracles’ illusions; according to Sextus, the crucial difference between the two is that in the first case the image of the Erinyes is entirely conjured up in the patient’s mind.

This is not the only time that Orestes makes his appearance in Sextus’ text. In Adversus Mathematicos Book 8, the paradigmatic example of the mad hero returns once again, only this time it is not the Aeschylean but the Euripidean Orestes. The difference is important; for while in Aeschylus Orestes is hallucinating the Furies, in Euripides he is mistaking Electra for one of them. This time it is not a hallucination but an illusion that the matricide is suffering from (Adversus Mathematicos 8.247.1–249.15):

τῶν δὲ ἀληθῶν [sc. φαντασιῶν] αἱ μέν εἰσι καταληπτικαὶ αἱ δὲ οὔ, οὐ καταληπτικαὶ μὲν αἱ προσπίπτουσαί τισι κατὰ πάθος· μυρίοι γὰρ φρενιτίζοντες καὶ μελαγχολῶντες ἀληθῆ μὲν ἕλκουσι φαντασίαν, οὐ καταληπτικὴν δὲ ἀλλ᾿ ἔξωθεν καὶ ἐκ τύχης οὕτω συμπεσοῦσαν, ὅθεν οὐδὲ διαβεβαιοῦνται περὶ αὐτῆς πολλάκις, οὐδὲ συγκατατίθενται αὐτῇ. καταληπτικὴ δέ ἐστιν ἡ ἀπὸ ὑπάρχοντος καὶ κατ᾿ αὐτὸ τὸ ὑπάρχον ἐναπομεμαγμένη καὶ ἐναπεσφραγισμένη, ὁποία οὐκ ἂν γένοιτο ἀπὸ μὴ ὑπάρχοντος· ἄκρως γὰρ ποιούμενοι ἀντιληπτικὴν εἶναι τῶν ὑποκειμένων τήνδε τὴν φαντασίαν, καὶ πάντα τεχνικῶς τὰ περὶ αὐτοῖς ἰδιώματα ἀναμεμαγμένην, ἕκαστον τούτων φασὶν ἔχειν συμβεβηκός. ὧν πρῶτον μὲν τὸ ἀπὸ ὑπάρχοντος γίνεσθαι· πολλαὶ γὰρ τῶν φαντασιῶν προσπίπτουσιν ἀπὸ μὴ ὑπάρχοντος ὥσπερ ἐπὶ τῶν μεμηνότων, αἵτινες οὐκ ἂν εἶεν καταληπτικαί. δεύτερον δὲ τὸ καὶ ἀπὸ ὑπάρχοντος εἶναι καὶ κατ᾿ αὐτὸ τὸ ὑπάρχον· ἔνιαι γὰρ πάλιν ἀπὸ ὑπάρχοντος μέν εἰσιν, οὐκ αὐτὸ δὲ τὸ ὑπάρχον ἰνδάλλονται, ὡς ἐπὶ τοῦ μεμηνότος Ὀρέστου μικρῷ πρότερον ἐδείκνυμεν. εἷλκε μὲν γὰρ φαντασίαν ἀπὸ ὑπάρχοντος τῆς Ἠλέκτρας, οὐ κατ᾿ αὐτὸ δὲ τὸ ὑπάρχον· μίαν γὰρ τῶν Ἐρινύων ὑπελάμβανεν αὐτὴν εἶναι, καθὸ καὶ προσιοῦσαν καὶ τημελεῖν αὐτὸν σπουδάζουσαν ἀπωθεῖται λέγων μέθες μί᾿ οὖσα τῶν ἐμῶν Ἐρινύων. καὶ ὁ Ἡρακλῆς ἀπὸ ὑπάρχοντος μὲν ἐκινεῖτο τῶν Θηβῶν, οὐ κατ᾿ αὐτὸ δὲ τὸ ὑπάρχον· καὶ γὰρ κατ᾿ αὐτὸ τὸ ὑπάρχον δεῖ γίνεσθαι τὴν καταληπτικὴν φαντασίαν.
And of true presentations some are apprehensive, others not,—not apprehensive being those which are experienced by persons in a morbid condition; for countless sufferers from frenzy and melancholia (φρενιτίζοντες καὶ μελαγχολῶντες) receive a presentation which though true is not apprehensive but occurs externally and fortuitously, so that often they make no positive affirmation about it and do not assent to it. An apprehensive presentation is one caused by an existing object and imaged and stamped in the subject in accordance with that existing object, of such a kind as could not be derived from a nonexistent object. For as they deem that this presentation is eminently perceptive of real objects and reproduces with artistic precision all their characteristics, they declare that it possesses each one of these as an attribute. Of these the first is derivation from an existing object; for many presentations occur from what is non-existent, as in the case of madmen, and these will not be apprehensive. Second is derivation both from an existing object and according to that existing object; for some again, though they are derived from an existing object, they do not resemble that object, as we showed a little while ago in the case of the mad Orestes. For though he derived a presentation from an existing object, Electra, it was not in conformity with that object; for he supposed that she was one of the Furies, and accordingly repulses her, as she approaches and eagerly seeks to tend him, with the words—Avaunt! For of my Furies thou art one. [30] Heracles, too, derived an impression of Thebes from an existing object, but not according to that object; for the apprehensive presentation must also be in accord with the object itself. [31]

For historians of philosophy, this is an incredibly important passage, as far as Stoic epistemology, the notion of phantasia and the distinction between cataleptic and non-cataleptic impressions are concerned. [32] For the purposes of the present chapter, it is worth drawing attention to Sextus’ employment of the term φρενιτίζοντες, which, in association with μελαγχολῶντες, are used as generic labels for everything that counts as “mental illness.” [33] One does not expect to find in Sextus the delicate distinctions made by Galen between mania, phrenitis and melancholia; [34] after all, this is a philosophical text and Sextus’ main concern lies with illustrating philosophical issues such as: what is true and false, existing and non-existing, plain and deceptive, and so on. To the extent that mental illness signals a violent break from—what is commonly and conventionally agreed, among sane people, to constitute—“reality,” it offers Sextus a prime opportunity to explore through it the very essence of what it means to be present or not, real or unreal; [35] but other than that, he is not interested in pursuing further details of a more clinical sort; a couple of prominent tragic examples of insanity [36] suffice to do the job for his argument.

Yet, despite the different priorities imposed by each category / genre of texts, philosophical and medical, phrenitis stands as a common denominator in the sense that both Galen and Sextus use it in order to draw a distinction between (i) a loss of touch with reality that remains, to some degree, anchored to the objects or persons which surround the patient and (ii) a loss of touch that is total, in which case the image that the patient is seeing are concocted entirely in his mind. What is more, just as Sextus borrows from medical terminology, so does Galen turn his eye on philosophical jargon. Here is what we read at De symptomatum differentiis 3.4 (7.60.3–7.61.19 K.):

ἐφεξῆς δ’ ἂν εἴη τὰς τῶν ἡγεμονικῶν ἐνεργειῶν βλάβας διελθεῖν, καὶ πρώτης γε τῆς φανταστικῆς. ἔστι δὲ καὶ ταύτης τὸ μὲν οἷον παράλυσίς τις, ὃ δὴ κάρος καὶ κατάληψις ὀνομάζεται, τὸ δὲ οἷον μοχθηρά τις ἢ πλημμελὴς κίνησις, ὅπερ δὴ παραφροσύνη καλεῖται, τὸ δὲ οἷον ἐλλιπὴς καὶ ἄτονος, ὡς ἐν κώμασί τε καὶ ληθάργοις. καὶ μέν γε καὶ αὐτῆς τῆς διανοητικῆς ἐνεργείας ἡ μὲν οἷον παράλυσις, ἄνοια, ἡ δ’ οἷον ἐλλιπὴς κίνησις, μωρία τε καὶ μώρωσις, ἡ δ’ οἷον πλημμελής, παραφροσύνη καλεῖται. τὰ πολλὰ μὲν γὰρ ἐπ’ ἀμφοῖν ἅμα συνίσταται τὸ παραφρονεῖν, ἔν τε τῷ μὴ καλῶς φαντασιοῦσθαι κᾀν τῷ μὴ δεόντως λογίζεσθαι, ἔστι δ’ ὅτε καὶ κατὰ τὸ ἕτερον αὐτῶν μόνον, ὥσπερ γε καὶ Θεοφίλῳ τῷ ἰατρῷ νοσοῦντι τὰ μὲν ἄλλα σωφρόνως ὑπῆρχε διαλέγεσθαί τε καὶ γνωρίζειν ἀκριβῶς τοὺς παρόντας, αὐλητὰς δέ τινας κατειληφέναι τὴν γωνίαν τοῦ οἰκήματος ἐν ᾧ κατέκειτο, καὶ διαπαντὸς αὐλεῖν τε ἅμα καὶ κτυπεῖν ἐνόμιζε καὶ τούτους βλέπειν ᾤετο, τοὺς μὲν ἑστῶτας αὐτόθι, τοὺς δὲ καθημένους, οὕτω διηνεκῶς αὐλοῦντας, ὡς μήτε νύκτωρ ἀνιέναι τι, μήτε δι’ ὅλης ἡμέρας ἡσυχάζειν μὴ τὸ σμικρότατον· ἐκεκράγει δὲ διὰ παντὸς, ἐκβληθῆναι κελεύων αὐτοὺς τῆς οἰκίας. καὶ τοῦτ’ ἦν αὐτῷ τὸ τῆς παραφροσύνης εἶδος. καὶ ὡς ἐῤώσθη γε τελέως καὶ ἀπέφυγε τὸ νόσημα, τά τε ἄλλα πάντα τὰ ὑπὸ τῶν εἰσιόντων ἑκάστου ηθέντα καὶ πραχθέντα διηγεῖτο καὶ τοῦ περὶ τοὺς αὐλητὰς ἐμέμνητο φαντάσματος. ἐνίοις δὲ φάντασμα μὲν οὐδὲν φαίνεται. λογίζονται δ’ οὐκ ὀρθῶς, τοῦ διανοητικοῦ τῆς ψυχῆς αὐτοῖς πεπονθότος· ὥσπερ καὶ τῷ φρενιτικῷ τῷ κλείσαντι μὲν τὰς θύρας ἔνδοθεν, ἕκαστον δὲ τῶν σκευῶν προτείνοντι διὰ τῶν θυρίδων, εἶτα ἐρωτῶντι τοὺς παριόντας, εἰ κελεύοιεν ίπτειν. οὗτος γὰρ ἑκάστου μὲν τῶν σκευῶν ἀκριβῶς ἔλεγε τοὔνομα, κᾀν τῷδε δῆλος ἦν οὔτ’ ἐν τῇ φαντασίᾳ τῇ περὶ αὐτὰ βεβλαμμένος οὔτ’ ἐν τῇ τῶν ὀνομάτων μνήμῃ. τί δὴ βούλεται αὐτῷ τὸ πάντα ίπτειν ἀφ’ ὑψηλοῦ καὶ καταγνύναι; τοῦτ’ οὐκέθ’ οἷός τ’ ἦν συμβαλεῖν, ἀλλ’ ἐν αὐτῷ δὴ τῷ ἔργῳ τῷδε κατάδηλος ἐγίνετο παραπαίων.
Next would be to go through the damages of the authoritative functions, and first those of the imagination. Of this also there is something akin to a paralysis, which is termed unconsciousness (karos) or catalepsy (katalepsis); something akin to an abnormal or defective movement, which is called delirium (paraphrosyne); and something akin to a deficiency or weakness, as in comas (komata) and lethargies (lethargiai). Furthermore, there is also a kind of paralysis of the rational function itself, amentia (anoia); a kind of deficient movement, dullness (moria) or dementia (morosis); and a kind of defective [movement], delirium (paraphrosyne) as it is called. Often delirium (paraphrosyne) exists in both at the same time, i.e. in a malfunctioning imagination and an improperly functioning reasoning. Sometimes it is in relation to one of these alone. For precisely in this way was it possible for Theophilus the physician, when ill, to converse sensibly on other things and correctly recognize those present, whereas he thought some flute players had occupied the corner of the house in which he was lying and were playing continuously at the same time as crashing about. And he thought he saw them, some standing on the spot, but some sitting, in this way playing unceasingly so that they neither let up during the night, nor were in the least bit silent throughout the whole day. He had cried out continuously, ordering them to be cast out of the house. And this was the form of the delirium (paraphrosyne) in him. And when he was restored to health completely and was free of the illness, he described in detail all the other things that had been said and done by each of those coming in and remembered the delusion (phantasma) concerning the flute players. In some no delusion (phantasma) appears. They do not reason correctly because the reasoning component of the soul is affected in them. Such was the case in the deranged person who, having closed the doors within, was holding each of the household utensils through the windows and asking those passing if they would order him to throw. He spoke the name of each of the utensils quite precisely, from which it was clear that he was neither damaged in the imagination about these things nor in the memory of their names. Why then did he wish to throw all these things from a high place and shatter them? This he was no longer able to understand, but by the act itself he was manifestly delirious. [37]

The story of the physician Theophilus (for whom we know next to nothing, other than Galen’s report of his episode of delirium) is incredibly interesting in its own right and would deserve a discussion of its own. For now let us just note the fact that in the context of an extremely systematic discussion of mental affections, Galen seizes the opportunity to stress, once again, that when someone is “not quite right in his mind,” this can manifest in two ways: either the patient makes strange thoughts [38] or he sees and hears things that are not there (there is, of course, a third distinct possibility, arising from the combination of these two mental affections). This time, Galen speaks of παραφροσύνη by which we should understand something fairly similar to phrenitis. What is more, the misperception of distorted or empty images is given in a language (ἔν τε τῷ μὴ καλῶς φαντασιοῦσθαι) that directly involves the notion of phantasia, which, as we have seen above, is the terminus operandi through which Sextus Empiricus discusses the case of Orestes.

The interaction between medicine and philosophy, philosophy and medicine in antiquity is constant and deep, and it should thus be no surprise that Sextus and Galen are found to make use of shared terminologies and distinctions. What I would like to highlight, by way of conclusion, is the importance of mental illness as a meeting point of sorts between medical and philosophical discourses and practices. One of philosophy’s main preoccupations is to define the essence of reality; and it seems to me that there are roughly two ways to address this fundamental question. One, obvious, way—as long as we maintain our health—is to trust our senses, thoughts, judgments and notions as reliable mediums that give us access to the world of sensible and intelligible things around us. The other way is to try and grasp reality by looking into what happens when the human mind stops functioning properly. In this latter case, a mental patient is not just an impaired individual: he, too, testifies to what reality is by letting us know, unwittingly and involuntarily though rewardingly in the end, what happens when we are deprived of our free and unimpeded access to it. There is a lot that remains to be done in this direction. I am referring to how reality is often formally understood and defined, in philosophical contexts, in contradistinction to falsehood and to deceiving appearances, and to how this sort of negative definition of reality might be forming a background for all those mental patients in medical texts, who—by means of their derangements, illusions, hallucinations and the alternate landscapes which they inhabit—function essentially as manifestations of the real, the unreal, and the line in-between.


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[ back ] 1. With my warmest wishes to Menelaos for a happy retirement, full of joy and productivity.
[ back ] 2. A point made by medical and non-medical writers alike. See e.g. Aretaeus De causis et signis acutorum morborum 1.6 (μανίης τρόποι εἴδεσι μὲν μυρίοι, γένει δὲ μοῦνος εἷς. ἔκστασις γάρ ἐστι τὸ ξύμπαν χρόνιος, ἄνευθε πυρετοῦ); Lucian Abdicatus 30 (ἐπεὶ καὶ τῆς μανίας αὐτῆς μυρία εἴδη ἐστὶν καὶ παμπόλλας ἔχει τὰς αἰτίας καὶ οὐδὲ τὰς προσηγορίας αὐτὰς ὁμοίας· οὐ γὰρ ταὐτὸν παρανοεῖν καὶ παραπαίειν καὶ λυττᾶν καὶ μεμηνέναι).
[ back ] 3. See Thumiger 2017:45–47, 391–392, 400–401.
[ back ] 4. Translations are by the author, unless stated otherwise.
[ back ] 5. See Mattern 2008 and Lehoux 2017.
[ back ] 6. The intriguing detail that the phrenetic patient has been left home with only a slave by his side as a guardian could be read as reminiscent of the opening scene of Aristophanes’ Wasps.
[ back ] 7. See Kazantzidis and Tsoumpra 2018. For attitudes towards the sick and the disabled in the Roman world, see Laes 2018.
[ back ] 8. Euripides fr. 472a (ed. Collard and Cropp 2008).
[ back ] 9. Translation by Helmbold 1939:499–501.
[ back ] 10. The participle συντριβέντα (πεσόντα δὲ προσδραμόντες ἀνείλοντο συντριβέντα) does not make it explicitly clear whether the slave who falls from the window dies in the end. At the very best, we must assume that he sustains some rather severe injuries; cf. Galen De locis affectis 4.3 [8.232–233 K.): ὅτ’ ἂν ὀστοῦν συντριβὲν σφοδρῶς τοῦ κρανίου θλίβῃ τὰς κοιλίας αὐτοῦ, καὶ μάλιστα τὴν μέσην, ὁ κάρος συμπίπτει. For the use of συντρίβεσθαι in descriptions of violent death, cf. Xenophon Anabasis 4.7.4.
[ back ] 11. See e.g. the significant use of the verb (οἱ δὲ γελῶντες) ἐκεκράγεισαν, which Galen applies to the crowd. It is tempting to trace at this point an allusion to the idiom of madness symptomatology, especially that of the aggressive type. Cf. e.g. [Hippocrates] De morbo sacro 15.1–5 [6.388 L.]: γίνεται δὲ ἡ διαφθορὴ τοῦ ἐγκεφάλου ὑπὸ φλέγματος καὶ χολῆς· γνώσῃ δὲ ἑκάτερα ὧδε· οἱ μὲν γὰρ ὑπὸ τοῦ φλέγματος μαινόμενοι ἥσυχοί τέ εἰσι καὶ οὐ βοῶσιν οὐδὲ θορυβέουσιν, οἱ δὲ ὑπὸ χολῆς κεκράκται καὶ κακοῦργοι καὶ οὐκ ἀτρεμαῖοι, ἀλλ’ αἰεί τι ἄκαιρον δρῶντες […] 13–15: ἐκ νυκτῶν δὲ βοᾷ καὶ κέκραγεν, ὅταν ἐξαπίνης ὁ ἐγκέφαλος διαθερμαίνηται· τοῦτο δὲ πάσχουσιν οἱ χολώδεες, οἱ δὲ φλεγματώδεες οὔ. On laughter as a symptom of madness, see Thumiger 2017: 366–367. Cf. Tsoumpra 2020. Finally, regarding the unsettling symbiosis of laughter with loud cries, I see a distant echo at this point of Aristophanes Wasps 1285–1287: ἡνίκα Κλέων μ᾿ ὑπετάραττεν ἐπικείμενος / καί με κακίσας ἔκνισε, κᾆθ᾿, ὅτ᾿ ἀπεδειρόμην, / οἱ ᾿κτὸς ἐγέλων μέγα κεκραγότα θεώμενοι. The Aristophanic intertext and its impact on Galen’s text would have demanded a discussion of their own.
[ back ] 12. For the Roman arena and crowd psychology, see the definitive treatment by Fagan 2011.
[ back ] 13. For the connection between the arena culture and Galen’s (bloody) anatomical experiments performed in front of extended audiences, see Gleason 2009.
[ back ] 14. For madness and illusions of grandeur, cf. Xenophon Memorabilia 3.9.7: ἐάν τε γάρ τις μέγας οὕτως οἴηται εἶναι, ὥστε κύπτειν τὰς πύλας τοῦ τείχους διεξιών, ἐάν τε οὕτως ἰσχυρός, ὥστ᾿ ἐπιχειρεῖν οἰκίας αἴρεσθαι ἢ ἄλλῳ τῳ ἐπιτίθεσθαι τῶν πᾶσι δήλων ὅτι ἀδύνατά ἐστι, τοῦτον μαίνεσθαι φάσκειν.
[ back ] 15. See also Athenaeus Deipnosophistae 517b–c: ὁ ἐν τῇ λιβανοφόρῳ χώρᾳ βασιλεὺς αὐτόνομός τέ ἐστι καὶ οὐδενὸς ὑπήκοος … οὗτος δ᾿ ὑπερβάλλει τῇ τρυφῇ καὶ ᾳθυμίᾳ. διατρίβει τε γὰρ αἰεὶ ἐν τοῖς βασιλείοις ἐν τρυφῇ καὶ δαπάνῃ τὸν βίον διάγων καὶ πράττει οὐδὲ ἓν πρᾶγμα <αὐτὸς> οὐδὲ <τοῖς> πολλοῖς πλησιάζει, ἀλλὰ δικαστὰς ἀποδεικνύει· καὶ ἐάν τις αὐτοὺς ἡγῆται μὴ δικαίως δεδικακέναι, ἔστι θυρὶς ἐν τῷ ὑψηλοτάτῳ τῶν βασιλείων καὶ αὕτη ἁλύσει δέδεται. ὁ οὖν ἡγούμενος ἀδίκως δεδικάσθαι ἐπιλαμβάνεται τῆς ἁλύσεως καὶ ἕλκει τὴν θυρίδα, καὶ ὁ βασιλεὺς ἐπειδὰν αἴσθηται εἰσκαλεῖ καὶ αὐτὸς δικάζει.
[ back ] 16. The detail of τῶν ὑαλίνων σκευῶν has its own significance. In the context of this particular episode, it underscores the idea of fragile things being thrown from the window and getting crushed in a spectacular way. But the notion of fragility might be pointing out, simultaneously, to an incipient embodied metaphor that, in current idiom, shapes expressions such as: “I feel broken / I feel crushed” etc. Compare, for instance, the case of a melancholic patient for whom Galen reports that he was avoiding people in the street because he thought that he had been transformed to an earthen vessel and he was thus afraid that he would get broken if people were to touch him (De locis affectis 3.10 = 8.189.19–8.190.10 K.): 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 Ἄτλας ἀποσείσηται κεκμηκὼς αὐτὸν, οὕτως τε καὶ αὐτὸς συντριβείη καὶ ἡμᾶς αὐτῷ συναπολέσειεν· ἄλλα τε μυρία τοιαῦτα φαντασιοῦνται. Cf. Reiss 2003:30.
[ back ] 17. On wool-working slaves in antiquity, see Wrenhaven 2009. There might also be a sexual implication infiltrating the lines of Galen’s text. On wool-workers as sex slaves in antiquity, see Galen’s cursory observation in his commentary on the Hippocratic De diaeta acutorum [15.445.5–6 K.]: τὸν γὰρ κίναιδον καὶ τὸν γυναικεῖον ἐπιτήδευμα μετιόντα, καθάπερ τὸν ἐριουργόν. On hetairai probably doubling as wool-workers in Comedy, see Papachrysostomou 2016:33–34, 119–121 (on Amphis’ plays The Anointress, and The Day-Labourers).
[ back ] 18. See DuBois 2003.
[ back ] 19. See Garnsey 1996:1–2; DuBois 2003:189–205; Forsdyke 2021:24–26.
[ back ] 20. Cf. Cato De agri cultura 2.7 (a sick or aged slave is no different from an overused tool or an aged animal): Auctionem uti faciat: vendat oleum, si pretium habeat; vinum, frumentum quod supersit, vendat; boves vetulos, armenta delicula, oves deliculas, lanam, pelles, plostrum vetus, ferramenta vetera, servum senem, servum morbosum, et si quid aliut supersit, vendat. See, also, Seneca De ira 3.34.1, with the discussion in Joshel 2011:214–216.
[ back ] 21. The same association between inanimate objects and slaves (in the context of an intense emotion that approximates madness) seems to underlie Galen’s references to some memorable episodes of fits of anger, which lead people to irrationally intense reactions. Someone unable to open a door, as we are told in De propriorum animi cuiuslibet affectuum dignotione et curatione 3 (5.16.4–7 K.), kicks it and bites (!) the key: ἐγὼ δὲ μειράκιον ὢν ἔτι ταῦτ’ ἀσκήσας, ἐπιδὼν ἄνθρωπον ἀνοῖξαι θύραν σπεύδοντα, μὴ προχωρούσης εἰς τὸ δέον αὐτῷ τῆς πράξεως δάκνοντα τὴν κλεῖν καὶ λακτίζοντα τὴν θύραν καὶ λοιδορούμενον τοῖς θεοῖς ἠγριωμένον τε τοὺς ὀφθαλμοὺς ὥσπερ οἱ μαινόμενοι. Later in the same treatise, Galen recalls the inappropriate behaviour of his irascible mother who used to bite the female servants when she was angry with them (5.40.14–5.41.2): μητέρα δ’ ὀργιλωτάτην, ὡς δάκνειν μὲν ἐνίοτε τὰς θεραπαίνας, ἀεὶ δὲ κεκραγέναι τε καὶ μάχεσθαι τῷ πατρὶ μᾶλλον ἢ Ξανθίππη Σωκράτει. The common denominator between these two episodes (highlighted through the sensational detail of “biting”) is provided by the acknowledgment that anger can make someone behave like a beast. In other words, it is the inhumanity associated with intense emotions that turns someone blind to the human status of a slave and leads to the latter’s mistreatment as though s/he were an inanimate object.
[ back ] 22. Galen boasts that—following the example set by his father—he never hit a slave with his own hand (De propriorum animi cuiuslibet affectuum dignotione et curatione 4 = 5.16.14–5.17.14 Κ.): τοῦτο δ’ ἂν πολλάκις ποιήσῃ, γνωριεῖ ποτε καὶ αὐτὸς ἑαυτὸν ἧττον νῦν <ἢ> πρόσθεν ὀργιζόμενον, ὡς μήτ’ ἐπὶ σμικροῖς μήτ’ ἐπὶ μέσοις θυμοῦσθαι ἀλλ’ ἐπὶ μόνοις τοῖς μεγάλοις μικρόν. οὕτως γὰρ ὑπάρξει ποθ’ ὕστερον αὐτὸν καὶ ἐπὶ τοῖς μεγίστοις ὀργίζεσθαι μικρόν, ἤν τις ὅπερ ἐγὼ προστάξας αὑτῷ μειράκιον ὢν ἔτι διὰ παντὸς ἐφύλαξα τοῦ βίου, <φυλάξῃ> τὸ μηδέποτε τυπτῆσαι τῇ χειρί μου μηδένα τῶν οἰκετῶν, ὅπερ ἤσκητό μου καὶ τῷ πατρί· καὶ πολλοῖς ἐπετίμησε τῶν φίλων περιθλάσασι νεῦρον ἐν τῷ πατάξαι κατὰ τῶν ὀδόντων οἰκέτας, ἀξίους εἶναι λέγων ἐπὶ τῇ γενομένῃ φλεγμονῇ καὶ σπασθῆναι καὶ ἀποθανεῖν, ὅπου γ’ ἐξῆν αὐτοῖς καὶ νάρθηκι καὶ ἱμάντι μικρὸν ὕστερον ἐμφορῆσαι πληγάϲ, ὅσαιϲ ἠβούλοντο τῇ βουλῇ τὸ τοιοῦτον ἔργον ἐπιτελεῖν. ἄλλοι δ’ οὐ μόνον πὺξ <παίουσιν>, ἀλλὰ καὶ λακτίζουσι καὶ τοὺς ὀφθαλμοὺς ἐξορύττουσι καὶ γραφείῳ κεντοῦσιν, ὅταν τοῦτο τύχωσιν ἔχοντες. εἶδον δέ τινα καὶ καλάμῳ δι’ οὗ γράφομεν ὑπ’ ὀργῆς εἰς τὸν ὀφθαλμὸν πατάξαντα τὸν οἰκέτην. This is an interesting passage; for while Galen is condemning the punishment of slaves, his point seems to be that one should delay that punishment for when anger has subsided—which is to say that violence against slaves is not criticized as such. See Harris 2001:329; Mattern 2008:134; Fagan 2011:34.
[ back ] 23. See Larner 2010:74 and Sacks 2012:224–225 on tactile hallucinations.
[ back ] 24. On gradualism and vagueness in psychiatry, see the recent volume by Keil, Keuck and Hauswald 2017, especially the chapters by Hucklenbroich 2017; Hauswald and Keuck 2017; and Helmchen 2017. For an attempt to trace evidence of mental and physical gradualist concepts in Graeco-Roman medicine, see the chapter by Lewis, Thumiger and Van der Eijk 2017, in the same volume.
[ back ] 25. Euripides Hercules Furens 982–983.
[ back ] 26. Translation by Bury 1935:271.
[ back ] 27. Sacks (2012: Introduction) neatly defines hallucinations as “percepts arising in the absence of any external reality—seeing things or hearing things that are not there.” Illusions, on the other hand, arise as misperceptions of existing objects or persons.
[ back ] 28. Translation by Sommerstein 2009:347–349.
[ back ] 29. Most 2013:399.
[ back ] 30. Euripides Orestes 264.
[ back ] 31. Translation by Bury 1935:134–135.
[ back ] 32. See Hankinson 2003.
[ back ] 33. For the same kind of generic grouping of various mental conditions in a philosophical context, cf. Chrysippus SVF 3.238.7–11 (on the question of whether virtue, once acquired, can be lost): ἔτι δὲ καὶ οἱ Στωϊκοὶ ἐν μελαγχολίαις καὶ κάροις καὶ ληθάργοις καὶ ἐν φαρμάκων λήψεσι συγχωροῦσιν ἀποβολὴν γίνεσθαι μεθ’ ὅλης τῆς λογικῆς ἕξεως καὶ αὐτῆς τῆς ἀρετῆς, κακίας μὲν οὐκ ἀντεισαγομένης, τῆς δὲ βεβαιότητος χαλωμένης καὶ εἰς ἣν λέγουσιν ἕξιν μέσην οἱ παλαιοὶ μεταπιπτούσης.
[ back ] 34. See Laes 2018:67–69.
[ back ] 35. In this context, Sextus offers some rather delicate thoughts. Of particular significance is his claim that the world inhabited by the insane is not downright “unreal”; see e.g. Adversus Mathematicos 8.63.1–64.1: ὁ δὲ Ἐπίκουρος ἔλεγε μὲν πάντα τὰ αἰσθητὰ εἶναι ἀληθῆ, καὶ πᾶσαν φαντασίαν ἀπὸ ὑπάρχοντος εἶναι, καὶ τοιαύτην ὁποῖόν ἐστι τὸ κινοῦν τὴν αἴσθησιν, πλανᾶσθαι δὲ τοὺς τινὰς μὲν τῶν φαντασιῶν λέγοντας ἀληθεῖς, τινὰς δὲ ψευδεῖς παρὰ τὸ μὴ δύνασθαι χωρίζειν δόξαν ἀπὸ ἐναργείας. ἐπὶ γοῦν τοῦ Ὀρέστου, ὅτε ἐδόκει βλέπειν τὰς Ἐρινύας, ἡ μὲν αἴσθησις ὑπ’ εἰδώλων κινουμένη ἀληθὴς ἦν (ὑπέκειτο γὰρ τὰ εἴδωλα), ὁ δὲ νοῦς οἰόμενος, ὅτι στερέμνιοί εἰσιν Ἐρινύες ἐψευδοδόξει. With this remark, compare Oliver Sacks’ introductory thesis in his Hallucinations (2011): “Perceptions are, to some extent, shareable—you and I can agree that there is a tree; but if I say, ‘I see a tree there,’ and you see nothing of the sort, you will regard my tree a hallucination, something concocted by my brain or mind, and imperceptible to anyone else. To the hallucinatory, though, hallucinations seem very real; they can mimic perception in every respect, starting with the way they are projected into the external world’.
[ back ] 36. In citing some of these examples, Sextus is not entirely free from committing mistakes. The Heracles mentioned in Adversus Mathematicos 8.249.14–15 (… καὶ ὁ Ἡρακλῆς ἀπὸ ὑπάρχοντος μὲν ἐκινεῖτο τῶν Θηβῶν, οὐ κατ᾿ αὐτὸ δὲ τὸ ὑπάρχον) is in all likelihood Pentheus (in Euripides’ Bacchae).
[ back ] 37. Translation by Johnston 2006:191.
[ back ] 38. Or, according to the text’s exact phrasing: “he does not think as one should” (κᾀν τῷ μὴ δεόντως λογίζεσθαι). But then again, who exactly is to say how one should or should not think? The history of mental illness, as Foucault has helped us understand, is deeply embedded in authoritative and oppressing discourses and cultural practices. Galen’s μὴ δεόντως at this point offers us a tiny glimpse of how mental illness is inextricably linked to superimposed norms as well as society’s urge to control all those who deviate from its rules.