Galen on Sleep, Health and Heartbreak

More of Galen’s comments on the aphorism attributed to Hippocrates:

“The kinds of habits that influence our health: diet, shelter, work, sleep, sex, thought.”

ἔθος δὲ, ἐξ οἵων ὑγιαίνομεν, διαίτῃσι, σκέπῃσι, πόνοισιν, ὕπνοισιν, ἀφροδισίοισι, γνώμῃ.

Epidemics 6.8.23

Other cases: Maiandros, the augur who predicted his own death; a Cappadocian man who thought the sky would fall.

“In Rome, I recently saw a grammarian named Kallistos whose books were destroyed in the Great Fire that had burned the Temple of Peace. He grieved about this and could no longer sleep. First, he was taken with fever, and then, in just a short time, he wasted away until he died. I have seen quite a number of people like this—whose bodies waste away, be it from grief or from a bad mental state. I will limit myself to a few cases, because their number is too large. First, I mention the story of the mother of the lawyer Nasutus. The story of this woman is as follows. She received news that a woman she loved very much, who was seventy years old, was going by invitation to another place. She arrived there and returned home after having made the long journey. When she returned, she lay down on the bed and asked for some water to drink. The servant replied, “I'll bring it to you right away,” but she fell asleep before the servant returned with the water. By then, some time had passed without the people around the woman noticing anything. When, however, they called to her, she gave no answer. The servants were then compelled to shake her, but she did not wake up. They examined her and touched her body to see what had happened. Her whole body was cold and it was clear that she was dead. They covered her with the clothes in which she had died. When the mother of Nasutus found out about this, it went to her heart so much that she could no longer sleep the way she usually used to do, and eventually she could no longer sleep at all. Her body wasted away from insomnia. She began to have a fever and four days after the news of her friend’s death, she too passed away.”

In Rom sah ich vor kurzem einen Grammatiker, namens Kallistos, dem seine Bücher bei dem großen Brand in Rom, bei dem der Tempel, der “Tempel des Friedens” heißt, verbrannte, vernichtet wurden. Darüber grämte er sich und fand keinen Schlaf mehr. Zuerst begannen bei ihm Fieber, und dann in nicht langer Zeit siechte er dahin, bis er starb. Ich habe noch eine ganze Anzahl derartiger Menschen gesehen, deren Körper dahinsiechte, sei es aus Gram oder einer schlechten Geistesverfassung. Ich beschränke mich auf ein paar Fälle, da ihre Zahl ja zu groß ist. Zuerst erwähne ich die Geschichte der Mutter des Rechtsgelehrten Nasutus. Die Geschichte dieser Frau ist folgende: Sie erhielt die Nachricht, daß eine Frau, die sie sehr liebte und die siebzig Jahre alt war, nach einem anderen Orte auf eine Einladung hin ging. Sie war dort eingetroffen und auch wieder zurückgekehrt, nachdem sie den weiten Weg gemacht hatte. Nach ihrer Rückkehr hatte sie sich auf das Bett gelegt und verlangte etwas Wasser zu trinken. Der Diener hatte geantwortet: “Ich bringe es dir sofort.” Sie schlief aber ein, bevor der Diener mit dem Wasser zurück war. Es verging nun einige Zeit, ohne daß die Leute um die Frau etwas gemerkt hatten. Dann aber riefen sie sie an, aber sie gab keine Antwort. Die Diener sahen sich deshalb gezwungen, sie zu rütteln. Sie wachte aber nicht auf. Sie machten sich nun daran, die Sache zu untersuchen, und befühlten sie, um zu sehen, was mit ihr vorgegangen war. Ihr ganzer Körper war kalt, und es war klar, daß sie tot war. Sie deckten sie mit dem Kleid zu, in dem sie gestorben war. Als die Mutter des Nasutus dies erfuhr, ging es ihr so zu Herzen, daß sie sich nicht mehr zum Schlafen niederlegen konnte, wie sie es sonst gewöhnt war, und überhaupt keinen Schlaf mehr finden konnte. Da siechte auch ihr Körper infolge der Schlaflosigkeit dahin. Sie begann zu fiebern, und schon nach vier Tagen seit der Todesnachricht verschied auch sie.*

Galen, Commentary on Hippocrates‘ Epidemics 6.8, 486,19-487,12 Wenkebach/Pfaff

*Pfaff’s German translation of Hunayn’s school’s Arabic translation (the Greek is lost).

Love Doctor: Aretaeus on Love-Sickness and Melancholy

“There’s a story that some incurably melancholic person fell in love with a girl and when the doctors could do nothing to help, love cured him. I think however that he was in love from the start and that he was feeling down and disheartened because of the bad luck he was having with the girl and so seemed to ordinary people to be melancholic. He had no idea at that point that it was love; but when he realized his love for the girl, he stopped feeling down and he got rid of his anger and sorrow and the joy sobered him up out of his sad state. For his mind was restored by doctor love.”

λόγος ὅτι τῶν τοιῶνδέ τις ἀνηκέστως ἔχων, κούρης ἤρα τε καὶ τῶν ἰητρῶν οὐδὲν ὠφελούντων ὁ ἔρως μιν ἰήσατο· δοκέω δὲ ἔγωγε ἐρᾶν μὲν αὐτὸν ἀρχῆθεν, κατηφέα δὲ καὶ δύσθυμον [ἢ] ὑπ' ἀτυχίης τῆς κούρης ἔμμεναι καὶ μελαγχολικὸν δοκέειν τοῖσι δημότῃσιν. οὗτος οὔτε μὴν ἦν ἔρωτα ἐγγιγνώσκων, ἐπεὶ δὲ τὸν ἔρωτα ξυνῆψε τῇ κούρῃ, παύεται τῆς κατηφείης, καὶ διασκίδνησι ὀργήν τε καὶ λύπην, χάρμῃ δὲ ἐξένηψε τῆς δυσθυμίης· καθίσταται γὰρ τὴν γνώμην ἔρωτι ἰητρῷ.

Aretaeus, Causes and Signs of Chronic Diseases 1.5.8, 41,4–11 Hude

Galen on what to do with a patient who thinks the sky will fall

"I know a man from Cappadocia who had put a nonsensical thing in his head and because of it fell into melancholy. The idea he had put in his head was frankly ridiculous. His friends saw him cry and asked him about his sorrow. Sighing deeply, he answered by saying he was afraid the whole world would collapse. His worry was that the Titan, who the poets say holds up the world and is called Atlas, had become weak because of the length of time he has been holding it up, and therefore, there is a danger that the heavens will fall down to earth and smash to pieces. You have also heard from me the story of the woman who I mentioned had imagined she swallowed a snake, and the story of the man who believed that a ghost had called out to him as he passed the churchyard, and the story of the man who had farted in the presence of other people, and who wasted away and died out of shame. The physician must therefore consider it his job, besides the other dispositions of the patient, to discover the things that oppress his soul. For healing a person for whom the cause of illness lies in his spirit can only be achieved by eliminating the idea that has become fixed, but not by food and drink, or their home, bathing routine, walking and the like."

Ich kenne einen Mann aus Kappadokien, der sich eine unsinnige Sache in den Kopf gesetzt hatte und dadurch der Melancholie verfiel. Die Idee, die er sich in den Kopf gesetzt hatte, war geradezu lächerlich. Seine Bekannten sahen ihn nämlich weinen und fragten ihn nach seinem Kummer. Indem er tief seufzte, antwortete er und sagte, er sei in Angst, daß die ganze Welt einstürze. Sein Kummer sei, daß der König, von dem die Dichter erzählen, daß er die Welt trage und Atlas heiße, infolge der langen Zeit, in der er sie trage, schwach to geworden sei. Deshalb sei Gefahr, daß der Himmel auf die Erde herabstürze und sie zertrümmere. Ihr habt von mir auch schon die Geschichte der Frau gehört, von der ich erzählte, daß sie sich einbildete, eine Schlange verschluckt zu haben, und die Geschichte des Mannes, der glaubte, daß ein Toter ihn gerufen habe, als er am Kirchhof vorbeiging, und die Geschichte von dem Mann, dem in Anwesenheit von Leuten ein Wind entfahren war und der aus Scham darüber hin siechte und starb. Der Arzt muß also es als seine Aufgabe betrachten, außer den übrigen Neigungen des Kranken auch die Dinge ausfindig zu machen, die seinen Geist bedrücken. Denn die Heilung eines Menschen, dessen Krankheitsursache in seinem Geiste liegt, kann nur durch Beseitigung der fixen Idee, nicht aber durch Speisen und Getränke, durch Wohnung, Baden, Marschieren und dergleichen erreicht werden.*

Galen, Commentary on Hippocrates' Epidemics VI, 8  (487,3-23 Wenkebach/Pfaff)

*Pfaff's German translation of Hunayn's school's Arabic translation (the Greek is lost). 

Heraclides of Pontus on the joy of madness

“In his book On Pleasure, Heraclides of Pontus relates not unpleasantly that a most pleasant luxury occured during a fit of madness. He writes:

‘Thrasyllus from Aexone, the son of Pythodorus, once went so mad that he thought all the ships arriving at Piraeus were his own. He would register them, dispatch them, and manage their affairs. When they returned to port, he would welcome them with the kind of joy you might expect from someone who was really in charge of such great wealth. When ships were lost, he did not inquire after them, but he rejoiced at every one that was saved and recounted it with greatest delight. When his brother Crito came to visit from Sicily, he took him into custody, handed him over to a doctor, and put an end to his madness. Afterwards, Thrasyllus would tell the story, saying that he had never in his life been happier, for he felt not pain whatsoever, while the amount of pleasure he felt was overwhelming.’”

ἐν μανίᾳ δὲ τρυφὴν ἡδίστην γενομένην οὐκ ἀηδῶς ὁ Ποντικὸς Ἡρακλείδης διηγεῖται ἐν τῷ περὶ Ἡδονῆς οὕτως γράφων· ‘ὁ Αἰξωνεὺς Θράσυλλος ὁ Πυθοδώρου διετέθη ποτὲ ὑπὸ μανίας τοιαύτης ὡς πάντα τὰ πλοῖα τὰ εἰς τὸν Πειραιᾶ καταγόμενα ὑπολαμβάνειν ἑαυτοῦ εἶναι, καὶ ἀπεγράφετο αὐτὰ καὶ ἀπέστελλε καὶ διῴκει καὶ καταπλέοντα ἀπεδέχετο μετὰ χαρᾶς τοσαύτης ὅσησπερ ἄν τις ἡσθείη τοσούτων χρημάτων κύριος ὤν. καὶ τῶν μὲν ἀπολομένων οὔτε ἐπεζήτησεν, τοῖς δὲ σῳζομένοις ἔχαιρεν καὶ διῆγεν μετὰ πλείστης ἡδονῆς. ἐπεὶ δὲ ὁ ἀδελφὸς αὐτοῦ Κρίτων ἐκ Σικελίας ἐπιδημήσας συλλαβὼν αὐτὸν παρέδωκεν ἰατρῷ καὶ τῆς μανίας ἐπαύσατο, διηγεῖτο <...> οὐδεπώποτε φάσκων κατὰ τὸν βίον ἡσθῆναι πλείονα· λύπην μὲν γὰρ οὐδ' ἡντινοῦν αὐτῷ παραγίνεσθαι, τὸ δὲ τῶν ἡδονῶν πλῆθος ὑπερβάλλειν.’ 

Athenaeus, Deipnosophistae 12.81 (p.223-4 Kaibel)

Habituation and the health of mind and body

Athenaeus of Attalia was one of the first doctors we know to work out a unified medical theory that covered both mental and physical health and habits. Before Athenaeus it was more often the business of philosophers to talk about good and bad mental habits, and of doctors to talk about physical habits like eating and exercise. Athenaeus, however, consciously brings philosophy and medicine together into one discipline, speaking interchangeably about habits of either mind or body. He calls the effects of these behaviours, "habituation", and our habituation in turn determines what things are good for us and what things are bad.

Athenaeus thinks of habituation as a kind of "state" or "innate disposition", but he also calls it (perhaps following Aristotle) "second nature", probably to emphasize that its effects on both body and mind can be quite permanent. There's a long tradition in Greco-Roman thought that treats art as something subordinate to nature; however, physicians (and farmers) were well aware that art can get the upper hand. Here, Athenaeus explains how. His thoughts were preserved by Oribasius.

"From the works of Athenaeus. On Habituation.

"Habituation is a state of the soul or body established over time with respect to benefit or harm when we are healthy or sick. For habit over time establishes something through itself in the soul and in the body, and this sometimes makes something beneficial, sometimes [something] harmful. Not only is it strong in times of health, but it often extends even into times of illness. And a habit that lasts for a long time is like an acquired nature. For this reason, if any self-mover undergoes a change [?], it is dangerous and introduces disease. Of these [changes], changes of place make a big difference: for change from healthy [places] to more diseased ones produces a greater and more serious alteration, while the [change] from diseased [places] to healthy ones [produces] a smaller [alteration] in both magnitude and duration. Indeed, every change, especially a sudden one, and most especially one which is not customary and unusual, alters bodies for the worse for the reason we gave. Habituation is so powerful that those who have been seized by it cannot exist separately [from it], being held in its bonds. An athlete, for example, has difficulty recovering: if he wishes to return to his original way of life by suddenly abolishing his acquired disposition, just like a second nature, then he will quickly be destroyed, because a way of life continued for a long time is (so to speak) a powerful form of being accustomed. Thus, a sudden departure from habit makes a great difference. For this reason it drives out of their proper place of rest those who do not abolish the earlier habituation gradually and by means of another, different habituation."

Ἐκ τῶν Ἀθηναίου. Περὶ συνηθείας.[1]

Συνήθειά ἐστιν ἕξις ψυχῆς ἢ σώματος ἐν χρόνῳ κατεσκευασμένη πρὸς ὠφέλειάν τε καὶ βλάβην ὑγιαινόντων τε καὶ νοσούντων· τὸ γὰρ ἔθος ἐν χρόνῳ κατασκευάζει τι δι’ ἑαυτοῦ περὶ τὴν ψυχὴν καὶ τὸ σῶμα, καὶ τοῦτό ποτε μὲν ἐπ’ ὠφέλειαν[2] ποιεῖ τινα, ποτὲ δὲ καὶ ἐπὶ βλάβην. καὶ οὐ μόνον ἐφ’ ὑγιαινόντων ἰσχύει, διατείνει δὲ πολλάκις καὶ πρὸς τοὺς νοσοῦντας. τὸ δὲ πολυχρόνιον ἔθος οἷον φύσις ἐστὶν ἐπίκτητος· διὸ πᾶν τὸ κινοῦν ἑαυτὸ μεταβάλλει, ἐπισφαλὲς καὶ προσαγωγὸν εἰς νόσον. τούτων δὲ διαφέρουσιν αἱ μεταβολαὶ τῶν τόπων· ἡ μὲν γὰρ ἐξ ὑγιεινῶν εἰς νοσερώτερα μεταβολὴ μείζονα ποιεῖ τὴν ἀλλοίωσιν καὶ χαλεπωτέραν, ἡ δ’ ἐκ νοσερῶν εἰς ὑγιεινὰ ἐλάσσονα καὶ τῷ μεγέθει καὶ τῷ χρόνῳ. πᾶσα μέντοι μεταβολή, καὶ μάλιστα αἰφνίδιος, καὶ ὡς ἔνι μάλιστα ἀσυνήθης καὶ ξένη, ἐπὶ τὸ χεῖρον μετακινεῖ τὰ σώματα δι’ ἣν ἀπεδώκαμεν αἰτίαν. οὕτως δ’ ἰσχυρὸν ἡ συνήθεια, ὥστε τοὺς ληφθέντας ὑπ’ αὐτῆς μηδὲ χωρισθῆναι δύνασθαι δεσμῷ κατεχομένους· δυσανάληπτος γὰρ ἀθλητής, εἰ θέλει πρὸς τὸν πρῶτον ἐπανελθεῖν βίον αἰφνιδίως τὴν ἐπίκτητον διάθεσιν ὥσπερ δευτέραν τινὰ φύσιν καταλύων, συντόμως ἀναλυθήσεται· οἷον γὰρ τρόπος ὁ πολυχρόνιος ἐθισμὸς ἰσχυρός. οὕτως ὁ αἰφνίδιος ἐξεθισμὸς μεγάλας ἔχει τὰς διαφοράς· διόπερ ἐξίστησι τῆς ἰδίας καταπαύσεως τοὺς μὴ ἐκ προσαγωγῆς καὶ δι’ ἑτέρας πάλιν συνηθείας τὴν προτέραν καταλύοντας συνήθειαν.

Athenaeus ap. Oribasius, libri incerti 17 (CMG VI 2,2 106,8-29 Raeder)

[1] cf. Sextus Empiricus, PH 1.146.3-4: ἔθος δὲ ἢ συνήθεια (οὐ διαφέρει γάρ) πολλῶν ἀνθρώπων κοινὴ πράγματός τινος παραδοχή. Sextus treats "habituation" and "habit" as synonyms, whereas Athenaeus considers habituation to be the result of habits over a long period of time.

[2] Must be ἐπ ὠφελειᾳ / ἐπὶ βλάβῃ