INTRODUCTION

In a well-known passage from the Hippocratic Epidemics, the doctor's duties are succinctly characterised as follows:

The principle that the doctor is there to help, to refrain from anything that may be harmful, and to use his skill and knowledge and all the relevant information about the disease and the patient in order to assist the patient in his battle against the disease is an idea that frequently recurs in Greek medicine. It is succinctly summarised here in the words ‘to help, or to do no harm’ (ὠφελεĩν ἢ μἠ βλάπτειν), a formula which is often quoted or echoed both in the Hippocratic Corpus and in later Greek and Roman medical literature.

This formula is interesting in that it reflects an early awareness of the possibility that medical treatment can also cause harm. The Hippocratic Oath, which explicitly mentions the well-being of the patient as the doctor's guiding principle, understands this ‘causing harm’ in the sense of deliberately terminating a person's life or otherwise purposively causing disadvantage to his or her situation.

INTRODUCTION

It is well known that Galen, in the epistemological debate (as he saw it) between the so-called Dogmatists and the Empiricists, adopted a position which might be defined both as an attempt at maintaining his cherished ideal of intellectual independence and as an endeavour to preserve the valuable insights that the different strands of tradition provided. The latter resulted in his conviction that medical knowledge is arrived at by means of rather special conjunction of, on the one hand, reason (logos), that is, a set of theoretical and logical concepts, definitions, axioms, arguments, and ideas referring both to observable and unobservable entities, and, on the other hand, experience (peira), that is, a more or less systematic collection of data derived from sense-perception. What makes his position more complicated is that according to Galen both reason and experience should be used or applied in a correct way, in a correct order, interrelation and/or proportion. This requirement may have different consequences for different areas within medical science. Moreover, it is precisely in this respect that Galen explicitly distances himself from the other medical schools, who, as he believes, either failed to take into account empirical data which would seem to him to be inconsistent with their theoretical assumptions, deductions, inferences or analogies, or who formulated unqualified generalising claims on the exclusive basis of empirical data.

PSYCHOLOGY, BIOLOGY, AND VARIATIONS IN COGNITIVE PERFORMANCES

Although Aristotle's On the Soul (De anima) has for centuries been regarded as a ‘metaphysical’ rather than a ‘physical’, or as a ‘philosophical’ rather than a ‘scientific’, work, there seems nowadays to be a consensus among students of his psychology as to the thoroughly biological status of the theory set forth there. This may have to do with recent developments in the philosophy of mind, but it is probably also related to a reassessment of the importance of Aristotle's zoological writings (i.e. History of Animals (Hist. an.), Parts of Animals (Part. an.), Generation of Animals (Gen. an.), Progression of Animals (De incessu animalium, IA) and Movement of Animals (De motu an.)) and to a growing conviction among students of Aristotle's biology concerning the interrelatedness of what were traditionally called the ‘psychological writings’ of Aristotle (i.e. On the Soul and parts of the Parva naturalia) and the zoological works. There also seems to be a general agreement as to the basic consistency of Aristotle's psychological theory, or at least a tendency to explain apparent contradictions between On the Soul and the Parva naturalia on the one hand, and statements related to the soul in the zoological writings on the other (or between On the Soul and the Parva naturalia, or between different sections of the Parva naturalia) as the result of differences of method, approach, or argumentative strategy of particular treatises or contexts rather than in terms of a development in Aristotle's psychological ideas.

Caelius Aurelianus' Methodism is often taken for granted. Yet the question may be asked how profoundly, pervasively and consistently Methodist doctrine and methodology is applied in Caelius' work. In this chapter I will attempt to answer this question with regard to some epistemological principles of Methodism as they are known to us from Soranus and from Caelius himself; and I will consider whether the difficulties that arise here are just apparent or amount to genuine inconsistencies, and, if the latter, whether these are to be explained as the result of a development in Methodism after Soranus or as tensions inherent in Methodist medicine as such. In so doing, I will treat Caelius Aurelianus (not Soranus) as the author of Acute Affections (Acut.) and Chronic Affections (Chron.). This is not to deny Caelius' dependence on Soranus – a dependence which is probably great, but in the absence of most of Soranus' work impossible to assess – but should leave room, at least theoretically, for Caelius' own contribution, whether that merely consisted of translating and partially rearranging Soranic material or of substantial revision with additions and omissions of his own.

To be sure, there is no question about Caelius' actually belonging to the Methodist school, to which he frequently refers as ‘our sect’ and whose doctrines he often presents as the standard for his therapeutic instructions.

In Eudemian Ethics (Eth. Eud.) 8.2 Aristotle is searching for an explanation of eutuchia (εὐτυχία), which might be defined as ‘good fortune’ – sheer luck in matters in which the lucky man does not have any rational or technical competence, befalling the same man so frequently that it cannot be a matter of coincidence. Textual problems, extreme brevity and looseness of expression as well as the enormous span of the argument make it difficult to follow Aristotle's reasoning in detail. Yet there seems to be a consensus among modern interpreters concerning the conclusion of the chapter. The principal question was whether eutuchia is caused by nature or not (1247 a 2), and Aristotle's answer to this question, briefly summarised in 1248 b 3–7, is as follows. There are two forms of eutuchia, the first of which is both ‘divine’ (theia) and ‘by nature’ (phusei), and the second of which is caused by ‘chance’ (tuchē); both forms are ‘irrational’ (alogoi), but the first form is ‘continuous’ (sunechēs), whereas the latter is not. The first form is the one which Aristotle has been trying to explain from the beginning; the existence of the second form he was compelled to recognise in the course of his argument.

It appears that this first form of eutuchia is based on a kind of interaction between a principal divine movement (1248 a 25ff.) and a human natural constitution (1248 a 30–1; 39–41).

THE DEBATE IN ANTIQUITY ON THE LOCATION OF THE MIND: ORIGIN, DEVELOPMENT AND MISREPRESENTATION

In one of the first chapters of his systematic account of the treatment of acute and chronic diseases, the Latin medical author Caelius Aurelianus (fifth century ce) discusses phrenitis, a psychosomatic disorder with symptoms including acute fever, mental confusion, a weak and fast pulse and various forms of abnormal behaviour such as the picking of threads out of clothing. Caelius Aurelianus, himself belonging to the medical school called the Methodists, begins his argument, as usual, with a survey of the views on the nature and origin of this disease held by doctors belonging to other schools of thought, in particular their views on the question of which part of the body is affected by the disease. His main reason for doing so is to show the contrast between his own and only correct treatment of the disease and the general confusion among other doctors:

INTRODUCTION

In a number of his writings Aristotle discusses a type of people he calls ‘the melancholics’ (hoi melancholikoi), without ever giving a definition of melancholy; indeed he does not even mention the term melancholia. He only mentions, in passing, some typical features of a melancholic, sometimes adding a short psychological or physiological explanation, yet without relating these features to each other or to an underlying physiological theory. There is just one chapter (30.1) of the Problemata physica (Pr.), a collection of knowledge attributed to Aristotle, that contains a rather extensive discussion of melancholy. However, it is unlikely that the form in which this collection has come down to us dates back to Aristotle. Recent scholarship has attributed the theory in this chapter to Theophrastus rather than Aristotle; according to Diogenes Laertius (5.44), Theophrastus wrote a treatise ‘On Melancholy’ (Peri melancholias) and the chapter in the Problemata is thought to be a summary or a revised version of this (lost) text.

So far no attempt has been made to describe Aristotle's concept of melancholy as based on his undisputed works, and to compare it to the theory presented in Pr. 30.1. Yet such an attempt could be useful, both because it would be the only way to provide a solid basis for assessing the theory presented in the Problemata, and because attempts to relate this theory to pre-Aristotelian, especially medical views have proved unsuccessful. Despite extensive research, the concept of melancholy in the Hippocratic Corpus remains a complicated issue.

INTRODUCTION

In antiquity Diocles of Carystus enjoyed the reputation of being a ‘younger Hippocrates’, or ‘second in fame and venerability to Hippocrates’. Yet this did not prevent him from developing his own ideas and from writing medical treatises in his own style in the Attic dialect. To be sure, later reports on his doctrines often represent him as being in perfect agreement with ‘Hippocrates’ on various subjects; but the fragments of his works that have been preserved, show that the authority of ‘the great Coan’ did not prevent him from taking issue with some ideas and practices that are similar to what is to be found in texts which we call Hippocratic. Of course we do not know whether Diocles, if he had actually read these works, took them to be by Hippocrates – in fact, if we accept Wesley Smith's suggestion that the Hippocratic Corpus was created by third-century Alexandrian philologists who brought together a number of anonymous medical works into one collection under the name of Hippocrates, we may wonder whether anything like Hippocratic authority already existed in Diocles' time (not to mention the fact that Diocles' date itself is the subject of another controversy). It is not even certain that Diocles had ever heard of Hippocrates or was familiar with any of his genuine works.

This heaping up of uncertainties at the beginning of this chapter may appear a rather weak rhetorical strategy.

Introduction

The author of the Hippocratic treatise On the Sacred Disease is renowned for his criticism of magical and superstitious conceptions and modes of treatment of epilepsy. He has been credited with attempting a ‘natural’ or ‘rational’ explanation of a disease which was generally believed to be of divine origin and to be curable only by means of apotropaeic ritual and other magical instruments. One interesting point is that he does not reject the divine character of the disease, but modifies the sense in which this disease (and, as a consequence of this conception, all diseases) may be regarded as divine: not in the sense that it is sent by a god, for example as a punishment, and is to be cured by this same god, but that it shares in the divine character of nature in showing a fixed pattern of cause and effect and in being subordinated to what may perhaps be called, somewhat anachronistically, a natural ‘law’ or regularity.

On the basis of these positive statements on the divine character of the disease various interpreters have tried to deduce the writer's ‘theology’ or religious beliefs, and to relate this to the development of Greek religious thought in the fifth century.

Whether its title, ὐπ⋯ρ τοũ μ⋯ γενν⋯ν (‘On Sterility’, ‘On Failure to Produce Offspring’), is authentic or not, the work transmitted as ‘Book 10’ of Aristotle's History of Animals (Hist. an.) deals with a wide range of possible causes for failure to conceive and generate offspring. It sets out by saying that these causes may lie in both partners or in either of them, but in the sequel the author devotes most of his attention to problems of the female body. Thus he discusses the state of the uterus, the occurrence and modalities of menstruation, the condition and position of the mouth of the uterus, the emission of fluid during sleep (when the woman dreams that she is having intercourse with a man), physical weakness or vigour on awakening after this nocturnal emission, the occurrence of flatulence in the uterus and the ability to discharge this, moistness or dryness of the uterus, wind-pregnancy, and spasms in the uterus. Then he briefly considers the possibility that the cause of infertility lies with the male, but this is disposed of in one sentence: if you want to find out whether the man is to blame, the author says, just let him have intercourse with another woman and see whether that produces a satisfactory result.

The main aim of this book is to clarify the moral concern about sexuality and sexual activities expressed by leading authors in classical antiquity. Michel Foucault was, of course, the first thinker to undertake this clarification, and one aim of his stimulating study was to demonstrate the way in which his new ethics programme worked. Therefore my starting point is the reconstruction of claims about the control of the desires and the creation of the moral subject in classical philosophical, medical, economic and rhetorical texts which Michel Foucault presents in the second volume of The History of Sexuality (The Use of Pleasure (UP)). There is now a mass of literature on Foucault's programme of ethics, some of which also deals with his interpretation of ancient sources. But most authors treat his analyses of these texts as documents illustrating his intellectual development, which is their primary interest. None of them subjects his thoughts on ancient sources to a detailed critical assessment in order to suggest alternative readings that are based not only on the general theoretical premises of Foucault's project, but also on modern standards of textual interpretation and the present state of philosophical and historical knowledge of the ancient world. What follows is intended to reduce this deficit.

Much of what I have to say is a critical reconstruction of Foucault's own reconstruction – while at the same time I try to maintain the systematic aspects of his perspective.