The treatment of mental illness provides an important window into the cultural and social realities of the ancient world. By tracking its development, interaction with other aspects of medical thought and religious and philosophical approaches, it is possible to see wider shifts in society as well as within medical learning and knowledge. One of the key ways of doing this is by looking at medical treaties and writings, how they interact with one another (use of similar sources/academic disagreements, etc.), and also studying the specific terminology used to consider the illness in question. It is here where this volume is particularly strong. Thumiger and Singer have assembled an excellent array of informed papers that reflect the different ways of thinking about and studying mental illness in the ancient world. A number of the chapters here make great effort to engage with the original vocabulary used, and from that trace not just intellectual currents, but also real world applications of medical knowledge. The other great strength to this volume is in how disease is defined and understood; crucially as both a social and cultural construct. This allows for a number of persuasive conclusions to be reached, and some important questions to be asked.
The book is divided between three sections. The first engages in a broad perspective (pp. 35–106), with a chapter looking at melancholy (Kazantzidis, pp. 35–78) and another investigating demonic influence in mental illness (Metzger, pp. 79–106). Kazantizidis provides an excellent dissection of insania, recognising the bifurcation found in the ancient writings between tristia (sadness/depression) and hilares (cheerfulness/hilarity). This division needs to be recognised immediately, as it requires different treatment (‘si imagines fallunt, ante Omnia videndum est, tristes an hilares sint’, Celsus, p. 45). This chapter also exposes what can be gained by bringing together medical and philosophical learning (esp. pp. 74–8). Metzger tackles an important issue head-on, the fear of demonic possession and its consequences for the mental health of its victims. Any reader of early Church writings will find a confusion between the possessed and those who suffer mental illness. This is, then, an important discussion of a complex topic and one that analyses the available evidence with care and precision. As Metzger reminds us: ‘[a]longside Christian demonology, there were at least two other schools of thought, namely Neoplatonic demonology and pagan popular beliefs which held very different notions concerning the nature of superhuman beings, both referring to such beings as daimones’ (p. 81). The most important conclusion reached here is about the subconscious bias of modern interpreters, in how we view religion and medicine as ‘closed systems’ when instead we should accept the ‘concept of ambiguity’ (p. 106).
The second part is more focused, with nine separate chapters studying individual writers such as Athenaeus of Attalia, Rufus of Ephesus and Archigenes of Apamea, as well as individual themes (pp. 109–340). As with any volume of collected essays, it can be difficult to present a strong sense of unity, and these chapters do not always sit quite so well together. Nonetheless, in focusing on individual writers and important themes, the reader is introduced both to familiar and unfamiliar writings and writers, and this can only help provide a deeper level of understanding. The chapters by Thumiger and Gäbel are the strongest in this section. Thumiger’s first chapter (pp. 245–68) looks to eating disorders, such as boulimos, atrophia, polysarkia, phagedaina, stomachikon and hydrophobia. These are discussed by focusing on the writings of the Anonymous Parisinus, Aretaeus and Caelius Aurelianus (covering the first to the fifth century CE). In discussing the specific medical terms, Thumiger provides a number of important observations. Boulimos differs from the modern use of the term, with a focus instead on an intense appetite that can quite literally chill the blood (p. 256). Phagedaina manifests itself with obscene hunger, consuming without chewing, and subsequently vomiting and weakness, but polysarkia stands in opposition to atrophia, in taking on simply too much for your body to deal with (pp. 256–7). It is also here that we see both mind and body working together to make the patient better: ‘animi oficiis sive curis applicatio’ (Caelius, at p. 257). Stomachikon is difficult to define, but carries with it melancholic symptoms, and hydrophobia is when ‘the patient is tortured by thirst and by a dread of water’ (p. 263). Thumiger’s second chapter (pp. 269–84) works best when read with the first, as together they ask similar questions of the thematically linked topics. In this chapter, Thumiger places her research against the backdrop of Foucault’s interpretation of ancient sexuality, and reaches a convincing conclusion, that ‘the case of sexual disorders is in many respects symmetrical to that of eating disturbances’ (p. 314). Gäbel’s chapter is a good example of what can be achieved, and the questions that can be asked by focused source analysis, here of Aätius of Amida (pp. 315–40). Gäbel is able to demonstrate, while working with complex source documents, that the compilers sought to link mental illness with cognitive function and the brain more generally, and in doing so set out a systematic methodology.
The final section takes a more philosophical approach, with three chapters that illuminate the interaction of medical aetiology and philosophical discourse (pp. 343–420). Of the three, Ahonen’s exploration of the Stoic interpretation is the most persuasive, in particular when looking at Seneca and Cicero (pp. 349–57). Both are famous figures, but studied and analysed here with focus and precision, which, when read together, allows for a more nuanced understanding both of mental health (animi sanitas, p. 356) and its importance to true wellbeing.
To close, this is an impressive collection of essays, reflecting a good level of historical analysis and a willingness to ask important questions of those sources still left to us. When read together, a much wider understanding of ancient approaches is possible, one that betrays the sophisticated and shifting pattern of intellectual and religious reflections upon illnesses of the mind. As with any edited collection, there are some concerns over how well each section fits together, and the over-long introduction is not quite as useful as needed to fully establish a clear and focused foundation and framework for the later studies. Nonetheless, this is an important volume, and one that offers much insight into a complex and multifaceted topic.
