The Byzantine author of the pseudo-Lucianic dialogue Timarion, a work dated to the twelfth century, offers an arresting prosopography of Galen centred around the characteristics of his personality that seem to have endured over time. As one might expect, his formidable prowess in medicine predominates, but other aspects that single him out from the medical conclave described in the dialogue surface too, notably his thoroughness and ambition that keep him so focused and show a transcendent devotion to his endeavours.Footnote ¹ Popular philosophy has been one of the least known of Galen’s passionate endeavours, and one which this book has attempted to illuminate from a number of angles.

This study has explored Galen’s vested interest in practical ethics, which is both intrageneric, that is developed in the context of ethical tracts, and extrageneric, percolating through his other writings as elementary particles of his moral thought. With the various pieces of Galen’s jigsaw puzzle of ethics now assembled, what emerges is a dynamic portrayal of his ethical mindset and his programme of moral transformation. This translates into a fully formed, coherent set of ideas on moral praxis and evolution in the first centuries of the common era. Motivated by his core belief that agents are responsible for shaping their own lives, acting beyond the bounds of ineluctable factors affecting their character and emotional trajectory, Galen addresses them as thinking entities, in ways that help them draw on and develop their ability to discriminate and form correct judgments as they proceed towards moral maturity. This core belief is revealed on a discursive level by means of the didactic and intimate relationship that Galen establishes between himself as moral authority and his audience as the party to be guided and cared for. That is a major feature of his practical ethics, as analysed in this book.

In a world in which moral flaws would have been an ever-present danger in all facets of everyday experience, Galen provides a broad array of ethical tactics to lead people towards integrity, happiness and success. These are moralising strategies of some sophistication that shield the inner condition, as we have seen. For example, he frequently uses moral anecdotes and quotations that are deftly embedded in the narrative to make as forceful an impact on the reader as possible. He also deploys paired illustrations of people who know how to live and people who do not in order to stimulate moral reflection and inform decision-making. He also uses the concepts of the emulation of ideal paradigms, and of the salience of intellectual attainment (paideia), supervening states and surroundings, and philosophical practice to promote morally upright and, most importantly, socially functional patterns of righteous living.

Issues of self-definition and self-projection are key to the effectiveness of the author’s exhortative advice and have a credentialling function too, enhancing his professional legitimacy in the discipline of popular philosophy. We have noted that, in formulating his moralising methodology, Galen claims to have rivalled both earlier works belonging to the tradition of the treatment of emotions and present-day ones by means of self-effacement or harsh polemics. At other times he sets about revising even his most cherished predecessors. The manner in which he employs allegories and imagery from Plato in particular is not that of a ruminative thinker, but a prime example of resourceful emulation of the past in the area of ethics.

Some ethical subjects that attract Galen’s attention are common to the legacy of popular philosophy he inherited, yet there are some others which are either specific to him, or, albeit familiar from other thinkers, reinvigorated by individualised approaches in his work. The autobiographical dimension of the ethical narratives is one of the elements specific to Galen’s ethics, since our author tends to place great stress on his personal experience to persuade his readers as he attempts to monitor or modify their behaviour. Through autobiography he also succeeds in foregrounding his moral influence in a way that carries the reader with him, in essence rendering himself a paragon, something his audience could aspire to become.

On the other hand, in tune with the chief aim of the practical ethical tradition of being truly pragmatic, Galen’s philosophical advice in his work is never utopic, theoretical or bookish, but always offers realistic responses to the idiosyncrasies of contemporary, upper-class life. This is manifested in the way Galen plays on the social credentials of his noble audience, especially by encouraging them to ponder their love of money, passion for self-esteem, and generally the degree to which their aspirations might be turned into a high-stakes game for the sake of their social decency or professional distinction. Nevertheless, to some extent Galen gives this familiar element a makeover through the single-minded adaptability and situatedness with which he invests his moral ideas on human relationships. Far from issuing rigid commands, unrelated to the moral learner’s immediate background and circumstances, Galen constructs a bespoke form of ethics for the different public activities and events the learner would have engaged in on a regular basis, and that is adapted to the nexus of routine problems they were likely to be caught up in. At the same time, he is conscious of the fact that the recipients of his ethics are inherently contextualised agents, people who must benefit from philosophy while remaining in their social environment and becoming successful in it, not as a result of isolating themselves from it. He knows very well, for instance, that drinking is an indispensable hallmark of interaction among educated adults, a social skill his Roman readers in particular would have acquired in adolescence in their peer group of iuvenes. Hence, in alerting his readers to the threat of drunkenness, Galen does not propose dispensing with the symposium, but gives advice on how to participate in it constructively, by exercising self-restraint, modesty and self-examination. Likewise, political activity was a marker of high culture that happened to involve significant moral trials. Therefore, Galen is sanguine that adjustment, not complete withdrawal, will form the basis of a workable solution here. By the same token, when it comes to social intercourse, he is not after seclusion, which would have been inconceivable for the elites he has in mind, who were key social players. He rather provides them with useful tips on how to acquaint themselves with the affectation and duplicity they were likely to be exposed to, so as to enable them to deal in the best possible way with the demands and anxieties of social bonding. In the context of the anatomical demonstration, another noteworthy cultural practice for a large part of Galen’s audience, where competition figured especially prominently, the author does not argue that harmony should be achieved by excluding contentious medics, but rather that there were effective ways of pre-empting their argumentativeness by assigning them, for example, some role in the process, as in the case of Alexander of Damascus in Prognosis. In opting for co-existence and good fellowship rather than isolation and self-love, Galen is closer to Plutarch and a far cry from Seneca, Musonius Rufus or Epictetus, who, in keeping with their Stoic ideology, asserted that one’s position and perception in society ought to be a matter of indifference to the agent, hence occasionally suggesting even exclusion from social activities.

Galen’s most pivotal contribution by far to ancient philosophical culture on ethics, however, is his creative combination of medicine and practical ethics, a powerful interdisciplinarity. This works on three levels. Firstly, Galen offers a thoughtful proposal for the administration of habits and social practices affecting the health of the body, which is more robust and more methodical than anything we find in other medical authors. This proposal complements the perspective of other Imperial-age moralists on the same issues by adding the standpoint of a doctor preoccupied with moral concerns. Secondly, Galen conceptualises a morally adjusted medical science – what has been called ‘moral medicine’ in this study – which serves humanity at large, abolishing self-interestedness and other toxic passions detrimental to human affairs. It thus operates beyond the strict limits of the professional ethics of other medical writers and introduces a substantial amount of material contemporary moralists would be interested in but did not tackle as such. Thirdly, through powerful moral commentaries attesting to the social and civic value of ‘moral medicine’ in his Imperial-period community, Galen develops a detailed sociology of his philosophical medicine, with which he replaces the banal, over-condensed, no-frills analogy of ‘philosophy as medicine’ encountered in other moralists. Remarkably, this analogy does not feature in Galen’s work though it is found extensively in the work of other philosophers, which might suggest that Galen anticipated his sociology of moral medicine would be his major contribution to Imperial moralia.

The more specific findings of the research into Galen’s medicine and practical ethics will not be rehearsed here, as they are detailed in the conclusions of the individual Chapters and in the summaries in the ‘Overview of Chapters’ section of the Introduction. So in the remainder of this Conclusion I would like to restrict my observations to some of the contextual implications of this study.

My 2016 monograph on moral education in Plutarch ended with an aspiration: that the Second Sophistic would one day be seen, in the light of practical ethical works and contrary to its traditional understanding as an age in which mastery of classical philosophy offered educated individuals increased chances of public elevation, from a different viewpoint, as a discourse for debating and fostering personal and social morality.Footnote ² The present book on Galenic ethics confirms my commitment to this very idea, namely that Imperial popular philosophy needs to be evaluated on its own terms, that is for its own edifying impact and intent, in tandem with its rhetorical, sophistic or even doctrinal functions, and persuasive and emotive results.

This book has attempted to make a significant contribution to the study of Galen’s production of practical ethics by approaching it as a social construct, ‘a shared cultural resource with which different members of society engage actively in different ways’, to use a relevant formulation reflecting the social dynamics of exempla in ancient Rome.Footnote ³ In my reading, Galen’s practical ethics, both in the form of independent works and when scattered throughout the corpus, offers a narrative model of a thought-world and a template for emotional resilience designed for contemporary readers. This is not to say that the sophistic thematology of Galen’s ethics is not important – for Galen frequently talks about professional sophists, figuratively presents doctors as sophists in the Platonising sense and abhors sophistic tendencies, as we have seen; it’s just that all these themes do not readily disclose an agonistic intent on the author’s part, but rather heighten his moral emphases, situating them at the forefront of ethical structures and cultural norms under the Empire so as to make them resonate with readers.

Indeed, the way Galen’s practical ethics is firmly enmeshed in social practice is perhaps the most significant underlying feature of his moral attitudes, as evinced throughout this book. The social implementation of moral instruction is made part of almost every discussion involving ethics in his work; and the moral garb in which he dresses up his powerful vision of medicine is equally entwined with a pragmatic appeal to social beings, members of organised society. The ethical values that Galen’s moralising enacts are not abstract ideas to the author and his readers, but instantiations of incidents they would have been intimately familiar with from their own moral experience or that of others around them. That might explain the absence in Galen of an ethics for self-isolating philosophers, those who had opted for the contemplative life (theōrētikos bios), which was conventionally considered to correspond to inactivity and idleness.

Galen’s commitment to medicine as a site for moral edification is also immensely practical. This concept in Galen, his ‘moral medicine’, is highly innovative with no parallel of the same kind and degree in the ancient world. As demonstrated in the various Chapters, Galen’s moral medicine is largely predicated on the use of polarised categories, either in the form of contrasting patterns of behaviour or of divergent ethical assessments (often praise vs blame) of two radically different figures or groups. This syncritic technique forms an overarching strategy of moralising in Galen, as seen above, which perhaps culminates in his (disturbingly) unrelenting moral estrangement from others.

Unlike more conventional scholarly approaches which have judged Galen’s tendency to distinguish himself from other physicians mainly as a means of competition and self-promotion, this book has drawn attention to the ethical dimension of such competitiveness, emphasising the moral lessons it carries and the range of moral analyses it is likely to evoke in Galen’s audience. On that premise, Galen’s moral position towards his medical and philosophical peers may be best understood in the light of positioning theory. This is a new paradigm in modern ‘folk’ psychology (a field-based cultural science as opposed to the laboratory-based variety), which explores human behaviour in relation to social reality, where common interpretations of the world are shared among members of a given community. These shared beliefs or ‘local moral orders’ are known as ‘positions’, affecting people’s relations with one another in accordance with their anticipated rights and duties in society. One type of positioning is ‘moral positioning’, when one behaves in a manner consistent with the rights, duties and obligations of one’s role.Footnote ⁴ It is on this kind of positioning that Galen bases his role as a physician and philosopher, portraying himself throughout his texts as acting and responding according to a recommended form of conduct that is consistently attuned to his place in society and science. He is a lover of truth, he works ceaselessly from dawn to dusk, opts for robust scientific and philosophical methods, offers his medical services even late at night when busy or physically exhausted and even takes on a new task, as we have observed, in catering for the moral health of his fellow men through a philanthropic spirit of empathy for the shortcomings of human morals. In other words, he positions himself as an active moralist in the service of his society, not an armchair philosopher.

By contrast, when Galen delineates his medical or philosophical peers, what we most often see is ‘indirect positioning’, which portrays a group of individuals favourably or unfavourably so as to serve the interests of the person who makes the positioning.Footnote ⁵ By minimising their mental attributes (e.g. calling them stupid, ignorant), their character traits (e.g. with words like ‘presumptuous’, ‘envious’) and their moral qualities (e.g. declaring them ignoble or sneaky), Galen undermines the perception of other professionals’ fitness to perform their assigned duties and therefore attempts to deny them access to their social rights. This move surely consolidates his own standing in medicine and philosophy, but at the same time it exposes moral pitfalls and signals to readers how much standards have slipped with a view to stimulating their critical reactions to the degeneracy of the contemporary world.

Social psychologists who are proponents of positioning theory have stressed that ‘indirect positioning’ often occurs in larger scale discourses, for example at the level of a nation or culture, where the indirect positioning of a leader has a bearing on the positioning of the larger community itself. By presenting himself as a moral leader of his society and of humanity at large, a champion of Graeco-Roman morals devoted to the public service, Galen reserves for himself the ‘high moral ground’Footnote ⁶, and with his moral uprightness on all fronts he provides a fully-fledged model of morality, which his fellow men were expected to look up to and eventually embrace, thereby restoring socio-political order.

In the same vein, the many slanders that Galen’s rivals level against him, according to his own narration, may be seen as ‘malignant or malevolent positioning’,Footnote ⁷ a guileful way to ensure Galen is seen in a deficit perspective and is deprived of his right to esteem – a shameful condition for any polite, literate male in the Roman Empire. Dominant values of the time would have deprecated such immoral practices, and hence Galen’s readers are easily made to side with Galen’s righteousness, deploring the crooked manners of his enemies, so that the slander against Galen eventually becomes morally didactic for readers. I hope that the different uses of ethics in Galen’s work have become clearer through the filter of positioning theory.

It only remains to tackle the question: Why ethics? Where was Galen thinking ethics would get him when he decided to compose his group of ethical works and when he embroidered the rest of his oeuvre with ethical episodes and inflections? For one thing, this study has emphasised that practical ethics is, to Galen’s mind, a companion to his medicine, with practical ethics sometimes informing medicine (Chapter 2: e.g. the moral associations of health-related contexts) and at other times being informed by it (Chapter 4 or 5: e.g. the correspondences between moral and medical therapy, or Chapter 8: the interconnection between Prognosis and Book 2 on Errors), albeit the direction of influence is occasionally fuzzy. Secondly, moral medicine looks more dignified and intellectualised than medicine devoid of any ethical and social elements, and so Galen may have aimed to reach a wider audience with at least some of his works. The philosophising observations he inserts would have made these texts more attractive to philosophers and other experts in matters philosophical. For example, the Therapeutics to Glaucon, Matters of Health or Therapeutic Method is not the kind of reading targeted only at doctors, but is ripe with potential for attracting a wider readership of pepaideumenoi, particularly lovers of medicine (philiatroi) or other cultivated enthusiasts.Footnote ⁸

That said, a sincere and serious concern for contemporary morals should not be underestimated as another explanation for Galen’s moral medicine. This does not mean simply reproducing platitudes of medical ethics, familiar from Hippocratic deontological tracts, e.g. that the doctor should not be money-grubbing and the like. Rather, the moral component of medicine ensures its philosophical regulation and social applicability, as I have argued above, especially in view of Galen’s evident realisation that contemporary society was falling apart and that moral aberrancy abounded. The literature of Galen’s time emphasises this crisis and offers cumulative evidence for the prioritising of the soul’s wellbeing over that of the body. Dio of Prusa is adamant that it is not ‘worse for a man to suffer from an enlarged spleen or a decayed tooth than from a soul that is foolish, ignorant, cowardly, rash, pleasure-loving, illiberal, irascible, unkind, and wicked, in fact utterly corrupt᾽ (Oration 8.7-8). With his main occupation being that of a doctor, Galen may have felt the need to respond to such intellectual arguments over the tension between medicine and philosophy. And so what he proposes is not sidestepping moral philosophy, in line with pseudo-Quintilian’s The Lesser Declamations 268, discussed in the Introduction. Rather he advocates integrating it with his medicine, in an attempt to produce a stronger, more socially dynamic variety of medicine.

Last but not least, as is obvious from the depth and breadth of his scholarly interests and his inquisitive personality, Galen embodies the ideal of the pepaideumenos in his day, so that embarking upon a new area of study and writing would have been a natural step for him to take. That may have been his own decision, or he may well have been motivated by his stellar friends, at the behest of whom he so often admits to having produced specialised works (remember the addressee of Affections and Errors of the Soul). A central argument of this book has been Galen’s probable dependence on Plutarch. The latter enjoyed a widespread reputation in scholarly circles in Rome and elsewhere from immediately after his death at the beginning of the second century AD onwards, so that by the time Galen composed his strictly ethical works towards the end of the same century Plutarch would have already been a celebrity in ethics. Given Galen’s high-flying ambitions in this area, it is not unreasonable to assume that he may have been inspired by Plutarch to become an active partaker in this living tradition.

How successful was he? This is a thorny question and its answer depends on how one defines success. If it connotes subsequent reception, then he was not very successful, since Galen’s ethics did not exert much influence, other than in some Arabic and Hebrew emulations in the medieval period (next to nothing compared with his imposing medical reception across geographies and cultures).Footnote ⁹ If success is defined in terms of comparison with other contemporary philosophical trends, then it is important to avoid any reductionist approaches that interpret Galen’s ethical or ethically informed works based purely on their factual, conceptual or linguistic content. In particular Galen’s essays on moral issues are, as we have seen, refined pieces of literature, reflective of and hence tailored to their social realities. Their primary aim is to convince readers to adopt suitable moral outlooks, regardless of whether that might sometimes run counter to the author’s doctrinal preferences. We have seen throughout the book that Galen advances various reconfigurings or retexturings to suit his moral theses; for example, he seems on occasion to be suggesting the eradication of emotions or abrogating political participation, but this he does to make a moral point and not because he believed those attitudes to be philosophically sound. In addition to these tactics, we could also cite Galen’s delicate linguistic modifications whereby certain concepts that are generally considered negative might take on positive meanings, or vice versa, in particular Galenic contexts to buttress ethical types of behaviour, especially those embodied by Galen.

Therefore, the scholarly view that Galen’s ethics do not conform to the standards of the philosophical language of other near-contemporary theoristsFootnote ¹⁰ is not consistent with the innovations of his ethical discourse. Nor should this view blind us to the multiplicity of moral works circulating in this period, a period that valued personal interpretation of ideas and transgression over straitjacketing uniformity and adherence to doctrinal authority. This study has demonstrated that Galen’s moralism is in close dialogue with the practical ethics of the Hellenistic and Roman periods, not in any passive or imitative fashion but through distinctive transformations. It would not be an exaggeration to say that, if we had all the works that have been lost from Galen’s ethical corpus, we would have a completely different picture of Imperial-period practical ethics than the one we currently possess.