Gill Ancient Psychoterapy

Ancient Psychotherapy
Author(s): Christopher Gill

Source: Journal of the History of Ideas, Vol. 46, No. 3 (Jul. - Sep., 1985), pp. 307-325
Published by: University of Pennsylvania Press
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ANCIENT PSYCHOTHERAPY
BY CHRISTOPHER GILL
My
title should
perhaps
be
phrased
as a
question:
"Ancient
Psy-
chotherapy?"
For the aim of this article is
not,
primarily,
to describe the
various ancient
practices
which were called
therapeia
tes
psuches ("cure
of the
soul").
Rather it is to ask whether we can find
anything
in the
Ancient World which resembles what
we, currently,
call
'psychother-
apy'.*
This term is used to cover a
range
of
contemporary psychiatric
practices.
But it is verbal
psychotherapy
I have
especially
in
mind,
the
kind of
activity
described
by Anthony Storr,
for
instance,
in his recent
book,
The Art
of Psychotherapy,'
which is
designed
to
give guidance
to
British medical
graduates entering psychiatry. 'Psychotherapy',
as Storr
defines
it,
is "the art of
alleviating personal
difficulties
through
the
agency
of words and a
personal, professional relationship."
The kind of treatment
he discusses in
"analytical
and
individual,
and involves
only
two
partic-
ipants,
the
patient
and the
therapist" (vii).
The
psychotherapeutic
method,
as Storr describes
it,
is not
highly
predetermined,
and varies from
patient
to
patient.
But it
consists,
essen-
tially,
of an
attempt
to induce the
patient
to
explore
his own
feelings,
wishes,
anxieties and
fantasies,
as
frankly
as
possible,
in a
way
that
helps
him to uncover the roots of his
personal problems
and
try
to solve them.
Storr is not an orthodox
Freudian,
Jungian,
Adlerian,
or Kleinian
(nor
is
he,
less
orthodoxly,
a
Laingian
or
Lacanian);
and so his method does
not rest on
any particular
set of
psychological
theories,
about the un-
conscious,
for
instance,
or the causation of neurosis. He
does, however,
assume that
people,
at some
level,
'know' the reason for their distress
and
anxiety,
and that
psychotherapy
can
help
to make them more
fully
aware of
this,
and thus better able to deal with their emotional difficulties.
In
comparison
with
Freud,
Storr
lays
less stress on the bare act of
bringing
to consciousness the source of the
problem,
and more on the
development
of the kind of
autonomy
or
'integrity'
of
personality
that can deal with
the
problem.2
The role of the
therapist,
as he
presents
it,
is a subtle
one,
*
This article is based on a
paper
read to a seminar on Ancient
Religion
in
Corpus
Christi
College,
Oxford. I am
grateful
to the members of the seminar for their
helpful
comments on the
paper, particularly
John Bramble. I would also like to thank David
Dickinson,
Brett
Kahr, Geoffrey Lloyd,
and David
Owen,
for their useful criticisms of
an earlier version of this article.
1
(London, 1979).
I am
grateful
to Graeme
Feggetter
for
drawing my
attention to
this book.
2 Cf. Storr's earlier
book,
The
Integrity of Personality (London, 1960).
This
aligns
Storr to the
approach
sometimes called
'ego psychology';
see n. 15 below for other
approaches.
307
Copyright
1985
by
JOURNAL OF THE HISTORY OF IDEAS,
INC.
308 CHRISTOPHER GILL
which is neither
passive
nor
overtly
active. The
therapist
tries to avoid
taking
the
place
of the
patient's autonomy (by explicit
advice or instruc-
tion),
but nonetheless
suggests, by questions
and
implicit guidance, ways
in which the
patient may develop
his own
autonomy.
The
therapist plays
a
role,
as a
person,
in the
therapeutic process:
he often
is,
and should
be,
the
object
of
'transference',
that
is,
someone to whom the
patient
'transfers'
feelings
of love and hate which are related to the
'working
through'
of his
problems.
But this is a role he
plays
not as an individual
but as a
therapist;
the
process
is not
designed
to bind the
patient
emo-
tionally
to the
therapist,
but to enable him to
develop
normal relations
outside the
therapeutic
context.
In
summarizing
Storr's account of
psychotherapy,
I do not wish to
suggest
that I
regard
his
psychiatric
method as
necessarily
ideal or nor-
mative.3 In
fact,
I will have occasion to refer to
psychiatric
methods
which are rather different from Storr's later in this article. But it is
useful,
nonetheless,
to have a
fairly representative
statement of what is
meant,
in
contemporary usage, by 'psychotherapy',
as a reference
point
for com-
parison
with what we find in the Ancient
World;
and it is for that reason
that I have summarized Storr's account.
As well as
giving
a
specific
answer to the
question
whether
psy-
chotherapy,
in this
sense,
or
anything closely resembling
it,
did or did
not exist in the Ancient
World,
I am interested in
seeing
how discussion
of this
question
bears on the
comparative 'mapping'
of ancient and modern
practices.
I am also interested in
demarcating
the various
conceptions
of
the self that the ancient and modern
practices
in this area
presuppose.4
The
question
of
comparative 'mapping'
is one of immediate
importance.
For I take it as obvious that there is
nothing
in the Ancient World
exactly
like the
psychotherapy
Storr
describes;
there is no class of
persons
whose
profession corresponds exactly
to that of modern
psychiatrists
and
psy-
chotherapists.5
To
identify
the nearest
equivalents
to modern
psycho-
therapy,
we need to look at the borders of certain ancient
areas,
the
borders of
religion
and
medicine,
on the one
hand,
and of medicine and
philosophy,
on the other. I
hope
the remainder of this article will make
it clear
why
I think these areas are the most
important
ones to examine
for this
purpose.
3
Storr himself sees the method as best suited for the treatment of neurosis rather
than
psychosis (160ff); although
the
psychotherapeutic
treatment of
psychosis
is advocated
in, e.g.,
Bertram P. Karon and
Gary
V.
VanDenBos,
Psychotherapy of Schizophrenia:
The Treatment
of
Choice
(New York, 1981).
4
I discuss another
aspect
of this
subject
in "The
Question
of
Character-Development
in Plutarch and
Tacitus,"
Classical
Quarterly,
33
(1983),
469-87.
5
Cf. Walther
Riese,
"An Outline of a
History
of Ideas in
Psychotherapy,"
Bulletin
of
the
History of
Medicine, 25
(1951), 442-56, Bennett Simon,
Mind and Madness in
Ancient Greece: The Classical Roots
of
Modern
Psychiatry (Ithaca
and
London, 1978),
217.
ANCIENT PSYCHOTHERAPY 309
As far as the
scope
of this discussion is
concerned,
the 'Ancient
World'
signifies
here the Greco-Roman World. Given the kinds of evi-
dence we have
available,
I shall have little to
say
about Greece
prior
to
the late fifth
century, B.C.,
and
relatively
little to
say
about Greco-Roman
culture after the second
century,
A.D.
(with
the
exception
of certain
medical
texts).
Within these
time-limits,
there seems to be a
good
deal
of
continuity
in the kinds of
practice
I am concerned
with;
and so the
discussion will move rather
freely
between
periods
of Classical
Antiquity.
One
topic
I
say nothing
about is
Christianity.
I omit this
topic although
I think
Christianity
is
potentially important
for this
question,
both in the
Ancient World and in later
periods,6
but it seems to me
impossible
to
do
justice
to the role of
Christianity
in a
survey
of this
length,
and so I
leave it
wholly
on one side.7
The borders
of religion
and medicine.-One
point
of
entry
to this
area is a
striking passage
in
Aristophanes' comedy,
the
Wasps,
in which
the slave Xanthias describes the
symptoms
of the disease
(nosos)
that
has afflicted his master's
father, Philocleon,
and then enumerates various
unsuccessful cures
(7 ff.).
Xanthias mentions a number of what we
might
call
'obsessions',
that
is,
conditions of
preternatural
attraction
(being
philo-)
to
dice, drink,
or
foreigners.
He then
specifies
Philocleon's con-
dition
(he
is
phileliastes,
"in love with
jury-service"),
a condition which
is
convincingly
'obsessive': Philocleon even dreams about
jury-service
(92-93).
The slave then describes the methods used to
try
to cure this
'disease': verbal
dissuasion,
katharsis
(ritual purification
with
water),
initiation in the
Corybantic
rites,
and incubation
(sleeping overnight)
in
Asclepius' sanctuary.
All these methods have failed and the 'madman'
has been locked
up (114ff.).
The
point
of the
passage
is
basically
satirical
(Aristophanes
in
parodying
the Athenian
passion
for
jury-service);
but
the
passage
seems to throw incidental
light
on
contemporary
treatment
of the
mentally
disturbed. If we leave aside the
attempt
at verbal dis-
suasion,
the three methods mentioned seem to be of a similar
type. They
are
clearly
linked with
religious practice;
and
they
are also
'curative',
in
some
sense,
although they
are not all
especially
associated with madness.8
The
Corybantic rites,
in
particular,
are
regularly presented
in our sources
6
See,
e.g.,
Michel Foucault's
suggestion
that Christian confessional
practice paved
the
way
for
psychoanalytic self-scrutiny,
The
History of Sexuality:
An Introduction
(Har-
mondsworth,
Penguin, 1981), 20ff., 60ff.,
115ff.
7
For some of the relevant
material,
see
Georg
Misch,
A
History of Autobiography
in
Antiquity,
2 vols.
(London, 1950), II,
Part III
(on
self-scrutiny
and confesssional liter-
ature).
See also G.
Kittel, ed., Theological Dictionary of
the New Testament
(Grand
Rapids, Michigan, 1965),
s.v.
therapeuo,
iaomai, nosos.
8
See further E. R.
Dodds,
The Greeks and the Irrational
(Berkeley
and Los
Angeles,
1951), 35-37;
G.E.R.
Lloyd, Magic,
Reason and
Experience:
Studies in the
Origin
and
Development of
Greek Science
(Cambridge, 1979), 40ff.,
and Robert
Parker,
Miasma:
Pollution and
Purification
in
early
Greek
Religion (Oxford, 1983), esp. chaps.
7-8.
as
being religious
rituals which are
capable
of
curing
states of emotional
disturbance and
anxiety.9
Plato describes them as a means of 'homeo-
pathic'
cure of emotional
agitation (that
is,
the cure of inner
agitation
by
external
agitation,
in the form of violent music and
dancing).?1
This
is the kind of
process
Aristotle seems to have in mind in the
Politics,
when he mentions the katharsis of emotions such as
pity,
fear,
and
excitement
(enthousiasmos) through religious
music of an intense and
exciting
kind.11 The
Corybantic
rites are not
unique;
as Dodds
points
out, they belong
to a
family
of
religious
rituals
(of
which Bacchic rites
are another
prominent example)
which induce ecstatic or
orgiastic
ex-
periences
and so
bring
to the
participants
some kind of satisfaction and
peace
of mind.12
If we take these
types
of
religious
cure as a
group,
how close is the
treatment to modern
psychotherapy?
It is
clearly quite
unlike the kind
of
psychotherapy Anthony
Storr describes.
Indeed,
if there are
analogues
in modern Western societies for this
type
of ancient
practice, they might
seem to lie outside
psychotherapy,
in
'hot-gospel'
Christianity,
faith-cures
at
Lourdes,
or
drugs, mysticism,
and
'heavy
rock' music.
However,
it is
worth
trying
to
analyze
what these ancient
practices
do or do not have
in common with the kind of
psychotherapy
I have described. Both the
ancient and the modern
practices presuppose
that
anxiety
and distress
cannot be cured
simply by inducing
the
suffering person
to exercise
rational
self-discipline.
The son of Philocleon
(if
we take this comic
example seriously)
failed to
'persuade'
his
father,
before he had recourse
to katharsis,
Corybantic
rites,
and incubation to treat the 'disease'
(Wasps,
114-24). Analogously,
modern
psychotherapists
do not
try
to reason
patients
out of their neurosis
simply by
an
appeal
to their
capacity
for
conscious self-control.
They try
to
probe
the unconscious levels of
per-
sonality,
which are not amenable to self-control in the usual
sense,
in an
attempt
to find the
unrecognized
sources of the neurosis. The differences
between the ancient and modern
practices
are also
fairly obvious,
how-
ever. The ancient
practices
were not
predominantly
verbal,
and did not
include sustained
dialogue; they
were
also,
by
the same
token,
relatively
impersonal. Corybantic
and Bacchic
rituals,
as far as we can reconstruct
them,
were
essentially
the same for all the individuals
participating
in
9
See I. M.
Linforth,
"The
Corybantic
Rites in
Plato," University of California
Pub-
lications in Classical
Philology,
13.5
(1946),
121-62 and "Telestic Madness in Plato,
Phaedrus, 244d-e," ibid.,
13.6
(1946),
163-72.
10
Plato, Laws,
790d-791a.
1
Politics, 1341b32ff., esp.
1342a4-15. This
passage
has often been taken to shed
light
on Aristotle's comment about katharsis
through tragedy
in
Poetics,
1449b24-31. For an
interpretation
of Aristotle's idea of
tragic
katharsis as a
theory
about
'group-psycho-
therapy',
see P. Lain
Entralgo,
The
Therapy of
the Word in Classical
Antiquity (New
Haven and
London, 1970),
183ff.
12
Dodds, op.
cit.,
77-80.
them.13 Some of our evidence
suggests
that
people
with
particular psy-
chological problems
were attracted to
particular
rituals
(the irrationally
frightened
were drawn to the
Corybantic rites,
for
instance)
and found
them
satisfying.14
But,
in the rites
themselves,
there does not seem to
have been
any
overt
attempt
to
explore
the individual's
problems
or to
rebuild his confidence.
In this
respect,
then,
there seems to be rather little in common between
the methods of modern
psychotherapy
and ancient rituals of the
Cory-
bantic
type.
However,
it is worth
noting
that there are some
types
of
modern
psychotherapy
which are much closer to the ancient rituals. In
the United
States,
in
particular, alongside
the standard
types
of
psycho-
analysis
and
psychotherapy, therapeutic
methods have been
developed
which
lay
much less
emphasis
on the verbal
exploration
of the
patient's
psychological
state and much more on the
discharge
of emotion in ex-
pressive physical
action.'5 In some
methods,
the use of
dialogue
is omitted
altogether;
and the treatment consists
entirely
of
attempts
to find the
kind of
physical
action
(for
instance,
muscular
relaxation,
violent
gestures,
screaming)
that
gives
the
patient
emotional release. This
type
of
therapy
is often conducted in
groups,
and the mutual excitement
generated by
the
group
is an
important
factor in
inducing
the
patient
to relax his
normal constraints and
express
himself
physically.'6
This
type
of
therapy
is much closer to ancient rituals of the
Corybantic type.
Indeed,
some
psychotherapists
of this
type
are interested in these ancient
practices,
as
well as in similar
practices
in
contemporary undeveloped
cultures,
re-
garding
them as
prototypes
for their own
methods.'7 However,
it is worth
examining precisely
how close these
parallels
are. It is clear that both
ancient and modern methods
provide
some kind of
expressive
action
which
gives
emotional release.
However,
the
personal
and
psychological
content of the modern
practice
is much more
important
and overt than
it was in the ancient
rites,
as far as we can reconstruct these. The modern
participant
is
encouraged
to find the
gestures
or movements that
help
him
relax,
to scream out his inmost
feelings ('Love me',
'I hate
you'),
to
'act out' his
suppressed urges.'8
Even in treatments where the element
of
explicit analysis
is
very small,
the
therapeutic
context
(and
the
prev-
alence,
in American culture at
least,
of a
psychotherapeutic approach
to
personal life) predisposes
the
participant
to think in terms of his individual
13
There
were,
of
course,
different roles within the
ceremony (e.g.
ministrant,
initiated
worshipper,
candidate for
initiation),
but the
performance
of these roles does not seem
to
vary
in
ways
that reflect the individual
psychology
of the
participant.
14
Cf.
Dodds, op. cit.,
78-79.
'5
Michael P. Nichols and Melvin
Zax,
Catharsis in
Psychotherapy (New York, 1977).
16
Nichols and
Zax, Chaps.
5 and 7.
17
Nichols and
Zax, Chap.
2.
18
Examples
from Nichols and
Zax, 109ff., 140,
148-9.
needs and satisfactions.
By comparison,
the Greek
religious
methods seem
to have been
corporate,
ritualistic,
and
impersonal.
This
generalization,
if it is a valid
one,
seems to
apply
to a rather
broad area in
Antiquity,
indeed to most of the treatments offered in
ancient
religious
and
religio-medical
contexts.
However,
it is worth look-
ing closely
at two
examples
where our evidence is
unusually
full,
to see
how far we should
qualify
this
generalization
about the
impersonality
of
the treatment offered in these contexts. The first
example
is that of Aelius
Aristides,
who is famous for his account of his own
prolonged
and varied
illnesses and the numerous treatments he
applied
to them.19 These treat-
ments were
inspired by
dreams which Aelius had
during
incubation in
Asclepius' sanctuary.
Aelius believed that
Asclepius
used these dreams
to
prescribe
remedies to
him;
and
that,
in this
sense,
his illness was
receiving
individual treatment
by Asclepius.20
Aelius himself does not
regard
his treatment as
psychotherapy
because he sees his illness as
being
physical
and
Asclepius
as
being
a medical doctor in the usual sense
(albeit
a divine
one).
But,
from our
point
of
view,
what is
psychiatrically
inter-
esting
about his account is that it shows how the
temple
of
Asclepius
provided
a context in which a
person
could
(with religious,
medical and
social
support) explore
his
psycho-physical individuality,
and could
treat,
with
partial
success,
diseases which were at least
partly psychosomatic.
For,
on Aelius'
evidence,
a
good
deal is left
up
to the individual
patient
of
Asclepius.
The
patient
has the
prescriptive
dreams,
and
interprets
them
(with
assistance from
friends, doctors,
and
contemporary techniques
of
dream-interpretation)21
in that
sense,
he discovers his own treatment. We
also
know,
from Aelius'
case,
that he could discover and
insistently apply,
cures which were
medically
insane
(by
ancient as well as modern stan-
dards)
but
which, nonetheless,
had a
temporarily
beneficial effect.22
Thus,
while Aelius is
not,
in an obvious
sense,
exploring
his own
psychology
(in fact,
in some
ways
he seems
markedly
blind to his own
character),23
the
Asclepian
context does not seem to
provide
a framework in which
Aelius,
in a
sense,
explores
his own
psychophysical individuality,
and
finds a
very personal
treatment for
very personal
diseases. In that
respect,
Asclepius' temple provides
a
psychotherapeutic
context,
though
one
whose methods are unlike
any
modern
psychotherapy.
The case of
Lucius,
in
Apuleius'
novel,
Metamorphoses (or
The Golden
Ass)
is in some
ways comparable,
as an
example
of a
religious
'cure' that
19
A lucid account of Aelius Aristides' Sacred Discourses,
including
translated
extracts,
is
given
in A.-J.
Festugiere,
Personal
Religion among
the Greeks
(Berkeley
and Los
Angeles, 1954), Chap.
vi.
20 The
'personal'
nature of their
relationship,
as Aelius sees
it,
is not confined to
dreams;
cf.
Festugiere,
ibid.,
95-97.
21
Cf.
ibid., 10lff., Lloyd, op.
cit.,
41-43.
22
Cf.
Festugiere,
ibid.,
92-95.
23
Ibid., 97-98, Misch, op.
cit.,
506-07.
has a
strongly personal
dimension.
Apuleius'
hero comes to feel that Isis
cares for
him,
as an
individual;
for she not
only miraculously changes
his
bodily shape (restoring
him from ass to
human),
but attaches as a
precondition
a
complete change
in his
way
of life. He is to transform his
life,
previously
dominated
by curiosity
about
magic,
into one dominated
by religious
devotion,
and to
reject
the sexual
pleasures
that were
formerly
important
to him and become celibate.24
By
non-Christian
standards,
this
is a
striking portrayal
of
religious
'conversion',
and one that
places
an
unusual stress on the
impact
of the conversion on the life of the initiate.25
It is not so much the moral
aspect
of the conversion that
Apuleius
stresses,
but rather the fascination of the initiate with the
religious
rituals,
espe-
cially
the initiation into the
'mysteries'
of the
cult,
and the
quasi-personal
relationship
he feels he has with the
goddess.
The
underlying
idea seems
to be that this
religious absorption
has 'cured' Lucius of his
previous
restless
curiosity
about
magic,
and at the same time
provided
a focus for
his whole
life,
channelling
all his desires into his love for Isis.26 It is
difficult to
say
how far we can draw
inferences,
from this
peculiar piece
of
fiction,
about the kind of
'psychotherapeutic' help
an ancient
mystery
religion
could
provide.
But one
point
that
emerges very clearly
is that
religious
rituals
may
be
apparently impersonal (the
Isis rituals are the
same for all
worshippers,
and the initiation
ceremony
is the same for all
initiates);
and
yet they
can have an
intensively personal significance
for
a
particular person.
Not
only
do the rituals have an intense emotional
power
for
Lucius,
but
they
make sense for him
(because
of the distinctive
role the conversion has
played
in his
life)
in a
way they
could not make
sense for
anyone
else.
Thus,
this
example, together
with that of Aelius
Aristides,
should
partly qualify
our
generalization
about the
impersonality
of ancient
religious
rituals,
considered as a form of
therapy.27
Folk-psychotherapy'
in Greek Drama. -I shall turn
shortly
from the
borders of
religion
and medicine to medicine
proper,
and to its borders
with
philosophy.
But,
first I want to consider
briefly
some of the evidence
we find in Greek
drama,
especially tragedy,
for what one
might
call 'folk-
psychotherapy',
that
is,
psychotherapy
which is not connected with
any
specific discipline
or
practice,
such as
medicine,
philosophy,
or
religion.
In an article on the
Bacchae,
Georges
Devereux describes the
dialogue
24
Apuleius, Metamorphoses,
lines
15;
cf. lines 6 and
11,
19. See further G. N.
Sandy
and J.
Gwyn
Griffiths in
Aspects of Apuleius'
Golden Ass,
ed. B. L.
Hijmans
and R. Th.
van der Paardt
(Groningen, 1978),
123ff.
(esp. 130-04),
and 141ff
(esp. 156-58).
25
Cf. A. D.
Nock,
Conversion
(Oxford, 1933), Chap. IX, esp. 155; Festugiere, op.
cit.,
77-84.
26
Festugiere
notes the
inexplicabilis voluptas (Metamorphoses,
11, 24)
Lucius takes
in
prolonged gazing
at the cult statue of
Isis,
op.
cit.,
80-84;
cf.
Gwyn
Griffiths
(n.
24
above),
156-58.
27 See
further,
on the
personal
and
psychological significance
of
folk-rituals,
Claude
Levi-Strauss,
Structural
Anthropology (London, 1968), Chap. X, esp.
198-204.
in which Cadmus
helps Agave
make the transition from madness to
sanity
as "the first
surviving
account of an
insight-and-recall
oriented
psychotherapy,
which sheds
light upon
an
aspect
of Greek
attempts
to
treat
psychiatric
illness,
which is not otherwise attested."28 This claim
(which
I shall discuss
shortly)
serves as a reminder of the fact
that,
in
several Greek
tragedies,
we see
people being helped
out of
madness,
or
helped
to
accept
the
consequences
of their
madness,
and that this
help
is sometimes
given sensitively
and
effectively.
In two notable
scenes,
in
Sophocles' Ajax
and
Euripides'
Heracles,
we see the
portrayal
of a man
who is now sane
coming
to terms with what he did when he was mad.
In both
cases,
his first instinct is to kill himself out of a sense of
shame;
this instinct is
opposed successfully by
Theseus in the
Heracles,
and
unsuccessfully by
Tecmessa in the
Ajax.
It is
perhaps significant
that,
in
the
Heracles,
Theseus is
strongly 'supportive'
to Heracles. He abstains
from criticism of
Heracles;
he offers him unconditional
friendship
and a
new
home;
he
ignores
the risk of
pollution
from contact with a man who
has murdered his own
family;
he ascribes
responsibility
for the act to
Hera;
he claims that all
gods,
as well as all
men,
are doomed to error
and misfortune.29 In this
way,
he leads Heracles to face what he has done
in madness and still want to live.30
Ajax
too is not
criticised,
either
by
Tecmessa or the
chorus,
when he recovers from his madness. But the
principal response
of Tecmessa is to make demands on
Ajax (that
he
should continue
living,
so that he can
protect
his
family, 492ff.).
Also,
Tecmessa,
as a
woman,
and a
slave-wife,
cannot be
'supportive'
to
Ajax
in the same
way
as Theseus is to Heracles. There
are,
of
course,
other
differences between the
protagonists
and the situations of the two
plays.31
But the contrast in the
responses
to the
ex-madman-support
on the
one hand and demand on the other-seems
potentially significant.
The
contrast
may simply
reflect different dramatic
requirements
in each
case;
but it
may
also
point
to a
general
awareness in Greek
society
of the
problem
of
finding
the
right way
to deal with the after-effects of madness.
Both
Ajax
and Heracles are sane at the time of these
'therapeutic'
dialogues.
In
Euripides'
Bacchae, however,
Agave
is
partially
mad on
stage
for a considerable
time;
and the
dialogue
with Cadmus
helps
to
lead her out of madness into a sane
recognition
of what she has done.
Camus' treatment of her is
sensitively 'supportive'
(as
Devereux
shows);
and Cadmus is sensitive too to the
ways
he can reawaken
Agave's
sane
consciousness and sense of herself.32 Devereux makes the further claim
28
"The
Psychotherapy
Scene in
Euripides'
Bacchae,"
Journal
of
Hellenic
Studies,
90
(1970),
35-48
(quotation
from
35).
29Heracles, 1163ff., esp.
1191, 1218ff, 1234-6, 1311ff,
140ff.
30 See
further,
H. H.
O. Chalk,
"Arete and Bia in
Euripides'
Herakles,"
Journal
of
Hellenic Studies,
82
(1962),
7ff.
31
Cf.
Simon,
op.
cit.,
137-39.
32
Cf.
Devereux,
op.
cit.,
40-47.
that this scene is 'the first
surviving example
of
insight-and-recall
oriented
psychotherapy' (35).
Devereux claims that Cadmus does not
simply
tell
Agave
what she did while she was mad
(that is,
tear her own
son,
Pentheus,
apart)
but
helps
her remember
this,
overcoming
her
psycho-
logical
'resistance' to
doing
so.
However,
Devereux's
interpretation
is not
the most natural
reading
of the text. On the face of
it,
what is
presented
is, first,
a
period
in which
Agave
is half-mad and remembers
killing,
but
thinks she has killed a
lion; second,
a
period
in which
Agave
is
sane,
and cannot remember
killing
at all.33 This
discontinuity
of
memory
be-
tween madness and
sanity
is
paralleled
in the
portrayals
of
Ajax
and
Heracles too.34 Devereux's
interpretation
is based less on
specific
indi-
cations in the text than in the
general similarity
he finds between
Agave's
behavior on
stage (for instance,
'a
defensive hypomanic
exaltation
masking
underlying grief
... a
coy, hysterical foolishness')
and the behavior of
psychotics
in
therapy 'resisting' insight
into their condition.35 Devereux's
claim is an
interesting one;
and his
reading
of the scene makes it into a
reproduction
of
'psychotherapy'
in a
very
modern sense.
But,
in the
absence of
any strong
textual
support,
Devereux is vulnerable to the
criticism that he has
superimposed
on the scene a
significance
which it
does not have. What we seem rather to have here is a
portrayal
of one
person helping
another from madness to
sanity,
and then
treating
her
gently
as she reenters normal consciousness. This is
interesting enough,
as an indication of Greek awareness of how to treat
people
in such
situations;
but the scene does not seem to be as different from the other
cases in Greek
tragedy
as Devereux claims.
Another
striking
scene,
and one that has received less
attention,
occurs,
again,
in
Aristophanes' Wasps.
Philocleon's
son,
after
failing
in
a second
attempt
at rational
persuasion,
seems to
pander
to his father's
'madness'. He sets
up
a curious
'psycho-drama'
in which a courtroom
scene is enacted inside the
household,
and the father is
given
the role of
juror
in a
dispute
between two domestic
dogs (760ff.).
At
first,
the son
seems to be
simply reinforcing
his father's obsession. But
then,
within
the
drama,
he
manages
to
'rig'
the
verdict; thus, by convincing
Philocleon
that he has voted for
acquittal,
he succeeds in
breaking
his father's
lifelong
habit of condemnation. At
this,
Philocleon
experiences
some kind of
emotional
collapse,
and hands himself over to his son for a
complete
change
in his
style
of life.36 It is difficult to
distinguish
here
good
comic
33The
two
periods
are
presented
in
1165-1258,
and 1271-1301
(esp. 1286ff) respec-
tively. Agave's
transition to
sanity
is
brought
about
during
1259-1270.
34 See
Sophocles, Ajax,
31
lff; Euripides,
Heracles, 1094ff,
esp. 1122;
cf.
Devereux,
op.
cit.,
nn.
6,
18.
35
Devereux,
37. Of the lines Devereux
discusses, only
1278 seems to lend much
support
to his thesis.
36
986ff,
cf. 875-84. The
subsequent
action shows that the reform of Philocleon's
character is
only skin-deep,
however.
theatre
(the
ridiculous
portrayal
of Philocleon's fanatical addiction to
jury-service)
from the
representation
of a
psychologically
credible situ-
ation.37 But the scene does seem to include the idea of
working
on madness
'from
within';
that
is,
of
playing
the madman's
game,
and
working
for
a
change
of attitude within the
game.
If this is
so,
it
gives
us evidence
of a
technique
that is not well-documented in the Ancient World. It is
not until a much later date that we find discussion of similar
techniques
in medical
writings.
The Roman doctor Celsus
advocated
agreeing
with
the
patient
instead of
opposing
him,
and
turning
his mind
slowly
and
imperceptibly
from irrational talk to
something
better.
Thus,
for
instance,
he tried to
allay
a
wealthy patient's
obsessive fear of starvation
by
an-
nouncing pretended legacies
from time to time.38 This medical
technique
seems similar to that used
by Aristophanes' figure, though
it lacks the
dramatic conversion within the 'mad' state that is so
striking
a feature
of the scene in the
Wasps.39
This evidence in Greek drama
presents
a number of difficulties of
interpretation.
However,
we can
say
that the
plays
show the mad and
ex-mad
being
handled
gently
and with
sensitivity;
and this
portrayal may
reflect a
general
awareness of the
importance
of
treating
disturbed
people
in this
way.
But,
if we discount Devereux's
interpretation
of the
Bacchae,
there seems to be no evidence of a
developed technique
of
psychotherapy
in the modern
sense;
that
is,
a
technique designed
to
give
the
patient
insight
into the basic causes of the mental disturbance and so effect a
cure for this.
The borders
of
medicine and
philosophy.
-So far we have found a
good
deal of
evidence,
in ancient
religion
and
drama,
for
practices
which
are in some
way comparable
to modern
psychotherapy,
but
nothing
that
resembles it
closely.
One
problem
has been the
difficulty
of
determining
the
presuppositions
about the nature of mental illness and its treatment
which underlie
religious practices
and dramatic
representations.
This
problem
is less acute in the next area I want to
explore,
the borders of
medicine and
philosophy.
For both ancient doctors and
philosophers
offered some accounts of mental or
psychic
diseases,
and of their
cure;
and the
philosophers
are
especially
articulate about the kind of disease
and treatment
they
have in mind.
However,
as we shall
see,
there is some
doubt about whether either doctors or
philosophers quite engage
in
'psy-
chotherapy',
as we understand this term. Ancient doctors were not un-
aware of what we call 'mental'
illnesses,
although
their main concern
was with what we call
'physical'
illnesses. But
they
did
not,
on the other
37 For other
components
of the
comedy
of the
scene,
see
Aristophanes, Wasps,
ed.
D. M. MacDowell
(Oxford, 1971),
249-50.
38
Celsus,
3.18
(mid
first
century A.D.).
39
See
Riese,
op,
cit., 442,
for a
comparable,
but more
successful,
case of dramatic
conversion in 11th c. Arabic medicine.
hand, develop
to
any great
extent
distinctively
mental or
psychological
techniques
to deal with these illnesses. Their normal methods of treat-
ment,
like those of most modern
non-psychiatric
doctors,
were
physical
rather than
psychological;
and this is
largely
true of their treatment of
mental illnesses.
Philosophers, by
contrast,
were
very
much concerned
with the area of the
psychological,
and sometimes claimed to be 'doctors'
of
psychic
diseases.
However, they mostly
seem to have had in mind
what we should
regard
as moral
failings
rather than mental illness. And
their methods of
cure,
correspondingly,
consist of moral
instruction,
of
various
kinds,
rather than
'therapy'
in our sense. To that
extent,
neither
type
of ancient cure
quite corresponds
to modem
psychotherapy; although
there are some
striking
borderline
cases,
on the more
psychological
mar-
gins
of
medicine,
and on the more medical
margins
of
philosophy,
that
are worth
considering closely.
Let us take medicine first. It is
striking
that,
in the
Wasps,
while so
many
other remedies are tried for Philocleon's
'madness', nobody
thinks
of
sending
for a doctor. This seems to
suggest
that,
as we would
expect
from other
evidence,
Greek doctors were associated
primarily
with the
treatment of
physical
rather than mental illness.40 This does not mean
that there is no evidence of interest in mental illness in medical texts in
the
Hippocratic corpus
and elsewhere. We find accounts of cases of
illnesses of the mind
(gnome)
or the
psyche,
which
give
close attention
to such features as irrational anxieties and distress as well as distortions
in
perception.41
We also find the
beginnings
of the classification of such
illnesses. For
instance,
doctors
distinguish
between
phrenitis
and mel-
ancholy.
Phrenitis is an acute delirious
condition,
marked
by,
for
instance,
feverish hand movements and
hallucination; melancholy
is a chronic
condition,
affecting
the
digestion
as well as the
emotions,
and defined
by
its
diagnosis
(an
excess of black
bile).42
The extent to which these illnesses were conceived as a
separate
class
of diseases
(mental
or
psychological
rather than
physical)
is
generally
not
very easy
to determine. It
depends
on the extent to which the writer
in
question regarded
it as
important
to reach a view on the nature
of,
and relations
between,
psyche
and
body.43 But,
as far as treatment
goes,
it is clear
that,
in this as in other areas of ancient
medicine,
the methods
were
largely physical. Drugs
were
prescribed,
often with
purgative
func-
tions,
for acute conditions;
long-term changes
in diet and
regime
were
40 Cf. Lain
Entralgo, op.
cit., 169-70, Simon,
op.
cit.,
215ff.
41
See Jackie
Pigeaud,
La Maladie de L'Ame: Etude sur la relation de 'ame et du
corps
dans le tradition
medico-philosophique antique (Paris, 1981),
42-45, 95ff., 124ff.,
Lain
Entralgo, op.
cit.,
161-63.
(Here
and
subsequently
I render
psuche
in its more familiar
form
psyche.)
42
Cf.
Pigeaud,
ibid., 71ff., 122ff.,
and H.
Flasher,
Melancholie und Melancholiker in
den medizinischen Theorien der Antike
(Berlin, 1966).
43
See
Pigeaud,
ibid.,
Chap.
I,
esp.
32ff.
prescribed
for chronic conditions. In the
Hippocratic corpus,
for
instance,
we find a
description
of a 'troublesome
illness',
phrontis,
whose
symptoms
include
unexplained
internal
pains
and irrational fears and anxieties. The
medical treatise
prescribes
"hellebore to
purge
the
head,
then a laxative
to
purge
the bottom. Then asses'
milk,
no
wine,
no
sport
or walks. Under
this
treatment,
the illness will
go away
in time...."4 In other
cases, by
contrast,
wine is
prescribed,
in moderate
quantities,
to counteract
anxiety
or
depression.45
To what extent were illnesses of this kind also treated
by non-physical
means? It had been
recognized
since Homer that the
skilful doctor "entertains with words" or
stories,
while he administers
herbs or
drugs.46
It was also sometimes
recognized
that the effectiveness
of a doctor's treatment
depended
on his success in
gaining
his
patient's
cooperation.47
This evidence of realization of the value of the 'bedside
manner' falls
short, however,
of
attesting
to the existence of what one
could
reasonably
call
psychological
treatment. Did ancient doctors ever
try
to cure mental illnesses
by psychological
means?
In
fact,
there are certain rather
interesting
discussions in medical
texts of
psychological
treatments of the
mentally
disturbed
though
some
of the texts are from late
antiquity.
Caelius Aurelianus is a
particularly
valuable source of evidence of this kind. He seems to have written in the
fifth
century, A.D.;
but much of his material is based on that of Soranus
(early
second
century, A.D.).48
Caelius advocates the use of
psychological
treatment in
conjunction
with
physical treatment;
his
psychological
treat-
ment aims to counteract the state of mind of the sick
person.
Thus,
he
proposes
visits to the theatre
(comedy
for the sad and
tragedy
for the
giddy
and
childish),
to restore the 'mean' state of mind
(mediocritas)
that constitutes
sanity.
He also recommends attendance at
philosophical
discussions;
"for
philosophers
remove
fear, sadness,
and
anger by
their
words,
and this
helps
to
provide
a considerable
improvement
in the
bodily
condition."
Here,
dialogue,
of a certain
kind,
makes its
appearance
in
the
therapeutic process. Presumably,
Caelius has in mind the exhortations
to emotional self-control
typical
of Stoic
philosophy,
for
instance,
in the
Roman
Empire (which
I shall note
again shortly).
Does Caelius also
advocate
therapeutic dialogue
between doctor and
patient?
Even in the
case of those afflicted
by phrenitis
(an acute,
delirious
condition), dialogue
can be
helpful.
Caelius' recommendations are based
again
on the
principle
of
trying
to counteract the sick
person's
state of mind. Overexcited
patients
should be addressed
gravely (like children); depressed
and irri-
tated
patients
should be addressed
gently,
with a cheerful and
encouraging
44
De Morbis
II, VII, Littre, 108-110;
cf.
Pigeaud,
ibid., 126, and,
for a similar
example,
Simon,
op.
cit., 218-19.
45
Cf.
Pigeaud,
ibid.,
497-503.
46Iliad, 11, 643; 15, 392-94,
cf. Lain
Entralgo, op.
cit.,
24.
47
Plato, Gorgias, 456b,
cf. Lain
Entralgo, op.
cit.,
97.
4
Pigeaud, op.
cit.,
20-21.
manner.
Authority,
in
particular,
can
play
a useful role in
dealing
with
the insane: the doctor should
try
to find someone whom the
patient
respected
when sane and
present
him to the
patient
to recall him to his
sane state of mind.
In
discussing
the
psychological techniques
of
dealing
with the
insane,
Caelius is
contributing
to a
subject
which had interested doctors for some
time.
Celsus,
for
instance,
writing
in the first
century, A.D.,
had
suggested
reading
to educated
patients
well,
or indeed
badly,
if that would serve
to
jolt
them into rational
thought.
Caelius
develops
this
suggestion, urging
the doctor to find
topics (such
as
agriculture
or
navigation)
that interest
the
patient,
and,
if he has no
special
interests,
to ask him about trivialities
or
play
chess. Caelius
emerges
from his
writings
as a rather sensitive
doctor,
and a 'liberal'
(as
we
might say)
in his treatment of the insane.
He
opposes
the crude or brutal
techniques
sometimes
used-starvation,
heavy drinking,
or
flogging.
Celsus had advocated a
discriminating
use
of
violence,
as a kind of
'shock-treatment',
to startle the madman out of
his mental state. Caelius
rejects
such
treatment;
if he has to use
ropes
to
restrain the
insane,
he winds wool around them so as not to hurt the
patient.49
He also
rejects
the use of music in
therapy,
which had been
advocated
by Asclepiades, among
others,
and which
was,
in a
sense,
a
continuation of the
Corybantic
cure.50 In
general,
he
opposed
'homeo-
pathic'
treatment,
that
is,
the
attempt
to cure emotional excitement
by
inducing excitement;
his own
method,
as we have
seen,
is
consistently
'allelopathic', designed
to counteract the
existing
mental disturbance.51
It is understandable that
Pigeaud
should describe Caelius as "le seul
psychiatre
coherent de
l'Antiquite" (112). Apart
from the fact that his
psychological
methods,
given
their limitations of
aim,
seem reasonable
ones,
he has a clear and consistent view of the nature of madness and
the treatment
appropriate
to it. He sees madness as a
physical
illness
with mental or
psychological
side-effects.52 Both
body
and mind
can,
and
should
be, treated;
and since
body
and mind
interact,
the treatment of
one
aspect
of
insanity
can
help
to cure the other.
It is clear that we have evidence
here,
in the later medical
tradition,
of
practices
in some
ways
more like modern
psychotherapy
than we have
found elsewhere in the Ancient World. The
patient
is
treated,
by
some
doctors at
least,
as an interrelated
complex
of mind and
body,
amenable
to
psychological
as well as
physical
treatment for mental disorders. He
is also sometimes treated as an
individual;
his
long-term
interests and
capacities,
as well as the transient
play
of his moods and
reactions,
are
noted,
and
responded
to, by
the more
perceptive
doctors. The medical
49 For refs. in Caelius and
Celsus,
see
Pigeaud, op.
cit., 109-11,
427.
50 Cf.
Dodds, op.
cit., 79-80,
and nn. 9-11 above.
51
Cf.
Pigeaud, op.
cit.,
109-112.
52
See
Storr,
The Art
of Psychotherapy, 93-94;
cf.
Chap.
13.
treatment includes an
attempt
to institute some kind of
dialogue,
and to
establish
personal
contact,
with the
patient.
However,
it seems an
overstatement to claim that the methods used
by Caelius,
or
any
other
ancient doctor we know
of,
constitute
psychotherapy
of the kind I de-
scribed at the start of this article. The
principal
reason for not
making
this claim is
that,
in ancient
medicine,
the verbal and
psychological part
of the treatment is
only ancillary
to the
physical
treatment. Verbal
therapy
is not seen as a means of
uncovering
the source of the mental disorder
and thus
opening
the
way
for the removal of the disorder.
Fundamentally,
the mental disorder is seen
(by
Caelius,
for
instance)
as a
by-product
of
a
physical
disease. There is a contrast here with the views of some modern
therapists (including Anthony Storr),
as
regards
at least some kinds of
mental disorder. While these
therapists accept
the need to use
drugs
to
alleviate extreme mental
disturbance, they regard therapeutic dialogue
as the
only way
to uncover the causative roots of the
disturbance,
and
so
bring
about a
lasting
cure. There seems to be no evidence for this
view in ancient
medicine,
and it is not a view which is consistent with
the
primarily physical approach
to illness
(including madness)
that we
find there.
The idea that
searching dialogue
can reach the root cause of a
person's
problems
in
living,
and can
produce
a cure for
them, is, however,
a
dominant theme in one ancient
discipline,
that of
philosophy.
This makes
ancient
philosophy
sound
very
much like modern
psychotherapy.
But we
find in this area the
general difficulty
of
knowing
whether the terms
mental 'sickness' and
'cure',
are
being
used in
anything
like the same
sense as in ancient
(and modern) medicine;
or whether these terms are
being
used to denote the rather different ideas of moral defectiveness and
moral instruction. The belief that the
philosopher
can function as a doctor
of the
psyche emerges
in the late fifth and
early
fourth
century,
B.C. We
are told that
Antiphon
"founded an art to cure
griefs, analogous
to that
which
among
doctors serves as a basis for the treatment of diseases. In
Corinth,
near the
market-place,
he set
up
a room with a
sign announcing
that he was able to treat with words those in distress. He asked them
the causes
(of
their
distress)
and offered consolation." 53 Our evidence
does not enable us to determine his
techniques
with
any certainty;
but
the idea that there exists a
psychological analogue
for the
technique
of
medicine becomes a standard one. Democritus claims
that,
"Medicine
heals diseases of the
body;
wisdom frees the
psyche
from
passions (path-e)";
and this claim seems to be connected with his
attempt
to find a
systematic
way
of
freeing
mankind from
despair
(dusthumia)
and
producing
cheer-
53
Cf. Lain
Entralgo (whose
translation of the relevant
passage
I
give,
in modified
form), op.
cit., 97-98,
and G. B.
Kerferd,
The
Sophistic
Movement
(Cambridge, 1981),
51.
fulness
(euthumia).54 Plato,
in
particular, appropriates
the idea that
phi-
losophy
is a
quasi-medicine,
sometimes
combining
this idea with the
claim that the Socratic
type
of
dialogue
is the most effective method of
cure for
psychic
illness. The locus classicus is the start of the Charmides,
an
early
Platonic
dialogue.
Here,
Socrates
presents
himself as a
special
kind of
doctor,
who will not cure the
body
without the
psyche,
and who
will not
attempt
to cure until he has made a
diagnostic
examination of
the
psyche
of the
patient,
Charmides,
to see if he
possesses
s-phrosune
(self-control)
or not. The
diagnostic
test and the
proposed
'cure' are
conducted in Socrates' distinctive method of
questioning dialogue,
the
elenchus.55 The Socratic method
may
seem,
superficially,
like a
psycho-
in the modern
sense;
for
instance,
both
types
of
dialogue require
the
'patient'
to examine himself
closely.
But the actual
content of the
dialogue
is a
very
different one. Instead of
exploring
the
particularities
of
personal
life
(especially
its emotional
aspects),
Socratic
dialogue
examines a
person's capacity
for
defining
abstract ideas
(such
as
sophrosune).
Given the Socratic
tendency
to
identify
moral excellence
with
knowledge,
this
procedure
makes
sense;
but it means that Socratic
dialogue
is a
quite
different kind of
technique
from modern
psycho-
therapy.
In his later
writings,
Plato
explores fully
the idea that moral defec-
tiveness is a sickness of the
psyche,
and,
as
such,
requires
cure,
of some
kind,
rather than
punishment.56
This
approach
is taken
up by
the
Stoics,
who
catalogue
in some detail the various sicknesses of the
psyche (that
is,
what we
normally
think of as
vices),
and reflect at
length
on the
possibility
and means of
curing
these.57 The term 'sickness of the
psyche'
is used with rather more
plausibility by
the Stoics and the later Plato
than
by
Socrates in the Charmides. For
they
use it to denote the
psy-
chologically
richer area of a
person's relationship
to his emotions or
passions, particularly
those to which he is
particularly
liable.58 Later
Stoics are interested in
examining,
in a
psychologically
realistic
way,
the
extent to which a
person
can master his own
particular
emotional weak-
nesses.
They
are also interested in the
way
in which this
process
of self-
correction can be
promoted by therapeutic dialogue
with another
person.59
However,
the fact remains that
philosophers
such as Plato and the
Stoics were
operating
with a
conception
of
psychic
sickness and cure
that it
significantly
different from that used
by
ancient or modern med-
54
Fragment 31;
cf.
Pigeaud, op.
cit.,
443-45.
55
Cf.
Plato,
Sophist,
227-30,
where Socratic dialectic is described as a means of
bringing
about a
quasi-medical purgation
(katharsis)
of
psychic
diseases.
56 Cf. M. M.
Mackenzie,
Plato on Punishment
(Berkeley, 181), Chaps.
10-11.
57 Cf.
Pigeaud, op.
cit.,
Chap.
3.
58
Ibid.,
291ff.
59
See, esp.,
Seneca,
De Ira and De
Tranquillitate
Animi;
cf.
Pigeaud, op.
cit., 315ff,
503ff, and,
on
Posidonius,
276ff.
icine. Stoic
'madness',
for
instance,
does not
necessarily
manifest itself
to the sufferer in the kinds of distress and
anxiety
that ancient medicine
saw as
symptomatic
of
melancholy
and that modern medicine sees as
symptomatic
of neurosis. Nor does Stoic madness
necessarily
manifest
itself to the observer in the kinds of
pronounced abnormality
of behavior
that ancient medicine saw as
symptomatic
of
phrenitis
and that modern
medicine sees as
symptomatic
of
psychosis.
This reflects the fact that the
Stoics,
like
Plato,
did not
proceed by accepting
the notions of madness
and
sanity
that were current in their
society
and then
attempting
to find
a
psychologically
richer account of these.
Instead,
they
wanted to revise
these
notions,
in line with their radical and
revisionary
moral theories.0
Modern
psychotherapists,
since
Freud,
have
produced revisionary psy-
chological
theories, too;
but their theoretical work has
developed directly
out of clinical
experience
of
people
who
already
seemed to themselves
or their
society
to be abnormal or distressed.
Are there
any
areas of
overlap
between the ancient medical and
philosophical approaches
to
psychic
illness? Did the
philosophers
ever
set out to cure
people
who were 'sick' or disturbed in a medical sense?
Pigeaud argues
that we can find evidence for certain kinds of
overlap,
particularly
with
respect
to what we call 'neurosis'.61 He
points
to Lu-
cretius'
description
of the ennui and restless
anxiety
that afflicted Roman
aristocrats,
and of the
ways
in which
they
felt
'weighed
down'
by
cares
whose
origin
was unclear to them. Lucretius sees these
feelings
as the
symptoms
of a 'sickness' whose
primary
cause is an
unrecognized
fear
of death. He undertakes to cure this sickness
by
his
teaching;
and his
poem
constitutes a kind of
therapeutic dialogue, designed
for this
pur-
pose.62 Pigeaud
also
points
to the
quasi-therapeutic
form of Seneca's De
Tranquillitate
Animi. At the start of this
work,
Serenus
describes,
"as
though
to a doctor"
(ut
medico, 1,
2)
his current
symptoms:
indeterminate
anxiety,
dissatisfaction with
himself,
inability
to settle down to
any
one
course of action.
Pigeaud
notes that these
symptoms
are close to some
of the
symptoms
of
melancholy,
as described in medical texts. This
suggests
that some ancient
philosophers,
as well as
doctors,
recognized
what we call 'neurosis'
(that
is,
anxiety
and distress which are not ex-
plained by
the external circumstances of a
person's life),
and that the
60 Plato's account of the
tyrannical psyche
in
Republic,
Book
IX,
might
seem a counter-
instance: the
psyche,
'maddened'
by
desire
(573a-e),
behaves in a
way
that
might
be seen
as mad in conventional terms
(574d-575a).
But Plato did not write the account in order
to
analyse
conventional
madness,
but to dramatize his
revisionary
ethical theories.
61
Pigeaud, op.
cit.,
513-14.
62Lucretius, 3.1051ff.,
cf.
Pigeaud, op.
cit., 205ff.,
and B.
Farrington,
"Form and
Purpose
in the De Rerum Natura," in
Lucretius, ed. D. R.
Dudley (London, 1965),
19-
34.
philosophers,
as well as the
doctors,
attempted
to offer a cure.63
Pigeaud
does not claim that these
passages
in Lucretius and Seneca constitute the
demarcation of a new area of ancient
thought, combining
the curative
aims of medicine with the
developed psychology
of
philosophy
and thus
constituting
a method which
might reasonably
be
compared
with modern
psychotherapy.
The two areas remain
distinct,
though closely juxtaposed.
Pigeaud's
statement of the
position
seems a fair one. Both ancient doctors
and
philosophers
sometimes
recognized
what we call 'neurosis'
though
neither of them conceived it
quite
as we do. Neurotic behavior was taken
by
doctors as a
symptom
of the
physical
disease of
melancholy,
and
by
philosophers
as a
symptom
of intellectual and moral weakness. The two
approaches
to 'neurosis'
co-existed,
but were not
bridged
or
synthesized
in
antiquity.64
Conclusion. -What conclusions can be drawn from this
survey
of
types
of
practice
in the Ancient World? This
survey
seems to
suggest
that modern
psychotherapy
holds a
place
which was not
recognized
in
the Ancient
World,
between medical and
religious therapy
on the one
hand,
and
philosophical therapy
on the other. Ancient medical and re-
ligious practice
seems to
presuppose
that the roots of emotional disturb-
ance lie in some
region
of the
person
that is 'irrational' in some
sense,
and not amenable to
therapy through dialogue.
For
religion,
this
region
is the one that is reached
through Corybantic
rites or initiation into
mystery
cults,
a
region
accessible to divine
dialogue (through
dreams and
visions)
but not to human
dialogue.
For
medicine,
the source of irra-
tionality
is
usually
taken to be a
physical
one. Humoral
imbalance,
for
instance,
is the
supposed
cause of
melancholy,
which doctors tried to
cure
by administering drugs
such as hellebore.
Enlightened
doctors
(Cae-
lius
Aurelianus,
for
instance) supplemented
such treatment with
attempts
to establish
personal
contact with mad
patients. Similarly,
in
ordinary
life
(if
we can draw
any
inferences from Greek
drama), people
were
conscious of the need to talk to the
mad,
and
ex-mad,
with
special
care
and
sensitivity.
But neither in
medicine, drama,
or
religion
do we find
attempts
to discover the roots of mental disturbance and so effect a cure
by
verbal
therapy
alone.
In ancient
philosophy,
on the other
hand,
dialogue
is much more
central;
and ancient
philosophical dialogue (like
modern
psychothera-
peutic dialogue)
aimed at
inducing
the
'patient'
to examine himself and
improve
his
capacity
for autonomous
living.
Ancient ethical
philosophy
also tended to assume that
personal problems
in
living
derive from the
63
Pigeaud, op.
cit., 204-08, 506,
516-18. One
might compare Antiphon's attempted
cure
(n.
53
above), although
the kinds of distress he tried to cure
may
have had more
determinate causes.
64
Pigeaud
attributes to Pinel
(the grandfather
of modern
psychiatry)
the eventual
attempt
to
join
the two traditions in a
systematic way, op.
cit., 245-47,
531-35.
irrational
regions
of the
psyche.
Unlike the other ancient
disciplines,
however,
ancient
philosophy
held that these
regions
are amenable to
rational
control,
and that
can
help
a
person
to
gain
rational
self-mastery.
This is an
assumption
which ancient
philosophy
may
seem to share with modern
psychotherapy,
but there are
significant
differences in the
types
of
dialogue
used and in the
psychological
as-
sumptions
on which
they
rest. With the
exception
of the unusual 'Socratic'
dialogue,
ancient
philosophical dialogue
was
overtly
didactic in character.
The
philosopher gave
instruction,
argued, urged;
he was
not,
like a
modern
psychotherapist, typically
reticent,
interrogative,
and concerned
to draw the other
person
out.
Also,
ancient
philosophical dialogue
was
explicitly
moral or evaluative in character. There is no
attempt,
as in
modern
psychotherapy,
to create a
morally-neutral,
'free'
space,
in which
the
patient
is invited to be
absolutely
frank about
himself,
without
fearing
the
therapist's
condemnation. There are also differences in
psychological
assumptions.
While ancient moral
philosophy
is interested in
(indeed,
preoccupied with)
the
'irrational',
it does not
recognize,
to
any significant
extent,
the notion of the 'unconscious'.
Certainly,
the
attempt
to
probe
the
person's
unconscious, by
the
exploration
of
dreams, fantasies,
or
verbal
associations,
forms no
part
of ancient
philosophical therapy.
An-
cient
philosophy approaches
the
person
as a conscious
agent,
who is
potentially capable
of
controlling
his emotions and desires
by
deliberate
choice. He is not treated as someone in whom the conscious self
is,
so
to
speak, only
the surface
level,
and whose behavior is
determined,
to a
significant
extent, by
unconscious desires and fears.65 In this
respect,
then,
modern
psychotherapy occupies
a
space
not
occupied
in the Ancient
World,
between the non-verbal
techniques
of
religion
and medicine and
the verbal
techniques
of
philosophy.
The
space
it holds in modern times
would be
hard,
perhaps impossible,
to
imagine
without the
expansion
of
psychological conceptions
we associate with Freud.66
In
pointing
to this
gap
in the ancient
range
of
therapies,
I do not
intend to
disparage
the facilities available for the mad and
emotionally
disturbed in the Ancient World.
My
aim has been to
try
to demarcate
differences and similarities rather than to
argue
for the
superiority
or
inferiority
of ancient or modern institutions. In
fact,
the two main classes
of the
mentally sick,
as we now
distinguish
them,
seem to have had some
kind of
recourse,
during
much of the
period
of Classical Civilization. For
the
'raving
mad' or
psychotics,
the medical
profession attempted
to
bring
65
In modern
psychotherapy,
there is considerable
dispute
about the nature of the
unconscious and the extent of its
power.
But to allocate some role
(often
a
large one)
to
the unconscious in the determination of behaviour has been characteristic of
psycho-
therapy
since Freud.
66 For recent
appraisals
of Freud's
conceptions,
see
Philosophical Essays
on Freud,
ed. Richard Wollheim and James
Hopkins (Cambridge, 1982),
and Ilham
Dilman,
Freud
and the Mind
(Oxford, 184).
about some kind of
cure,
sometimes in a humane and
sympathetic way.67
For those
looking
for a cure for
fears, anxieties,
and distresses with no
obvious source
(neurotics,
as we call
them),
a
range
of
therapies
existed,
religious,
medical,
and
philosophical
in character.
Jung suggests
that a
good many
of the
people
who
go
to
psychotherapists
in the twentieth
century
are
really suffering
from the lack of
any strong
moral or
spiritual
conviction;
and that older
people, especially,
are troubled
essentially by
the fear of death.68 If
people
were troubled for similar reasons in the
Ancient
World, they
had no
shortage
of would-be
therapists, especially
for the treatment of the fear of death.69
The
University College
of
Wales, Aberystwyth.
67
According
to Michel
Foucault,
Madness and Civilization
(New York, 1967),
this
attempt
was
rarely
made in modern
Europe
before the Nineteenth
Century.
68
C. G.
Jung,
Modern Man in Search
of
a Soul
(London, 1933),
120ff.
69
Ancient
'mystery' cults,
e.g.
that of
Isis,
typically
offered the
hope
of
immortality
of the
psyche
to initiates. For
philosophical
exhortations to overcome the fear of
death,
see
Pigeaud, op.
cit., 205-08, 349-53.

Gill Ancient Psychoterapy

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