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Did Schizophrenia Exist in Ancient Greece and Rome?:

Schizophrenia and Epigenetics

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 VOLUME 7 ISSUE 4

The International Journal of

Health, Wellness, and

Society
_________________________________________________
Did Schizophrenia Exist in Ancient Greece
and Rome?
Schizophrenia and Epigenetics

PAUL RICHARD KAUFFMAN AND ROGER MCLENNAN

HEALTHANDSOCIETY.COM
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 Did Schizophrenia Exist in Ancient Greece and
Rome? Schizophrenia and Epigenetics
Paul Richard Kauffman,1 Australian National University, Australia
Roger McLennan, University of Melbourne, Australia

Abstract: Objective: To consider (i) whether schizophrenia is of recent (post 1,800 AD) origin, or has existed and was
documented by the ancients; (ii) any consistency between modern evidence-based treatments, e.g., medications (clozapine
in modern times) and supportive psychotherapy, and ancient treatments; and (iii) whether epigenetics offers the promise
of better personal identification of mental illness in future, leading to better-tailored treatments. Method: The authors
analyze Greek and Latin medical sources including English, French and German translations, concerning mental illness
in classical times, in the light of modern definitions and understandings of schizophrenia. We discuss treatments
recommended by classical writers. We consider the possibility of better identification and treatment of schizophrenia in
future medicine using epidemiology. Results: Beginning with Asclepiades of Bithynia before 40 BC and subsequently, Aulus
Cornelius Celsus (c. 25 BC–c. 50 AD), Soranus of Ephesus (c. 98–c. 138 AD) and Aretaeus of Cappadocia (c. 54–c. 79
AD) a range of mental illnesses consistent with types of schizophrenias are analyzed. Descriptions are more forthcoming
after major Roman urbanisation from 27 BC onwards. It is possible that the form and prevalence of schizophrenias altered
with urbanisation. Aretaeus worked in Rome and wrote: “The modes of mania are infinite in species, but one alone in
genus. For it is altogether a chronic derangement of the mind, without fever.” Conclusion:
We conclude that severe mental illness consistent with schizophrenia probably existed in ancient Greece and Rome, with
urbanisation of the Roman Empire. The best modern treatments include all-encompassing support (e.g., medication such
as clozapine, brief hospitalization, and supportive psychotherapy), recall aspects of treatments provided by some early
Greek doctors. We note advances in treatment of cancer through epigenetics and suggest that epigenetics offers the promise
of better personal identification of mental illness including schizophrenia, leading to better-tailored treatments.

Keywords: Schizophrenia, Sexual Abuse and Schizophrenia Treatments for Schizophrenia, Aretaeus of Cappadocia,
Asclepiades of Bithynia, Aulus Cornelius Celsus, Aretaeus of Cappadocia, Soranus of Ephesus,
Galen of Pergamon, Classical Greek and Roman Medicine, Epigenetics, Mental Disorders

Introduction

T o understand the causes of schizophrenia, it is useful to consider a thresh hold question of

whether schizophrenia is a new illness which emerged after about 1,800 AD (Torrey 2013,
372, Semple 2005, 178), or whether schizophrenia-type illnesses have been around for a
much longer period.
Systematic approaches to treating such illnesses by early Greek physicians are considered, to
ascertain if any have therapeutic value in the light of modern evidence-based medicine. Such an
approach is consistent with the neurologist Oliver Sacks, whose elder brother suffered from
schizophrenia, advocating for “more research on the power of community, friendship, and love
combined with the right medication and perhaps psycho-therapy” to treat schizophrenia (Sacks O
2014, 2015). Greek and Roman doctors developed taxonomies of mental illnesses based on
observations and recommended pharmaceutical and non-pharmaceutical methods of healing. A
review of their writings follows Sacks’ advocacy for more effective treatments, which in
contemporary medicine includes medication combined with psycho-social support. We consider
the ancient past and reflect on the direction of future insights into these illnesses, including
epigenetics.
Jeste surveying ancient medical sources from early Mesopotamia to the 17th century wrote
“certainly delusions, hallucinations, and bizarre behaviour existed in ancient times.” Mania was

1
Corresponding Author: Paul Kauffman, 142 Dryandra Street, Classics, Australian National University,
Canberra, Australian Capital Territory, 2602, Australia. email: paul.kauffman@gmail.com

The International Journal of Health, Wellness, and Society

Volume 7, Issue 4, 2017, www.healthandsociety.com
© Common Ground Research Networks, Paul Richard Kauffman, Roger McLennan
All Rights Reserved. Permissions: support@cgnetworks.org
ISSN: 2156-8960 (Print), ISSN: 2156-9053 (Online)
https://doi.org/10.18848/2156-8960/CGP/v07i04/9- (Article)
THE INTERNATIONAL JOURNAL OF HEALTH, WELLNESS, AND SOCIETY

the general Greek term for madness or insanity and used in a much broader and more valuable
sense than our word “madness,” and terms were used differently by different authors. Jeste
observes that from about 500 AD to 1,500 AD people who heard voices or saw visions were
considered to have had divine or satanic experiences).

In the pre-industrialisation period, many schizophrenic patients were probably cared for
by their families. Today this is still true for developing countries where a majority of
schizophrenia patients are not hospitalised. (Jeste 1985, 494, 501, cf Kauffman 2016)

Torrey wrote that he could not find descriptions of schizophrenia with the initial break in late
adolescence or early adulthood, the constellation of symptoms and the chronic course before 1800
(Torrey 2013, 372). Evans applied DSM-IV criteria for schizophrenia to literary texts and did not
locate descriptions of schizophrenia (Evans et al. 2003).
Through contact with Greek culture, the Romans employed Greek doctors and adopted their
ideas on medicine and mental illness (von Staden1996, 369). The ancient Fathers deduced quite a
lot about variability, plasticity, and overlap between disorders and we conclude that symptoms
which can identify schizophrenia were known and described in classical times. Hippocrates of Cos
(470–ca. 360 BC) classified mental illnesses, including paranoia, epilepsy, mania, and
melancholia. From about 100 BC onwards Asclepiades, Celsus, Aretaeus, Soranus, Aurelianus,
and Galen wrote on mental illness.
Celsus (c. 25 BC–c. 50 AD) described three forms of insanity: phrenitis (delirium),
melancholia (depression) and an unnamed third form “the most chronic, involving hallucinations
or disordered intellect.” The third form has two subtypes, “some are deceived by false images…
(and) some are disordered in their judgement.” (Celsus 1853, 242).
Aretaeus of Cappadocia (pre-54 AD–c.79 AD) described a range of severe mental illnesses,
including mania (insanity) some types of which appear to satisfy all five parts of the DSM
definition of schizophrenia. Soranus’ work survives in a Latin, translated by Aurelianus. He wrote
that mania can also manifest itself as memory disorders, dysfunctions of the senses (i.e.,
hallucinations) and all kinds of delusional ideas. The famous Galen of Pergamon (129–c. 216 AD)
wrote about patients suffering from various forms of insanity including experiencing disturbing
hallucinations (visual and acoustic) and fear.

Current Knowledge of Schizophrenia

Kraepelin (1896), Bleuler (1911) and the Diagnostic and Statistical Manual of Mental
Disorders(DSM-5 2013) (Picchioni et al. 2007) have described schizophrenia. There is a lack of
objective tests, and discontinuation of subtypes (DSM 101, Tandon et al. 2013). Schneider (1959)
and Mellor (1970) have attempted to identify ten first-rank symptoms of schizophrenia. Delusional
beliefs are important (Torrey 2013, 30), but they are defined differently in different cultures
(Semple 2005, 86). Schizophrenia has an extensive range of identifying phenomena (Buckley et
al. 2009). There is an overlap between conditions and high variability in particular cases and
between cultures (Semple 2005, 158, Chandrasena et al. 1979).
Torrey describes some schizophrenic experiences as religious (Torrey 2013, 11). Polytheistic
societies which flourished around the Mediterranean until the 3rd century AD had a greater
tolerance for otherworldly beliefs than modern urban industrial secular societies. Subsistence
agricultural societies also had lower demands for consistent patterns of independent work. That
may have been a factor that masked the prevalence of reported schizophrenia, particularly before
the reign of Augustus (27 BC–14 AD) and the life of Trajan (53–117 AD) (Beckjan 2014). The
Roman Empire doubled in geographical area. There was significant migration to cities which grew
rapidly during the period which corresponds with better descriptions of psychiatric illness.

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 KAUFFMAN & MCLENNAN: DID SCHIZOPHRENIA EXIST IN ANCIENT GREECE AND ROME?

Contemporary social therapies for schizophrenia stress the importance of family support and
how symptoms may vary between episodes (Becker and Kilian 2006; Pharoah et al. 2010; Dickson
et al. 2010).
The ancients described depression (called “melancholia”), and bipolar disorder/manic
depression (called mania), which is variable in presentation. Aretaeus connected the two
syndromes of mania and depression (Semple 2005, 300–2). There are similarities between manic
depression and schizophrenia in modern psychiatry (Torrey 2013, 58). Management of the
mentally ill was very different to modern times, but Killackey and McGorry’s emphasis on tailored
psycho-social interventions would resonate with some ancient Greek doctors (Killackey et al.
2012).
Doctors would admit a patient with a mental (or physical) illness and assess him at an
asklepion, a centre dedicated to the god Asclepius over some days. A patient would use
pharmacopia, bathe and eat suitably, and purge emotions through theatre and art and a healer would
talk with the patient. By contrast, modern psychiatric treatment includes short-term hospital
admission, antipsychotic medications such as clozapine and supportive psycho-therapy (Semple
2005, 204).

Hippocrates of Cos (c. 460–c. 370 BC)

Hippocrates was born on the island of Cos in the Aegean and practiced medicine at the asklepion.
He is considered the father of western medicine. He wrote the famous Hippocratic Oath which
includes the statement:

With regard to healing the sick…I will take care that they suffer no hurt or damage.

Hippocrates promoted medicine as a distinct field of endeavor that can be advanced by scientific
study. His writings are extensive, but later authors may have written come of his works (Adams
1891). He often used lifestyle modifications such as diet and exercise to treat some diseases
including diabetes. He said:

Let food be your medicine, and medicine be your food….Walking is man's best medicine
(Chisti 1988, 11).

Hippocrates is credited with being the first recorded physician who believed that diseases were
caused naturally and not caused by superstitions or gods (Grammaticus et al. 2008). He advocated
that physicians should record their findings and their medicinal methods in a clear and objective
manner, so that records may be passed down to other physicians (Margotta, R. 1968,68).
He advanced the systematic study of clinical medicine. He described four types of mental
illnesses but did not identify schizophrenia as a separate illness. Three important categories were
“mania” (“insanity”) “melancholy” (literally “black bile” used in most subsequent literature to
refer to depression), and phrenitis, (delirium, condition of the mind which was originally thought
to exist in the diaphragm, temporary delusional belief -modern English derives the word
“phrenetics” meaning “frantic” from it). He writes “mania manifests itself through hallucinations,
delusions, bizarre fears and other inappropriate moods.” His book On the Sacred Disease does not
describe the treatment for epilepsy or mania in any detail, but it implies that treatment consists of
correcting the imbalanced state of the body and the brain. Epilepsy’s symptoms are characterised
by sudden, transient seizures. Hippocrates observed that “the range of its symptoms also includes
nocturnal fears and terrors and derangements (paranoia) and jumping out of the bed and running
outdoors. Thus it is akin to madness (mainesthai)” (I, II Jouana, Ahonen 2014, 10–4). Hippocrates’
terms for mental illnesses shaped subsequent medical thought and continued in general use for
millennia.

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THE INTERNATIONAL JOURNAL OF HEALTH, WELLNESS, AND SOCIETY

The writings of Asclepiades of Bithynia, in present day Turkey, (c. 124/129–40 BC) survive
in fragments and in quotes by later authors. He advocated humane treatments. His aphorism “to
treat safely, quickly and pleasantly” was a welcome innovation (Celsus II.4.1, Rawson 1982, 359).
Asclepiades founded his medical practice on a modification of the atomic or corpuscular theory of
disease and arranged diseases into Acute and Chronic. From quotes in subsequent medical writers,
it is also possible to reconstruct his use of pharma, involving seventy different substances in a total
of 116 materials, although his precise pharmacology for mental illnesses is not discernible
(Gumpertz, C.G. 1794, Scarborough 1975, 54).
Aulus Cornelius Celsus (c. 25 BC–c. 50 AD) was a Roman encyclopedist who wrote in Latin
using Greek sources. He is known for his De Medicina, which discusses diet, pharmacology,
surgery and mental illness. He probably did not himself practice medicine or make long term
observations about patients. He described phrenitis, occurring in fever, depression and a “third sort
of insanity...the most prolonged...which does not shorten life” with two subtypes (i) deceived by
phantoms, and (ii) disordered in judgement and foolish in spirit. Celsus approves of Asclepiades
who said patients should not be kept in the dark and blood-letting and opium should not be used.
For the “other sort of insanity” of longer duration because it generally begins without a fever, as
possible remedies Celsus recommends:

Good hope should be put forward; entertainment sought by story-telling…

They should not be left alone or among those they do not know (Celsus 1938, 301–3).

Celsus quotes Asclepiades’ insanity remedies and human treatments approvingly. Modern
“tailored psycho-social interventions” now advocate similar approaches. He states that insanity is
present when continuous dementia begins due to the mind being at the mercy of imaginings. He
suggests that people must heal their souls through philosophy and personal strength. He describes
diverse contemporary practices including talking therapy, incubation in temples, exorcism,
incantations and amulets, as well as restraints and “tortures” to restore rationality, including
starvation, being terrified suddenly, agitation of the spirit, and stoning and beating.
Aretaeus of Cappadocia worked during the reigns of the Emperors Nero 54–68 AD and
Vespasian 69–79 AD. He came from Cappadocia, in what is now central Turkey. He wrote eight
books on medicine in Greek including a general treatise on disease and precise symptoms. His
most relevant book for psychiatry is On the Causes and Symptoms of Chronic Disease. According
to DSM-V, the symptoms of schizophrenia involve two or more of (i) delusions (ii) hallucinations
(iii) disorganised speech (iv) catatonia (v) negative symptoms i.e., asociality, as well as (vi)
decreased function at work (Torrey 2013, 61). Aretaeus discusses several chronic mental illnesses.
There is a type of illness of the head (cephalaea) where one finds:

There is much torpor, heaviness of the head, anxiety, and ennui. For they flee the light;
the darkness soothes their disease

There is a type of epilepsy where patients

are languid, spiritless, stupid, inhuman, unsociable,…slow to learn, from torpidity of the
understanding and of the senses; dull of hearing; have noises and ringing in the head;

It is most likely that Aretaeus had seen and treated illnesses which would now be diagnosed as
schizophrenia. He identifies all six of the DSM criteria in his chapter VI on mania (insanity) and
writes:

The modes of mania are infinite in species, but one alone in genus. For it is altogether a
chronic derangement of the mind, without fever…

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 KAUFFMAN & MCLENNAN: DID SCHIZOPHRENIA EXIST IN ANCIENT GREECE AND ROME?

Persons are most given to mania, namely, those about puberty, young men, and such as
possess general vigour… Women also sometimes become affected with mania…
But the modes are infinite in those who are ingenious and docile…
In the uneducated, the common employments are the carrying of loads, and working at
clay… They are also given to extraordinary phantasies; for one is afraid of the fall of the
oil cruets ... and another will not drink…others roar aloud, bewailing themselves… Some
flee the haunts of men and going to the wilderness, live by themselves. If they should
attain any relaxation of the evil, they become torpid, dull, sorrowful; for having come to
a knowledge of the disease they are saddened with their own calamity.

He also discusses mental confusion or delirium (phrenitis) where patients

see things not present as if they were present, and objects which do not appear to others,
manifest themselves to them…they are sharp in hearing, but very slow in judgment; for
in certain cases there are noises of the ears, and ringings like those of trumpets and pipes.
(Aretaeus 1972, Bk 1 chapters 3–6: passim pp. 49–59)

Aretaeus records a strong appreciation of variability, plasticity and overlap between severe mental
disorders. His descriptions of “epilepsy” and “melancholy” (depression) immediately recall
modern diagnoses of those illnesses, partly because the same words probably describe similar
illnesses.
It seems likely that Aretaeus had observed epilepsy, depression, bipolar illness, and
schizophrenia, but his descriptions of major mental illnesses do not precisely correspond to modern
descriptions. Patients lacked the benefit of modern medications and systematic observations. A
patient was observed for a few hours or at most days, and there were no patient records extending
over years (Nutton 2009).
Soranus (pre-98–138 AD) lived in Ephesus, a major trading city in what is now the coast of
western Turkey. It was once a harbour city, famous for its Temple of Artemis, library and baths.
Soranus also practised in Alexandria and Rome in the 1st and 2nd centuries AD. His work on
psychiatry survives in some Greek fragments and translation, or possibly further development, On
Acute and Chronic Diseases, translated into Latin by Caelius Aurelianus, who lived during the
5th century AD.
Caelius/Soranus writes that mania (insanity) can also manifest itself as memory disorders,
dysfunctions of the senses (i.e., hallucinations?) and all kinds of delusional ideas. Mania is
typically a disease of young and middle-aged men. As its antecedent causes, he lists both physical
and psychological factors, indulging in excessive use of alcohol or drugs, immoderate sexual
indulgence, insomnia and mental stress, along with intense emotions such as anger, grief or fear.
Sometimes no cause can be identified.

Intense but inappropriate emotions are also among the most typical symptoms of the
illness: patients may be excessively joyful, gloomy or angry, or obsessively afraid of some
harmless object. Mania can also manifest itself as memory disorders, dysfunctions of the
senses and all kinds of delusional ideas (see Ahonen 2014, 15).

Caelius enumerates cases of fanciful delusions concerning the patient’s identity: “one patient
believed himself to be a sparrow, another a god, another an actor, another an ear of corn, and
another a baby, acting according to his delusions and demanding to be held.”. Mania is an affliction
of the head and the whole nervous system. He advocates the following treatments:

The patient should be kept in bed (tied up, if necessary for safety reason), in a warm and
peaceful room (with no murals, and only carefully selected visitors allowed). He is

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massaged, fomented…he is prescribed fasting, then light food, physical exercise and, later
on, a change of climate.

Sometimes mania becomes chronic or recurs periodically, being relieved by periods of

remission. Aurelianus recommends many psychotherapeutic measures. Servants or slaves should
correct inappropriate beliefs or delusions gently suggesting that his delusions are untrue. They can
read to the patient. The patient can watch dramatic performances. Hilarious mime can help a
depressed patient. Tragedy can subdue an excessively cheerful patient. The patient should be
encouraged to give speeches to his family and friends, which should be praised, or to play checkers.
He condemns previous therapies of keeping a patient in darkness, drugging him with alcohol, or
flogging a patient (Caelius 1950, Ahonen 2014).

Galen of Pergamon (129–c. 216 AD)

Aelius Galenus, also called Claudius Galenus or Galen, lived in Pergamon, which lies about 180
km. north of Ephesus. It was a large city and had a large asclepeion. Galen was famous as a
surgeon, physician and philosopher. He influenced anatomy, physiology, pharmacology and
pathology for the following 1,400 years. He probably wrote or dictated ten million words although
only three million of them still survive.
His treatment of mental illness is “of a more incoherent and patchy nature than that of other
ancient medical authors such as Caelius Aurelianus and Aretaeus,” and his surviving comments on
mania are meagre (Ahonen 2014, 159, 176). He discusses mental symptoms in “On the parts
affected by disease” (Kühn On Affected Parts: 8.185, 190). He refers to mania and melancholia in
Book III and discusses phrenitis in Book IV. He also discusses melancholia in Book VIII: 176–
93. He writes that the two primary sources of “melancholy” are fear (phobos) and depression
(dysthymia) (Kühn 7, 202) He writes

The “unnatural impressions” (phantasia) which patients experience when suffering from
melancholy are of infinite number (Kühn 8: 190 quoted in Ahonen 2014, 147).

The word phantasia covers hallucinations, delusions and a combination of these. Galen writes
about patients suffering from various forms of mania (insanity) including phrenitis (a type of
insanity) where patients experience disturbing hallucinations (mostly visual or acoustic), forget
things, be fearful or over-courageous. Galen also uses the term phrenitis to refer to derangement
occurring with fever. He distinguishes fever-related delirium with “phrenitis proper,” which does
not subside as the fever subsides. This “phrenitis” is of two kinds. The patients can experience
disturbing hallucinations (mostly visual and/or acoustic), forget things, be fearful or over-
courageous, aggressive or joyful, or utter obscenities.

Sometimes, however, they are able to perform intellectually demanding tasks during their
derangement such as explaining geometrical theorems, although their sense of reality is
utterly lost (Kühn 16: 566 quoted in Ahonen 2014, 156).

The case that Galen refers to is not distinctly different from John Nash’s schizophrenia
diagnosed in the 20th century. Galen writes about a “Theophilus” who constantly sees and hears a
group of flute-players in the corner of the room, who keep playing day and night, to his great
annoyance. After he recovers, Theophilus remembers receiving visitors while unwell, as well as
the “imaginary” flute-players. Melancholy and epilepsy share some similarities. Regular exercise
and massage and keeping the body warm are helpful for both conditions. In medical therapy
generally, he emphasises the principal metron ariston “moderation is best.” Galen writes that major
mental illnesses occur fairly rarely (Ahonen 2014).

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 KAUFFMAN & MCLENNAN: DID SCHIZOPHRENIA EXIST IN ANCIENT GREECE AND ROME?

Conclusions
Many similar psychiatric illnesses are described with Greek words, apart from “schizophrenia” a
term created using Greek roots and first used in the 20th century. Classical taxonomies do not
correspond perfectly with contemporary definitions of various mental illnesses, and these evolved
over time.
Aretaeus of Cappadocia’s observation in the first century that ‘the modes of insanity are
infinite in species, but one alone in genus’ may inform future research into schizophrenia.
Medical time was very different in antiquity. Doctors lacked a modern patient record
extending over years. In contemporary medicine the diagnosis of some of the major mental
illnesses such as schizophrenia are not immediately apparent, and diagnoses of particular cases can
change over time for particular patients. It is therefore understandable that classical sources did not
unambiguously identify schizophrenia.
It appears that symptoms consistent with schizophrenia were known in classical times. There
is a reference to an unnamed third type of insanity by Celsus in the first century AD. Soranus in
the second century AD, translated by Aurelianus writes of dysfunctions of the senses (i.e.,
hallucinations) and fanciful delusions—a patient believes himself to be a sparrow, a god, an actor,
an ear of corn, a baby. Aretaeus in the first century provides extended definitions of mania, which
can be languid, inhuman, unsociable, with noises and ringings in the head. Patients become torpid,
dull and sorrowful. In melancholy, patients can be seized by extreme fear and die.
The Greek typologies of mental illness differed somewhat from modern psychiatry but the
terms were influential for millennia, and five medical writers’ definitions were broad enough to
encompass types of schizophrenia (see Table 1).
It is possible that the clinical manifestations of schizophrenia have altered through history. Its
form and prevalence may have altered (Jeste 1985, 501). Many people suffering from this illness
were probably cared for by their families in early classical times, just as they are today in rural
Africa and Asia.

The Future of Psychiatric Medicine

Psychiatry may be on the verge of the bio-molecular revolution seen first in the study of
haematological and malignant diseases. For example, cancer is no longer considered as a general
disorder.
The haematological and later the cancer sector had a fifty year advantage by virtue of the
removability of viable tissue from the body, its ability to be artificially cultured in the laboratory
and its transplantable nature into other immune modulated species along with the development of
molecular sciences which enabled the growth in understanding of the genetic and more recently,
epigenetic control mechanisms for the expression of phenotype and hence variance from the norm.
The problem for psychiatry has been how to examine the organ of mentation objectively. From
the nineteen fifties, organic chemists and physiologists using surrogate species and tissues,
identified neural cellular emitters and receptors for a variety of molecules including adrenalin,
serotonin, dopamine, glutamine and cholinergic molecules; various pharmacological
manipulations of these pathways by blockade, enhancement, and reuptake inhibition have resulted
in dramatic alteration and suppression of the more florid expressions of mental disorder, and some
reduction in morbidity for the suffering. These developments have been accompanied by the
emptying of long-term mental institutions, as a result of more sympathetic and tolerant public
attitudes to mental illness and better pharmacologic control of symptoms. The change resulted in
a greater direct burden to be shared by families and the community.
From the 1970s new modalities of static neural imaging with computed tomographs of X-ray
images enabled the neurologist and psychiatrist to discriminate organic and structural disease
manifesting as mental disorder quickly. Ten years later computed tomographic imaging from

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magnetic resonance stimulation complimented by infusional chemical enhancement and

radioisotope positron computational imaging have produced static and dynamic images of brain
activity of even greater clarity and curiosity. Unfortunately these tools have barely changed our
understanding of disordered mentation although the images of electro-biochemical activity during
‘thinking’ are fascinating; on the positive side they have demonstrated the plasticity of functional
repair after structural damage and the holistic activity of the brain during mental activity as distinct
from the twentieth century’s neuroanatomist's view of strict specialization of segments of the brain.
The new tools for understanding the underlying order and variance in nature have developed
in analyzing the structure and function of cellular mechanisms at many levels. The study of nuclear
genetic coding, replication, suppression, translation and epigenetic modification has been most
fruitful. We now understand not only of hereditable disorders but also the enormous variety of
phenotype within our and other species.
We no longer think of cancer as a generic disorder, for each patient one of many thousands of
genetic abnormalities which are capable of being “read,” in each case to enable the design and
application of a specific treatment for that cancer. We are now in the era of tailored medicine.
How then is psychiatry to proceed? Psychiatric diseases are not understood to be post foetal
mutational disorders as are most malignant diseases. Since the complete reading of the human
genome ten years ago, the cost of reading has decreased to the order of a thousand dollars per
reading in the last five years and is heading lower. Similarly, reading of selected segments of
genetic material of interest has led to the science of epigenetics, the mechanisms of control of
genetic silencing and expression.
It is now possible to examine or read in detail for specific abnormalities in broad groups of
disease. Like cancer medicine we should not expect to find a single explanation within each disease
group but myriad differences in genetic makeup contributing to common patterns of phenotypic
expression.
Will the pain of distressing hallucinations, the soporific life following medication or the
sensation of ten tons of concrete in the face during depression be amenable to relief by
understanding abnormal epigenetic expression? If cancer and haematological sciences are
signposts, it is to be hoped the answer is yes.

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 KAUFFMAN & MCLENNAN: DID SCHIZOPHRENIA EXIST IN ANCIENT GREECE AND ROME?

Table 1: Summary of Mental Illnesses in Greek and Roman Medical Literature

Hippocrates of Cos (c. 460–c. 370 BC)
Phrenitisi: delirium, temporary delusional belief
Mania: insanity
Epilepsy: includes nocturnal fears, terrors and derangements (paranoia), akin to mania
Melancholy: associated with phobos fear and dysthymia depression
Aulus Cornelius Celsus: Roman Encyclopaedist (c. 25 BC–c. 50 AD)
Phrenesis: those who rave in their talk
Melancholy: depression
Another…kind: …does not shorten life…the patient is a) duped…by phantoms b) disordered in
judgement
Soranus of Ephesus: Translated by Caelius Aurelianus 5th century AD (c. 98–c. 138 AD)
Memory Disorders/Dysfunctions of the Senses: i.e., hallucinations (?)
Mania: is typically a disease of young and middle-aged
Fanciful Delusions: a patient believes himself to be a sparrow, a god, an actor, an ear of corn, a baby
Aretaeus of Cappadocia (1st century AD)
Cephalæa: [with] infinite varieties, [if] chronic…there is…torpor, heaviness of the head, anxiety, and
ennui…they flee the light…if incurable it [becomes] mania, melancholy, or epilepsy… [with]
heaviness of the head…ignorance of themselves and of those around.
Phrenitis: hallucinations are its main feature…see things not present as if they were present, and
objects which do not appear to others, manifest themselves to them…in certain cases there are noises
of the ears, and ringings like those of trumpets and pipes.
The modes of mania are infinite in species, but one alone in genus. It can be languid, spiritless, stupid,
inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable,…sleepless, subject to
many horrid dreams…slow to learn, from torpidity…have noises and ringing in the head. Mania…of
young men…given to extraordinary phantasies…there are noises of the ears, and ringing like those of
trumpets and pipes…terror seizes them as if from a thunderbolt. If they should attain any relaxation of
the evil, they become torpid, dull, sorrowful; for they are saddened with their own calamity
Melancholy: [is diverse] they are either suspicious of poisoning, or flee to the desert from
misanthropy, or turn superstitious…women are worse affected with mania than men. As to age,
towards manhood, and those actually in the prime of life…Unreasonable fear also seizes
them…when their dreams are true, terrifying, and clear… [some] desire to die.
Claudius Galen: Also known as Aelius Galenus (129–216 AD)
Phrenitis: delirium, temporary delusional belief
Phrenitis Proper: disturbing visual and aural hallucinations…their sense of reality lost
Mania: insanity
Melancholy: associated with fear and depression
Epilepsy: includes some symptoms akin to mania and often associated with depression

Acknowledgements
Discussions with Professor Richard Ball MD, Robert Barnes, Dr. Les Drew MD, Professor Kathy
Griffiths, Professor Gregory Horsley, Dr. Jean Hollis MD, Professor Michael Jackson, Dr. Rodrigo
Kalyana MD, Professor Harold Koenig MD, Dr. Bruce Lean MD, Professor Tim Lambert MD,
Professor Patrick McGorry MD, Dr. John Saboisky MD, Dr. Joseph Stoklosa MD and Dr. Florian
Wettenmeyer MD and anonymous reviewers are acknowledged.
The authors` personal and scientific interests in this topic are explained in Kauffman 2015,
Kauffman 2016, 2017(a), (b), and Cutajar M et al. 2015.

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ABOUT THE AUTHORS

Paul Richard Kauffman, BAAS, MA, PhD: Australian National University FAIM FASA,
Consultant, Canberra ACT Australia

Clive Roger McLennan, MD: Universities of Melbourne and Cambridge, FRCP, FRACP,
Consultant, Geelong Victoria Australia

23
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