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COMPETENCE CONFLICTS BETWEEN PHILOSOPHY AND MEDICINE: CAELIUS AURELIANUS AND THE STOICS ON MENTAL DISEASES*

  • Roberto Polito

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It is an established Hellenistic topos that philosophy is the ‘medicine’ of the soul, in charge of ‘healing’ the soul in the same way as medicine is in charge of healing the body. The ‘diseases’ of the soul deemed to be in need of healing are its passions, that is, its fears and desires, and the moral ‘health’ that philosophers pledge to grant their followers is freedom from passions and hence peace of mind.

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I would like to thank Prof. van der Eijk for following the Sitz im Leben of this paper during my Berlin stay, as well as all those attending the 2014 ‘SedFest’ Conference in Cambridge for helpful comments on a revised draft of the paper. I alone am responsible for any remaining errors. This paper has been written thanks to the generous support of the Alexander von Humboldt Foundation.

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1 This description goes back as far as Democritus (B 31 DK = Clem. Paed. 1.6 [1.93.15 Stähl.]), and finds parallels in both Plato and Aristotle (references in M.C. Nussbaum, The Therapy of Desire [Princeton, 1994], 48–77; see also Jaeger, W., ‘Aristotle's use of medicine as model of method in his ethics’, JHS 77 [1957], 5461 ). Nussbaum (this note), esp. 13–47, however, argues that the medical simile captures a feature of Hellenistic philosophies as distinct from classical ones. See also, more recently, C. Gill, ‘Philosophical therapy as preventive medicine’, in W.V. Harris (ed.), Mental Disorders in the Classical World (Leiden, 2013), 339–60. The Stoic use of the medical simile is discussed by T. Tieleman, Chrysippus on Affections: Reconstruction and Interpretation (Leiden, 2003), 142–57.

2 The work of Caelius Aurelianus on chronic and acute diseases, the only one which has come down to us, is edited and translated by I.E. Drabkin, Caelius Aurelianus: On Acute Diseases and on Chronic Diseases (Chicago, 1950). A more recent edition, with a German translation, is that of G. Bendz (ed.) and I. Pape (trans.), Caelii Aureliani Celerum Passionum libri III, Tardarum Passionum libri V (Caelius Aurelianus, Akute Krankheiten, Buch I-III. Chronische Krankheiten, Buch I-V) (CML VI.1) (Berlin, 1990).

3 Hanson, A.E. and Green, M.H., ‘Soranus of Ephesus: methodicorum princeps ’, ANRW 37.2 (1994), 9681075 offer an account of Soranus. Caelius was long considered to be a mere translator of him. Recent scholarship has a more favourable view on the originality of his contribution (P. van der Eijk, ‘Antiquarianism and criticism: forms and functions of medical doxography in Methodism [Soranus, Caelius Aurelianus]’, in id. [ed.], Ancient Histories of Medicine: Essays in Medical Doxography and Historiography in Classical Antiquity [Leiden, 1999], 397–452, at 414–24). Be that as it may, Caelius does not mention any author later than Soranus, something which suggests that the medical debate for which he is a witness does not postdate Soranus’ day.

4 Testimonia are edited by P. Podolak, Soranos von Ephesos, Περὶ ψυχῆς: Sammlung der Testimonien, Kommentar und Einleitung (Berlin, 2010).

5 The group of texts from Caelius that I will consider is also referred to by M. Ahonen, Mental Disorders in Ancient Philosophy (Studies in the History of Philosophy of Mind 13) (Cham/New York, 2014), 25–6, who, however, believes that the controversy to which they give voice does not reflect a widespread concern.

6 Caelius’ expression insipientiae genus (lit. ‘a form of lack of wisdom’) is a mere periphrasis for insipientia.

7 The specification nunc (‘now’) leaves the possibility open that he will write about intellectual madness at a later stage. However, no such discussion is found elsewhere in the treatise. Thus this specification presumably indicates ‘in this context’, referring to a medical treatise.

8 Acute Diseases 3.109. M. Horstmanshoff, ‘Les émotions chez Caelius Aurelianus’, in P. Mudry (ed.), Le traité des Maladies aigues et des maladies chroniques de Caelius Aurelianus (Nantes, 1999), 259–90, at 283 attributes the argument to Caelius himself, but this is wrong.

9 To claim that hydrophobia is treatable by means of philosophical remedies may look strange in view of the fact that the disease ‘kills the patient most quickly’ (Acute Diseases 3.106). However, the lethal nature of the disease was a matter of controversy in antiquity (see e.g. Arist. Hist. an. 604a5–7). Caelius Aurelianus himself at Acute Diseases 3.106 mentions the case of patients suffering from hydrophobia for several years.

10 Here I agree with J. Pigeaud, La maladie de l'âme. Étude sur la relation de l'âme et du corps dans la tradition médico-philosophique antique (Paris, 1981), 109.

11 The text has come down to us in a fragmentary status, and, moreover, it looks as if the author failed to give the final touch, something that affects the intelligibility of the plan itself of the work, or at least of its consistency throughout. The text has been edited by D. Manetti, Anonymus Londiniensis: De Medicina (Berlin, 2011); for a survey, see D. Manetti,‘“Aristotle” and the role of doxography in the Anonymus Londiniensis (Pbrlibr Inv. 137)’, in van der Eijk (ed.) (n. 3), 95–141.

12 Anon. Lond. 1.15–33 passim: τῶν παθῶν τὰ μέν φασιν εἶναι ψυχικά, τὰ δὲ σωματικά […] σωματικὰ δὲ πυρετός—προηγούμενον μὲν πάθος ἐστὶν τοῦ σώματος, κατ' ἐπακολούθημα δὲ τῆς ψυχῆς—μανία ὁμοίως (‘Of affections some are said to be psychic, others bodily … Bodily affections are fever—it is a primary affection of the body, as an affection of the soul is secondary—similarly mania’). I follow Diels's text.

13 Anon. Lond. 2.34–41: τῶν τε παθῶν τῶν περὶ τὴν ψυχὴν δύο ἐστὶν τὰ γενικώτατα κατὰ τοὺς ἀρχαίους· ἡδονή τε γὰρ καὶ ὄχλησις […] κατὰ δὲ τοὺς Στωικοὺς τέσσαρά ἐστιν τὰ γενικώτατα τῆς ψυχῆς πάθη· ἡδονὴ γὰρ καὶ ἐπιθυμία, φόβος τε καὶ λύπη (‘Of affections of the soul two, according to the ancients, are the most generic: pleasure and distress … But according to the Stoics the most generic affections of the soul are four in number: pleasure and desire, fear and grief’). As for the Stoics, see e.g. Diog. Laert. 7.111 (= SVF 3.412): τῶν δὲ παθῶν τὰ ἀνωτάτω […] εἶναι γένη τέτταρα, λύπην, φόβον, ἐπιθυμίαν, ἡδονήν; also Stob. Ecl. 2.88 (= SVF 3.378); Cic. in e.g. Fin. 3.35 (= SVF 3.381); cf. Tieleman (n. 1), 114–22. It is not clear who the Ancients to whom Anonymus refers were. Galen, De animi cuiuslibet affectuum dign. et cur. 5.3 K claims that both Plato and Aristotle had already written on the ‘cure of the affections of the soul’ before Chrysippus did. But they can hardly be credited with positing pleasure and distress as the most basic passions, let alone ‘diseases of the soul’.

14 Anon. Lond. 21.13–18: συνέστηκεν δὲ ὁ ἄνθρωπος ἐκ ψυχῆς καὶ σώματος. ὡς δ' εἰς τοῦτο ὑποτυπώσεως οὐ χρεία ἐστίν, περὶ μὲν ψυχῆς ἄλλοις ἀναβάλλομαι· ἡμῖν δὲ τοῦ σώματος μελητέον, ἐπεὶ μάλιστα περὶ τοῦτο σπουδάζει ἡ ἰατρική.

15 The title is mentioned by Galen at Adversus Iulianum K18A.257.

16 To the best of my knowledge, Ptolemy (Tetr. 3.15) is the only author who uses the expression πάθη ψυχικά for indicating mental diseases with a bodily origin.

17 Gal. De locis affectis K8.166: γίνονται μὲν οὖν καὶ μετὰ πυρετοῦ βλάβαι τῶν ἡγεμονικῶν ἐνεργειῶν, ὡς ἐπὶ φρενίτιδός τε καὶ ληθάργου· γίνονται δὲ καὶ χωρὶς πυρετοῦ, καθάπερ ἐπὶ μανίας τε καὶ μελαγχολίας· ὥσπέρ γε καὶ κατὰ συμπάθειάν τε καὶ πρωτοπάθειαν ἐγκεφάλου (‘It also happens that the ruling activities of the soul are damaged in fever, as during phrenitis and lethargy. This also occurs without fever, as in mania and melancholy, also by sympathy and by a primary affection of the brain’).

18 Galen's psychological writings have been recently translated and commented on by P.N. Singer (ed.), Galen: Psychological Writings (Cambridge, 2014). See also Ahonen (n. 5), 139–77.

19 Stok, F., ‘Follia e malattie mentali nella medicina dell'età romana’, ANRW 2.37.3 (1996), 2282–409, at 2344–6 is therefore right in labelling this distinction as a medical topos.

20 See n. 13 above.

21 I skip on the distinction between temporary passions and chronicized passion-dispositions (on which see Ahonen [n. 5], 128) as irrelevant to my argument.

22 Tieleman (n. 1), 142–57 argues for the Stoics to be taken literally, a view recently advocated by P. van der Eijk, ‘Cure and (in)curability of mental disorders’, in Harris (n. 1), 307–38, at 326, who hypothesizes that ‘physical therapy (dietetics, drugs) made up a significant component of their therapeutic regime’.

23 The alternative reading commits the Stoics to the view that virtue, as taught by philosophers, requires external aid from non-philosophical disciplines and is therefore not sufficient for happiness, a view which is in sharp conflict with the fundamental Stoic thesis concerning the self-sufficiency of virtue for happiness.

24 Diog. Laert. 7.124 πάντας τε τοὺς ἄφρονας μαίνεσθαι· οὐ γὰρ φρονίμους εἶναι, ἀλλὰ κατὰ τὴν ἴσην τῇ ἀφροσύνῃ μανίαν πάντα πράττειν (‘All the unwise men are mad: for they are unintelligent, and do everything in virtue of a form of madness that is tantamount to lack of wisdom’). On the Stoic distinction between mental and intellectual madness, see also Ahonen (n. 5), 103–7.

25 Diog. Laert. 7.118 (= SVF 3.644): καὶ οἰνωθήσεσθαι μέν, οὐ μεθυσθήσεσθαι δέ [sc. τὸν σπουδαῖον], ἔτι δὲ οὐδὲ μανήσεσθαι· προσπεσεῖσθαι μέντοι ποτὲ αὐτῷ φαντασίας ἀλλοκότους διὰ μελαγχολίαν ἢ λήρησιν, οὐ κατὰ τὸν τῶν αἱρετῶν λόγον, ἀλλὰ παρὰ φύσιν (‘They [the wise men] will take wine, but not become drunk. Nay more, they will not be liable to madness either; however, there will at times occur to the wise man abnormal impressions due to melancholia or delirium, which do not conform to the principle of what is choiceworthy [as natural impulses do], but are unnatural’ [Loeb translation, slightly modified]). See also Stobaeus, Eclog. 2.7 (= SVF 3.643) as concerns drunkenness alone. The topic, however, apparently was a matter of controversy among the Stoics themselves. Seneca, Ep. 83, for once, challenges the mainstream Stoic view that the wise man will not become drunk even if overcome with wine (see also Philo, De plantatione Noë 142 = SVF 3.712, who reports a disagreement among ‘those who have dealt with this proposition [that to be overcome with wine is not the same thing as to become drunk]’). Diog. Laert. 7.127 (= SVF 3.237) attributes to Chrysippus the view that virtue may be lost because of drunkenness and melancholia (καὶ μὴν τὴν ἀρετὴν Χρύσιππος μὲν ἀποβλητήν, Κλεάνθης δὲ ἀναπόβλητον· ὁ μὲν ἀποβλητὴν διὰ μέθην καὶ μελαγχολίαν, ὁ δὲ ἀναπόβλητον διὰ βεβαίους καταλήψεις; see also Simpl. In Aristot. categ. 102B = SVF 3.238), which is exactly what is denied at 7.118 (quoted at the beginning of the note). It is remarkable that the view that Diogenes attributes to the Stoics in general should conform to Cleanthes’ position instead of Chrysippus’. Tieleman (n. 1), 164 relegates Diog. Laert. 7.118 to a footnote (n. 96), and explains away the passage as a ‘compromise’ between Chrysippus’ and Cleanthes’ position, which it is not. Perhaps all that Chrysippus meant to say was that drunkenness and mental diseases pose a special threat to virtue, without thereby implying that the wise man automatically loses it. Be that as it may, Diogenes does not refer the thesis he reports at 7.118 to any individual author but rather to ‘the Stoics’ without qualifications. Hence we must understand it as reflecting the mainstream Stoic view, as Seneca, Ep. 83, who disagrees with it, implicitly confirms that it was. The Stoic claim, paradoxical as it is, has a distinctive Socratic pedigree: according to Pl. Symp. 220a, Socrates never became drunk nor lost control of himself in spite of being a hard drinker in social contexts. See the comparable claim about Chrysippus at Diog. Laert. 7.183.

26 Unwise men, ignorant as they are, may well fail to notice that their becoming angry is the result of a judgement they have made, but this is another story.

27 Sen. De ira 2.1–3. Seneca speaks of ‘movements’ (motus) that the soul cannot help undergoing. I follow B. Inwood, ‘Seneca and psychological dualism’, in J. Brunschwig and M.C. Nussbaum (edd.), Passions and Perceptions (Cambridge, 1993), 150–83, and take Seneca's account to give voice to Stoic orthodoxy.

28 Diog. Laert. 7.102 gives a list of indifferents, which includes health. Needless to say, health in normal circumstances is preferable to disease, according to the Stoics (e.g. Diog. Laert. 7.105).

29 The literature on this topic is huge. See D.N. Sedley, ‘Chrysippus on psychophysical causality’, in J. Brunschwig and M.C. Nussbaum (edd.), Passions and Perceptions (Cambridge, 1993), 313–31.

30 See e.g. Diog. Laert. 7.158 αἰτίας δὲ τῶν παθῶν ἀπολείπουσι τὰς περὶ τὸ πνεῦμα τροπάς. Here again Aristotle (e.g. De an. 403a 17–25) is a precursor.

31 Lucullus at Cic. Acad. 2.53 mentions the case of the wise man withholding assent in furore.

32 But see the ambiguous concession he makes to philosophical therapy at Chronic Diseases 1.167, and my discussion at pp. 361–2 above.

33 Tert. De anima 2: nec ignoro, quanta sit silua materiae istius apud philosophos … sed et medicinam inspexi, … sibi quoque hoc negotium uindicantem. quidni? ad quam magis animae ratio pertinere uideatur per corporis curam. unde et plurimum sorori refragatur, quod animam quasi coram in domicilio suo tractando magis norit (‘I am aware of how huge the philosophical literature addressing the topic of the soul is […]. But I did consult also medicine […] which claims the job of investigating the soul for herself. Why not? To account for the soul may well appear to pertain to medicine more, on account of her treating the body. Hence, medicine comes in conflict with her sister [philosophy] very often, alleging that she is better acquainted with the soul by visiting her, as it were, in her own domicile’). Tertullian attributes the claim to medicina as a whole, but by this metonymy he undoubtedly refers to his source, Soranus, deemed by him to speak for the entire medical tradition. Soranus, at Gyn. 2.57, seems to permit philosophers exclusive competence over the spiritual growth of children, but see my article, Matter, medicine, and the mind: Asclepiades vs Epicurus’, OSAPh 30 (2006), 285335 , at 315.

* I would like to thank Prof. van der Eijk for following the Sitz im Leben of this paper during my Berlin stay, as well as all those attending the 2014 ‘SedFest’ Conference in Cambridge for helpful comments on a revised draft of the paper. I alone am responsible for any remaining errors. This paper has been written thanks to the generous support of the Alexander von Humboldt Foundation.

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COMPETENCE CONFLICTS BETWEEN PHILOSOPHY AND MEDICINE: CAELIUS AURELIANUS AND THE STOICS ON MENTAL DISEASES*

  • Roberto Polito

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